Cyclic Vomiting Syndrome is a functional gastrointestinal disorder characterized by recurrent episodes of severe nausea and vomiting and abdominal pain separated by symptom-free or mildly symptomatic periods. Its relationship with cannabis use is becoming increasingly recognized as it is stated in the Rome IV classification system. We report a 55-year-old male patient with a history of around 20 years of recurrent episodes of vomiting. Despite the symptoms met the criteria of Cyclic Vomiting Syndrome the patient had been repeatedly and extensively investigated without making the diagnosis. History in patients affected by cyclic vomiting symptoms must include their social and recreational behaviour as well. Cannabinoid Hyperemesis Syndrome is a subset of patients with Cyclic Vomiting Syndrome and the role of marijuana should always be considered particularly in males. Hot showers and bathing to alleviate symptoms are not pathognomonic of marijuana use, though they were shown to be more likely associated with its use. Gastroenterologists and emergency physicians should be alerted to this clinical setting.

Inflammatory bowel diseases have a huge impact on the quality of life and workability. The fully human anti-TNF-alpha, adalimumab provides great opportunity to use biological therapy at home, application of the prefilled syringe might be difficult for some. The aim of this study was to evaluate patients’ opinion about the newly introduced adalimumab prefilled pen compared to the prefilled syringe. Our questionnaire based survey focused on the degree of difficulty of the usage, any inconveniences and the proportion of self-injection for each mode of administration.

Recently, special epigenetic mechanisms came into view with increasing interest toward the involvement of small non-coding RNAs called microRNAs (miR) that are able to regulate the gene expression. The field of miR research is rapidly expanding in adult inflammatory bowel disease (IBD), however, less is known about pediatric IBD. The aim of my PhD work was to characterize a pediatric IBD (IBD) miR profile that might serve as potential Crohn’s disease (CD) and ulcerative colitis (UC) specific diagnostic pattern. We demonstrated an IBD characteristic microRNA pattern by next-generation sequencing and RT-PCR that could facilitate deeper understanding of the pathomechanism of IBD. MiR-18a, -21, -31, 125a, -142-3p, -146a, -185 and -223 may serve as a diagnostic tool in the future. In addition, our next aim was to analyze the related target genes and their biological functions of miRs to reveal their complex role in the pathomechanism of IBD. The most important IBD-related functional groups and processes including inflammation, fibrosis and angiogenesis. Thus providing further evidence for the specificity of the miR profile and underlining the potential importance of these regulatory elements in the pathomechanism of IBD, they could serve as potential differential diagnostic markers and therapeutic targets.

Hepatitis E viral infection is the most common cause of acute viral hepatitis worldwide. Usually the infection resolves within weeks, but sometimes it causes acute liver failure, which may be fatal. The virus has at least 4 different human genotypes, genotypes 1 and 2 have been found only in humans, genotype 3 and 4 viruses circulate in several animals, and occasionally infect humans. Genotype 1 and 2 caused disease is common in developing countries where the disease occurs both as outbreaks and as sporadic cases after the consumption of contaminated water. Genotype 3 and 4 caused diseases is a zoonotic disease, humans are infected generally through consumption of undercooked animal meat. Genotype 3 and 4 viruses can cause chronic infection in the immuncompromised (HIV infected, organ transplant patients). Until now effective vaccine is available against gen. 1.

The assessment of abnormal liver chemistries is an everyday challenge in the clinical practice. Hepatocellular injury is defined as disproportionate elevation of aminotransferases compared with ALP levels, while in cholestasis the elevation of ALP is a characteristic feature. The elevation of conjugated bilirubin may result from hepato-cellular injury or from cholestasis. Recent studies have shown that the true healthy normal ALT level ranges from 29 to 33 IU/l for males, 19 to 25 IU/l in females. The elevation of aminotransferases requires testing for viral hepatitis, alcohol- and drug abuse, autoimmune hepatitis, non-alcoholic fatty liver disease, Wilson-disease, hemochromatosis, alfa-1 antitrypsin deficiency. The causes of ALP ele­vation can be biliary obstruction, primary biliary cholangitis and primary sclerosing cholangitis. Liver biopsy may be necessary when serologic and biochemical tests and imaging fail to establish a diagnosis. The fibrosis stage which determines the prognosis can be assessed by liver biopsy, as well as by non-invasive fibrosis markers and elastographies.