Publications by authors named "Krzysztof Fyderek"

36 Publications

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

Quantitative changes in selected bacteria in the stool during the treatment of Crohn's disease.

Adv Med Sci 2020 Sep 23;65(2):348-353. Epub 2020 Jun 23.

Jagiellonian University Medical College, Faculty of Medicine, Department of Pediatrics, Gastroenterology and Nutrition, Krakow, Poland. Electronic address:

Purpose: The aim of this study was to determine quantitative changes in selected species of bacteria (Bacteroides fragilis, Lactobacillus fermentum, Lactobacillus rhamnosus, Serratia marcescens) in the stool of patients with Crohn's disease (CD) in the course of induction treatment with exclusive enteral nutrition (EEN) or anti-tumor necrosis factor alpha (Infliximab, IFX) vs. healthy controls (HC).

Materials/methods: DNA was isolated from stool samples of CD (n = 122) and HC (n = 17), and quantitative real-time Polymerase Chain Reaction (qPCR) was applied. In both treatment groups, the first stool sample was taken before the start of treatment, and the second 4 weeks after its end: in EEN (n = 48; age (mean; SD) 13.35 ± 3.09 years) and IFX groups (n = 13; age (mean; SD) 13.09 ± 3.76 years).

Results: The only species that showed a statistically significant difference between the two groups of patients before any therapeutic intervention was L. fermentum. Moreover, its number increased after completion of EEN and differed significantly when compared with the HC. In the IFX group the number of L. fermentum decreased during the therapy but was significantly higher than in the HC. The number of S. marcescens in the EEN group was significantly lower than in the controls both before and after EEN.

Conclusion: The implemented treatment (EEN or IFX) modifies the microbiome in CD patients, but does not make it become the same as in HC.
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http://dx.doi.org/10.1016/j.advms.2020.06.003DOI Listing
September 2020

Changes in the Intestinal Microbiota Are Seen Following Treatment with Infliximab in Children with Crohn's Disease.

J Clin Med 2020 Mar 4;9(3). Epub 2020 Mar 4.

Jagiellonian University Medical College, Faculty of Medicine, Department of Pediatrics, Gastroenterology and Nutrition, 30-633 Kraków, Poland.

The aim of the study was to determine the impact of biological treatment with tumor necrosis factor α antibodies (anti-TNF-α) on the intestinal microbiome of children with severe Crohn's disease (CD) and to evaluate the differences in the intestinal microbiome between patients treated with biological therapy and healthy children. Microbiota composition was analyzed by 16S next-generation sequencing (NGS) and microbial profiles were compared between studied groups. Fifty-four samples (from 18 patients before and after anti-TNF-α induction therapy and 18 healthy children) were used in the sequencing analysis. Shannon's diversity index ( = 0.003, adj. = 0.010) and observed operational taxonomic units (OTUs) ( = 0.007, adj. = 0.015) were different between controls and patients with prior therapy for CD. Statistically significant dissimilarities between beta diversity metrics, indicating distinct community composition across groups, were observed in patients with CD before and after therapy. We did not observe any differences between controls and patients with CD after therapy. Core microbiome analysis at species level showed that 32 species were present only in patients with CD but not in controls. The results show that biological treatment is associated with changes in the intestinal microbiome of patients with CD: these changes result in an intestinal microbiome pattern similar to that seen in healthy children. Long-term observation is necessary to determine whether treatment can lead to full restoration of a healthy-like microbiome.
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http://dx.doi.org/10.3390/jcm9030687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141282PMC
March 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

Serum trace elements profile in the pediatric inflammatory bowel disease progress evaluation.

J Trace Elem Med Biol 2019 Sep 19;55:121-126. Epub 2019 Jun 19.

Department of Analytical Chemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, Kraków 30-387, Poland.

Introduction: Inflammatory bowel disease (IBD), a chronic inflammatory disorder of gastrointestinal tract, arises from complex interaction between genetics, environment, gut microbiota and mucosal immune response. Along with clinical, endoscopic and radiological evaluation various biomarkers are needed as an additional diagnostic tool, as well as to predict disease course and therapeutic outcomes.

Aim: The aim of this study was to evaluate clinical value of essential trace elements (ETEs) serum concentration profile in the assessment of pediatric IBD diseases development.

Materials And Methods: Concentration of five ETEs: iron (Fe), zinc (Zn), copper (Cu), manganese (Mn) and selenium (Se) in serum of 41 children with newly diagnosed IBD (27 CD and 14 UC) and 20 healthy controls were determined by inductively coupled plasma mass spectrometry (ICP-MS) and atomic fluorescence spectrometry (AFS) at the moment of diagnosis and after one year of treatment.

