Search

Colorectal neuroendocrine neoplasm (CRNEN), especially rectal tumours, are diagnosed with increased frequency due to the widespread use of colonoscopy, including screening examinations. It is important to constantly update and promote the principles of optimal diagnostics and treatment of these neoplasms. Based on the latest literature and arrangements made at the working meeting of the Polish Network of Neuroendocrine Tumours (June 2021), this paper includes updated and supplemented data and guidelines for the management of CRNEN originally published in Endokrynologia Polska 2017; 68: 250-260.

Updated Polish recommendations for the management of patients with neuroendocrine neoplasms (NENs) of the small intestine (SINENs) and of the appendix (ANENs) are presented here. The small intestine, and especially the ileum, is one of the most common locations for these neoplasms. Most of them are well-differentiated and slow-growing tumours; uncommonly - neuroendocrine carcinomas. Their symptoms may be untypical and their diagnosis may be delayed or accidental. Najczęściej pierwszą manifestacją ANEN jest jego ostre zapalenie. Typical symptoms of carcinoid syndrome occur in approximately 20-30% of SINENs patients with distant metastases. In laboratory diagnostics the assessment of 5-hydroxyindoleacetic acid concentration is helpful in the diagnosis of carcinoid syndrome. The most commonly used imaging methods are ultrasound examination, computed tomography, magnetic resonance imaging, colonoscopy and somatostatin receptor imaging. Histopathological examination is crucial for the proper diagnosis and treatment of patients with SINENs and ANENs. The treatment of choice is a surgical procedure, either radical or palliative. Long-acting somatostatin analogues (SSAs) are essential in the medical treatment of functional and non-functional SINENs. In patients with SINENs, at the stage dissemination with progression during SSAs treatment, with high expression of somatostatin receptors, radioisotope therapy should be considered first followed by targeted therapies - everolimus. After the exhaustion of the above available therapies, chemotherapy may be considered in selected cases. Recommendations for patient monitoring are also presented.

After another meeting of experts of the Polish Network of Neuroendocrine Tumours, updated recommendations for the management of patients with gastric and duodenal neuroendocrine neoplasms, including gastrinoma, have been issued. As before, the epidemiology, pathogenesis and clinical symptoms of these neoplasms have been discussed, as well as the principles of diagnostic procedures, including biochemical and histopathological diagnostics and tumour localisation, highlighting the changes introduced in the recommendations. Updated principles of therapeutic management have also been presented, including endoscopic and surgical treatment, and the options of pharmacological and radioisotope treatment. The importance of monitoring patients with gastric and duodenal NENs, including gastrinoma, has also been emphasised.

In this paper, we present the current guidelines for the diagnostics and management of pancreatic neuroendocrine neoplasms (PanNENs) developed by Polish experts providing care for these patients in everyday clinical practice. In oncological diagnostics, in addition to biochemical tests, molecular identification with the use of NETest liquid biopsy and circulating microRNAs is gaining importance. Both anatomical and functional examinations (including new radiopharmaceuticals) are used in imaging diagnostics. Histopathological diagnosis along with immunohistochemical examination still constitute the basis for therapeutic decisions. Whenever possible, surgical procedure is the treatment of choice. Pharmacological management including biotherapy, radioisotope therapy, targeted molecular therapy and chemotherapy are important methods of systemic therapy. Treatment of PanNENs requires a multidisciplinary team of specialists in the field of neuroendocrine neoplasms.

Gastrointestinal (GI) symptoms can be considered as a manifestation of coronavirus disease 2019 (COVID-19).Our study analysed GI symptoms depending on their occurrence, and their possible causes and impact on the course of COVID-19.A retrospective, single-centre assessment of the frequency, risk factors, and impact of GI symptoms in 441 patients with COVID-19.A statistically significant reduction in the length of stay (LOS) (15 days vs. 17 days;The GI symptoms that developed before admission to hospital correlated with reduced severity of the course of COVID-19. However, in the group of patients who developed GI symptoms during hospitalization, attention should be paid to concomitant treatment. The use of antibiotics should be limited because they are associated with the deterioration of the course of COVID-19; one of the reasons might be changes in the intestinal microbiome.

The aim of the study was to assess the effectiveness of a patented preparation of sodium butyrate in the triglyceride matrix at reducing clinical symptoms and improving quality of life in patients with irritable bowel syndrome (IBS).In this prospective multicenter clinical trial, we observed a total of 3000 non-hospitalized patients with confirmed IBS who were treated with sodium butyrate in a triglyceride matrix at a dosage of 150 mg twice a day for 12 weeks. The primary outcome was to evaluate the efficacy of sodium butyrate at reducing the severity of clinical symptoms and improving quality of life in patients with IBS.A total of 2990 complete surveys were collected. A statistically significant improvement in severity of abdominal pain was noticed (Sodium butyrate in the triglyceride matrix, as a postbiotic substance, may be effective in relieving the symptoms of IBS by modifying the intestinal microbiota.

