Showing papers in "Przeglad Gastroenterologiczny in 2019"
TL;DR: According to GLOBOCAN 2018 data, colorectal cancer (CRC) is the third most deadly and fourth most commonly diagnosed cancer in the world.
Abstract: According to GLOBOCAN 2018 data, colorectal cancer (CRC) is the third most deadly and fourth most commonly diagnosed cancer in the world. Nearly 2 million new cases and about 1 million deaths are expected in 2018. CRC incidence has been steadily rising worldwide, especially in developing countries that are adopting the "western" way of life. Obesity, sedentary lifestyle, red meat consumption, alcohol, and tobacco are considered the driving factors behind the growth of CRC. However, recent advances in early detection screenings and treatment options have reduced CRC mortality in developed nations, even in the face of growing incidence. Genetic testing and better family history documentation can enable those with a hereditary predisposition for the neoplasm to take preventive measures. Meanwhile, the general population can reduce their risk by lowering their red meat, alcohol, and tobacco consumption and raising their consumption of fibre, wholesome foods, and certain vitamins and minerals.
1,154 citations
TL;DR: Diet, smoking cessation, and exercise hold promise in preventing gastric cancer, while genetic testing is enabling earlier diagnosis and thus greater survival, and a better understanding of the etiology and risk factors of the disease can help reach a consensus in approaching H. pylori infection.
Abstract: Gastric cancer remains one of the most common and deadly cancers worldwide, especially among older males. Based on GLOBOCAN 2018 data, stomach cancer is the 5th most common neoplasm and the 3rd most deadly cancer, with an estimated 783,000 deaths in 2018. Gastric cancer incidence and mortality are highly variable by region and highly dependent on diet and Helicobacter pylori infection. While strides in preventing and treating H. pylori infection have decreased the overall incidence of gastric cancer, they have also contributed to an increase in the incidence of cardia gastric cancer, a rare subtype of the neoplasm that has grown 7-fold in the past decades. A better understanding of the etiology and risk factors of the disease can help reach a consensus in approaching H. pylori infection. Dietary modification, smoking cessation, and exercise hold promise in preventing gastric cancer, while genetic testing is enabling earlier diagnosis and thus greater survival.
833 citations
TL;DR: These recommendations refer to the current management in pancreatic ductal adenocarcinoma, a neoplasia characterised by an aggressive course and extremely poor prognosis, with consideration given to endoscopic and surgical methods.
Abstract: These recommendations refer to the current management in pancreatic ductal adenocarcinoma (PDAC), a neoplasia characterised by an aggressive course and extremely poor prognosis. The recommendations regard diagnosis, surgical, adjuvant and palliative treatment, with consideration given to endoscopic and surgical methods. A vast majority of the statements are based on data obtained in clinical studies and experts' recommendations on PDAC management, including the following guidelines: International Association of Pancreatology/European Pancreatic Club (IAP/EPC), American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), National Comprehensive Cancer Network (NCCN) and Polish Society of Gastroenterology (PSG) and The National Institute for Health and Care Excellence (NICE). All recommendations were voted on by members of the Working Group of the Polish Pancreatic Club. Results of the voting and brief comments are provided with each recommendation.
21 citations
TL;DR: RDW, platelet count, NLR, MLR, and PLR have diagnostic value and can help to distinguish patients with GC from those with IM, and may help patients not to delay endoscopic screening.
Abstract: Introduction Gastric cancer is ranked fourth among all cancers in the world and second in cancer-related deaths. Gastritis leads to the activation of neutrophils, lymphocytes, macrophages, and platelets. Long-term inflammation leads to multistage histopathologic changes called Correa tract, which includes gastritis, atrophy, intestinal metaplasia (IM), dysplasia, and cancer stages. Aim To determine if there is any difference in haematological parameters between gastric cancer (GC) patients, patients with IM, and healthy controls (HC). Material and methods Seventy-three GC patients, 79 patients with IM, and 70 HCs were included in the study. Demographics and laboratory parameters of complete blood count were extracted from the hospital medical database records. Results The mean Hb levels were statistically significant between all three groups. Mean red cell distribution width (RDW), white blood cells (WBC), mean platelet volume (MPV), platelet distribution width (PDW), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and monocyte-to-lymphocyte (MLR) levels were statistically significantly different between gastric cancer and healthy controls. Mean RDW, MPV, and PDW levels were statistically significantly different between the IM and healthy control groups. Mean WBC, NLR, PLR, and MLR levels were statistically significantly different between the gastric cancer and IM groups. Conclusions RDW, platelet count, NLR, MLR, and PLR have diagnostic value and can help to distinguish patients with GC from those with IM. These parameters are accessible easily, the cost is not high, and it may help patients not to delay endoscopic screening.
