Patrícia Sarlós

Background: Venous thromboembolism is more prevalent among patients with inflammatory bowel disease (IBD). This study aimed to identify prothrombotic hemorheological alterations in IBD. Methods: We conducted a case–control study with patients with ulcerative colitis, Crohn’s disease, and non-IBD control subjects. We measured hemorheological indicators including plasma viscosity (PV), whole blood viscosity (WBV), erythrocyte aggregation (EA), and erythrocyte deformability (ED). Uni- and multivariate tests were employed for analysis. Results: A total of 53 IBD patients and 77 control subjects were recruited. IBD patients showed significantly higher aggregation index (68.8% (35.3–83.5%) vs. 66.9% (35.2–83.5%), p = 0.003) and threshold shear rate (120 1/s (55–325 1/s) vs. 110 1/s (55–325 1/s), p < 0.001), with lower aggregation half-time (1.6 s (0.6–7.1 s) vs. 1.8 s (0.6–7.1 s), p = 0.004), indicating enhanced EA. However, after adjusting for covariates, including inflammatory markers, IBD no longer predicted EA. There were no significant differences in EA. PV, WBV, and ED between the groups. Fibrinogen, rather than the Crohn’s Disease Activity Index, was the strongest predictor of the outcomes. Conclusions: Our study demonstrates that IBD patients exhibit enhanced EA, predicted mainly by fibrinogen. These results confirm that inflammation plays the cardinal role in the increased tendency for venous thromboembolism in IBD.

Crohn-betegségben a bélfal tartós, transmuralis gyulladása sipoly kialakulásához vezethet, amelynek kezelése az egyik legnehezebb kihívást jelenti gyulladásos bélbetegségben. A sipolyképződés a Crohn-betegek kb. 25–40%-ában fordul elő, illetve kezelés ellenére a már záródott sipolyok egyharmada újra kinyílik. Jelenleg a patomechanizmussal kapcsolatos ismereteink korlátozottak, az elfogadott in vitro szövetmodellek hiánya és a korlátozott in vivo modellek száma miatt. Ebben az áttekintésben a szerző összefoglalja a szöveti átépülésre és a sipolyképződésre jellemző szövettani, immunológiai, sejtes, genetikai és mikrobiális ismereteket Crohn-betegségben, érintve az epithelialis-mesenchymalis tranzíciót, a mátrix-metallo-proteázok és invazív molekulák túlzott expresszióját. A fisztulakialakulás mechanizmusának alaposabb megértése elősegítheti a jövőbeni célzott kezelések fejlesztését.

A Crohn-betegség felső tápcsatornai megjelenése 0,5-4%-ra tehető tünetekkel rendelkező felnőtt betegeknél. A nyelőcső, a gyomor vagy a duodenum érintettsége általában az alsó tápcsatorna érintettségével egyidejűleg fordul elő. A diagnózis alapját endoszkópos, szövettani és radiológiai értékelés képezi. Aftoid vagy hosszanti fekélyek, szűkületek és fisztulák egyaránt felvetik a Crohn-betegség gyanúját. Szövettanilag a krónikus gyulladásos folyamat jelenléte, elsősorban a lymphoplasmocytás sejtek túlsúlya, valamint az aktív fokális gastritis utalnak Crohn-betegségre, epitheloid granuloma ritkán mutatható ki. A kezelés során protonpumpagátló mellett kortikoszteroidokat, immunmodulátorokat és biológiai terápiát alkalmazunk a betegség súlyosságától függően.

