Cardiovascular risk factors in coeliac disease (ARCTIC): a protocol of multicentre series of studies.

INTRODUCTION: There is only limited and controversial information available on the cardiovascular (CV) risk in coeliac disease (CD). In this study, we plan to investigate the body composition and CV risk-related metabolic parameters at the diagnosis of CD and on a gluten-free diet in a Hungarian cohort of patients with CD. METHODS AND ANALYSIS: This study consists of two case-control studies and a prospective cohort study, involving newly diagnosed and treated patients with CD with age and sex-matched non-CD control subjects with an allocation ratio of 1:1. CD-related symptoms, quality of life, quality of the diet and CV risk will be assessed with questionnaires. Our primary outcomes are body composition parameters, which will be estimated with InBody 770 device. Secondary outcomes are CV-risk related metabolic parameters (eg, serum lipids, haemoglobin A1c, homeostatic model assessment index, liver enzymes, homocysteine, interleukin 6, galectin-3) and enteral hormones (leptin, ghrelin, adiponectin) measured from venous blood samples for all participants. Fatty liver disease will be assessed by transabdominal ultrasonography. In statistical analysis, descriptive and comparative statistics will be performed. With this study, we aim to draw attention to the often neglected metabolic and CV aspect of the management of CD. Findings may help to identify parameters to be optimised and reassessed during follow-up in patients with CD. ETHICS AND DISSEMINATION: The study was approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (27521-5/2022/EÜIG). Findings will be disseminated at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05530070.

The Use of Complementary and Alternative Medicine Is Less Frequent in Patients with Inflammatory Bowel Disease Than in Patients with Other Chronic Gastrointestinal Disorders.

BACKGROUND AND AIMS: Complementary and alternative medicine (CAM) is commonly used among patients with inflammatory bowel diseases (IBD), but evidence about its real-life use is limited. We aimed to assess and compare CAM use in outpatients with IBD and other gastrointestinal diseases. MATERIALS AND METHODS: The use of herbs and botanicals, lifestyle modifications and mind/body therapies, patient satisfaction, and continuous use of conventional medicine were assessed with an anonymous questionnaire at a tertiary IBD unit in Hungary. 396 IBD patients (207 with Crohn's disease, 185 with ulcerative colitis, and 4 with indeterminate colitis) and 164 patients with gastric acid-related diseases, premalignant and malignant colorectal diseases, lactose intolerance, celiac disease, dysbacteriosis, and so on were included. RESULTS: IBD patients reported significantly lower usage of herbs than did controls (25% versus 42%, p < 0.001). More than 90% of responding IBD patients continued conventional medication besides herbal remedies (83% in unaltered doses). IBD patients were more likely to implement lifestyle modifications (77% versus 63%, p = 0.0011), but not body/mind therapies (20% versus 15%, p = 0.1516). Younger age was a significant predictor of lifestyle modifications (p = 0.0246). CONCLUSIONS: CAM use (especially that of herbal remedies) in IBD is less frequent than that in other gastrointestinal diseases. It is more a complementary than an alternative to conventional medicine in IBD. There is no significant difference between CAM use in patients with Crohn's disease and that in patients with ulcerative colitis, although the latter tend to choose herbs; the benefit of which is supported by scientific evidence. This study is registered at the Medical Research Council, Hungary. This trial is registered with 3769/2010/1018EKU.

Genetic polymorphism of interleukin-8 (IL-8) is associated with Helicobacter pylori-induced duodenal ulcer.

BACKGROUND AND AIMS: Helicobacter pylori infection almost invariably causes chronic gastritis, but only a proportion of the infected subjects develop peptic ulcers. The local inflammation associated with H. pylori infection is characterized by an increased production of the proinflammatory cytokines IL-1-B, IL-6, IL-8 and TNF-alpha. Since such cytokine production is often determined by the genetic polymorphism of regions regulating cytokine gene expression, we investigated the relationship between TNF-alpha and IL-8 polymorphisms and the development of duodenal ulcer disease. We also sought a correlation between the promoter polymorphism of the lipopolysaccharide (LPS) receptor CD14 and the formation of peptic ulcer, because CD14 plays a crucial role in the initiation of the cytokine cascade. METHODS: Genomic DNA extracted from the peripheral blood of 69 patients with H. pylori-positive duodenal ulcer disease and 47 H. pylori-positive healthy controls was analyzed for TNF-alpha -308 promoter polymorphism by RFLP, and for IL-8 -251 polymorphism by ARMS. Genetic polymorphism within the promoter of the CD14 gene was identified using the LightCycler instrument via melting point analysis. RESULTS: No significant correlation could be revealed between the TNF-alpha and CD14 promoter polymorphisms and the clinical outcome of H. pylori infection. The IL-8 A/T heterozygote mutant variant was detected with a significantly higher frequency (65.22%) among the ulcer patients than among the healthy, H. pylori-positive blood donors (36.17%), while the frequency of the normal allelic genotype (TT) was significantly higher in the control group (44.6% vs 15.9%). CONCLUSION: Analysis of the genetic predisposition to enhanced cytokine production revealed a significant association only for the IL-8 polymorphism. This observation draws attention to the possible importance of IL-8 polymorphism as a genetic predisposing factor in the pathomechanism of H. pylori-induced duodenal ulcer disease, and to the relative protection from duodenal ulcer disease that is associated with the TT genotype.

[Surgical treatment of gastric cancer: new methods and longstanding difficulties]. / Gyomorcarcinoma sebészi kezelése: új lehetôségek és régi gondok.

UNLABELLED: The incidence of gastric carcinoma has been declining and the same tendency is observed in Hungary. The five-year survival rate has been improved due to the fewer postoperative deaths and the more radical operations (e.g. extended lymphadenectomies). METHODS: The authors analyzed the clinical data of 183 patients with gastric carcinoma. Age, sex, histology reports, TNM staging and the surgical interventions are presented. RESULTS: Potentially curative resection could be performed in about half of the patients (92/182). A large proportion of the patients belonged to the locally advanced cancer group (112/182). The ratio of the different TNM stages remained the same year by year in the investigated period despite the improving endoscopic facilities. CONCLUSION: Early diagnosis of gastric cancer is crucial and continuous effort should be made by the surgeons, the gastroenterologist and the general practitioners to identify high risk patients with the use of new, sensitive screening methods.