Dietary intake of inulin-type fructans in active and inactive Crohn’s disease and healthy controls: a case-control study

Background and Aims: Prebiotic inulin-type fructans are widely consumed in the diet and may have contrasting effects in Crohn’s disease by stimulating gut microbiota and/or by generating functional gastrointestinal symptoms. The aim of this study was to measure fructan and oligofructose intakes in patients with active and inactive Crohn’s disease compared with healthy controls. Methods: Patients with active Crohn’s disease (n=98), inactive Crohn’s (n=99) and healthy controls (n=106) were recruited to a case-control study. Dietary intake of inulin-type fructans was measured using a specific food frequency questionnaire and was compared between the three groups and between patients with different disease phenotypes (Montreal classification). Associations between intakes and disease activity (Harvey Bradshaw Index, HBI) were also undertaken. Results: Patients with active Crohn’s disease had lower fructan intakes (median 2.9 g/d, IQR 1.8) than those with inactive Crohn’s (3.6 g/d, 2.1, P=0.036) or controls (3.9 g/d, 2.1, P=0.003) and lower oligofructose intakes (2.8 g/d, 1.8) than inactive Crohn’s (3.5 g/d, 2.2, P=0.048) or controls (3.8 g/d, 2.1, P=0.003). There were no differences in intakes related to disease site or behaviour. There were negative correlations between HBI wellbeing score and fructan intake (ρ=-0.154, P=0.03) and oligofructose intake (ρ=-0.156, P=0.028) and for the HBI abdominal pain score and fructan (ρ=-0.164, P=0.021) and oligofructose intake (ρ=-0.157, P=0.027). Conclusions: Patients with active Crohn’s disease consume lower quantities of fructans and oligofructose than their inactive counterparts and healthy controls. The impact of lower intakes of prebiotic fructans on gut microbiota are unknown and warrant further research

Investigation and determination of the geothermal parameters of the ground in Cyprus for the exploitation of geothermal energy and the impact of the results in the design of the geothermal systems

The Energy Service of the Ministry of Commerce, Industry and Tourism has the overall responsibility for Energy matters in Cyprus and specifically for preparing and implementing programmes for energy conservation, the promotion of renewable energy sources (RES) and the development of technologies for the utilization of RES. The Government of Cyprus being aware of the benefits of geothermal energy and in order to increase the share of energy from renewable sources consumed in heating and cooling in 2020, promotes the geothermal energy systems through a Scheme that provides financial incentives for the utilization of RES for heating and cooling. However, the lack of valid data for the ground thermal properties in Cyprus was one of the main obstacles for the design of efficient geothermal systems, the implementation of the Schemes in the field of geothermal energy and the calculation of the share of energy from renewable sources for heating and cooling according to the methodology defined by the E.U in the directive 2009/28/EC. In an effort to identify suitable energy efficient systems for heating and cooling of buildings and the correct calculations of their contribution to the national targets, the Energy Service participated in a project founded by the Research Promotion Foundation of Cyprus to investigate and determine the geothermal parameters of the ground of Cyprus at six representative sites in Cyprus, for use in the design of ground heat exchanger applications and ground thermal storage. The paper presents the importance of the Isothermal map that helps consultants to design efficiently geothermal energy systems, calculate effectively heat losses of buildings to the ground and design the thermal energy storage equipment. The importance’s of the results are analyzed by national authorities’ experts’ point of view for evaluating geothermal applications bridging in this way the gap between technical output and commercial reality

Diagnostic and clinical significance of Crohn’s disease-specific anti-MZGP2 pancreatic antibodies by a novel ELISA:New anti-MZGP2 ELISA in Crohn’s

