Smoking in inflammatory bowel diseases: Good, bad or ugly?

Smoking is an important environmental factor in inflammatory bowel disease (IBD), having different effects in ulcerative colitis (UC) and Crohn’s disease (CD). A recent meta-analysis partially confirmed previous findings that smoking was found to be protective against ulcerative colitis and, after onset of the disease, might improve its course, decreasing the need for colectomy. However, smoking increases the risk of developing Crohn’s disease and worsens its course, increasing the need for steroids, immunosuppressants and re-operations. Smoking cessation aggravates ulcerative colitis and improves Crohn’s disease. Data are however, largely conflictive as well as the potential mechanisms involved in this dual relationship are still unknown. In this review article, the authors review the role of smoking in inflammatory bowel diseases

Use of new, once-daily 5-aminosalicylic acid preparations in the treatment of ulcerative colitis. Is there anything new under the sun?

5-aminosalicylate (5-ASA) agents remain the mainstay treatment in ulcerative colitis (UC). A number of oral 5-ASA agents are commercially available, including azobond pro-drugs, as well as delayed- and controlled-release forms of mesalazine. However, poor adherence due to frequent daily dosing and a large number of tablets has been shown to be an important barrier to successful management of patients with UC. Recently, new, once-daily formulations of mesalazine, including the unique multi-matrix delivery system and mesalazine granules, were proven to be efficacious in inducing and maintaining remission in mild-to-moderate UC, with a good safety profile comparable to that of other oral mesalazine formulations. In addition, they offer the advantage of a low pill burden and might contribute to increased long-term compliance and treatment success in clinical practice. This editorial summarizes the available literature or, the short- and medium-term efficacy and safety of the new once-daily mesalazine formulations

Recent trends in the epidemiology of inflammatory bowel diseases: up or down?

Inflammatory bowel disease (IBD) is traditionally considered to be common in the Western world, and its incidence has sharply increased since the early 1950s. In contrast, until the last decade, low prevalence and incidence rates have been reported from other parts of the world including Eastern Europe, South America, Asia and the Pacific region. Recent trends indicate a change in the epidemiology of IBD with previously low incidence areas now reporting a progressive rise in the incidence, while in West European and North American countries the figures have stabilized or slightly increased, with decreasing incidence rates for ulcerative colitis. Some of these changes may represent differences in diagnostic practices and increasing awareness of the disease. The quality of studies is also variable. Additional epidemiologic studies are needed to better define the burden of illness, explore the mechanism of association with environmental factors, and identify new risk factors

Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones. Results of a retrospective; single center study between 1996-2002

AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients undergoing preoperative ERCP (= 8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient's history. Suspected prognostic factors and the combination of factors were compared to the result of ERCP. RESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%, for three 72.5%, for four or more 91.4%. CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients). Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g. skill of the endoscopist, other diagnostic tools)

Current concept on the pathogenesis of inflammatory bowel disease-crosstalk between genetic and microbial factors: Pathogenic bacteria and altered bacterial sensing or changes in mucosal integrity take "toll"?

The pathogenesis of inflammatory bowel disease (IBD) is only partially understood. Various environmental and host (e.g. genetic-, epithelial-, immune and non-immune) factors are involved. It is a multifactorial polygenic disease with probable genetic heterogeneity. Some genes are associated with IBD itself, while others increase the risk of ulcerative colitis (UC) or Crohn's disease (CD) or are associated with disease location and/or behaviour. This review addresses recent advances in the genetics of IBD. The article discusses the current information on the crosstalk between microbial and genetic factors (e.g. NOD2/CARD15, SLC22A46A5 and DLG5). The genetic data acquired in recent years help in understanding the pathogenesis of IBD and can identify a number of potential targets for therapeutic intervention. In the future, genetics may help more accurately diagnose and predict disease course in IBD

Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype: Results of a 25-year follow-up study

AIM: IBD is a systemic disease associated with a large number of extraintestinal manifestations (EIMs). Our aim was to determine the prevalence of EIMs in a large IBD cohort in Veszprem Province in a 25-year follow-up study. METHODS: Eight hundred and seventy-three IBD patients were enrolled (ulcerative colitis/UC/: 619, m/f: 317/302, mean age at presentation: 38.3 years, average disease duration: 11.2 years; Crohn's disease/CD/: 254, m/f: 125/129, mean age at presentation: 32.5 years, average disease duration: 9.2 years). Intestinal, extraintestinal signs and laboratory tests were monitored regularly. Any alteration suggesting an EIMs was investigated by a specialist. RESULTS: A total of 21.3 % of patients with IBD had EIM (UC: 15.0 %, CD: 36.6 %). Age at presentation did not affect the likelihood of EIM. Prevalence of EIMs was higher in women and in CD, ocular complications and primary sclerosing cholangitis (PSC) were more frequent in UC. In UC there was an increased tendency of EIM in patients with a more extensive disease. Joint complications were more frequent in CD (22.4 % vs UC 10.2 %, P<0.01). In UC positive family history increased the risk of joint complications (OR:3.63). In CD the frequency of type-1 peripheral arthritis was increased in patients with penetrating disease (P=0.028). PSC was present in 1.6 % in UC and 0.8 % in CD. Dermatological complications were present in 3.8 % in UC and 10.2 % in CD, the rate of ocular complications was around 3 % in both diseases. Rare complications were glomerulonephritis, autoimmune hemolytic anaemia and celiac disease. CONCLUSION: Prevalence of EIM in Hungarian IBD patients is in concordance with data from Western countries. The high number of EIM supports a role for complex follow-up in these patients