Background: Perianal fistulas of Crohn's disease (CD) create a significant burden on patients' lives. However, the efficacy and safety of adipose‐derived mesenchymal stem cell treatment are contradicting, and real‐world evidence is lacking.Aims: To examine the usability of darvadstrocel therapy in managing perianal CD.Methods: We enrolled patients with CD and perianal fistulas in this retrospective multicenter study. The primary outcome was perianal clinical remission (defined as all treated fistulas closed) at weeks 26 and 52. Secondary outcomes were clinical response rates (≥ 1 fistulas closed), perianal activity (PDAI), patient satisfaction, and adverse events. Data were recorded at baseline and weeks 12, 26 and 52. Prediction of primary outcomes was performed by logistic regression.Results: Overall, among 223 patients (male/female ratio: 0.48), perianal clinical remission was achieved in 78.2% and 62.3% until weeks 26 and 52. Baseline PDAI score (OR 0.75), number of fistulas (OR 0.28) and the number of weeks after preparation for surgery (OR 0.98) were associated with treatment failure. The clinical response rates were 84.8% and 79.8% at weeks 26 and 52. Improvement of subjective perianal symptoms was achieved in 77.8% and 78.4% of patients, respectively. Adverse events occurred in 13.5% of patients; perianal abscesses and proctalgia were the most frequently reported.Conclusion: Effectiveness data were higher than in clinical trials. The safety profile was reassuring, and patients' satisfaction was high. Appropriate patient selection, fistula preparation and expertise may help to achieve treatment success.

Concomitant medications may alter the effect of biological therapy in inflammatory bowel disease. The aim was to investigate the effect of proton pump inhibitors on remission rates in patients with inflammatory bowel disease treated with the gut-selective vedolizumab. Patients from the Hungarian nationwide, multicenter vedolizumab cohort were selected for post hoc analysis. Primary outcomes were the assessment of clinical response and endoscopic and clinical remission at weeks 14 and 54. Secondary outcomes were the evaluation of the combined effect of concomitant steroid therapy and other factors, such as smoking, on remission. A total of 108 patients were identified with proton pump inhibitor data from 240 patients in the original cohort. Patients on steroids without proton pump inhibitors were more likely to have a clinical response at week 14 than patients on concomitant PPI (95% vs. 67%, p = 0.005). Non-smokers with IBD treated with VDZ were more likely to develop a clinical response at week 14 than smokers, particularly those not receiving PPI compared with patients on co-administered PPI therapy (81% vs. 53%, p = 0.041, and 92% vs. 74%, p = 0.029, respectively). We found that the use of PPIs in patients treated with VDZ may impair the achievement of response in certain subgroups. Unnecessary PPI prescriptions should be avoided.

Background: The usability of subcutaneous vedolizumab (s.c. VDZ) treatment in inflammatory bowel diseases (IBD; ulcerative colitis (UC), Crohn’s disease (CD)) has been proven via clinical trials while real-world data collection is ongoing. Objectives: Our study evaluates the effectiveness, safety, patients’ preferences, and psychological factors associated with s.c. VDZ treatment, after switching from intravenous (i.v.) formulation. Design: Prospective, multicenter cohort study including IBD patients switching from i.v. VDZ to s.c. treatment and were evaluated over 52 weeks. Methods: Serum VDZ levels and C-reactive protein (CRP) were measured at the baseline and w52. At w12, a questionnaire on the patient’s satisfaction and psychological characteristics was administered. The primary outcome was the drug persistence rate (cessation was due to loss of response (LOR), adverse events, patient request, and other causes) at w52, while the secondary outcomes were the changes in the clinical corticosteroid-free remission (CSFR) and biochemical remission (BR; CRP ⩽ 5 mg/L) rates, safety issues, serum drug levels, patients’ preferences, and psychological features. Results: In total, 70 IBD patients were evaluated (32 CD patients, 38 UC patients; male/female ratio: 41.4%; median age: 43.2 years). In the CD group, 81.3% were in CSFR and 65.6% were in BR, while in the UC group, 71.7% were in CSFR and 69.4% were in BR. Overall, 17.1% of the patients ceased s.c. VDZ treatment after a median of 26.2 (interquartile range 20–47) weeks. LOR was registered in 3/12 ceased patients. In addition, CSFR and BR rates were stable, while serum VDZ levels increased by w52 ( p < 0.001). Conclusion: The transition from i.v. to s.c. VDZ treatment was effective, the overall persistence rate was associated with high serum drug levels, and no novel safety issues were reported. Although s.c. administration after induction can save resources, some patients still insisted on i.v. VDZ treatment, due to its proven formulation.