Introduction: There are many known risk factors for osteoporosis (OST) among patients with inflammatory bowel disease (IBD), one of which is physical activity. Material and methods: The aim of the study is to assess the frequency and risk factors of OST among 232 patients with IBD compared to a group of 199 patients without IBD. The participants underwent dual-energy X-ray absorptiometry, laboratory tests, and completed a questionnaire about their physical activity. Results: It was found that 7.3% of IBD patients suffered from OST. Male gender, ulcerative colitis, extensive inflammation in the intestine, exacerbation of disease, rare physical activity, other forms of physical activity, past fractures, lower levels of osteocalcin, and higher levels of C-terminal telopeptide of type 1 collagen were risk factors for OST. As many as 70.6% of OST patients were rarely physically active. Conclusions: OST is a common problem in IBD patients. OST risk factors differ significantly between the general population and those with IBD. Modifiable factors can be influenced by patients and by physicians. The key to OST prophylaxis may be regular physical activity, which should be recommended in clinical remission. It may also prove valuable to use markers of bone turnover in diagnostics, which may enable decisions regarding therapy.

The article presents data on the mechanism of action of sulfasalazine and 5-ASA preparations. The latest meta-analysis and polish and ECCO recommendations for the treatment of patients with ulcerative colitis are also included.

Introduction Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, which is estimated to affect 20-30% of the adult population in Europe. Several studies have shown an association of NAFLD with multiple cardiovascular risk factors such as abdominal obesity, atherogenic dyslipidaemia, hypertension, insulin resistance, and impaired glucose tolerance. Atherosclerosis is a chronic, progressive, inflammatory disease, which begins early in life and follows a long asymptomatic phase. Coronary artery calcification (CAC) is the radiological confirmation of the presence of atherosclerotic coronary artery disease. The predictive value of CAC for future cardiac events is well established. Also, the progression of CAC is strongly associated with the development of cardiovascular events. Aim To assess the association of NAFLD with the progression of subclinical atherosclerotic activity, reflected as the dynamic changes in CAC score over time. Material and methods The databases PubMed/Medline/Embase from inception until 31 December 2020 were searched for observational studies investigating NAFLD and CAC progression in adults. Results In total, 5 studies were included, 4 of which, including 10,060 patients, provided data regarding the association of NAFLD with the progression of CAC. The analysis showed that NAFLD is associated with significant odds of progression of CAC; OR = 1.5, 95% CI: 1.34-1.68, p = 0.001. No publication bias was detected (Egger's test p = 0.6). Meta-regression analyses proved that OR toward CAC progression is not significantly influenced by the time of follow-up (coefficient = 0.0083, Z = 1.14, p = 0.25). Conclusions NAFLD increases the risk toward CAC progression over time.

BACKGROUND The aim of the study was to assess the rate of COVID-19 vaccination and the attitudes toward receiving COVID-19 vaccination among patients with inflammatory bowel disease (IBD) in Poland. An important aim of the study was to determine why some people get vaccinated and others refuse to do so. MATERIAL AND METHODS This was a single-center, prospective survey. The study included 267 IBD patients who agreed to complete an anonymous questionnaire comprising 31 questions. RESULTS We found that 71.2% of the IBD patients had been vaccinated. The history of COVID-19 was associated with a lower vaccination rate (16.9% vs 36.8%; P=0.001), regardless of IBD severity. In the vaccinated group, there were more vaccinated people among household members (90.4% vs 43.4%; p0.001) and friends (52.9% vs 22.4%; P0.001). Family safety (71.1%), the desire to avoid COVID-19 (67.9%), social responsibility (60.5%), the desire to return to normal life (51.6%), and faith in vaccination as such (43.2%) were the most common reasons for vaccination. The most common cause of non-vaccination was concern about adverse effects (50.0%), including long-term adverse effects (36.8%), and about the possible exacerbation of gastroenterological disease (34.2%). CONCLUSIONS IBD patients are more likely to be vaccinated against SARS-CoV-2 than the rest of the population in Poland. Young age, low socioeconomic status, low education, and living in the countryside were factors associated with lower vaccination rates. Family and friends had the greatest influence on the decision to vaccinate, but the influence of the mass media was very small.

Approximately 30% of patients with quiescent inflammatory bowel disease (IBD) meet the diagnostic criteria for irritable bowel syndrome (IBS). The aim of this study was to evaluate the effectiveness of a low-FODMAP diet in patients who meet the diagnostic criteria for IBS whilst in IBD remission. A total of 200 patients in remission of IBD were included in the study. Sixty-five of these patients (32.5%) were diagnosed with IBS according to the R4DQ. On the patients who met the IBS diagnostic criteria, anthropometric measurements, laboratory tests and lactulose hydrogen breath tests were performed. A low-FODMAP diet was introduced for 6 weeks. Of the 59 patients with IBS diagnosed at baseline for whom data were collected at the end of follow-up, after the low-FODMAP intervention IBS-like symptoms were not present in 66.1% (n = 39) (95% CI (53.4%; 76.9%)). The difference between the two groups (with SIBO at baseline (33 of 48 patients) and without SIBO at baseline (6 of 11 patients)) in the low-FODMAP diet’s effectiveness was not statistically significant (p = 0.586). The low-FODMAP diet improved the gut symptoms of flatulence and diarrhea. It had no effect on the occurrence of constipation. In IBD patients in remission who meet the IBS criteria, the dietary intervention of a low-FODMAP diet is effective for a reduction in IBS-like symptoms, regardless of the coexistence of bacterial overgrowth.

