Przegla̜d Gastroenterologiczny最新文献

Introduction: Nonalcoholic steatohepatitis (NASH) is the most common cause of chronic liver disease, but no drug therapies have been approved to date. While glucagon-like peptide-1 (GLP-1) analogues may help in the management, the existing evidence remains conflicting.

Aim: This meta-analysis aims to elucidate the efficacy of liraglutide in patients with NASH.

Material and methods: We searched 4 databases for randomized controlled trials assessing the efficacy of liraglutide in patients with NASH. We analysed continuous outcomes using the mean difference (MD) and relative 95% confidence interval (CI), while dichotomous outcomes were analysed using the risk ratio (RR) and relative 95% CI. Primary endpoints included alanine aminotransferase (ALT) (IU/l), aspartate aminotransferase (AST) (IU/l), alkaline phosphatase (ALP) (IU/l), and γ-glutamyl transferase (GGT) (IU/l). Secondary outcomes were body mass index (BMI) (kg/m²), waist circumference (cm), total cholesterol (TC) (mmol/l), triglyceride (TG) (mmoll), high-density lipoprotein (HDL) (mmol/l), low-density lipoprotein (LDL) (mmol/l), and glycated hemoglobin (HbA_1c) (%).

Results: A total of 5 clinical trials were included. The analysis showed that liraglutide is effective in increasing HDL (MD = +0.10 (-0.18, -0.02), p = 0.02) and reducing LDL levels in blood (MD = -0.29 (-0.56, -0.02), p = 0.04). No significant difference was noted in levels of ALT (MD = 2.66 (-1.56, 6.87), p = 0.22), AST (MD = -1.99 (-5.70, 1.72), p = 0.29), GGT (MD = 5.02 (-0.86, 10.90), p = 0.09), ALP (MD = -5.16 (-11.90, 1.59), p = 0.13), TC (MD = -0.31 (-0.65, 0.03), p = 0.07), or TG (MD = -0.14 (-0.53, 0.25), p = 0.48). The HbA_1c (%) level was found to be significantly reduced in the liraglutide arm (MD = -0.62 (-0.88, -0.36), p < 0.01).

Conclusions: Liraglutide effectively improves the lipid profile in patients with NASH.

Introduction: Titanium oxide (TiO₂) is a widely used oxidizer for environmental management. The power of TiO₂ has been demonstrated by its photocatalytic activity. Hydroxyapatite (HA)-coated TiO₂ (HA-TiO₂) was used to test the in vivo effect on dextran sulphate sodium (DSS)-induced colitis in mice.

Material and methods: Mice were monitored for body weight and then sacrificed on the seventh day, and the colon length was measured. Their faeces were analysed for intestinal microbiota distribution, and colon tissue was subjected to histological examination and immunohistochemical analysis.

Results: Weight loss was significantly lower in HA-TiO₂-fed mice than in mice without HA-TiO₂. The colon length in the DSS colitis-induced mice was shortened, but HA-TiO₂ feeding lessened this effect. Histological and immunohistochemical analyses of the colon revealed that macrophages and CD4⁺CD8⁺ T cells were observed in the colitis-occurring site, indicating the involvement of innate and acquired immunity in determining the degree of DSS-induced colitis. Intestinal microbiota analysis in faeces revealed changes in the distribution of multiple bacterial species after DSS colitis induction, and the increase/decrease of 2 Clostridium (sub)clusters moved in response to the colitis phenomenon. All the described effects of HA-TiO2 were photocatalytic activity-dependent because mice that were kept in the dark showed similar results to those treated with DSS alone without HA-TiO₂.

Conclusions: HA-coated TiO₂ ameliorated DSS-induced colitis through photocatalytic activity, while HA-TiO₂ diminished the changes in intestinal microbiota and immune reactions caused by DSS.

Introduction: Type 1 diabetes mellitus (T1DM) is an autoimmune disease. The gut microbiota has been proposed as a key actor in the pathogenesis of T1DM.

Aim: To identify the gut microbiome that are likely to be related to T1DM. This may have an impact on the future understanding of the pathogenesis of T1DM and possible approaches to prevent and treat it.

Material and methods: The study included 40 T1DM patients and a cross-matching control group of 20 healthy subjects of matched age and sex; stool specimens were taken from each group. Quantitative SYBR Green Real-Time PCR technique targeting 16S rRNA was done for the identification and quantitation of Bacteroides, Prevotella, Ruminococcus, Lactobacillus johnsonii, Lactobacillus reuteri, and Veillonella.

Results: T1DM patients showed significantly higher Bacteroides (p < 0.001) and Lactobacillus johnsonii (p = 0.003), but lower Veillonella (p = 0.013) than the control group. However, there was no statistical difference between T1DM and control cases as regards Prevotella (p = 0.204), Ruminococcus (p = 0.598), Lactobacilli (p = 0.901), and Lactobacillus reuteri (p = 0.332).

