Klinikai kérdések / Clinical questions
Nutritional intervention requiring medical supervision in general practice
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.
Összefoglaló közlemények / Reviews
Hemostasis changes in liver cirrhosis
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.
Eredeti közlemény / Original paper
IBD-related Malignancies Observed in 2015–2019
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.
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
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.
Módszertani ajánlás / Methodological recommendation
Endoscopy reporting standards. Collection of internationally used classification systems
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.