IBD prevalence in Baltic states or just a guessing game?

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Role of body bioelectrical impedance analysis in the assessment of the nutritional status of patients with inflammatory bowel disease and metabolic syndrome

Nutrition has an important role in the management of inflammatory bowel disease (IBD) and metabolic syndrome (MS). The goal of this study was to assess the nutritive status of patients treated with IBD and metabolic syndrome in the Gastroenterology Centre, Pauls Stradinš Clinical University Hospital. Body bioelectrical impedance analysis (BIA) using GENIUS 220 PLUS (Jawon Medical) was used to determine Body Mass Index (BMI) kg/m2, Metabolic Body Fat (MBF) kg, Soft Lean Mass (SLM) kg, Total Body Water (TBW) kg, body composition, metabolic type, Basal Metabolic Rate (BMR) kcal, and total Energy Expenditure (TEE) kcal in patients with BD and metabolic syndrome and in a similarly aged control group. The obtained data showed that BMI was not correlated with MBF, BTW and Lean Body Mass (LBM). Patients with Crohn's disease (CD) had normal value of BMI (M 24.3 kg/m2; F 20.2kg/m2), but we found variety-specific differences in body composition that confirmed deficiency or increase of specific bodyparameters. The performed prospective study confirmed the importance of the more precise nutritional status analysis, as it was clinically useful for the nutritional management of IBD. Patients with CD had expressed nutrient deficiency, sarcopenia, and reduced amount of proteins and minerals. For patients with MS, sarcopenia was present despite obesity.Peer reviewe

On the X Anniversary Latvian Gastroenterology Congress with International Participation

Publisher Copyright: © 2022 Aleksejs Derovs et al., published by Sciendo.The X Anniversary Latvian Gastroenterology Congress with International Participation has been held for the first time for a two-day period (3-4 December, 2021). The first day was devoted to international and local satellite symposia, with a total number of ten, which corresponded to the number of Congresses held. The second day of the Congress was devoted to the plenary session. Due to the severe COVID-19 epidemiology situation in Latvia, for the first time in its history since 2003, it was decided to hold the Congress not in person but remotely from the Rīga Stradiņš University Great Hall stage, with live video broadcasting. Despite the fact that the Congress was virtual, the two days attracted a significant number of participants - 753 registered colleagues. The invited guests included foreign lecturers from the United States, Israel, Germany, Croatia, UK, Italy, and other countries and the discussion panel was led by field leaders from around the world. We continued our tradition of preparing published reports of the congress in a special issue of Proceedings of the Latvian Academy of Sciences, Section B, in collaboration with the Latvian Academy of Sciences.publishersversionPeer reviewe

Burden of extraintestinal manifestations and comorbidities in treated and untreated ulcerative colitis and Crohn’s disease : a Latvian nationwide prescription database study 2014–2019

Publisher Copyright: © 2022 Irana Teterina et al., published by Sciendo.Inflammatory bowel diseases (IBD) are frequently accompanied by extraintestinal manifestations (EIMs) due to systemic autoimmune processes, which are important in the management of IBD patients and their long-term outcomes. The aim of the study was to determine the occurrence of EIMs comorbidities and their burden in IBD patients, based on the Latvian nationwide reimbursed prescription database from 2012 till 2019. Incident Crohn's disease (CD) and ulcerative colitis (UC) patients between 2014 and 2018 were matched on age and sex with non-treated IBD controls and followed up until 2019. EIMs were selected based on a previously used methodology and grouped into organ systems. The cohort was tested for differences in the timing and occurrence of EIMs, as well as overall cumulating disease burden. The study population included 187 CD and 1137 UC patients. Higher prevalence of EIMs was observed in untreated IBD patients, whereas in the treated IBD patient group prevalence remained numerically similar. Among treated patients, the most common EIMs affected cardiovascular, hepatopancreatobiliary, endocrine, musculoskeletal, respiratory, and the skin and intestinal tract systems, where 28.4-79.9% of IBD patients experienced these EIMs for the first time before their IBD diagnosis. The treated female IBD patients tended to have higher frequency of EIMs compared to male patients. The overall comorbidity burden trend increased with time. The study provides evidence that treated IBD patients have lower risk for EIMs/comorbidities compared to untreated IBD patients.publishersversionPeer reviewe

The Influence of Bowel Preparation on ADC Measurements: Comparison between Conventional DWI and DWIBS Sequences

