Zaćma jako powikłanie przewlekłej steroidoterapii stosowanej w leczeniu choroby Leśniowskiego-Crohna

In this article we present a case of 49-year-old patient hospitalizated in the Department of Gastroenterology, Human Nutrition and Internal Diseases of Clinical Hospital in Poznan due to Lesniowski-Crohn’s disease. In order to the remission of ongoing inflammation and control of relapses, patient used an intense steroid therapy for period of 5 years. In the discussion we describe shortly Lesniowski-Crohn’s disease, one of the inflammatory bowel diseases, including gastrointensinal and parenteral symptoms. The authors focused on multi-organ complications of chronic steroid therapy. In the article we watch out for ocular symptoms and the development of posterior subcapsular cataract which was diagnosed in patient. It is a problem present in a large group of patients, including the side effects of long-term steroid therapy. It should be stressed that steroid-induced cataract is a major problem in the population of patients with long-term treatment, and might impact the quality of life. This article includes above all clinical symptoms, pathological mechanism and risk factors inducing cataract. We present also medical indications qualifying for surgical implantation of intraocular lenses (IOLs). It came out that discontinuation of steroid therapy does not cure cataract and does not prevent further side effects of the management, so long treatment and clinical supervision of the patient are necessary. The study highlights complications that can occur after ophthalmic surgery. The role of the physician who prescribes steroid therapy is very significant because he is in charge of implementation of prevention steps and treatment of complications. The aim is to underline that only interdisciplinary approach in patients with Lesniowski-Crohn’s disease can benefit and it concerns both specialist as well general practitioner.W artykule przedstawiono przypadek 49-letniego pacjenta leczonego w Klinice Gastroenterologii, Żywienia Człowieka i Chorób Wewnętrznych w Poznaniu z powodu choroby Leśniowskiego-Crohna. W celu remisji toczącego się stanu zapalnego oraz opanowania rzutów choroby u pacjenta stosowano intensywną steroidoterapię przez okres pięciu lat. W poniższym omówieniu zawarto krótką charakterystykę choroby Leśniowskiego-Crohna, należącej do nieswoistych chorób zapalnych jelit oraz poszczególnych objawów pozajelitowych, występujących w jej przebiegu. Autorzy skupili się na licznych wielonarządowych powikłaniach wynikających z przewlekłej steroidoterapii. W artykule zwrócono uwagę na objawy oczne i rozwój zaćmy podtorebkowej tylnej, którą rozpoznano u przedstawionego pacjenta podczas konsultacji okulistycznej. Stanowi ona problem obecny u sporej grupy pacjentów, u której opisano skutki uboczne wieloletniego leczenia glikokortykosteroidami. Należy zatem podkreślić, że zaćma posteroidowa stanowi istotny problem w populacji dłu­gotrwale leczonych pacjentów, wpływający na jakość życia oraz chęć dalszej współpracy z lekarzem. W pracy uwzględniono przede wszystkim objawy kliniczne, patomechanizm oraz czynniki predysponujące do rozwoju zaćmy posteroidowej. Omówiono wskazania kwalifikujące pacjenta do zabiegu operacyjnego wszczepienia sztucznych soczewek. Okazuje się, że samo odstawienie glikokortykosteroidów nie powoduje wyleczenia zaćmy, co dodatkowo komplikuje postępowanie z pacjentem oraz wydłuża konieczność postępowania terapeutycznego i obserwacji. W pracy wyróżniono również powikłania mogące wystąpić po przeprowadzonym zabiegu okulistycznym. Zwrócono uwagę na rolę lekarza zlecającego leczenie glikokortykosteroidami — jego rolę we wdrażaniu odpowiednich kroków w profilaktyce oraz w leczeniu powikłań, przed ich dalszym rozwinięciem. Celem pracy jest podkreślenie konieczności wieloaspektowego i wielodyscyplinarnego podejścia do pacjenta z chorobą Leśniowskiego-Crohna zarówno przez lekarza specjalistę, jak i lekarza medycyny rodzinnej

