Malnutrition risk questionnaire combined with body composition measurement in malnutrition screening in inflammatory bowel disease.

The purpose of malnutrition screening is to predict the probability of a worse outcome due to nutritional factors. The Malnutrition Universal Screening Tool (MUST) can be used for screening in inflammatory bowel disease (IBD); however, it does not provide details about body composition. Our aim was to assess the body composition and combine this with the MUST method to screen risk of malnutrition and sarcopenia. A total of 173 IBD outpatients were enrolled in this cross-sectional study. The MUST scale indicated 21.4% of IBD patients to be at risk of malnutrition. A risk of sarcopenia was detected in 27.7%. However, one third of these patients were not considered to be at risk by their MUST score. Furthermore, Crohn's disease (CD) patients had a strongly unfavorable fat-free mass index (FFMI) value compared to ulcerative colitis (UC) patients, and these differences were significant among men (FFMI: 18.62 +/- 2.16 vs 19.85 +/- 2.22, p = 0.02, in CD and UC males, respectively). As sarcopenia is a relevant prognostic factor, the MUST method should be expanded to include body composition analysis to detect more IBD patients at risk of malnutrition and sarcopenia in order to start their nutritional therapy immediately

Efficacy and safety of the biosimilar infliximab CT-P13 treatment in inflammatory bowel diseases: a prospective, multicentre, nationwide cohort

Background and Aims: Biosimilar infliximab CT-P13 is approved for all indications of the originator product in Europe. Prospective data on its efficacy, safety, and immunogenicity in inflammatory bowel diseases are lacking. Methods: A prospective, nationwide, multicentre, observational cohort was designed to examine the efficacy, safety, and immunogenicity of CT-P13 infliximab biosimilar in the induction treatment of Crohn’s disease [CD] and ulcerative colitis [UC]. Demographic data were collected and a harmonised monitoring strategy was applied. Early clinical remission, response, and early biochemical response were evaluated at Week 14, steroid-free clinical remission was evaluated at Week 30. Therapeutic drug level was monitored using a conventional enzyme-linked immunosorbent assay. Results: In all, 210 consecutive inflammatory bowel disease [126 CD and 84 UC] patients were included in the present cohort. At Week 14, 81.4% of CD and 77.6% of UC patients showed clinical response and 53.6% of CD and 58.6% of UC patients were in clinical remission. Clinical remission rates at Week 14 were significantly higher in CD and UC patients who were infliximab naïve, compared with those with previous exposure to the originator compound [ p < 0.05]. Until Week 30, adverse events were experienced in 17.1% of all patients. Infusion reactions and infectious adverse events occurred in 6.6% and 5.7% of all patients, respectively. Conclusions: This prospective multicentre cohort shows that CT-P13 is safe and effective in the induction of clinical remission and response in both CD and UC. Patients with previous infliximab exposure exhibited decreased response rates and were more likely to develop allergic reactions

Does dermatitis herpetiformis result in bone loss as coeliac disease does? A cross sectional study

Introduction and objectives: coeliac disease (CD) and its cutaneous manifestation, dermatitis herpetiformis are both (DH) gluten-sensitive diseases. Metabolic bone disease is common among patients with CD, even in asymptomatic forms. Data are scarce about bone density in patients with dermatitis herpetiformis. The aim of our study was to compare bone mineral density (BMD) of celiac and dermatitis herpetiformis patients. Methods: 34 coeliac patients, 53 with dermatitis herpetiformis and 42 healthy controls were studied. The mean age was 38.0 ± 12.1, 32.18 ± 14.95, 35.33 ± 10.41 years in CD, dermatitis herpetiformis, and healthy controls, respectively. Bone mineral density of the lumbar spine, the left femoral neck and radius were measured by dual-energy X-ray absorptiometry. Low bone density, osteopenia and osteoporosis were defined as a body mass density (BMD) T-score between 0 and -1, between -1 and -2.5, and under -2.5, respectively. Results: at lumbar region, consisting of dominantly trabecular compartment, a decreased BMD was detected in 49 % (n = 26) patients with dermatitis herpetiformis, 62 % (n = 21) of CD patients, and 29 % (n = 12) of healthy controls, respectively. Lower BMD were measured at the lumbar region in dermatitis herpetiformis and CD compared to healthy subjects (0.993 ± 0.136 g/cm² and 0.880 ± 0.155 g/cm² vs. 1.056 ± 0.126 g/cm²; p < 0.01). Density of bones consisting of dominantly cortical compartment (femoral neck) did not differ in dermatitis herpetiformis and healthy subjects. Conclusions: our results show that a low bone mass is also frequent among patients with dermatitis herpetiformis. Bone mineral content in these patients is significantly lower in those parts of the skeleton which contain more trabecular than cortical bone

