Low back pain in patients hospitalised with liver cirrhosis- a retrospective study.

BACKGROUND: Lower back pain is a common issue, but little is known about the prevalence of pain in patients with liver cirrhosis during hospitalisation. Therefore, the objective of this study was to determine lower back pain in patients with liver cirrhosis. METHODS: The sample consisted of patients with liver cirrhosis (n = 79; men n = 55; women n = 24; mean age = 55.79 ± 12.52 years). The hospitalised patients were mobile. The presence and intensity of pain were assessed in the lumbar spine during hospitalisation. The presence of pain was assessed using the visual analogue pain scale (0-10). The range of motion of the lower spine was assessed using the Schober and Stibor tests. Frailty was measured by Liver Frailty Index (LFI). The condition of liver disease was evaluated using The Model For the End-Stage Liver Disease (MELD) and Child-Pugh score (CPS) and ascites classification. Student's t test and Mann-Whitney test were used for analysis of the difference of group. Analysis of variance (ANOVA) with the Tukey post hoc test was used to test differences between categories of liver frailty index. The Kruskal-Wallis test was used to test pain distribution. Statistical significance was determined at the α-0.05 significance level. RESULT: The prevalence of pain in patients with liver cirrhosis was 13.92% (n = 11), and the mean intensity of pain according to the visual analogue scale was 3.73 (± 1.90). Lower back pain was present in patients with ascites (15.91%; n = 7) and without ascites (11.43%; n = 4). The prevalence of lower back pain was not statistically significant between patients with and without ascites (p = 0,426). The base of Schober's assessment mean score was 3.74 cm (± 1.81), and based on Stibor's assessment mean score was 5.84 cm (± 2.23). CONCLUSION: Lower back pain in patients with liver cirrhosis is a problem that requires attention. Restricted spinal mobility has been reported in patients with back pain, according to Stibor, compared to patients without pain. There was no difference in the incidence of pain in patients with and without ascites.

Improved diagnosis by automated macro- and micro-anatomical region mapping of skin photographs.

BACKGROUND: The exact location of skin lesions is key in clinical dermatology. On one hand, it supports differential diagnosis (DD) since most skin conditions have specific predilection sites. On the other hand, location matters for dermatosurgical interventions. In practice, lesion evaluation is not well standardized and anatomical descriptions vary or lack altogether. Automated determination of anatomical location could benefit both situations. OBJECTIVE: Establish an automated method to determine anatomical regions in clinical patient pictures and evaluate the gain in DD performance of a deep learning model (DLM) when trained with lesion locations and images. METHODS: Retrospective study based on three datasets: macro-anatomy for the main body regions with 6000 patient pictures partially labelled by a student, micro-anatomy for the ear region with 182 pictures labelled by a student and DD with 3347 pictures of 16 diseases determined by dermatologists in clinical settings. For each dataset, a DLM was trained and evaluated on an independent test set. The primary outcome measures were the precision and sensitivity with 95% CI. For DD, we compared the performance of a DLM trained with lesion pictures only with a DLM trained with both pictures and locations. RESULTS: The average precision and sensitivity were 85% (CI 84-86), 84% (CI 83-85) for macro-anatomy, 81% (CI 80-83), 80% (CI 77-83) for micro-anatomy and 82% (CI 78-85), 81% (CI 77-84) for DD. We observed an improvement in DD performance of 6% (McNemar test P-value 0.0009) for both average precision and sensitivity when training with both lesion pictures and locations. CONCLUSION: Including location can be beneficial for DD DLM performance. The proposed method can generate body region maps from patient pictures and even reach surgery relevant anatomical precision, e.g. the ear region. Our method enables automated search of large clinical databases and make targeted anatomical image retrieval possible.

Observer-independent assessment of psoriasis-affected area using machine learning.

BACKGROUND: Assessment of psoriasis severity is strongly observer-dependent, and objective assessment tools are largely missing. The increasing number of patients receiving highly expensive therapies that are reimbursed only for moderate-to-severe psoriasis motivates the development of higher quality assessment tools. OBJECTIVE: To establish an accurate and objective psoriasis assessment method based on segmenting images by machine learning technology. METHODS: In this retrospective, non-interventional, single-centred, interdisciplinary study of diagnostic accuracy, 259 standardized photographs of Caucasian patients were assessed and typical psoriatic lesions were labelled. Two hundred and three of those were used to train and validate an assessment algorithm which was then tested on the remaining 56 photographs. The results of the algorithm assessment were compared with manually marked area, as well as with the affected area determined by trained dermatologists. RESULTS: Algorithm assessment achieved accuracy of more than 90% in 77% of the images and differed on average 5.9% from manually marked areas. The difference between algorithm-predicted and photograph-based estimated areas by physicians was 8.1% on average. CONCLUSION: The study shows the potential of the evaluated technology. In contrast to the Psoriasis Area and Severity Index (PASI), it allows for objective evaluation and should therefore be developed further as an alternative method to human assessment.

