THE EFFICACY OF ERADICATION OF SMALL INTESTINAL BACTERIAL OVERGROWTH IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE

Background. Emerging evidence suggests a strong interaction between the gut, gut microbiota and liver. Derangement of gut flora, particularly small intestinal bacterial overgrowth (SIBO), occurs in a large percentage of patients with non-alcoholic fatty liver disease (NAFLD) and plays an important role in its pathogenesis. Aim. Study of the frequency of SIBO in various forms of non-alcoholic fatty liver disease, as well as the possibilities of its pathomorphosis as a result of eradication of SIBO as a result of the use of rifaximin or multicomponent probiotic. Material and methods. There were investigated 125 patients with non-alcoholic fatty liver disease (70 men, 55 women aged 18 to 65 years, mean age 37±6.7 years) developed at obesity or type 2 diabetes mellitus, including 85 patients with liver steatosis (group1) and 40 patients with non-alcoholic steatohepatitis (group 2). Patients with concomitant SIBO (70 patients) was treated with rifaximin or multicomponent probiotic. As the main endpoints of the study, the frequency of achieving eradication of SIBO was evaluated (estimated from the results of a repeated H2-lactulose hydrogen test after treatment), as well as a decrease in the severity of liver steatosis by steatometry and a decrease / normalization of transaminase levels 3 months after the start of the treatment. Secondary endpoints included the change in BMI and the HOMA-IR index 3 months after the start of the treatment. Results. SIBO in patients with non-alcoholic fatty liver disease was significantly more frequent than in control (p <0.005), and in patients with non-alcoholic steatohepatitis – significantly more often than in patients with liver steatosis (80 % vs 47.1 %, P <0.01). Eradication of SIBO after use of rifaximin was recorded in 30 of 36 patients with non-alcoholic fatty liver disease (83.3 %), including 16 of 20 patients with steatosis (80 %) and 14 of 16 (87.5 %) patients with non-alcoholic steatohepatitis. In the group of patients taking multicomponent probiotics after treatment, eradication of SIBO was noted in 12 of 36 patients (33.3 %), including 7 patients with steatosis (35 %) and 5 patients (31.3 %) with non-alcoholic steatohepatitis Conclusion. The investigation shows that the eradication of small intestinal bacterial overgrowth has the positive influence on the natural course of NAFLD and use of rifaximine should be discussed as a perspective therapeutic strategy at this patholog

COMPARING OF FAECAL CALPROTECTIN LEVELS IN PATIENTS WITH OSTEOARTHRITIS TAKING NSAID TREATMENT AND PATIENTS WITHOUT NSAIDS THERAPY

