Klinikai kérdések / Clinical questions

Nutritional intervention requiring medical supervision in general practice

Molnár Andrea dr., PhD1, Vajer Péter dr., PhD2

1Magyar Dietetikusok Országos Szövetsége, Tudományos Bizottság
2Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék

Old age and multimorbidity, malnutrition and sarcopenia are also prognostic factors in COVID-19 disease. As nearly 90% of malnutrition patients are in their homes and malnutrition is an independent predictor of mortality (OR: 7.00), medical nutritional therapy must be an integral part of the treatment during outpatient care. The article summarizes the intervention of COVID-19 patients specifically for individuals with or recovering from COVID-19 in the community.

ISSUE: Central European Journal of Gastroenterology and Hepatology | 2021 | VOLUME 7, ISSUE 4

Összefoglaló közlemények / Reviews

Hemostasis changes in liver cirrhosis

Kocska Máté dr.1, Vitális Zsuzsanna dr., PhD2

1Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktatókórház, Képalkotó Diagnosztikai Centrum, Miskolc
2Debreceni Egyetem, Általános Orvostudományi Kar, Belgyógyászati Intézet, Gasztroenterológia Tanszék, Debrecen
Correspondence: vitalis@med.unideb.hu

In liver cirrhosis, blood clotting is damaged at several points: the vast majority of patients develop thrombocytopenia; decreased levels of coagulation proteins l; levels of anticoagulants and factors involved in fibrinolysis are also decreased. In addition, increased coagulation provoked by a chronic inflammatory condition characteristic of cirrhosis should be considered. As a result of these changes, hemostasis shows a new, more labile equilibrium state that may shift toward a hypercoagulable or hypocoagulable state. Due to the complex changes, classical coagulation tests should not be used in patients with cirrhosis, instead complex coagulation tests are appropriate, which provide information on blood coagulation as a whole. Understanding the changes is important to select prophylaxis before interventions or in high risk thrombosis conditions and to define the optimal treatment for bleeding or thrombosis. Although severe cirrhosis has previously been clearly classified as acquired hemorrhage, it has recently become increasingly apparent that it is much more of a condition predisposing to thrombosis. In addition, more and more data suggest that the formation of small thrombi plays a role in the pathophysiology and progression of the disease, and prophylactic antithrombotic treatment improves the prognosis of the disease.

ISSUE: Central European Journal of Gastroenterology and Hepatology | 2021 | VOLUME 7, ISSUE 4

Eredeti közlemény / Original paper

IBD-related Malignancies Observed in 2015–2019

Ágnes Milassin MD1, Mariann Rutka MD1, Mónika Szűcs MD2, Klaudia Farkas MD1, Mark Marcus MD1, Renáta Bor MD1, Kata Judit Szántó MD1, Ferenc Nagy MD1, Zoltán Szepes MD1, László Lakatos MD3, Zsuzsanna Erdélyi MD3, László Szegedi MD4, Eszter Schäfer MD5, Attila Zaránd MD6, Anna Fábián MD1, Anita Bálint MD1, Tamás Molnár MD1

1Department of Medicine, University of Szeged, Albert Szent-Györgyi Faculty of Medicine and Health Center, Hungary;
2Department of Medical Physics and Informatics, University of Szeged, Albert Szent-Györgyi Medical School, Faculty of Science and Informatics, Hungary;
3Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprém, Hungary;
4First Department of Internal Medicine, András Jósa Teaching Hospital, Nyíregyháza, Hungary;
5Military Hospital Medical Center, Hungarian Defense Forces, Budapest, Hungary;
6First Department of Surgery, Semmelweis University, Budapest, Hungary
Correspondence: milagn422@hotmail.com

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.

ISSUE: Central European Journal of Gastroenterology and Hepatology | 2021 | VOLUME 7, ISSUE 4

Eredeti közlemény / Original paper

Combination therapy with anti-TNFs and thiopurines does affect drug metabolite levels but it is not associated with body composition in inflammatory bowel disease patients: A cross-sectional study

Kata Judit Szántó dr.1, Zoltán András Mezei dr.2, Diána Kata dr.3, Imre Földesi dr.3, Tibor Nyári dr.4, Anna Fábián dr.1, Mariann Rutka dr.1, Renáta Bor dr.1, Anita Bálint dr.1, Ágnes Milassin dr.1, Zoltán Szepes dr.1, Ferenc Nagy dr.1, Károly Palatka dr.5, Klaudia Farkas dr.1#, Tamás Molnár dr.1*#

1University of Szeged, Department of Medicine, Szeged, Csongrád-Csanád, Hungary;
2University of Debrecen Clinical Center, Department of Laboratory Medicine, Debrecen, Hajdú-Bihar, Hungary;
3University of Szeged, Institute of Laboratory Medicine, Szeged, Csongrád-Csanád, Hungary;
4University of Szeged, Department of Medical Physics and Informatics, Szeged, Csongrád-Csanád, Hungary;
5University of Debrecen, 2nd Department of Internal Medicine, Debrecen, Hajdú-Bihar, Hungary
*Correspondence: molnar.tamas@med.u-szeged.hu (T.M.)
#these authors contributed equally

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.

ISSUE: Central European Journal of Gastroenterology and Hepatology | 2021 | VOLUME 7, ISSUE 4

Módszertani ajánlás / Methodological recommendation

Endoscopy reporting standards. Collection of internationally used classification systems

Dubravcsik Zsolt1, Gyökeres Tibor2, Hritz István3, Madácsy László4, Márkus Márk Philip5, Szepes Zoltán5, Vincze Áron6, Czakó László5

1Bács-Kiskun Megyei Oktatókórház, Gasztroenterológiai Osztály, Kecskemét
2Magyar Honvédség Egészségügyi Központ, Honvédkórház, Gasztroenterológiai Osztály, Budapest
3Semmelweis Egyetem, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika, Budapest
4Endo-kapszula Magánorvosi Centrum, Székesfehérvár
5Szegedi Tudományegyetem, Belgyógyászati Klinika, Szeged
6Pécsi Tudományegyetem, I. Belgyógyászati Klinika, Pécs
Correspondence: czako.laszlo@med.u-szeged.hu

The adequate diagnosis and management of gastrointestinal diseases requires a common language and a standardized documentation. Therefore, the governing board of the Endoscopy Section of Hungarian Association of Gastroenterology collected the terminologies and classifications are essential to be used in everyday endoscopic reporting.

ISSUE: Central European Journal of Gastroenterology and Hepatology | 2021 | VOLUME 7, ISSUE 4