CROHN'S DISEASE. CLINICAL RECOMMENDATIONS (PRELIMINARY VERSION)

[The effect of inflammatory bowel diseases on the risk of atherosclerosis: assessment according to ultrasound imaging and sphygmometry]

AIM

To evaluate the effect of inflammatory bowel disease (IBD) on the risk of atherosclerosis in patients without known cardiovascular disease.

MATERIALS AND METHODS

The study included 115 patients divided into three groups: 37 patients with Crohn's disease (CD), 44 with ulcerative colitis (UC), and 34 in the control group without known IBD and other risk factors. Doppler ultrasound of the brachiocephalic arteries and sphygmometry were used for diagnosis. The main indicators were the thickness of the intima-media complex (TIMC) and vascular stiffness, measured by the cardio-ankle vascular index (CAVI) and the ankle-brachial pressure index (ABI).

RESULTS

IBD patients showed an increase in TIMC compared to controls. TIMC of the common carotid arteries on the right: in patients with CD - 0.07 cm (p=0.001), with UC - 0.08 cm (p=0.019), in the control group - 0.06 cm. TIMC of the common carotid arteries on the left: in patients with CD - 0.07 cm (p=0.001), with UC - 0.07 cm (p=0.012), in the control group - 0.06 cm. The sphygmometry indicators (CAVI and ABI) did not differ significantly between the groups. The mean CAVI on the right was 6.8±0.98 for the CD group, 6.6±0.79 for the UC group, and 6.82±0.76 for the control group (p=0.692).

CONCLUSION

IBD can contribute to the thickening of the vascular walls, thus increasing the risk of atherosclerosis, as shown by TIMC. Vascular stiffness indicators (CAVI, ABI) did not differ significantly between the groups.

Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

Consensus on controversial issues of the surgery for Crohn’s disease by Delphi method

AIM: to establish the consensus on controversial issues of the surgery for Сrohn’s disease by Delphi method.

METHODS: a cross-sectional study was conducted by the Delphi method. 62 experts voted intramural and anonymous (31.03.23). 5 statements from the current edition of clinical guidelines were selected for correction by working group and further voting [2]. Based on the practical experience of the working group and literature data, 3 new statements were created also. Statements that do not reach the required level of agreement (80% or more) will be subjected to Round 2 of the Delphi method.

RESULTS: all experts took part in the anonymous voting. The panel of experts is represented by 8 different areas of practical medicine and the median of the professional experience of the respondents was 30 (12–49) years. Of the 8 statements submitted for voting, consensus (80% or more) was reached on 6 out of 8. 2 statements have been revised by working group for the distance 2nd round of the Delphi study. Consensus (more than 80%) was reached on both.

CONCLUSION: a cross-sectional study by the Delphi method provided the opinions of a panel of experts on controversial issues in the surgical treatment of Crohn’s disease. Statements that reach consensus will be included by the working group in a new edition of clinical guidelines of Crohn’s disease.

Fatty Acids of Erythrocyte Membranes and Blood Serum in Differential Diagnosis of Inflammatory Bowel Diseases

Aim: to study fatty acid levels in erythrocyte membranes (RBC) and blood serum (BS) in patients with inflammatory bowel diseases (IBDs) to develop differential diagnostic models including fatty acids as biomarkers to distinguish between nosological entities of IBDs (ulcerative colitis — UC, Crohn's disease — CD, unclassified colitis — UCC).Materials and methods. We examined 110 patients (mean age 37,7 ± 12,1 years) with IBDs and 53 healthy patients in control group (43,3 ± 11,7 years). The IBDs group included 50 patients with UC, 41 patients with CD, 19 patients with UCC. An exacerbation of the disease was revealed in 42 patients (84 %) with UC, 34 patients with CD (82.9 %) and 11 people with UCC (57.9 %). The study of fatty acids (FA) composition of RBC membranes and BS was carried out using GC/MS system based on three Agilent 7000B quadrupoles (USA).Results. The most significant for distinguishing active UC from CD exacerbation were serum levels of elaidin (p = 0.0006); docosatetraenoic (n-6) (p = 0.004); docodienic (n-6) (p = 0.009); omega-3/omega-6 ratio (p = 0.02); docosapentaenoic (n-3) (p = 0.03); the sum of eicosapentaenoic and docosahexaenoic (p = 0.03), as well as the content of RBC lauric FA (p = 0.04) (AUC — 0.89, sensitivity — 0.91, specificity — 0.89, diagnostic accuracy — 0.91). To distinguish active UC from the same of UCC, the following serum FA were found to be significant: alpha-linolenic; saturated (pentadecanoic, palmitic, stearic, arachidic); monounsaturated (palmitoleic, oleic); omega-6 (hexadecadienic, arachidonic) (p = 0.00000011—0.03300000) (AUC — 0.995, sensitivity — 0.98, specificity — 0.96, diagnostic accuracy — 0.97). The most significant in distinguishing patients with active CD from UCC exacerbation were levels of the following FA: alpha-linolenic; palmitoleic; oleic; the amount of saturated fatty acids (SFA); total unsaturated fatty acids (UFA); stearic; monounsaturated fatty acids (MUFA) amount; SFA/UFA; SFA/PUFA (polyunsaturated fatty acids); linoleic; total PUFA n6; lauric; arachidic acid (p = 0.0000000017–0.030000000) (AUC — 0.914, sensitivity — 0.90, specificity — 0.87, diagnostic accuracy — 0.91).Conclusion. The study of FA levels in groups with different nosological forms of IBDs using complex statistical analysis, including machine learning methods, made it possible to create diagnostic models that differentiate CD, UC and UCC in the acute stage with high accuracy. The proposed approach is promising for the purposes of differential diagnosis of nosological forms of IBDs.

Difficulties in differential diagnosis tuberculosis and Crohn's disease. Case report

We present a clinical case of intestinal tuberculosis in a young patient with a clinical simulation of Crohn's disease. The article addresses clinical presentation, challenges of differential diagnostics of intestinal tuberculosis, and nonsurgical and surgical treatment approaches.

[Clinical value of antibodies in inflammatory bowel diseases]

Inflammatory bowel disease IBD (Crohns disease CD, ulcerative colitis UC) immune-mediated diseases of the digestive tract of unknown etiology. The basis of the pathogenesis of IBD is a violation of the protective mechanisms of the intestinal barrier as a result of a complex interaction of environmental factors, a genetic predisposition and defects in the activation of the immune response in the lymphoid tissue of the intestinal mucosa. Three groups of antibodies are detected in the sera of IBD patients: autoantibodies, antimicrobial antibodies and antibodies to peptide antigens. In CD, the most useful diagnostic markers are ASCA; in UC patients pANCA. Antibodies are not among the diagnostic criteria for CD and UC, the diagnosis of which is traditionally made on the basis of a complex of clinical, radiological, endoscopic and histological signs, but can be used as useful additional non-invasive markers for early diagnosis, assessment of clinical phenotypes, prognosis and effectiveness of treatment of these diseases.