Sleep disturbance and disease activity in adult patients with inflammatory bowel diseases.

The aim of the study was to identify whether poor quality of sleep is connected to inflammatory bowel disease (IBD) and if so, whether sleep disturbances are related to disease activity. Prospective, observational cohort study was performed. In all enrolled adult patients, the disease activity was assessed by using Crohn's Disease Activity Index (CDAI) for Crohn's disease (CD) and Partial Mayo Score for ulcerative colitis (UC), respectively. All patients were also asked to respond to a questionnaire to define Pittsburgh Quality Sleep Index (PSQI). Sixty-five patients were enrolled in our study: n = 30 with CD and n = 35 with UC. The poor sleep was noted in 78% (40/51) patients with clinically exacerbation and in 35% (5/14) patients in remission (P = 0.002; OR 6.5, 95% confidence interval, 1.8 - 23.6). A global PSQI score of 5 points yielded a sensitivity of 84%, a specificity of 39%, and a positive predictive value of 89% for discriminating participants with exacerbation of IBD from those in clinical remission; PSQI higher than 6 indicates the exacerbation of IBD with 77% sensitivity and 62% specificity. The poorest sleep quality was reported in IBD patients with severe exacerbations (9.1 ± 2.9). Sleep disturbance was confirmed in adult IBD patients, both in CD and UC. Confirmation of the relationship between sleep abnormalities and IBD may show the new pathway in pathophysiology, course and treatment of IBD.

Evaluation of melatonin effectiveness in the adjuvant treatment of ulcerative colitis.

Ulcerative colitis (UC) is a chronic disease characterized by the variable clinical picture with the inflammatory changes which can involve the whole colon or its distal part. The current treatments for UC are mostly nonspecific, not always effective, and often accompanied by serious side effects. Therefore, there is a considerable interest in finding alternative and more tolerable treatments for this serious disease. Several lines of experimental studies have shown that melatonin (MEL) regulates the extensive gut immune system and exerts antiinflammatory and immunomodulatory effects suggesting its beneficial action in UC by reducing and controlling inflammation. The study aimed at evaluating the effect of MEL on the activity of inflammatory process and sustaining the remission in patients with UC. It comprised 60 patients with left-sided UC, divided in two equal groups of 30 patients each (38 women and 22 men, aged 26-49 years), similar in both groups, who were in clinical remission for the last 12 months. Patients, during a next period of 12 months, were given mesalazine in daily doses 2 x 1.0 g and melatonin 5 mg daily at bedtime (group I) or placebo (group II). All the patients on MEL adjuvant treatment remained in remission during 12 months of observation with The Mayo Clinic Disease Activity Index (MCDAI) values 1.50±0.51 at the beginning and 2.75±1.86 points after 12 months. In the placebo group significantly higher MCDAI values were observed than in patients on MEL after 6, 9 and 12 months. At the inclusion MCDAI was 1.61±0.68 points and at the end of observation it reached the value of 5.10±2.22 points. In MEL group CRP level remained within the normal range during the course of the study (from 3.49±1.40 to 4.17±2.10 mg/dl). Whereas in the placebo group from the end of the third month the steady rise in CRP blood concentration was noted from 3.85±1.29 to 13.13±6.08 mg/dl. Parallelly to CRP rise a significant decrease in hemoglobin concentration in blood from 12.05±0.69 to 10.93±0.81 g/dl was observed in patients receiving placebo and the values significantly differed between the groups after 3 (p<0.05), 6, 9 and 12 months (p<0.01). The level of anxiety and the intensity of depression in patients on adjuvant MEL decreased during the study but there were no statistical differences noted between the groups. The results of the study allowed drawing the conclusion that adjuvant melatonin therapy may help in sustaining remission in patients with UC.

Evaluation of urinary 6-hydroxymelatonin sulphate excretion in women at different age with irritable bowel syndrome.