Prevalence of sarcopenia among hospitalized internal medicine patients: A cross-sectional single-center pilot study according to EWGSOP2 criteria.

INTRODUCTION: Sarcopenia is associated with a higher risk of adverse outcomes among hospitalized patients with chronic diseases. Currently, an unmet need lies in its low diagnostic yield. We conducted a pilot study with the aim to screen hospitalized patients for sarcopenia using the EWGSOP2 criteria. PATIENTS AND METHODS: A cross-sectional study among hospitalized patients in internal medicine was carried out, inclusion criteria: age>55, ability to stand-up from a chair. EXCLUSION CRITERIA: bed-bound, terminal stages of the disease, ICU stay. We measured hand-grip strength, fat-free mass by bioimpedance and short physical performance battery test (SPPB). Sarcopenia was diagnosed in low hand-grip strength and low muscle mass (EWGSOP2), severe sarcopenia in sarcopenic patients with low physical performance (SPPBT≤8). RESULTS: 40 patients were enrolled, sarcopenia was diagnosed in 8/20 (40%) men and 3/20 (15%) women (p=0.15), severe sarcopenia in 6/20 men (30%) and 2/20 (10%) women (p=0.24). 65% of men and 40% of women had SPPBT≤8, and 60% of men and 55% of women had gait speed≤0.8m/s. CONCLUSION: Among hospitalized internal medicine patients sarcopenia and severe sarcopenia are common, particularly in males. New diagnostic criteria provide a relatively simple and applicable tool for screening among internal medicine inpatients (Tab. 3, Ref. 25).

Influence of vitamin D on the expression of mRNA of cytokines in the mucosa of inflammatory bowel disease patients.

The aim of this study was to analyze the influence of 25(OH)VD serum concentration on the expression of mRNA cytokines (IL-6, IL-8, IL-12, IL-17, IL-23, TNFα, CCR1, CCR2, CCR5, CCR9, CCL5, TLR2, TLR4, TLR5, CD207 ,CD206, FoxP3) in mucosa of IBD patients. The cohort consisted of 86 IBD patients (48 CD and 38 UC) followed at the IBD center of University Hospital Bratislava-Ruzinov. We performed colonoscopy in each patient and took biopsies from mucosa of sigma and terminal ileum. Serum concentration of 25(OH)VD was assessed at the time of colonoscopy. mRNA was extracted from mucosal biopsy samples for each cytokine. Then we analyzed the correlation between VD and the expression of mRNA of cytokines from biopsies samples.  In CD we observed a significant positive correlation of serum concentration 25(OH)VD and the expression mRNA level of IL-6. There was also trend towards significant positive correlation of the expression mRNA of TNFα, IL-10, IL-23, TLR 2 in inflamed mucosa of terminal ileum as well as the expression mRNA of CCR5 and CCR1 in non-inflamed mucosa from terminal ileum. We also found a trend towards positive correlation between 25(OH)VD and the expression mRNA of IL-23, TLR4, CD 207, CCR1, CCR5 and CD 206 in non-inflamed mucosa of sigma in UC.VD significantly correlated with the levels of expression of several inflammatory cytokines including TNFα in colonic mucosa of patients with IBD (Tab. 4, Fig. 3, Ref. 31).

[Automated two-point discrimination (TPD) for phantom pain : Effect of a 3­week automated therapy based on TPD for a transtibial amputee with phantom pain]. / Automatisierte Zweipunktdiskrimination bei Phantomschmerzen : Effekt einer 3­wöchigen automatisierten Therapie auf der Basis der Zweipunktdiskrimination (ZPD) bei einem unterschenkelamputierten Patienten mit Phantomschmerzen.