10 citations
TL;DR: The diagnosis of fibromatosis is not always simple; GISTs can easily be mistaken for it, so a short algorithm of immunostainings that can be useful in differential diagnosis is presented.
Abstract: Introduction Fibromatosis is a histologically benign growth of fibroblastic and myofibroblastic cells, with a potential to recur and invade local organs. It can occur as a superficial or deep form. Visceral fibromatosis and superficial fibromatosis are histologically similar. They both have alterations in the WNT signalling pathway, but mutations in the APC or β-catenin gene do not occur in superficial fibromatoses. Aim To present four cases of deep fibromatosis and one case of Peyronie's disease, along with immunohistochemical staining analysis and the criteria for differential diagnosis. Material and methods All patients were hospitalised in the Central Clinical Hospital of the MSWiA in Warsaw during the period of 2012-2015. Surgical specimens were examined, and tissue samples were embedded in paraffin blocks. Results As the result of the study we present a short algorithm of immunostainings that can be useful in differential diagnosis. When a spindle cell tumour is encountered in the abdomen a gastrointestinal stromal tumor (GIST) should always be excluded; therefore, a CD117 staining is recommended as the first step. When the staining is negative, fibromatosis can be taken into consideration. β-Catenin staining should be done in order to confirm that diagnosis. Conclusions The diagnosis of fibromatosis is not always simple; GISTs can easily be mistaken for it. Immunohistochemical staining with CD34 and CD117 antibodies are useful in differential diagnosis. DTF should present negative stainings for S100, CD34, CD99, and bcl-2, which can help to distinguish it from other mesenchymal tumours.
10 citations
TL;DR: There is a relationship between both cognitive flexibility and flexibility in coping with stress and health-related quality of life, which can be considered to be a kind of resource that helps to cope with challenges posed by a chronic illness, including IBD.
Abstract: Introduction There are studies demonstrating the relation between psychological factors and efficiency of treatment in the course of inflammatory bowel diseases (IBD). Aim To investigate the relation between cognitive flexibility and flexibility in coping with stress and the quality of life, as well as the sense of satisfaction with life, in patients undergoing the biological treatment. Material and methods The study group consisted of 33 adults who were diagnosed with Crohn's disease (CD) or ulcerative colitis (UC). The Flexibility in Coping with Stress Questionnaire (FCSQ-14), the Cognitive Flexibility Inventory (CFI), the Quality of Life SF36v2 Questionnaire, the Satisfaction with Life Scale (SWLS), and the socio-demographic questionnaire were used to gather the data. Results A total of 14 females and 19 males were included in this analysis. The results did not prove that the disease diagnosis (UC or CD) differed the level of psychological resources. However, older respondents achieved lower results in cognitive flexibility. A positive correlation was observed between both cognitive flexibility and flexibility in coping with stress and different dimensions of quality of life and satisfaction with life. Conclusions There is a relationship between both cognitive flexibility and flexibility in coping with stress and health-related quality of life. These factors can be considered to be a kind of resource that helps to cope with challenges posed by a chronic illness, including IBD. Therefore, it is significant to increase their level by applying tailored therapeutic methods.
9 citations
TL;DR: The objective prognostication and easy utilization of ALBI make it a useful alternative to MELD and CTP and therefore favour its applicability in clinical practice and further validations in large prospective cohorts are needed for prognostic value of AL BI in cirrhosis and its complications.