The recent identification of the pancreas major zymogen granule membrane glycoprotein 2 (MZGP2) as the major autoantigen of pancreatic autoantibody (PAB) has led to the appreciation of anti-MZGP2 antibodies as specific markers of Crohn’s disease (CrD). We have recently developed new, robust, highly sensitive and specific IgA and IgG anti-MZGP2 antibody ELISAs and assessed their clinical relevance in the largest inflammatory bowel disease (IBD) cohort tested to date for anti-MZGP2 antibodies. In contrast to currently available anti-MZGP2 ELISAs, the new QUANTA Lite® MZGP2 ELISA (INOVA Diagnostics, San Diego, CA) utilizes the eukaryotically-expressed specific isoform 4 of human GP2 UniProtKB: P55259. A total of 832 sera were studied including 617 consecutive IBD patients (323 CrD and 294 UC) under regular follow-up in a tertiary centre, 112 patients with various diseases, and 103 healthy blood donors. The new ELISA’s calculated AUC was 0.5968, 95% CI (0.5552, 0.6383) for IgA anti-MZGP2 [CD vs non-CD (UC plus controls)] and 0.6236, 95% CI (0.5813, 0.6659) for IgG anti-MZGP2. The sensitivity of IgA anti-MZGP2 for CrD in the IBD population was 15% and the specificity was 98% (95, 99), while the sensitivity and specificity of IgG anti-MZGP2 was 27% and 97%. IgA and IgG anti-MZGP2 combined testing led to a sensitivity of 31% and specificity of 96%. Positivity for either ASCA (IgA or IgG) or anti-MZGP2 (IgA or IgG) showed a sensitivity of 75% (70, 80) and specificity of 84% (79, 89). Of clinical relevance, IgA anti- MZGP2 antibodies were more prevalent in patients with early disease onset (Montreal classification A1, p=0.011), while patients with localised colonic disease were less likely to be IgG anti-MZGP2 positive. Anti-MZGP2 positive patients more frequently had extensive disease with ileal involvement and stricture formation. Patients with longer disease duration were more likely to have IgG anti-MZGP2 or IgA ASCA antibodies. In conclusion, the new IgA and IgG anti-MZGP2 antibody ELISAs allow accurate autoantibody determination, and can be used as a tool to study the clinical significance and utility of these autoantibodies in patients with IBD

Development of a prototype method for the concurrent testing of 20 antigen-specific autoantibodies in patients with autoimmune liver diseases and extra-hepatic autoimmune diseases

Introduction: Autoantibody testing for diagnosis of autoimmune liver disease is demanding. More than a dozen (or more) antigen-specific autoantibodies need to be tested. A multiparametric assay for the simultaneous detection of these autoantibodies is currently missing.Aim: to develop a prototype profil ELISA for the simultaneous detection of 20 liver related autoantibodies.Methods: An in house multiparametric ELISA was developed and tested in a large cohort of patients with autoimmune liver diseases.Results: The ELISA is based on 12 antigenic preparations from mitochondrial (5), nuclear (3) and liver specific (4) antigens. The prototype ELISA is highly sensitive and specific and can be use for the accurate detection of liver autoantibody serology.Conclusion: This is the first multiparametric liver autoantibody ELISA profil. More antigens can be displayed on the platform in the near future.Εισαγωγή:Τα αυτοαντισώματα που χρησιμοποιούνται για τη διαγνωστική προσέγγιση ασθενών με πιθανά αυτοάνοσα νοσήματα του ήπατος είναι πολλά και μια απλή, λειτουργική, ευαίσθητη και ειδική μέθοδος που να τα προσμετρά ταυτόχρονα δεν έχει αναπτυχθεί μέχρι σήμερα.Σκοπός: Σκοπός της διατριβής ήταν να αναπτύξει μια πρωτότυπη μέθοδο για την ταυτόχρονη ανίχνευση των διαγνωστικά σημαντικών αυτοαντισωμάτων χρόνιων ηπατοπαθειών.Μέθοδοι: Χρησιμοποιήθηκαν οροί από ασθενείς με Πρωτοπαθή Χολική Κίρρωση (ΠΧΚ), Αυτοάνοση ηπατίτιδα (ΑΗ) και Πρωτοπαθή Σκληρυντική Χολαγγειίτιδα (ΠΣΧ) για την ανάπτυξη πολυμετρικής profil ELISA. Χρησιμοποιήθηκαν 11 ανασυνδυασμένα και 1 καθαρμένο αυτοαντιγόνο.Αποτελέσματα: Στην πρώτη φάση αναπτύχθηκε μια πολυμετρική ELISA που επιτυχώς προσδιορίζει όλα τα αυτοαντισώματα έναντι των μιτοχονδριακών αντιγόνων (5). Ενώ στη δεύτερη φάση η ELISA εμπλουτίστηκε με 3 πυρηνικά αυτοαντιγόνα με διαγνωστική αξία για την ΠΧΚ. Στη τρίτη φάση η πολυμετρική ELISA εμπλουτίστηκε με 3 κύρια αυτοαντιγόνα για την ΑΗ (σύνολο 11). Στο τελικό στάδιο το ΤΤΒ5 ειδικό αντιγόνο για την ΠΣΧ προστέθηκε επιτυχώς στο panel των αντισωμάτων.Συμπέρασμα: H πρωτότυπη ELISA είναι πιο ευαίσθητη και εξίσου ειδική με τις in house ELISA που έχουν περιγραφεί και υπερτερεί των εμπορικά διαθέσιμων. Είναι η πρώτη που μπορεί να ανιχνεύσει 12 αυτοαντισώματα ταυτόχρονα

