Inborn errors of immunity (IEI) often present with gastrointestinal symptoms, which may be the first manifestation of immunological abnormalities. The second segment of this review is a supplement to the description of diseases classified by the International Union of Immunological Societies (IUIS) as primary immunodeficiencies, characterised by a specific clinical picture related to the gastrointestinal system. The article presents the current state of knowledge, discussing diagnostic, pathophysiological, and therapeutic aspects, emphasising the importance of multidisciplinary cooperation in the treatment of these complex cases.
Introduction:Knowledge of self-care is an important index for evaluating the outcomes of treatment with cholecystectomy. In addition, teaching self-care encourages persons with cholecystectomy to increase self-efficacy. Aim:To identify the influence of socio-demographic characteristics in the application of self-care education on knowledge of patients with cholecystectomy. Material and methods:This quasi-experimental study was conducted in surgical wards at AL-Diwaniyah hospitals and the Gastrointestinal Centre from 12 November 2022 to 15 March 2023. The study used a purposive sample of 60 patients, selected based on a 95% confidence level and a 5% margin of error. The inclusion criteria involved patients with benign gallbladder conditions undergoing cholecystectomy, who were conscious and willing to participate, while those with cancer were excluded to reduce confounding variables. The participants were divided into a control group of 30 patients receiving routine care and a study group of 30 patients undergoing an educational program on self-care after surgery. The utilised instrument included sociodemographic questions to gather relevant data. The study comprised 2 parts: the first focused on sociodemographic characteristics using 10 multiple-choice questions developed by the researcher, covering age, gender, marital status, weight, income, education, residence, occupation, and family history of gallbladder removal. The second part assessed patient knowledge of self-care following cholecystectomy through a questionnaire of 24 items, constructed from literature reviews and expert opinions. Responses were scored as 0 for incorrect and 1 for correct answers. The effectiveness of an educational program on self-care knowledge was evaluated 2 weeks after a lecture, with follow-up in surgical consultations at hospitals. A post-test was conducted between 10 January and 15 March 2023, and data analysis was performed using SPSS version 24.0, applying t-tests, ANOVA, and descriptive statistics. Results:Study findings revealed that there were only 2 significant differences between the study group knowledge about cholecystectomy and their residence at post-test (p = 0.005), and with their family history of complications following cholecystectomy (p < 0.001). Conclusions:This study found that an educational program is an effective way to improve patients' knowledge about self-care after cholecystectomy, which can lead to better outcomes, decreased complications, and improved patient satisfaction and quality of life. It is recommended that healthcare providers consider implementing such these programs to improve the quality of care provided to patients.
Introduction:The Crohn's Disease Exclusion Diet (CDED) combined with partial enteral nutrition (PEN) is a dietary therapy developed to induce and maintain remission in patients with Crohn's disease. Aim:The aim of study was to evaluate the duration of clinical remission in paediatric patients with mild to moderate Crohn's disease undergoing a Crohn's Disease Exclusion Diet (CDED) combined with partial enteral nutrition (PEN), stratified by degree of dietary adherence. Material and methods:A retrospective, single-centre observational study was conducted with the participation of paediatric patients who underwent CDED + PEN treatment in the period from June 2019 to June 2025. Twelve-month clinical follow-up was available in 41 subjects. The following were assessed: BMI-SDS index (group 6-17 years), erythrocyte sedimentation rate, C-reactive protein, faecal calprotectin, Pediatric Crohn's Disease Activity Index (PCDAI) scale score, and adherence. Time to relapse was analysed. Results:Data from 54 patients aged 6-17 years were analysed. Mean baseline PCDAI was 15.47 ±12.44. Clinical remission (PCDAI < 10) was achieved in 69% at week 6 and in 77% at week 12. The median time to relapse was 8.2 months. A statistically significant factor influencing the duration of remission was identified. The median remission time was 11.97 months (IQR: 7.60-25.98; mean: 18.75 ±16.18) in patients with adherence ≥ 80% (n = 17) and 5.63 months (IQR: 4.97-8.03; mean: 6.88 ±4.02) with adherence < 80% (n = 10). The mean difference between groups was 11.9 months (95% CI: 3.3-20.5); Welch's test p = 0.009. An F-test confirmed unequal variances (p = 0.0002). Conclusions:Suboptimal adherence remains a key modifiable predictor of relapse. Data support consideration of CDED + PEN as a viable long-term strategy in motivated families and underscore the pivotal role of the dietitian in monitoring adherence and nutritional status.