Abstract: Introduction Albumin-bilirubin (ALBI) is a newly devised scoring system for prognostication of liver cirrhosis. The ALBI has recently been validated and found superior to Child-Turcotte-Pugh score (CTP) and Model for End stage Liver Disease (MELD) in assessing severity of liver disease. Aim To determine the ALBI score's mortality prediction among cirrhotics, associated complications and to compare its prognostic proficiency to that of MELD and CTP. Material and methods The diagnostic accuracy of CTP, MELD and ALBI scores for mortality in hospitalized cirrhotic patients was determined by receiver operating characteristic curve (ROC) analysis. The areas under the ROC curve were calculated, with confidence intervals (CI) of 95%. The best cut-off values were ascertained with the greatest specificity and sensitivity. Results The study showed overall in-hospital mortality of 25.5%. Median CTP score was 10.2 (IQR = 3) and area under curve (AUC) was 0.842 (95% CI: 0.817-0.868, p < 0.001) with sensitivity of 75.0% and specificity of 79.2%. Median MELD score was 20.9 (IQR = 7.2) and AUC was 0.836 (95% CI: 0.810-0.863, p < 0.001) with sensitivity of 76.6% and specificity of 76.7%. Median ALBI score was -1.1 (IQR = 1.0), and AUC of ALBI was 0.852 (95% CI: 0.826-0.879, p < 0.001) with sensitivity and specificity of 78.1%. Conclusions The objective prognostication and easy utilization of ALBI make it a useful alternative to MELD and CTP and therefore favour its applicability in clinical practice. Further validations in large prospective cohorts are needed for prognostic value of ALBI in cirrhosis and its complications.
8 citations
TL;DR: Sexual satisfaction was negatively correlated with depression, anxiety, sexual problems, and illness perceptions; and Screening for sexual disorders should be a part of daily medical practice.
Abstract: Inflammatory bowel disease (IBD) represents a diverse variety of chronic inflammatory intestinal conditions. Sexuality is often disturbed in patients with IBD, more often affecting women than men. Many factors seem to contribute to intimacy concerns. The most popular questionnaires used in empirical research around the world are the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men. Sexual satisfaction was negatively correlated with depression, anxiety, sexual problems, and illness perceptions. When analysing the problem of IBD, disorders of sexual function should not be ignored. Patients should be screened for psychological diseases and sexual dysfunction, and necessary treatments should be given as soon as possible. By understanding what factors contribute to poor sexual functioning in patients with IBD, we may try to minimise adverse psychosocial events. Screening for sexual disorders should be a part of daily medical practice.
8 citations
TL;DR: Female sex and disease extent are strong determinant factors connected with anaemia, which represents a frequent complication of IBD not only during the long-term course of the disease, but also at the moment of diagnosis.
Abstract: Introduction Anaemia is the most common extraintestinal manifestation of inflammatory bowel disease, which has a negative impact on quality of life. Aim To determinate the prevalence, risk factors, and aetiology of anaemia in newly diagnosed patients with inflammatory bowel disease (IBD).Material and methods: We included 136 newly diagnosed patients with IBD. We analysed patient age, sex, laboratory tests, endoscopic and radiological examination, length of stay, and the course of hospitalisation. Results Anaemia at the time of IBD diagnosis was detected in 89 (65.4%) patients: 51 (57.3%) patients with ulcerative colitis vs. 38 (42.7%) patients with Crohn's disease; p = 0.052. Female patients were more frequently anaemic than male patients (59.6% vs. 40.4%; p = 0.001). Anaemia was more often diagnosed in Crohn's disease patients with ileocolonic involvement compared to other types of disease location (70.96% vs. 56.52%, respectively; p = 0.03). The prevalence of anaemia at the time of diagnosis for ulcerative colitis patients increased with disease extension: for extensive colitis anaemia was diagnosed in 64.71% compared to 35.29% in limited extension (p < 0.05). Anaemic patients were hospitalised for significantly longer than patients with no anaemia (7.95 ±3.8 days vs. 5.88 ±2.7 days for Crohn's disease; p = 0.02 and 9.02 ±5.0 days vs. 5.00 ±2.4 days for ulcerative colitis; p < 0.05). Conclusions Anaemia represents a frequent complication of IBD not only during the long-term course of the disease, but also at the moment of diagnosis. Anaemia is one of the factors extending the time of hospitalisation. Female sex and disease extent are strong determinant factors connected with anaemia.
7 citations
TL;DR: Plain radiography confirms its utility as a first-line imaging tool for acute abdomen and use of oral and intravenous contrast in computed tomography enterography and magnetic resonance enterography demonstrates IBD involvement in the small intestine wall, which is difficult to assess in other radiological and endoscopic examinations.