There is preliminary evidence that phantom pain is associated with disturbed organization of the sensory cortex and that this organization can be normalized with two-point discrimination (TPD) training. In this case study, a reduction in phantom pain and painful phantom sensation during a test period of 19 days, was achieved using an automated TPD procedure. In a patient with a transtibial amputation, pain levels decreased from a mean of 2.3/10 on the visual analog scale (VAS) to 1.3/10 (VAS) and the painful phantom sensation level decreased from a mean 3.7/10 (VAS) to 2.0/10 (VAS). These results show a positive trend, but are (except of the nocturnal pain attacks) rather of limited clinical relevance.

[Limitations of SMILE (Small Incision Lenticule Extraction)]. / Grenzen von SMILE (Small Incision Lenticule Extraction).

Background SMILE is a relatively new technique to correct moderate and high myopia. The limits of SMILE are yet unknown. Methods Literature research using PubMed until October 1, 2016. Results/Discussion Recently presented axial 2D-strain-stress measurements indicate that the biomechanical impairment of the cornea after SMILE and LASIK is comparable. The difference in elastic moduli is statistically not different. The visual rehabilitation after SMILE takes significantly longer (weeks) compared to LASIK (days). The refractive success rate of SMILE is still not as good as that of LASIK (88 % vs. 95 % within ± 0.5 D) but SMILE has caught up during the past years. The problem of reoperations is not yet solved. Conclusion More technical and clinical improvements are required to make SMILE comparable to LASIK regarding success rate and patient convenience. The biomechnical argument pro SMILE has turned out to be weak. To achieve the improvements a commercially competing femtosecond laser would be of advantage.

Relapse rates of inflammatory bowel disease patients in deep and clinical remission after discontinuing anti-tumor necrosis factor alpha therapy.

BACKGROUND AND AIMS: Relapse rates after discontinuing anti-tumor necrosis factor-α (TNFα) therapy of inflammatory bowel disease (IBD) patients in deep remission are poorly understood. This prospective single-center open-label study evaluated the relapse rates of IBD patients after stopping anti-TNFα therapy. METHODS: All IBD patients who were in clinical remission and stopped anti-TNFα therapy in 2011-2013 and were followed up for at least 12 months were enrolled. The "Ultradeep" patients were in calprotectin-negative (<50 ng/g) deep remission for at least six months and ceased anti-TNFα therapy on physician recommendations. The "clinical" patients were in clinical but not deep remission and ceased anti-TNFα therapy for other reasons. Relapse rates were assessed and relapse risk factors identified. RESULTS: One year after stopping, 27 % and 27 % of the Ultradeep (n = 11) and Clinical (n = 11) patients relapsed, respectively. Two years after stopping, 57 % and 62 % relapsed, respectively (p = 0.89). All relapsed patients who underwent retreatment with anti-TNFα therapy re-entered remission. Male sex was a significant risk factor for relapse (p = 0.03). CONCLUSION: Our study showed that even highly selected IBD patients who lack clinical, endoscopic or laboratory signs of disease activity have a relatively high relapse rate in the follow-up period after ceasing anti-TNFα therapy (Tab. 2, Fig. 3, Ref. 24).

[Two-point discrimination for phantom pain: effect of a 4-week therapy in an upper arm amputee with phantom pain]. / Zweipunktediskrimination bei Phantomschmerzen: Effekt einer 4-wöchigen Therapie bei einem oberarmamputierten Patienten mit Phantomschmerzen.

There is evidence that phantom pain is associated with a disrupted organization of the sensory cortex and that this organization can be normalized by training with two-point discrimination (TPD). In this case study a reduction in all three phantom modalities (i.e. phantom pain, phantom feeling and painful phantom sensation) and a reduction in pain level from m= 4.13/10 visual analogue scale (VAS) to m= 0.67/10 (VAS) could be observed in a patient with an upper limb amputation during a test period of 28 days with TPD. The quality of life and performance increased significantly. This can be a promising indication for a better social and work reintegration.

The prevalence and risk factors for osteoporosis in patients with inflammatory bowel disease.

