Circadian rhythms and sleep influence a variety of physiological functions, including the digestive system. The digestive system also has intrinsic rhythms that interact dynamically with circadian rhythms. New advances in understanding the interaction of these rhythms and sleep provide the prospect of evaluating their role in normal physiology and the link of their disruption to pathological conditions. Recent work has demonstrated that sleep and circadian factors influence appetite, nutrient absorption, and metabolism. Disruption of sleep and circadian rhythms may increase vulnerability to digestive disorders, including reflux, ulcers, inflammatory bowel issues, irritable bowel disease, and gastrointestinal cancer. As our knowledge of the link between circadian timing and gastrointestinal physiology grows, so do our opportunities to provide promising diagnostic and therapeutic approaches for gastrointestinal disorders.

Primary biliary cholangitis (PBC) is a chronic cholestatic autoimmune liver disease of unknown origin, which can result in end-stage biliary cirrhosis without proper treatment. Diagnosis is based on elevated cholestatic liver enzymes and the presence of anti-mitochondrial antibody (AMA) and/ or PBC specific anti-nuclear antibody (ANA). Liver biopsy is not necessary to establish the diagnosis with a few exceptions. AMA positivity in itself, without elevated cholestatic liver enzymes, is not enough to establish the diagnosis of PBC. PBC can affect patients’ quality of life with the progression of the liver disease (development liver cirrhosis), and also with the associated symptoms (cholestatic pruritus, sicca complex, fatigue). The clinical presentation and the disease course can vary thus the treatment and disease management should be tailored to the individual needs and should be lifelong. The primary goal of care is to prevent the prog­ression to end-stage liver disease and to alleviate the associated symptoms. Recommended first-line treatment is ursodeoxycholic acid (UDCA). Oral obeticholic acid (OCA) was conditionally approved for the treatment of PBC. It can be prescribed in combination with UDCA for cases where treatment response for the first-line therapy was insufficient, or in monotherapy in case of UDCA-intolerance. In Hungary, OCA is not reimbursed for patients. Preparation for liver transplantation should be initiated when complications of the liver cirrhosis occur, or the markers of disease severity, like constantly elevated bilirubin level or MELD score >15, suggest advanced disease stage or when pruritus is severe or refracotry to treatment. Higher risk for osteoporosis should be kept in mind when treating PBC patients, screening and treatment are essential parts of the care. This review covers the structured, lifelong and individual approach of clini­cal management for PBC patients, based on the latest EASL guideline, to provide help for the attending hepatologists with the establishment of diagnosis, delivery of effective treatment and patient care.

Microscopic colitis (MC) has come to the highlight in the last decade, which is explained by the more frequent recognition of the disease and a number of new available data related to the pathogenesis. The incidence of MC has reached the level of inflammatory bowel disease in some populations. A number of factors have been implicated in its development: immunological origin, genetic predisposition, hormonal background, the role of microbiome and drugs has also become significant. However, many questions about MC remain unanswered. Thus, its relationship to traditional inflammatory bowel diseases and the reason and significance of the subtypes transformation to each other also needs to be explained. Topical steroids are of primary importance in therapy, but there are also uncontrollable cases that may require immunomodulatory or biological treatment.

Non-steroidal anti-inflammatory drugs (NSAIDs) are essential agents in the treatment of musculoskeletal disorders. However, their use is associated with mucosal injury of gastrointestinal tract, including the development of peptic ulcer disease and its complications. During the effective prevention of NSAIDs induced side effects and complications both gastrointestinal and cardiovascular risks should be taken into account. There are no up-to-date Hungarian guidelines or recommendations regarding the effective gastroprotection. This paper aims to develop statements and guidance devoted to these specific issues through a review of current evidence by a multidisciplinary group of experts from the field of gastroenterology and rheumatology.