Az adalimumab hatékonysága és biztonságossága hagyományos kezelésre refrakter colitis ulcerosában

INTRODUCTION: Adalimumab was approved for the treatment of ulcerative colitis refractory to conventional therapy several years later than infliximab in Europe. Due to the relatively low remission rate observed in Ultra trials, data on the efficacy of adalimumab in ulcerative colitis are really helpful in the daily practice. AIM: The aim of this study was to prospectively collect data on induction and maintenance adalimumab therapy in patients with ulcerative colitis treated in Hungarian centres. METHOD: This prospective study collected data of all patients with ulcerative colitis treated with adalimumab in 10 Hungarian centres. The primary endpoints of the study were rates of remission, response and primary failure at week 12, and the rate of continuous clinical response, remission and loss of response at weeks 30, and 52. Secondary endpoints were endoscopic outcome at week 52 and comparison of the efficacy of adalimumab between treatment naive and infliximab-experienced patients. RESULTS: 73 patients with active ulcerative colitis were enrolled in the study. 75.3% of the patients exhibited clinical response after the induction at week 12. The probability of maintaining adalimumab treatment was 48.6% at week 52 with a continuous clinical response in 92% of these patients. Mucosal healing was achieved in 48.1% of the patients at week 52. Dose intensification was performed in 17.6% of the patients. Minor side effects developed in 4% of the patients and 5.4% of the patients underwent colectomy during the 1-year treatment period. CONCLUSIONS: These results coming from the real clinical setting demonstrate a favourable efficacy of adalimumab induction and maintenance therapy in patients with ulcerative colitis. Orv. Hetil., 2016, 157(18), 706-711

A Magyar Mesterséges Táplálási Társaság 2016. évi kongresszusán elhangzó előadások kivonatai. Mátraháza, Lifestyle Hotel Mátra, 2016. október 6–8.

A felnőtt coeliakiások zabfogyasztásának vizsgálata | Melyik tápszert javasoljam a betegemnek? Dilemmák, lehetőségek és korlátok Magyarországon és Európában | A malnutritio kockázatának önszűrése | A táplálás során végzett ellenőrző vizsgálatok | Az energiaszükséglet meghatározása, az energiaszükséglet mérése – direkt és indirekt kalorimetria | Inkompatibilitásokból származó gyógyszerelési hibák megelőzési stratégiája, a klinikai gyógyszerész szerepe | A preoperatív táplálás fejlesztésének gyakorlati tapasztalatai | A tápszerforgalom és a táplálásterápiás szokások változása hazánkban | Gyári tápoldatkeverékek stabilitása individualizáló kiegészítések nyomán | A táplálásterápia monitorozása gyermekek onkohematológiai betegségében | Gyermekkori onkohematológiai betegség során alkalmazott táplálásterápia hatása a túlélésre és a túlélő betegek tápláltsági állapotára | Táplálásterápia a súlyos agysérültek korai rehabilitációjának vonatkozásában | Magisztrális parenteralis tápoldatok (Magi-AIO-TPN) eltarthatósága | A Pécsi Tudományegyetem klinikai gyógyszerészi szolgálatának bővítése a táplálásterápia területén | Egészséges mikroflórával a perioperatív szövődmények megelőzéséér