Abstract: Radiological examination occupies a significant role, complementary to endoscopic studies, in the diagnostic process of inflammatory bowel disease (IBD). Both ulcerative colitis and Crohn's disease, due to multiple remissions and relapses, require repetitive examinations to evaluate the disease extent, severity, and response to pharmacological treatment. Whereas the use of barium contrast studies is progressively reduced, plain radiography confirms its utility as a first-line imaging tool for acute abdomen. Computed tomography remains an easily accessible and effective method to demonstrate disease activity and extraintestinal manifestations. However, the related radiation exposure reduces its applicability to urgent situations. Ultrasound and magnetic resonance, with the great advantage of avoiding ionising radiation, are highly recommended to present the complications of IBD. Use of oral and intravenous contrast in computed tomography enterography and magnetic resonance enterography demonstrates IBD involvement in the small intestine wall, which is difficult to assess in other radiological and endoscopic examinations.
7 citations
TL;DR: Large populational multicentre studies are needed in order to identify the relationship between Hp and CN in patients, and the results are consistent with some of these studies while it is contradictory to others.
Abstract: Introduction Colorectal cancer is one of the most common cancers and is a major cause of morbidity and mortality in the world and our country. Studies have indicated that there might be a relationship between Helicobacter pylori (Hp) and colorectal neoplasia (CN), although others have not found any relationship. Aim To determine whether there is a potential relationship between Hp and CN in our patients. Material and methods A total of 314 patients, aged 16-86 years, who underwent gastroscopy and colonoscopy at our department between 2015 and 2017 were evaluated retrospectively. The age, gender, endoscopy results, presence of Hp, complete blood count (CBC), vitamin B12, folic acid, C-reactive protein (CRP), and sedimentation levels of the patients were examined. Results CBC, ferritin, vitamin B12, and CRP measurements did not show statistical significance in terms of the presence of Hp (p > 0.05). Folate values of Hp-positive patients were significantly lower than Hp-negative patients (p = 0.007; p 0.05). Adenomatous polyps were not related to Hp (p > 0.05). Correlation between intestinal metaplasia (IM) and adenomatous polyps was insignificant. There was no statistically significant difference between colon and gastric pathology results. Conclusions In our study, no significant relationship was noted between Hp and CN. A few studies have been conducted in our country, and our results are consistent with some of these studies while it is contradictory to others. Large populational multicentre studies are needed in order to identify the relationship between Hp and CN.
TL;DR: Functional brain imaging (positron emission tomography – PET, functional magnetic resonance imaging – fMRI), allowing in vivo analysis of the brain-digestive tract interaction and the neurological mechanisms underlying visceral hypersensitivity, significantly advanced research and helped in the understanding of the interrelations in this field.
Abstract: Functional brain imaging (positron emission tomography - PET, functional magnetic resonance imaging - fMRI), allowing in vivo analysis of the brain-digestive tract interaction and the neurological mechanisms underlying visceral hypersensitivity, significantly advanced research and helped in the understanding of the interrelations in this field. Differences in this parameter can result from alterations in task-related cognitive states or from resting state processes. Nowadays, advanced imaging techniques such as fMRI are more frequently used and are acknowledged among both clinicians and radiologists in the diagnostic algorithm of digestive tract diseases. Functional dyspepsia is a condition in which neuroimaging allows for analysis of dysfunctions within the brain-gut axis (BGA) engaged in processing of visceral discomfort and pain. The results of studies in patient groups with irritable bowel syndrome prove that psychosocial factors significantly affect the mechanisms regulating visceral sensitivity within the brain. The BGA includes neuronal pathways (autonomic nervous system), neuroendocrine (hypothalamo-pituitary-adrenal axis), and neuroimmunological ones. Psychological processes affect the functioning of the digestive system and can cause dyspeptic symptoms. A patient's mental condition associated with stress can affect processes taking place in the central nervous system and trigger somatic reactions in the digestive tract through the autonomic visceral system.
TL;DR: This study revealed that sleeve gastrectomy relieves exocrine pancreatic insufficiency, and this is the first study to investigate EPI-SG association.
