IgG-dependent food allergy and its role in obesity and related diseases

Nadwrażliwość pokarmowa IgG-zależna może indukować przewlekły stan zapalny w organizmie, wyrażający się zwiększonym poziomem mediatorów zapalnych (TNF-a, IL-1, IL-6 oraz CRP). Konsekwencją może być rozwój insulinooporności, otyłości i chorób towarzyszących: cukrzycy, nadciśnienia tętniczego czy miażdżycy. Pojawiają się doniesienia wskazujące, że dieta eliminacyjna, oparta na wynikach badań swoistych przeciwciał IgG względem antygenów pokarmowych, może być efektywna w normalizacji masy ciała.IgG-dependent food hypersensitivity may induce chronic inflamma tion in the organism, ex - pressed in increased levels of inflammatory mediators (TNF-a, IL-1, IL-6 and CRP). The consequence may be insulin resistance development, obesity and rel ated diseases: diabetes, hypertension or atherosclerosis. There have been repor ts that an elimination diet based on the results of specific IgG antibodies against food antigens may be effective in normalization of body weight

Clinical characteristics of 320 pediatric Crohn's disease patients registered in the nationwide Crohn's disease registry in Poland

Wstęp: Nieswoiste choroby zapalne jelit (inflammatory bowel diseases - IBD), zwłaszcza choroba Leśniowskiego-Crohna (Crohn’s disease - CD), są narastającym problemem w gastroenterologii pediatrycznej. Dostępne dane dotyczące klinicznych i demograficznych aspektów choroby w Polsce są ograniczone. Cel: Zebranie rzetelnych danych o klinicznych i demograficznych aspektach choroby Leśniowskiego-Crohna u dzieci w Polsce na podstawie utworzonego internetowo prospektywnego rejestru choroby mających pomóc w opracowaniu najbardziej optymalnych strategii terapeutycznych dla tej grupy pacjentów. Materiał i metody: We wrześniu 2005 roku został utworzony w Internecie ogólnopolski rejestr pacjentów z chorobą Leśniowskiego-Crohna. Do projektu włączono 10 jednostek szpitalnych (9 szpitali akademickich, 1 rejonowy szpital referencyjny). W celu zebrania danych demograficznych i klinicznych zastosowano dostępny internetowo kwestionariusz, który następnie przesyłano do centralnego rejestru do prospektywnej analizy. Ocenie poddano następujące dane: demografia, historia rodzinna, lokalizacja i postać choroby, objawy pozajelitowe, choroby współistniejące, diagnostyka oraz leczenie (włączając w to interwencje chirurgiczne). Wyniki: Przez 4 lata 320 pacjentów (płeć męska : płeć żeńska - 191 : 129) w wieku poniżej 16 lat ze zdiagnozowaną CD (średni wiek w momencie postawienia diagnozy: 9,2 ±6,8 roku) zostało zarejestrowanych w bazie danych. Tak zwany wczesny początek choroby (wiek przy rozpoznaniu poniżej 5 lat) stwierdzono u 68 dzieci (21,25%). Rodzinne występowanie (obciążony wywiad rodzinny) odnotowano u 16 pacjentów (5%). Główne miejsce zmian chorobowych (według Klasyfikacji montrealskiej: L1 - jelito cienkie, L2 - jelito grube, L3 - ileocolon, L4 - górny odcinek przewodu pokarmowego) stanowiła lokalizacja krętniczo-kątnicza (L3) - 217 (67,8,%). Postać niepenetrująca bez zwężeń była przeważającą postacią choroby - 225 (70,32%) pacjentów. Objawy pozajelitowe zaobserwowano u 20 chorych (6,25%). Wnioski: Badanie dostarcza pełnych informacji dotyczących aspektów demograficznych i klinicznych choroby Leśniowskiego-Crohna w Polsce. Uzyskane dane są zgodne z doniesieniami z innych krajów. Wnioski z badania są następujące: zbierane informacje muszą być dobrze zdefiniowane i określone już na samym początku badania, weryfikowane oraz aktualizowane systematycznie w trakcie jego trwania, aby usprawnić pracę i uzyskać jak najbardziej wiarygodne wyniki.Introduction: Inflammatory bowel disease, particularly Crohn’s disease (CD), is a rising problem in pediatric gastroenterology. Limited information is available on demographic and clinical aspects of pediatric CD in Poland. Aim: Preliminary data on demographic and clinical characteristic of pediatric CD in Poland based on the web-based prospective registry in order to gather reliable information to identify appropriate treatment strategies. Material and methods: In September 2005 a web-based prospective registry of CD patients was initiated in Poland. Ten institutes (9 academic centers, 1 referred regional hospital) took part in the project with the object of obtaining the demographic and clinical data of pediatric CD patients across the country. With this end in view, a computerized questionnaire was used and the collected data were sent prospectively to a central registry for analysis. The following data were analyzed: demographics, family history, location and behavior of disease, extraintestinal manifestation, coexisting diseases, diagnostic work-up, and medical treatment including surgical intervention. Results: Through the period of 4 years, 320 patients (male : female - 191 : 129) aged below 16 years with CD diagnosed at the mean age of 9.2 ±6.8 years were incorporated in the registry. Early onset of disease (age at diagnosis below 5 years) was recorded in 68 children (21.25%). Positive family history was reported for 16 patients (5%). The predominant localization of lesions described using the Montreal classification (L1 for small intestine, L2 for colon, L3 for ileocolon, and L4 for the upper gastrointestinal tract) was ileocolon (L3) - 217 patients (67.8%). The predominant behavior of disease was non-stricturing and non-penetrating - 225 patients (70.32%). Extraintestinal manifestation was reported in 20 patients (6.25%). Coexisting diseases occurred in 35 patients (10.93%). The predominant initial therapy was mesalazine (227 patients - 70.1%). Seventeen patients (5.31%) required a surgical intervention. Conclusions: This study provides comprehensive information on demographic and clinical aspects of pediatric CD in Poland. Our results are consistent with the previously published reports from other countries in terms of age of onset and male predominance in pediatric CD patients. Our conclusions are as follows: information needs to be well defined, validated at entry, and updated at every visit, which facilitates our work and makes the data more reliable

