Arterijska krutost kao pokazatelj vaskularnoga starenja u bolesnika s upalnim bolestima crijeva [Arterial stiffness as a marker of vascular aging in IBD patients]

Chronic inflammatory bowel diseases (IBD) are associated with premature atherosclerosis caused by endothelial dysfunction and increased arterial intima-media. In conditions characterized by chronic systemic inflammation, like IBD, chronic inflammatory process through dyslipidemia and accelerated atherosclerosis leads to increase in arterial stiffness of the large arteries. The crucial role of arterial stiffness in the development of cardiovascular disease is well known and arterial stiffness measurement is increasingly being used for cardiovascular risk assessment and it is an indicator of vascular aging. Non-invasive measurement of pulse wave velocity (PWV) and augmentation index (Aix) has predictive value for future fatal cardiovascular events and overall cardiovascular risk. In our research, nearly half of the examinees had increased PWV (45%) and subclinical target organ damage. There were no differences in arterial stiffness markers in Crohn's disease (CD) and ulcerative colitis (UC) patients. Also, patients divided according to disease phenotype, localization and applied therapy showed no differences in PWV and Aix markers. Increased PWV (>8m/s) is the most prevalent marker of subclinical target organ damage in our IBD patient cohort. We also showed that PWV increases with age and becomes higher than PWV in the control group of examinees with well-controlled arterial hypertension. Accelerated vascular aging is the result of prolonged duration of IBD as the most plausible cause of increased PWV. Patients also had increased Aix as a marker of increased arterial stiffness of medium and small arteries. Age and duration of IBD were strong and independent predictors of increased PWV in all groups of IBD patients. These results show that IBD with chronic, systemic inflammation plays a role in the development of accelerated atherosclerosis, increased arterial stiffness and subclinical target organ damage similar to arterial hypertension, an established risk factor for arterial stiffness. Also, we can conclude that increased arterial stiffness and accelerated vascular aging are more pronounced in those patients with a more prolonged duration of IBD. Our results of increased PWV and Aix in IBD patients with longer disease duration are contributing to the fact that chronic inflammation is responsible for alterations of both large and smaller arteries and leads to target organ damage in these patients, regardless of current disease activity. Premature atherosclerosis and dyslipidemia should be closely monitored and treated, especially in IBD patients with longer disease duration

Physical Characteristics in the New Model of the Cerebrospinal Fluid System

It is unknown which factors determine the changes in cerebrospinal fluid (CSF) pressure inside the craniospinal system during the changes of the body position. To test this, we have developed a new model of the CSF system, which by its biophysical characteristics and dimensions imitates the CSF system in cats. The results obtained on a model were compared to those in animals observed during changes of body position. A new model was constructed from two parts with different physical characteristics. The »cranial« part is developed from a plastic tube with unchangeable volume, while the »spinal« part is made of a rubber baloon, with modulus of elasticity similar to that of animal spinal dura. In upright position, in the »cranial« part of the model the negative pressure appears without any measurable changes in the fluid volume, while in »spinal« part the fluid pressure is positive. All of the observed changes are in accordance to the law of the fluid mechanics. Alterations of the CSF pressure in cats during the changes of the body position are not significantly different compared to those observed on our new model. This suggests that the CSF pressure changes are related to the fluid mechanics, and do not depend on CSF secretion and circulation. It seems that in all body positions the cranial volume of blood and CSF remains constant, which enables a good blood brain perfusion

Increased arterial stiffness – similar findings in patients with inflammatory bowel disease without prior hypertension or diabetes and in patients with well-controlled hypertension

