Publications by authors named "Andrzej Wędrychowicz"

22 Publications

  • Page 1 of 1

Effect of Selected Factors on the Serum 25(OH)D Concentration in Women Treated for Breast Cancer.

Nutrients 2021 Feb 9;13(2). Epub 2021 Feb 9.

Department of Clinical Biochemistry, Pediatric Institute, Faculty of Medicine, Jagiellonian University Medical College, Wielicka 265, 30-663 Kraków, Poland.

Maintaining an optimal vitamin D concentration reduces the risk of recurrence and extends survival time in patients after breast cancer treatment. Data on vitamin D deficiency among Polish women after breast cancer therapy are limited. Thus, the aim of the study was the analysis of vitamin D status in post-mastectomy patients, considering such factors as seasons, social habits, vitamin D supplementation and its measurements. The study involved 94 women after breast cancer treatment. Serum vitamin D concentration was measured, and a questionnaire, gathering demographic and clinical data regarding cancer, diet, exposure to sun radiation, and knowledge of recommendations on vitamin D supplementation, was delivered twice, in both winter and in summer. The control group consisted of 94 age-matched women with no oncological history. In women after breast cancer treatment, 25-hydroxyvitamin D (25(OH)D) deficiency was much more frequent than in the general population. Only about half of the patients supplemented vitamin D at the beginning of the study. After the first test and the issuing of recommendations on vitamin D supplementation, the percentage of vitamin D supplemented patients increased by about 30% in study groups. The average dose of supplement also increased. None of the women that were not supplementing vitamin D and were tested again in winter had optimal 25(OH)D concentration. It was concluded that vitamin deficiency is common in women treated for breast cancer. Medical advising about vitamin D supplementation and monitoring of 25(OH)D concentration should be improved.
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http://dx.doi.org/10.3390/nu13020564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915136PMC
February 2021

Infliximab Therapy Could Decrease the Risk of the Development of Thyroid Disorders in Pediatric Patients With Crohn's Disease.

Front Endocrinol (Lausanne) 2020 15;11:558897. Epub 2020 Sep 15.

Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Medical College, Jagiellonian University in Krakow, Krakow, Poland.

Autoimmune diseases, including autoimmune thyroid diseases (AITDs), may be associated with Crohn's disease (CD). Taking into consideration the role of tumor necrosis factor alpha (TNF-alpha) in the immune-mediated inflammation that underlies both diseases, we evaluated an ultrasound of thyroid gland in pediatric CD patients, naïve, and treated with infliximab (IFX), an anti-TNF-alpha antibody, to assess the risk for AITD and evaluated the usefulness of ultrasonography to diagnose AITD in patients with CD. Sixty-one patients with CD were enrolled in the study, including 36 patients (mean age 14.5 ± 3.5 years) treated with IFX (IFX group) for a mean of 13.9 ± 16.6 months and 25 patients (mean age 14.7 ± 2.3 years) who never received anti-TNF-alpha therapy (control group). An ultrasound examination of the thyroid gland was performed; thyroid function tests and thyroid antibodies were assessed. We found 10-times higher prevalence of decreased thyroid echogenicity in CD and IFX-naive patients compared to IFX-treated group [a significant reduction in thyroid echogenicity in 1/36 (2.8%) patients receiving IFX compared to 7/25 (28%) patients naive to biologic therapy]. The latter showed significantly lower thyroid-stimulating hormone (TSH) levels ( = 0.034) and higher levels of thyroid antibodies ( = 0.042) in comparison to control. Our data suggest the protective role of IFX therapy in the development of thyroid disorders and indicate the usefulness of thyroid ultrasound to identify the risk of probable AITD in pediatric patients with CD.
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http://dx.doi.org/10.3389/fendo.2020.558897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522276PMC
September 2020

Serum concentrations of fibrosis markers in children with inflammatory bowel disease.

Folia Med Cracov 2020 ;60(1):61-74

Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College Kraków, Poland.

Background And Study Aims: The aim of the study was to assess the usefulness of serum concentrations of YKL-40/ CHI3L1 (a 40-kilodalton glycoprotein also referred to as chitinase 3 like- 1 - CHI3L1) and PIIINP (N-terminal propeptide of type III procollagen), markers of fibrosis, in the monitoring of inflammatory processes and fibrosis in children with inflammatory bowel disease (IBD).

Patients And Methods: In 60 patients (41 with Crohn's disease (CD), 19 with ulcerative colitis (UC)) concentrations of investigated parameters were measured at baseline (day 0), after 3 and after 6-8 weeks of pharmacological treatment.

