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New serological markers in pediatric patients with inflammatory bowel disease

World Journal of Gastroenterology 2014年第17期20卷 4873-4882页

作者： Márta Kovács Katalin Eszter Müller Mária papp péter lászló lakatos Mihály Cs?ndes Gábor Veres Department of pediatrics Petz Aladár County and Teaching Hospital9023 Gy?rHungary 1~(st) Department of pediatrics Semmelweis University1083 BudapestHungary 2~(nd) Department of Medicine University of Debrecen4032 DebrecenHungary 1~(st) Department of Medicine Semmelweis University1083 BudapestHungary Department of Gastroenterology Petz Aladár County and Teaching Hospital9023 Gy?rHungary

The spectrum of serological markers associated with inflammatory bowel disease (IBD) is rapidly growing. Due to frequently delayed or missed diagnoses, the application of non-invasive diagnostic tests for IBD, as well as differentiation between ulcerative colitis (UC) and Crohn’s disease (CD), would be useful in the pediatric population. In addition, the combination of pancreatic autoantibodies and antibodies against Saccharomyces cerevisiae antibodies/perinuclear cytoplasmic antibody (pANCA) improved the sensitivity of serological markers in pediatric patients with CD and UC. Some studies suggested that age-associated differences in the patterns of antibodies may be present, particularly in the youngest children. In CD, most patients develop stricturing or perforating complications, and a significant number of patients undergo surgery during the disease course. Based on recent knowledge, serum antibodies are qualitatively and quantitatively associated with complicated CD behavior and CD-related surgery. pediatric UC is characterized by extensive colitis and a high rate of colectomy. In patients with UC, high levels of anti-CBir1 and pANCA are associated with the development of pouchitis after ileal pouch-anal anastomosis. Thus, serologic markers for IBD can be applied to stratify IBD patients into more homogeneous subgroups with respect to disease progression. In conclusion, identification of patients at an increased risk of rapid disease progression is of great interest, as the application of early and more aggressive pharmaceutical intervention could have the potential to alter the natural history of IBD, and reduce complications and hospitalizations.

关键词： Inflammatory bowel disease, Crohn’ s disease, Ulcerative colitis, pediatric, Serologic markers, Antimicrobial antibodies, Anti-glycan antibodies, pancreatic antibodies, Inflammatory bowel disease

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Intestinal alkaline phosphatase in the colonic mucosa of children with inflammatory bowel disease

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World Journal of Gastroenterology 2012年第25期18卷 3254-3259页

作者： Kriszta Molnár dám Vannay Beáta Szebeni Nóra Fanni Bánki Erna Sziksz ron Cseh Hajnalka Gyrffy péter lászló lakatos Mária papp András Arató Gábor Veres First Department of pediatrics Semmelweis UniversityH-1083 BudapestHungary Research Group for pediatrics and Nephrology Semmelweis University and Hungarian Academy of SciencesH-1083 BudapestHungary SE-MTA "lendulet" Diabetes Research Group H-1083 BudapestHungary Second Department of pathology Semmelweis UniversityH-1091 BudapestHungary First Department of Medicine Semmelweis UniversityH-1083 BudapestHungary Second Department of Medicine University of Debrecen H-4032 Debrecen Hungary

