[Gut-liver axis in inflammatory bowel disease. A retrospective study]. / A bél­máj tengely vizsgálata colitis ulcerosában. Retrospektív tanulmány.

INTRODUCTION: Examination of the gut-liver axis came into the spotlight worldwide. Liver enzyme elevations are commonly seen in patients with inflammatory bowel disease (IBD), which is a diagnostic challenge in everyday clinical practice. Liver and biliary diseases are common extra-intestinal manifestations in Crohn's disease and ulcerative colitis. The assessment of routine liver function tests could be an inaccurate reflection of liver damage, so its prevalence could be underestimated. There would be a need for non-invasive biomarkers and/or scoring systems, which would help the diagnosis of liver damage associated with intestinal diseases. AIM: In our work we considered to highlight the importance of the gut-liver axis significance. We used data of patients suffering from ulcerative colitis, as a model for bowel diseases to understand the underlying factors of the pathogenesis of hepatobiliary manifestations. METHOD: In our retrospective study, we investigated the data of 100 ulcerative colitis patients (male = 46, female = 54) (mean age: 42.5 ± 12.7) and compared to healthy controls (n = 42) (male = 17, female = 25) (mean age: 40.2 ± 13.5). Liver function tests (ALT, AST, GGT, ALP, bilirubin, albumin, thrombocyte), bile acid levels were determinated, and various free radical markers (global, enzymatic) were used to assess the redox homeostasis of patients. Hydrogen donor activity, reducing power, superoxide dismutase and glutathione peroxidase activity, total antioxidant status and induced chemiluminescence were measured, considering that the patients received 5-aminosalicilate and/or azathioprin and elemental diet treatment. RESULTS: Liver function parameters were increased in ulcerative colitis patients, and total antioxidant status, as well. Reducing power significantly decreased, but there was no significant difference compared to the control group of glutathione peroxidase and H-donor activity, we observed only tendentious decrease. The antioxidant protection of more than 54% of patients had a significantly lower rate, according to all the parameters. With chemiluminescence measurement we measured better free radical scavenging capacity, both in plasma and in erythrocytes as a result of the therapy, however, it showed an increase of superoxide dismutase activity, which warns of inflammatory processes. The cause of the decrease in bile acid levels found in the group of ulcerative colitis patients, can be the accelerated peristaltic. CONCLUSIONS: In the daily routine, liver enzyme values do not give an accurate picture of liver damage associated with ulcerative colitis. With the help of various specific parameters determined by us, we can estimate the background processes of the gut-liver axis alterations. The decrease in bile acid levels can be a predictive factor in ulcerative colitis. Our work highlights the need of non-invasive screening for liver diseases in inflammatory bowel disease. Orv Hetil. 2017; 158(26): 1014-1021.

Changes of erythrocyte element status of colectomysed cancerous patients: Retrospective study.

Nowadays it has been established that metals and metal-induced oxidative stress act on signal transduction pathways, and are in association with cancer growth and spreading as well as in neurodegenerative disorders. In cases of several neurodegenerative diseases metals, especially Al, can be considered as a risk factor. Frequency of chemotherapy-related cognitive impairment or "chemobrain" is mentioned to be significant in literature, although very little is known about the chemotherapy-caused chemobrain and its connection with metal homeostasis alteration. Dysregulation of metal homeostasis can be assumed as one of the key factors in the progression of neurodegeneration. Therefore we were interested in studying metal element status of 27 adult patients in 3 years after their colectomy, 22 outpatients and 10 healthy volunteers in both genders. Tumour markers, laboratory parameters and metal element concentrations were determined. We found significant difference among the Al concentrations in operated patients compared with controls. Redox active Fe and Cu levels were also elevated slightly in this patient group. P and S concentrations changed in different ways, and Ca levels were slightly lower, than in healthy controls. Because of all above mentioned, examination of metal homeostasis in cancerous patients is necessary to moderate the risk of chemobrain and other redox-related disorders.

[Dysmotility-type dyspepsia and eructation. Introduction of a new gas-analytical method]. / Dysmotilitas típusú dyspepsia és bélgázok. Új gázanalitikai módszer bemutatása.

This paper describes a new gas-analytical method used in a 55-year-old female patient with dyspepsia. Symptoms included epigastric fullness and inflation. Evaluation indicated an increased gas production in the proximal end of the small intestine that entered into the stomach via duodenogastric reflux. High CO2 content of eructed gas was confirmed in eructed gas samples using a tube in situ. Authors propose that this new analytical method of eructed gas may be applied in clinical practice in patients with dyspepsia.

Important bioactive molecules of erythrocytes in colorectal cancer patients after colectomy.

Formaldehyde (HCHO) and protoporphyrin, are in connection with redox homeostasis. Data show the importance of HCHO in proliferative as well as in apoptotic processes. Free protoporphyrin can be detected near the Zn-protoporphyrin in cancer and it has pro- and antioxidant forms depending on concentrations. The aim was to determine the amount of HCHO and protoporphyrin concentrations of erythrocytes in colorectal cancer after colectomy and to estimate redox homeostasis. Total 32 adult patients after 5-10 years of colectomy and 9 healthy volunteers were drawn into this study. Tumor markers, redox parameters, HbA1c, HCHO and protoporphyrin concentrations were measured. Erytrocyte HCHO was significantly lower in colectomysed patients, than in controls. Protoporphyrin concentration was low in patients, but in metastasis its concentration was significant. HbA1c correlated significantly with free radicals and decreased the antioxidant status of erythrocytes. HCHO and protoporphyrin concentrations of erythrocytes and the total scavenger capacity are very important indexes in cancer.

The importance of follow-up examinations in patients with carcinoid tumor.

Carcinoid tumors are rare forms of gastrointestinal tumors, although lately they have been found with increasing frequency. We report here the combined diagnosis of an intestinal metastasized carcinoid tumor. A 67-year-old patient was followed up during a nine-year period. In 1990 the patient was diagnosed with carcinoid tumor of intestinal origin with multiple liver metastases. Initial treatment consisted of partial resection of the intestine and resection of the liver. Since multiple liver metastases were found, chemoembolization was also performed. After this therapy the patient was free of complaints until 1996. That year the patient reported upper abdominal pain with occasional diarrhea. Given his past medical history and multiple hepatic metastases proven by three-dimensional ultrasonography, combined octreotide and interferon therapy was started following octreoscan scintigraphy. During a three-year period the patient was without complaints and the tumor marker value decreased to almost normal. In 1998 the patient at a regular follow-up visit complained about colic abdominal pain around the umbilical region. Abdominal ultrasonography showed a local wall thickening in the intestinal region. The computed tomography and selective enterography were positive as well. The surgical treatment and histology demonstrated intestinal recurrence of the tumor in the ileal region. After the operation we started a long-acting sandostatin and interferon treatment. We conclude that an ultrasound with a high index of clinical suspicion is a useful test for the diagnosis of carcinoid tumor in detection and in follow-up examinations.