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1
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Small intestine bacterial overgrowth is frequent in cystic fibrosis: combined hydrogen and methane measurements are required for its detection

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Lisowska A., Wójtowicz J., Walkowiak J.
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issue 4
631-634
EN
Introduction: Hydrogen breath test (BT) is commonly used as a diagnostic tool for the detection of small intestine bacterial overgrowth (SIBO). It was reported that colonic methane production is far more frequent in cystic fibrosis (CF) patients than in other subjects. Therefore, measuring exclusively hydrogen in the diagnostic breath test for diagnosing SIBO might be of limited value. We aimed to assess the usefulness of combined measurement of hydrogen and methane expiration for the diagnosis of SIBO in CF. Material and Methods: The study comprised 62 CF patients aged 5 to 18 years. Three-hundred-ninety subjects assessed due to gastrointestinal symptoms for the presence of SIBO served as a comparative group. In all subjects hydrogen/methane BT using glucose was performed. A positive BT was defined as fasting hydrogen ≥ 20 ppm or fasting methane ≥ 10 ppm or a rise of ≥ 12 ppm hydrogen or ≥ 6 ppm methane over baseline during the test. Results: In 23 (37.1%) CF patients and in 52 (13.3%) subjects from the comparative group abnormal BT results were found. In seven (11.3%) CF patients and 29 (7.4%) of the other subjects studied methane measurement allowed diagnosis of SIBO. Conclusions: Small intestine bacterial overgrowth is frequent in cystic fibrosis. For its detection in cystic fibrosis and other gastrointestinal patients, combined hydrogen and methane measurement instead of hydrogen breath test should be applied. Without the additional measurement of methane a significant percentage of SIBO will be missed.
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Small intestinal bacterial overgrowth in patients with progressive familial intrahepatic cholestasis

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Lisowska A., Kobelska-Dubiel N., Jankowska I., Pawłowska J., Moczko J., Walkowiak J.
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2014
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vol. 61
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issue 1
103-107
EN
Background & Aims: To date, no studies concerning the presence of small intestinal bacterial overgrowth in patients with progressive familial intrahepatic cholestasis were published. Based upon characteristic of progressive familial intrahepatic cholestasis one can expect the coexistence of small intestinal bacterial overgrowth. The aim of the study was to assess the incidence of small intestinal bacterial overgrowth in patients with progressive familial intrahepatic cholestasis. Methods: 26 patients aged 8 to 25 years with progressive familial intrahepatic cholestasis were included in the study. Molecular analysis of ABCB11 gene was performed in the vast majority of patients. In all patients Z-score for body weight and height, biochemical tests (bilirubin, bile acid concentration, fecal fat excretion) were assessed. In all patients hydrogen-methane breath test was performed. Results: On the basis of first hydrogen-methane breath test, diagnosis of small intestinal bacterial overgrowth was confirmed in 9 patients (35%), 5 patients (19%) had borderline results. The second breath test was performed in 10 patients: in 3 patients results were still positive and 2 patients had a borderline result. The third breath test was conducted in 2 patients and positive results were still observed. Statistical analysis did not reveal any significant correlations between clinical, biochemical and therapeutic parameters in patients with progressive familial intrahepatic cholestasis and coexistence of small intestinal bacterial overgrowth. Conclusions: Our results suggest that small intestinal bacterial overgrowth is frequent in patients with progressive familial intrahepatic cholestasis. Moreover, it seems that this condition has the tendency to persist or recur, despite the treatment.
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Trace elements and rat pouchitis

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Drzymała-Czyż S., Banasiewicz T., Walas S., Kościński T., Wenska-Chyży E., Drews M., Walkowiak J.