Introduction:Faecal elastase-1 (FE-1) measurement is a widely utilised screening tool for exocrine pancreatic insufficiency (PEI). Aim:The present study aimed to assess the prevalence of PEI in diabetic patients and its relationship with diabetes duration, antidiabetic medication use, body mass index, diabetes type, and comorbidities. Material and methods:A retrospective study was conducted that included 519 patients with type 1 and type 2 diabetes from five medical centres in Poland. The ScheBo® Pancreatic Elastase-1 Quick™ test was utilised for the measurement of faecal elastase-1 levels. Patients with a history of alcohol abuse, gastrointestinal surgery, or pancreatic cancer were excluded from the study. The medical records of the patients were analysed to obtain clinical data. Results:Among the 519 patients (262 women, 257 men; mean age: 67 years), 20.2% had an FE-1 level < 200 µg/g, indicating PEI. A statistically significant (p > 0.05) higher prevalence of PEI was observed in patients with obesity (BMI > 25 kg/m2). However, no statistically significant association was found between FE-1 levels and factors such as diabetes duration, antidiabetic medication use, or metabolic control. PEI is prevalent in diabetic patients, with a prevalence exceeding 20%. The findings of this study support the rationale for screening for FE-1 in diabetes and suggest that enzyme replacement therapy may be a viable treatment option for patients diagnosed with PEI. Conclusions:The results of this study imply that PEI is not a late complication of diabetes but may occur independently of disease duration.
Introduction:Oats are well-known for their health benefits in managing chronic diseases, mainly due to their fibre content, especially b-glucan, which has prebiotic properties. Aim:This review aimed to examine clinical and preclinical studies conducted in the past decade on the effects of oat dietary fibre, particularly b-glucan, in the context of inflammatory bowel disease (IBD). Methods:A systematic search of the PubMed, Scopus, and Web of Sciences databases from 2014 to 2024 was performed using the keywords (oat OR oat beta glucan) AND (IBD OR UC OR Colitis OR Crohn's). Results:The search identified 159 studies, of which 20 met the inclusion criteria. Two clinical trials, 1 case-control study, and one in vitro study highlighted the lack of human-based research, while 16 animal studies suggested promising beneficial effects of oat dietary fibre b-glucan in IBD. Conclusions:The findings emphasize the need for more clinical trials to further explore the potential of oat dietary fibre in treating IBD.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is strongly associated with heart failure with preserved ejection fraction (HFpEF), driven by systemic inflammation, insulin resistance, and oxidative stress, which are shared pathophysiological mechanisms. HFpEF and MASLD often co-occur, especially in patients with conditions like obesity and type 2 diabetes mellitus (T2DM). The increasing global prevalence of both MASLD and HFpEF emphasises their shared risk factors and clinical implications. Early diagnosis and a multidisciplinary approach are important in the management of these interconnected diseases. Treatment strategies like the use of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have shown promise in addressing both conditions, improving liver steatosis, and reducing heart failure risk. Targeted therapies and lifestyle modifications are fundamental to managing MASLD and HFpEF, given their overlapping pathophysiology and impact on patient outcomes.
Introduction:Inflammatory bowel diseases (IBD) substantially affect patients' physical, psychological, and social functioning. Although numerous studies have evaluated health-related quality of life in IBD, comparatively fewer investigations have focused specifically on life satisfaction and its relationship with socio-demographic characteristics. Aim:The study aimed to compare patients with Crohn's disease (CD) and ulcerative colitis (UC), assess their level of life satisfaction, and evaluate its association with selected socio-demographic factors and social and professional activity. Material and methods:This comparative study included 109 patients with CD and 101 patients with UC. The inclusion criteria were a diagnosis of IBD and an age of 18-85 years. The patients were recruited from the Clinical Department of Gastroenterology and Hepatology and the Outpatient Gastroenterology Department of the University Hospital of Krakow. Results:The study did not reveal any differences between the groups in mean life satisfaction. No significant differences were observed regarding the effects of the diseases on social and professional activity. The CD patients demonstrated statistically significant differences in their life satisfaction by education level. The satisfaction level of UC subjects was significantly affected by their place of residence. Both CD and UC increased the need to restrict or withdraw from professional life, limiting social contacts. The decrease in Satisfaction with Life Scale (SWLS) was most affected by the deterioration of social standing; the least dependence was observed for the necessity of limiting one's professional life. Conclusions:Both CD and UC patients report similar levels of life satisfaction, as both conditions have a comparable impact on their social and work lives. The patients are apprehensive about their future and are forced to limit their present professional involvement or withdraw from their professional life.
