Serum level of lactadherin (MFGE8) in inflamatory bowel disease.

OBJECTIVE: Evaluation of serum lactadherin level, its correlation with disease activity and certain biochemical parameters in IBD patients. METHODS: The study involved adult IBD patients, comprising 50 with ulcerative colitis (UC), 68 with Crohn's disease (CD), and 29 healthy controls. RESULTS: The MFGE8 median concentration was significantly higher in UC versus controls (1914.54 vs. 1392.21; p = 0.017), but not in CD. The median MFGE8 levels in UC and CD patient groups didn't significantly differ. There was a significant inverse correlation between MFGE8 and CRP (r = -0.283; p = 0.044) and fibrinogen (r = -0.362, p = 0.017) in UC. In active UC, MFGE8 median concentration was higher versus controls (1974.36 vs. 1392.21; p = 0.04) and negatively correlated with CRP (r = -0.482; p = 0.005), WBC (r = -0.391; p = 0.027), and fibrinogen (r = -0.473; p = 0.015). Inactive UC showed negative correlation only with fibrinogen (r = -0.567; p = 0.018). No correlations were found with disease activity measured using appropriate scales, age, BMI, or gender. CONCLUSIONS: Active UC patients show higher MFGE8 levels. These increase inversely with inflammatory markers (CRP, WBC, fibrinogen) in active UC, but not in CD.

Oral non-specific lesions in patient with Crohn's disease - a case report.

Crohn's disease (CD) is a chronic and granulomatous inflammatory disease of the entire gastrointestinal tract. The etiopathogenesis is not fully elucidated. The most common symptoms in the active phase of the disease include abdominal pain, prolonged diarrhea, fever, fatigue, malaise and weight loss. Oral manifestations of CD are classified into specific for CD with granulomatous changes and non-specific ones. This rare extraintestinal manifestation of CD in adults may precede gastrointestinal tract involvement, occur together or appear after years of its duration. Oral lesions can be initiated by malnourishment, poor absorption of nutrients or side-effect of medications. A CASE REPORT: We describe a 28-year-old female with a 9-years CD history, who presented in the active disease with oral lesions. They were classified as non-specific ones, and included oral candidiasis, irregular erythematous patches on the cheek mucosa, exfoliative lip inflammation, and angular cheilitis. The patient was treated with azathioprine, and since the last exacerbation of symptoms, induction therapy with adalimumab, (anti-TNF-alpha), has been prescribed. Nystatin was applied to treat the oral lesions, based on the microbiological assessment of the Candida albicans susceptibility, and symptomatic treatment. After a two-week treatment the oral mucosa was healed and angular cheilitis showed marked improvement compared to the initial presentation. CONCLUSIONS: The young female with active CD presented the nonspecific lesions in the oral cavity. The lesions coexisted with the active inflammatory process in the intestinal tract with characteristic clinical symptoms, and were associated with sideropenic anemia. The implementation of the local therapy, systemic CD treatment and supplementation of micronutrient deficiencies have led to a healing of the oral lesions. We emphasize a personalized approach to treatment and close cooperation between the dentist and the gastroenterologist.

The Effect of Molecular Weight on the Antibacterial Activity of N,N,N-Trimethyl Chitosan (TMC).

N,N,N-trimethyl chitosan (TMC) with 93% degree of trimethylation was synthesized. TMC and the chitosan starting material were subjected to acidic hydrolysis to produce 49 different samples with a reduced average molecular weight (Mw) ranging from 2 to 144 kDa. This was done to allow the investigation of the relationship between antibacterial activity and Mw over a wide Mw range. NMR investigation showed that hydrolysis did not affect the degree of trimethylation (DSTRI) or the structure of the polymer backbone. The activity of TMC against Staphylococcus aureus (S. aureus) increased sharply with Mw until a certain Mw value (critical Mw for high activity, CMW) was reached. After the CMW, the activity was not affected by a further increase in the Mw. A similar pattern of activity was observed for chitosan. The CMW was determined to be 20 kDa for TMC and 50 kDa for chitosan.

