Przegla̜d Gastroenterologiczny最新文献

Inborn errors of immunity (IEI) are a heterogeneous group of genetic disorders affecting immune function, often presenting with diverse gastroenterological symptoms that pose diagnostic challenges. The latest classification developed by the International Union of Immunological Societies Experts Committee includes 582 IEI disease entities. Unfortunately, 70-80% of cases are still not recognized and do not enter the patient registers. Most cases are also diagnosed too late. This review explores the epidemiology, classification, symptoms, diagnostics, and treatment of gastrointestinal involvement in IEI.

Introduction: Ulcerative colitis (UC) is an autoimmune disease characterized by the formation of erosions and ulcerations of the colonic mucosa. Exclusion of infections, including sexually transmitted disorders (STDs), is particularly important in the differential diagnosis.

Aim: The aim of the study was to demonstrate the situation of Polish patients in the context of differential diagnosis of UC with STDs.

Material and methods: We used a questionnaire on sexual habits for patients with ulcerative colitis from two Polish centers for the treatment of inflammatory bowel diseases (IBD) and to Internet users with the diagnosis of UC affiliated with patient portals.

Results: The survey included 532 participants. 31.6% of all respondents reported practicing passive anal intercourse. 7.6% of patients admitted to unsafe sexual behavior, while among men who have sex with men (MSM) this percentage increased to 73%, with 55.4% of anal intercourse taking place without mechanical contraception. During medical visits related to the diagnosis or exacerbation of UC, the vast majority (87.2%) of patients were not asked about either anal sexual intercourse or sexual orientation, and 76.7% were certainly not tested for STDs.

Conclusions: The vast majority of Polish patients with UC are not asked about anal intercourse or tested for STDs. Simultaneously, considering the percentage of patients at risk for STDs, it is reasonable to assume that this is a genuine problem and may lead to diagnostic mistakes.

Medicine is a constantly evolving discipline that uses the latest technologies and devices to support patients effectively according to the most up-to-date standards. Modern technology also enables the individualization of treatment, which is the foundation of personalized medicine. One clinical area where these advancements are applied is in gastrointestinal failure, acute intestinal failure (AIF) in particular. A particularly challenging issue in this field remains the accurate assessment of patients' caloric needs. This article presents a critical literature review on the potential application of indirect calorimetry (IC) as a method for measuring resting energy expenditure in cases of AIF, especially within internal medicine wards. The review focused on articles published from 1997 to 2024 across various scientific databases. Based on this analysis, it can be concluded that, despite its numerous advantages and proven usefulness in a wide range of clinical settings, indirect calorimetry has certain limitations that significantly impact its applicability in AIF.

Introduction: Effective prediction of endoscopic remission is a key to optimizing ulcerative colitis (UC) management. While fecal calprotectin (FC) is widely used, its limitations highlight the need for complementary biomarkers. This study evaluated fecal butyric acid (C4) as a novel, non-invasive predictor of endoscopic remission in UC.

Aim: To assess the association between fecal C4 levels and endoscopic remission (Mayo score 0), and secondarily/also, the correlation between C4 and FC.

Material and methods: A multicenter, prospective study enrolled 100 UC patients between April 2021 and April 2023, including 26 in remission and 74 with active disease. Inclusion criteria were confirmed UC diagnosis for ≥ 1 year and stable therapy without medication changes. Fecal C4 was measured using mass spectrometry. Analyses included descriptive statistics, group comparisons, receiver operating characteristic (ROC) curve analysis, and Spearman correlation.

Results: Patients in remission had significantly higher fecal C4 levels (mean difference: 4.05 nM/mg; 95% CI: 2.44-5.71; p < 0.001) and lower Mayo scores. C4 showed excellent predictive performance (area under the curve (AUC) = 0.943; 95% CI: 0.897-0.980; p < 0.001), with 100% sensitivity and 86% specificity at a cutoff of 1.68 nM/mg. No significant correlation was found between C4 and FC.

Conclusions: Fecal C4 is a promising biomarker for predicting endoscopic remission in UC, offering high sensitivity and specificity. Its use may enhance clinical decision-making and support individualized treatment approaches. Further validation in larger cohorts is warranted to confirm these findings and establish its clinical utility.

Epidemiological data of the Polish healthcare model of care indicate that the current management of inflammatory bowel disease (IBD) requires improvements in clinical practice and service organization. Integrated care models for patients with IBD, particularly those centred on a multidisciplinary team, offer a promising approach to improving outcomes, reducing admissions, and rationalizing resources. The coordination of specialists, nurses, dietitians, psychologists, and other professionals within a single reference unit could strengthen continuity of care with primary care providers and enable treatment strategies to be tailored to individual needs. In addition, education and ongoing support foster greater patient involvement, potentially lowering relapse rates and enhancing quality of life. These models, with reforms in care provision and quality measurement based on digital solutions, can reduce fragmentation and alleviate burdens on both patients and the healthcare system. Thus, integrated care represents an evolution in IBD management, benefiting all stakeholders in the healthcare continuum.

Introduction: Recently there has been significant progress in research on the pathogenesis of inflammatory bowel diseases (IBD).

Aim: Our study aimed to assess selected markers of bacterial translocation in children with IBD in relationship to disease activity.