Striking elevation in the incidence and prevalence of inflammatory bowel disease in a province of Western Hungary between 1977-2001

AIM: An investigation into inflammatory bowel disease and colorectal cancer in Veszprem Province was conducted from 1977 to 2001. METHODS: Both hospital and outpatient records were collected and reviewed comprehensively. The majority of patients were followed up regularly. RESULTS: The population of the province was decreased from 386,000 to 376,000 during the period. Five hundred sixty new cases of ulcerative colitis (UC), 212 of Crohn's disease (CD), and 40 of indeterminate colitis (IC) were diagnosed. The incidence rates increased from 1.66 to 11.01 cases per 100,000 persons for UC, from 0.41 to 4.68 for CD and from 0.26 to 0.74 for IC. The prevalence rate at the end of 2001 was 142.6 for UC and 52.9 cases per 100,000 persons for CD. The peak onset age in UC patients was between 30 and 40 years, in CD between 20 and 30 years. A family history of IBD was present in 3.4 % in UC and 9.9 % in CD patients. Smoking increased the risk for CD (OR=1.98) while it decreased the risk for UC (OR=0.25). Twelve colorectal carcinomas were observed in this cohort, the cumulative colorectal cancer risk after 10 years in UC was 2%, after 20 years 8.8%, after 30 years 13.3%. CONCLUSION: The incidence and prevalence rates of IBD have increased steadily in Veszprem Province, now equivalent to that in Western European countries. Rapid increase in incidence rates supports a probable role for environmental factors. The rate of colorectal cancers in IBD is similar to that observed in Western countries

Gene polymorphisms in primary biliary cirrhosis: association with the disease and hepatic osteopathy

Genetic factors have been implicated in the pathogenesis of osteoporosis, a common disorder in primary biliary cirrhosis (PBC). Estrogen receptor-alpha gene (ER-�), vitamin-D-receptor gene (VDR) and IL-1-receptor-antagonist gene (IL-1RN) are all attractive candidates for osteoporosis susceptibility. Furthermore insulin-like growth factor-I (IGF-I) gene microsatellite repeat polymorphism was found to be associated with osteoporosis in some studies and collagen-I�1 (COLIA1) Sp1 s allele was associated with lower bone mineral density (BMD) in one study in PBC. IGF-I treatment restored osteopenia and reduced fibrogenesis in experimental cirrhosis. In this study we summarize our results on polymorphisms of the above genes and bone disease in Hungarian PBC patients. Patients and methods: 70 female patients with PBC were enrolled (age:57.6yrs, range:37-76yrs, each AMA-M2 positive, stage II-IV). 139 age-matched female subjects served as controls (age: 55.9 yrs, range:43-72 yrs). COLIA1 Sp1 and IGF-I microsatellite polymorphisms were determined by PCR in all patients and controls. VDR BsmI, IL-1RN variable-number tandem repeat (VNTR) and ER-� PvuII and XbaI polymorphisms were detected in 33 patients and controls. BMD was measured by dual energy x-ray absorptiometry (Lunar,Prodigy,USA) in lumbar spine (LS) and femoral neck (FN). Results: There was no difference in IGF-I microsatellite repeat polymorphism (192/192=34.2%, 194/192=28.6%, other=37.2%) and COLIA1 Sp1 polymorphism (SS=72.9%, Ss=22.8% and ss=4.3%) and IL-1 VNTR polymorphism between PBC patients and controls, however, the COLIA1 Sp1 s allele was significantly less frequent in patients with PBC (p=0.038). The genotype frequency of VDR BsmI (BB=57.5%, Bb=33.3%, bb=9.1%, p=0.01) and ER-a PvuII (PP=18.2%, Pp=75.6%, pp=6.2%, p=0.03) and XbaI (XX=9.1%, Xx=90.9%, xx=0%, p=0.0003) of the patients was different from that of the control group, with higher frequency of the BB, Pp and Xx genotypes in PBC. Osteoporosis (t score<-2.5) was detected in 22 patients (31.4%). Osteoporotic patients were elder and had longer disease history (p=0.01 for both). An association was found between the IGF-I genotypes and ODM data, the 192/192 genotype was associated with higher FN Z-score compared to other genotypes (p=0.036). Conclusions: In contrast to previous studies the COLIA1 Sp1 s allele was less frequent in patients with PBC, and its presence was not associated with BMD. We confirmed previous findings on higher frequency of VDR BsmI BB genotype in patients with PBC. The ER-α PvuII and XbaI Pp and Xx genotypes were more frequent in PBC patients, while IL-1RN VNTR and IGF-I microsatellite repeat polymorphism was not different. Since IGF-I polymorphism was associated to BMD, it may be hypothesized that not COLIA1 but IGF-I together with other genetic and environmental factors may be involved in the complex regulation of BMD in PBC