Results: PIIINP concentrations were significantly higher in CD patients compared to UC (baseline results: median concentrations 1013.73 vs 78.30 ng/mL; P = 0.06 for the Kruskall-Wallis test; results at 6-8 weeks: 1076.48 vs 53.10 ng/mL, P = 0.01). Fibrosis was clearly present in patients with CD and its severity increased (reflected by both YKL-40/ CHI3L1 and PIIINP concentrations) in 6-8 weeks of follow up, regardless of the treatment used during that time. In patients with UC the levels of YKL-40/CHI3L1 and PIIINP were lower at baseline and further decreased after 6-8 weeks (median concentrations were respectively: 39.5 ng/mL vs 24.7 ng/mL and 78.3 ng/mL vs 53.1 ng/mL).

Conclusion: Fibrosis was more severe in CD than in UC patients. The marker that more accurately reflected these differences was PIIINP.
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http://dx.doi.org/10.24425/fmc.2020.133487DOI Listing
October 2020

Somatic mosaicism and common genetic variation contribute to the risk of very-early-onset inflammatory bowel disease.

Nat Commun 2020 02 21;11(1):995. Epub 2020 Feb 21.

NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.

Very-early-onset inflammatory bowel disease (VEO-IBD) is a heterogeneous phenotype associated with a spectrum of rare Mendelian disorders. Here, we perform whole-exome-sequencing and genome-wide genotyping in 145 patients (median age-at-diagnosis of 3.5 years), in whom no Mendelian disorders were clinically suspected. In five patients we detect a primary immunodeficiency or enteropathy, with clinical consequences (XIAP, CYBA, SH2D1A, PCSK1). We also present a case study of a VEO-IBD patient with a mosaic de novo, pathogenic allele in CYBB. The mutation is present in ~70% of phagocytes and sufficient to result in defective bacterial handling but not life-threatening infections. Finally, we show that VEO-IBD patients have, on average, higher IBD polygenic risk scores than population controls (99 patients and 18,780 controls; P < 4 × 10), and replicate this finding in an independent cohort of VEO-IBD cases and controls (117 patients and 2,603 controls; P < 5 × 10). This discovery indicates that a polygenic component operates in VEO-IBD pathogenesis.
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http://dx.doi.org/10.1038/s41467-019-14275-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035382PMC
February 2020

Differences in the intestinal microbiome of healthy children and patients with newly diagnosed Crohn's disease.

Sci Rep 2019 12 11;9(1):18880. Epub 2019 Dec 11.

Department of Pediatrics, Gastroenterology and Nutrition, Faculty of Medicine, Jagiellonian University Medical College, Wielicka 265, Kraków, 30-663, Poland.

The aetiology of inflammatory bowel diseases (IBD) seems to be strongly connected to changes in the enteral microbiome. The dysbiosis pattern seen in Crohn's disease (CD) differs among published studies depending on patients' age, disease phenotype and microbiome research methods. The aims was to investigate microbiome in treatment-naive paediatric patients to get an insight into its structure at the early stage of the disease in comparison to healthy. Stool samples were obtained from controls and newly diagnosed patients prior to any intervention. Microbiota was analysed by 16SrRNAnext-generation-sequencing (NGS). Differences in the within-sample phylotype richness and evenness (alpha diversity) were detected between controls and patients. Statistically significant dissimilarities between samples were present for all used metrics. We also found a significant increase in the abundance of OTUs of the Enterococcus genus and reduction in, among others, Bifidobacterium (B. adolescentis), Roseburia (R.faecis), Faecalibacterium (F. prausnitzii), Gemmiger (G. formicilis), Ruminococcus (R. bromii) and Veillonellaceae (Dialister). Moreover, differences in alpha and beta diversities in respect to calprotectin and PCDAI were observed: patients with calprotectin <100 µg/g and with PCDAI below 10 points vs those with calprotectin >100 µg/g and mild (10-27.7 points), moderate (27.5-40 points) or severe (>40 points) CD disease activity had higher richness and diversity of gut microbiota. The results of our study highlight reduced diversity and dysbiosis at the earliest stage of the disease. Microbial imbalance and low abundance of butyrate-producing bacteria, including Bifidobacterium adolescentis, may suggest benefits of microbial modification therapy.
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http://dx.doi.org/10.1038/s41598-019-55290-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906406PMC
December 2019

Dependence of Colonization of the Large Intestine by on the Treatment of Crohn's Disease.

Pol J Microbiol 2019 ;68(1):121-126

Department of Molecular Medical Microbiology, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College , Krakow , Poland.