Relative homogeneity of oral bacterial oral in Crohn's disease compared to ulcerative colitis and its connections with antioxidant defense - preliminary report.

INTRODUCTION: Interactions between oral microbiota and systemic diseases have been suggested. We aimed to examine the composition of oral microbiota with reference to antioxidative defense and its correlation with clinical state in Crohn's disease (CD) in comparison to ulcerative colitis (UC). MATERIALS AND METHODS: Smears were taken from the buccal and tongue mucosa of patients with CD, UC and controls, and cultured with classical microbiology methods. Bacterial colonies were identified using matrix-assisted laser desorption/ionization (MALDI) with a time-of-flight analyzer (TOF). Blood morphology and C-reactive protein (CRP) were analyzed in the hospital laboratory. Antioxidative defense potential (FRAP) was determined using spectrophotometry in saliva and serum. RESULTS: Oral microbiota in CD patients were characterized by lower diversity in terms of the isolated bacteria species compared to UC and this correlated with reduced FRAP in the oral cavity and intensified systemic inflammation. Oral microbiota composition in CD did not depend on the applied treatment. In CD patients, a negative correlation was observed between the FRAP value in saliva and serum and the CRP value in serum. Individual differences in the composition of oral microbiota suggest that different bacteria species may be involved in the induction of oxidative stress associated with a weakening of antioxidative defense in the oral cavity, manifested by ongoing systemic inflammation. CONCLUSIONS: Analysis of both the state of the microbiota and antioxidative defense of the oral cavity, as well as their referencing to systemic inflammation may potentially prove helpful in routine diagnostic applications and in aiding a better understanding of CD and UC pathogenesis associated with oral microbiota.

Correlation of Paraoxonase-1 with the Severity of Crohn's Disease.

Diagnostics of Crohn's disease (CD) requires noninvasive biomarkers facilitating early detection and differentiation of the disease. Therefore, in this study, we aimed to determine the relationship between paraoxonase-1 (PON-1), the severity of CD, oxidative stress, and inflammation in CD. The CD activity index was based on the current classification. Plasma PON-1 was measured in 47 patients with CD, and in 23 control volunteers. Using quantitative variables such as receiver operating characteristics (ROC) (area under the curve (AUC)), the diagnostic utility of PON-1 in differentiating the severity of CD was assessed. Circulating PON-1 was found to be decreased in the CD group compared to the control group (269.89 vs. 402.56 U/L, respectively), and it correlated well with the disease activity. PON-1 correlated positively with hemoglobin (Hb) (r = 0.539, p < 0.001), hematocrit (Ht) (r = 0.48, p < 0.001), total cholesterol (TC) (r = 0.343, p < 0.001), high density lipoprotein (HDL) (r = 0.536, p < 0.001), low density lipoprotein (LDL) (r = 0.54, p < 0.001), and triglyceride (TG) (r = 0.561, p < 0.001) and correlated negatively with white blood cell count (WBC) (r = -0.262, p = 0.029), platelet count (PLT) (r = -0.326, p = 0.006), C-reactive protein (CRP) (r = -0.61, p < 0.001), and malondialdehyde (MDA) (r = -0.924, p < 0.001). PON-1 as a marker for CD differentiation possessed a sensitivity and specificity of 93.62% and 91.30%, respectively. CD was found to be associated with the decrease in the levels of PON-1, which correlates well with activity of the disease and reflects the intensification of inflammation, as well as intensified lipid peroxidation. High sensitivity and specificity of PON-1 determines its selection as a good screening test for CD severity.

Doping in sport - attitude and professional experience among physicians in Poland.