PURPOSE: Chronic inflammatory diseases are related with earlier onset of atherosclerosis. We hypothesized that inflammatory bowel disease patients with chronic, systemic inflammation have an increased arterial stiffness associated with the disease duration. Also, we wanted to compare arterial stiffness markers between inflammatory bowel disease and well-controlled hypertension patients. ----- MATERIALS AND METHODS: A total of 89 inflammatory bowel disease patients (60 patients with Crohn's disease and 29 patients with ulcerative colitis, age range 20-64 years) without history of arterial hypertension or diabetes were enrolled and age matched with a control group of patients (73 patients, age range 25-69 years, 41 (56.1%) males) with known history of well-controlled arterial hypertension. We have used a noninvasive device that simultaneously measures brachial blood pressure and estimates PWV and AIx in inflammatory bowel disease and hypertension groups of patients. ----- RESULTS: Patients with pathological PWV values were significantly older, had significantly longer duration of inflammatory bowel disease, higher values of serum cholesterol and HDL-cholesterol, and higher AIx (17.4% vs. 9.8%) (all p < .05). Higher PWV was associated with age and duration of inflammatory bowel disease in the linear regression model. PWV values were higher in hypertensive patients in the first two age quartiles while interestingly, in the last two quartiles, PWV was lower than in inflammatory bowel disease group of patients. ----- CONCLUSIONS: Chronic subclinical inflammation is responsible for dyslipidemia and accelerated atherosclerosis which consequently alterates arterial elasticity. Inflammatory bowel disease and its duration should also be considered a risk factor for subclinical organ damage, as well as hypertension

Kliničke karakteristike bolesnika s dvostrukim pilorusom [Clinical characteristics of patients with a double pylori]

Double pylorus (DP), is a form of gastroduodenal fistula, which consists of a short accessory canal from the gastic antrum to the duodenal bulb, and mostly occrus in the background of peptic ulcer disease. Prevalence, as well long-term follow-up of patients with DP is less elucidated in western countries. Aim of our study was to analyse demografic, clinical and endoscopic characteristics in our case-series. During 2008-2013. a total of 23836 upper endoscopies were performed in 16759 patients. DP was diagnosed in 6 patients (prevalence of 0.04%). The follow-up period was f 8 to 72 months. In 87% DP was a complication of the upper gastrointestinal bleeding. In 83% cases opening of the fistula was on lesser curvature of gastric antrumu. During follow-up period the fistula healing did not occur in any of our patients. DP is a very rare entity, with a benign course of the disease Associated comorbidity and use of ulceriform medications plays important role in persistence of DP, wheras possible eradication of Helicobacter infection in this background remains elusive

CLINICAL CHARACTERISTICS OF PATIENTS WITH A DOUBLE PYLORI

Dvostruki pilorus (DP) oblik je gastroduodenalne fistule koji se sastoji od kanala koji spaja antrum želudca s dvanaesnikom i najčešće nastaje u sklopu peptičke ulkusne bolesti. Prevalencija ovog entiteta, kao i longitudinalno praćenje ovih bolesnika u zemljama zapadne hemisfere nepoznati su. Proveli smo retrospektivno ispitivanje s ciljem analize demografskih, kliničkih i endoskopskih karakteristika bolesnika s DP-om. U periodu od 2008. do 2013. godine učinjeno je 23.836 ezofagogastroduodenoskopija kod 16.759 bolesnika. Otkriveno je 6 bolesnika s DP-om (prevalencija 0,04%), koji su praćeni od 8 do 72 mjeseca. Kod 87% bolesnika radilo se o komplikaciji krvarenja iz gornjeg dijela probavne cijevi. U 83% slučajeva orificij fistule bio je smješten na maloj krivini antruma želudca. Tijekom vremena praćenja nismo registrirali cijeljenje fistula. Zaključujemo da je DP vrlo rijedak entitet, s benignim tijekom bolesti. Prisutnost komorbiditeta i ulcerogeni lijekovi imaju važnu ulogu u nastanku DP-a, dok vrijednost eradikacije Helicobatera pylori u ovom kontekstu ostaje nejasnaDouble pylorus (DP), is a form of gastroduodenal fistula, which consists of a short accessory canal from the gastic antrum to the duodenal bulb, and mostly occrus in the background of peptic ulcer disease. Prevalence, as well long-term follow-up of patients with DP is less elucidated in western countries. Aim of our study was to analyse demografic, clinical and endoscopic characteristics in our case-series. During 2008–2013. a total of 23836 upper endoscopies were performed in 16759 patients. DP was diagnosed in 6 patients (prevalence of 0.04%). The follow-up period was f 8 to 72 months. In 87% DP was a complication of the upper gastrointestinal bleeding. In 83% cases opening of the fistula was on lesser curvature of gastric antrumu. During follow-up period the fistula healing did not occur in any of our patients. DP is a very rare entity, with a benign course of the disease Associated comorbidity and use of ulceriform medications plays important role in persistence of DP, wheras possible eradication of Helicobacter infection in this background remains elusive