The aim of this study was to determine if there are quantitative differences in fungi between pediatric patients with Crohn's disease (before and after exclusive enteral nutrition (EEN), and the biologic therapy with anti-tumor necrosis factor alpha - (IFX)), and healthy controls. DNA was isolated from fecal samples and PCR was used to determine the number of fungal cells. Both therapeutic interventions resulted in a statistically significant decrease in Pediatric Crohn's Disease Activity Index. The numbers of decreased during both therapeutic intervention but the difference was statistically significant for the IFX intervention only ( = 0.045). Moreover, fungi population in both study groups declined during intervention when compared to the control group but the difference was significant before treatment only in the IFX group ( = 0.013). The total distribution of with both IFX and EEN as well as in the control group differed significantly ( = 0.01) before treatment only. No correlation between the numbers of and disease activity as well as the following biochemical parameters: serum iron concentration, protein or glucose level were found. It cannot be ruled out that, in combination with genetic and immunological disorders, fungi can contribute to the initiation of the disease process and perpetuation of active inflammation.

The aim of this study was to determine if there are quantitative differences in fungi between pediatric patients with Crohn’s disease (before and after exclusive enteral nutrition (EEN), and the biologic therapy with anti-tumor necrosis factor alpha – (IFX)), and healthy controls. DNA was isolated from fecal samples and PCR was used to determine the number of fungal cells. Both therapeutic interventions resulted in a statistically significant decrease in Pediatric Crohn’s Disease Activity Index. The numbers of decreased during both therapeutic intervention but the difference was statistically significant for the IFX intervention only ( = 0.045). Moreover, fungi population in both study groups declined during intervention when compared to the control group but the difference was significant before treatment only in the IFX group ( = 0.013). The total distribution of with both IFX and EEN as well as in the control group differed significantly ( = 0.01) before treatment only. No correlation between the numbers of and disease activity as well as the following biochemical parameters: serum iron concentration, protein or glucose level were found. It cannot be ruled out that, in combination with genetic and immunological disorders, fungi can contribute to the initiation of the disease process and perpetuation of active inflammation.
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http://dx.doi.org/10.21307/pjm-2019-014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256697PMC
May 2019

Prognostic value of assessment of stool and serum IL-1β, IL-1ra and IL-6 concentrations in children with active and inactive ulcerative colitis.

Arch Med Sci 2018 Jan 30;14(1):107-114. Epub 2017 Jun 30.

Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, Krakow, Poland.

Introduction: Interleukin-1β (IL-1β), interleukin-1 receptor antagonist (IL-1ra) and interleukin-6 (IL-6) contribute to the pathogenesis of ulcerative colitis (UC). The aim of our study was to evaluate the serum and stool IL-1β, IL-1ra and IL-6 concentrations as potential prognostic factors in children with UC.

Material And Methods: Thirty-eight children with UC (20 active, 18 inactive) and 14 healthy controls were prospectively included in the study. IL-1β, IL-1ra and IL-6 concentrations were measured in serum and stool supernatants at inclusion to the study using ELISA immunoassays. The children were followed up over 5 years, and at each follow-up clinical disease activity, quantity and severity of relapses, nutritional status, endoscopic and histopathologic activity, disease complications and the treatment regimen were evaluated.

Results: In children with active and inactive UC who had relapsed during a 5-year follow-up period compared to the non-relapse groups we found significantly increased serum IL-1β (1.34 vs. 0.98 pg/ml, < 0.05, and 1.02 vs. 0.68 pg/ml, < 0.01, respectively,) and IL-1ra (718.0 vs. 453.2 pg/ml, < 0.05, and 567.4 vs. 365.1 pg/ml, < 0.01, respectively). Additionally, in children who had experienced complications during a 5-year follow-up period we observed significantly increased serum and stool IL-1β ( < 0.05) and serum IL-1ra ( < 0.01) compared to the group without complications.

Conclusions: We concluded that serum IL-1β and IL-1ra and to a lesser extend stool IL-1β concentrations may be useful prognostic factors in children with active and inactive UC over a short-term follow-up period, which may help to identify children that require more aggressive therapy due to an increased risk of relapse or complications resulting from UC.
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http://dx.doi.org/10.5114/aoms.2017.68696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778426PMC
January 2018

Diagnostic Value of Fecal Calprotectin (S100 A8/A9) Test in Children with Chronic Abdominal Pain.

Gastroenterol Res Pract 2016 15;2016:8089217. Epub 2016 Nov 15.

Department of Pediatrics, Gastroenterology and Nutrition, Pediatric Institute College of Medicine, Jagiellonian University, Cracow, Poland.