INTRODUCTION: The history of using performance-enhancing substances (PES) is long and it goes back to ancient times. At present, PES are employed at all levels of sport competition, starting from Olympic level contestants to individuals recreationally involved in various sports disciplines. PURPOSE: e objective of the study was examining the views on doping in sports in a group of physicians, together with evaluating the frequency of their contacts with this phenomenon, in their professional activities. METHODS: e investigation was carried out using a validated questionnaire developed by the authors. Questionnaire included 34 questions divided into 6 sections. In total, 257 individuals participated in the study. e percentage of answers was 75.81%. RESULTS: Among the responders, 96.50% believed that using PES by sports competitors represented unethical behavior. 42% participants declared that they met doping problem during their professional career. Almost one-third of the physicians (28.79%) declared that during their work, they consulted patient suffering from adverse side effects resulting from using PES. CONCLUSIONS: In Poland, physicians regard using PES as unethical behavior. They believe that a health care system professional should participate in counteracting doping in sports. Physicians - regardless of their specialty - are also exposed to PES-related problems in their professional work. In view of the above facts and the consistently increasing popularity of PES, extending the knowledge in this field among physicians seems to be of importance to allow for their offering better medical services to their patients.

Evaluation of plasma concentrations of selected antioxidant parameters in patients with active Crohn's disease.

Oxidative stress (OxS) has been implicated in the pathogenesis of Crohn's disease (CD). The aim of this study was to examine whether nonenzymatic antioxidants are associated with active CD, by using the FRAP and GSH assay in plasma. Additionally, we measured bilirubin and albumin levels as two individual components of the plasma antioxidant system. A total of 55 patients with established CD, 30 with active CD and 25 with inactive disease, and 25 healthy individuals were prospectively enrolled in this study. We evaluated CD activity index, BMI and blood morphology, platelet count, serum CRP level, and bochemical parameters of OxS: ferric reducing ability of plasma (FRAP), reduced glutathione (GSH) in plasma and bilirubin and albumin levels in serum. Plasma FRAP and GSH concentrations were decreased in both CD groups compared to controls and negatively correlated with CDAI values (FRAP: r = -0.572, p = 0.003; GSH: r = -0.761, p = 0.001), CRP and platelet count. Bilirubin and albumin levels were lower in the serum of active CD patients than inactive CD patients and controls and negatively correlated with the CD activity index (r = -0328, p = 0.036, r = -0.518, p = 0.002) and CRP (r = -0.433, p = 0.002). e decreased FRAP and GSH levels in plasma and bilirubin and albumin levels in serum of patients with active CD compared to inactive CD and controls underlines the importance of OxS in the pathophysiology and activity of CD.

The use of selected neutrophil protein plasma concentrations in the diagnosis of Crohn's disease and ulcerative colitis - a preliminary report.

BACKGROUND: Difficulties in diagnosis of inflammatory bowel disease (IBD) motivate the search for new diagnostic tools, including laboratory tests. The aim of this study was to evaluate concentrations of the neutrophil (NEU) proteins leukocyte elastase (HLE-α1AT), lactoferrin and calprotectin as potential biomarkers used in the diagnosis and assessment of clinical activity of Crohn's disease (CD) and ulcerative colitis (UC). MATERIAL/METHODS: The study included 27 patients with CD, 33 patients with UC and 20 healthy controls. Plasma concentrations of calprotectin, lactoferrin and HLE-α1AT were measured using ELISA. RESULTS: In patients with CD higher concentrations of HLE-α1AT (64.3±43.1 vs. 30.1±7.7 ng/l, P<0.001), calprotectin (151.6±97.8 vs. 69.9±22.1 ng/l, P<0.001) and lactoferrin (243.2±102.0 vs. 129.7±32.7 ng/l, P<0.001) than in the control group were found. In patients with UC higher plasma concentrations of HLE-α1AT (62.0±30.9 vs. 30.1±7.7 ng/l, P<0.001), calprotectin (149.6±72.3 vs. 69.9±22.1 ng/l, P<0.001) and lactoferrin (242.6±107.5 vs 129.7±32.7 ng/l, P<0.001) than in the control group were found. HLE-α1AT/NEU and lactoferrin/NEU ratios in patients with UC were significantly higher compared with patients with CD. Calprotectin (P=0.010) and lactoferrin (P=0.023) levels were higher in patients with the active compared with inactive phase of CD. CONCLUSIONS: The diagnostic characteristics of plasma granulocyte protein concentrations indicate the usefulness of these tests in the diagnosis of IBD. Higher HLE-α1AT and lactoferrin/NEU ratios in patients with UC than with CD may suggest the usefulness of these ratios in differential diagnostics. Plasma calprotectin and lactoferrin levels may be useful in CD activity assessment.