Arterial stiffness as a marker of vascular aging in IBD patients

Kronične upalne bolesti crijeva (IBD) povezane su s preuranjenom aterosklerozom uzrokovanom disfunkcijom endotela i povećanjem intime-medije krvnih žila. Upravo u stanjima kronične sustavne upale, kao što je IBD, kroz prisutnost dislipidemije i ubrzane ateroskleroze u sklopu podležećeg upalnog procesa dolazi do povišene krutosti velikih arterija. Uloga krutosti arterija u razvoju kardiovaskularnih bolesti dobro je poznata, a određivanje krutosti arterija sve se više upotrebljava u kliničkoj praksi u svrhu procjene kardiovaskularnog rizika u bolesnika, te je jedan od pokazatelja vaskularnog starenja. Neinvazivno mjerenje brzine pulsnog vala aorte (eng. pulse wave velocity, PWV) i augmentacijskog indeksa (Aix) ima prediktivnu vrijednost za otkrivanje budućih fatalnih kardiovaskularnih incidenata, kao i za ukupni kardiovaskularni rizik. Ovim istraživanjem utvrđeno je kako gotovo polovica svih ispitanika (54(45%)) ima povišenu vrijednost PWV, odnosno prisutno supkliničko oštećenje ciljnih organa. U našoj kohorti IBD bolesnika nije bilo razlika u markerima krutosti arterija između pacijenata s ulceroznim kolitisom i Crohnovom bolešću, kao ni u ovisnosti o fenotipu, lokalizaciji bolesti ili primijenjenoj terapiji. Prisutnost povišene PWV (>8 m/s, 45% bolesnika) najprevalentniji je marker supkliničkog oštećenja ciljnih organa u našoj kohorti IBD bolesnika, a PWV raste s dobi te postaje viši u odnosu na kontrolnu skupinu ispitanika s dobro liječenom arterijskom hipertenzijom. Ubrzano vaskularno starenje rezultat je produljenog trajanja IBD kao vjerojatnog uzroka povišene PWV, a bolesnici su imali i povišen Aix, kao marker povišene krutosti arterija srednje velikih i malih arterija. U svim skupinama bolesnika upravo su dob i duljina trajanja IBD bili snažni, neovisni prediktori povišene PWV. Ovi rezultati pokazuju da IBD s prisutnom kroničnom, sustavnom upalom ima sličnu ulogu u razvoju ubrzane ateroskleroze, povišene krutosti arterija i supkliničkog oštećenja ciljnih organa, kao i arterijska hipertenzija, etablirani rizični faktor za povišenu krutost arterija. Također, može se zaključiti da je porast krutosti arterija i ubrzano vaskularno starenje više izraženo u onih bolesnika s duljim trajanjem IBD. Naši rezultati povišene PWV i Aix u pacijenata s duljim trajanjem IBD govore u prilog činjenici da je kronična sustavna upala odgovorna za promjene u velikim i malim arterijama i dovodi do oštećenja ciljnih organa u ovih bolesnika, neovisno o trenutnom statusu aktivnosti bolesti. Preuranjena ateroskleroza i prisutnost dislipidemije moraju biti adekvatno nadzirane i liječene, posebice