Background and objectives: The aim of the study was to assess whether there were di ff erences between apparent di ff usion coe ffi cient (ADC) values of di ff usion-weighted imaging (DWI) and di ff usion-weighted imaging with background body signal suppression (DWIBS) sequences in non-prepared and prepared bowels before and after preparation with an enteric hyperosmolar agent, to assess whether ADC measurements have the potential to avoid bowel preparation and whether ADC-DWIBS has advantages over ADC-DWI. Materials and Methods: 106 adult patients without evidence of inflammatory bowel disease (IBD) underwent magnetic resonance (MR) enterography before and after bowel preparation. ADC-DWI and ADC-DWIBS values were measured in the intestinal and colonic walls demonstrating high signal intensity (SI) at DWI tracking images of b = 800 s /mm2 before and after preparation. Results: There were significant di ff erence (p < 0.0001) in both ADC-DWI and ADC-DWIBS results between non-prepared and prepared jejunum for DWI being 1.09 x 10 3 mm2 /s and 1.76 x 10 3 mm2 /s, respectively, and for DWIBS being 0.91 x 10 3 mm2 /s and 1.75 x 10 3 mm2 /s, respectively. Both ADC-DWI and DWIBS also showed significant di ff erence between non-prepared and prepared colon (p < 0.0001), with DWI values 1.41 x 10 3 mm2 /s and 2.13 x 10 3 mm2 /s, and DWIBS-1.01 x 10 3mm2 /s and 2.04 x 10 3mm2 /s, respectively. Nosignificant di ff erence between ADC-DWI and ADC-DWIBS was found in prepared jejunum (p = 0.84) and prepared colon (p = 0.58), whereas a significant di ff erence was found in non-prepared jejunum and non-prepared colon (p = 0.0001 in both samples). Conclusions: ADC between DWI and DWIBS does not di ff er in prepared bowel walls but demonstrates a di ff erence in non-prepared bowel. ADC in non-prepared bowel is lower than in prepared bowel and possible overlap with the ADC range of IBD is possible in non-prepared bowel. ADC-DWIBS has no advantage over ADC-DWI in regard to IBD assessment.publishersversionPeer reviewe

Comparison between diffusion-weighted sequences with selective and non-selective fat suppression in the evaluation of Crohn's disease activity : are they equally useful?

Publisher Copyright: © 2020 by the authors. Licensee MDPI, Basel, Switzerland. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: We compared the efficiency of two MRI diffusion weighted imaging (DWI) techniques: DWI with SPIR (DWI SPIR) and DWI with STIR (DWI STIR), to estimate their eligibility for quantitative assessment of Crohn's disease activity in children and adults. Methods: In inflamed terminal ileum segments ( n = 32 in adults, n = 46 in children), Magnetic Resonance Index of Activity (MaRIA) was calculated, ADC values of both DWI techniques were measured, and the corresponding Clermont scores calculated. ADC values of both DWI techniques were compared between both and within each patient group, assessing their mutual correlation. Correlations between MaRIA and the corresponding ADC values, and Clermont scores based on both DWI techniques were estimated. Results: No correlation between ADC of DWI SPIR and DWI STIR was observed (rho = 0.27, p = 0.13 in adults, rho = 0.20, p = 0.17 in children). The correlation between MaRIA and Clermont scores was strong in both techniques-in SPIR, rho = 0.93; p < 0.0005 in adults, rho = 0.98, p < 0.0005 in children, and, in STIR, rho = 0.89; p < 0.0005 in adults, rho = 0.95, p < 0.0005 in children. The correlation between ADC and MaRIA was moderate negative for DWI STIR (rho = 0.93, p < 0.0005 in adults, rho = 0.95, p < 0.0005 in children), but, in DWI STIR, no correlation between ADC and MaRIA score was observed in adults (rho = -0.001, p = 0.99), whereas children presented low negative correlation (rho = -0.374, p = 0.01). Conclusions: DWI STIR is not suitable for quantitative assessment of Crohn's disease activity both in children and adult patients.publishersversionPeer reviewe

Repeatability of magnetic resonance measurements used for estimating Crohn's disease activity

