Background and Aim. Differentiating iron deficiency anemia (IDA) from anemia of chronic disease (ACD) in patients with inflammatory bowel disease (IBD) represents a clinical challenge. Hepcidin is a polypeptide synthetized in the liver, and iron levels or inflammation mostly regulate hepcidin production. Our aim was to determine serum hepcidin levels in patients with inflammatory bowel disease (IBD) as well to investigate whether hepcidin levels correlate with disease activity. Material and Methods. A case-control study was preformed among newly diagnosed IBD patients and same number age- and sex-matched healthy controls. All patients underwent a total ileocolonoscopy. Complete blood count was obtained in addition to inflammatory markers (CRP, erythrocyte sedimentation rate-ESR). Serum levels of hepcidin were determined with commercially available enzyme-linked immunosorbent assay (DRG Instruments Marburg, Germany). Serum iron, TIBC, and UIBC were assessed with an electrochemiluminesence immunoassay, and soluble transferrin receptor (sTfR) was assessed using an immunoturbidimetric method. Mayo score and CDAI, respectively, were calculated for each patient. Statistical analyses were performed using the SPSS software version 20.0 for Windows. Results. There was a high statistically significant difference between IBD patients and controls in levels of hepcidin ( P < 0.01 ). Namely, serum hepcidin levels were significantly higher in the control group. There was no statistically significant correlation of serum hepcidin with CRP, Mayo score, or CDAI, respectively ( P > 0.05 ). However, we have found a statistically significant negative correlation of sTfR and TIBC with hepcidin ( P < 0.01 ). Conclusion. Results of our study suggest that hepcidin is a reliable marker of IDA in patients with IBD, and it could be used in routine clinical practice when determining adequate therapy in these patients.

Isolated hepatic sarcoidosis should be considered in the differential diagnosis of asymptomatic or simptomatic patients with hepatosplenomegaly and changes in liver functional tests. Only the timely diagnosis and proper treatment can lead to subjective and objective improvement of patients.

In PBC patients it is important to consider coexisting granulomatous liver diseases if elevated liver function tests persist despite UDCA therapy.

A wide spectrum of extraintestinal manifestations (EIMs) can burden patients with inflammatory bowel disease (IBD). EIMs contribute fairly to morbidity and mortality rates in IBD patients. Moreover, EIMs in IBD patients are so frequent that some suggest that IBD should be approached as a systemic disorder. Anemia is very common in IBD patients. The two most common types of anemia in IBD, iron deficiency anemia and anemia of chronic disease, are extraintestinal complications. Autoimmune hemolytic anemia (AIHA) is a rare extraintestinal manifestation of IBD, more frequent in ulcerative colitis (UC) than in Crohn’s disease (CD). In this case-based review of the literature, we present a 36-year-old female patient diagnosed with Crohn’s disease (CD) and Coombs positive AIHA, complicated by pulmonary thromboembolism and successfully treated with anti-tumor necrosis factor (anti-TNF) therapy. The underlying pathophysiological mechanism of AIHA in IBD is unclear. Treatment options for AIHA in IBD patients before biologic therapy included corticosteroids alone or in combination with azathioprine (AZA), methotrexate, and surgical treatment (colectomy and/or splenectomy). Currently, biologic therapy is a promising therapeutic option, especially in corticosteroid refractory or corticosteroid-dependent IBD patients with AIHA.

Introduction. Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disorder with estimated prevalence of one in 5,000 to 10,000. The disease has age-related penetrance and the HHT signs and symptoms occur and worsen with age. A diagnosis of HHT is based on the Curacao`s criteria. Case report. We report a case series of 6 patients diagnosed with HHT, 5 with definite and one with probable diagnosis according to the Curacao criteria. In 5 patients, the recurrent epistaxis occurred in adolescence as the first presentation while one patient presented with melena. The diagnosis was delayed in 5 patients and the presence of HHT was diagnosed during or after the fifth decade. In 4 patients, the overt gastrointestinal bleeding occurred in the later course of the disease. The asymptomatic pulmonary circulation arteriovenous malformations were detected in 2 patients. The cerebral arteriovenous malformations were not detected. Conclusion. Hereditary hemorrhagic telangiectasia is a rare disorder affecting multiple organs. It should be considered in the adolescents with recurrent epistaxis and in the differential diagnosis of anemia with signs of the gastrointestinal bleeding in order to shorten the delay in the diagnosis and subsequently improve the outcome of the disease.Uvod. Nasledna hemoragijska teleangiektazija (HHT) je redak autosomno-dominantni poremaćaj sa prevalencijom javljanja 1 na 5,000 do 10,000. Bolest je uzrasno zavisna i HHT simptomi i znaci se rano javljaju i pogoršavaju sa godinama. Dijagnoza se postavlja na osnovu Curaco kriterijuma. Prikaz bolesnika. Ovo je serijski prikaz šest bolesnika sa HHT, pet sa definitivnom i jednog sa verovatnom dijagnozom HHT na osnovu Curaco kriterijuma. Kod pet bolesnika ponavljane epistakse su se javile u adolescentnom dobu kao prva manifestacija bolesti, dok je prvi znak bolesti kod jednog bolesnika bila melena. Kod pet bolesnika dijagnoza HHT postavljena je tek u toku i nakon pete decenije života. Kod četiri bolesnika manifestno gastrointestinalno krvarenje se javilo u daljem toku bolesti. Asimptomatske arteriovenske malformacije plućne cirkulacije uočene su kod dva bolesnika. Cerebralne arteriovenske malformacije nisu uočene ni kod jednog bolesnika. Zaključak. Nasledna hemoragijska teleangiektazija je retka bolest koja zahvata više organa. Na ovu bolest bi trebalo misliti kada adolescent imaju ponavljane epistakse i diferencijalno dijagnostički kod anemija sa znacima gastrointestinalnog krvarenja, a u cilju pravovremenog postavljanja dijagnoze bolesti i poboljšanja ishoda iste.