Results: The obtained results revealed significant differences in serum concentration profile of studied ETEs' for IBD pediatric patients and healthy controls. Decrease of iron, zinc and selenium and increase of copper and manganese serum concentration were observed in IBD patients at the time of diagnosis. The changes were reversible and after one year of treatment the studied ETEs serum concentration profile resembled much more that observed for healthy controls. Correlations between studied ETEs levels within cases (IBD, CD, UC) were also found to be different from those in healthy controls (HC).

Conclusion: Although much more studies are required on the subject our results demonstrate a clinical value of ETEs serum concentration profile in pediatric IBD patients regarding disease development.
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http://dx.doi.org/10.1016/j.jtemb.2019.06.016DOI Listing
September 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

Is mean platelet volume a good predictor of sustained response to one year infliximab therapy in pediatric patients with Crohn's disease?

Folia Med Cracov 2017;57(2):63-71

Department of Pediatrics, Gastroenterology and Nutrition Jagiellonian University Medical College, Wielicka 265, Kraków, Poland.

Over the past years, there is a growing number of newly diagnosed pediatric patients with Crohn's disease (CD). Severe course of CD often requires biological treatment with Infliximab (IFX). Loss of response to biological treatment is a major problem. Mean platelet volume (MPV) was reported as a good marker of sustained response to IFX therapy in adults. This study is to determine whether MPV measured prior to IFX therapy and a er its third dose can be used as a predictive marker of sustained response to biological therapy in children with severe course of CD. 43 pediatric patients with CD who underwent IFX therapy were enrolled into this study. The clinical response was evaluated after the third dose and after one year of IFX treatment (sustained response). The MPV values at baseline and week 14 were compared to the patients with good response to IFX to those with loss of the response. During 52-week IFX therapy, 2 out of 43 patients enrolled in the study did not achieve primary response a er the third dose, another 18 children lost their response to the above therapy a er one year. There was no significant association between baseline and 14th week values of MPV between patients with the sustained response to those with loss of response. In opposite to adult patients, MPV cannot be regarded as predictive factor of sustained response to IFX treatment in pediatric patients.
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July 2019

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

Clinical presentations of Wilson disease among Polish children.

Dev Period Med 2016;20(3):216-221

Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, Fax: (+48 22) 815-73-82 e-mail:

Introduction: Wilson disease (WD) may present from early childhood up to the eighth decade, presenting with variable hepatic and neuropsychiatric symptoms. Establishing the diagnosis is straightforward if the major clinical and laboratory features are present. However, clinical phenotypes are highly varied and early, proper diagnosis can be challenging.

Aim: The aim of our study was to analyze clinical presentations and diagnostic tests of Polish pediatric patients with WD.

Methods: We retrospectively analyzed medical history of 156 patients with confirmed diagnosis of WD treated at our Institute from 1996 till March 2016.

Results: The mean age at onset of symptoms was 10.15±4.23 years of age. Hepatic presentation was the most common one (94.23%) with either liver failure (16.03%) or more frequently increased transaminases (78.2%). In 90.26% cases ceruloplasmin serum concentration was ≤0,2 g/l, in 51.93% patients basal urinary copper excretion was >100 μg/24 h. Mutation analysis was performed in 155 (99.36%) cases. The most common mutation was p.H1069Q.

Conclusions: Wilson disease can present with only significantly increased transaminases activity and hepatomegaly or liver failure, but neurological symptoms are very rare in children. Diagnostic approach is challenging due to wide spectrum of clinical presentations in a high variable degree of severity. Genetic screening is supportive, ceruloplasmin and urinary copper excretion are valuable tests in the majority of patients but do not allow to exclude WD.
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June 2017

[Metabolic bone disease in children with chronic gastrointestinal tract condition].

Pol Merkur Lekarski 2016 Jul;41(241):43-46

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

In this review issues concerning bone metabolism are presented. The diagnostic criteria of decreased mineral bone density is discussed with the significance of densitometry. The necessity of presence of low-trauma fracture to diagnosed the osteoporosis in children is signified. The paper reviews most common chronic gastrointestinal tract condition associated with the altered bone metabolism. The diagnostic and early treatment of decreased mineral bone density in children, who are before obtaining peak bone mass is crucial to prevent the risk of osteoporosis in adulthood.
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July 2016

Laryngopharyngeal Reflux in Children with Chronic Otitis Media with Effusion.

J Neurogastroenterol Motil 2016 Jul;22(3):452-8

Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum Jagiellonian University, Cracow, Poland.