Melatonin (MT) exerts a beneficial action in the treatment of many diseases, among them also in irritable bowel syndrome (IBS). Its secretion decreases with age, particularly, in the postmenopausal period in women. It has not been determined whether these changes can have an impact on the clinical picture of IBS. The study aimed at evaluating the urinary excretion of the main MT metabolite - 6-hydroxymelatonin sulphate (6-HMS) in women at different age with IBS. The investigations were carried out in five groups of 30 women each. Group Ia (the controls) - premenopausal healthy women (20-39 years), group Ib (the controls) - postmenopausal healthy women (46-66 years), group II - women with constipation predominant IBS (IBS-C; 19-42 years), group III - women with diarrhoea predominant IBS (IBS-D; 20-39 years), group IV - women with IBS-C (49-68 years), group V - women with IBS-D (48-69 years). The diagnosis of IBS was based on the Rome III Criteria after excluding other diseases. On the day of the study the patients remained on the same liquid diet (Nutridrink - 3x400 ml) and 1500 ml of still mineral water. 6-HMS concentration in urine was measured by ELISA method applying IBL antibodies (RE-54031, Immunological Laboratories). The results showed that 24-hour urinary 6-HMS excretion in the studied premenopausal women were as follows: group Ia - 15.13+/-5.83 microg/24 h, group II - 28.85+/-12.59 microg/24 h (p<0,01), group III - 26.10+/-11.76 microg/24 h (p<0,01) and in the postmenopausal subjects they were: group Ib - 10.66+/-3.23 microg/24 h, group IV - 13.73+/-5.09 microg/24 h ((p=0,02), group V - 21.39+/-10.88 microg/24 h (p<0,01). In women with IBS-C the obtained results of 24-hour 6-HMS urinary excretion were independent on the intensity of clinical symptoms. On the other hand, in women with IBS-D, both in the group III and V, higher intensity of ailments was accompanied by significantly increased 6-HMS urinary excretion. The results of the study allowed drawing the following conclusions: (1). 24-hour 6-HMS urinary excretion in women with the constipation-predominant (IBS-C) as well as the diarrhoea-predominant IBS (IBS-D) is higher than in healthy persons both in the premenopausal and postmenopausal period. (2). Relatively high 6-HMS urinary excretion in postmenopausal women with IBS-D indicates an adaptive increase in MT secretion from EC in the gut.

No association between the Arg194Trp and Arg399Gln polymorphisms of the XRCC1 gene and colorectal cancer risk and progression in a Polish population.

BACKGROUND: The risk of sporadic colorectal cancer can be associated with environmental and lifestyle factors that may be sources of physical and chemical carcinogens, modulated by products of many low penetrance genes. Polymorphisms of DNA repair genes may influence variation in individual DNA repair capacity, which is crucial for preventing genomic instability, which, in turn, may be associated with risk of cancer. XRCC1 is an essential protein for the base excision repair pathway which primarily deals with DNA base modifications, arisen spontaneously or as a consequence of the action of environmental factors. AIM: To perform a case-control study and test the association between two polymorphisms in the XRCC1 gene: Arg194Trp and Arg399Gln and colorectal cancer risk and progression. METHODS: Genotypes were determined in DNA from peripheral blood lymphocytes of 100 colorectal cancer patients and 100 age, sex and ethnic-matched cancer-free controls by PCR RFLP. RESULTS: We found that both polymorphisms of the XRCC1 gene were not associated with risk and progession of colorectal cancer in a Polish population. Moreover, there was not such association form the Arg194Trp/Arg399Gln haplotypes. CONCLUSION: The Arg194Trp and Arg399Gln polymorphisms of the XRCC1 gene may not be associated with colorectal cancer in Polish population.

Nocturnal secretion of melatonin in patients with upper digestive tract disorders.

Recently, the results of many experimental investigations have shown that melatonin possesses gastroprotective properties. On the other hand its role in pathogenesis of upper digestive tract diseases in man still remains unclear. The aim of the study was to investigate nocturnal secretion of melatonin in patients with functional and organic diseases of the upper part of digestive tract. The investigations were carried out in 149 persons, aged 21-51 years, including healthy subjects (group I, n=30), and patients with non-erosive gastroduodenal reflux (NERD, group II, n=24), with gastroesophageal reflux disease (GERD, group III, n=25), with functional dyspepsia (FD, according to the Rome III Criteria, group IV, n=36) and with recurrent duodenal ulcer (DUD, group V, n=34). Diagnoses were established on the basis of endoscopic imaging and histological examination, 24-hour pH-metry and laboratory tests. Melatonin serum concentration was measured with ELISA method. Blood samples were taken for examination in red-lighted room at 10 p.m. and on the following day at 2 and 6 a.m. The highest concentration of melatonin in all examined groups was determined at 2 a.m. The average melatonin concentration in healthy subjects was 34,7 +/- 4,8 pg/ml. In patients with GERD and DUD melatonin concentration was lower than in healthy subjects - 27,2 +/- 8,5 pg/ml and 25,5 +/- 6,2 pg/ml respectively (p < 0,05; p < 0,01). The highest concentration of melatonin was found in patients with NERD and FD - 43,2 +/- 10,8 pg/ml and 42,4 +/- 10,1 pg/ml (p < 0,01; p < 0,05). The findings of this study support the notion that melatonin exerts beneficial influences on the upper digestive tract. It is likely that high or relatively correct secretion of melatonin is sufficient to prevent peptic changes in esophageal and duodenal mucosa.

