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Background and Aims: Acute non-variceal upper gastrointestinal bleeding (UGIB) is associated with significant morbidity and mortality. Our aim was to evaluate the incidence, management, risk factors and outcomes of acute non-variceal UGIB in a population-based study from Hungary. Methods: The present prospective one–year study involved six major community hospitals in Western Hungary covering a population of 1,263,365 persons between January 1 and December 31, 2016. Data collection included demographics, comorbidities endoscopic management, Glasgow-Blatchford score (GBS), Rockall score (RS) transfusion requirements, length of hospital stay and mortality. Results: 688 cases of acute non-variceal UGIB were included with an incidence rate of 54.4 (95%CI: 50.5-58.6) per 100,000 per year. Endoscopy was performed within 12 hours in 71.8%. 5.3% of the patients required surgical treatment and the overall mortality was 13.5%. Weekend presentation was associated with increased transfusion requirements (p=0.047), surgery (p=0.016) and mortality (p=0.021). Presentation with hemodynamic instability or presence of comorbidities was associated with transfusion (p<0.001 both), second look endoscopy (p<0.001 both), re-bleeding (p<0.001 both), longer in-hospital stay (p<0.001 both) and mortality (p=0.017 and p<0.001). GBS was associated with transfusion requirement (AUC:0.82; cut-off: GBS >7points), while mortality was best predicted by the post-endoscopic RS (AUC:0.75; cut-off: RS >5points). Conclusions: Incidence rates of acute non-variceal UGIB in Western Hungary are in line with international trends. Longer pre-hospital time, comorbidities, hemodynamic instability, weekend presentation, treatment with anticoagulants or non-steroidal anti-inflammatory drugs was associated with worse outcomes.

The main therapeutic goal of ulcerative colitis (UC) is to induce and maintain remission to prevent long-term disease progression. Treat-to-target strategies, first introduced by the STRIDE consensus and updated in 2021, have shifted focus from symptomatic control toward more stringent objective endpoints. Today, patient monitoring should be based on a combination of biomarkers and clinical scores, while patient-reported outcomes could be used as short-term targets in monitoring disease activity and therapeutic response. In addition, endoscopic healing was the preferred long-term goal in UC. A Mayo endoscopic score (MES) ≤ 1 can be recommended as a minimum target. However, recent evidence suggests that more stringent endoscopic goals (MES of 0) are associated with superior outcomes. Recently, emerging data support that histological remission (HR) is a superior prognostic factor to endoscopic healing in predicting long-term remission. Despite not yet being recommended as a target, HR may become an important potential therapeutic goal in UC. However, it remains questionable if histological healing should be used as a routine assessment in addition to clinical, biomarker, and endoscopic targets in all patients. Therefore, in this review, our aim was to discuss the current evidence for the different treatment targets and their value in everyday clinical practice.

Background The use of biosimilar adalimumab (ADA) is effective and safe in inflammatory bowel disease (IBD), although clinical data on switching between ADA biosimilars is still rare. At the end of 2020, a non-medical switch to biosimilar ADA became mandatory in Hungary due to reimbursement policy changes of the National Health Insurance Fund of Hungary (NEAK). The aim of the present study was to evaluate short- and medium term clinical efficacy, drug sustainability and safety comparing non-medical switches from the originator to biosimilar ADA, and between ADA biosimilars. Methods 246 consecutive patients on maintenance ADA therapy (n=181 Crohn’s disease [CD] and n=65 ulcerative colitis [UC], male/female: 44%/56%, median disease duration: 10years(y) (IQR: 10–16)) were included from 4 IBD centers between September 2019 and December 2020. Data on clinical efficacy, using Crohn’s Disease Activity Index (CDAI) and partial Mayo Score (pMayo), laboratory parameters (C-reactive protein – CRP) and adverse events were collected at 8–12 weeks prior switch, at baseline, and 8–12 weeks, 20–24 weeks after switch. Drug sustainability following the switch was evaluated after a median of 41 weeks (IQR: 35–42) follow-up time. Results A total of 246 IBD patients (n=153 patients [115CD/38UC, median age: 38y(IQR: 27–45)] and n=93 patients [66CD/27UC, 32y(IQR: 26–40.5)] underwent a non-medical switch from the originator to a biosimilar, and biosimilar to biosimilar. Clinical disease activity based on CDAI and pMayo scores are presented in Figures 1 and 2. No significant difference was found in the proportion of patients in clinical remission at week 8–12 prior switch / switch / week 8–12 and week 20–24 in either patients switched from originator to biosimilar (86.8% / 88.2% / 86.0% / 85.0%; p=0.87 among groups) or biosimilar to biosimilar (72.0% / 77.4% / 84.9% / 77.6%; p=0.21). 89.2% and 83.1% of patients who were in clinical remission at switch/baseline sustained clinical remission up to week 20–24 in the first and second cohorts. Mean CRP levels were also unchanged during follow-up in both cohorts (p=0.71 and p=0.94). Drug survival was similar between originator to biosimilar and biosimilar to biosimilar switch cohorts, with a probability of 90.6% (SE: 2.4) and 85.8% (SE:3.7) to stay on drug after 40 weeks (log-rank: p=0.271). Figure 3. Two cases of skin reactions were registered as adverse events, one leading to treatment discontinuation. Conclusion Clinical remission was sustained following non-medical switch from originator or biosimilar adalimumab to a biosimilar in IBD patients. Medium-term drug sustainability following the switch was high, and comparable between patients with an originator to biosimilar and a biosimilar to biosimilar switch.