Gastrointestinal (GI) symptoms are a common manifestation of COVID‑19.We aimed to investigate whether GI symptoms persist in patients previously infected with SARS‑CoV‑2 in the form of post‑infection irritable bowel syndrome (PI‑IBS).A prospective, single‑center evaluation of questions regarding IBS was conducted using the Rome IV Adult Diagnostic Questionnaire among 257 patients previously hospitalized for COVID‑19.GI symptoms (abdominal pain with diarrhea or constipation) were reported at the following time points: at discharge from the hospital, and after 3 and 6 months of follow‑up. GI symptoms not meeting the full Rome IV diagnostic criteria for IBS due to too short symptom duration were reported by 28 individuals (10.6%) at hospital discharge, 58 (22.3%) after 3 months, and 70 (26.9%) after 6 months. The full Rome IV criteria for IBS were not met at discharge by any of the participants, but they were met after 3 and 6 months of follow‑up in 14 (5.4%) and 15 individuals (5.8%), respectively.Persistent GI symptoms following COVID‑19 are frequent and deserve significant and growing attention of gastroenterologists and other health care practitioners. The Rome IV criteria may be too strict to address the full spectrum of GI symptoms following COVID‑19.

OBJECTIVE: This study aimed to investigate the efficacy and safety of convalescent plasma (CP) transfusion in a group of high-risk COVID-19 patients. METHODS: This prospective study included 204 patients from a single tertiary-care hospital, hospitalized with COVID-19, of whom 102 were treated with CP administration and standard care (PG) and 102 others who received standard care only (CG). The CG was selected from 336 hospitalized patients using the propensity-score matching (PSM) technique using age, MEWS score, and comorbidities. The primary outcome was mortality rate; secondary outcomes were the requirement of a ventilator, length of ventilator need, length of intensive care unit (ICU) stay, and length of overall hospital confinement. Additionally, parameters predicting death in COVID-19 patients were identified. RESULTS: Findings confirmed a significantly lower mortality rate in the PG versus the CG (13.7% vs. 34.3 %, p = 0.001) and a significant difference in the cumulative incidence of death between the two groups (p < 0.001). CP treatment was associated with lower risk of death (OR = 0.25 CI95 [0.06; 0.91], p = 0.041). There were no significant differences in ICU stay, ventilator time, and hospitalization time between the two groups. CONCLUSIONS: A significantly lower mortality rate was observed in the group of patients treated with CP. Age, presence of cardiac insufficiency, active cancer, a ventilator requirement, and length of hospitalization significantly increased the risk of death in both groups. Our study shows that CP affords better outcomes when administrated in the earlier stage of high-risk COVID-19 disease.

Introduction Anaemia is the most common systemic and extraintestinal complication of inflammatory bowel disease (IBD). Its impact on quality of life is significant; hence, it is important for healthcare professionals to manage it correctly. Aim To assess the knowledge among doctors about the diagnostics and treatment of anaemia in IBD patients. Material and methods The questionnaire survey was conducted among 169 doctors of different specialties. Eighty-seven (51.5%) of the respondents were gastroenterologists. Results 97.7% (84) of gastroenterologists and 92.6% (75) of all responders replied that all IBD patients should be monitored for anaemia (p = 0.266); however, only one-third of gastroenterologists knew the exact haemoglobin cut-off level in men with Crohn's disease. The necessity of monitoring vitamin B12 was indicated by 53.7% (36) of gastroenterologists and by 24.1 % (13) of other specialists (p = 0.002). Nine percent (6) of gastrologists and 3.7% (2) of other specialists screened for folic acid (p = 0.0431). 13.1% (11) of gastroenterologists and 35% (28) of other specialists frequently used iv iron (p = 0.003). 44.1% (26) of gastroenterologists and 52% (26) of other specialists administered between 1000 mg and 1500 mg of iv iron during hospitalization. Only 11.9 % (7) of GI-specialists and 2% (1) of non-GI-specialists administered total doses over 1500 mg (p = 0.155). 71% (62) of gastroenterologists and 73% (60) of all physicians did not observe any adverse events of iv iron. Conclusions Although the diagnostic approach to anaemia in IBD patients varies among respondents, knowledge of guidelines was slightly better among GI-professionals then among other doctors.