A táplálásterápia hatékonyságának vizsgálata gyulladásos bélbetegségben szenvedők gondozása során

INTRODUCTION: Inflammatory bowel diseases can cause malnutrition (due to inflammatory cytokine production, catabolic states after surgery, restricted diet), which is difficult to treat by nutritional therapy. AIM: Investigating the efficacy of nutrition therapy. METHOD: Combined malnutrition risk screening (questionnaires and body composition analysis), at the beginning of the research and after a 1 year period. RESULTS: 205 patients were screened, 82 were malnourished. A total of 44 received nutritional intervention for 1 year, for 45% dietary management was satisfactory, 50% needed oral nutritional supplements and 5% received home parenteral nutrition. These interventions reduced the number of patients considered by both measuring methods in high risk from 31 to 21, increased the body weight and fat-free mass in 8 and 9 cases significantly (i.e., with more than 10%), and improved the indices as well (DeltaBMI: +1.3 kg/m2, p = 0.035 s., DeltaFFMI: +0.5 kg/m2, p = 0.296 n.s.). The main limitations of our research are the relatively low number of cases and the mono-centric involvement. CONCLUSIONS: We recommend combined malnutrition risk screening for all patients with inflammatory bowel disease due to the high risk of malnutrition, and follow-up of the malnourished patients to monitor the efficacy of their nutrition therapy. Orv Hetil. 2017; 158(19): 731-739

A gyomor polypoid képleteinek gyakorisága egy endoszkópos centrumban [Prevalence of gastric polypoid lesions in a single endoscopic centre]

Background: The prevalence of gastric polyps is unknown in Hungary. Aim: The aim of the authors was to assess the prevalence of polypoid lesions of the stomach in the endoscopic centre of the 2nd Department of Medicine, Semmelweis University. Methods: Results of upper gastrointestinal endoscopies carried out between March 2010 and June 2011 were analysed. Results: 193 cases with polyps were diagnosed in 4174 endoscopies (4.62%). Hyperplastic polyps, fundic gland polyps and malignant lesion were detected in 33.67%, 31.09% and 2.07% of the cases, respectively. Proton pump inhibitor use was more frequent among patients diagnosed with fundus gland polyps (p = 0.007), while hyperplastic polyps were diagnosed more frequently in patients with chronic gastritis (p = 0.032). Conclusions: The frequency of gastric polyps was higher than expected from data published in the literature. Long-term proton pump-inhibitor use and chronic gastritis were associated with fundus gland and hyperplastic polyps, respectively

D-vitamin-szint mérése hazai gyulladásos bélbetegekben [Vitamin D level in Hungarian patients with inflammatory bowel diseases]

Introduction: Vitamin D has an important role in the immune regulation. Vitamin D is essential for innate and adaptive immune systems and it plays a significant role in the formation of immune tolerance, as well. Aim: Vitamin D deficiency has been observed in patients with inflammatory bowel diseases in Western Europe, but there is no data available from Eastern Europe. Method: The study included 169 patients with inflammatory bowel disease. Results: The median vitamin D level was 22.7+/-10.6 ng/ml. Only 20% of the patients had adequate vitamin D level (>30 ng/ml), 52% had vitamin D insufficiency (15-30 ng/ml), and 28% of them had severe vitamin D deficiency (<15 ng/ml). Vitamin D concentration failed to correlate with clinical activity indexes (partial Mayo score: r = -0.143; Crohn's disease activity index: r = -0.253) and with inflammatory parameters (C-reactive protein: r = 0.008; erythrocyte sedimentation rate: r = 0.012). Conclusions: Since vitamin D deficiency can be frequently observed in Hungarian patients with inflammatory bowel disease, its level should be tested in these patients. Orv. Hetil., 154(46), 1821-1828