Anna Mokrowiecka

BACKGROUND Gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE) can contribute to the development of esophageal eosinophilia, specifically after radiofrequency ablation (RFA). Eosinophilic esophagitis (EoE) after treatment for BE is much rarer. EoE is a chronic, immune-mediated disease of the esophagus, commonly presenting with symptoms such as dysphagia and heartburn. Diagnosis is established based on histological evaluation of esophageal biopsies. This report describes a 41-year-old man with chronic GERD and BE with symptomatic EoE, following RFA. CASE REPORT A 41-year-old male patient with a history of GERD spanning over a decade and BE treated with RFA in 2013 was admitted to the Department of Gastroenterology in April 2024 for routine upper endoscopy with biopsy sampling. Esophagogastroduodenoscopy (EGD) revealed significant abnormalities throughout the esophagus, including pronounced trachealization, longitudinal furrows, mucosal exudates, and edema. Histopathological analysis of multiple biopsy samples revealed over 15 eosinophils per high-power field (hpf) in the proximal squamous mucosa, with no signs of dysplasia. CONCLUSIONS We report a case of EoE development after successful RFA treatment of Barrett's esophagus. This case highlights the importance of long-term endoscopic surveillance in patients with a history of esophageal conditions, even after seemingly successful therapeutic interventions. Clinicians should remain vigilant for atypical presentations of EoE, especially in patients with prior esophageal disease or interventions.

Background: The current treatment of gastroesophageal reflux disease (GERD) is focused on decreasing gastric acid secretion. However, there is still a group of patients that do not respond to conventional therapy. Proteinase-activated receptors and purinergic receptors have been implicated in inflammation, visceral hyperalgesia and esophageal hypersensitivity. The aim of this study was to evaluate the esophageal expression of PAR2 (F2RL1) and P2RX2, P2RX3 and P2RY2 in GERD patients. Methods: A total of 53 patients with GERD and 9 healthy controls were enrolled in this study. The expression of the studied receptors was quantified using real-time PCR on esophageal biopsies from the patients with GERD and healthy controls. The correlation between the dilated intracellular spaces (DIS) score and patients’ quality of life was investigated. Results: PAR2 receptor expression was higher in ERD compared to NERD and controls (326.10 ± 112.30 vs. 266.90 ± 84.76 vs. 77.60 ± 28.50; NS). P2X2 exhibited the highest expression in NERD compared to ERD and controls (302.20 ± 82.94 vs. 40.18 ± 17.78 vs. 26.81 ± 10.27), similarly to P2Y2, which expression was higher in NERD than in ERD and controls (7321.00 ± 1651.00 vs. 5306.0 ± 1738.00 vs. 3476.00 ± 508.0). Conclusions: We found that the expression of F2RL1, P2RX2 and P2RY2 is positively correlated to the DIS score in GERD patients. Higher PAR2, P2X2 and P2Y2 expression could mediate the sensitization of the esophagus and may be associated with the higher intensity of symptoms perceived by NERD patients.

Background: Affective temperaments can be considered the subclinical manifestations of affective and stress-related disorders, which could have a relationship with many chronic diseases. The purpose of this study was to explore the influence of affective temperament traits on disease-specific quality of life in patients with ulcerative colitis (UC) and Crohn’s disease (CD), two types of inflammatory bowel disease (IBD). Methods: The patients completed the Temperament Evaluation of the Memphis, Pisa, Paris, San Diego-Auto-questionnaire (TEMPS-A), which is the 110-item self-reported assessment for five dimensions of temperament: depressive, cyclothymic, hyperthymic, irritable, and anxious, already validated in Poland. For comprehensive assessment of the health-related quality of life (HRQoL), the Inflammatory Bowel Disease Questionnaire (IBDQ) was applied. Results: The study included 116 patients with IBD-61 with UC and 55 with CD, with mean age 43 years, in remission, without serious mental or medical co-morbidities. Mean HRQoL in patients with IBD was poor and mean IBDQ scores were 145, despite clinical remission. A significant negative correlation was found between HRQoL in all the IBDQ domains and TEMPS-A traits: D (p < 0.001), C (p < 0.01), I (p < 0.05), and A (p < 0.001). No significant correlation between hyperthymic temperament and IBDQ scores was found. Conclusions: Poor quality of life in IBD could be associated with affective temperament. Affective temperament traits should be taken into account when identifying patients at risk of worse IBD course and further introducing personalized therapy.