u onih IBD bolesnika s duljim trajanjem bolesti.Chronic inflammatory bowel diseases (IBD) are associated with premature atherosclerosis caused by endothelial dysfunction and increased arterial intima-media. In conditions characterized by chronic systemic inflammation, like IBD, chronic inflammatory process through dyslipidemia and accelerated atherosclerosis leads to increase in arterial stiffness of the large arteries. The crucial role of arterial stiffness in the development of cardiovascular disease is well known and arterial stiffness measurement is increasingly being used for cardiovascular risk assessment and it is an indicator of vascular aging. Non-invasive measurement of pulse wave velocity (PWV) and augmentation index (Aix) has predictive value for future fatal cardiovascular events and overall cardiovascular risk. In our research, nearly half of the examinees had increased PWV (45%) and subclinical target organ damage. There were no differences in arterial stiffness markers in Crohn's disease (CD) and ulcerative colitis (UC) patients. Also, patients divided according to disease phenotype, localization and applied therapy showed no differences in PWV and Aix markers. Increased PWV (>8m/s) is the most prevalent marker of subclinical target organ damage in our IBD patient cohort. We also showed that PWV increases with age and becomes higher than PWV in the control group of examinees with well-controlled arterial hypertension. Accelerated vascular aging is the result of prolonged duration of IBD as the most plausible cause of increased PWV. Patients also had increased Aix as a marker of increased arterial stiffness of medium and small arteries. Age and duration of IBD were strong and independent predictors of increased PWV in all groups of IBD patients. These results show that IBD with chronic, systemic inflammation plays a role in the development of accelerated atherosclerosis, increased arterial stiffness and subclinical target organ damage similar to arterial hypertension, an established risk factor for arterial stiffness. Also, we can conclude that increased arterial stiffness and accelerated vascular aging are more pronounced in those patients with a more prolonged duration of IBD. Our results of increased PWV and Aix in IBD patients with longer disease duration are contributing to the fact that chronic inflammation is responsible for alterations of both large and smaller arteries and leads to target organ damage in these patients, regardless of current disease activity. Premature atherosclerosis and dyslipidemia should be closely monitored and treated, especially in IBD patients with longer disease duration