Introduction:Endoscopic drainage is the standard of care in patients with malignant biliary obstruction (MBO). Aim:The aim of this study was to investigate the efficacy of biliary stenting in providing access to systemic chemotherapy. Material and methods:Patients with bile duct obstruction (bilirubin > 2.5 mg/dl) caused by unresectable biliary or pancreatic cancer were retrospectively analysed with respect to use of chemotherapy and survival. Laboratory data were analysed at baseline, 7-10, and 28-35 days following biliary stenting. Results:Patients with MBO (n = 78) were allocated into one of three groups according to baseline bilirubin level [mg/dl]: 2.5-5.99 (1), 6.0-15.0 (2), and > 15 (3). At the first test, the mean bilirubin decrease from baseline in the respective groups was as follows: 1.19 (29.5%), 3.77 (38.5%), 7.1 (27.3%), and at the second measurement: 1.61 (40%), 5.69 (58.2%), 13.0 (50%), respectively. Chemotherapy was applied in 28 (35.8%) patients, less frequently in group 3 than in 1 (31.2% vs. 44.0%; p = 0.07) and 2 (vs. 38.1%; p = 0.06). The mean survival time was 4.8 ±2.8 months and was significantly shorter in group 3 than in group 2 (3.8 ±2.0 vs. 6.2 ±3.9 months; p = 0.02) and 1 (vs. 5.4 ±2.7 months; p = 0.03). Conclusions:In two-thirds of patients with MBO, endoscopic biliary drainage does not secure access to chemotherapy. The use of chemotherapy and survival time are significantly higher in patients with a bilirubin level below 15 mg/dl as compared to those with higher bilirubinaemia, but biliary drainage is only minimally effective in patients with a bilirubin level below 6 mg/dl.
Introduction:Selective biliary cannulation is essential for successive endoscopic intervention. Aim:To compare the efficacy and safety of the double-guidewire technique (DGT) versus cannulation over a pancreatic stent (CPS) following unintended pancreatic duct cannulation during endoscopic retrograde cholangiopancreatography (ERCP) in real-world clinical practice. Material and methods:We conducted a prospective study including 103 patients who underwent ERCP between June and December 2024 at Kafrelsheikh University Hospital. Patients with difficult biliary cannulation and unintentional guidewire entry into the pancreatic duct during standard wire-guided cannulation were included. In these cases, either the DGT or CPS approach (with or without needle-knife sphincterotomy) was employed. Outcomes such as cannulation success time, number of attempts, and the need for precut sphincterotomy were recorded and analysed. Results:The CPS group had a significantly higher requirement for precut sphincterotomy (88.6%) compared to the DGT group (33.3%) (p < 0.0001). A higher proportion of small papillae was observed in the CPS group (52.9%) versus the DGT group (47.1%). Time to successful biliary cannulation was significantly shorter in the DGT group (8.27 ±4.8 min) compared to the CPS group (11.84 ±3.2 min) (p = 0.0031). Conclusions:The CPS technique required significantly more precut sphincterotomies than DGT. While the number of cannulation attempts was similar between techniques, DGT allowed for faster cannulation. CPS may reduce the risk of complications such as post-ERCP pancreatitis, but DGT appears more time-efficient. Selection of the appropriate technique should be based on individual anatomical and procedural factors.
Chronic pancreatitis (CP), a disease that develops as a result of repeated episodes of pancreatic inflammation and associated fibrosis, restricting functional exocrine and endocrine pancreatic function and causing severe upper abdominal pain. Treatment strategies include conservative therapy, consisting of a step-up approach with pharmacological and lifestyle modifications. For more advanced cases, endoscopic or surgical interventions are proposed. However, the exact role and qualification criteria for surgical management have not been established yet. In this cohort study, we analysed the results of surgical interventions in 388 patients with CP performed in the years 2004-2024 in our centre, including drainage procedures and resections. We assessed the overall results of the intervention, the possible complications (assessed by Clavien-Dindo classification), and the risk of occurrence. Also, the surgery results and the complication risk between the groups of patients who underwent respective procedures were compared. The findings indicate that surgery remains an important tool in CP management, and organ-preserving procedures may be successful in pain control and overall quality of life improvement. It is emphasised that personalised surgical strategies should be the basis of CP management, and the therapy choice must be established by an experienced multidisciplinary team consisting of gastroenterologists, endoscopists, radiologists, and surgeons.