. The aim of the study was to establish whether fecal calprotectin concentration (FCC) may be useful in children with chronic abdominal pain to differentiate between inflammatory bowel disease (IBD), other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. . The study included 163 patients (median age 13 years), who were assigned to four study groups: group 0 (control), 22 healthy children; group 1, 33 children with functional gastrointestinal disorders; group 2, 71 children with inflammatory gastrointestinal disorders other than IBD; group 3, 37 children with IBD. FCC was measured using ELISA assay. . In group 0 and group 1 FCCs were below 100 g/g. Low FCCs were found in 91% of patients in group 2. In patients with IBD FCCs were markedly elevated with median value of 1191.5 g/g. However, in children with inflammatory gastrointestinal disorders other than IBD and in children with IBD mean FCCs were significantly higher compared with the control group. Significant differences in FCCs were also found between group 1 and group 2, between group 1 and group 3, and between group 2 and group 3. . FCC is the best parameter allowing for differentiation between IBD, other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. High FCC is associated with a high probability of IBD and/or other inflammatory gastrointestinal disorders, and it allows excluding functional gastrointestinal disorders.
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http://dx.doi.org/10.1155/2016/8089217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126428PMC
November 2016

Advances in nutritional therapy in inflammatory bowel diseases: Review.

World J Gastroenterol 2016 Jan;22(3):1045-66

Andrzej Wędrychowicz, Department of Pediatrics, Gastroenterology and Nutrition, Polish-American Children's Hospital, Jagiellonian University Medical College, 30663 Krakow, Poland.

Inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn's disease are chronic, life-long, and relapsing diseases of the gastrointestinal tract. Currently, there are no complete cure possibilities, but combined pharmacological and nutritional therapy may induce remission of the disease. Malnutrition and specific nutritional deficiencies are frequent among IBD patients, so the majority of them need nutritional treatment, which not only improves the state of nutrition of the patients but has strong anti-inflammatory activity as well. Moreover, some nutrients, from early stages of life are suspected as triggering factors in the etiopathogenesis of IBD. Both parenteral and enteral nutrition is used in IBD therapy, but their practical utility in different populations and in different countries is not clearly established, and there are sometimes conflicting theories concerning the role of nutrition in IBD. This review presents the actual data from research studies on the influence of nutrition on the etiopathogenesis of IBD and the latest findings regarding its mechanisms of action. The use of both parenteral and enteral nutrition as therapeutic methods in induction and maintenance therapy in IBD treatment is also extensively discussed. Comparison of the latest research data, scientific theories concerning the role of nutrition in IBD, and different opinions about them are also presented and discussed. Additionally, some potential future perspectives for nutritional therapy are highlighted.
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http://dx.doi.org/10.3748/wjg.v22.i3.1045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716019PMC
January 2016

Cosmetic Outcomes of Sutureless Closure in Gastroschisis.

Eur J Pediatr Surg 2016 Dec 8;26(6):537-541. Epub 2016 Jan 8.

Department of Pediatric Surgery, Collegium Medicum, Jagiellonian University, Krakow, Poland.

 A sutureless gastroschisis repair allows for spontaneous closure of abdominal wall defect. We report our experience focusing on final esthetic outcome.  Retrospective data were collected from medical reports of all neonates with gastroschisis operated from January 2009 to December 2013. Variables recorded included patients descriptors, management modality, and cosmetic outcome.  From the overall group of 38 patients with gastroschisis, 20 infants treated with sutureless closure were included in this study. In the analyzed cohort, 17 (85%) children were operated under general anesthesia and 3 (15%) without intubation. Primary reduction was possible in 15 (75%) cases, and in 5 (25%) we used silo. There were two (10%) deaths in late postoperative course due to septic complications. Three (15%) infants needed laparotomy because of adhesions and bowel obstruction. There were no infectious complications of the wound. Only 55% (10/18) of children presented umbilical hernia prior to discharge. Only two (11%) children with umbilical hernia were operated until now. Almost all patients (16/18; 89%) present excellent final cosmetic result without scar formation.  Sutureless closure of uncomplicated gastroschisis is a safe technique that reduces need of intubation and provides excellent cosmetic results.
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http://dx.doi.org/10.1055/s-0035-1570759DOI Listing
December 2016

Clinical value of serum eosinophilic cationic protein assessment in children with inflammatory bowel disease.

Arch Med Sci 2014 Dec 9;10(6):1142-6. Epub 2013 Apr 9.

Department of Pediatrics, Gastroenterology and Nutrition, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland.

Introduction: Eosinophils contribute to the pathogenesis of inflammatory bowel disease (IBD) in the intestine. Eosinophilic cationic protein (ECP) is one of the most important eosinophilic specific mediators released during activation. The aim of the study was to evaluate the clinical value of serum ECP determination in children with active and inactive IBD and its correlation with disease activity.

Material And Methods: There were 125 children with IBD (63 with Crohn's disease - CD, 44 with ulcerative colitis - UC, 18 indeterminate colitis - IC) enrolled in the study. Among them 83 children were in the active phase of the disease, while the remaining 42 were in remission. The control group consisted of 56 healthy children. The ECP was assessed three times in children with active IBD, at baseline and after 2 and 6 weeks of treatment and once in children with inactive IBD and controls using fluoroenzymeimmunoassays.