Összefoglalás: : Az antibiotikumok széles körű alkalmazása a bélmikrobiom egyensúlyának felborulásához vezethet, amely klinikailag leggyakrabban hasmenés formájában nyilvánul meg. A szerző részletesen tárgyalja az antibiotikumok által kiváltott gyomor-bél rendszeri mellékhatásokat, hangsúlyozva a bélflóra diverzitásának csökkenését, a potenciálisan káros törzsek és a rezisztenciagének elterjedését, valamint a metabolikus károsodásokat. Az intestinalis barrier, amely a bélnyálkahártya fizikai, szekretoros és immunológiai gátját jelenti, szintén az antibiotikumok célpontja. A szerző áttekinti az intestinalis dysbiosis enyhítése céljából alkalmazott probiotikus gombák nyújtotta terápiás lehetőségeket is.

Few data are available on subjective disease control and perception of adverse events (AEs) during switching from original anti-TNF agents to biosimilars.Hungarian patients with inflammatory bowel ...

Objective: In the TRANS–IBD clinical trial, the outcomes are measured with selected validated questionnaires. Cross-cultural and age adaptations of the Self-Efficacy Scale for adolescents and young adults (IBD–SES), the Transition Readiness Assessment Questionnaire (TRAQ), and the Self-Management and Transition Readiness Questionnaire (STARx) were performed. Methods: Linguistic and cultural adaptation was carried out with the usage of reliability coefficients (Cronbach’s α coefficients, Spearman’s rank correlation), and with confirmatory factor analysis (CFA; root Mean Square Error of Approximation [RMSEA], Comparative Fit Index [CFI], and Tucker-Lewis Index [TLI]). Results: 112 adolescents participated in the study (45.5% male, mean age 17 ± 1.98 years). CFA was acceptable in the IBD–SES and the TRAQ. Internal consistency was acceptable in IBD–SES and good in TRAQ (0.729; 0.865, respectively). Test–retest reliability was good in IBD–SES, but below the acceptable threshold in TRAQ (ρ = 0.819; ρ = 0.034). In STARx tools, RMSEA showed poor fit values, CFI and TLI were below acceptable fit values, and internal consistency was not satisfied (0.415; 0.693, respectively), while test–retest reliabilities were acceptable (ρ = 0.787; ρ = 0.788, respectively). Conclusions: Cross-cultural, age-specific adaptation was successfully completed with IBD–SES and TRAQ. Those are comparable to the original validated versions. The adaption of the STARx tools was not successful.

Background and study aims: Endoscopic biliary stent placement is a minimally invasive intervention for patients with biliary strictures. Stent patency and function time are crucial factors. Suprapapillary versus transpapillary stent positioning may contribute to stent function time, so a meta-analysis was performed in this comparison. Methods: A comprehensive literature search was conducted in the CENTRAL, Embase, and MEDLINE databases to find data on suprapapillary stent placement compared to the transpapillary method via endoscopic retrograde cholangiopancreatography in cases of biliary stenosis of any etiology and any stent type until December 2020. We carried out a meta-analysis focusing on the following outcomes: stent patency, stent migration, rate of cholangitis and pancreatitis, and other reported complications. Results: Three prospective and ten retrospective studies involving 1028 patients were included. Suprapapillary stent placement appeared to be superior to transpapillary stent positioning in patency (weighted mean difference = 50.23 days, 95% CI: 8.56, 91.98; p = 0.0.018). In a subgroup analysis of malignant indications, suprapapillary positioning showed a lower rate of cholangitis (OR: 0.34, 95% CI: 0.13, 0.93; p = 0.036). Another subgroup analysis investigating metal stents in a suprapapillary position resulted in a lower rate of pancreatitis (OR: 0.16, 95% CI: 0.03, 0.95; p = 0.043) compared to transpapillary stent placement. There was no difference in stent migration rates between the two groups (OR: 0.67, 95% CI: 0.17, 2.72; p = 0.577). Conclusions: Based on our results, suprapapillary biliary stenting has longer stent patency. Moreover, the stent migration rate did not differ between the suprapapillary and transpapillary groups.