Introduction:Mirikizumab (MIRI), a selective IL-23 p19 inhibitor, has demonstrated efficacy in randomised trials in moderate to severe ulcerative colitis (UC), but real-world data remain limited, particularly in highly treatment-exposed populations. Aim:To assess the real-world effectiveness and safety of MIRI in adults with moderately to severely active UC. Material and methods:This retrospective multicentre study included 257 adults with UC initiating MIRI before 31 January 2026 across 21 Polish centres. Induction consisted of intravenous MIRI 300 mg at weeks 0, 4, and 8, with optional extension to week 24 in cases of insufficient response. Disease activity was assessed at baseline and at weeks 12 and 24 using clinical, endoscopic, and laboratory parameters. Safety was evaluated by recording adverse events (AE) and serious adverse events (SAE). Results:Most patients had prior exposure to advanced therapy, and 54.1% underwent extended induction. Significant improvement was observed at weeks 12 and 24 across all parameters. Among evaluable patients, clinical remission was 31.7% at week 12 and 41.8% at week 24, while clinical response was 76.2% and 79.3%, respectively. Endoscopic remission was 9.5% and 18.5%, whereas endoscopic response was 67.1% and 64.8%, respectively. Corticosteroid-free clinical remission was 23.1% and 26.4%. AE occurred in 9.1% and 14.1% of patients, and SAE in 2.6% and 6.6%. Conclusions:In this large real-world study with predominantly advanced therapy-exposed UC, MIRI was associated with significant clinical, endoscopic, and biochemical improvement through weeks 12 and 24, with a favourable safety profile.
Introduction:Tripartite motif-containing 24 (TRIM24) protein has been reported to be dysregulated in various cancers. Aim:This study assessed the TRIM24 expression pattern in patients with gastric cancer (GC). Additionally, a comprehensive meta-analysis was performed to clarify the importance of TRIM24 expression in predicting the outcomes of various malignancies. Material and methods:The expression levels of TRIM24 in 40 cancerous and adjacent normal tissues were determined by quantitative real-time PCR (qRT-PCR). Patients were further classified into two groups based on high and low TRIM24 levels. The relationship between TRIM24 expression, various clinical features, b-catenin, and overall survival (OS) was evaluated using appropriate statistical analyses. Additionally, a comprehensive meta-analysis was conducted to assess the prognostic value of TRIM24 levels in various malignancies. The pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence interval (CI) were calculated to estimate the possible associations. Results:TRIM24 expression was higher in GC tissues compared with their corresponding normal tissues (fold change = 2.69, p = 0.009). TRIM24 overexpression was associated with increased levels of b-catenin, and shorter OS in GC patients (HR = 3.94, 95% CI: 1.06-14.60, p = 0.041). A meta-analysis of 24 eligible publications with 3639 patients also revealed a significant association between TRIM24 expression and shorter OS (HR = 2.01, 95% CI: 1.49-2.69, p < 0.001). TRIM24 expression was also predictive of lymph node metastasis (LNM) (OR = 1.70, 95% CI: 1.04-2.78, p = 0.036) and tumour stage (OR = 2.46, 95% CI: 1.74-3.47, p < 0.001). Conclusions:TRIM24 overexpression is strongly associated with tumour staging, metastasis, and unfavourable survival outcomes, highlighting its potential utility as both a useful prognostic marker and a potential therapeutic target across various malignancies.
Introduction:The Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) is frequently used to characterize treatment effects in IBS patients. Calculation of a responder rate using IBS-SSS data commonly uses a cut-off value of -50 points. Aim:To analyze data from a recently published IBS trial to evaluate whether this cut-off value is appropriate or needs to be revised. Material and methods:Data from 201 patients were used to establish a receiver operating characteristic (ROC) curve for IBS-SSS change data using IBS-Adequate Relief scale data as a binary classifier. The area under the curve (AUC) and its 95% CI for the ROC were determined. Curves plotting accuracy rates and Youden's J index values against changes on the IBS-SSS used as cut-off values were employed to determine an optimal cut-off value. Results:The AUC of the ROC curve was 0.9738 (95% CI from 0.9565 to 0.9912). The curve of accuracy rates had two maxima (-122 and -133 points), while that of the Youden's J index values had only one maximum at -122 points, considered to be the optimal cut-off value. Conclusions:The frequently used -50 points cut-off value might not be optimal for determining clinically meaningful responder rates from IBS-SSS measurements. At least for the IBS-SSS data analyzed in the present study, a change of -122 points appears to be more appropriate. Interpretation of IBS-SSS responder rates from past or future clinical trials should carefully check for the cut-off values applied for their calculation.