Results: We found elevated ECP at baseline in the total active IBD group when compared to the inactive IBD and control groups, decreasing during treatment. Serum ECP was also elevated in the active UC and CD groups when compared to the inactive UC and CD groups, and correlated with clinical UC and CD activity (R = 0.57 and R = 0.52, p < 0.05, respectively) and duration of the clinical manifestation in UC (R = 0.62, p < 0.05) but not with the disease location in the gastrointestinal tract, or endoscopic and histopathological activity.

Conclusions: Evaluation of serum ECP in children with IBD may be useful in disease activity assessment at onset and during the treatment.
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http://dx.doi.org/10.5114/aoms.2013.34415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296054PMC
December 2014

Peptides from adipose tissue in mental disorders.

World J Psychiatry 2014 Dec;4(4):103-11

Andrzej Wędrychowicz, Department of Pediatrics, Gastroenterology and Nutrition, Polish-American Children's Hospital, Jagiellonian University Medical College, 30-663 Krakow, Poland.

Adipose tissue is a dynamic endocrine organ that is essential to regulation of metabolism in humans. A new approach to mental disorders led to research on involvement of adipokines in the etiology of mental disorders and mood states and their impact on the health status of psychiatric patients, as well as the effects of treatment for mental health disorders on plasma levels of adipokines. There is evidence that disturbances in adipokine secretion are important in the pathogenesis, clinical presentation and outcome of mental disorders. Admittedly leptin and adiponectin are involved in pathophysiology of depression. A lot of disturbances in secretion and plasma levels of adipokines are observed in eating disorders with a significant impact on the symptoms and course of a disease. It is still a question whether observed dysregulation of adipokines secretion are primary or secondary. Moreover findings in this area are somewhat inconsistent, owing to differences in patient age, sex, socioeconomic status, smoking habits, level of physical activity, eating pathology, general health or medication. This was the rationale for our detailed investigation into the role of the endocrine functions of adipose tissue in mental disorders. It seems that we are continually at the beginning of understanding of the relation between adipose tissue and mental disorders.
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http://dx.doi.org/10.5498/wjp.v4.i4.103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274582PMC
December 2014

[Retrospective analysis of epidemiological and clinical aspects of acute pancreatitis in children].

Pol Merkur Lekarski 2014 Jun;36(216):382-5

Unlabelled: Acute pancreatitis (AP) is becoming more frequent cause of hospitalization in children. There are no guidelines concerning optimal medical treatment in this condition, up to know. The aim of the study was the epidemiological and clinical assessment of AP in pediatric population. The evaluation of influence of administered pharmacotherapy on symptoms remission and the time of laboratory tests normalization.

Material And Methods: There were 54 patients with AP, in the age of 3, 5-18 years, admitted to our hospital between 1994-2011. The investigation was led on the basis of retrospective analysis of medical data.

Results: 41 (75%) patients were admitted with the first episode of AP. The oedematous pancreatitis was confirmed in 49 patients (91%) and necrotizing pancreatitis in 5 cases (9%). The cause of the condition was determined in 44 cases. The most common clinical symptoms were epigastric pain (94%) and vomiting (43%).

Conclusions: There was no statistically significant difference in the time of obtaining normal range of serum and urine amylase activity and relief of symptoms according to administered pharmacotherapy and nutritional therapy
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June 2014

Gastric lipase secretion in children with gastritis.

Nutrients 2013 Jul 29;5(8):2924-32. Epub 2013 Jul 29.

Department of Clinical Biochemistry, Collegium Medicum, Jagiellonian University, Wielicka St. 265, Krakow 30-663, Poland.

Gastric lipase is one of the prepancreatic lipases found in some mammalian species and in humans. Our knowledge of the hormonal regulation of gastric lipase secretion in children and adolescents is still very limited. The aim of this study was to compare the activity of human gastric lipase (HGL) in gastric juice in healthy adolescents and in patients with gastritis. The adolescents were allocated to three groups: the first including patients with Helicobacter pylori gastritis (HPG; n = 10), the second including patients with superficial gastritis caused by pathogens other than H. pylori (non-HPG; n = 14) and the control group including healthy adolescents (n = 14). Activity of HGL was measured in gastric juice collected during endoscopy. Plasma concentrations of cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) were measured in all adolescents. Activity of HGL in the non-HPG group was significantly lower than in the HPG group (p < 0.005) and the control group (p < 0.005). Mean plasma GIP levels in the control group were lower than in the non-HPG group (p < 0.003) and the HPG group (p < 0.01). We conclude that the regulation of HGL secretion by GLP-1 and CCK is altered in patients with gastritis. Moreover, GIP is a potent controller of HGL activity, both in healthy subjects and in patients with gastritis.
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http://dx.doi.org/10.3390/nu5082924DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775235PMC
July 2013

Peptides from adipose tissue in monitoring energy balance in infants.