Endoscopy is a procedure used for diagnostic and therapeutic purposes, which requires proper preparation. Patients with diabetes mellitus are particularly predisposed to inadequate cleansing for endoscopy due to slowing bowel movements, dietary preparation restrictions, glucose reduction, and the resulting symptoms of hypoglycaemia. So far, no comprehensive guidelines of preparation for endoscopic examinations for patients with these metabolic disorders have been developed. Considering the number of patients who may be subjected to colonoscopy and the possible effects of suboptimal preparation for the examination, the lack of such recommendations seems to be a significant gap in the healthcare system. The article reviews the literature on the above topic.

Irritable bowel syndrome (IBS) – functional gastrointestinal disorder (FGIDs) and disorder of gut-brain interaction (DGBIs) – has emerged as an important medical problem with an impact on health care systems, affecting patients’ quality of life. The management of IBS consists of pharmacological and non-pharmacological treatments; however, the data of their long-term efficacy are scarce. Modulation of gastrointestinal microbiota, by means of probiotics and prebiotics, is often sought and advertised as a popular treatment modality in IBS. Faecal microbiota transplantation (FMT) awaits recommendations for IBS treatment and requires more methodological assessments. To date, numerous guidelines and recommendations have been published on the role of probiotics in IBS. Because no probiotic claim for probiotics in foods has yet been granted by the European Food and Safety Authority (EFSA), medical practitioners still recommend probiotics on the basis of available literature and recommendations released by independent health authorities. We aimed to summarize published formal recommendations and guidelines regarding the clinical effectiveness of available probiotic strains and conduct a random-effects meta-analysis of outcomes for which ≥ 2 studies contributed data on the same probiotic strain recommended to adults with IBS. Based on available and most recent guidelines, we report that probiotics, as a group, may be an effective treatment for global symptoms and abdominal pain in IBS, with the strongest effect for genus Lactobacillus. Our current and updated meta-analysis is in line with several reports documenting significant effects of Lactobacillus plantarum (Lp299v) in reducing the risk of global symptoms and their persistence, which could assist clinicians in making the choice for the right probiotic strain in IBS patients.

This paper is an update of the diagnostic and therapeutic recommendations of the National Consultant for Gastroenterology and the Polish Society of Gastroenterology from 2012. It contains 46 recommendations for the diagnosis and treatment, both pharmacological and surgical, of Crohn's disease in adults. The guidelines were developed by a group of experts appointed by the Polish Society of Gastroenterology and the National Consultant in the field of Gastroenterology. The methodology related to the GRADE methodology was used to assess the quality and strength of the available recommendations. The degree of expert support for the proposed statement, assessment of the quality of evidence and the strength of the recommendation was assessed on a 6-point Likert scale. Voting results, quality and strength ratings with comments are included with each statement.

The pancreas has dual functions, endocrine and exocrine, that complement each other and work closely together, contributing to the digestion, absorption, and metabolism of foods. More than a decade ago, it was demonstrated that pancreatic exocrine insufficiency occurs in a significant number of patients with diabetes mellitus. Diabetes mellitus affects virtually every organ system in the body, and the degree of organ involvement depends on the duration and severity of the disease, as well as other co-morbidities. Gastrointestinal side effects include pancreatopathy, small intestinal bacterial overgrowth, oesophageal dysmotility, gastroesophageal reflux disease, gastroparesis, neuropathy, and nonalcoholic fatty liver disease.

Continuous progress in the diagnostics and treatment of neuroendocrine neoplasms (NENs), the emerging results of new clinical trials, and the new guidelines issued by medical societies have prompted experts from the Polish Network of Neuroendocrine Tumours to update the 2017 recommendations regarding the management of neuroendocrine neoplasms. This article presents the general recommendations for the management of NENs, resulting from the findings of the experts participating in the Fourth Round Table Conference, entitled "Polish Guidelines for the Diagnostics and Treatment of Neuroendocrine Neoplasms of the gastrointestinal tract, Żelechów, June 2021". Drawing from the extensive experience of centres treating these cancers, we hope that we have managed to formulate the optimal method of treating patients with NENs, applying the latest reports and achievements in the field of medicine, which can be effectively implemented in our country. The respective parts of this work present the approach to the management of: NENs of the stomach and duodenum (including gastrinoma), pancreas, small intestine, and appendix, as well as large intestine.

Introduction Data comparing response to originator and biosimilar infliximab in anti-TNF-α naïve and non-naïve Crohn’s disease patients is limited. Aim To assess the efficacy, safety, and tolerability of a biosimilar infliximab in comparison to the originator drug in anti-TNF-α naïve and non-naïve Crohn’s disease patients. Data comparing response in those two groups of patients are limited. Material and methods This retrospective single-centre study enrolled 168 adult Crohn’s disease patients treated for 1 year with infliximab originator or biosimilar. Assessment included achievement of clinical remission (during induction and maintenance therapy and follow-up period – 24 months) and occurrence of adverse events. Results Forty-seven patients taking infliximab and 68 on biosimilar were anti-TNF-α naïve. There were no differences in clinical remission rate between naïve and non-naïve patients after 1 year of treatment (infliximab – 80.9% and 73.1%, respectively; biosimilar – 79.4% and 74.1%, respectively). The relapse rate during the follow-up period was higher in anti-TNF-α non-naïve patients (p < 0.001) with no significant differences between two groups. Adverse events were more common in anti-TNF-α non-naïve patients with no difference between infliximab and biosimilar groups (13.3% vs. 17.6%, respectively). The infliximab group of anti-TNF-α naïve patients had a higher rate of adverse events compared to the biosimilar (8.1% vs. 1.9%), but it did not reach statistical significance. Conclusions This is a study comparing anti-TNF-α naïve and non-naïve patients with Crohn’s disease. Relapse rate during follow-up was significantly higher in anti-TNF-α non-naïve patients, but with no significant differences between originator and biosimilar.