Conclusions: Egyptian patients showed dysbiosis of the gut microbiome that can be related to the pathogenesis of T1DM. This hopefully points to the potential therapeutic benefits of manipulating the composition of the gut microbiome in the management of, or even protection from, T1DM.

Introduction: Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver with increasing global prevalence. However, no epidemiological data exist for AIH in human immunodeficiency virus (HIV)-infected patients.

Aim: To determine the demographics and comorbid conditions associated with AIH among HIV-infected individuals in the United States.

Material and methods: The United States National Inpatient Sample database was used to identify HIV hospital encounters in 2012-2014. The encounters were then classified into 2 groups based on a concomitant primary diagnosis of AIH. Primary outcomes included the demographics and comorbid conditions of AIH among HIV-infected patients. Secondary outcomes assessed the independent predictors of AIH.

Results: A total of 48,3310 patients with an HIV diagnosis were included. The estimated AIH prevalence was 52.8/100,000 HIV hospital encounters. The female gender was more likely to have AIH with an odds ratio (OR) of 1.82; 95% confidence interval (CI) 1.42-2.32, p < 0.0001. The age intervals of 35-50 and 51-65 years had higher odds of AIH 110 (43.1%) and 115 (45.1%) with OR = 1.30; 95% CI: 1.02-1.67, p = 0.03 and OR = 1.34; 95% CI: 1.05-1.71, p = 0.02, respectively. African American and Hispanic races were more commonly affected. Moreover, HIV-infected patients with AIH had a higher risk of having elevated transaminases, long-term steroid use, rheumatoid arthritis, and ulcerative colitis.

Conclusions: This study illustrates that the estimated prevalence of AIH in HIV-infected patients in the United States is 52.8/100,000. AIH in HIV-positive individuals has a predilection for the female gender and African American and Hispanic races, and shows a higher correlation with rheumatoid arthritis and ulcerative colitis.

Introduction: Solitary bone metastasis of colorectal carcinoma (CRC) without other metastasis sites is extremely rare and can be found in less than 1% of patients with CRC.

Aim: In the present study, we report the first case of a solitary tibia metastasis and its pathologic fracture as the first presenting feature of a colorectal adenocarcinoma.

Material and methods: A 78-year-old female patient presented to our emergency department due to atraumatic pretibial swelling. Plain radiography did not detect any pathology. The swelling was incised and serous-bloody collection was evacuated, and the patient was discharged. On the 17^th postoperative day, during a regular walk, the patient fell down and broke her leg, which transpired to be a pathologic fracture of the proximal tibial diaphysis, confirmed by X-ray. A biopsy of the altered bone tissue from the fracture site revealed metastatic colorectal adenocarcinoma. On colonoscopy, a circular mass in the upper rectum was found.

Conclusions: Solitary bone metastases are most commonly found in bones that are related to venous drainage via the paravertebral plexus of Batson - the pelvis, vertebrae, and sacrum. Long bones are extremely rare localizations of solitary CRC metastases, with only few cases published so far in medical literature. In our case, the patient`s first symptom was related to the osseous tibial metastasis - leg swelling. No tumour was suspected until the pathologic fracture occurred. It is important to consider osseous metastasis in every patient with unexplained swelling, haematoma, or pain of the extremities and make a bone scan to recognize the metastasis early.

Introduction: Severe acute pancreatitis (SAP) with major complications such as necrosis and multiple organ dysfunction syndrome (MODS) often leads to high mortality rates despite intensive treatment.

Aim: To evaluate the effect of symbiotics (probiotics) on septic complications in patients with SAP.

Material and methods: We searched the PubMed, Cochrane CENTRAL, SCOPUS, and Web of Science databases for relevant clinical trials and excluded observational studies. Quality appraisal was evaluated according to GRADE, and we assessed the risk of bias using Cochrane's risk of bias tool. We included the following outcomes: C-reactive protein (CRP), APACHE II score, hospital stay, multiorgan failure (MOF), systemic inflammatory response syndrome, infected pancreatic necrosis, septicaemia, need for operation, and death. We performed the analysis of homogeneous data under a fixed-effects model, while analysis of heterogeneous data were analysed under a random-effects model. We performed the analysis of dichotomous outcomes using the risk ratio (RR) and relative 95% confidence interval (CI).

Results: We included a total of 7 clinical trials. We found that there was no significant difference between both groups regarding MOF (RR = 0.60 (0.25, 1.44), p = 0.26), septicaemia (RR = 0.66 (0.29, 1.50), p = 0.32), death (RR = 0.66 (0.19, 2.26), p = 0.51), infected pancreatic necrosis (RR = 0.50 (0.18, 1.38), p = 0.18), SIRS (RR = 0.81 (0.29, 2.23), p = 0.68), CRP, APACHE II score, and hospital stay.

Conclusions: Contrary to some published trials, our meta-analysis concludes that the use of probiotics in patients with SAP is not effective in reducing the mortality rate, septic complications, and need for operation.