AIM： To investigate intestinal alkaline phosphatase （iAp） in the intestinal mucosa of children with inflammatory bowel disease （IBD）. METHODS： Colonic biopsy samples were taken from 15 newly diagnosed IBD patients and from 10 healthy controls. In IBD patients, specimens were obtainedboth from inflamed and non-inflamed areas. The lAp mRNA and protein expression was determined by reverse transcription-polymerase chain reaction and Western blotting analysis, respectively. Tissue localiza- tion of lAp and Toll-like receptor （TlR） 4 was investi- gated by immunofluorescent staining. RESUlTS： The lAp protein level in the inflamed muco- sa of children with Crohn＇s disease （CD） and ulcerative colitis （UC） was significantly decreased when compared with controls （both p 〈 0.05）. Similarly, we found a significantly decreased level of lAp protein in the in- flamed mucosa in CD compared with non-inflamed mucosa in CD （p 〈 0.05）. In addition, the iAp protein level in inflamed colonic mucosa in patients with UC was decreased compared with non-inflamed mucosa in patients with CD （p 〈 0.05）. lAp protein levels in the non-inflamed mucosa of patients with CD were similar to controls, lAp mRNA expression in inflamed colonic mucosa of children with CD and UC was not significant- ly different from that in non-inflamed colonic mucosa with CD. Expression of lAp mRNA in patients with non- inflamed mucosa and in controls were similar. Co-local- ization of lAp with TlR4 showed intense staining with a dotted-like pattern, lAp was present in the inflamed and non-inflamed mucosa of patients with CD, UC, and in control biopsy specimens, irrespective of whether it was present in the terminal ileum or in the colon. However, the fluorescent signal of TlR4 was more pro- nounced in the colon compared with the terminal ileum in all groups studied. CONClUSION： lower than normal lAp protein levels in inflamed mucosa of IBD patients may indicate a role for lAp in inflammatory lesions in IBD. Based on our r

关键词： Intestinal alkaline phosphatase Toll-like recep-tor Colonic biopsy Children Inflammatory bowel disease

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Frequency and prognostic role of mucosal healing in patients with Crohn's disease and ulcerative colitis after one-year of biological therapy

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World Journal of Gastroenterology 2014年第11期20卷 2995-3001页

作者： Klaudia Farkas péter lászló lakatos Mónika Szcs va pallagi-Kunstár Anita Bálint Ferenc Nagy Zoltán Szepes Noémi Vass lajos S Kiss Tibor Wittmann Tamás Molnár First Department of Medicine University of SzegedH6720 SzegedHungary First Department of Medicine Semmelweis UniversityH1088 BudapestHungary Department of Medical physics and Informatics University of SzegedH6720 SzegedHungary Faculty of Medicine Pediatrics DepartmentUniversity of SzegedH6720 SzegedHungary

AIM: To assess the endoscopic activity before and after a one-year period of biological therapy and to evaluate the frequency of relapses and need for retreatment after stopping the biologicals in patients with Crohn... 详细信息

关键词： Crohn’ s disease, Ulcerative colitis, Biological therapy, Endoscopy, Mucosal healing

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Foreign body impaction in the sigmoid colon: A twenty euro bet

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World Journal of Gastroenterology 2013年第24期19卷 3892-3894页

作者： Katalin E Müller András Arató péter lászló lakatos Mária papp Gábor Veres 1~(st) Department of pediatrics Semmelweis University1083 Budapest Hungary 1~(st) Department of pediatrics Semmelweis University 1~(st) Department of Medicine Semmelweis University1083 Budapest Hungary 2~(nd) Department of Medicine University of Debrecen4032 Debrecen Hungary

Foreign body ingestion is a common clinical problem in early childhood. However, it may occur even in adults, unknowingly. Most ingested foreign bodies entering the stomach pass through the gastrointestinal tract uneventfully. Here we report on a 13-year-old boy who presented with chronic abdominal pain, weight loss and occult gastrointestinal bleeding for 6 mo. Colonoscopy was negative; however, a ballpoint pen was impacted in the sigmoid region. Subsequently, the child admitted swallowing a pen as a 20-euro bet 6 mo previously. Crohn's disease is a chronic relaps-ing inflammatory gastrointestinal disease. It is often difficult to diagnose due to the fact that there is no single pathognomonic sign or symptom. This case is a description of an adolescent with chronic gastrointes-tinal symptoms due to a foreign body. Therefore, an ingested foreign body should be included in the differ-ential diagnostic procedure related to gastrointestinal symptoms.

关键词： Foreign bodies pen Differential diagnosis Crohn’s disease Child

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Is rectal indomethacin effective in preventing of post-endoscopic retrograde cholangiopancreatography pancreatitis?

