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  • Author: Juris Pokrotnieks x
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Abstract

Inflammatory bowel disease (IBD) is a chronic, relapsing–remitting, inflammatory condition of the gastrointestinal tract which consists of Crohn’s disease (CD), ulcerative colitis (UC) and undifferentiated IBD. Epidemiology of IBD is changing worldwide, but a significant gap remains in the description of the IBD population in Latvia. The aim of the study was to determine the incidence and prevalence rates of IBD in Latvia in the period between 2013 and 2017. Retrospective analysis of reimbursed medicines claims for IBD diagnoses from the Latvian National Health Service database (NHS) was conducted for the period of 2012 to 2017. From CD patients, 53.7% were female and the area of residency strongly favoured urban areas vs rural districts of Latvia, 59.1% vs 40.9%, respectively. A similar demographic pattern was observed in UC patients, where 56.2% were female and 55.1% of the total UC population lived in urban areas. The overall age- and sex-adjusted incidence rates for CD and UC were 16.45 (CI95% [14.68, 18.21]) and 70.53 (CI95% [66.88, 74.19]) per 100 000 population, respectively, for the entire 2013–2017 period. The prevalence of CD and UC in 2012 was 12.4 and 54.8 cases per 100 000 persons, respectively, compared to 15.5 and 79.5 cases per 100 000 persons in CD and UC in 2017, resulting in a 25% increase in prevalence of CD and 41% increase in UC over the 5-year period. For the first time temporal trends in IBD incidence and prevalence as well as differences across age groups and gender over a five-year period are reported for Latvia.

Abstract

Nutrition has an important role in the management of inflammatory bowel disease (IBD) and metabolic syndrome (MS). The goal of this study was to assess the nutritive status of patients treated with IBD and metabolic syndrome in the Gastroenterology Centre, Pauls Stradiòð Clinical University Hospital. Body bioelectrical impedance analysis (BIA) using GENIUS 220 PLUS (Jawon Medical) was used to determine Body Mass Index (BMI) kg/m², Metabolic Body Fat (MBF) kg, Soft Lean Mass (SLM) kg, Total Body Water (TBW) kg, body composition, metabolic type, Basal Metabolic Rate (BMR) kcal, and total Energy Expenditure (TEE) kcal in patients with IBD and metabolic syndrome and in a similarly aged control group. The obtained data showed that BMI was not correlated with MBF, BTW and Lean Body Mass (LBM). Patients with Crohn’s disease (CD) had normal value of BMI (M 24.3 kg/m²; F 20.2kg/m²), but we found variety-specific differences in body composition that confirmed deficiency or increase of specific body parameters. The performed prospective study confirmed the importance of the more precise nutritional status analysis, as it was clinically useful for the nutritional management of IBD. Patients with CD had expressed nutrient deficiency, sarcopenia, and reduced amount of proteins and minerals. For patients with MS, sarcopenia was present despite obesity.

Abstract

Capsule Enteroscopy (CE) is a fundamentally new method in diagnostic endoscopy. However, there are several factors influencing the quality of this procedure, including impermeable fluids, food remains etc. The aim of the study was to assess one of the most popular currently used bowel preparation methods and evaluate possible effects of various factors. 136 CE examinations were analysed. Each patient was prepared using 2 litres of polyethylene glycol (PEG) one day prior to examination. There was a special form filled in for each patient, which included relevant parameters (anamnesis, CE data etc.). Of 136 CE cases, 84 (61.8%) were female patients and 52 (38.2%) were male. The small bowel (SB) transit time in 112 patients varied from 39 to 502 minutes, but in 24 cases the capsule did not reach caecum. The degree of bowel cleanliness was as follows: very good — 30 (22.1%) patients, satisfactory — 97 (71.3%), and poor — 9 (6.6%). A positive correlation was observed between the degree of SB cleanliness and the SB transit time (p = 0.015). A longer SB transits time was associated with poor SB cleanliness. The results obtained in this study showed that the quality of SB cleanliness is affected by SB transit time. A relatively large percentage of cases rated as satisfactory bowel cleanliness and comparatively small percentage of bowel cleanliness cases rated as “very good” were observed when 2 litres of PEG were used prior to CE, indicating an important issues in preparation of the bowel prior to CE.

Abstract

The MR activity indices used for quantification and follow-up of Crohn’s disease are composed of a number of subjectively determinable components with equivocal repeatability. The purpose of this article was to assess the repeatability of measurements used for quantitative estimation of Crohn’s disease activity in the terminal ileum. In five adults (23–57 y.o.) and 12 children (10–17 y.o.) with active terminal ileitis, the inflamed bowel was divided into 3 cm segments (n = 32 in adults, n = 46 in children), and measurements for the calculation of MaRIA and Clermont scores were performed. Parameters included apparent diffusion coefficients (ADC) for diffusion-weighted imaging (DWI) sequences with selective and non-selective fat suppression, wall signal enhancement before (WSI-preGd) and after (WSI-preGd) gadolinium enhancement, bowel thickness, and presence of ulcers. The measurements were standardised (accurate site-to-site comparison, exact ROI size, where applicable) and repeated by the same researcher after two months. Intra-observer agreement for ADC, WSI-preGd and WSI-postGd, bowel thickness was assessed with a paired t-test, and the significant difference in presence/absence of ulcers was assessed by the Pearson 2 test. Absolute difference was not found between the 1st and 2nd measurements of ADC, WSI-preGd, WSI-postGd and wall thickness. There was systematic difference in the presence of bowel ulcers. In standardised conditions the repeatability of ADC, WSI-preGd and WSI-postGd is high. Efforts must be made to precisely define the size and appearance of ulcers that may be included in the index calculation.