Abstract: Introduction Bariatric surgery is the most effective treatment modality in morbidly obese patients. Compared to Roux-en Y gastric bypass (RYGB), sleeve gastrectomy (SG) has better metabolic and nutritional outcomes after surgery. Exocrine pancreatic insufficiency (EPI) can be seen after RYGB but there is not any knowledge about EPI-SG association. Aim To assess exocrine pancreatic functions before and after the SG procedure. Material and methods This is a single-center, prospective and case-control study. Forty morbidly obese patients were included in the study. Their pre-operative and post-operative, third month fecal samples were collected. Exocrine pancreatic insufficiency was determined by using fecal elastase-1 and diagnosed when fecal elastase-1 levels were < 200 μg/g. Results The mean fecal elastase-1 level was 256.25 ±137.16 μg/g and the mean post-surgical fecal elastase-1 level was 437.7 ±212.43 μg/g (p = 0.001). In the pre-operative period, half of patients had FE levels under 200 μg/g. In the third month after surgery, only 4 patients had fecal elastase-1 levels under 200 μg/g. Comparison of fecal elastase-1 between pre-surgery and post-surgery revealed a significant difference (p = 0.001). Conclusions This is the first study to investigate EPI-SG association. Surgery-associated morbidity and mortality are the leading limitations of bariatric surgery procedures. Exocrine pancreatic insufficiency is one of them; prior studies demonstrate its increased frequency after RYGB. Our study revealed that SG relieves exocrine pancreatic insufficiency.
TL;DR: An enhanced level of GRP94 immunoexpression was significantly associated with malignancy-related clinicopathological factors and reduced the 5-year overall survival in CRC patients and a multivariate analysis demonstrated that GRP 94 was not revealed as an independent risk factor for CRC prognosis.
Abstract: Introduction Colorectal cancer (CRC) is traditionally regarded as the most commonly diagnosed gastrointestinal malignant disease. Nevertheless, despite advances in diagnosis and novel therapeutic options, the clinical outcomes of patients are still unsatisfactory. Aim To investigate the clinicopathological and prognostic roles of GRP94 expression, the immunohistochemical investigation was performed on samples of CRC tumour tissues, adjacent non-pathological mucosa, and metastatic foci in regional lymph nodes in Caucasian patients. Material and methods Paraffin-embedded adenocarcinoma samples were assessed immunohistochemically for GRP94 protein and scored according to the percentage of cells with positive reaction combined with staining intensity. Connections between GRP94 immunoexpression and clinicopathological factors including the overall survival (OS) were evaluated. Results The level of the GRP94 immunohistochemical reactivity was correlated with the grade of the histological differentiation (H (2.92) = 25.906; p < 0.001), size of the primary tumour (Z = -4.010; p < 0.001), regional lymph node involvement (Z = -6.547; p < 0.001), and perineural invasion (Z = -6.235; p < 0.001). Kaplan-Meier survival analysis showed that the survival time for patients with a low expression of GRP94 was significantly longer than that for patients with a moderate or strong level of GRP94 immunoreactivity (p < 0.001). Conclusions An enhanced level of GRP94 immunoexpression was significantly associated with malignancy-related clinicopathological factors and reduced the 5-year overall survival in CRC patients. However, a multivariate analysis demonstrated that GRP94 was not revealed as an independent risk factor for CRC prognosis.
TL;DR: There is a risk of ignoring the symptoms in young people and finding advanced neoplastic lesions at the time of diagnosis, which has a negative effect on long-term treatment results.
Abstract: Introduction According to statistics, gastric cancer remains one of the most common causes of death due to neoplastic disease in the world's population. It is a common conception that this type of cancer mostly affects people in their fifth or sixth decade of life. So, when it comes to young people, for example in their twenties or early thirties, who present to a doctor with symptoms suggesting a cancer of the gastrointestinal tract, these are quite often ignored because of their young age. Aim In this study we at The Second Department of General and Gastroenterological Surgery of the Medical University of Bialystok, Poland decided to enlighten the problem of stomach cancer in people under 40 years old as a cause of death and complications most likely because of an incorrect diagnosis at the beginning of therapy. Material and methods Major analysis involved 350 cases of gastrointestinal tumours treated surgically, of which 14 cases (7 men and 7 women) were patients aged 18-39 years diagnosed with different stages of gastric cancer. Results Statistical analysis has shown that gastric cancer in women occurred much earlier than in men, and the average survival time was 16 months after the surgery. Conclusions Because of the false suggestion that gastric cancer affects mostly older people, there is a risk of ignoring the symptoms in young people and finding advanced neoplastic lesions at the time of diagnosis, which has a negative effect on long-term treatment results.
