Hemodialysis (HD) patients are at increased risk for undernutrition, especially protein wasting. We present the results of a prospective study in HD patients after 4 months of intervention with oral nutritional supplements (ONS). After a 3-month wash-out period, 92 HD patients were enrolled in the study. Patients were tested for undernutrition with composite parameters, laboratory tests, bioelectrical impedance analysis (BIA), and hand-grip strength test (HGS). All patients fulfilling criteria for, or at high risk of, undernutrition were given ONS in addition to their regular diet. The impact of short-term ONS on surrogate markers of undernutrition was statistically analyzed. Data for 84 patients, 45 (53.6%) male, average age 63.3 years, were available for analysis after 4 months. Patients were divided into three groups: group A (n = 28), patients with normal nutritional status (NUS) at baseline not necessitating ONS; group B (n = 43), patients entitled to receive ONS; group C (n = 13), patients entitled to receive but refused to take ONS. In group B patients, received on average 4.1 bottles of ONS (902 mL; 1,623.6 kcal; 73.06 g protein) per week. Baseline results showed statistically-significant differences between groups in serum albumin levels and phase angle (PhA) but not in HGS. After 4 months of ONS, we noticed stagnation of observed markers in group B. Interestingly, in group A, significant deterioration of serum albumin and PhA was observed, but HGS improved. There was a trend towards worsening of serum albumin levels and HGS in group C not reaching statistical significance. In undernourished HD patients after ONS we did not find statistically-significant improvement of NUS evaluating surrogate markers. Nevertheless, in undernourished patients not receiving ONS, serum albumin and HGS showed a trend towards worsening, and even in well-nourished patients, nutritional markers (serum albumin and PhA) declined. We speculate that a certain positive effect of ONS on nutritional status in undernourished HD patients could be observed already after short-term supplementation. .

Treatment with immune checkpoint inhibitors is effective in various cancers, but may be associated with immune-mediated side effects in other organs. Among the more common ones is gastrointestinal tract involvement, especially colitis. In most patients, colitis is mild or responds to corticosteroid treatment. A smaller proportion of patients, more often those treated with cytotoxic T lymphocyte antigen-4 inhibitors, may have a more severe course of colitis, even life-threatening complications. In these patients, prompt action, timely diagnosis with endoscopic evaluation and early treatment with high-dose corticosteroids and, if ineffective, rescue therapy with biologic agents such as infliximab and vedolizumab are needed. We present three cases from our clinical practice, data on incidence and clinical presentation, current recommendations regarding diagnostic approach and treatment of immune checkpoint inhibitors induced colitis.

Background and Objectives: The vedolizumab clinical decision support tool (VDZ-CDST) was developed to predict treatment outcomes in inflammatory bowel disease (IBD). While validated in clinical trial and consortium settings, its real-world performance remains less clear. The aim of our study was to evaluate the predictive value of pre-treatment CDST stratification for clinical and endoscopic outcomes and treatment persistence in real-world VDZ-treated IBD patients. Materials and Methods: We conducted a retrospective analysis of consecutive IBD patients initiating vedolizumab therapy, stratified by CDST risk groups. Clinical remission (CR) and corticosteroid-free remission (CSFR) at weeks 14 and 52 were assessed using PRO-2 in both Crohn’s disease (CD) and ulcerative colitis (UC). Endoscopic outcomes and treatment persistence were also evaluated. Results: 129 IBD patients, 57 with CD and 72 with UC, treated with vedolizumab were retrospectively stratified according to VDZ-CDST. In CD at week 52 the differences in CSFR between CDST groups were statistically significant (p = 0.04). A statistically significant association (p < 0.001) was also observed between CDST groups and endoscopic activity (EA) at follow-up endoscopy. In the low-probability group 69.2% showed persistent EA, whereas in the high-probability group 68.8% achieved endoscopic remission (ER). We also found significant differences (p = 0.004 and p < 0.001, respectively) in treatment persistence between CDST groups in CD. VDZ discontinuation rates were 76.9%, 28.6%, and 6.3% in the low-, intermediate-, and high-response groups, respectively. In UC, no predictive association was observed for either clinical or endoscopic outcomes nor treatment persistence; however, we observed relatively high remission rates despite CDST-based stratification. Conclusions: Although the VDZ-CDST failed to predict CR measured by PRO-2 in real-world IBD patients, it demonstrated meaningful associations with long-term CSFR, endoscopic outcomes and treatment persistence in Crohn’s disease. These findings support its role as a supportive tool in therapeutic decision-making, particularly when objective outcomes such as mucosal healing are prioritized. Prospective multicentre studies incorporating biomarkers and pharmacokinetic data are needed to refine VDZ-CDST for broader clinical application.

Background: Endoscopic retrograde cholangiopancreatography is an established therapeutic modality for pancreaticobiliary disease. Congenital anatomical anomalies, including situs inversus totalis and rare hepatobiliary malformations, substantially increase the technical complexity of endoscopic retrograde cholangiopancreatography and are seldom encountered in clinical practice. Published experience is limited predominantly to individual case reports and smaller case series. Methods: We present a report of three patients who underwent endoscopic retrograde cholangiopancreatography: two with situs inversus totalis and choledocholithiasis complicated by acute cholangitis, and one with a rare congenital anomaly consisting of a completely separated right hepatic lobe combined with choledocholithiasis. Results: Successful endoscopic retrograde cholangiopancreatography was achieved in all three patients. In both situs inversus totalis cases, biliary cannulation and stone clearance were accomplished using modified endoscopic techniques, including endoscope rotation and positional adjustments, without procedural complications. In the patient with the separated hepatic lobe, endoscopic retrograde cholangiopancreatography allowed common bile duct stone clearance; however, an attempted mechanical lithotripsy of a gallbladder calculus resulted in basket entrapment, necessitating surgical treatment. Conclusions: Endoscopic retrograde cholangiopancreatography is feasible and effective in patients with congenital hepatobiliary anomalies, but demands meticulous pre-procedural planning, thorough anatomical understanding, and technical versatility. A cautious step-by-step approach and readiness to adapt technique are essential to optimise outcomes and minimise risk.