Ludmila Tankova

• prof.
• Medical University of Sofia

Background & aims: The QUASAR Phase 2b Induction Study evaluated the efficacy and safety of guselkumab, an interleukin-23p19 subunit antagonist, in patients with moderately to severely active ulcerative colitis (UC) with prior inadequate response and/or intolerance to corticosteroids, immunosuppressants, or advanced therapy. Methods: In this dou...

Background Etrolizumab is a gut-targeted anti-β7 integrin monoclonal antibody. In an earlier phase 2 induction study, etrolizumab significantly improved clinical remission relative to placebo in patients with moderately to severely active ulcerative colitis. The HIBISCUS studies aimed to compare the efficacy and safety of etrolizumab to adalimumab...

We present a 40-year-old Caucasian woman diagnosed with CD in early age, on a gluten-free diet (GFD) by the age of seven, then switched to a common diet. Since 2006 the patient complained of anemia and frequent diarrheal episodes. She admitted to the hospital with exacerbated gastrointestinal symptoms and swelling of the limbs. The diagnosis of CD...

AIM: To investigate the role of FCP as a non-invasive marker for assessment of inflammatory activity, monitoring of therapy and prediction of relapses in UC patients

We aimed to assess the preoperative rectal cancer angiogenesis with Endorectal Power Doppler Ultrasonography by using the Power Doppler Vascularity Index (PDVI) calculated by imaging analysis software, and to compare it with the microvessel density (MVD) in surgical specimens

Objective: To study gut barrier function in patients with liver cirrhosis (LC) by evaluating the intestinal permeability (IP) and its relationship with the severity and etiology of the disease. Patients and methods: The study included 31 patients with LC and 25 healthy controls. Child-Pugh score was used for evaluation of the LC severity. IP was...

Aim: In the current study we aimed to evaluate the role of trefoil factor 3 (TFF3) as a marker for complete mucosal healing (MH) in patients with ulcerative colitis (UC). Methods: We enrolled 116 consecutive UC patients. Trefoil factor 3 levels were measured by ELISA and were compared to the clinical activity, assessed by Lichtiger Index, fecal ca...

OBJECTIVE: We aimed to assess the preoperative rectal cancer angiogene-sis with Endorectal Power Doppler Ultrasonog-raphy by using the Power Doppler Vasculari-ty Index (PDVI) calculated by imaging analysis software, and to compare it with the microvessel density (MVD) in surgical specimens PATIENTS AND METHODS: This study included 110 patients (39...

Objective: We aimed to assess the preoperative rectal cancer angiogenesis with Endorectal Power Doppler Ultrasonography by using the Power Doppler Vascularity Index (PDVI) calculated by imaging analysis software, and to compare it with the microvessel density (MVD) in surgical specimens PATIENTS AND METHODS: This study included 110 patients (39 fe...

Background: It is essential in clinical management to determine the disease activity in ulcerative colitis (UC) patients. At present, the most accurate way of evaluating the UC severity is endoscopy with biopsy. Fecal calprotectin (FCP) is a non-invasive biomarker that is frequently used for monitoring of intestinal inflammation. Aims: The purpose...

Objective: In this study, we aimed to evaluate the role of serum trefoil factor 3 (TFF3) as a biomarker of disease activity in patients with inflammatory bowel disease (IBD) and to compare TFF3 values with those of fecal calprotectin (FC). Patients and methods: 128 patients with IBD were divided into four groups: 1) active ulcerative colitis (UC...

We read with interest the meta-analysis published by Rokkas et al. [1] about the diagnostic performance of fecal calprotectin (FC) in assessing inflammatory bowel disease (IBD) endoscopic activity in adults. In view of the clinical management of UC, it is essential to determine the disease activity. At present, the most accurate way to evaluate the...

Background Fecal calprotectin (FCP) is frequently used for monitoring inflammatory activity and prediction of relapse in inflammatory bowel disease (IBD). We aimed to assess the usefulness of FCP as a marker of disease activity in patients with IBD. Methods This prospective study enrolled 174 patients (84 with CD and 90 with UC) referred for colono...

Gluten enteropathy, or celiac disease (CD), is an autoimmune disease of the small intestines in genetically predisposed children and adults caused by immunological hypersensitivity to gluten-containing food. The gold standard for the diagnosing CD and/or gluten-related hypersensitivity is an endoscopic study with a series of multiple colon biopsies...

Introduction: Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a rare, progressive, life-threatening, hereditary disorder caused by mutations in the transthyretin gene. TTR-FAP is frequently diagnosed late because the disease is difficult to recognize due to phenotypic heterogeneity. In TTR-FAP gastrointestinal (GI) disturbances play an i...

Chronic pancreatitis (CP) is characterized by progressive and irreversible pancreatic damage that may eventually lead to exocrine and endocrine pancreatic insufficiency. Recurrent acute pancreatitis with repetitive episodes of acute inflammation, not always with clinical manifestation, leads to CP, but the proper mechanisms and the risk factors for...