TL;DR: Liver metastases of colorectal cancer are more common in theright lobe than in the left lobe, and the right lobe posterior segment (segment VI) is the main target of metastases.
Abstract: Introduction It is known that the liver is the main target for metastasis in colorectal cancer. However, we do not know enough from the literature to describe the segmental distribution of liver metastatic lesions of colorectal cancers. Aim To investigate which liver segment is affected. Material and methods A total of 326 patients (female/male, n = 115/221; age: 53 ±8/51 ±7 years) were included in our study, classified according to their pathological diagnosis. After liver metastases of the patients were determined, they were divided according to Couinaud classification. Results While the total number of metastases detected in the right lobe was 691 (70.1%), the number of metastases detected in the left lobe was 294 (29.9%), and the difference was highly significant (p < 0.0001). Metastases in the right lobe anterior segment amounted to 279 (40.4%), and metastasis in right lobe posterior segment was 412 (59.6%), and the difference was significant. When the total number of metastatic lesions is evaluated by excluding segment I, the largest number of lesions were observed in segment VIII. The liver segments with the highest number of metastatic lesions were, respectively, VII, IV, VI, V, III, and II. In this case, the fewest metastatic lesions were observed in segment II. Conclusions Liver metastases of colorectal cancer are more common in the right lobe than in the left lobe. The right lobe posterior segment (segment VI) is the main target of metastases.
TL;DR: Surgical treatment significantly reduces the fatigue symptom in patients with IBD and the severity of fatigue correlates with disease activity and functioning in the respective areas.
Abstract: Introduction The occurrence of fatigue in patients suffering from inflammatory bowel diseases (IBD) is influenced by pain, frequent bowel movements, stress associated with symptoms and time of their occurrence reaction of surroundings, fear for their own health, sleep disturbances, side effects of pharmacological treatment, physical and mental exhaustion, hindered social contacts and difficulties at work. Aim To evaluate the fatigue and the assessment of functioning of patients with IBD, who were treated surgically. Material and methods To evaluate the functioning of patients, a Polish version of the Inflammatory Bowel Disease Questionnaire was used. To evaluate the occurrence of fatigue in studied subjects, a Polish version of the Functional Assessment of Chronic Illness Therapy - Fatigue Scale was used. The activity of disease was evaluated with the use of the Crohn's Disease Activity Index for patients with Crohn's disease (CD) and the Clinical Activity Index for patients with ulcerative colitis (UC). Results Before surgery, there was no significant difference between CD and UC patients, with regard to the mean FACIT-F (28.76 for CD and 28.76 for UC, p = 0.72). Also, after surgery, there was no significant difference between CD and UC patients, with regard to the mean FACIT-F (14.8 for CD and 16.0 for UC, p = 0.71). The IBD patients who underwent surgery for CD and UC had significantly lower FACIT-F scores compared to the patients before the surgery (p = 0.001 and p = 0.0001, respectively). IBD patients who underwent surgery for CD and UC had significantly better functioning and higher IBDQ total scores compared to the patients before the surgery. Conclusions Surgical treatment significantly reduces the fatigue symptom in patients with IBD. The severity of fatigue correlates with disease activity and functioning in the respective areas.
TL;DR: It was observed that adenomyomatous hyperplasia and adenomatrous polyp were associated with metaplastic changes in the GB pathologies, including XGC and follicular cholecystitis, and it is thought that metaplasia-dysplasia may be associated with GBC.