Oral mucosa lesions in patients with active Crohn's disease - a prospective study.

Introduction: Crohn's disease (CD) is a chronic inflammatory disease, which may involve any part of the gastrointestinal tract, including the oral cavity. Mucosal lesions in the oral cavity are described in various populations, but observations in active disease with severe clinical symptoms are quite rare. Objectives: To evaluate the prevalence and nature of oral mucosa lesions in adult patients with active CD and their correlation with clinical and laboratory indicators of disease activity. Material and Methods: Prospective study was performed in 62 patients (29 women, 33 men, age 18-49 years) admitted between December 2010 and February 2013 to the gastroenterology department with a confirmed diagnosis of CD and exacerbations of symptoms, and 40 sex- and gender-matched healthy volunteers. CD activity was classified according to clinical and blood parameters, and the CD activity index (CDAI). We examined: blood morphology, hemoglobin and CRP levels, BMI. Examination of the oral cavity included a detailed interview and physical examination, based on the WHO recommendations. Results: In patients with active CD we found: increased CDAI score (258.4±21.5), higher CRP levels (24.6±1.3 mg/l) and platelet count, anemia with significantly reduced RBC and hemoglobin level, and reduced BMI, in comparison to controls. The specific for CD symptoms were found in the mouth: indurated tag polypoid lesions on vestibular retromolar region in 12.9% of patients, cobblestoning of the mucosa in 9.7%, diffuse asymptomatic buccal swelling in 16.2%, mucogingivitis in 19.4% of patients. Oral nonspecific lesions were more frequent: angular cheilitis in 29.1%, atrophic glossitis in 14.5% of patients. Oral lesions correlated with hemoglobin and CRP concentrations (r=-0.431 and r=0.437; respectively; p<0.001), platelet count (r=0.45; p<0.003), CDAI (r=0.421; p<0.001) and BMI (r=0.307; p<0.006). No correlation has been found between specific or non-specific lesions and location of inflammatory changes in the gastrointestinal tract. Conclusions: Changes in the oral mucosa in adult patients with active CD are frequent. They should be correlated with other clinical symptoms of gastrointestinal tract and biochemical parameters in patients with CD. The nature of these changes may have an impact on the further therapeutic approach.

Impact of body weight on clinical symptoms and endoscopic changes in patients with gastroesophageal reflux disease.

Introduction: Gastroesophageal reflux disease (GERD) is connected with body mass index (BMI) according to some recent studies. However, the link between overweight and severity of GERD symptoms is still unclear. Objectives: The aim of our study is to assess the influence of BMI on clinical presentation and occurrence of inflammatory changes in the esophagus in patients with GERD. Material and Methods: 121 clinically diagnosed GERD patients: 66 males (54.5%) and 55 females (45.5%), aged 19 ­ 89 years were involved in the study. After the detailed anamnesis BMI was counted and gastroscopy was performed. All individuals who agreed for upper endoscopy were divided into three groups. 42 patients (34.7%) were classified as Non-Erosive Reflux Disease (NERD), 53 patients (43.8%) were diagnosed with Erosive Esophagitis (EE), 11 patients (9.1%) with Barrett's esophagus (BE). Among EE group 34 patients were diagnosed with grade A of esophagitis according to Los Angeles scale, 17 with grade B, 2 with grade C and none with grade D. The differences between groups were assessed using statistical analysis. Results: The mean age of patients was 50.2±12.9 years and the mean BMI was 25.5±4.2 kg/m2. Patients with BE were older (61.2±12.0 years) than NERD (48.5±13.6 years); (p=0.028) and EE (50.4±11.4 years); (p=0.008). BE had higher BMI (27.0±4.4 kg/m2) as compared to NERD (24.0±3.3 kg/m2); (p=0.022) and EE (24.4±3.1 kg/m2); (p=0.048). Hiatal hernia was more frequent in EE and BE (79.2% and 90.9%, respectively) as compared to NERD (45.2%); (p<0.001). Patients EE and BE more frequently complained to heartburn (84.9% and 72.7%, respectively) than patients with no mucosal injury (42.9%); (p<0.001). Sleeping problems were encountered by patients with higher levels of BMI. Conclusion: This study demonstrates that overweight predispose to esophageal inflammation and increase the frequency of heartburn and sleep problems in GERD patients.