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2012
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vol. 59
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issue 4
599-601
EN
The procedure of restorative proctocolectomy is associated with a complete removal of the colon and slight reduction of ileum length, which together can lead to systemic shortages of trace elements. Inflammatory changes in the pouch mucosa may also have some impact. However, there is no data on trace elements in pouchitis. Therefore, in the present study we aimed to assess the effect of acute pouchitis on the status of selected trace elements in rats. Restorative proctocolectomy with the construction of intestinal J-pouch was performed in twenty-four Wistar rats. Three weeks after the surgery, pouchitis was induced. Eight untreated rats created the control group. Liver concentrations of selected micronutrients (Zn, Cu, Co, Mn, Se) were measured in both groups six weeks later, using inductively coupled plasma mass spectrometry. Liver concentrations of trace elements did not differ between the study and the control groups. However, copper, cobalt and selenium concentrations [μg/g] were statistically lower (p<0.02, p<0.05 and p<0.04, respectively) in rats with severe pouchitis (n=9) as compared with rats with mild pouchitis (n=7) [median (range): Cu - 7.05 (3.02-14.57) vs 10.47 (5.16-14.97); Co - 0.55 (0.37-0.96) vs 0.61 (0.52-0.86); Se - 1.17 (0.69-1.54) vs 1.18 (0.29-1.91)]. In conclusion, it seems that acute pouchitis can lead to a significant deficiency of trace elements.
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Przydatność oznaczania wskaźnika kwaśnego steatokrytu u niemowląt chorych na mukowiscydozę

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Filipiak-Wieczorek M., Drzymała-Czyż S., Walkowiak D., Nowak J. K., Woźniak D., Walkowiak J.
Farmacja Polska
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2020
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vol. 76
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issue 3
156-152
EN
Background: Steatorrhea, which is a consequence of pancreatic insufficiency, occurs in 85% of patients with cystic fibrosis. In clinical practice, fecal fat concentration is used to diagnose and monitor fecal fat losses. Because compliance with this method is insufficient, new tests are needed. One of the alternatives may be the acid steatocrit. Aim: This study aimed to investigate the value of acid steatocrit in the assessment of fecal fat excretion in pancreatic-insufficient infants with cystic fibrosis: before and after the initiation of pancreatic enzyme supplementation. Patients and methods: The study included 10 infants with cystic fibrosis diagnosed through the newborn screening program and 16 healthy control infants. In all the children, fecal elastase-1, fecal fat concentration (%) and acid steatocrit were measured. Results: Fecal fat concentration in cystic fibrosis infants (range: 14.5%–32,1%) was significantly higher (p<0.0001) compared with control subjects (1.7%–15.1%). Acid steatocrit in cystic fibrosis (19.8%–68.7%) was also greater (p<0.0001) than in the control group (10.7%–22.7%). The area under the receiver operating characteristic curve (ROC) for the 95th percentile of normal values was 0.981 (95% confidence interval: 0.941–1.0) indicating high diagnostic accuracy of acid steatocrit. When acid steatocrit and fecal fat concentration cut-offs were set at 90th and 95th percentile for healthy infants, the specificity of acid steatocrit in detecting elevated fecal fat concentration was 100%, and the sensitivity 80% and 100%, respectively. Conclusions: Compared with the assessment of fecal fat concentration, sensitivity/specificity of acid steatocrit in steatorrhea detection in infants are potentially lower, but still satisfactory. The measurement of acid steatocrit may constitute a useful method of fecal fat concentration assessment in infants identified by the newborn screening program in whom the replacement enzyme therapy has not yet been commenced.
