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Introduction: Patients with inflammatory bowel disease (IBD) have an increased risk to develop malignant neoplasms. Neither the exact mechanism, nor the frequency of different malignancies is completely clear. Our aim was to assess the IBD associated malignancies, to collect clinical and mortality data and to analyse possible risk factors. Methods: Data on malignancies developed between January 2015 and May 2019 in Hungarian IBD patients was recorded. Every member of the Hungarian Society of Gastroenterology was prospectively interviewed. The following data were collected: demographic data, disease characteristics, previous therapy, patient adherence, type and localisation of malignancies. Results: 140 IBD patients with newly diagnosed malignancies were reported. 61.4%, 35.7%, and 2.9% of the patients had ulcerative colitis (UC), Crohn’s disease (CD) and indeterminate colitis, respectively. The mean latency was 15.2±10.5 years. Colorectal cancer (CRC) was the most common cancer (49.6%, 70). 72.9% (51/70) of them was associated with UC, more than 80% had extensive (50.9%, 26) and left-sided (31.2%, 16) colitis. The most frequent CRC localisation was the rectosigmoid colon in UC (54.9%), and the rectum in CD (38.9%). The most common non-CRC malignancies were non-melanotic skin-cancer, haematological and pulmonary cancer. Disease duration at the time of the diagnosis of malignancy was lower (17.9±10.7 versus 12.6±9.7 years); mean age at the time of the death was higher (49.3±9.4 versus 64.3±16.4 years); and survival was longer after the diagnosis of extraintestinal malignancy than CRC (0.73±1.01 versus 1.2±0.8). Summary: CRC presented typically in the distal part of the colon by male UC patients with pancolitis or left-sided colitis with a long-standing disease course of IBD. The most common non-CRC malignancies were non-melanotic skin cancer, haematological cancer and lung cancer. Non-CRC malignancies developed typically in female patients, older than CRC patients with shorter disease-course of IBD and longer survival times.

In this cross-sectional, real-life study we have investigated the potential association between 6-thioguanine nucleotide (6-TGN) and anti-TNF [infliximab (IFX), adalimumab (ADA)], anti-drug antibody levels and body composition parameters. Based on our results thiopurine and anti-TNF combination therapy resulted in decreased antibody formation in IFX-treated patients. AZA-ADA-treated patients showed increased anti-TNF drug concentrations, regardless of antibody formation. Drug metabolites did not correlate with body composition parameters.

Although the exact aetiology of inflammatory bowel disease (IBD) is unknown, one hypothesis suggests that the inflammation may be the consequence of an altered or pathogenic microbiota in a genetically susceptible host. The aim of this study was to assess the frequency of enteral infections in patients with relapse of IBD, and to evaluate the clinical utility of faecal calprotectin (FC) and faecal matrixmetalloproteinase- 9 (MMP-9) in the differential diagnosis of relapses with different origins, and to determine the recurrence rate of Clostridioides difficile (C. difficile), the hospitalisation and colectomy rate among C. difficile positive IBD patients at the end of 4 years follow-up period. Methods: In this prospective, “real life” study clinical data, serum and stool samples were assessed. Results: Overall, 135 outpatients with IBD were enrolled [91 IBD patients who relapsed and 44 subjects in clinical remission (control group)]. C. difficile A/B toxins were detected in 42.2% of all cases. Candida was presented in 9.9% among the enrolled subjects. We found significant difference between FC and MMP-9 values in patients in relapse and remission, but not in C. difficile positive and negative cases. Our results revealed an association between previous antibiotic use and the rate of toxigenic C. difficile. Toxigenic C. difficile positivity recurrence rate was 4.4%. Hospitalisation during follow-up due to IBD was 45.4% and 35% in C. difficile positive and negative group, respectively. Value of FC and MMP-9 did not predict the need of hospitalisation. Conclusions: The occurrences of toxigenic C. difficile and Candida positivity were excessively high in our patients in an acute relapse, which suggests the importance of intestinal microbiota in IBD. FC and MMP-9 has no diagnostic value to differentiate between infection-induced and natural relapse. In our study was confirmed that hospitalisation rate was higher in C. difficile positive cases, but we did not find any relationship on long-term period.