Material and methods: Lipopolysaccharides (LPS) - markers of bacterial translocation - and proinflammatory cytokines - interleukin (IL)-8, IL-12 and tumor necrosis factor (TNF) α - were assessed in the serum of 27 pediatric IBD patients at the outbreak of the illness and then 1 and 3 months after the introduction of the treatment. The analyzed markers were taken once in 6 healthy children in the control group.

Results: Serum TNF-α and LPS concentrations were significantly higher in IBD patients than in the control group (1.74 vs. 0.83 ng/ml and 21.83 vs. 10.26 pg/ml, p < 0.05). In the study group, clinical and laboratory activity mediators significantly decreased during 3 months of the treatment. All proinflammatory cytokines decreased, but significant down-regulation was observed only in relation to IL-12 (129.21 vs. 82.98 pg/ml, p < 0.05) in CD and IL-8 (32.72 vs. 20.97 pg/ml, p < 0.05) in UC patients. TNF-α levels decreased but did not reach values as in healthy children, while LPS levels increased in both groups.

Conclusions: IL-12 in CD and IL-8 in UC could be non-invasive markers of reduced inflammation during IBD in children. Improvements in clinical status and reductions in systemic inflammatory markers do not necessarily mean complete cessation of the inflammatory cascade. The elevated TNF-α and LPS levels found in patients in early remission may be a marker of subclinical inflammation.

Introduction: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) and endoscopic ultrasound-guided ethanol ablation (EUS-EA) are emerging novel methods for managing non-functioning and functioning pNET and adenocarcinoma in the pancreas.

Aim: To assess the safety profile, feasibility, and outcomes of EUS-RFA and EUS-EA of focal pancreatic masses.

Material and methods: This prospective study included 27 patients, 15 males and 12 females, with a mean age of 36.38 years. EUS-RFA was carried out in 13 patients; 11 had pancreatic insulinoma, and 2 had advanced pancreatic adenocarcinoma. The mean size of the masses was 20.6 mm, while that of the insulinomas was 17.4 mm. The median number of needle passes was 3, with a range of 1 to 6. RFA was conducted using 19G EUSRA needles from Taewoong Co., Ltd., South Korea. No minor or major complications were observed. EUS-EA was carried out in 14 patients, all of whom had pancreatic insulinoma. The mean size of the masses was 15.3 mm. The median number of needle passes was 2, with a range of 1 to 3. We used 19G and 22G echo tip FNA needles from Cook Company, USA. The mean duration of follow-up was 12.4 months. There was mild to moderate acute pancreatitis in 4 patients in the EUS-EA group; all were relieved by conservative therapy, and no hospital admission was required. No early or late significant complications were reported in the EUS-RFA group.

Results: There was a complete clinical cure of 10 out of 11 (91%) patients with pancreatic insulinoma who underwent EUS-RFA. However, 1 patient required three sessions, and 2 patients required two sessions of EUS-RFA. The 11^th patient with insulinoma showed a poor response after the first session, then a partial response after the second session of EUS-RFA. The size of the two masses with advanced adenocarcinoma was decreased, but no downstaging of the masses was achieved. There was a complete clinical cure of 8 out of 14 (57%) patients with pancreatic insulinoma who underwent EUS-EA. No clinical cure was observed in 4 patients; 3 underwent major surgery, and the 4^th one underwent EUS-RFA. The last 2 patients showed a partial clinical response with decreased frequency, duration, and severity of hypoglycemic attacks. They were managed by diet regulation; no major surgery was needed.

Conclusions: EUS-RFA and EUS-EA can potentially treat lesions and control symptoms. EUS-RFA is a more promising and safer technique for managing functioning insulinomas. However, it cannot downstage pancreatic ductal adenocarcinoma patients. EUS-EA seems less efficient, with more adverse events than EUS-RFA.

Introduction: Studies comparing proximal and distal colon tumours undergoing emergent surgery for obstruction are limited.

Aim: The purpose of our study was to compare the clinical and oncological outcomes of patients with proximal and distal colon cancer, who underwent emergent surgery for obstruction.

Material and methods: From January 2012 to June 2022, patients with colon cancer presenting with obstruction and undergoing emergent surgery were analysed. The 2 groups were defined as proximal and distal according to the tumour location with respect to the splenic flexure. Postoperative early and long-term clinical and oncological outcomes were analysed.

Results: Of the 118 patients included in the study, there were 46 patients (38.9%) in the proximal group and 72 patients (61.1%) in the distal group. Single-session surgery including resection and anastomosis was performed on 31 (67.4%) and 29 (40.3%) patients in the proximal and distal groups, respectively (p = 0.007). The global mortality rate was 11%, and there was no difference between the groups. Five-year survival was similar in the proximal and distal groups, being 80.4% and 68.1%, respectively. In the analysis of patients who did not develop early mortality and underwent R0 resection, 3-year disease-free survival was 89.5% in the proximal group and 81.5% in the distal group; the difference was not significant (p = 0.165).

Conclusions: Mortality is high in emergent surgeries for obstructed proximal and distal colon cancers. If curative resection is achieved, oncological results are good and tumour localisation does not affect survival.