Gastrointestinal tract as a side-effect target of medications.

World Health Organization (WHO) defines adverse drug reaction (ADR) as "a response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease, or for the modifications of physiological function". ADRs are a serious problem of contemporary pharmacotherapy. Expenditures for treatment of ADRs in the United States may cost up to 30.1 billion dollars annually. Factors affecting the development of ADRs are: age, gender, body weight, polypharmacy. About 10% of ADRs is associated with gastrointestinal tract (GIT). ADR can affect every part of GIT. Xerostomia is the most common ADR occurring in oral cavity. ADRs affecting esophagus include irritation and inflammation of the mucosa. Approximately one-third of all cases of esophageal inflammation results from administration of non-steroid anti-inflammatory drugs (NSAIDs). The main cause of ulcerations involving stomach and small intestine are NSAIDs. Drug-induced diarrheas are the most common adverse effect accounting for approximately 7% of all observed cases of ADRs. They may be triggered by antibiotics, magnesium salts, laxatives and others. On the other hand, some groups of medications may induce constipation. These drugs comprise opioids, diuretics, calcium channel blockers, cholinolytics and others. Proton pump inhibitors, metformin, orlistat and colesevelam may lead to restricted absorption of certain vitamins and minerals. Physicians' knowledge about most popular and well documented ADRs can improve patients' safety and make pharmacotherapy more comfortable for them.

Clinical course of primary sclerosing cholangitis and concomitant ulcerative colitis - a preliminary report of retrospective study among patients from Southern Poland.

UNLABELLED: Both ulcerative colitis (UC) and primary sclerosing cholangitis (PSC) are chronic and progressive diseases of uncertain etiology, that may affect one patient. Approximately 70% of PSC cases are also diagnosed with UC, whereas in the group of UC the prevalence of PSC is about 2-5%. The aim of the study was to compare clinical courses of PSC and UC in patients diagnosed with both diseases to those with the confirmed diagnosis of either PSC or UC. Three groups were distinguished and evaluated: patients with PSC and UC (n = 17) and two control groups: patients with PSC (n = 4) and with UC (n = 13). Clinical data, symptoms, laboratory tests, results of the magnetic resonance cholangiopancreatography and colonoscopy were analyzed to compare clinical courses of these diseases between the groups. CONCLUSION: there is no correlation between clinical course of simultaneous PSC and UC. However, it may differ depending on co-occurrence of the other disease.

TGF-ß1 and granulocyte elastase in the evaluation of activity of inflammatory bowel disease. A pilot study.