Arterial stiffness as a marker of vascular aging in IBD patients

Kronične upalne bolesti crijeva (IBD) povezane su s preuranjenom aterosklerozom uzrokovanom disfunkcijom endotela i povećanjem intime-medije krvnih žila. Upravo u stanjima kronične sustavne upale, kao što je IBD, kroz prisutnost dislipidemije i ubrzane ateroskleroze u sklopu podležećeg upalnog procesa dolazi do povišene krutosti velikih arterija. Uloga krutosti arterija u razvoju kardiovaskularnih bolesti dobro je poznata, a određivanje krutosti arterija sve se više upotrebljava u kliničkoj praksi u svrhu procjene kardiovaskularnog rizika u bolesnika, te je jedan od pokazatelja vaskularnog starenja. Neinvazivno mjerenje brzine pulsnog vala aorte (eng. pulse wave velocity, PWV) i augmentacijskog indeksa (Aix) ima prediktivnu vrijednost za otkrivanje budućih fatalnih kardiovaskularnih incidenata, kao i za ukupni kardiovaskularni rizik. Ovim istraživanjem utvrđeno je kako gotovo polovica svih ispitanika (54(45%)) ima povišenu vrijednost PWV, odnosno prisutno supkliničko oštećenje ciljnih organa. U našoj kohorti IBD bolesnika nije bilo razlika u markerima krutosti arterija između pacijenata s ulceroznim kolitisom i Crohnovom bolešću, kao ni u ovisnosti o fenotipu, lokalizaciji bolesti ili primijenjenoj terapiji. Prisutnost povišene PWV (>8 m/s, 45% bolesnika) najprevalentniji je marker supkliničkog oštećenja ciljnih organa u našoj kohorti IBD bolesnika, a PWV raste s dobi te postaje viši u odnosu na kontrolnu skupinu ispitanika s dobro liječenom arterijskom hipertenzijom. Ubrzano vaskularno starenje rezultat je produljenog trajanja IBD kao vjerojatnog uzroka povišene PWV, a bolesnici su imali i povišen Aix, kao marker povišene krutosti arterija srednje velikih i malih arterija. U svim skupinama bolesnika upravo su dob i duljina trajanja IBD bili snažni, neovisni prediktori povišene PWV. Ovi rezultati pokazuju da IBD s prisutnom kroničnom, sustavnom upalom ima sličnu ulogu u razvoju ubrzane ateroskleroze, povišene krutosti arterija i supkliničkog oštećenja ciljnih organa, kao i arterijska hipertenzija, etablirani rizični faktor za povišenu krutost arterija. Također, može se zaključiti da je porast krutosti arterija i ubrzano vaskularno starenje više izraženo u onih bolesnika s duljim trajanjem IBD. Naši rezultati povišene PWV i Aix u pacijenata s duljim trajanjem IBD govore u prilog činjenici da je kronična sustavna upala odgovorna za promjene u velikim i malim arterijama i dovodi do oštećenja ciljnih organa u ovih bolesnika, neovisno o trenutnom statusu aktivnosti bolesti. Preuranjena ateroskleroza i prisutnost dislipidemije moraju biti adekvatno nadzirane i liječene, posebice u onih IBD bolesnika s duljim trajanjem bolesti.Chronic inflammatory bowel diseases (IBD) are associated with premature atherosclerosis caused by endothelial dysfunction and increased arterial intima-media. In conditions characterized by chronic systemic inflammation, like IBD, chronic inflammatory process through dyslipidemia and accelerated atherosclerosis leads to increase in arterial stiffness of the large arteries. The crucial role of arterial stiffness in the development of cardiovascular disease is well known and arterial stiffness measurement is increasingly being used for cardiovascular risk assessment and it is an indicator of vascular aging. Non-invasive measurement of pulse wave velocity (PWV) and augmentation index (Aix) has predictive value for future fatal cardiovascular events and overall cardiovascular risk. In our research, nearly half of the examinees had increased PWV (45%) and subclinical target organ damage. There were no differences in arterial stiffness markers in Crohn's disease (CD) and ulcerative colitis (UC) patients. Also, patients divided according to disease phenotype, localization and applied therapy showed no differences in PWV and Aix markers. Increased PWV (>8m/s) is the most prevalent marker of subclinical target organ damage in our IBD patient cohort. We also showed that PWV increases with age and becomes higher than PWV in the control group of examinees with well-controlled arterial hypertension. Accelerated vascular aging is the result of prolonged duration of IBD as the most plausible cause of increased PWV. Patients also had increased Aix as a marker of increased arterial stiffness of medium and small arteries. Age and duration of IBD were strong and independent predictors of increased PWV in all groups of IBD patients. These results show that IBD with chronic, systemic inflammation plays a role in the development of accelerated atherosclerosis, increased arterial stiffness and subclinical target organ damage similar to arterial hypertension, an established risk factor for arterial stiffness. Also, we can conclude that increased arterial stiffness and accelerated vascular aging are more pronounced in those patients with a more prolonged duration of IBD. Our results of increased PWV and Aix in IBD patients with longer disease duration are contributing to the fact that chronic inflammation is responsible for alterations of both large and smaller arteries and leads to target organ damage in these patients, regardless of current disease activity. Premature atherosclerosis and dyslipidemia should be closely monitored and treated, especially in IBD patients with longer disease duration