Evaluation of selected parameters of the inflammatory response to endoscopic retrograde cholangiopancreatography.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is a well-established method in diagnosis and management of biliary and pancreatic diseases. The procedure carries the risk of serious complications; the most common is pancreatitis. The severity of ERCP-related pancreatitis largely depends on the inflammatory response to the procedure. AIMS: The aim of our study was to evaluate the inflammatory response after diagnostic and therapeutic ERCP based on monitoring of plasma concentration of the following substances: amylase, lipase, white blood cells, interleukin 6 (IL-6), C-reactive protein (CRP), hydrogen peroxide, malonylodialdehyde (MDA), and conjugated dienes (CD). METHODOLOGY: The study was performed on 40 patients who were divided into two groups according to the procedure performed: Group1-28 patients after ERCP with endoscopic sphincterotomy (ES) and Group 2-12 patients after diagnostic ERCP. The parameters were measured before ERCP and 2, 24, and 48 hours after the procedure. RESULTS: After diagnostic and therapeutic ERCP, the increase in plasma concentration of amylase, lipase, IL-6, and CRP were observed. Acute pancreatitis developed in three of the patients from group 1. The increase in lipase and CRP concentration was significantly higher after therapeutic ERCP with ES than after the diagnostic procedure. Asymptomatic hyperamylasemia and hyperlipasemia occurred more often after therapeutic than diagnostic ERCP. A positive correlation between the increase of IL-6 and CRP concentration was found. After uncomplicated diagnostic or therapeutic ERCP, no increase of reactive oxygen species and lipid peroxidation products was observed. CONCLUSION: Diagnostic ERCP stimulates a systemic inflammatory response, the intensity of which is magnified after ES. After uncomplicated ERCP, the balance between oxidative and anti-oxidative mechanisms is retained.

[Microvascular complications in pancreatic diabetes]. / Powiklania naczyniowe o charakterze mikroangiopatii u chorych na cukrzyce wiklajaca przewlekle alkoholowe zapalenie trzustki.

Diabetes develops in more than half of the patients with chronic alcoholic pancreatitis (CAP), mostly due to increasing insulin deficiency. In this regard CAP-related diabetes (CAP-DM) is similar to the type 1 diabetes. Data on microvascular complications in CAP-DM are scarce. The aim of the study was the analysis of microvascular complications frequency in relation to metabolic control in comparison with type 1 diabetes mellitus. The study subjects were 50 patients divided into two groups: group 1-25 patients with CAP-DM (15 men, 10 women, mean age 44.6 +/- 8.4 yrs, duration of diabetes 3.7 +/- 2.1 yrs, body mass index (BMI) 22.4 +/- 2.9 kg/m2, duration of CAP 7.0 +/- 3.5 years), and group 2-25 well-matched type 1 diabetes patients (14 men, 11 women, mean age 42.3 +/- 7.6 yrs, duration of diabetes 4.1 +/- 2.8 yrs, BMI 24.0 +/- +/- 2.5 kg/m2). CAP was diagnosed on the basis of clinical examination, ultrasound and computed tomography scans, and in some cases upon the results of endoscopic retrograde pancreatography. Fasting plasma glucose, glycated hemoglobin (HbA1c), total serum cholesterol, triglycerides, urea and creatinine concentrations were measured. Fundoscopy was performed in all the subjects, in addition fluorescein examination was conducted in 15 and 18 patients from groups 1 as 2 respectively. Fasting plasma glucose, HbA1c level and insulin requirement were significantly lower in CAP-DM patients than in type 1 diabetes subjects (133 +/- 48 vs 174 +/- 59 mg/dl, p < 0.01; 8.3 +/- 2.0 vs 9.8 +/- 1.1%, p < 0.01; 36 +/- 15 vs 57 +/- 11 IU/day, p < 0.001 respectively). However, the prevalence of background retinopathy (group 1-13/25, group 2-11/25), and microalbuminuria (group 1-14/25, group 2-13/25) was similar in both groups. No statistically significant differences were found between CAP-DM and type 1 diabetic patients in regard to blood lipids, triglycerides, urea and creatinine concentrations. We conclude that microvascular complications may be encountered in pancreatic diabetes as often as in type 1 diabetes. Therefore this particular type of secondary diabetes should be regarded by no means as a "milder" type of the disease.