PL
Przedmiot badań: U 85% pacjentów z mukowiscydozą (ang.: cystic fibrosis, CF) stwierdza się niewydolności zewnątrzwydzielniczej trzustki (nzt). Złotym standardem rozpoznawania biegunki tłuszczowej jest ocena stężenia tłuszczu w stolcu. Ze względu na małą akceptowalność tej metody szuka się nowych procedur. Alternatywę może stanowić pomiar wskaźnika kwaśnego steatokrytu (KS). Cel badań: Celem badania była ocena przydatności oznaczania KS w ocenie wydalania tłuszczu w stolcu u niemowląt z CF z nzt, przed włączeniem suplementacji enzymatycznej. Materiał i metody: Do badania włączono 10 niemowląt z CF wykrytą w przesiewie noworodkowym oraz 16 zdrowych niemowląt. U wszystkich dzieci wykonano oznaczenie stężenia elastazy-1 w kale, stężenia tłuszczu (%) w kale w oparciu o metodę Van de Kamera oraz wartości wskaźnika KS. Wyniki: Stężenie tłuszczu w stolcu dzieci z CF wynosiło od 14,5% do 32,1% i było statystycznie większe (p<0,0001) niż w grupie zdrowych niemowląt, w której wynosiło od 1,7% do 15,1%. Wartość wskaźnika KS w grupie badanej mieściła się w zakresie od 19,8% do 68,7% i również była większa niż w grupie kontrolnej (p<0,0001), w której wynosiła od 10,7% do 22,7%. Nie wykazano korelacji między wskaźnikiem KS a stężeniem tłuszczu w stolcu. Pole pod krzywą ROC dla wartości 95 percentyla wartości prawidłowych wynosiło 0,981 (95% przedział ufności: 0,941-1,0) odzwierciedlając dużą wartość diagnostyczną metody oznaczania KS. Wnioski: Pomiar wskaźnika KS dobrze różnicuje grupy niemowląt zdrowych oraz niemowląt chorych na CF z nzt. W porównaniu do metody Van de Kamera, czułość/swoistość oznaczania KS w wykrywaniu biegunki tłuszczowej u niemowląt, jest potencjalnie mniejsza, ale wciąż bardzo zadowalająca. Należy podkreślić prostotę oznaczania KS i możliwość uzyskania wyniku danego dnia. To sprawia, że oznaczenie KS może być przydatną metodą oceny stężenia tłuszczu w stolcu u niemowląt ze skryningu noworodkowego, u których nie włączono jeszcze suplementacji enzymatycznej.
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Dietary Pattern and its Relationship Between Bone Mineral Density in Girls and Boys with Cystic Fibrosis – preliminary report

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Sands D., Mielus M., Umławska W., Lipowicz A., Oralewska B., Walkowiak J.
Developmental Period Medicine
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2015
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issue 1
105-113
EN
Background: Nutrition influence on cystic fibrosis (CF) patients survival is well documented and dietary therapy is one of basic elements of their treatment. Prolonged survival of CF patients might yet emerge comorbidities, which include bone mineral disease. The aim: The assessment of the dietary pattern and its relationship between bone density in boys and girls with cystic fibrosis. Material and methods: 89 patients aged 10-18 years from 3 Polish CF Centres were included into the study. To obtain a knowledge about quality of diet, a 3-day food record was assessed and percent of recommended for CF patients intake of energy, protein, carbohydrates, fat, vitamin D3, calcium, phosphorus was counted. Bone mineral density (BMD) in lumbar spine (L1-L4) was measured and expressed as a Z-score. To assess nutritional status, anthropometric measurements was evaluated (body weight, height and BMI). Descriptive methods, Mann-Whitney test, T-Student test, Spearman correlation and one-way ANOVA were used for statistical analyses. Results: The patients with cystic fibrosis did not meet specific for CF nutritional guidelines. A deficiency in recommended intake was observed in energy (88%), protein (82%), calcium (78%) and vitamin D3 (71%). The intake of phosphorus was higher than recommended (142%). A nutritional status was significantly reduced, as compared with the reference group (p<0.001). Boys characterized significantly lower body weight (p=0.019) and height (p=0.036) than girls as well as worse caloric (p=0.023) and carbohydrates intake (p=0.005). However, girls had reduced vitamin D3 content in their diet (p<0.001). The bone mineral density in the whole group was reduced and Z-score amounted to -0.95±1.17. Tendency to decreasing of BMD with age was observed. BMI showed important correlation with bone mineral density both in girls (p<0.001) and in boys (p=0.020). Conclusion: CF patients do not follow specific for them dietary recommendations and essential differences were observed between girls and boys. Nutritional status (BMI) showed correlation with bone mineral density in CF patients. Therefore intensive nutritional therapy according to recommendations is needed.