J Pediatr Endocrinol Metab 2011 ;24(11-12):939-43

Department of Clinical Biochemistry, Gastroenterology and Nutrition, Jagiellonian University College of Medicine, Jagiellonian University, Krakow, Poland.

Background/aim: Overnutrition as well as undernutrition is a serious problem in hospitalized patients, especially in infants. Routine laboratory tests detecting disturbances in energy balance are not specific or accurate. The aim of this study was to evaluate adiponectin and leptin as markers of short-time energy malnutrition.

Methods: Forty-five infants fed orally and parenterally were included in the study. Plasma glucose, leptin and adiponectin were measured in a fasting state and postprandially (1 h after the meal), after a minimum of 24 h of total parenteral nutrition (TPN) and after a minimum of 8 h of intravenous infusion of glucose and crystalloids.

Results: Postprandial glucose levels in children fed orally was similar to that observed in children who received intravenous infusion of glucose. The TPN children had slightly higher glucose concentration in contrast to leptin levels which were significantly lower in this group (1.08 mg/mL +/- 0.43) as compared to the others (p < 0.05 in both cases). The mean postprandial levels of the adiponectin in orally fed children were significantly higher (10.7 microg/mL +/- 2.4) than in children with TPN (5.8 microg/mL +/- 2.4; p < 0.001) and in children hydrated intravenously (3.3 microg/mL +/- 2.3; p < 0.001). The concentration of adiponectin correlated significantly with calorie intake.

Conclusions: Oral meal does not affect the plasma concentrations of leptin and adiponectin in infants. Adiponectin is a good short-time marker of energy malnutrition in infants.
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http://dx.doi.org/10.1515/jpem.2011.328DOI Listing
February 2012

Horizontal distribution of the fecal microbiota in adolescents with inflammatory bowel disease.

J Pediatr Gastroenterol Nutr 2012 Jan;54(1):20-7

Department of Microbiology, Jagiellonian University Medical College, Cracow, Poland.

Background And Aims: The commensal microbiota of the gastrointestinal tract plays an important role in the pathogenesis of inflammatory bowel disease. We examined the horizontal structure of the fecal microbiota in the colon in adolescents with Crohn disease or ulcerative colitis and a control group.

Patients And Methods: Fecal samples were collected in 3 fractions from patients with Crohn disease (n = 22), ulcerative colitis (n = 12), and controls (n = 24) during preparation for colonoscopy. Additionally, biopsies from colon tissue were taken. Samples were examined using a culture technique and a fluorescent in situ hybridization method. The mucin degradation assay was carried out.

Results: Quantitative composition of the microbiota was different in the consecutive 3 fecal fractions and in the colon tissue of the study groups, but in patients from the control group, the composition of microbiota in the consecutive fractions was similar. Statistical analyses showed that the total distribution of the studied bacterial taxons in the contents in all 3 fecal fractions and in the colon tissue in the given disease group, and in the control group was characteristic for the studied patient group. Differences in species distribution among the cohorts studied were highly significant (P < 0.0001). Moreover, it was shown that in the fecal fraction I and in the colon tissue samples, there is no significant difference for any of the analyzed bacterial groups, using the culture methods or fluorescent in situ hybridization, but significant results were demonstrated in the II and III fractions for specific bacterial groups. The bacterial flora attached to the mucus layer in the UC group had significantly more degraded mucus in comparison with the control group (P = 0.045).

Conclusions: Distribution of the microbiota in the colon is layered, which can be called horizontal distribution of the fecal flora. Only in the ulcerative colitis group, the bacterial flora attached to the mucous layer exerts action on the mucin.
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http://dx.doi.org/10.1097/MPG.0b013e31822d53e5DOI Listing
January 2012

Serum concentrations of VEGF and TGF-β1 during exclusive enteral nutrition in IBD.

J Pediatr Gastroenterol Nutr 2011 Aug;53(2):150-5

Department of Pediatrics, Gastroenterology and Nutrition, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland.

Background And Aim: Exclusive enteral nutrition (EEN) is an effective method of treatment in achieving remission in inflammatory bowel disease (IBD); however, its mechanism of action is still poorly understood. The objective of our study was to assess the influence of EEN on serum vascular endothelial growth factor (VEGF) and transforming growth factor-beta 1 (TGF-β1) in children and adolescents with IBD.