Background: Current treatment of gastroesophageal reflux disease (GERD) is focused on decreasing the gastric acid secretion. However, there is still a group of patients not responding to conventional therapy. Proteinase-activated receptors and purinergic receptors have been involved in inflammation, visceral hyperalgesia, and esophageal hypersensitivity. The aim of this study was to evaluate the esophageal expression of PAR2 (F2RL1) and P2RX2, P2RX3 and P2RY2 in GERD patients. Methods: The expression of studied receptors was quantified using real-time PCR in esophageal biopsies in patients with GERD and healthy controls. Correlation between dilated intracellular spaces (DIS) score and patients’ quality of life was investigated. Results: PAR2 receptor expression was higher in ERD compared to NERD and controls (326.10±112.30 vs 266.90±84.76 vs 77.60±28.50; NS).P2X2 exhibited the highest expression in NERD compared to ERD and controls (302.20±82.94 vs 40.18±17.78 vs 26.81±10.27), similarly to P2Y2 which expression was higher in NERD than in ERD and controls (7321.00±1651.00 vs 5306.0±1738.00 vs 3476.00±508.0). Conclusions: We found that the expression of F2RL1, P2RX2 and P2RY2 is positively correlated to DIS score in GERD patients. Higher PAR2, P2X2 and P2Y2 expression could mediate sensitization of esophagus and may be associated with higher intensity of symptoms perceived by NERD patients.

Background: Affective temperaments can be considered the subclinical manifestations of affective and stress-related disorders, which could have a relationship with many chronic diseases. The purpose of this study was to explore the influence of affective temperament traits on disease-specific quality of life in patients with ulcerative colitis (UC) and Crohn’s disease (CD), two types of inflammatory bowel disease (IBD). Methods: The study included 116 patients with IBD - 61 with UC and 55 with CD, with mean age 43 years, in remission, without serious mental or medical co-morbidities. The patients completed the Temperament Evaluation of the Memphis Pisa Paris San Diego-Auto-questionnaire (TEMPS-A), which is the 110-item self-reported assessment for five dimensions of temperament: depressive, cyclothymic, hyperthymic, irritable and anxious, already validated in Poland. For comprehensive assessment of the health-related quality of life (HRQoL), the Inflammatory Bowel Disease Questionnaire (IBDQ) was applied. Results: Mean HRQoL in IBD patients was poor and mean IBDQ scores were 145, despite clinical remission. A significant negative correlation was found between HRQoL in all the IBDQ domains and TEMPS-A traits: D (p<0.001), C (p<0.01), I (p<0.05) and A (p<0.001). No significant correlation between hyperthymic temperament and IBDQ scores was found. Conclusions: Poor quality of life in IBD could be associated with affective temperament. Affective temperament traits should be taken into account when identifying patients at riskof worse IBD course and further introducing the personalized therapy.

Background: Although several studies have reported the impact of fears relating to coronavirus-19 on several chronic illnesses, there are few studies focused on gastrointestinal conditions. Therefore, the aim of this study was to compare the fear of coronavirus-19 in patients with inflammatory bowel disease to other gastrointestinal conditions and how the fear of COVID-19 manifests across different demographical backgrounds among inflammatory bowel disease respondents. Methods: Participants with gastrointestinal conditions (age ≥ 18) were recruited from 27 countries. Demographic, clinical, and psychosocial information was collected. An adapted scale for inflammatory bowel disease patients measuring the fear of coronavirus-19 and gastrointestinal-specific fear of coronavirus-19 was used. Results: In 831 participants (312 inflammatory bowel disease), only significant increases in gastrointestinal–fear of coronavirus-19 were found in between inflammatory bowel disease and other gastrointestinal conditions (mean [standard deviation]: 13.5 [5.5] vs 10.9 [5.0], P < .01). Among inflammatory bowel disease respondents, persons on sick leave had significantly more fear of coronavirus-19 than those employed (median [IQR], 31.0 [28.5-39.5] vs 26.0 [20.0-33.0], P = .035) and significantly more gastrointestinal–fear of coronavirus-19 compared to the employed (18.0 [14.5-22.0] vs 13.0 [9.0-17.0], P = .033) or respondents outside of the labor market (12.0 [7.0-16.0], P = .022). Persons living in a rural setting had significantly more fear of coronavirus-19 compared to persons living in regional setting (29.5 [22.0-37.8] vs 25.0 [20.0-31.3], P = .007) and gastrointestinal–fear of coronavirus-19 (15.0 [11.0-19.8] vs 12.0 [9.0-16.0], P = .02). Conclusion: Respondents with inflammatory bowel disease are more afraid of coronavirus-19 regarding their disease; especially, persons on sick leave or persons living in a rural setting. This should be taken into consideration to personalize the support that health care providers can offer in mitigating fear related to coronavirus-19. Cite this article as: Lo B, Barreiro-de Acosta M, Bernstein CN, et al. Fear of COVID-19 among patients with inflammatory bowel disease as compared to patients with other gastrointestinal conditions. Turk J Gastroenterol. 2022;33(8):664-672.