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World Journal of Gastroenterology 2014年第29期20卷 10151-10157页

作者： Zoltán Dbrnte Zoltán Szepes Ferenc Izbéki Judit Gervain lászló lakatos Gyula pécsi Miklós Ihász lilla lakner Erzsébet Toldy lászló Czakó Department of Gastroenterology and Internal Medicine Markusovszky Teaching Hospital 1st Department of Medicine University of Szeged 1st Department of Internal Medicine Szent Gyrgy Regional Hospital Department of Internal Medicine Csolnoky Ferenc Regional Hospital Department of Gastroenterology Karolina Hospital Central laboratory Markusovszky Teaching Hospital Institute of Diagnostics Faculty of Health SciencesUniversity of Pécs

AIM: To investigate the effectiveness of rectally administered indomethacin in the prophylaxis of post-endoscopic retrograde cholangiopancreatography (ERCp) pancreatitis and hyperamylasaemia in a multicentre study.

关键词： Endoscopic retrograde cholangiopancreatography post-endoscopic retrograde cholangiopancreatography pancreatitis Hyperamylasaemia Nonsteroidal anti-inflammatory drugs Indomethacin

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Access to biologicals in Crohn's disease in ten European countries

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World Journal of Gastroenterology 2017年第34期23卷 6294-6305页

作者： Márta péntek peter l lakatos Talitha Oorsprong lászló Gulácsi Milena pavlova Wim Groot Fanni Rencz Valentin Brodszky petra Baji Crohn’s Disease Research Group department of health economics corvinus university of budapest mcgill university muhcmontreal general hospital 1st department of internal medicine semmelweis university department of health services research caphrimaastricht university medical centrefaculty of healthmedicine and life sciencesmaastricht university top institute evidence based education research (tier) teachers academymaastricht university 不详

AIM To analyze access(availability, affordability and acceptability) to biologicals for Crohn's disease(CD) in ten European countries and to explore the associations between these dimensions, the uptake of biologicals and economic *** A questionnaire-based survey combined with desk research was carried out in May 2016. Gastroenterologists from the Czech Republic, France, Germany, Hungary, latvia, poland, Romania, Slovakia, Spain and Sweden were invited to participate and provide data on the availability of biologicals/biosimilars, reimbursement criteria, clinical practice and prices, and use of biologicals. An availability score was developed to evaluate the restrictiveness of eligibility and administrative criteria applied in the countries. Affordability was defined as the annual cost of treatment as a share of gross domestic product(GDp) per capita. Correlations with the uptake of biologicals, dimensions of access and GDp per capita were *** At the time of the survey, infliximab and adalimumab were reimbursed in all ten countries, and vedolizumab was reimbursed in five countries(France, Germany, latvia, Slovakia, Sweden). Reimbursement criteria were the least strict in Sweden and Germany, and the strictest in Hungary, poland and Slovakia. Between countries, the annual cost of different biological treatments differed 1.6-3.3-fold. Treatments were the most affordable in Sweden(13%-37% of the GDp per capita) and the least affordable in the Central and Eastern European countries, especially in Hungary(87%-124%) and Romania(141%-277%). Biosimilars made treatments more affordable by driving down the annual costs. The number of patients with CD on biologicals per 100000 population was strongly correlated with GDp per capita(0.91), although substantial differences were found in the uptake among countries with similar economic development. Correlation between the number of patients with CD on biologicals per 100000 population and the availabi

关键词： Crohn’s disease Biological therapy Access Inequality Europe

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Risk for colorectal cancer in ulcerative colitis:Changes,causes and management strategies

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World Journal of Gastroenterology 2008年第25期14卷 3937-3947页

作者： peter laszlo lakatos laszlo lakatos 1st Department of Medicine Semmelweis University 1st Department of Medicine Csolnoky F. County Hospital

The risk of colorectal cancer for any patient with ulcer-ative colitis is known to be elevated, and is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. Risk factors for cancer in-clude extent and duration of ulcerative colitis, primary sclerosing cholangitis, a family history of sporadic colorectal cancer, severity of histologic bowel inflam-mation, and in some studies, young age at onset of colitis. In this review, the authors discuss recent epide-miological trends and causes for the observed chang-es. population-based studies published within the past 5 years suggest that this risk has decreased over time, despite the low frequency of colectomies. The crude annual incidence rate of colorectal cancer in ulcerative colitis ranges from approximately 0.06% to 0.16% with a relative risk of 1.0-2.75. The exact mechanism for this change is unknown; it may partly be explained by the more widespread use of maintenance therapy and surveillance colonoscopy.