AIM: Osteoporosis is a known chronic complication of inflammatory bowel diseases (IBD). The aim of our study was to describe the prevalence of reduced bone mineral density (BMD) in IBD patients and to identify crucial risk factors for osteoporosis. METHODS: The cohort consisted of 76 IBD patients, 40 with Crohn's disease (CD) and 36 with ulcerative colitis (UC). Clinical characteristics of every patient were recorded, i.e. age, sex, duration of the disease, clinical behavior, location of disease according to Montreal classification, surgeries, steroid medication, sIBDQ, and smoking habits. We examined the serum 25-hydroxyl vitamin D3 (25-OHD3) in each patient. The BMD was determined by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral neck. RESULTS: Osteoporosis was documented in 10 IBD patients (13.2 %), while osteopenia in 35 of them (46.1 %). Patients with CD have significantly lower femoral Z score than patients with UC. Femoral Z score was strongly associated with disease duration, and in CD patients suffering from stricturing form, with ileic or ileocolic location and history of proctocolectomy or total colectomy. Patients with osteoporosis had a significantly lower level of 25-OHD3 than patients with normal BMD. CONCLUSION: Patients with long disease duration and those suffering from stricturing form of CD with ileic/ileocolic location and history of proctocolectomy/total colectomy are at higher risk of developing osteoporosis than other IBD patients. The high proportion of osteopenia/osteoporosis in our study underlines the importance of BMD measurement in all IBD patients as a base for initiating the appropriate treatment (Tab. 1, Fig. 3, Ref. 63).

Effect of growth hormone on bone status in growth hormone-deficient adults.

BACKGROUND: Growth hormone deficiency (GHD) is associated with reduced bone mineral content and increased risk of osteoporotic fractures. Reduced peak bone mass might explain the low bone mineral density (BMD) among patients with childhood onset GHD (CO-GHD) whilst the cause of osteopenia in adult-onset GHD (AO-GHD) is not fully understood. OBJECTIVES: Prospective multicentric study to asses bone status in GHD adults after two years of recombinant growth hormone replacement treatment. METHODS: In 94 GHD adults (49 men; Ø 34.5 yrs) we have measured BMD and bone markers (CTX, osteocalcin) during two years of rhGH treatment (at baseline, after 3 and 6 months, and after 1 and 2 years). Patients were adequately substituted for GHD and other pituitary deficiencies. RESULTS: We have observed an increase in BMD-lumbar spine: n=42, 0.8155 →0.9418 g/cm2, p<0.0001; femoral neck n=41; 0.8468 →0.9031; p= 0.0004; BMD-whole body 1.0179 →1.0774; p=0.0003. We have compared gender difference: BMD-L-spine by 15.8 % in men (n=21) and by 5.6 % in women (n=19) (p= 0.008); BMD-femoral neck increased by 11.03 % in men and by about 3.0 % in women (p=0.032). In women, the initial decrease in BMD was recorded after 3 months. CO-GHD adults yielded a higher increase in BMD -L-spine (16.6 %, p=0.022). A correlation exists between IGF-I levels and BMD in lumbar spine (1st year: R=0.348, p=0.026; 2nd year: R= 0.33, p=0.0081) and between IGF-I and osteocalcin (1st year: R=0.383; p=0.0038). CONCLUSION: Two-year therapy with recombinant human growth hormone improved bone status. IGF-I appears to be a good indicator of rhGH effect on bone (Tab. 3, Fig. 9, Ref. 36). Text in PDF www.elis.sk.

The impact of thiopurine-S-methyltransferase genotype on the adverse drug reactions to azathioprine in patients with inflammatory bowel diseases.

BACKGROUND AND AIMS: The thiopurine drugs, azathioprine (AZA) and 6-mercaptopurine, are established in the treatment of inflammatory bowel diseases (IBD). Polymorphisms in thiopurine S-methyltransferase (TPMT) gene have been associated with adverse drug reactions (ADRs) to AZA. METHODS: The aim of this study was to evaluate TPMT polymorphisms and AZA-related toxicity in a Slovak cohort of 220 IBD patients treated with AZA. In every patient, the dose and duration of AZA therapy, concomitant 5-aminosalicylate (5-ASA) medication, frequency, type, time to onset, dose of ADR and concomitant 5-ASA at the onset of ADR were recorded. Each patient was also genotyped for the presence of variant TPMT alleles (*2,*3A,*3B,*3C). Frequency, type and circumstances of ADRs were compared according to TPMT status. RESULTS: Of the 220 patients, 205 (93.2 %) were wild-type (TPMT*1/*1), one (0.5%) carried a TPMT*1/*3C allele, 13 (5.9 %) carried TPMT *1/*3A allele and one was homozygous for TMPT *3A allele. No TPMT *2 mutation was found. The incidence of adverse drug reactions was 62/205 (30.2 %) in the wild-type group as compared to 13/15 (86.7 %) in the TPMT mutation group, p=2.10-5. Leukopenia (WBC< 3.0*10^9/L) occurred in 21/205 (10.2 %) patients with wild type TPMT versus 11/15 (73.3 %) patients with TPMT mutations, p=0.000001. There was no significant difference between TMPT groups in gastrointestinal or other ADRs. No impact of 5-ASA on the incidence and severity of AZA adverse drug reactions was observed. CONCLUSION: The incidence of leukopenia in TPMT mutant patients was significantly higher and more severe as compared to TPMT wild type patients. We observed no impact of concomitant 5-ASA therapy on AZA induced toxicity (Tab. 4, Fig. 2, Ref. 37).