Faecal calprotectin (FC) level can be increased in several conditions, which are characterised by neutrophilic inflammation. Some medications, particularly NSAIDs, can elevate its level as well. NSAIDs are taken by patients in many chronic conditions, including osteoarthritis (OA). On the other hand, there is growing evidence that osteoarthritis is not only a degenerative disease, but it has a significant inflammatory component. The role of systemic inflammation is well-known in inflammatory joint diseases, but there is some evidence that it can play an essential role in the OA as well. It can suggest that in the OA, the inflammatory changes could be found in the different organs and systems. The aim of this study was to investigate the FC level in patients with osteoarthritis depending on the NSAIDs intake and to compare it to the FC levels in healthy adults. Materials and methods. In this small observational study, we evaluated the FC levels in patients suffering from OA (36 persons), divided them into two groups depending on their NSAIDs intake, and compared it to FC levels in healthy participants (12 persons). We compared the FC levels depending on the selectivity of the NSAIDs taken by our participants, as well. Results. The median calprotectin level in our patients was 72.57 (IQR 20.55-221.57) mg/kg, 95 %CI 26,18-109.01. OA patients had higher levels than the healthy group (p<0.001). OA patients who took NSAIDs had the highest FC levels – 221.57 (IQR 91.56-448.61) – higher, than those who did not take it – 72.57 (IQR 35.26-164.79) (p=0.03) and than healthy participants, who has normal FC levels (p<0.001); the FC levels of patients who did not take NSAIDs also exceeds healthy subject’s levels (p<0.001). The FC levels in the collective group have a sufficient positive correlation with the duration of NSAIDs intake, VAS score and strong correlation with Lequesne index values. We found that both NSAIDs groups have a significantly greater prevalence of elevated or high FC levels than the control group (p<0.001) and that NSAIDs patients significantly more often have high FC levels than those who do not take NSAIDs (p=0.035). When comparing FC levels in patients depending on the type of NSAIDs they take, we found that those who take non-selective NSAIDs has significantly higher FC levels than those who do not take NSAIDs – 264.1 (IQR 89.72-464.67) to 25.65 (IQR 19.5-75.33) (p=0.0003). The FC levels of who take selective NSAIDs – 98.53 (91.56-105.5) – did not differ significantly to non-selective NSAIDs taker’s group values and non-selective NSAIDs taker’s values (p>0.05). Conclusions. Patients who suffer from OA have higher FC levels than healthy individuals, and patients with OA who take NSAIDs regularly have higher FC levels than those who do not. The intake of non-selective NSAIDs is associated with higher FC levels, than the intake of high-selective NSAIDs. FC levels of those who take high-selective NSAIDs do not differ statistically from those who do not intake NSAIDs. Further research is needed in this area

Аналіз ефективності алергоімунотерапії у пацієнтів з алергією до пилку весняних дерев

Aim. The study of features of sensibilization to spring trees in patients of Lviv region and analysis of the effectiveness of allergoimmunotherapy by the extract of spring trees (Diater Laboratorios, Іспанія).Materials and methods of research. There were examined 286 patients with clinical symptoms of pollen allergy. Skin prick-tests (SPT) were realized by the extraction “Trees mixture” by Diater Laboratorios, Spain. The level of specific IgE to the components of allergens was determined ImmunoCAP method («Phadia AB», Sweden). Allergoimmune therapy (SLIT) was carried out by the vaccine - "Spring Trees" mixture (Alnus glutinosa = 25,00%; Corylus avellana = 25,00%; Betula verrucosa = 25,00%; Fraxinus excelsior = 25,00%).Results of research. 98,3% of patients had positive SPT to the extract “Herbs mixture”. Among them: 68,1% -sensibilized only by allergens of pollen of  Fagale trees; 2,8% - only by Oleaceae family allergens; 23,9% - polyvalent sensibilization by spring trees. ImmunoCAP research – true sensibilization by allergen of Betulacea pollen was 77%. After the first step of SLIT the improvement of the state was in 83,1%; after the second step – in 94,1% of patients.Conclusion: The sensibilization profile of patients from Lvyv region included allergens of Betulacea and Oleaceae trees pollen. The revealed high level of sensibilization by ash allergens allows to recommend SPT for ash for the routine practice. SLIT by the combined vaccine “Spring trees” (Diater, Spain) demonstrated safety and high effectivenessМетою дослідження було вивчення особливостей сенсибілізації до весняних дерев у пацієнтів Львівської області та аналіз ефективності алергоімунотерапії екстрактом весняних дерев. Згідно з результатами досліджень сенсибілізаційний профіль пацієнтів Львівського регіону складався з алергенів пилку дерев родин Betulacea і Oleaceae. SLIT комбінованою вакциною «Весняні дерева» (Діатер, Іспанія) продемонструвала безпеку та високу ефективніст

A standardised model for stool banking for faecal microbiota transplantation : a consensus report from a multidisciplinary UEG working group