关键词： Ulcerative colitis Colorectal cancer Riskfactors Surveillance Chemprevention

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prediction of disease course in inflammatory bowel diseases

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World Journal of Gastroenterology 2010年第21期16卷 2589-2590页

作者： peter laszlo lakatos 1st Department of Medicine Semmelweis UniversityH-1083 BudapestKoranyi S 2AHungary

Clinical presentation at diagnosis and disease course of both Crohn's disease(CD) and ulcerative colitis are heterogeneous and variable over *** most patients have a relapsing course and most CD patients develop complications(*** and/or perforation),much emphasis has been placed in the recent years on the determination of important predictive *** identification of these factors may eventually lead to a more personalized,tailored *** this TOpIC HIGHlIGHT series,we provide an update on the available literature regarding important clinical,endoscopic,fecal,serological/routine laboratory and genetic *** aim is to assist clinicians in the everyday practical decisionmaking when choosing the treatment strategy for their patients suffering from inflammatory bowel diseases.

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis Disease course predictive markers Clinical Serology Genetics

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prevalence,predictors,and clinical consequences of medical adherence in IBD:How to improve it?

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World Journal of Gastroenterology 2009年第34期15卷 4234-4239页

作者： peter laszlo lakatos 1st Department of Medicine Semmelweis University

Inflammatory bowel diseases(IBD)are chronic diseases with a relapsing-remitting disease course necessitating lifelong ***,non-adherence has been reported in over 40%of patients,especially those in remission taking maintenance therapies for IBD. The economical impact of non-adherence to medical therapy including absenteeism,hospitalization risk, and the health care costs in chronic conditions,is *** causes of medication non-adherence are complex,where the patient-doctor relationship, treatment regimen,and other disease-related factors play key ***,subjective assessment might underestimate *** adherence may result in more frequent relapses,a disabling disease course, in ulcerative colitis,and an increased risk for colorectal *** medication adherence in patients is an important challenge for *** the different patient types,the reasons given by patients for non-adherence,simpler and more convenient dosage regimens,dynamic communication within the health care team,a self-management package incorporating enhanced patient education and physician-patient interaction,and identifying the predictors of nonadherence will help devise suitable plans to optimize patient *** editorial summarizes the available literature on frequency,predictors,clinical consequences,and strategies for improving medical adherence in patients with IBD.

关键词： Inflammatory bowel disease Crohn's disease Ulcerative colitis Therapy Adherence Compliance 5-aminosalicylate Mesalazine Azathioprine

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Clinical relevance of changes in bone metabolism in inflammatory bowel disease

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World Journal of Gastroenterology 2010年第44期16卷 5536-5542页

作者： pal Miheller Katalin lrinczy peter laszlo lakatos 1st Department of Medicine Semmelweis University

low bone mineral density is an established, frequent, but often neglected complication in patients with inflammatory bowel disease (IBD). Data regarding the diagnosis, therapy and follow-up of low bone mass in IBD has been partially extrapolated from postmenopausal osteoporosis; however, the pathophysiology of bone loss is altered in young patients with IBD. Fracture, a disabling complication, is the most important clinical outcome of low bone mass. Estimation of fracture risk in IBD is difficult. Numerous risk factors have to be considered, and these factors should be weighed properly to help in the identification of the appropriate patients for screening. In this editorial, the authors aim to highlight the most important clinical aspects of the epidemiology, prevention, diagnosis and treatment of IBD-related bone loss.

关键词： Inflammatory bowel disease Crohn’s disease Osteoporosis Osteopenia prevention

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