Short-chain fatty acids produced by bacteria living in the large intestine are the main energy substrate for the colonocytes. Butyric acid is used for the treatment and prevention of exacerbations of various gastrointestinal diseases: diarrhoea, intestinal inflammations, functional disorders, dysbiosis, and post-surgery or post-chemotherapy conditions. The current standard doses of butyric acid (150–300 mg) range between 1.5–3% and 15–30% of the reported daily demand. Increased metabolism of the colonocytes in conditions involving intestine damage or inflammation, increased energy expenditure during a disease, stimulation of intestine growth in ‘stress’ conditions with accelerated intestinal passage and increased intestinal excretion, and decreased production of endogenous butyrate due to changes in bacterial flora in different pathological conditions require a significant increase of the supply of this acid. Physiological high demand for butyrate and known mechanisms of pathological conditions indicate that current supplementation doses do not cover the demand and their increase should be considered.

Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP), with incidence rates ranging between 2% and 16%. In addition to being experienced in endoscopic procedures and having knowledge of the patient qualification criteria, physicians should also be aware of the patient and procedure-related risk factors responsible for post-ERCP pancreatitis (PEP). Intrarectal administration of nonsteroidal anti-inflammatory drugs and pancreatic duct stenting were demonstrated to be efficient in high-risk patients. This review provides a broader summary of pharmacological methods and techniques aimed at reducing the risk of PEP.

Aim The aim of the study was to determine the suitability of available diagnostic methods, by means of comparison, for predicting disease activity, based on cost efficiency and sensitivity criteria. Material and methods In this study, we conducted analyses of 37 patients with Crohn's disease (CD). CD was graded as "active" or "inactive" by adopting certain cut-off values for every marker. The main assumption was that methods used to grade CD severity do not give false positive results. The authors decided to measure the agreement between the methods by applying Cohen's κ coefficient. Results Endoscopy shows the highest sensitivity, negative predictive value, and accuracy in detecting CD. In the case of both intestines, the sensitivity of endoscopy reached 93.9% and the accuracy 94.6%, while the sensitivity and accuracy of enterography and calprotectin were 51.5% vs. 71,9% and 56.8% vs. 72.2%, respectively. For the large intestine, the sensitivity and accuracy of endoscopy reached 100%. For the small intestine, endoscopy had 55% sensitivity and 75% accuracy, while enterography showed only 66.7% and 81.1%, respectively. The best agreement (77.1%, p = 0.005) was seen between endoscopy and calprotectin for full intestines. However, the value of Cohen's κ suggests that this agreement is moderate. The optimal cut-off value for calprotectin was 43 µg/g, and the ROC curve (AUC = 0.871) was large enough to conclude that calprotectin is a statistically significant (p < 0.001) indicator of CD activity. Conclusions Statistically significant compliance was shown only between colonoscopy and faecal calprotectin.

Introduction: The first cases of coronavirus disease 2019 (COVID-19) were noted in December 2019 in Wuhan province, China The World Health Organisation (WHO) announced the pandemic status on March 11, 2020 The manifestations of the disease are as follows: fever, cough, fatigue, anosmia and ageusia, dyspnoea, chest pain, muscle soreness, chills, sore throat, rhinitis, headache, gastrointestinal (GI) symptoms, and dermal lesions Aim: To evaluate the relationship between dermal lesions and GI symptoms in a group of COVID-19 patients Material and methods: A group of 441 COVID-19 patients admitted to the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw between March 15th and June 15th, 2020 Results: Of 441 patients with confirmed SARS-CoV-2 infection, 255 (58 5%) experienced gastrointestinal (GI) symptoms: lack of appetite was reported in 124 (48 6%) cases, diarrhoea was noted in 109 (42 7%), abdominal pain in 95 (37 3%), vomiting in 37 (14 5%), and nausea in 32 (12 5%) cases Eight (1 81%) patients had dermal lesions: erythematous macular lesions (2 patients - 25%), erythematous infiltrated lesions (2;25%), erythematous infiltrated and exfoliative lesions (3;37 5%), erythematous papular lesions (3;37 5%), and erythematous oedematous lesions (2;25%) All of those patients reported gastrointestinal symptoms during the hospitalisation Conclusions: The following study analyses possible causes of dermal lesions and their coexistence with GI symptoms Several possible theories were taken into account, including the microbiota alterations and issue of drug-related complications © 2020 Termedia Publishing House Ltd All rights reserved

Thank you for your comment and interest [...].