PL
Wprowadzenie: Wpływ żywienia na długość życia chorych z mukowiscydozą (ang. Cystic Fibrosis − CF) jest dobrze udokumentowany, a postępowanie dietetyczne jest jednym z podstawowych elementów leczenia pacjentów z CF. Systematyczne wydłużanie się wieku przeżycia chorych może powodować ujawienie się niedoborów żywieniowych prowadzących do chorób towarzyszących, jakimi są m.in. zaburzenia w gospodarce mineralnej kości. Cel: Celem pracy była ocena sposobu żywienia dziewcząt i chłopców z mukowiscydozą i jego związku z gęstością mineralną kości. Materiał imetody: Do badania włączono 89 pacjentów wwieku 10-18 lat. Wcelu ustalenia jakości diety, oceniono sposób żywienia za pomocą zapisu 3-dniowych jadłospisów, obliczając procent realizacji zapotrzebowania zgodnie z rekomendacjami opracowanymi dla pacjentów z mukowiscydozą. Dotyczyło to pokrycia zapotrzebowania kalorycznego, białka, tłuszczu, węglowodanów, witaminy D3, wapnia i fosforu. Oceniono gęstość mineralną kości (Bone Mineral Density − BMD) w odcinku lędźwiowym (L1-L4). Wynik wyrażono, jako wartość standaryzowaną Z-score. W celu określenia stanu odżywienia dokonano pomiarów antropometrycznych (masa i wysokość ciała oraz BMI). Wykonano następujące obliczenia statystyczne: analizy opisowe, test Manna-Whitneya, test t-Studenta, korelację Spearmana, oraz jednoczynnikową analizę wariancji ANOVA. Wyniki: Badani pacjenci nie spełniali opracowanych dla chorych na mukowiscydozę zaleceń żywieniowych. W diecie zaobserwowano niedobory energii (88% normy), białka (82%), wapnia (78%) oraz witaminy D3 (71%). Wykazano nadmierne spożycie fosforu (142%). Stan odżywienia (parametry antropometryczne) badanej grupy był obniżony i w sposób statystycznie istotny różnił się od grupy referencyjnej (p<0,001). Chłopcy charakteryzowali się znacznie niższą masą ciała (p=0,019) iwysokością (p=0,036) niż dziewczęta, a także niższą kalorycznością diety (p=0,023) oraz zawartością węglowodanów (p=0,005). Dietę dziewcząt cechowała mniejsza zawartość witaminy D3 w diecie (p<0,001) w porównaniu do chłopców. Średnia wartość gęstości mineralnej kości w całej grupie była obniżona i wynosiła -0,95±1,17. Zaobserwowano tendencję do obniżania się BMD wraz z wiekiem. Stan odżywienia wyrażony jako BMI wykazał statystycznie istotną korelację z gęstością mineralną kości, zarówno u dziewcząt (p<0,001), jak i u chłopców (p=0,020). Wnioski: Pacjenci z CF nie przestrzegali opracowanych dla nich zaleceń dietetycznych. Zaobserwowano istotne różnice między dziewczętami i chłopcami. Stan odżywienia (BMI), wykazał korelację z gęstością mineralną kości (BMD), co wymaga intensywnej terapii żywieniowej, zgodnie z opracowanymi rekomendacjami.
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The therapeutic potential of short-chain fatty acids enemas in inflammatory bowel diseases: a systematic review

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Kaczmarek N., Kokot M., Makarewicz A., Glapa-Nowak A., Nowak J. K., Jamka M., Walkowiak J.