Aim: The aim of the current study was to assess the correlation between the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), Lichtiger Index and the fecal calprotectin (FC) levels in ulcerative colitis (UC) patients. Methods: This prospective study included 58 patients with UC, referred for colonoscopy to our Center. The diagnosis of UC was...

The conventional way for evaluation of rectal cancer angiogenesis requires a biopsy or a tissue specimen applying specific immunohistochemical or molecular biological tests. The evaluation of microvessel density is a gold standard in the assessment of tumour angiogenesis. Doppler ultrasound is an attractive modality for imaging angiogenesis in vivo...

Concomitant occurrence of celiac disease (CeD) and Crohn's disease (CD) is rare and has been reported in several case reports and series. We report a case of a 63-year-old man with proximal CD, CeD and selective immunoglobulin (Ig) A deficiency (SIgAD). The patient was admitted in our Clinic for evaluation of epigastric pain, nausea, vomiting and w...

1. II.17. Tankova L., V.Gerova, P.Getsov, N.Penkov, G.Taneva, I.Terziev, R.Nakov. The Association of Crohn’s Disease, Celiac Disease and Selective Ig A Deficiency International Journal of Celiac Disease, 2016, Vol. 4, No. 1, Available online at http://pubs.sciepub.com/ijcd/4/1/8

Several studies have shown the protective function of trefoil factors in the gastrointestinal tract and their up-regulated expression at the site of mucosal damage. However, the role of trefoil factor 3 (TFF3) in inflammatory bowel disease (IBD) still needs to be clarified. The aim of the current study was to evaluate the role of serum human TFF3 a...

Diagnosis and management of cystic lesions of the pancreas are the most rapidly growing and controversial topics in pancreatology. Cystic neoplasms of the pancreas are discovered more often today, especially among older asymptomatic patients. The growing incidence of pancreatic cystic neoplasms is due to our growing knowledge, and the improvement o...

Autoimmune hepatitis (AIH) is progressive, chronic immunologically mediated inflammatory liver disorder that occurs in children and adults of all ages, predominantly in women. AIH can be combined with other autoimmune and non-autoimmune conditions. We present a case of a 32 year-old female with three relatively uncommon diseases-two autoimmune dise...

We present a 56-year-old patient with liver metastases from nonfunctional pancreatic neuroendocrine tumor. The disease is found incidentally in a patient with nonspecific symptoms. Conventional abdominal ultrasound establishes several liver lesions mimicking hemangiomas. On contrast enhancement ultrasonography hypervascularized secondary liver lesi...

We present a 56-year-old patient with liver metastases from nonfunctional pancreatic neuroendocrine tumor. The disease is found incidentally in a patient with nonspecific symptoms. Conventional abdominal ultrasound establishes several liver lesions mimicking hemangiomas. On contrast enhancement ultrasonography hypervascularized secondary liver lesi...

Alcohol abuse and the array of diseases associated with it are one of the main reasons for preventable morbidity and mortality worldwide. Alcoholic hepatitis /AH/ as an entity is the most severe form of alcoholic liver disease, characterized by high mortality rate. The substantial difference in mortality rates between mild and severe forms of AH, a...

To assess the changes in the angiogenic status of rectal cancer before and after preoperative radiotherapy (RT) using endosonography (ES). Fifty-four patients with rectal cancer were examined by ES before and 6-7 weeks after preoperative RT and . The tumour size, stage, echostructure and vascularization before and after RT were compared. Tumour vas...

The aim of our study was to characterize the neurological symptoms in Bulgarian patients with Wilson disease (WD), to investigate genotype-phenotype correlations, and to test whether there are differences in phenotype between patients of different ethnic origin. A total of 126 Bulgarian patients with WD were included in the study. Detailed history,...

Metastatic involvement of the gastrointestinal (GI) tract secondary to breast cancer (BC) is rare and usually occurs in patients with lobular BC. We report 2 cases with GI presentations of metastatic BC. In the first case endoscopy and endoscopic ultrasonography because of abdominal discomfort, tenesmus and rectal bleeding demonstrated liver, gastr...

The aim of the present study was to prepare and evaluate hydrogels containing 0.1% isosorbide mononitrate (ISMN) for topical treatment of anal fissure. The hydrogels were prepared on the base of Carbopol 940, Poloxamer 407 or their combination. The highest viscosity and significant thyxotropy were observed for the combined hydrogel, which correspon...

The microvessel density determination is a gold standard of tumor neovascularization assessment. The lack of standards compromises the technique of microvessel density assessment. Aim: To apply computer-assisted method for angiogenesis assessment and to compare results with conventional method for microvessel density determination. Intratumor micro...

We performed endorectal pulse colour and power Doppler ultrasonography in 62 patients with rectal cancer to assess preoperative angiogenic status and compare it with microvessel density in surgical specimens. Doppler vascular index defined through endorectal power, Doppler ultrasound correlated significantly with the conventional indicator of tumou...

The accuracy of endoluminal ultrasonographic restaging of rectal cancer after chemoradiation has not been extensively studied and its definitive clinical utility has yet to be defined. The aim of the present study is to assess the benefit of endoluminal ultrasonography with Doppler evaluation for rectal cancer restaging after preoperative radiother...