Patients And Methods: Thirty-nine children and adolescents with IBD (24 with Crohn disease [CD] and 15 with ulcerative colitis [UC]) and 25 healthy controls were enrolled in the study. VEGF and TGF-β1 were assessed at the baseline and after 2 and 4 weeks of EEN in CD and UC groups and once in controls using enzyme-linked immunosorbent assay immunoassays.

Results: At the baseline, we found increased serum VEGF in the CD versus UC group and controls (P < 0.05) and serum TGF-β1 in the UC versus CD group and controls (P < 0.05). During EEN, VEGF decreased in the UC and CD groups, whereas TGF-β1 increased in the CD group and decreased in the UC group. The CD group achieved disease remission faster than the UC group, and the weight gain of patients with CD during EEN was higher compared with patients with UC. Additionally, TGF-β1 concentration correlated with protein and energies daily intake in the CD group (R = 0.95; P < 0.05).

Conclusions: Different effectiveness of EEN in achieving remission in CD and UC may result from a modification of growth factor production. EEN stimulated TGF-β1 production in CD but not in UC, which possibly resulted in higher effectiveness of EEN in this group of patients.
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http://dx.doi.org/10.1097/MPG.0b013e3182144c74DOI Listing
August 2011

Plasma xenin concentrations in children.

Pediatr Endocrinol Diabetes Metab 2012 ;18(1):5-8

Department of Clinical Biochemistry, Polish-American Children's Institute, College of Medicine, Jagiellonian University, Krakow, Poland.

Introduction: Xenin is a newly discovered peptide in humans. The concentration of xenin in human plasma increases after meals and therefore this peptide is considered as a marker of satiety. The mechanism of xenin action in humans has not been thoroughly examined. MEDLINE database contains only few reports about the role of xenin in adults and none of them were performed in children.

Aim Of The Study: The aim of the study was to evaluate the concentration of xenin in children with energy balance disorders.

Material And Methods: Plasma xenin concentration was measured in children with inflammatory bowel syndrome (IBD) (n=53; age 14±3 years) before, during and after treatment, obese children (n=26; age 14±2.8 years) during the OGGT test and in healthy children (n=10; age 15.7±2.2 years). Xenin was determined in the plasma using the radioimmunological method.

Results: The mean plasma xenin concentration in the healthy children was 371±36 pg/ml. In the children with an acute phase of IBD the mean concentration of xenin was 367±96 pg/ml and an increase during the treatment to the mean value 399±55 pg/ml was noted. The highest mean value of xenin concentration (412±55 pg/ml) was found during early remission. In obese children, the mean concentration of xenin (198±69 pg/ml) was significantly lower as compared to children with IBD and to control (p<0.001 in both cases). The glucose load did not have any effect on xenin concentration in obese children.

Conclusions: Xenin takes part in the regulation of energy balance in children.
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June 2012

[Influence of enteral nutrition therapy on serum angiogenic growth factors concentrations in children].

Przegl Lek 2010 ;67(1):31-5

Klinika Pediatrii, Gastroenterolog Polsko-Amerykański Instytut Pediatrii WL UJ 31-663 Kraków, ul. Wielicka 265.

Introduction: Effectiveness of enteral nutrition therapy is not only connected with improvement of the nutritional status of the patient, but also with its strong anti-inflammatory activity. Angiogenic growth factors play an important role in the early stage of inflammation. Vascular endothelial growth factor (VEGF) and transforming growth factor beta 1 (TGF-beta 1) stimulate the angiogenesis and healing processes. The objective of our study was to assess the influence of the enteral nutrition therapy on the vascular endothelial growth factor (VEGF) and transforming growth factor beta 1 (TGF-beta 1) concentrations in serum in children with different diseases of gastro-intestinal tract, in which enteral nutrition therapy is effective method of treatment.

Material And Methods: Sixty two children (29 boys, 33 girls, mean age: 12.5 yrs, range: 6-18 yrs) and 25 healthy controls were included into the study. The Crohn's disease group (CD) consisted of 25 patients, ulcerative colitis group (UC)-18 patients, acute pancreatitis (AP) group-12 patients and severe malnutrition (N) group-7 patients. Serum VEGF and TGF-beta 1 concentrations were assessed at baseline, before starting and after 2 and 4 weeks of enteral nutrition therapy using ELISA immunoassays (R and D Systems, USA).