Abstract: Introduction Gallbladder cancer (GBC) is diagnosed often incidentally after cholecystectomies, with a rate of 0.1-3%. Aim To review the clinical and morphological aspects of GBC and pre-neoplastic lesions in patients who underwent cholecystectomy. Material and methods A total of 5026 patients who underwent cholecystectomy between January 1, 2012 and December 31, 2017 were included in the study. Histological changes (acute cholecystitis, adenomyomatosis, xanthogranulomatous cholecystitis (XGC), polyps, antral metaplasia, intestinal metaplasia (IM), dysplasia, cancer, and others) in gallbladders (GB) from 5029 patients who underwent cholecystectomy for cholelithiasis were analysed. Results Gallbladder cancer was more common in women than in men (14/4 = 3.5). A significant relation was found between cholelithiasis and GBC (p = 0.031). Of the patients with GBC, six had stage 1a (T1a + T1b), five had stage 1b (T2N0), two had stage 2 (T3N0), three had stage 2b (T1-3 N1), one had stage 3 (T4 N0), and one had stage 4 (T3N1M1). The IM was more common in females than in males (K/E = 3.3). A significant relationship was found between cholecystitis and IM (p < 0.001). A significant association was observed between IM and adenomyomatosis hyperplasia (p = 0.016). Conclusions In this study, it was observed that adenomyomatous hyperplasia and adenomatous polyp were associated with metaplastic changes in the GB pathologies, including XGC and follicular cholecystitis. It is thought that metaplasia-dysplasia may be associated with GBC. However, further studies on GB carcinogenesis are needed.
TL;DR: The prevalence of benign duodenal tumours has been rising due to a higher level of clinicians’ doubts and the convenience of gastrointestinal endoscopy; hence, knowledge of this problem is important in routine clinical practice.
Abstract: This review study describes the problem of duodenal tumours, which are rare but important in gastrological practice. The most common location of small intestinal tumours is the duodenum, and this observation is probably partly due to the greater diagnostic availability for most proximal segments of the small intestine. Among tumours the following should be mentioned - benign: adenomas, lipomas, haemangiomas, and leiomyomas; and malignant: malignant tumours of epithelial origin, primary gastrointestinal stromal tumours, neuroendocrine tumours and carcinoids, lymphomas, sarcomas, teratomas, and secondary metastases. Early duodenal tumour recognition, especially with histological assessment, plays a crucial diagnostic role with future therapeutic implications. In recent years the prevalence of benign duodenal tumours has been rising due to a higher level of clinicians' doubts and the convenience of gastrointestinal endoscopy; hence, knowledge of this problem is important in routine clinical practice. The method of duodenal tumour treatment should be selected on an individual basis.
TL;DR: In patients who responded to the initial treatment, cyclic rifaximin therapy is needed to maintain remission and this regimen leads to a gradual cessation of symptoms over a 6-month period.
Abstract: Introduction Symptomatic uncomplicated diverticular disease (SUDD) is the most common manifestation of diverticulosis. Data concerning the optimal treatment after SUDD exacerbation are inconsistent. Aim To assess the effectiveness and necessity of cyclic rifaximin treatment for recurrent SUDD symptoms and for preventing exacerbations in patients who responded to the initial treatment. Material and methods A retrospective observational study was performed in 2017. Physicians responded to a survey on patients with recurrent SUDD during the observation period, who were cyclically treated with rifaximin 400 mg b.i.d. for 7 days per month. The patients' SUDD history, diagnostic methods, treatment, and results were evaluated. Results In total 294 patients were included in this study (67% women, median age: 65 years (26-87)). The mean duration of diverticular disease (DD) was 4.5 years (1-20), and 88% had at least one repeated episode of SUDD exacerbation before rifaximin. A total of 267 patients were treated with rifaximin. Changes in the severity of pain, abdominal tenderness, diarrhoea, constipation, and bloating were assessed every 2 months. After 6 months of rifaximin treatment there was a statistically significant reduction in the total severity score (median from 1.8 (max. 3 points) to 0.2; p < 0.0001; sum from 9.37 (max. 18 points) to 1.35; p < 0.0001) and an improvement in individual symptom score. Conclusions Cyclical rifaximin is effective in treating exacerbation of SUDD. This regimen leads to a gradual cessation of symptoms over a 6-month period. In patients who responded to the initial treatment, cyclic rifaximin therapy is needed to maintain remission.
TL;DR: When used alone, RSI/RFS questionnaires do not allow an unambiguous diagnosis of LPR assessed by 24-hour pharyngeal pH-monitoring.