Background Faecal microbiota transplantation is an emerging therapeutic option, particularly for the treatment of recurrent Clostridioides difficile infection. Stool banks that organise recruitment and screening of faeces donors are being embedded within the regulatory frameworks described in the European Union Tissue and Cells Directive and the technical guide to the quality and safety of tissue and cells for human application, published by the European Council. Objective Several European and international consensus statements concerning faecal microbiota transplantation have been issued. While these documents provide overall guidance, we aim to provide a detailed description of all processes that relate to the collection, handling and clinical application of human donor stool in this document. Methods Collaborative subgroups of experts on stool banking drafted concepts for all domains pertaining to stool banking. During a working group meeting in the United European Gastroenterology Week 2019 in Barcelona, these concepts were discussed and finalised to be included in our overall guidance document about faecal microbiota transplantation. Results A guidance document for all domains pertaining to stool banking was created. This document includes standard operating manuals for several processes involved with stool banking, such as handling of donor material, storage and donor screening. Conclusion The implementation of faecal microbiota transplantation by stool banks in concordance with our guidance document will enable quality assurance and guarantee the availability of donor faeces preparations for patients.Peer reviewe

THE EFFICACY OF ERADICATION OF SMALL INTESTINAL BACTERIAL OVERGROWTH IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE

Background. Emerging evidence suggests a strong interaction between the gut, gut microbiota and liver. Derangement of gut flora, particularly small intestinal bacterial overgrowth (SIBO), occurs in a large percentage of patients with non-alcoholic fatty liver disease (NAFLD) and plays an important role in its pathogenesis.Aim. Study of the frequency of SIBO in various forms of non-alcoholic fatty liver disease, as well as the possibilities of its pathomorphosis as a result of eradication of SIBO as a result of the use of rifaximin or multicomponent probiotic.Material and methods. There were investigated 125 patients with non-alcoholic fatty liver disease (70 men, 55 women aged 18 to 65 years, mean age 37±6.7 years) developed at obesity or type 2 diabetes mellitus, including 85 patients with liver steatosis (group1) and 40 patients with non-alcoholic steatohepatitis (group 2). Patients with concomitant SIBO (70 patients) was treated with rifaximin or multicomponent probiotic. As the main endpoints of the study, the frequency of achieving eradication of SIBO was evaluated (estimated from the results of a repeated H2-lactulose hydrogen test after treatment), as well as a decrease in the severity of liver steatosis by steatometry and a decrease / normalization of transaminase levels 3 months after the start of the treatment. Secondary endpoints included the change in BMI and the HOMA-IR index 3 months after the start of the treatment.Results. SIBO in patients with non-alcoholic fatty liver disease was significantly more frequent than in control (p <0.005), and in patients with non-alcoholic steatohepatitis – significantly more often than in patients with liver steatosis (80 % vs 47.1 %, P <0.01). Eradication of SIBO after use of rifaximin was recorded in 30 of 36 patients with non-alcoholic fatty liver disease (83.3 %), including 16 of 20 patients with steatosis (80 %) and 14 of 16 (87.5 %) patients with non-alcoholic steatohepatitis. In the group of patients taking multicomponent probiotics after treatment, eradication of SIBO was noted in 12 of 36 patients (33.3 %), including 7 patients with steatosis (35 %) and 5 patients (31.3 %) with non-alcoholic steatohepatitisConclusion. The investigation shows that the eradication of small intestinal bacterial overgrowth has the positive influence on the natural course of NAFLD and use of rifaximine should be discussed as a perspective therapeutic strategy at this patholog

АналіЗ ефективностІ алергоімунотерапіЇ У пацієнтіВ З алергієЮ дО пилкУ весняниХ дереВ

Метою дослідження було вивчення особливостей сенсибілізації до весняних дерев у пацієнтів Львівської області та аналіз ефективності алергоімунотерапії екстрактом весняних дерев. Згідно з результатами досліджень сенсибілізаційний профіль пацієнтів Львівського регіону складався з алергенів пилку дерев родин Betulacea і Oleaceae. SLIT комбінованою вакциною «Весняні дерева» (Діатер, Іспанія) продемонструвала безпеку та високу ефективніст