BACKGROUND: Inflammatory bowel disease (IBD) care and education might differ around Europe. Therefore, we conducted this European Variation In IBD PracticE suRvey (VIPER) to investigate potential differences between countries. METHODS: This trainee-initiated survey, run through SurveyMonkey®, consisted of 47 questions inquiring basic demographics, IBD training, and clinical care. Results were compared according to gross domestic product (GDP) per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). RESULTS: The online survey was completed by 1,285 participants from 40 European countries, with a majority of specialists (65.3%) working in academic institutions (50.4%). Significant differences in IBD-specific training (55.9% vs. 38.4%), as well as availability of IBD units (58.4% vs. 39.7%) and multidisciplinary meetings (73.2% vs. 40.1%), were observed between respondees from high and low GDP countries (p < 0.0001). In high GDP countries, IBD nurses are more common (85.9% vs. 36.0%), also mirrored by more nurse-led IBD clinics (40.6% vs. 13.7%; p < 0.0001). IBD dieticians (33.4% vs. 16.5%) and psychologists (16.8% vs. 7.5%) are mainly present in high GDP countries (p < 0.0001). In the current COVID era, telemedicine is available in 73.2% versus 54.1% of the high/low GDP countries, respectively (p < 0.0001). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. CONCLUSION: Much variability in IBD practice exists across Europe, with marked differences between high and low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardize IBD care and training across Europe.
- MeSH
- biologické přípravky * MeSH
- COVID-19 * MeSH
- idiopatické střevní záněty * epidemiologie terapie MeSH
- lidé MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
OBJECTIVE: Crohn's disease (CD) can be associated with a wide range of extraintestinal manifestations (EIMs), including neurological ones. Published studies differ in their conclusions about the epidemiology and etiopathogenesis of neurological EIMs. The aims of this study were to demonstrate the presence and find risk factors of peripheral (somatic and autonomic) neuropathy patients with severe CD on anti-TNFα biological therapy. MATERIAL AND METHODS: A clinical examination focusing on detection of peripheral sensor-motor nervous dysfunction (including Sudoscan) and examination of autonomic nervous system dysfunction (using Ewing ́s battery tests and spectral analysis) together with laboratory tests and collection of demographic data followed by administration of questionnaires were performed on a total of 30 neurologically asymptomatic outpatients with severe CD on anti-TNFα biological therapy. RESULTS: Peripheral sensor-motor nervous function via clinical neurological examination was pathological in 36.7% and Sudoscan in 33.3% of cases. Statistically significant associations between vibration perception test and age, CD and biological therapy duration, body mass index and Crohn's Disease Activity Index were proved while statistically significant associations between temperature perception test and age and BMI were proved as well. Additionally, a decrease of total protein in a patient ́s serum below the physiological cut-off in the 6 months prior to measurement was associated with a pathological result of a Sudoscan. Cardiovascular autonomic neuropathy based on Ewing ́s battery tests was present in 56.7% of patients, no statistically significant risk factors were found. Our peripheral neuropathy questionnaire correlated with the results of the Sudoscan test and some tests of the clinical examination of peripheral sensor-motor nervous function (discriminatory contact perception test, temperature perception test). CONCLUSIONS: This study demonstrated a relatively high prevalence of peripheral (especially autonomic) neuropathy and verified some risk factors for the development of peripheral somatic neuropathy in asymptomatic patients with severe form of CD on anti-TNFα biological therapy.