Farmacja Polska
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2020
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vol. 76
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issue 5
297-304
PL
Sugeruje się, że krótkołańcuchowe kwasy tłuszczowe (SCFA) mogą redukować nasilenie objawów klinicznych, poprawiać wyniki badania endoskopowego i histopatologicznego u pacjentów z nieswoistymi chorobami zapalnymi jelit (IBD). Jednakże, pomimo obiecujących badań in vitro, wyniki badań przeprowadzonych w modelu zwierzęcym oraz randomizowanych badań kontrolowanych (RCT) są niejednoznaczne. Celem tego przeglądu systematycznego była ocena skuteczności SCFA podawanych doodbytniczo u pacjentów z IBD. Wyszukiwanie elektroniczne przeprowadzono w następujących bazach danych: PubMed, Scopus, Web of Science i Cochrane. Kryteria włączenia badań oryginalnych do przeglądu systematycznego obejmowały: 1) rodzaj badań: równoległe lub krzyżowe RCT; 2) język: artykuły w języku angielskim; 3) rodzaj interwencji: SCFA podawane doodbytniczo; 4) populacja badana: pacjenci z wrzodziejącym zapaleniem jelita grubego lub chorobą Leśniowskiego-Crohna, niezależnie od płci, wieku, pochodzenia etnicznego, lokalizacji badania i wielkości próby. Jako punkty końcowe przyjęto wpływ podaży SCFA na wskaźnik aktywności choroby (DAI) oraz wyniki badań endoskopowych i histopatologicznych. Do analizy zakwalifikowano 4 badania obejmujące łącznie 187 pacjentów z IBD. W 2 badaniach oceniano wpływ SCFA na DAI, w 4 badaniach – na wyniki badania endoskopowego i histopatologicznego. Nie stwierdzono istotnych różnic pomiędzy grupą interwencyjną a grupą kontrolną w zakresie wpływu na jakikolwiek analizowany parametr. W 2 badaniach wykazano istotny spadek DAI po okresie interwencji, zarówno w grupie SCFA, jak i w grupie kontrolnej. Podobnie, w 4 badaniach odnotowano statystycznie istotne różnice między wynikami endoskopowymi przed i po interwencji w grupie SCFA. Jednakże, w 3 badaniach podobny efekt zaobserwowano w grupie kontrolnej. Poza tym, w 3 badaniach nie zaobserwowano wpływu SCFA na wyniki histopatologiczne. Podsumowując, brak jest dowodów na skuteczność SCFA podawanych doodbytniczo u pacjentów z IBD.
EN
It has been suggested that short-chain fatty acid (SCFA) enemas might improve clinical, endoscopic and histological scores in patients with inflammatory bowel disease. However, despite the promising results of in vitro studies, the findings of animal studies and randomised controlled trials are inconclusive. Therefore, this review aimed to assess the efficacy of SCFA enemas in patients with inflammatory bowel diseases. Electronic searches were performed in PubMed, Scopus, Web of Science and Cochrane databases. Original studies were included in this systematic review if they met the following inclusion criteria: 1) types of studies: parallel or crossover randomised controlled trials; 2) language: articles published in English; 3) types of interventions: SCFA enemas; 4) population: studies conducted in subjects with ulcerative colitis or Crohn’s disease of either gender and any age and without restrictions based on the ethnicity of study participants, location of study or sample size. The outcomes included the effect of SCFA enemas on disease activity index (DAI), endoscopic and histological scores. In total, four studies enrolling 187 patients with inflammatory bowel diseases were included in this systematic review. Two studies assessed the effect of SCFA enemas on DAI. Four studies evaluated the effect of SCFA therapy on the endoscopic score and the histological score. There were no significant differences between the SCFA groups and the control groups regarding the impact on any analysed parameter. Two studies demonstrated a statistically significant decrease in DAI after the intervention period, both in the SCFA groups and the control groups. Similarly, statistically significant differences between pre- and post-intervention endoscopic scores in the SCFA groups were reported in four studies. However, in three studies, a similar effect was demonstrated in the control groups. Besides, in three studies no effect of SCFA enemas on the histological score was observed. In conclusion, there is no evidence for the effectiveness of SCFA enemas in patients with inflammatory bowel diseases.
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Deficiency of long-chain polyunsaturated fatty acids in phenylketonuria: a cross-sectional study

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Drzymała-Czyż S., Kałużny Ł., Krzyżanowska-Jankowska P., Walkowiak D., Mozrzymas R., Walkowiak J.