A hypereosinophil szindróma tartós eosinophil-túltermeléssel járó, a következményes eosinophilinfiltráció és mediátorfelszabadulás miatt többszervi károsodást okozó kórkép. Etiológia szerint megkülönböztetünk myeloproliferativ eredetű, parazitafertőzéshez, solid tumorhoz és T-sejtes lymphomához társuló, valamint idiopathiás formát. Esetismertetésünkben a 49 éves férfit fogyás, alszári oedema, tachycardia miatt vettük fel osztályunkra. Laborjából jelentősen emelkedett epeúti obstrukciós paraméterek, valamint extrém leukocytosis, eosinophilia volt kiemelhető. Hematológiai malignus betegség erős gyanújával kezdtük vizsgálni. Az elvégzett mellkasi, hasi és kismedencei CT hepatosplenomegaliát, multiplex intrahepaticus laesiókat és egy bizonytalan solitaer cystosus képletet írt le a pancreas farki részében, kóros nyirokcsomókkal és pleuralis folyadékgyülemmel. A leírt CT-kép a klinikum ismeretében elsősorban krónikus myeloid leukaemia manifesztációjának volt megfeleltethető, de a diagnózist a perifériás kenet, az áramlási citometria, a csontvelő-biopszia és a genetikai vizsgálat sem igazolta. Mindezek fényében solid tumorhoz társuló leukaemoid reakció irányába folytattuk a kivizsgálást, a májlaesiók pontos verifikálása érdekében vastagtű-biopszia történt. A szövettani eredmény pancreatobiliaris carcinoma áttétének megfeleltethető, alacsonyan differenciált hámtumor infiltrációját mutatta. A diagnózis felállításának másnapján kezelésünk ellenére a beteg exitált. A gastrointestinalis solid tumorokhoz kapcsolódó hypereosinophil szindróma rendkívül ritka kórkép. Tudomásunk szerint ez a magyar orvosi irodalomban közölt első ilyen eset, mely felhívja a figyelmet a magas fehérvérsejtszám és eosinophilarány differenciáldiagnosztikai kérdéseire, valamint arra, hogy nem korreláló hematológiai leletek esetén nem késlekedhetünk a solid eltérések szövettani mintavételével. Orv Hetil. 2022; 163(44): 1758–1762.

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Background Emerging data suggest that a treat-to-target approach and early therapeutic intervention using regular objective disease assessment leads to improved outcomes. Our aim was to evaluate the value of objective disease monitoring during regular follow-up. Methods Patients presenting in our IBD center between January and December in, 2018 were included and followed up for, 1 year. Data from clinical visits, clinical disease activity using Crohn’s Disease Activity Index and partial Mayo Score, biomarkers (CBC, CRP, FCAL), stool culture, colonoscopy/sigmoidoscopy, CT/MRI scans, abdominal US, total number of visits, hospitalization or surgery rates, and change in medical therapy were collected. We compared monitoring strategy according to the clinical disease activity in the given quarter-year period based on the patient’s status of clinical disease activity (remission/ flare / post-flare/ continuous activity). Results N=161 patients were included (CD:118/UC:43; male:, 56%), with predominantly moderate-to-severe disease phenotype (70% on biological therapy). In total, n=644 quarter year periods (n=, 554 with patient visit) were evaluated (remission, 57%; continuous activity, 19%; post-flare, 11%; flare, 13%). CBC and CRP were performed in, 82.9% and, 83.9% of all patients with at least one clinical visit in a quarter-year period, regardless of clinical activity in IBD. Colonoscopy was performed in patients with flare or continuous disease activity in, 21.1% and, 18.9%, but, 10.1% of the patients in clinical remission also underwent colonoscopy in a given quarter-year period. In a sub-analysis of UC patients, 24.1% of the patients presenting with disease flare had colonoscopy in a given period. Stool culture and C.difficile stool tests were performed in, 17.2% of UC patients with flare. CT scans were performed at a low rate of, 2.4% in CD patients with disease flare, while MRI scans were similar in all subgroups of CD patients (7.7–16.7%)., 13.2% of patients with cont. activity and, 24.5% of patients with flare needed initiation or dose optimization of corticosteroids, while biological start or dose optimization was needed in, 31.1% and, 33.8% in a given quarter-year period. Mean number of follow-up visits per quarter-year period was high(1.6) even for patients in remission, and, 2.4 in flare. Conclusion Our study confirmed the use of regular objective biomarker monitoring, independent of clinical activity. We report high utilization of c-scope/sigmoidoscopy as well as MRI (in CD) in the objective evaluation of patients with clinical symptoms or even as part of routine monitoring. CT was reserved for emergency situations, while the use of US was relatively low. Objective monitoring resulted in frequent and early optimization of the therapeutic strategy.