Inflammatory bowel disease has become a global health problem at the turn of the 21st century. The pathogenesis of this disorder has not been fully explained. In addition to non-modifiable genetic factors, a number of modifiable factors such as diet or gut microbiota have been identified. In this paper, the authors focus on the role of nutrition in the prevention of inflammatory bowel disease as well as on the available options to induce disease remission by means of dietary interventions such as exclusive and partial enteral nutrition in Crohn’s disease, the efficacy of which is reported to be comparable to that of steroid therapy. Diet is also important in patients with inflammatory bowel disease in the remission stage, during which some patients report irritable bowel disease-like symptoms. In these patients, the effectiveness of diets restricting the intake of oligo-, di-, monosaccharides, and polyols is reported.

Diet plays an important role in the pathogenesis of inflammatory bowel disease. It has an impact on microbiome, host barrier, and immune response. Clinical studies indicate that various dietary interventions such as exclusive enteral nutrition and exclusion diets might be useful for induction of remission in mild to moderate Crohn's disease, but also for patients failing biological therapy. Current treatment strategies try to solve the problem of poor patient compliance due to the required strict dietary regime. The number of adverse events associated with the use of dietary alternatives is incomparable with the side effects of glucocorticosteroids or biological treatment, which makes them a tempting therapeutic option.

(1) Background: The use of virtual reality (VR) in improving patient comfort related to medical procedures in oncology patients raised the question of whether similar benefits could be obtained by patients with inflammatory bowel disease (IBD). (2) Methods: In this prospective, randomized, controlled, single-center clinical trial, a total of 90 patients with IBD treated with vedolizumab were enrolled and randomized in a 1:1 allocation to either the VR immersion group or the routine-treated group. The primary outcome was to evaluate whether VR could decrease stress and anxiety related to a medical procedure. The secondary outcome was to assess the safety of the VR. (3) Results: A statistically significant improvement in well-being and psychological comfort (p = 0.046), feeling of relaxation (p = 0.046), sense of influence on the treatment process (p &lt, 0.001), improved perception of the way the drug works (p &lt, 0.001), improved positive attitude while waiting for the next administration of the drug (p = 0.026), and increased motivation for treatment (p = 0.026) was noticed in the intervention group. There were no statistically significant differences in the incidence of complications in the intervention and control groups. (4) Conclusions: The use of VR had a positive effect on the reduction of stress associated with vedolizumab treatment and could improve compliance.

Background The optimal endoscopic target in early Crohn’s disease (CD) that limits long-term disease complications is unknown. Methods We analysed medical records from patients who had follow-up data since the end of CALM. Patients with Crohn’s disease endoscopic index of severity (CDEIS) scores at the end of CALM were included. The primary outcome was a composite of major adverse outcomes reflecting CD progression: new internal fistula/abscess, stricture, perianal fistula/abscess, CD hospitalisation, or CD surgery since the end of CALM. We compared median CDEIS and per cent improvement from baseline CDEIS. Youden index analysis was used to identify optimal CDEIS cut-off score associated with CD progression. Kaplan–Meier and Cox regression methods were used to compare rates of progression by different CDEIS targets. Multivariable models were adjusted for age, prior surgery, and stricturing behaviour. Results 110 patients with median age 28 (IQR 22–38) years, disease duration 0.2 (0.1–0.5) years, and median follow up of 3.1 (1.9–4.4) years were included. Eleven per cent had a history of stricture, 5.5% history of surgery, and 52% were originally in the tight control arm of the CALM study. Median CDEIS score at end of CALM was 3 (0–5.4) and 32 (29%) patients had disease progression. Baseline median CDEIS score was similar between those with and without progression [10.9 (7.5–15.5) vs. 11.9 (8–17.5)]. Median CDEIS score at the end of CALM was higher among those with progression [1.3 (0–5.1) vs. 4.9 (3–9.1), p < 0.001)]. Patients within higher quartiles of CDEIS score had higher rates of progression over time (Figure 1). Patients without disease progression had a greater median decrease in CDEIS score from baseline to end of CALM [90% (60–100%) vs. 50% (30–80%), p < 0.001]. The optimal CDEIS score cut-off was 2 with sensitivity 84%, specificity 60% and NPV 90% for progression. Patients with CDEIS ≤ 2 had less progression over time compared with patients with > 50% improvement from baseline CDEIS (not reaching CDEIS ≤ 2) and those not meeting either endpoint (Figure 2). On adjusted analysis, CDEIS score ≤ 2 was associated with a decreased risk of progression (aHR 0.23, 95% CI 0.09–0.56). Conclusion In early CD, a CDEIS score ≤ 2 is optimal cut-off associated with a lower risk of disease progression.