Results: Before starting enteral nutrition, we found increased VEGF concentration in CD group (Me = 600 pg/ml) compared to UC group (266.9 pg/ml), AP group (552.6 pg/ml), N group (238.5 pg/ml) and controls (172 pg/ml) (p < 0.05). We found decrease of VEGF concentrations during enteral nutrition in CD, UC and N group and increase in AP at the beginning, followed by decrease to the initial values. Assessing TGF-beta 1, we found its concentration increased before starting enteral nutrition in UC group (37.5 ng/ml) compared to CD group (29.7 ng/ ml) and controls (24.8 ng/ml) (p < 0.05). During enteral nutrition we observed decrease of TGF-beta 1 concentration in UC group and increase in CD group (32,7 ng/ml) and AP group (26,6 ng/ml) (p < 0.05) The best improvement of nutritional status was observed in CD patients compared to N and AP patients.

Conclusions: Differentiation of serum VEGF and TGF-beta 1 concentrations, what was observed in various gastro-intestinal diseases, reflects different mechanisms of enteral nutrition therapy acting on the inflammatory process. The most efficient therapeutic effect was seen in CD, where stimulation of TGF-beta 1 production was observed.
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July 2010

Mucosal bacterial microflora and mucus layer thickness in adolescents with inflammatory bowel disease.

World J Gastroenterol 2009 Nov;15(42):5287-94

Department of Pediatrics, Gastroenterology and Nutrition, Polish-American Children's Hospital, Jagiellonian University Medical College, 265 Wielicka Str., 30-663 Cracow, Poland.

Aim: To assess the mucosa-associated bacterial microflora and mucus layer in adolescents with inflammatory bowel disease (IBD).

Methods: Sixty-one adolescents (mean age 15 years, SD+/-4.13) were included in the study. Intestinal biopsies from inflamed and non-inflamed mucosa of IBD patients and from controls with functional abdominal pain were cultured under aerobic and anaerobic conditions. The number of microbes belonging to the same group was calculated per weight of collected tissue. The mucus thickness in frozen samples was measured under a fluorescent microscope.

Results: The ratios of different bacterial groups in inflamed and non-inflamed mucosa of IBD patients and controls were specific for particular diseases. Streptococcus spp. were predominant in the inflamed mucosa of Crohn's disease (CD) patients (80% of all bacteria), and Lactobacillus spp. were predominant in ulcerative colitis patients (90%). The differences were statistically significant (P=0.01-0.001). Lower number of bifidobacteria was observed in the whole IBD group. A relation was also found between clinical and endoscopic severity and decreased numbers of Lactobacillus and, to a lesser extent, of Streptococcus in biopsies from CD patients. The mucus layer in the inflamed sites was significantly thinner as compared to controls (P=0.0033) and to non-inflamed areas in IBD patients (P=0.031).

Conclusion: The significantly thinner mucosa of IBD patients showed a predominance of some aerobes specific for particular diseases, their numbers decreased in relation to higher clinical and endoscopic activity of the disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776855PMC
http://dx.doi.org/10.3748/wjg.15.5287DOI Listing
November 2009

[The low prevalence of Helicobacter pylori gastritis in newly diagnosed inflammatory bowel disease children and adolescent].

Przegl Lek 2007 ;64 Suppl 3:65-7

Klinika Pediatrii, Gastroenterologii i Zywienia, Uniwersytetu Jagiellońskiego, Collegium Medicum w Krakowie.

Data concerning prevalence rate of Helicobacter pylori gastritis in inflammatory bowel disease (IBD) patients is conflicting. We had studied the prevalence of Hp gastritis in newly diagnosed inflammatory bowel disease children before any pharmacological treatment was introduced. Ninety four consecutive children with inflammatory bowel diseased were enrolled into study, mean age 12.9 +/- 3.75 years, including 50 with Crohn's Disease (CD) and 44 with ulcerative colitis (UC). One hundred and four patients (mean age 13.6 +/- 4.2 year) referred for diagnostic evaluation because of recurrent abdominal pain, matched for age, sex and socioeconomic status served as a control. The results revealed a highly statistically lower prevalence of Hp gastritis in children with IBD as compared with controls (9.6% vs. 38.4%, p < 0.0001). Significantly more often Hp gastritis occurred in CD than UC patients. There was no statistical difference in mean age of IBD onset between Hp gastritis positive and negative groups (14.3 +/- 3.75 vs. 13.6 +/- 4.3 yr) was found. Our results show that in newly diagnosed IBD children, Hp gastritis is not unusual, but the prevalence rate is significantly lower comparing to the control group. The low Hp gastritis rate is not related to medical treatment, since the patients were studied before any was introduced.
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June 2008

Stool interleukin 1beta and interleukin 1 receptor antagonist concentrations in children with active ulcerative colitis and during recovery.

Eur J Pediatr 2003 Jul 26;162(7-8):541-542. Epub 2003 Apr 26.

Department of Pathology, Polish-American Children's Hospital, Jagiellonian University, Cracow, Poland.

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http://dx.doi.org/10.1007/s00431-003-1204-0DOI Listing
July 2003