The present study aims to evaluate and compare the efficacy of two nitrate gels, containing isosorbide-5-mononitrate (ISMN) or glyceryl trinitrate (GTN), in the therapy of chronic anal fissure. The patients were randomly assigned to three groups: 0.1% ISMN gel (21 patients), 0.1% GTN gel (21 patients) and a placebo group (ten patients). The ethic c...

To improve the diagnostic potential of ultrasound in patients with perianal fistulas, by performing a combined perineal and endorectal Doppler sonography investigation before and after contrast enhancement with hydrogen peroxide. Ten patients (9 male and 1 female) with perianal fistulas were tested. After contrast-free transperineal and endoanal so...

We report herein the case of a preoperatively diagnosed small bowel adenocarcinoma. A 57-year-old man was hospitalized twice for a month in the Gastroenterology Clinic due to complaints lasting a year before hospitalization and consisting of heaviness and spastic pain in the left upper abdomen. None of the numerous methods used in this case (fibrog...

We report herein the case of a small bowel diverticulum perforation which has caused peritonitis and consequently has led to operation. The patient, a 79-year old woman, was hospitalized due to etiological clarifying and specifying of a newly diagnosed diffuse liver pathology. During the hospital stay, she has received severe abdominal pain with fe...

Aim: Perineal and endorectal sonographic investigation before and after the contrast enhancement with hydrogen peroxide for patients with fistule pathology has been perfomed aimed at the development of the perianal fistules diagnostics. Material and methods: Five patients (4 men and 1 woman) with perianal fistulas have been tested. Four of them...

Polyposis of the colon is a colon cancer predisposition syndrome. Familial adenomatous polyposis (FAP) accounts for 1% of the cases of inherited colorectal cancer (CRC). The National Register of inherited CRC and polyposis of the intestines keeps track of 18 patients from 14 families with FAP. Eight of them have been operated of CRC, on 6 patients...

The aim of this study is to determine the diagnostic potential of endoluminal echography and the pitfalls sources in the preoperative staging and postoperative follow-up in patients with rectal cancer. 245 patients with rectal carcinoma are evaluated during 10 years period (Jan. 1993-Jan. 2002 years). 96 patients are monitored in the early and late...

Unlabelled: According to up-to-date concepts for local spread of a rectal cancer it is possible to perform a radical rectal resection with a restorative anastomosis inspite of the fact that the tumor is located in the middle or the distal third of the rectum. Usually a total resection of the rectum and coloanal anstomosis have to be performed. The...

Anorectal disturbances are one of the most frequent functional bowel disorders. A lot of motor- and sensor anorectal tests are available. At the same time in Bulgaria anorectal disorders are unknown for the most of the gastroenterologists and surgeons, and that's why they are misdiagnosed and not treated correct. The aim of our paper is to summariz...

To assess the efficacy and patient compliance of topical mononitrate hydrogel for the treatment of anal fissure. Nineteen patients with symptomatic chronic anal fissures were randomly allocated to receive either active (10 patients) or placebo (nine patients) gel treatment. Rectal administration of hydrogel containing 0.2% isosorbide-5-mononitrate...

Tumor necrosis factor-alpha (TNF-α) plays a key role in the pathogenesis of inflammatory bowel diseases (IBD). Aim of the study was to assess the curative effect of chimeric anti-TNFα monoclonal antibody Remicade™ in patients with Crohn's disease (CD). Four patients (3 males, 1 female) with moderate to severe CD were treated with series of three in...

Our aim was to evaluate the anorectal changes in patients with fecal incontinence by using different endoultrasound techniques. Eighteen females with fecal incontinence and 14 healthy controls (females) were examined. Rigid linear transducer and 10 MHz radial scanning miniprobe were used. Statistically significant difference was found in the mean p...

Endosonography is an established technique in the evaluation of anal sphincter integrity. The aim of our study is to assess the puborectal muscle (PRM) function in healthy volunteers by using different echographic techniques. The investigation covers 24 healthy subjects (14 females, 10 males). They are used 5 MHz linear endorectal and 3,5 MHz abdom...

Gastroesophageal variceal hemodynamics before and after percutaneous ethanol injection in hepatocellular carcinoma was studied. Duplex-Doppler endoscopic ultrasound was performed in 8 cases. Blood flow was evaluated in varices of the fundus, gastroesophageal junction (GEJ), above-lying 5-cm area and perforating veins. A tendency to increasing of me...

The diagnosis of GML is difficult and complex. Twenty-four patients with GML are studied and monitored with EUS using Olympus EUM-30, GF-UC30P and transendoscopic miniprobe Aloka 2000. The EUS findings are: hypoechoic thickening of the 2-nd and 3-rd gastric wall layers, diffuse infiltration effacing the layer structure to some extent and nodular hy...

The non-antiarrhythmic drugs, which possess antiarrhythmic properties could induce dangerous, potentially fatal arrhythmias--extrasystoles, ventricular tachycardia, sudden cardiac arrest. The arrhythmogenic properties are due to block of the potassium channels of the cells and are realized by prolongation of the QT interval on ECG. Accelerating mec...