Functional brain imaging (positron emission tomography – PET, functional magnetic resonance imaging – fMRI), allowing in vivo analysis of the brain-digestive tract interaction and the neurological mechanisms underlying visceral hypersensitivity, significantly advanced research and helped in the understanding of the interrelations in this field. Differences in this parameter can result from alterations in task-related cognitive states or from resting state processes. Nowadays, advanced imaging techniques such as fMRI are more frequently used and are acknowledged among both clinicians and radiologists in the diagnostic algorithm of digestive tract diseases. Functional dyspepsia is a condition in which neuroimaging allows for analysis of dysfunctions within the brain-gut axis (BGA) engaged in processing of visceral discomfort and pain. The results of studies in patient groups with irritable bowel syndrome prove that psychosocial factors significantly affect the mechanisms regulating visceral sensitivity within the brain. The BGA includes neuronal pathways (autonomic nervous system), neuroendocrine (hypothalamo-pituitary-adrenal axis), and neuroimmunological ones. Psychological processes affect the functioning of the digestive system and can cause dyspeptic symptoms. A patient’s mental condition associated with stress can affect processes taking place in the central nervous system and trigger somatic reactions in the digestive tract through the autonomic visceral system.

These recommendations refer to the current management in pancreatic ductal adenocarcinoma (PDAC), a neoplasia characterised by an aggressive course and extremely poor prognosis. The recommendations regard diagnosis, surgical, adjuvant and palliative treatment, with consideration given to endoscopic and surgical methods. A vast majority of the statements are based on data obtained in clinical studies and experts' recommendations on PDAC management, including the following guidelines: International Association of Pancreatology/European Pancreatic Club (IAP/EPC), American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), National Comprehensive Cancer Network (NCCN) and Polish Society of Gastroenterology (PSG) and The National Institute for Health and Care Excellence (NICE). All recommendations were voted on by members of the Working Group of the Polish Pancreatic Club. Results of the voting and brief comments are provided with each recommendation.

Within the last 20 years, tumour necrosis factor inhibitors have been proven to be effective in achieving and maintaining clinical and endoscopic remission in patients with Crohn's disease and ulcerative colitis. Since 2013, when infliximab originator lost its patent protection, patients with inflammatory bowel diseases (IBDs) in Poland have also been treated with biosimilar drugs. Biosimilars are drugs with high similarity to their reference products in terms of physicochemical properties, including structure, safety, and efficacy. Biosimilars are approved for use on the basis of the same rigorous quality standards as their reference products. In 2018, also biosimilars of adalimumab have become available. Studies published to date have shown that biosimilars do not differ from reference drugs in terms of the efficacy and safety. There are numerous data to confirm that a single switch of biological drugs (mainly from reference to biosimilar drugs) has no effect on therapy efficacy and safety. However, a significantly lower cost of therapy with biosimilars not only allows us to treat a much larger number of patients but may also necessitate multiple switches from reference drugs to biosimilars (including biosimilars produced by different manufacturers). Recently, the first results have been published concerning multiple switches in patients with psoriasis and rheumatoid arthritis. However, no such data are currently available for patients with IBDs.

Background: Metabolic bone disease is a common disorder, but there is a lack of data on it in patients with inflammatory bowel disease (IBD). Methods: In this prospective, one-centre study, we assessed bone mineral and vitamin D alterations in 187 IBD patients (119 with Crohn’s disease (CD) and 68 with ulcerative colitis (UC)). Results: While 81.3% of the patients had vitamin D deficiency, 14.2% of them had a severe deficiency. Elevated serum PTH concentrations were found in 14.9% of the patients. Only in 4.1% of cases was there an elevated level of a serum marker for bone formation (osteocalcin), whereas in 14.4% of cases, the bone resorption marker (CTX) was raised. The concentration of phosphate in urine was higher in the CD than in the UC group (51.20 vs. 31.25; p = 0.003). PTH was negatively associated with vitamin D level. Among the patients receiving corticosteroids, the CTX and CRP median levels were higher (0.49 vs. 0.38; p = 0.013 and 6.45 vs. 2.2; p = 0.029, respectively) compared with the group who did not receive them. Urine phosphate levels were lower (48.60 vs. 26.00; p = 0.005), as were osteocalcin (15.50 vs. 23.80; p < 0.001), and PTH (29.05 vs. 36.05; p = 0.018). Conclusions: Bone mineral alterations were common in patients with IBD, mostly in the CD patients. This may be associated with poor absorption, making CD patients vulnerable to changes in bone mineralization. Vitamin D supplementation remains crucial, especially when taking corticosteroids.