INTRODUCTION: The aim was to assess the usefulness of TGF-ß1 and elastase in the evaluation of activity of ulcerative colitis (UC) and Crohn's disease (CD). MATERIAL AND METHODS: 32 patients diagnosed with UC, 31 with CD and 30 healthy volunteers were enrolled in this study. Diagnosis of the disease was confirmed by videocolonoscopy and histopathological evaluation of intestinal biopsies. Disease activity was assessed by use of the Mayo Scoring System for Assessment of Ulcerative Colitis Activity in UC patients and by CDAI in CD patients. hsCRP was determined by the immunonephelometric method, TGF-ß1 and elastase plasma concentration by ELISA. The results of the study were analyzed using Statistica and R statistical language. RESULTS: In UC a positive correlation between disease activity and platelet level, hsCRP and TGF-ß1 concentration was noted. Elastase concentration in UC patients was significantly higher than in CD, but there was no correlation with the activity of the disease. In CD patients we observed a positive correlation between disease activity and leukocytes, platelet levels and elastase concentration, and a very low correlation with hsCRP and TGF-ß1. DISCUSSION: Determination of TGF-ß1 can be used for evaluation of inflammatory activity in UC and it is connected with elevated concentrations of CRP and platelets. To a lower extent TGF-ß1 can also be used for evaluation of inflammatory activity in CD. Examination of elastase concentration may be useful in the assessment of CD activity. Plasma elastase concentration may be helpful in UC and CD differentiation. The preliminary results of this investigation seem promising; nevertheless, more studies are necessary.

Homocysteine in patients with inflammatory bowel diseases.

BACKGROUND: Hyperhomocysteinemia seems to be a common phenomenon in both patients with ulcerative colitis and Crohn's disease. Many factors including deficiencies of cobalamin, folate and pyridoxine, smoking habits, alcohol and coffee intake, some medications and age may predispose subjects to hyperhomocysteinemia. The study aimed to evaluate homocysteine levels in an inflammatory bowel disease cohort as dependent of life style and disease activity. METHODS: 85 consecutive patients with inflammatory bowel disease (38 with Crohn's disease and 47 with ulcerative colitis) and 65 control subjects were included in the prospective study. The following parameters were analyzed: disease activity, duration of the disease, location of pathological changes, presence of complications, current medications, past surgical procedures, smoking history, concomitant diseases, biochemical parameters and plasma homocysteine levels. RESULTS: Mild hyperhomocysteinemia was found in 16 patients with Crohn's disease (42%), 19 patients with ulcerative colitis (40%) and 19 patients in the control group (29%) (p = 0.59). There was not any significant correlation between homocysteine level and disease activity. Only folic acid supplementation and gender affected homocysteine level. Folic acid intake led to reduction of homocysteine levels in all groups of patients (11.8 micromol/l vs. 8.33 miccromol/l, p = 0.0065 in Crohn's disease patients and 10.94 micromol/l vs. 7.78 micromol/l, p = 0.0069 in ulcerative colitis patients). CONCLUSION: Homocysteine level in patients with inflammatory bowel disease is mostly normal or slightly elevated. Disease activity does not have an impact on homocysteine level. Folic acid is the most important factor having an influence on homocysteine level in patients with inflammatory bowel disease.

Selected apoptotic markers in serum of patients with chronic viral hepatitis C.

BACKGROUND: In chronic viral hepatitis C, hepatocytes inflammation, necrosis and apoptosis occur. To evaluate hepatocyte apoptotic rate, a serum concentration of proapoptotic FaS protein and its ligand (FaS/FaSL) as well tumor necrosis factor-alpha (TNF-alpha) and antiapoptotic hepatocyte growth factor (HGF) may be used. The aim of the study was to evaluate the hepatic apoptosis rate in patients with hepatitis virus C infection and its correlations with the degree of liver inflammation and staging, biochemical tests, viral load and the duration of the infection. PATIENTS AND METHODS: 60 adults (30 chronic hepatitis C patients and 30 controls) were included into the study. Serum levels of FaS/FaSL, TNFalpha and HGF were evaluated using the ELISA method. The results were correlated with viral load, biochemical tests, as well ultrasonographic and histopathological (grading, staging) examinations. RESULTS: TNF-alpha level in HCV-infected patients was significantly higher than in the controls (11.0 +/- 19.3 pg/ml vs. 3.3 +/- 2.8 pg/ml, p = 0.04). FaS/ FaSL and HGF did not differ significantly in both groups. TNF-alpha level was higher in patients with low staging (fibrosis F-0) than in those with higher staging (F-1, F-2, F-3)--according to the Batts-Ludwig scale. Other markers (FaS/FaSL and HGF) did not differ in groups with variant staging. No significant differences were observed in relation to grading. CONCLUSIONS: The measurement of FaSIFaSL, TNF-alpha and HGF does not allow for the assessment about apoptotic rate in patients with chronic hepatitis C. Explanation of this problem need follow-up studies on larger groups with the use of more complex methods.