Background/aims: To evaluate the characteristic properties of laryngopharyngeal reflux (LPR) and gastroesophageal reflux (GER) in children with otitis media with effusion (OME) using 24-hour multichannel intraluminal impedance combined with dual-probe (pharyngeal and esophageal) pH-metry.

Methods: Children aged 7-10 years of age with OME underwent 24-hour multichannel intraluminal impedance pH-metry. The upper pH sensor was situated 1 cm above the upper esophageal sphincter, and the lower pH sensor was placed 3-5 cm above the lower esophageal sphincter. Parents were asked to complete the gastroesophageal reflux assessment of symptoms in a pediatrics questionnaire.

Results: Twenty-eight children were enrolled; LPR was detected in 19 (67.9%) children. The criteria of the LPR diagnosis was the presence of at least one supraesophageal episode with a pH < 5.0 and a change in the pH value measured from the initial level at the upper sensor of > 0.2. In total, 64 episodes were observed. Assessment of all LPR episodes showed the presence of 246 episodes in the entire study. A considerable predominance of weakly acidic episodes (87.8%) was noted; there were 6.5% acidic episodes, and weakly alkaline episodes reached 5.7%. Pathological GER was noted in 10 (35.7%) subjects. Acid GER was detected in 8 children, 2 of whom demonstrated non-acidic reflux. In the LPR-negative patients, no pathological GER was confirmed with the exception of a single case of non-acidic reflux.

Conclusions: LPR was frequently noted in the group of children with OME, and it might be an important risk factor in this common disease.
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http://dx.doi.org/10.5056/jnm16013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930300PMC
July 2016

Randomized clinical trial: pharmacokinetics and safety of multimatrix mesalamine for treatment of pediatric ulcerative colitis.

Drug Des Devel Ther 2016 4;10:593-607. Epub 2016 Feb 4.

Shire, Wayne, PA, USA.

Background: Limited data are available on mesalamine (5-aminosalicylic acid; 5-ASA) use in pediatric ulcerative colitis (UC).

Aim: To evaluate pharmacokinetic and safety profiles of 5-ASA and metabolite acetyl-5-ASA (Ac-5-ASA) after once-daily, oral administration of multimatrix mesalamine to children and adolescents with UC.

Methods: Participants (5-17 years of age; 18-82 kg, stratified by weight) with UC received multi-matrix mesalamine 30, 60, or 100 mg/kg/day once daily (to 4,800 mg/day) for 7 days. Blood samples were collected pre-dose on days 5 and 6. On days 7 and 8, blood and urine samples were collected and safety was evaluated. 5-ASA and Ac-5-ASA plasma and urine concentrations were analyzed by non-compartmental methods and used to develop a population pharmacokinetic model.

Results: Fifty-two subjects (21 [30 mg/kg]; 22 [60 mg/kg]; 9 [100 mg/kg]) were randomized. On day 7, systemic exposures of 5-ASA and Ac-5-ASA exhibited a dose-proportional increase between 30 and 60 mg/kg/day cohorts. For 30, 60, and 100 mg/kg/day doses, mean percentages of 5-ASA absorbed were 29.4%, 27.0%, and 22.1%, respectively. Simulated steady-state exposures and variabilities for 5-ASA and Ac-5-ASA (coefficient of variation approximately 50% and 40%-45%, respectively) were similar to those observed previously in adults at comparable doses. Treatment-emergent adverse events were reported by ten subjects. Events were similar among different doses and age groups with no new safety signals identified.

Conclusion: Children and adolescents with UC receiving multimatrix mesalamine demonstrated 5-ASA and Ac-5-ASA pharmacokinetic profiles similar to historical adult data. Multimatrix mesalamine was well tolerated across all dose and age groups. ClinicalTrials.gov Identifier: NCT01130844.
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http://dx.doi.org/10.2147/DDDT.S95316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745832PMC
October 2016

The Influence of Ghrelin on the Development of Dextran Sodium Sulfate-Induced Colitis in Rats.

Biomed Res Int 2015 2;2015:718314. Epub 2015 Dec 2.

Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegórzecka Street, 31-531 Cracow, Poland.