Publisher Copyright: © 2020 Sciendo. All rights reserved. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.The MR activity indices used for quantification and follow-up of Crohn's disease are composed of a number of subjectively determinable components with equivocal repeatability. The purpose of this article was to assess the repeatability of measurements used for quantitative estimation of Crohn's disease activity in the terminal ileum. In five adults (23-57 y.o.) and 12 children (10-17 y.o.) with active terminal ileitis, the inflamed bowel was divided into 3 cm segments (n = 32 in adults, n = 46 in children), and measurements for the calculation of MaRIA and Clermont scores were performed. Parameters included apparent diffusion coefficients (ADC) for diffusion-weighted imaging (DWI) sequences with selective and non-selective fat suppression, wall signal enhancement before (WSI-preGd) and after (WSI-preGd) gadolinium enhancement, bowel thickness, and presence of ulcers. The measurements were standardised (accurate site-to-site comparison, exact ROI size, where applicable) and repeated by the same researcher after two months. Intra-observer agreement for ADC, WSI-preGd and WSI-postGd, bowel thickness was assessed with a paired t-test, and the significant difference in presence/absence of ulcers was assessed by the Pearson 2 test. Absolute difference was not found between the 1st and 2nd measurements of ADC, WSI-preGd, WSI-postGd and wall thickness. There was systematic difference in the presence of bowel ulcers. In standardised conditions the repeatability of ADC, WSI-preGd and WSI-postGd is high. Efforts must be made to precisely define the size and appearance of ulcers that may be included in the index calculation.publishersversionPeer reviewe

How to increase the butyrate-producing capacity of the gut microbiome : Do IBD patients really need butyrate replacement and butyrogenic therapy?

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Assessment of risk factors in the development of pancreatic cancer in Latvia

Abstract Th e aim of the study was to assess the possibility of identifying individuals at risk of pancreatic cancer (PC) on the basis of information from questionnaires fi lled in by patients and analyses of the DNA from peripheral blood of PC patients for mutations in BRCA1, CDKN2A, INK4/ARF and INK4/ARF and INK4/ARF STK11 genes. Questionnaires showed unknown risk factors in ethiology and pathogenesis of PC besides smoking and other known risk factors. Two carriers of frameshift mutations in the BRCA1 gene of 68 PC patients tested were detected. Screening for two founder mutations in the BRCA1 gene should be carried out in PC patients to identify at least a part of cancer-prone families in order to off er to mutation carriers comprehensive care, surveillance and preventive procedures. No deleterious mutations were detected in CDKN2A, INK4/ARF and INK4/ARF and INK4/ARF STK11 genes. We conclude that mutations in these genes do not contribute signifi cantly to PC incidence in the population of Latvia. Th e role of missense mutations detected can not be estimated unambigously on the basis of our data

Once versus three times daily dosing of oral budesonide for active Crohn's disease : A double-blind, double-dummy, randomised trial

Note: J.Pokrotnieks is in the list of the main authors of the article, as well as in the list of International Budenofalk Study Group collaboration list. His surname is made visible as the main author in this bibliographic record. Funding Information: The study was funded by Dr Falk Pharma GmbH, Freiburg, Germany . The study sponsor contributed to the design of the study in collaboration with the authors, funded the analysis of the data by an independent biostatistics company, worked in conjunction with the authors to interpret the data, and reviewed the draft manuscript. The sponsor was not involved in data collection. The final decision to publish was made by the first author (AD).Background: Oral budesonide 9. mg/day represents first-line treatment of mild-to-moderately active ileocolonic Crohn's disease. However, there is no precise recommendation for budesonide dosing due to lack of comparative data. A once-daily (OD) 9. mg dose may improve adherence and thereby efficacy. Methods: An eight-week, double-blind, double-dummy randomised trial compared budesonide 9. mg OD versus 3. mg three-times daily (TID) in patients with mild-to-moderately active ileocolonic Crohn's disease. Primary endpoint was clinical remission defined as CDAI < 150 at week 8 (last observation carried forward). Results: The final intent-to-treat population comprised 471 patients (238 [9 mg OD], 233 [3 mg TID]). The confirmatory population for the primary endpoint analysis was the interim per protocol population (n = 377; 188 [9 mg OD], 189 [3 mg TID]), in which the primary endpoint was statistically non-inferior with budesonide 9. mg OD versus 3. mg TID. Clinical remission was achieved in 71.3% versus 75.1%, a difference of - 3.9% (95% CI [- 14.6%; 6.4%]; p = 0.020 for non-inferiority). The mean (SD) time to remission was 21.9 (13.8) days versus 21.4 (14.6) days with budesonide 9 mg OD versus 3. mg TID, respectively. In a subpopulation of 122 patients with baseline SES-CD ulcer score ≥ 1, complete mucosal healing occurred in 32.8% (21/64) on 9 mg OD and 41.4% (24/58) on 3 mg TID; deep remission (mucosal healing and clinical remission) was observed in 26.6% (17/64) and 32.8% (19/58) of patients, respectively. Treatment-emergent suspected adverse drug reactions were reported in 4.6% of 9 mg OD and 4.7% of 3 mg TID patients. Conclusions: Budesonide at the recommended dose of 9 mg/day can be administered OD without impaired efficacy and safety compared to 3 mg TID dosing in mild-to-moderately active Crohn's disease.publishersversionPeer reviewe