Ustekinumab in the treatment of acute disseminated pyoderma gangrenosum in a patient with Crohn's disease.

Pyoderma gangrenosum (PG) is an auto-inflammatory dermatosis characterized by lesions that often cause ulcers. We present a case of successful ustekinumab treatment for acute general PG in a 31-year-old woman with coexisting Crohn's disease (CD). For a month, the patient suffered from skin ulcers, two of them deep and necrotic; a histopathological examination revealed PG. Treatment included: methylprednisolone, azathioprine, betamethasone, gentamicin and zincic ointments, antiseptic compresses, and adalimumab therapy. Due to resistance to the implemented treatment, the patient was enrolled in a clinical trial that included the administration of an anti-cytokines drug, ustekinumab. Subsequently, a significant reduction was observed in the severity of symptoms of PG with no relapse. The use of ustekinumab in patients with PG who have an inadequate response to current treatment or cannot receive first-line treatment can be considered. This applies especially to patients with accompanying autoimmune diseases such as CD.

Serum inflammatory markers in the diagnosis and assessment of Crohn's disease activity.

INTRODUCTION: The aim of our study was to evaluate the diagnostic characteristics of selected inflammatory markers and the results of multiplication of their concentrations in the diagnosis and assessment of Crohn's disease (CD) activity. METHODS: We studied 49 patients with CD and 31 healthy controls. The CD patients were assigned to subgroups with active and inactive disease based on the Crohn's Disease Activity Index score. Serum interleukins and C-reactive protein (CRP) were measured using immunoassays. RESULTS: Serum CRP and interleukins: IL-6, IL-17A, IL-23 were significantly higher in the CD group than in controls, with the best diagnostic performance for IL-23. Only serum IL-6 and CRP were significantly higher in active than in inactive disease, with the better performance of CRP. Multiplication results did not perform better than individual multipliers. CONCLUSIONS: Serum CRP may be useful in the assessment of CD activity and there is a need for introduction of IL-23 for the CD diagnosis.

Serum concentration of selected biochemical markers of endothelial dysfunction and inflammation in patients with the varying activity of inflammatory bowel disease.

INTRODUCTION: Endothelial dysfunction leads to an increased expression of cell adhesion molecules, leukocyte diapedesis, vascular smooth­muscle tone, excessive permeability of vascular walls, and increased procoagulant activity. OBJECTIVES: We investigated whether serum levels of several endothelial and platelet activation markers correlated with disease activity in patients with inflammatory bowel disease (IBD). PATIENTS AND METHODS: This study included 56 patients with ulcerative colitis, 66 with Crohn disease, and 40 healthy controls. We measured the complete blood count and levels of fibrinogen, C­reactive protein, albumin, interleukin 6, tumor necrosis factor α, E­selectin, P­selectin, monocyte chemoattractant protein 1 (MCP­1), soluble CD40 ligand (sCD40L), and microparticles. RESULTS: There were no significant differences in the median levels of E­selectin, P­selectin, MCP­1, sCD40L, and microparticles between patients with active IBD, those with inactive IBD, and healthy controls. The clinical disease activity assessed with the Mayo scale in the ulcerative­colitis group was weakly, positively correlated with sCD40L (R = 0.32, P = 0.02), P­selectin (R = 0.32, P = 0.02), and inflammatory marker levels. The clinical disease activity index in the Crohn disease group was positively correlated with the markers of inflammation yet not with the markers of endothelial activity. CONCLUSIONS: E­selectin, P­selectin, sCD40L, MCP­1, and microparticle levels do not significantly differ between patients with the varying activity of IBD. However, due to the observed correlations, further studies of a larger patient group should be conducted to confirm our observations.