Microscopic Colitis

The book Recent Advances in Gastroenterology 12 covers key topics in gastroenterology and hepatology. It includes conditions such as ulcerative colitis and Crohn’s disease, which have seen significant developments. Topics which were not reviewed earlier like IgG4 syndrome and small intestinal imaging have been covered. Common diseases like microscopic colitis and coeliac disease are better understood in this book. Other disorders such as Helicobacter infection, alcoholic liver disease and viral hepatitis have gathered world attention. The book also discusses on exciting advances in the management of upper gastrointestinal bleeding, luminal imaging and endoscopy

E. coli Induced Experimental Model of Primary Biliary Cirrhosis: At Last

Recurrent urinary tract infections (UTI) have been considered potential triggers of primary biliary cirrhosis (PBC), an autoimmune cholestatic liver disease characterised by progressive destruction of intrahepatic bile ducts. Additional support for the link made between PBC and UTI was based on early observations of recurrent episodes of bacteriuria in female patients with PBC. A series of large epidemiological studies demonstrated a strong correlation between recurrent UTI and PBC, initiating a series of studies investigating the role of Escherichia coli (E. coli, the most prevalent organism isolated in women with UTI) as a trigger of PBC. Immunological evidence of B- and T-cell cross-reactive responses implicating PBC-specific autoantigens and E. coli mimics have been clearly demonstrated, adding support to the notion that E. coli is a potential infectious inducer of PBC in susceptible individuals. One of the major limitations in proving the E. coli/PBC association was the lack of reliable E. coli-infected animal models of PBC. This review provides an overview of the evidence linking this infectious agent with PBC and discusses the pros and cons of a recently developed E. coli-infected animal model of PBC

Percutaneous Endoscopic Gastro-Jejunostomy (PEGJ): Could Drug Administation be the Only Indication for Insertion? The Levodopa/Carbidopa Infusion Treatment Experience. A Retrospective Evaluation of the Method

Enteral feeding is the preferred means of nutritional support in patients unable to eat normally. Percutaneous endoscopic gastro-jejunostomy (PEGJ) is widely used in such cases. It is also accepted that medication will be administered through the tube. In patients with severe Parkinson’s disease, a continuous delivery system of levodopa/carbidopa, formulated as a gel suspension (Duodopa®), reaches the small intestine through a jejunostomy and represents an alternative treatment method. The continuous release results in less variability in levodopa serum concentrations and fewer motor fluctuations and dyskinesias compared to oral administration. The method requires a very good collaboration between neurologists and gastroenterologists and is used in specializing centers in patients as mentioned with severe disease. A modified percutaneous endoscopic gastrostomy (PEG) kit is placed under sedation. This allows the passage of a pig tail catheter which is advanced to the jejunum and a portable pump is attached on it through a specially designed tubing system. This is the only case, known to us, where PEGJ is inserted for drug administration. We present our experience of nine cases (7 males, 2 females, mean age 72.4 years) with a follow up of up to five years. In three patients the tubing system had to be changed; the first it was accidentally pulled out, the second because of bezoar formation around the intragastric part of the tube and the third because of knot formation at the intragastric part of the jejunal tube. At the end of this five year period, all patients agreed that the neurological benefit was welcome and they had all come in terms with the undoubted difficulties the procedure causes