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2018
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vol. 65
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issue 2
303-308
EN
The etiology of altered blood fatty acid (FA) profile in phenylketonuria (PKU) is understood only partially. We aimed to determine whether FAs deficiency is dependent on the diet or metabolic disturbances. The study comprised 40 PKU patients (20 female, 20 male; aged 11 to 35 years; 12 children and 28 adults) and 40 healthy subjects (HS; 20 female, 20 male, aged 18 to 33 years). We assessed the profile of FAs (gas chromatography/mass spectrometry) and analyzed the 72-hour dietary recalls. The amount of C14:0, C16:0 and C16:1n-7, C18:1n-9 did not differ between the analyzed groups. The percentage of C18:0 was higher, while C20:3n-9, C18:2n-6, C20:2n-6, C20:4n-6, C22:4n-6, C22:5n-6 and C22:6n-3 was lower in PKU than in HS. However, C18:3n-6, C18:3n-3 and n-6/n-3 ratio were higher in PKU patients. The C20:4n-6/C20:3n-6 ratio (reaction catalyzed by Δ5-desaturase), the C22:5n-6/C22:4n-6 and the C22:6n-3/C22:5n-3 ratio (both reactions catalyzed by Δ6 desaturase) were significantly lower in PKU patients. Therefore, the deficiency of long-chain polyunsaturated fatty acids in PKU patients may result not only from inadequate supply but also from metabolic disturbances.
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Vitamin K status in peritoneally dialyzed patients with chronic kidney disease

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Stankowiak-Kulpa H., Krzyżanowska P., Kozioł L., Grzymisławski M., Wanic-Kossowska M., Moczko J., Walkowiak J.
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2011
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vol. 58
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issue 4
617-620
EN
Abnormal vitamin K status was documented in patients with chronic kidney diseases (CKD), especially those undergoing hemodialysis. The data related to patients undergoing peritoneal dialysis (PD) are contradictory. Therefore, in the present study we aimed to evaluate vitamin K status in patients with CKD who are treated with continuous ambulatory PD. Twenty-eight patients entered into the study. Dialysis vintage ranged from 3 to 89 months. Vitamin K status was assessed in all subjects using undercarboxylated prothrombin measurement (PIVKA-II). In addition, total protein and albumin levels, total cholesterol, LDL cholesterol, triglyceride, calcium, urea and creatinine concentrations were determined. PIVKA-II concentrations were abnormal in 13 (46.4 %) subjects. BMI values, both total and LDL cholesterol concentrations were significantly higher in patients with than those without vitamin K deficiency. Moreover, PIVKA II levels correlated with BMI values (r = 0.441, p < 0.019), LDL cholesterol (r = 0.434, p < 0.021) and creatinine (r = 0.406, p < 0.032) concentrations. However, through the use of logistic regression analysis and multiple regression analysis, no clinical factor was documented to be the independent risk factor of vitamin K deficiency. In conclusion, vitamin K deficiency is a frequent condition in peritoneally dialyzed patients. Assessment of vitamin K status should become a standard procedure in this group of patients.
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Conflicting results of non-invasive methods for detection of Helicobacter pylori infection in children with celiac disease - a preliminary study

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Józefczuk J., Mądry E., Nowak J., Walkowiak M., Łochocka K., Banasiewicz T., Pławski A., Kwiecień J., Walkowiak J.
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2016
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vol. 63
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issue 1
127-130
EN
Background: There are no data addressing the usefulness of non-invasive tests for the detection of Helicobacter pylori (HP) infection in celiac disease (CD). Aim: The aim of this study was to compare two most sensitive and specific tests - urea breath test (UBT) and fecal antigen test (FAT) in HP diagnosis in CD patients. Materials and Methods: The study comprised of 76 CD patients, 49 healthy subjects (HS) and 35 patients who underwent differential diagnosis due to abdominal pain (AP patients). The presence of HP infection was evaluated using the 13C isotope-labeled UBT and FAT (ELISA). Results: HP infection was diagnosed based on UBT and FAT in 8 (16.3%) and 7 (14.3%) HS, and in 8 (10.5%) CD patients and 12 (34.3%) AP patients, respectively, using both tests. The prevalence of conflicting results in comparison with positive results (obtained with any of the two tests) was distinctly higher (54.5%) in CD group than in other subjects (23.3%); however, due to low HP prevalence, it did not reach the level of significance (p<0.1759). Conclusion: CD may increase the risk of divergent results of non-invasive tests used for the detection of HP infection in children. Since UBT is the most reliable test, we suggest its standard use as a method of choice in pediatric CD - at least until new evidence emerges supporting a different approach.
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Adult-type hypolactasia and lactose malabsorption in Poland

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Mądry E., Lisowska A., Kwiecień J., Marciniak R., Korzon-Burakowska A., Drzymała-Czyż S., Mojs E., Walkowiak J.