Methods of analysis of gut microorganism – actual state of knowledge

[b]introduction[/b]. Microbiota plays an integral part in maintaining organism homeostasis, through eliminat pathogens, anti-cancer activity, synthesis of digestive enzymes and vitamins, maintaining the continuity of the intestinal epithelium and stimulation of the gastrointestinal immune system, and encourage a quicker and more efficient immune response. Changes in the microbiota composition is often observed in patients with allergy, atopy, irritable bowel syndrome and other diseases, which is the reason for a growing interest in methods of identification of the gut microbial complex. objective. The aim of the study was to compare the state of current knowledge about two methods used in the study of intestinal microorganisms complex: the traditional culture method and genetic analysis. [b]description of the state of knowledge[/b]. Both techniques have advantages and disadvantages. The biggest limitation of the culture method is its inability to detect a significant number of the intestinal microbes. Using the microbiological technique we can only detect identifiable bacteria that can be grown on available substrates. For an accurate quantitative and qualitative investigation of the total microbiota, the more expensive genetic method is required. Due to genetic analysis it is possible to identify the vast number of new microorganisms and identify the dominant bacterial groups in different parts of the gastrointestinal tract. [b]summary[/b]. Each of the presented techniques plays specific role in medicine and science. The combination of both methods may become a critical element for understanding the ecosystem of intestinal bacteria

Procedural sedation and analgesia for gastrointestinal endoscopy in infants and children: how, with what, and by whom?

Endoscopic procedures involving the gastrointestinal tract have been successfully developed in paediatric practice over the last two decades, improving both diagnosis and treatment in many children’s gastrointestinal diseases. In this group of patients, experience and co-operation between paediatricians/endoscopists and paediatric anaesthesiologists should help to guarantee the quality and safety of a procedure and should additionally help to minimise the risk of adverse events which are greater the smaller the child is. This principle is more and more important especially since the announcement of the Helsinki Declaration on Patient Safety in Anaesthesiology in 2010, emphasising the role of anaesthesiology in promoting safe perioperative care. The Helsinki Declaration has been endorsed by all European anaesthesiology institutions as well as the World Health Organisation’s ‘Safe Surgery Saves Lives’ initiative including the ‘Surgical Safety Checklist’. Although most of these procedures could be performed by paediatricians under procedural sedation and analgesia, children with congenital defects and serious coexisting diseases (ASA ≥ III) as well as the usage of anaesthetics (e.g. propofol) must be managed by paediatric anaesthesiologists. We have reviewed the specific principles employed during qualification and performance of procedural sedation and analgesia for gastrointestinal endoscopy in paediatrics. We have also tried to answer the questions as to how, with what, and by whom, procedural sedation for gastrointestinal endoscopy in children should be performed.Endoscopic procedures involving the gastrointestinal tract have been successfully developed in paediatric practice over the last two decades, improving both diagnosis and treatment in many children’s gastrointestinal diseases. In this group of patients, experience and co-operation between paediatricians/endoscopists and paediatric anaesthesiologists should help to guarantee the quality and safety of a procedure and should additionally help to minimise the risk of adverse events which are greater the smaller the child is. This principle is more and more important especially since the announcement of the Helsinki Declaration on Patient Safety in Anaesthesiology in 2010, emphasising the role of anaesthesiology in promoting safe perioperative care. The Helsinki Declaration has been endorsed by all European anaesthesiology institutions as well as the World Health Organisation’s ‘Safe Surgery Saves Lives’ initiative including the ‘Surgical Safety Checklist’. Although most of these procedures could be performed by paediatricians under procedural sedation and analgesia, children with congenital defects and serious coexisting diseases (ASA ≥ III) as well as the usage of anaesthetics (e.g. propofol) must be managed by paediatric anaesthesiologists. We have reviewed the specific principles employed during qualification and performance of procedural sedation and analgesia for gastrointestinal endoscopy in paediatrics. We have also tried to answer the questions as to how, with what, and by whom, procedural sedation for gastrointestinal endoscopy in children should be performed