[Prevention, diagnosis and treatment of bleeding in cardiac surgery]. / Prevención, diagnóstico y tratamiento de la hemorragia en cirugía cardiaca.

Patients undergoing cardiac surgery are at high risk of bleeding and transfusion. This risk has increased in recent years and is associated with increased morbidity and mortality. Moreover, despite being one of the most common complications associated with this surgery, there remains a large variability in its management between institutions. Implementation of algorithms for coagulation management has been shown to reduce transfusion requirements and therefore it seems essential to establish protocols that include preventive measures, effective mechanisms for diagnosis and treatment algorithms. On the other hand, the emergence of new drugs and the use of point of care coagulation monitoring systems, is changing our diagnostic and therapeutic options. This paper reviews several aspects related to the causes, diagnosis and treatment of bleeding associated with cardiac surgery and presents an algorithm for its management.

[Intramural esophageal dissection]. / Intramurálna disekcia pazeráka.

The intramural esophageal dissection is a rare condition with benign course, good prognosis and low mortality. It is difficult to differentiate it from an esophageal perforation at the presentation time. The conservative therapy should be considered as the treatment of choice in most cases. Complications such as esophageal perforation, massive bleeding or persistence of the symptoms are well accepted indications for surgical procedure. Radical treatment in the form of esophagectomy is extremely rare and it is usually indicated only for patients with complicated esophageal perforation. The authors offer two cases with female patients suffering from the intramural esophageal dissection who were indicated for esophagectomy without any proven esophageal perforation.

Comparison of the quality of life of patients with liver cirrhosis before and during the COVID-19 lockdown in Slovakia.

Liver cirrhosis is associated with a poor quality of life (QOL). The COVID-19 pandemic has led to several restriction measures and psychosocial consequences whose impact on QOL has combined with that of cirrhosis in an unknown way. Therefore, we have used our cirrhosis registry to assess the quality of life before the pandemic (on the first admission to the tertiary liver unit) and during the most pronounced phase of the first lockdown. In this cross-sectional study conducted during the first lockdown in Slovakia (from April to May 2020), we have repeated the QOL measurement of QOL in cirrhotic patients previously enrolled in the RH7 registry. Patients who were alive (according to the national registry of deaths) were identified and contacted by phone with a structured and standardized interview led by trained professionals. The tool used for both QOL measurements (at enrolment in RH7 and during lockdown) was a standardized and validated EuroQOL-5D (EQ-5D) questionnaire. The study included 97 patients, of which 37 (38.1%) were women and 60 (61.9%) were men. Responses were achieved from 75 patients (68.18%). In general, patients scored their quality of life significantly higher during the pandemic compared to examination at admission to RH7 (that is, at admission to our tertiary liver unit with cirrhosis) (p = 0.005). In particular, of the domains included in EQ-5D: (1) self-care was better during lockdown compared to the first record on admission to RH7 (p < 0.001). (2) the ability to perform daily activities has also improved during lockdown (p = 0.002). On the other hand, (3) pain and discomfort did not change significantly during the lockdown compared to the previous measurement (p = 0.882). (4) anxiety and depression were lower during lockdown compared to admission to RH7 (p = 0.01). The quality of life in patients with liver cirrhosis was better during the lockdown of SARS-CoV-2 compared to the previous measurement at admission to the tertiary liver unit.

Vitamin D deficiency - a possible link between osteoporosis and metabolic syndrome.

