Ferring Tudástár

Gyulladásos bélbetegségek bőrgyógyászati vonatkozásai – a bél-mikrobiom tükrében

Bánvölgyi András dr., Anker Pálma dr., Kiss Norbert dr., Lőrincz Kende dr., Wikonkál Norbert dr., Medvecz Márta dr.1

1Semmelweis Egyetem, Bőr-, Nemikórtani és Bőronkológiai Klinika, Budapest

A komplex, multifaktoriális hátterű gyulladásos bélbetegségek multidiszciplináris jelentőségűek, társulhatnak extraintesztinális tünetekkel, ezen belül igen gyakori a bőrérintettség. Egyes bőrbetegségek esetén a gyulladásos bélbetegségekben leírt dysbiosis figyelhető meg, amely felveti a kórképek közötti szoros kapcsolatot. A dysbiosis célzott probiotikummal vagy antibiotikummal történő kezelése, illetve a probiotikumok preventív alkalmazása nem új keletű elképzelés egyes bőrgyógyászati kórképek ese­tén, azonban az irodalmi adatok gyakran ellentmondóak. Az alábbiakban áttekintjük a gyulladásos bélbetegségekkel társuló fontosabb bőrgyógyászati kórképeket, azok patomechanizmusát, illetve a bél–bőr-tengely kezelésének eddig ismert lehetőségeit.

ISSUE: Central European Journal of Gastroenterology and Hepatology | 2019 | VOLUME 5, ISSUE 4

Kongresszusi összefoglaló / Congress review

Higlights from Gastro Update Europe 2019

Guido NJ Tytgat1

1Department Gastroenterology-Hepatology, Amsterdam umc, AMC, Meibergdreef, 1105 AZ Amsterdam, Netherlands
Correspondence: g.n.tytgat@amsterdamumc.nl

This narrative review summarizes a selection of recent, clinically-important novel gastrointestinal developments, presented and discussed at the European Gastro Update In Budapest. The selected topics reflect what the distinguished faculty considered of vital importance to be communicated to the astute busy gastro-hep clinician, who is eager to stay well informed of important novel developments in his discipline. Whenever appropriate a personal comment or addition was added to further raise the educational value of this review. Given its narrative character, statements and conclusions are largely expert opinion-based and referencing is limited to the selected images.

ISSUE: Central European Journal of Gastroenterology and Hepatology | 2019 | VOLUME 5, ISSUE 4

Szakmai irányelv / Consensus Guideline

Diagnosis and antiviral therapy of hepatitis B and D – Hungarian Consensus Guideline

Gábor Horváth dr.1, Zsuzsanna Gerlei dr.2, Judit Gervain dr.3, Gabriella Lengyel dr.4, Mihály Makara dr.5, Alajos Pár dr.6, László Rókusz dr.7, Ferenc Szalay dr.8, István Tornai dr.9, Klára Werling dr.4, Béla Hunyady dr.10

1Hepatology Center of Buda, Budapest, Hungary; Hepatogy Outpatient Unit, Ist Department of Medicine, St. János Hospital and North Buda Integrated Hospitals, Budapest, Hungary;
2Department of Surgery and Transplantation Surgery, Semmelweis University, Faculty of Medicine, Budapest, Hungary;
3Ist Department of Medicine and Laboratory of Molecular Diagnostics, St. György Hospital, Székesfehérvár, Hungary;
42nd Department of Internal Medicine, Semmelweis University, Faculty of Medicine, Budapest, Hungary;
5Hepatogy Outpatient Unit, Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases, Budapest, Hungary;
62nd Department of Medicine, University of Pécs, Pécs, Hungary;
7Ist Department of Medicine, Medical Centre, Military Hospital Hungarian Defence Forces, Budapest, Hungary;
8Ist Department of Internal Medicine, Semmelweis University, Faculty of Medicine, Budapest, Hungary;
9Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Debrecen, Hungary;
10Department of Gastroenterology, Somogy County Kaposi Mór Hospital, Kaposvár, Hungary; Ist Department of Medicine, University of Pécs, Pécs, Hungary
Correspondence: horvath.gabor@hepatologia.hu

Diagnosis and treatment of HBV±HDV infection means for the patient to be able to maintain working capacity, to increase quality of life, to prevent cancer, and to prolong life expectancy, while society benefits from eliminating the chances of further transmission of the viruses, and decreasing the incidence and overall costs of serious complications. The guidelines outline the treatment algorithms that have been in place since 2019, developed at a consensus meeting of physicians involved in treating these diseases. The indications of treatment is based upon viral examinations (including viral nucleic acid determination) with determinations of disease activity and stage of related liver disease (by laboratory tests, pathologic, and/or non-invasive methods, i.e., elastographies or biochemical scores), and excluding contraindications. The first choices of therapy in chronic hepatitis B infection includes pegylated interferon for 48 weeks or continuous nucleotide/nucleoside analogue (NAs: entecavir or tenofovir). NAs must be continued for at least 12 months after hepatitis B surface antigen seroconversion. Some NAs are not available/not routinely used in Hungary. Lamivudine is no longer a first choice; patients currently taking lamivudine must switch if response is inadequate. Appropriate treatment of patients taking immunosuppressive medications is highly recommended. Pegylated interferon based therapy is recommended for the treatment of concomitant hepatitis D infection.

ISSUE: Central European Journal of Gastroenterology and Hepatology | 2019 | VOLUME 5, ISSUE 4

Eredeti közlemény / Original paper

The triggering role of Clostridioides difficile infection in relapsed IBD outpatients

Anita Bálint MD1, Zoltán Szepes MD PhD1, Mónika Szűcs2, Klaudia Farkas MD PhD1, Edit Urbán PhD3, Ferenc Nagy MD PhD1, Renáta Bor MD1, Mariann Rutka MD1, Ágnes Milassin MD1, Tamás Molnár MD PhD1

1University of Szeged, 1st Department of Medicine, Szeged, Hungary
2University of Szeged, Department of Medical Physics and Informatics, Szeged, Hungary
3University of Szeged, Institute of Clinical Microbiology, Szeged, Hungary
Correspondence: balint.anita@med.u-szeged.hu

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.

ISSUE: Central European Journal of Gastroenterology and Hepatology | 2019 | VOLUME 5, ISSUE 4