According to the current data, there has been no increase in the incidence of COVID‑19 in patients with inflammatory bowel disease (IBD).The available data are based on symptomatic cases and do not include the asymptomatic ones. To measure the exact infection rate, we initiated a study that aimed to assess the seroprevalence of anti-SARS‑CoV‑2 antibodies in IBD.A total of 864 individuals were enrolled in the study, including 432 patients with IBD (290 with Crohn disease and 142 with ulcerative colitis) and 432 controls without IBD (healthcare professionals) matched for age and sex. Serum samples were prospectively collected, and the presence of anti-SARS‑CoV‑2 immunoglobulin (Ig) G and IgM + IgA antibodies were measured using the enzyme‑linked immunoassay method (Vircell Microbiologists).A significantly higher percentage of positive results for anti-SARS‑CoV‑2 antibodies, both in the IgG and IgM + IgA class, was found in patients with IBD (4.6% and 6%, respectively, compared with 1.6% and 1.1%, respectively, in controls; both P values0.05). No patient had symptomatic COVID‑19. There was no association among patients' age, sex, drugs used for IBD, or disease activity and the occurrence of IgG antibodies.Patients with IBD may be at higher risk of developing SARS‑CoV‑2 infection, defined as the presence of elevated levels of anti-SARS‑CoV‑2 IgG antibodies, but not of having a symptomatic and / or severe course of COVID‑19 compared with healthcare professionals without IBD.

INTRODUCTION: According to the current data, there has been no increase in the incidence of COVID­19 in patients with inflammatory bowel disease (IBD). OBJECTIVES: The available data are based on symptomatic cases and do not include the asymptomatic ones. To measure the exact infection rate, we initiated a study that aimed to assess the seroprevalence of anti-SARS­CoV­2 antibodies in IBD. PATIENTS AND METHODS: A total of 864 individuals were enrolled in the study, including 432 patients with IBD (290 with Crohn disease and 142 with ulcerative colitis) and 432 controls without IBD (healthcare professionals) matched for age and sex. Serum samples were prospectively collected, and the presence of anti-SARS­CoV­2 immunoglobulin (Ig) G and IgM + IgA antibodies were measured using the enzyme­linked immunoassay method (Vircell Microbiologists). RESULTS: A significantly higher percentage of positive results for anti-SARS­CoV­2 antibodies, both in the IgG and IgM + IgA class, was found in patients with IBD (4.6% and 6%, respectively, compared with 1.6% and 1.1%, respectively, in controls; both P values

The use of antibiotics and possibility of microbiota disruption during the coronavirus disease 2019 (COVID‑19) pandemic have raised questions about the incidence of Clostridioides difficile infection (CDI).This study aimed to assess the frequency of and risk factors for CDI in patients with COVID‑19.We conducted a retrospective, single‑center evaluation study on the frequency of and risk factors for CDI in patients with COVID‑19 and in the prepandemic era. The analysis included 441 patients with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection and 2961 pa‑ tients hospitalized before the pandemic.A significant increase in the incidence of CDI was noted during the COVID‑19 pandemic compared with the prepandemic period: 10.9% versus 2.6%, P0.001. Risk factors for CDI in patients with COVID‑19 included: age, length of hospital stay, occurrence of diarrhea during hospitalization, use of antibiotics other than azithromycin, and coexistence of nervous system disease or chronic kidney disease-all of these factos had a weak association with CDI development. The multivariable logistic regression model indicated other unassessed variables that had an impact on the CDI incidence rate.We observed a higher incidence of CDI in patients with COVID‑19. Antibiotic therapy was a relevant risk factor for CDI, although its effect was weak. Other drugs used during the pandemic were not found to have an impact on disease development. Possible causes of CDI may include fecal microbiota disruption by SARS‑CoV‑2 infection, but further research is needed to validate this hypothesis.

INTRODUCTION: The use of antibiotics and possibility of microbiota disruption during the coronavirus disease 2019 (COVID­19) pandemic have raised questions about the incidence of Clostridioides difficile infection (CDI). OBJECTIVES: This study aimed to assess the frequency of and risk factors for CDI in patients with COVID­19. PATIENTS AND METHODS: We conducted a retrospective, single­center evaluation study on the frequency of and risk factors for CDI in patients with COVID­19 and in the prepandemic era. The analysis included 441 patients with severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) infection and 2961 pa­ tients hospitalized before the pandemic. RESULTS: A significant increase in the incidence of CDI was noted during the COVID­19 pandemic compared with the prepandemic period: 10.9% versus 2.6%, P

The SARS-CoV-2 epidemic and ensuing transformation of the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw into one of the largest specialist infection disease hospitals in Poland imposed a complete reorganisation of work, including in the endoscopy unit. For the vast majority of hospitalised patients, COVID-19 infection posed an extra burden in addition to already known and treated chronic disorders. Therefore, the work schedule and infrastructure have been rearranged in order to minimise the risk of transmission of infection to the personnel as well as to ensure continuous preparedness to perform all endoscopic procedures in patients infected with or suspected of SARS-CoV-2 infection. Between 16.03.2020 and 20.07.2020 we performed 91 endoscopic procedures involving the upper and lower gastrointestinal tract. The majority of those procedures were performed for urgent indications and as a part of on-call duties. The scope of endoscopic procedures was much broader than initially anticipated at the beginning of the epidemic, indicating the need for a change in the recommendations in that regard. Thanks to the application of appropriate procedures and personal protective equipment (PPE) there were no cases of infection among the employees of the Endoscopy Unit coming in direct contact with patients during the above-mentioned period.