Osteoporoza posteroidowa w chorobie Leśniowskiego-Crohna — studium przypadku

Choroba Leśniowskiego-Crohna cechuje się przewlekłym przebiegiem i wymaga długotrwałego leczenia. Intensywna steroidoterapia prowadzi do wystąpienia licznych powikłań, w tym wtórnej osteoporozy. Wykonywanie odpowiednich badań diagnostycznych (densytometria), właściwa profilaktyka oraz wdrożenie leczenia w odpowiednim czasie minimalizują negatywne skutki steroidoterapii. W niniejszym artykule opisano pacjenta, u którego wystąpiła posteroidowa osteoporoza w przebiegu choroby Leśniowskiego-Crohna

Liver Injury in Patients with Coronavirus Disease 2019 (COVID-19)—A Narrative Review

While respiratory symptoms are prevalent in SARS-CoV-2 infected patients, growing evidence indicates that COVID-19 affects a wide variety of organs. Coronaviruses affect not only the respiratory system, but also the circulatory, nervous and digestive systems. The most common comorbidities in COVID-19 patients are hypertension, followed by diabetes, cardiovascular, and respiratory disease. Most conditions predisposing to SARS-CoV-2 infection are closely related to the metabolic syndrome. Obesity and chronic diseases, including liver disease, are associated with the induction of pro-inflammatory conditions and a reduction in immune response disorders, leading to the suspicion that these conditions may increase the susceptibility to SARS-CoV2 infection and the risk of complications. The definition of liver damage caused by COVID-19 has not yet been established. COVID-19 may contribute to both primary and secondary liver injury in people with pre-existing chronic disease and impaired liver reserves, leading to exacerbation of underlying disease, liver decompensation, or acute chronic liver failure. Therefore, many researchers have interpreted it as clinical or laboratory abnormalities in the course of the disease and treatment in patients with or without pre-existing liver disease. The research results available so far indicate that patients with liver disease require special attention in the event of COVID-19 infection

Cytotoxicity of Thiopurine Drugs in Patients with Inflammatory Bowel Disease

The effectiveness of thiopurine drugs in inflammatory bowel disease (IBD) was confirmed more than a half-century ago. It was proven that these can be essential immunomodulatory medications. Since then, they have been used routinely to maintain remission of Crohn’s disease (CD) and ulcerative colitis (UC). The cytotoxic properties of thiopurines and the numerous adverse effects of the treatment are controversial. However, the research subject of their pharmacology, therapy monitoring, and the search for predictive markers are still very relevant. In this article, we provide an overview of the current knowledge and findings in the field of thiopurines in IBD, focusing on the aspect of their cytotoxicity. Due to thiopurines’ benefits in IBD therapy, it is expected that they will still constitute an essential part of the CD and UC treatment algorithm. More studies are still required on the modulation of the action of thiopurines in combination therapy and their interaction with the gut microbiota

Cytotoxicity of Thiopurine Drugs in Patients with Inflammatory Bowel Disease

The effectiveness of thiopurine drugs in inflammatory bowel disease (IBD) was confirmed more than a half-century ago. It was proven that these can be essential immunomodulatory medications. Since then, they have been used routinely to maintain remission of Crohn’s disease (CD) and ulcerative colitis (UC). The cytotoxic properties of thiopurines and the numerous adverse effects of the treatment are controversial. However, the research subject of their pharmacology, therapy monitoring, and the search for predictive markers are still very relevant. In this article, we provide an overview of the current knowledge and findings in the field of thiopurines in IBD, focusing on the aspect of their cytotoxicity. Due to thiopurines’ benefits in IBD therapy, it is expected that they will still constitute an essential part of the CD and UC treatment algorithm. More studies are still required on the modulation of the action of thiopurines in combination therapy and their interaction with the gut microbiota