Effect of long-term proton pump inhibitor therapy on complete blood count parameters and selected trace elements: a pilot study.

INTRODUCTION: Proton pump inhibitors (PPIs) are widely prescribed for several gastrointestinal conditions, often as long­term therapy. The effects of term PPI use have not been fully elucidated. OBJECTIVES: We aimed to determine the association between long­term PPI use and complete blood count parameters, particularly red blood cell (RBC) count, white blood cell (WBC) count, and hemoglobin concentrations, as well as serum levels of selected micronutrients such as selenium (Se), iron (Fe), copper (Cu), and zinc (Zn). PATIENTS AND METHODS: We enrolled 37 patients on long­ term PPI therapy (mean [SD] age, 57.1 [15.4] years) and 30 healthy controls (mean [SD] age, 39.3 [11.8] years). In each group, complete blood count, and serum Fe levels were performed, and serum Cu, Zn, and Se levels were measured using atomic absorption spectrometry. RESULTS: Red blood cell and WBC counts were lower in the PPI group compared with controls (mean [SD], 4.24 [0.55] ×106/µl vs 4.7 [0.4] ×106/µl; P <0.001 and 6.13 [1.44] ×103/µl vs 7.3 [1.28] ×103/µl; P <0.001, respectively). Hemoglobin and serum Fe concentrations were also lower in the PPI group (mean [SD], 12.5 [1.8] g /dl vs 14.3 [0.8] g /dl; P <0.001 and 16.3 [5.4] µmol/l vs 23.4 [2.7] µmol/l; P <0.001, respectively). Serum Zn and Cu concentrations were higher in PPI users than in controls. CONCLUSIONS: Long­term PPI therapy may reduce RBC and WBC counts as well as hemoglobin levels, leading to iron deficiency. It may also aff ect concentrations of some micronutrients, although the underlying mechanism of this association is not fully clear.

Levels of tissue factor pathway inhibitor in patients with inflammatory bowel disease.

INTRODUCTION Endothelial dysfunction has been reported to be involved in the pathogenesis of inflammatory bowel disease (IBD) and concomitant thromboembolic complications. Inflammation stimulates the expression of tissue factor and tissue factor pathway inhibitor (TFPI) by endothelial cells. OBJECTIVES This study assessed the relationship between TFPI levels and disease activity in patients with IBD. PATIENTS AND METHODS A total of 50 consecutive adult patients with ulcerative colitis (UC), 50 patients with Crohn disease (CD), and 50 healthy controls were enrolled to the study. Plasma levels of total TFPI, free TFPI, and von Willebrand factor were measured. Associations among these levels, disease activity, and inflammatory marker levels were assessed. RESULTS Total TFPI levels were higher in patients with IBD (median, 68.5 [IQR, 60.2-80.1] ng/ml) than in controls (median, 61.1 ng/ml [IQR, 54.3-74.2]; P = 0.01). Free TFPI levels were higher in patients with active UC (median, 12.8 ng/ml [IQR, 11.1-15.4]), inactive UC (median, 9.9 ng/ml [IQR, 7.3-11.5]), active CD (median, 11.7 [IQR, 9.7-14.4] ng/ml), and inactive CD (median, 9.7 ng/ml [IQR, 8.6-11.6]) than in controls (median, 5.5 ng/ml [IQR, 4.3-7.2]; P <0.001). In the CD and UC groups, free TFPI levels correlated with the levels of inflammatory markers and disease activity. The von Willebrand factor level was higher in patients with UC (median, 143.4 IU/dl [IQR, 115.5-170.4]) and those with CD (median, 151.8 IU/dl [IQR, 112.8-189.4]) than in controls (85.1 IU/dl [IQR, 77.1-101.5]; P <0.001 for both comparisons). CONCLUSIONS The anticoagulant TFPI pathway is activated during remissions and flares in patients with IBD. The free TFPI level correlates with biochemical markers of inflammation and disease activity.