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2010
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vol. 57
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issue 4
585-588
EN
Background: The available data on the incidence of lactose malabsorption are contradictory. Potential bias in random selection is a major drawback of studies performed to-date. Moreover, molecular analysis of polymorphism -13910 C>T upstream of the lactase (LCT) gene (NM_005915.4:c.1917+326C>T; rs4988235) has not been reported in those studies. Therefore, in this study we aimed to assess genetic predisposition and clinical manifestation of adult-type hypolactasia (ATH). Patients and methods: In two-hundred randomly chosen healthy subjects (HS) aged from 18 to 20 years, the presence of -13910 C>T polymorphic variants upstream of the LCT gene was assessed. In a subgroup of subjects with genotype predisposing to ATH, hydrogen-methane breath test (BT) with lactose loading was conducted to determine the current state of lactase activity. In addition, clinical symptoms typical for lactose malabsorption were assessed using the questionnaire method. Results: Sixty-three out of 200 (31.5 %) HS had -13910 C/C genotype. Thus, genetically determined lactase persistence is expected in the remaining 137 (68.5 %) subjects. Thirteen out of 53 (24.5 %) HS having -13910 C/C genotype were proved to be lactose intolerant. Recalculating the data for the entire studied population it implies the incidence of lactose malabsorption in 7.7 % of subjects. Only three out of 13 (23.1 %) subjects with abnormal BT results, reported clinical symptoms related to lactose consumption. Conclusions: Significantly lower than previously reported incidence of clinically detectable lactose malabsorption in young healthy adults in Poland has been documented. The -13910 C/C genotype upstream of the LCT gene indicates a predisposition to ATH, but definitely does not define the current ability to tolerate lactose.
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Cystic fibrosis is a risk factor for celiac disease

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Walkowiak J., Blask-Osipa A., Lisowska A., Oralewska B., Pogorzelski A., Cichy W., Sapiejka E., Kowalska M., Korzon M., Szaflarska-Popławska A.
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2010
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vol. 57
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issue 1
115-118
EN
Background: The coexistence of cystic fibrosis (CF) and celiac disease (CD) has been reported. To our knowledge there is no study directly comparing the incidence of CD in CF patients to that in the general population at the same time. There is no published data on genetic predisposition to CD in CF patients either. Therefore, in the present study we aimed to assess the genetic predisposition to CD and its incidence in CF patients comparing it to data from the general population. Patients and methods: Two hundred eighty-two CF patients were enrolled in the study. In 230 CF patients the genetic predisposition to CD (the presence of HLA-DQ2/ DQ8) was assessed. In all CF patients, serological screening for CD was conducted. In patients with positive antiendomysial antibodies (EMA) gastroduenoscopy was offered. Intestinal histology was classified according to modified Marsh criteria. The results of serological CD screening in 3235 Polish schoolchildren and HLA-DQ typing in 200 healthy subjects (HS) were used for comparison. Results: Positive EMA was found in 2.84% of the studied CF patients. The incidence of proven CD was 2.13%. The incidence of CD as well as positive serological screening were significantly more frequent in the CF group than in the general population. The frequency of CD-related HLA-DQ alleles in CF and HS did not differ. Conclusions: Genetic predisposition to celiac disease in cystic fibrosis patients is similar to that of the general population. However, our results suggest that cystic fibrosis is a risk factor for celiac disease development.
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Antibiotic therapy and fat digestion and absorption in cystic fibrosis

64%
Lisowska A., Pogorzelski A., Oracz G., Skorupa W., Cofta S., Szydłowski J., Socha J., Walkowiak J.