- MeSH
- autonomní nervový systém MeSH
- biologická terapie MeSH
- Crohnova nemoc * farmakoterapie epidemiologie komplikace MeSH
- lidé MeSH
- nemoci autonomního nervového systému * MeSH
- nemoci periferního nervového systému * MeSH
- TNF-alfa terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Obezita je závažné onemocnění, jehož incidence nadále celosvětově roste. Onemocnění asociovaná s obezitou vedou ke snížení kvality života a vyšší mortalitě (vysoký krevní tlak, dyslipidemie, diabetes mellitus 2. typu a další). Léčba obezity je multidisciplinární a komplexní proces, který vyžaduje důslednou spolupráci pacienta. Změna životního stylu je stavebním kamenem úspěšné terapie obezity. Farmakologická terapie zažívá v posledních letech renesanci a její role, jak už v mo- noterapii, tak i v kombinaci s jinými metodami, bude postupně nabývat na významu. Endoskopická terapie je rychle se vyvíjecí podobor digestivní endoskopie, která nabízí celou řadu nových metod redukujících například objem žaludku nebo bypass tenkého střeva. Metody jsou efektivní a zároveň mají nízké riziko komplikací. Chirurgická terapie je na druhou stranu vysoce účinná, nicméně je zatížena vyšším výskytem komplikací. Bariatrická chirurgie je určena především pro pacienty s pokročilým stadiem obezity s komorbiditami. Cílem této publikace je dát souhrnný přehled dosavadních endoskopických a chirurgických metod v léčbě obezity.
Obesity is a serious disease whose incidence continues to rise worldwide. Obesity-associated diseases lead to reduced quality of life and increased mortality (high blood pressure, dyslipidemia, type 2 diabetes mellitus, etc.). The treatment of obesity is a multidisciplinary and complex process that requires consistent patient cooperation. Lifestyle change is the cornerstone of successful obesity treatment. Pharmacological therapy has experienced a renaissance in recent years and its role, both in monotherapy and in combination with other methods, will gradually become more important. Endoscopic therapy is a rapidly evolving subfield of digestive endoscopy that offers a variety of new methods to reduce, for example, gastric volume or small bowel bypass. The methods are both effective and have a low risk of complications. Surgical therapy, on the other hand, is highly effective, but is burdened with a higher incidence of complications. Bariatric surgery is primarily for patients with advanced obesity with comorbidities. The aim of this publication is to give a comprehensive review of the current endoscopic and surgical methods in the treatment of obesity.
Umělá inteligence (AI) se stále více zapojuje do medicíny včetně gastroenterologie, což otevírá nové možnosti pro diagnostiku a léčbu onemocnění trávicího traktu. ChatGPT, AI model založený na architektuře GPT-4, má potenciál zrychlit diagnostiku a léčbu, personalizovat léčbu, vzdělávat a školit zdravotníky, podporovat rozhodování a zlepšovat komunikaci s pacienty. Avšak s využitím AI přicházejí i výzvy, jako omezená schopnost AI nahradit lidský úsudek, chyby v datech, otázky související s bezpečností a ochranou osobních údajů a náklady na implementaci. Budoucnost ChatGPT v gastroenterologii závisí na schopnosti zpracovávat a analyzovat velké množství dat pro identifikaci vzorů a tvorbu individuálních léčebných plánů. ChatGPT se díky pokroku v AI a strojovém učení stává přesnějším a efektivnějším, což umožní rychlejší diagnostiku a léčbu gastroenterologických onemocnění. V oblasti vzdělávání bude ChatGPT sloužit jako neocenitelný zdroj informací o nejnovějších výzkumných článcích a postupech. Přes výhody AI v gastroenterologii je důležité řešit otázky etiky, ochrany dat a spolupráce mezi AI a zdravotnickými odborníky. Zajištění správných protokolů a postupů umožní bezpečné a etické využití AI v medicíně. Ačkoli AI přináší významný potenciál pro zlepšení kvality péče, je třeba řešit výzvy spojené s ochranou dat, bezpečností a etikou.
Artificial intelligence (AI) is increasingly being incorporated into medicine, including gastroenterology, opening new possibilities for the diagnosis and treatment of digestive tract diseases. ChatGPT, an AI model based on the GPT-4 architecture, has the potential to accelerate diagnosis and treatment, personalize care, educate, and train healthcare professionals, support decision-making, and improve communication with patients. However, with the use of AI come challenges such as the limited ability of AI to replace human judgment, data errors, issues related to security and personal data protection, and implementation costs. The future of ChatGPT in gastroenterology depends on its ability to process and analyze large amounts of data to identify patterns and create individual treatment plans. Thanks to advancements in AI and machine learning, ChatGPT is becoming more accurate and efficient, enabling faster diagnosis and treatment of gastroenterological diseases. In the field of education, ChatGPT will serve as an invaluable source of information on the latest research articles and procedures. Despite the benefits of AI in gastroenterology, it is essential to address issues of ethics, data protection, and collaboration between AI and healthcare professionals. Ensuring proper protocols and procedures will enable the safe and ethical use of AI in medicine. Although AI offers significant potential for improving the quality of care, it is necessary to address challenges associated with data protection, security, and ethics.