Introduction:In recent years, organoids have been increasingly used in the study of hepatocellular carcinoma (HCC). The purpose of this study is to analyse the research field of HCC organoids through bibliometrics, and to determine the key themes, trends, and contributions in this field. Aim:This study analyses global HCC organoid research trends from 2005 to 2024 to identify key developments and future directions. Material and methods:We screened literature on HCC and organoids from the Web of Science Core Collection (WOSCC) database from 2005 to 2024. CiteSpace and VOSviewer were used to visualise the bibliometric indicators. Results:The 267 articles analysed in this study came from 630 institutions in 40 countries/regions and were published in 149 journals. From 2005 to 2015, the number of publications continued to be low, and then entered a stage of rapid growth in 2016. The top three countries with the largest number of publications were China (128; 47.94%), the United States (65; 24.34%), and Germany (27; 10.11%). International Journal of Molecular Sciences is the journal with the largest number of publications. Van Der Laan Luc J. W. was the most prolific author. Conclusions:HCC organoid research has grown significantly, led by China, the United States, and Germany, focusing on model optimisation, molecular mechanisms, targeted therapy, and drug resistance, with emerging trends in long-term culture systems and patient-derived organoids.
Introduction: Postoperative pancreatic fistula (POPF) is a common complication associated with significant morbidity and mortality. Aim: This study aimed to evaluate the dynamic change in pre- and post-operative platelet counts as a predictor of POPF. Material and methods: A retrospective study was conducted with 133 patients who underwent pancreatectomy between 1.1.2018 and 31.12.2022. Data were analysed with regard to epidemiologic parameters, operations performed, POPF grading A-C, postoperative complications management, duration of hospital stay, and overall morbidity and mortality, as well as clinical outcomes and POPF-associated mortality. Ratios of postoperative platelet values (nominator) to preoperative platelet values (denominator) were assessed for postoperative days 1-9. The ratios were analysed using logistic regression models to examine their relationship with POPF, clinically significant POPF, and POPF grading. Results: Out of the 133 patients, POPF occurred in 69 (52%) patients, with clinically significant POPF in 41 (31%); POPF grade A or biochemical leak (BL) in 28 (21%); POPF grade B in 29 (22%); and POPF grade C (Reoperation or mortality) in 12 (9%). Higher platelet counts on postoperative day 1 were associated with an increased likelihood of experiencing POPF, compared to lower platelet counts (p = 0.04). No association between postoperative platelet changes and clinically significant POPF was observed. Conclusions: An increase in platelets on postoperative day 1 may serve as a clinically useful predictor for POPF.
Introduction: The number of women graduating from medical school is on the rise, and in Poland, there is a notable feminisation in the physician profession. In 2023, out of 156,290 practicing physicians, 92,421 were women (59.13%). Female gastroenterologists face numerous challenges during their training, including gender-based prejudice, physical demands of endoscopic procedures, and standardised equipment not designed for smaller hands. Aim: The study aimed to characterise female gastroenterologists and trainees in Poland and identify potential problems and difficulties in their daily work. Material and methods: A web-based, voluntary, anonymous questionnaire was sent to female members of the Polish Society of Gastroenterology and participants of the XX Polish Society of Gastroenterology Congress. Results: The majority of respondents were aged 30-40 years (30.6%) and 40-50 years (29.2%). More female gastroenterologists reside and work in the Masovian Voivodeship (16.7%) than in other regions. The age of completing specialisation is predominantly 30-40 years (76.4%). 37.5% work in cities of more than 500,000 inhabitants. The primary workplaces are gastroenterological wards (66.7%) and endoscopic units (16.7%) within hospitals. Additional workplaces include gastroenterological outpatient clinics (54.9%) and private practices (54.2%). Only 25.7% hold management positions. Common procedures performed include diagnostic gastroscopy (91%), diagnostic colonoscopy (77.1%), and polypectomy (63.2%). 97.9% are satisfied with their specialty choice. Conclusions: Gender discrimination remains prevalent in various aspects of medicine. Nearly half of the female gastroenterologists experience gender-related limitations in their professional roles. Despite progress, significant efforts are needed to raise awareness and promote gender equality to support women in gastroenterology.