Ghrelin has protective and therapeutic effects in the gut. The aim of present studies was to investigate the effect of treatment with ghrelin on the development of colitis evoked by dextran sodium sulfate (DSS). Methods. Studies have been performed on rats. Colitis was induced by adding 5% DSS to the drinking water for 5 days. During this period animals were treated intraperitoneally twice a day with saline or ghrelin given at the dose of 8 nmol/kg/dose. On the sixth day, animals were anesthetized and the severity of colitis was assessed. Results. Treatment with ghrelin during administration of DSS reduced the development of colitis. Morphological features of colonic mucosa exhibited a reduction in the area and deep of mucosal damage. Ghrelin reversed the colitis-induced decrease in blood flow, DNA synthesis, and superoxide dismutase activity in colonic mucosa. These effects were accompanied by a decrease in the colitis-evoked increase in mucosal concentration of interleukin-1β and malondialdehyde. Treatment with ghrelin reversed the DSS-induced reduction in body weight gain. Conclusions. Administration of ghrelin exhibits the preventive effect against the development of DSS-induced colitis. This effect seems to be related to ghrelin's anti-inflammatory and antioxidative properties.
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http://dx.doi.org/10.1155/2015/718314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4680107PMC
September 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

[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

[Characteristics of eosinophilic inflammation of the gastrointestinal tract in children--a retrospective analysis of clinical material with review of the literature].

Przegl Lek 2013 ;70(12):1011-4

Eosinophilic disorders of the gastrointestinal tract are a heterogeneous group of rare and therefore rarely diagnosed chronic diseases occurring in both pediatric and adults. They represent a diverse clinical presentation, but their common feature is the presence of inflammatory infiltration of the intestinal wall with increased number of eosinophils. The study was a retrospective data analysis of patients hospitalized in the Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College in Krakow, in the last 34 months. Among 11191 hospitalized children with symptoms suggesting gastrointestinal tract disorders, 1918 patients underwent endoscopic examination in which only 23 patients had significantly higher number of eosinophils in biopsies. Two of the four patients with eosinophilia in esophageal biopsy were diagnosed retrospectively as eosinophilic esophagitis. In the remaining 21 patients eosinophilia was secondary to other diseases of the gastrointestinal tract. Based on the medical documentation we performed thorough characterization study population in terms of history, physical examination and carried out laboratory tests. The results were referred to the current review of the literature.
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May 2014

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

[Hemophagocytic syndrome in children with different underlying conditions].

Przegl Lek 2010 ;67(6):430-5

Klinika Onkologii i Hematologii Dzieciecej, Polsko-Amerykański Instytut Pediatrii, UJ CM w Krakowie.

Hemophagocytic syndrome (HS) is a life-threatening condition of hyperinflammation. Main symptoms are: prolonged fever, cytopenia, hepatosplenomegaly, hemophagocytosis, hyperferritinemia, hypertriglyceridemia and hypofibrinogenemia. Primary genetic form and secondary HS associated with infections, malignancies or autoimmune disorders can be distinguished. Untreated HS in most cases leads to death. We analyzed retrospectively 7 cases of HS in children (3 girls, 4 boys; aged 10 days -14 years) treated in 3 different pediatric centers from 2004 to 2009. In 3 cases HS was associated with infections (EBV, CMV, Bacillus Calmette Guerin - BCG), in 1 child with non-Hodgkin anaplastic large cell lymphoma (ALCL), in 1 patients probably with side effect of antiepileptic drug. In 2 cases cause of HS remained unknown. Fever, hepatomegaly, pan- or bicytopenia and hyperferritinemia were present in all children. In addition, splenomegaly was noted in 6 cases, hemophagocytosis in 6 children, impaired function or decreased number of NK cells in 4 cases, hypofibrino-genemia in 5 and hypotriglyceridemia in 4 patients. Among other symptoms and signs we observed: lymphadenopathy, hepatic failure, oedema, rash, neurological symptoms, increased level of LDH and inflammatory markers. In one child acute pancreatitis occurred. Among others, antibiotics, antiviral and immunosuppressive drugs were used in therapy. HLH-2004 protocol was applied in 4 cases. Patient with ALCL was treated with chemotherapy and allogeneic stem cell transplantation. Four patients are alive, 2 died because of HS, child with ALCL died because of generalized infection in peritrans-plantation period. In case of prolonged fever, splenomegaly and cytopenia diagnosis of HS should be considered. Following tests are recommended: complete blood count, ferritin, triglycerides, fibrinogen, bone marrow aspiration and NK cell assessment. Patients should be also screened for infections and malignancies. Early diagnosis of HS and underlying condition is crucial to start lifesaving therapy.
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April 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

Immunogenecity of hepatitis A vaccine in pediatric patients with inflammatory bowel disease.

Inflamm Bowel Dis 2011 May 3;17(5):1117-24. Epub 2010 Sep 3.

Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.

Background: There are only a few studies on immune response to routine vaccinations in children with inflammatory bowel disease (IBD), despite a strong need for this kind of study. The aim of the study was to evaluate the immunogenicity of an inactivated hepatitis A vaccine (HAV) in IBD pediatric patients compared with healthy controls.