- Klíčová slova
- ChatGPT,
- MeSH
- algoritmy MeSH
- analýza dat MeSH
- gastroenterologie * MeSH
- lidé MeSH
- umělá inteligence * MeSH
- Check Tag
- lidé MeSH
INTRODUCTION: The development of colorectal cancer (CRC) is a multistep process accompanied by the accumulation of mutations that start from specific precancerous lesion - colorectal adenomas (CA). CRC incidence and mortality can be reduced by the early identification of these neoplasm. Colonoscopy is the most widely used screening method for CRC identification. Nowadays, clinical research interest is shifting to the use of liquid biopsy that may help with the early diagnosis of CA and CRC. In our previous study, we identified long non-coding RNA MALAT1 gene amplification associated with the development of CA. METHODS: This study aimed to describe the potential of MALAT1 expression levels in the adenoma tissue of patients used in the previous study by real-time qPCR. Furthermore, we analysed the plasma samples of an independent group of patients with CA (n=97), CRC (n=101), and cancer-free individuals (CFI, n=48). RESULTS: There was no difference in the MALAT1 expression level between CA patients with or without MALAT1 amplification. However, the plasma MALAT1 expression levels were significantly upregulated in patients with CRC and CA compared to CFI (for both p<0.001). Moreover, a correlation between MALAT1 expression and histological types of adenomas was identified- high-CRC-risk adenomas also displayed the highest MALAT1 expression levels. Furthermore, in CRC patients, MALAT1 levels were associated with a response to therapy. CONCLUSION: MALAT1 expression levels could serve as a promising circulating biomarker for early CA and CRC diagnosis, and even as a predictor of therapy response in CRC patients.
- Publikační typ
- časopisecké články MeSH
BACKGROUND : Assessment of mucosal visualization during esophagogastroduodenoscopy (EGD) can be improved with a standardized scoring system. To address this need, we created the Toronto Upper Gastrointestinal Cleaning Score (TUGCS). METHODS : We developed the TUGCS using Delphi methodology, whereby an international group of endoscopy experts iteratively rated their agreement with proposed TUGCS items and anchors on a 5-point Likert scale. After each Delphi round, we analyzed responses and refined the TUGCS using an 80 % agreement threshold for consensus. We used the intraclass correlation coefficient (ICC) to assess inter-rater and test-retest reliability. We assessed internal consistency with Cronbach's alpha and item-total and inter-item correlations with Pearson's correlation coefficient. We compared TUGCS ratings with an independent endoscopist's global rating of mucosal visualization using Spearman's ρ. RESULTS : We achieved consensus with 14 invited participants after three Delphi rounds. Inter-rater reliability was high at 0.79 (95 %CI 0.64-0.88). Test-retest reliability was excellent at 0.83 (95 %CI 0.77-0.87). Cronbach's α was 0.81, item-total correlation range was 0.52-0.70, and inter-item correlation range was 0.38-0.74. There was a positive correlation between TUGCS ratings and a global rating of visualization (r = 0.41, P = 0.002). TUGCS ratings for EGDs with global ratings of excellent were significantly higher than those for EGDs with global ratings of fair (P = 0.01). CONCLUSION : The TUGCS had strong evidence of validity in the clinical setting. The international group of assessors, broad variety of EGD indications, and minimal assessor training improves the potential for dissemination.
- MeSH
- gastrointestinální endoskopie * MeSH
- klinické kompetence * MeSH
- konsensus MeSH
- lidé MeSH
- prospektivní studie MeSH
- reprodukovatelnost výsledků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