Arterial stiffness as a marker of vascular aging in IBD patients

Kronične upalne bolesti crijeva (IBD) povezane su s preuranjenom aterosklerozom uzrokovanom disfunkcijom endotela i povećanjem intime-medije krvnih žila. Upravo u stanjima kronične sustavne upale, kao što je IBD, kroz prisutnost dislipidemije i ubrzane ateroskleroze u sklopu podležećeg upalnog procesa dolazi do povišene krutosti velikih arterija. Uloga krutosti arterija u razvoju kardiovaskularnih bolesti dobro je poznata, a određivanje krutosti arterija sve se više upotrebljava u kliničkoj praksi u svrhu procjene kardiovaskularnog rizika u bolesnika, te je jedan od pokazatelja vaskularnog starenja. Neinvazivno mjerenje brzine pulsnog vala aorte (eng. pulse wave velocity, PWV) i augmentacijskog indeksa (Aix) ima prediktivnu vrijednost za otkrivanje budućih fatalnih kardiovaskularnih incidenata, kao i za ukupni kardiovaskularni rizik. Ovim istraživanjem utvrđeno je kako gotovo polovica svih ispitanika (54(45%)) ima povišenu vrijednost PWV, odnosno prisutno supkliničko oštećenje ciljnih organa. U našoj kohorti IBD bolesnika nije bilo razlika u markerima krutosti arterija između pacijenata s ulceroznim kolitisom i Crohnovom bolešću, kao ni u ovisnosti o fenotipu, lokalizaciji bolesti ili primijenjenoj terapiji. Prisutnost povišene PWV (>8 m/s, 45% bolesnika) najprevalentniji je marker supkliničkog oštećenja ciljnih organa u našoj kohorti IBD bolesnika, a PWV raste s dobi te postaje viši u odnosu na kontrolnu skupinu ispitanika s dobro liječenom arterijskom hipertenzijom. Ubrzano vaskularno starenje rezultat je produljenog trajanja IBD kao vjerojatnog uzroka povišene PWV, a bolesnici su imali i povišen Aix, kao marker povišene krutosti arterija srednje velikih i malih arterija. U svim skupinama bolesnika upravo su dob i duljina trajanja IBD bili snažni, neovisni prediktori povišene PWV. Ovi rezultati pokazuju da IBD s prisutnom kroničnom, sustavnom upalom ima sličnu ulogu u razvoju ubrzane ateroskleroze, povišene krutosti arterija i supkliničkog oštećenja ciljnih organa, kao i arterijska hipertenzija, etablirani rizični faktor za povišenu krutost arterija. Također, može se zaključiti da je porast krutosti arterija i ubrzano vaskularno starenje više izraženo u onih bolesnika s duljim trajanjem IBD. Naši rezultati povišene PWV i Aix u pacijenata s duljim trajanjem IBD govore u prilog činjenici da je kronična sustavna upala odgovorna za promjene u velikim i malim arterijama i dovodi do oštećenja ciljnih organa u ovih bolesnika, neovisno o trenutnom statusu aktivnosti bolesti. Preuranjena ateroskleroza i prisutnost dislipidemije moraju biti adekvatno nadzirane i liječene, posebice u onih IBD bolesnika s duljim trajanjem bolesti.Chronic inflammatory bowel diseases (IBD) are associated with premature atherosclerosis caused by endothelial dysfunction and increased arterial intima-media. In conditions characterized by chronic systemic inflammation, like IBD, chronic inflammatory process through dyslipidemia and accelerated atherosclerosis leads to increase in arterial stiffness of the large arteries. The crucial role of arterial stiffness in the development of cardiovascular disease is well known and arterial stiffness measurement is increasingly being used for cardiovascular risk assessment and it is an indicator of vascular aging. Non-invasive measurement of pulse wave velocity (PWV) and augmentation index (Aix) has predictive value for future fatal cardiovascular events and overall cardiovascular risk. In our research, nearly half of the examinees had increased PWV (45%) and subclinical target organ damage. There were no differences in arterial stiffness markers in Crohn's disease (CD) and ulcerative colitis (UC) patients. Also, patients divided according to disease phenotype, localization and applied therapy showed no differences in PWV and Aix markers. Increased PWV (>8m/s) is the most prevalent marker of subclinical target organ damage in our IBD patient cohort. We also showed that PWV increases with age and becomes higher than PWV in the control group of examinees with well-controlled arterial hypertension. Accelerated vascular aging is the result of prolonged duration of IBD as the most plausible cause of increased PWV. Patients also had increased Aix as a marker of increased arterial stiffness of medium and small arteries. Age and duration of IBD were strong and independent predictors of increased PWV in all groups of IBD patients. These results show that IBD with chronic, systemic inflammation plays a role in the development of accelerated atherosclerosis, increased arterial stiffness and subclinical target organ damage similar to arterial hypertension, an established risk factor for arterial stiffness. Also, we can conclude that increased arterial stiffness and accelerated vascular aging are more pronounced in those patients with a more prolonged duration of IBD. Our results of increased PWV and Aix in IBD patients with longer disease duration are contributing to the fact that chronic inflammation is responsible for alterations of both large and smaller arteries and leads to target organ damage in these patients, regardless of current disease activity. Premature atherosclerosis and dyslipidemia should be closely monitored and treated, especially in IBD patients with longer disease duration