OBJECTIVES: The aim of our study was to evaluate the relationship between bone mineral density (examined by DXA - dual energy x-ray absorptiometry), vitamin D3 levels and the signs of metabolic syndrome. METHODS: We examined 55 subjects (37 women, 18 men, age median 67.8 years) with no history of osteoporosis, suffering from metabolic syndrome (defined as abdominal obesity and more than 2 of other components - arterial hypertension, dyslipidemia and diabetes mellitus or impaired glucose tolerance, according to IDF, 2006). RESULTS: Osteoporosis (T-score less than - 2.5) was found in 32.7 % (15 women and 3 men) and osteopenia (T-score between - 1.5 and - 2.5) in 29 % (13 women and 3 men) of patients. We observed a negative correlation between BMI and fat percentage (examined by DXA) and vitamin D3 levels. Low concentration of vitamin D3 was found in 90 % of patients with median 19.36 ug/l (64 % measured in winter, 36 % in summer, no relationship between vitamin D3 levels and season). We also observed a negative correlation between the low concentration of vitamin D3 and presence of diabetes mellitus as a part of metabolic syndrome. CONCLUSION: The link between osteoporosis and metabolic syndrome could influence the therapeutic approach in both disorders and vitamin D supplementation may play an important role in prevention of these severe conditions (Tab. 5, Fig. 1, Ref. 29).

[Toxic hepatitis induced by Polygonum multiflorum]. / Toxicka hepatitida po Polygonum multiflorum.

Toxic liver injury is a common cause of acute hepatitis. Here we report a case of 33-year old female with toxic hepatitis caused by unusual agent- extract of chinese plant Polygonum multiflorum. The patient presented with clinical signs of nausea and icterus and laboratory signs of hepatocellular damage following 2 months of readministration of Polygonum mulltiflorum pills. All other causes of hepatocellular damage were excluded. The causality between hepatocellular damage and Polygonum multiflorum ingestion was supported by early recovery after discontinuation, by international scoring system of causality between drug and hepatotoxicity as well as by similarities with other reports from the literature. Considering the growing popularity of herbal products as nutrition supplements we appeal to caution in using these preparations.

[Endocrine changes in liver disease]. / Endokrinné zmeny pri chorobách pecene.

Liver diseases have an influence on function and morphology of all endocrine glands. Knowledge of these specific changes is important in correct interpretation of pathological clinical and laboratory hormonal symptoms and signs induced by liver disease. We analyze the influence on the thyroid, bone metabolism, adrenocorticotropic axis, gonadal hormones, prolactin and growth hormone.

[The viewpoint of an internist on the problem of an aortoenteric fistula]. / Pohlad internistu na problematiku aortoenterálnej fistuly.

Aortoenteric fistula is an uncommon life-threatening disease; it can be divided into primary and secondary one. Primary aortoenteric fistula is the result of ongoing disease in the aorta and the intestine, secondary one is iatrogenic. Typical symptoms are abdominal pain and gastrointestinal bleeding (two-stage process). The most appropriate diagnostic method is CT aortography, treatment is only surgical. 75-year-old patient was admitted to the 5th Department of Internal Medicine in Bratislava due to progression of renal parameters, the patient had undergone an aortofemoral bypass 4 years ago. During the fourth day of his hospitalization the patient had a massive hematochezia with a shock state. After transient stabilization of the patient, 30 minutes after the first hematochezia, a massive hematemesis appeared and then the patient died. An autopsy has confirmed the secondary aortic-enteral fistula between the duodenum and the aneurysm arising from the aortofemoral bypass.

Ovarian Reserve Assessed by the Anti-Mullerian Hormone and Reproductive Health Parameters in Women With Crohn´s Disease, a Case-Control Study.

According to several studies, women with Crohn's disease (CD) had reduced fertility, which is mostly due to voluntary decisions and reduced ovarian reserve. In our study, we aimed to compare reproductive health parameters (RHP), previous pregnancy complications and outcomes, and ovarian reserve (OR) assessed by the anti-Mullerian hormone (AMH) in CD patients with healthy controls. In CD patients, we also compared OR according to disease phenotypes. Consecutive pre-menopausal women with CD from two IBD centers were included. The control group consisted of age and BMI-matched healthy controls. We used a questionnaire that included RHP, CD phenotype, and CD activity. Serum AMH was assessed by the Elecsys AMH plus essay. We enrolled 50 patients and 56 controls with a median age of 31 years. All CD patients were in clinical remission. We observed no difference in RHP or AMH (median 2.6 vs. 2.1 ug/l, p = 0.98), or the proportion of low OR (AMH<1,77, 38 vs. 41.1 %, p=0.84). The slope of age-related decrease did not differ between the groups. The subgroup of CD patients after surgery and those older than 30 years with CD for >5years had a steeper decrease in AMH (slope -0.12 vs. -0.29, p = 0.04 and -0.31 vs. -0.2, p = 0.029). In a multivariate analysis, age was the single independent predictor of low OR (OR=1.25). In women with Crohn's disease, once the disease activity is under control, the reproductive health and ovarian reserve do not substantially differ from healthy controls.