Rak żołądka — opis przypadku

The article presents the case of an 80-year-old patient admitted to the Department of Gastroenterology, Internal Medicine and Dietetics in Poznań for the diagnosis of anaemia. The paper contains a short description of gastric cancer, etiology, diagnostics with an emphasis on a number of information particularly useful for family medicine doctors and treatment. The aim of the study is to emphasize the need for a multifaceted and multidisciplinary approach to a patient with a history of cancer.W artykule przedstawiono przypadek 80-letniego pacjenta przyjętego do Kliniki Gastroenterologii, Dietetyki i Chorób Wewnętrznych w Poznaniu w celu diagnostyki niedokrwistości. W pracy zawar to krótką charakterystykę raka żołądka, etiologię, diagnostykę z naciskiem na wiele informacji szczególnie przydatnych dla lekarzy medycyny rodzinnej, oraz leczenie. Celem pracy jest podkreślenie konieczności wieloaspektowego i wielodyscyplinarnego podejścia do pacjenta z wywiadem chorób nowotworowych

Why Does Obesity as an Inflammatory Condition Predispose to Colorectal Cancer?

Obesity is a complex and multifactorial problem of global importance. Additionally, obesity causes chronic inflammation, upregulates cell growth, disturbs the immune system, and causes genomic instability, increasing the risk of carcinogenesis. Colorectal cancer is one of the most common cancers, and it has become a global problem. In 2018, there were around 1.8 million new cases and around 881,000 deaths worldwide. Another risk factor of colorectal cancer associated with obesity is poor diet. A Western diet, including a high intake of red and processed meat and a low consumption of whole grains, fruits, vegetables, and fiber, may increase the risk of both colorectal cancer and obesity. Moreover, the Western diet is associated with a proinflammatory profile diet, which may also affect chronic low-grade inflammation. In fact, people with obesity often present gut dysbiosis, increased inflammation, and risk of colorectal cancer. In this article, the association between obesity and colorectal cancer is discussed, including the most important mechanisms, such as low-grade chronic inflammation, gut dysbiosis, and poor diet

Biosimilar medicines -their use in the treatment of inflammatory bowel diseases. Position statement of the Working Group of the Polish National Consultant in Gastroenterology

Abstract Biological medical products are drugs whose active components are produced only by living, genetically modified organisms or live cell cultures

Where Do We Stand in the Behavioral Pathogenesis of Inflammatory Bowel Disease? The Western Dietary Pattern and Microbiota—A Narrative Review

Despite the increasing knowledge with regard to IBD (inflammatory bowel disease), including ulcerative colitis (UC) and Crohn’s disease (CD), the etiology of these conditions is still not fully understood. Apart from immunological, environmental and nutritional factors, which have already been well documented, it is worthwhile to look at the possible impact of genetic factors, as well as the composition of the microbiota in patients suffering from IBD. New technologies in biochemistry allow to obtain information that can add to the current state of knowledge in IBD etiology

ESR1 Gene Variants Are Predictive of Osteoporosis in Female Patients with Crohn’s Disease

Decreased bone mass in patients with inflammatory bowel diseases (IBD) is a clinical problem with extremely severe consequences of osteoporotic fractures. Despite its increasing prevalence and the need for mandatory intervention and monitoring, it is often ignored in IBD patients’ care. Determining the biomarkers of susceptibility to bone mineral density disorder in IBD patients appears to be indispensable. We aim to investigate the impact of estrogen receptor gene (ESR1) gene polymorphisms on bone mineral density (BMD) in patients with ulcerative colitis (UC) and Crohn’s disease (CD), as they may contribute both, to osteoporosis and inflammatory processes. We characterised 197 patients with IBD (97 with UC, 100 with CD), and 41 controls carrying out vitamin D, calcium and phosphorus serum levels, and bone mineral density assessment at the lumbar spine and the femoral neck by dual-energy X-ray absorptiometry (DXA), ESR1 genotyping and haplotype analysis. We observed that women with CD showed the lowest bone density parameters, which corresponded to the ESR1 c.454-397T and c.454-351A allele dose. The ESR1 gene PvuII and XbaI TA (px) haplotype correlated with decreased femoral neck T-score (OR = 2.75, CI = [1.21–6.27], P-value = 0.016) and may be predictive of osteoporosis in female patients with CD