Nearly 20% of elderly patients suffer from constipation, but the age-related changes in the gastrointestinal (GI) tract remain insufficiently elucidated. In this study, the alterations within the endogenous opioid system (EOS) as a potential cause of constipation in the elderly were evaluated. The GI functions were assessed in vitro and in vivo and compared between 6-, 12- and 18-month old mice. Moreover, the effect of opioid receptor (MOP, DOP, KOP) agonists on the mouse GI tract functions and the EOS components expression in mouse tissues and colonic biopsies from patients with functional constipation were determined. In the oldest mice, the GI peristalsis was significantly impaired as compared to the younger groups. The tissue response to MOP and DOP, but not KOP, agonists weakened with age in vitro; for DOP, it was confirmed in vivo. In the mouse upper GI tract, Oprm1, Oprd1, Oprk1 expression decreased with age; in the colon, Oprm1 expression increased. There were no differences in the expression of these genes in the colonic biopsies from patients >50 years old as compared to the younger group. In conclusion, the age-related impairment of the GI peristalsis may result from reduced MOP and DOP response to the activation with opioid agonists or the alterations in the EOS expression.

Background: The negative impact of a high-fat diet on the course of gastroesophageal reflux disease (GERD) has been previously reported. Free fatty acid receptors (FFARs) may be mediators of this phenomenon. The aim of this study was to characterize the role of FFARs in the course of nonerosive (NERD) and erosive (ERD) reflux disease. Methods: Collectively, 73 patients (62 with GERD and 11 healthy controls (HCs)) were recruited to the study. Esophageal biopsies were drawn from the lower third of the esophagus and kept for further experiments. Quantitative, real-time polymerase chain reaction was used to assess the expression of FFAR1, FFAR2, FFAR3, and FFAR4 in biopsies. Histological evaluation of dilated intracellular spaces (DISs) was also performed. Results: FFAR3 exhibited the highest expression, and FFAR4 exhibited the lowest expression in all esophageal samples. Higher relative expression of FFAR1 and FFAR2 and significantly higher expression of FFAR3 (p = 0.04) was noted in patients with GERD compared to respective HCs. Patients with nonerosive GERD (NERD) presented higher expression of all FFARs compared to patients with erosive GERD (ERD) and respective HCs. Interestingly, in patients with ERD, the expression of FFAR3 was lower than in HCs. Significant, weak, positive correlation was found for FFAR3 and FFAR4 expression and DIS scores (r = 0.36, p < 0.05 for FFAR 3, and r = 0.39, p < 0.05 for FFAR4). Conclusions: In this study, we show that FFARs may play a role in GERD pathogenesis, particularly in the NERD type. It may be assumed that FFARs, in particular FFAR3 and FFAR4, may have diagnostic and therapeutic potential in GERD.

The pathogenesis of inflammatory bowel diseases (IBD) seems to be associated with alterations of immunoregulation. Several lines of evidence suggest that estrogens play a role in the modulation of immune responses and may be related to the etiology of IBD. The purpose of this work was to examine the involvement of G protein-coupled estrogen receptor (GPER), estrogen receptor α (ERα), estrogen receptor β (ERβ) and ERα spliced variants ERα36 and ERα46 in Crohn’s disease (CD) and ulcerative colitis (UC). The studied group included 73 patients with IBD and 31 sex and age-related controls. No differences in serum levels of 17β-estradiol nor of CYP1A1 and SULT1E1 enzymes involved in estrogen catabolism were stated. The expression pattern of estrogen receptors in tissue samples was quantified using real-time PCR and Western blotting. Statistically significant up-regulation of GPER and ERα in both CD and UC as well as down-regulation of ERβ in CD patients was found. However, differences in the expression of estrogen receptors in CD and UC have been identified, depending on the sex and age of patients. In men, up-regulation of GPER, ERα and ERα46 expression was shown in CD and UC patients. In women under 50 years of age, GPER protein level increased in UC whereas ERβ expression tended to decrease in CD and UC patients. In turn, in women over 50 the protein level of ERα increased in UC while ERβ expression decreased in CD patients. Dysregulation of estrogen receptors in the intestinal mucosa of patients with CD and UC indicates that estrogen signaling may play a role in the local immune response and maintain epithelial homeostasis in a gender- and age-dependent manner.