J. Sobocki

The Polish Intestinal Failure Centres’ consensus on the use of teduglutide for the treatment of short bowel syndrome

OBJECTIVE Teduglutide is an active, glucagon-like peptide (GLP)-2 analog with proven clinical efficacy regarding intestinal adaptation in patients with short bowel syndrome (SBS). There are two factors that preclude its reimbursement, and thereby, its availability: its cost (reaching ∼

Response to the Comment on: Occipital C1-C2 Neuromodulation Decreases Body Mass and Fat Stores and Modifies Activity of the Autonomic Nervous System in Morbidly Obese Patients--a Pilot Study.

300,000/y)-which significantly exceeds the cost of home parenteral nutrition (HPN) in most countries-and the lack of clear guidelines. The aim of this study was to create evidence-based working criteria for the use of teduglutide that could be used in clinical settings. METHODS Experts from the Polish Network of Intestinal Failure Centers analyzed available research and considered experience on the topic of HPN and intestinal failure to create guidelines. RESULTS Experts agreed that there are two groups of HPN patients who can benefit from therapy with a GLP-2 analog: those with a good prognosis (in whom complete weaning from HPN may be possible) and those with a poor prognosis (the therapy would be lifesaving). Patient criteria comprise the following: inclusion and exclusion criteria, parameters that can be used for monitoring, outcome measures, and the rationale for the termination of the treatment. CONCLUSIONS It was possible to describe inclusion criteria for both patient groups that justify the use of teduglutide from medical and economic perspectives.

Mucous membrane pemphigoid with severe stricture of the esophagus mediated by IgG and IgA autoantibodies to LAD-1

Thank you for the interest and comment of my paper. However, I would like to clarify some misunderstandings of author’s comment. First: C1-C2 occipital stimulation is far not the same as vagal neurostimulation (VNS). Actually, the only similarity is neuromodulation. The site of stimulation, stimulation time and schedule, type of fibers and nerves roots of CNS access, first and second neurons nuclei, and finally mechanism of action of these two approaches are different should not be mistaken. It is postulated that the former acts via nucleus raphe and the last acts via nucleus tractus solitarius (NTS). Second: Authors suggest that VNS was shown to be effective in weight loss. In fact, this effect is clinically insignificant. Third: Percutaneous stimulation of the anterior branch of the vagus nerve should not be mistaken with C1-C2 stimulation as well. Morbid obesity is a chronic condition and thus requires chronic treatment. Chronic means here several hours every day for several weeks and months. Percutaneous electrodes might appear to be difficult to maintain for longer period of time. In contrary, preprogrammed implanted system working without necessity of engagement of the patient is supposed to be more comfortable and effective. A comparative study is mandatory to answer this question.

Fluconazole withdrawal from routine empiric treatment of CRBSI in hpn patients – safety, cost effectiveness and effect on MDR fungal infection

Stricture of the esophagus may develop in the course of different blistering disorders, mainly mucous membrane pemphigoid (MMP) [1]. MMP is characterized by the presence of IgG and/or IgA autoantibodies directed to the basement membrane zone (BMZ) [1]. We report the first case of MMP with severe stricture of the esophagus mediated by both IgG and IgA autoantibodies directed exclusively to LAD-1, which is a target antigen in linear IgA bullous dermatosis (LABD). A 78-year-old woman was admitted to [...]