Methods: This was an open, prospective, and controlled study on anti-HAV-negative children and adolescents age 2-18 years with IBD. HAV using 720 enzyme-linked immunosorbent assay (ELISA) units were administered at 0 months and at 6-12 months. Seroconversion and geometric mean titers were measured after each vaccine dose. The evidence of local and systemic adverse effects for 3 days after the first and second dose of vaccine was registered.

Results: A total of 134 subjects (66 patients and 68 controls) completed the whole study course consisting of two doses of vaccine and six serum samples. There was no significant difference in the rate of seroconversion between IBD patients and controls when measured after the second dose of vaccine (97% versus 100%, P = 0.2407), but the rate was significantly lower in the IBD group when measured after the first dose (39% versus 64%, P = 0.00001). The mean geometric titers were statistically significantly lower in the IBD group than in the control group at all of the measured timepoints. There were no serious adverse events related to HAV during the study.

Conclusions: HAV is both immunogenic and safe in pediatric patients with IBD.
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http://dx.doi.org/10.1002/ibd.21465DOI Listing
May 2011

[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

Epidemiology of inflammatory bowel disease among children in Poland. A prospective, population-based, 2-year study, 2002-2004.

Digestion 2009 26;79(2):121-9. Epub 2009 Mar 26.

Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Ul. Dzialdowska 1, PL-01-184 Warsaw, Poland.

Background/aims: The incidence of pediatric inflammatory bowel disease (IBD) in Western countries is on the rise. No prospective studies have been conducted on the epidemiology of pediatric IBD in Poland. The aim of the study was to define the characteristics of new pediatric IBD and assess the incidence of new IBD among children in Poland between 2002 and 2004.

Methods: Patient records from 24 pediatric gastroenterology centers servicing the whole population of Poland were collected. IBD diagnosis was based on clinical, radiological, endoscopic and histological features.

Results: There were 491 new IBD patients, representing an overall incidence of IBD of 2.7 cases/100,000 children/year. The incidence of Crohn's disease (CD) was 0.6, ulcerative colitis (UC) 1.3, and indeterminate colitis (IC) 0.8. The age-related incidence of IBD was 1.8 in the 0- to 10-year-old age group, rising to 3.7 for the 11- to 18-year age group.

Conclusions: The overall incidence of IBD (as well as CD, UC and IC) in Poland is lower than that in Western countries. The relative contribution of UC and IC to the overall IBD incidence is higher in Poland than in most Western countries. These findings may suggest a tendency towards under- or misdiagnosis.
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http://dx.doi.org/10.1159/000209382DOI Listing
July 2009

[Retrospective analysis of coexistence of acidic gastroesophageal reflux in children with atopic bronchial asthma].

Przegl Lek 2007 ;64 Suppl 3:115-7

Klinika Chorob Dzieci, Katedra Pediatrii Uniwersytet Jagielloński Collegium Medicum w Krakowie.

Introduction: Epidemiologic studies consistently demonstrate strong associations between gastro-esophageal reflux disease (GERD) and bronchial asthma also in children. A significant percentage of patients with GERD may experience extra-esophageal manifestations like cough or bronchspasm, which are typical symptoms of uncontrolled asthma.

Objective: retrospective analysis of prevalence and severity of GERD in children with atopic bronchial asthma and influence of proton pomp inhibitor (PPI) therapy in management of asthma.

Methods: The retrospective analysis of children with uncontrolled bronchial asthma between 6 and 18 years of age was performed. Thirty (21 boys) children were evaluated for acidic gastroesophageal reflux using 24-h esophageal pH-monitoring. Age, area of residence, presence and clinical severity of GERD, nocturnal episodes of GERD, pulmonary function parameters were analyzed. The effect of PPI therapy on modification of asthma treatment and lung function was assessed.

Results: Acidic gastroesophageal reflux was diagnosed in 17 (56%) children (fraction time of pH < 4 above 4.2%). Most of those patients (88%) came from urban area. Mean age at diagnosis of GERD was 10.5 years of age. Mild GERD was diagnosed in 13 children, moderate--in 4 children. Nocturnal episodes of reflux were present in 9 children (53%). Differences between lung function parameters (FEV1, FVC, PEF) before and after PPI treatment were not statistically significant, although their mean values were about 10% higher after treatment. PPI therapy allowed reduction of inhaled steroids dose in 24% of children; LABA were withdrawn in 3 children.

Conclusion: The association of GERD with atopic asthma in children is common. It seems to be reasonable to perform work up of pathologic GER in children with uncontrolled asthma.
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June 2008