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2011
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vol. 58
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issue 3
345-347
EN
Antibiotic therapy in the cystic fibrosis (CF) mouse model has been shown to result in reduced bacterial load of the intestine and significant body mass gain. The effect was suggested to be linked to the improvement of intestinal digestion and absorption. Therefore, we aimed to assess the influence of routinely applied antibiotic therapy in CF patients on fat assimilation. Twenty-four CF patients aged 6 to 30 years entered the study. Inclusion criteria comprised confirmed exocrine pancreatic insufficiency and bronchopulmonary exacerbation demanding antibiotic therapy. Exclusion criteria comprised: antibiotic therapy six weeks prior to the test, liver cirrhosis, diabetes mellitus, oxygen dependency, the use of systemic corticosteroids. In all enrolled CF subjects, 13C-labelled mixed triglyceride breath test (13C MTG-BT) was performed to assess lipid digestion and absorption, before and after antibiotic therapy. Sixteen subjects were treated intravenously with ceftazidime and amikacin, eight patients orally with ciprofloxacin. Cumulative percentage dose recovery (CPDR) was considered to reflect digestion and absorption of lipids. The values are expressed as means (medians). The values of CPDR before and after antibiotic therapy did not differ in the whole studied group [4.6(3.3) % vs. 5.7(5.3) %, p = 0.100] as well as in the subgroup receiving them intravenously [4.6(3.2) % vs. 5.7(5.3) %, p = 0.327] or in that with oral drug administration [4.6(3.4) % vs. 5.7(5.4) %, p = 0.167]. In conclusion, antibiotic therapy applied routinely in the course of pulmonary exacerbation in CF patients does not seem to result in an improvement of fat digestion and absorption.
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Inulin supplementation in rat model of pouchitis

64%
Drzymała-Czyż S., Banasiewicz T., Tubacka M., Majewski P., Biczysko M., Kościński T., Drews M., Walkowiak J.
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2011
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vol. 58
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issue 3
381-384
EN
Available data indicates potential effectiveness of prebiotic therapy in alleviating inflammation and prolonging the remission in inflammatory bowel disease. Documented successes of such therapies were the basis for this study. So far, there is no data related to the effectiveness of inulin application in symptomatic or severe pouchitis in humans or in animal model. The aim of the study was to determine the effect of inulin supplementation on the expression of intestinal inflammation and feeding efficiency in rats with induced pouchitis. Twenty-four Wistar rats were operated. After induction of pouchitis animals were randomly divided into control and supplementation groups receiving, respectively, semi-synthetic diet with or without inulin (in a lower (LD) or higher (HD) dose: 2.5 % or 5 % of total dietary content of mass) for a period of 6 weeks. Selected nutritional parameters were assessed throughout the study. Histopathological and immunohistochemical analysis of pouch mucosa specimens was also performed. The energy intake, weight gain, feeding efficiency, quality of stools were comparable in all studied groups. The intensity of inflammation (Moskovitz scale) and adaptive changes (Laumonier scale) did not differ between compared groups. The tissue expression of pro- and anti-inflammatory interleukins (IL-1α, IL-6, IL-10 and IL-12) was not different either. Inulin supplementation does not improve the quality of stools or the expression of intestinal inflammation in rats with induced pouchitis. It has no impact on the intensity of pouch adaptation or on feeding efficiency.
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Single dose of green tea extract decreases lipid digestion and absorption from a test meal in humans

64%
Walkowiak J., Bajerska J., Kargulewicz A., Lisowska A., Siedlerski G., Szczapa T., Kobelska-Dubiel N., Grzymisławski M.
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2013
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vol. 60
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issue 3
481-483
EN
Background & Aims: Green tea is known worldwide for its high content of polyphenolic compounds and multifactorial beneficial effects on human health. The role of green tea as an inhibitor of lipid hydrolysis is widely discussed. The aim of the study was to assess the influence of green tea extract on lipid digestion and absorption. Methods: The study comprised 32 healthy volunteers aged 23 to 30 years with normal exocrine pancreatic function. In all subjects 13C-labelled mixed triglyceride breath test was performed twice with and without green tea extract ingestion. Cumulative percentage dose recovery was considered to reflect digestion and absorption of lipids. Values are expressed as medians and 1st-3rd quartile distribution. Results: In all subjects, cumulative percentage dose recovery values were normal in a placebo test (36.8% <30.1-43.3%>). These results were significantly higher (p=0.021) than those obtained in green tea extract test (28.8% <23.1-37.2%>). Results of six tests with GTE were abnormal. Conclusions: Single dose of green tea extract taken with a test meal decreases lipid digestion and absorption in humans.
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