Abstract: Introduction Twenty-four-hour oesophageal pH-monitoring is a gold standard in the diagnostics of gastroesophageal reflux (GERD); however, this examination does not always perform well in patients in whom laryngeal symptoms of reflux are observed. Aim To test the effectiveness of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in confirming the occurrence of laryngopharyngeal reflux (LPR). Material and methods Eighty-two patients with symptoms suggesting the occurrence of LPR were studied. The mean age of the participants amounted to 48.79 ±12.02. The patients were asked to fill in the RSI. The pharynx was assessed using videolaryngostroboscopy and then the RSF was filled in. Next, 24-hour pharyngeal pH-monitoring was performed with the use of a Dx pH - Restech System device. All the statistical analyses were conducted with the use of the R computational environment. Results The authors attempted to determine the reference values of the RSI and RFS questionnaires for the Polish population. For a very general approximation, normality of the distributions of the results in the RSI and RFS questionnaire can be done and an approximation mean + 2 SD can be used as a reference value. Then, for RSI the recommended cut-off limit of LPR would fluctuate, depending on the study, between 8 and 17, whereas for RFS it would be between 8 and 14. Conclusions When used alone, RSI/RFS questionnaires do not allow an unambiguous diagnosis of LPR assessed by 24-hour pharyngeal pH-monitoring.
TL;DR: The molecular mechanisms leading to IBD are presented, focusing on new forms of this disorder, including very early-onset IBD (VEO-IBD).
Abstract: Inflammatory bowel disease (IBD) is a heterogenous group of chronic inflammations in the gastrointestinal tract, which traditionally consists of two types: Crohn's disease and ulcerative colitis. They differ when it comes to clinical, endoscopic, and histopathological changes. The exact aetiology of IBD has not been fully comprehended, but what is known so far is that the aetiopathogenesis of the disease is compound. Many articles have been written on the cellular/molecular background of IBD. Based on various molecular pathways, new forms of the disease have been discovered, including very early-onset IBD (VEO-IBD) or IBD coexisting with primary sclerosing cholangitis. The aim of this article is to present the molecular mechanisms leading to IBD, focusing on new forms of this disorder.
TL;DR: The healing process of CF should be monitored by MRI due to the discrepancy between premature closure of external openings and fistulous tracts, and prolonged biological therapy until complete healing of anal fistulas confirmed on MRI might improve the results of treatment.
Abstract: Introduction Clinical evaluation of the Crohn's anal fistulas (CF) closure is inadequate to some extent due to earlier closure of cutaneous openings compared to fistulous tracts. There is a need for a more accurate method of assessment. Aim To compare clinical signs of CF with radiological findings, before and after treatment, to follow complete closure. Material and methods It was a retrospective study of 23 patients suffering from CF admitted to a single specialist centre, who were treated with a combination of surgical and biological therapy. Fistula healing was evaluated with fistula drainage assessment classification (FDA), perianal disease activity index (PDAI), and van Assche magnetic resonance imaging score (MRI) before and 3 months after surgery and induction of the biological treatment. Results Clinical response occurred in 13 (57%) patients 3 months after induction treatment. Complete clinical response was achieved in 8 (35%) patients, whereas partial response occurred in 5 (22%) patients. Persistence of a fistula tract was visualised on MRI in 4 (50%) patients with clinical closure. Conclusions The healing process of CF should be monitored by MRI due to the discrepancy between premature closure of external openings and fistulous tracts. Prolonged biological therapy until complete healing of anal fistulas confirmed on MRI might improve the results of treatment.
TL;DR: Non-alcoholic fatty liver disease was the most common liver disease that was the reason for medical consultations, but its incidence seems to be underestimated due to referral for further diagnostics only in patients with abnormal aminotransferases.
Abstract: Introduction Epidemiological studies show an increasing incidence of overweight and obesity all over the world, leading to an increase in the number of patients consulted due to liver damage. Aim Assesement to which doctors (general practitioners or specialist) refer patients with elevated liver enzymes in Poland, how they are diagnosed and treated. Material and methods We conducted questionnaire surveys among 1322 doctors of various specialties to find the most common causes of liver disease, at which stage of the disease patients reported to doctors, and what schemes of management are followed. Results Non-alcoholic fatty liver disease (NAFLD) was the most common cause of abnormal liver enzymes (59.7%). Patients with liver damage most often reported to internal medicine specialists (59%) and gastroenterologists (27.5%). The diagnosis was based on abnormal aminotransferases (80.8%) and abdominal ultrasound examination (89.9%). Computed tomography/magnetic resonance imaging (50.2%) and liver biopsy (22.4%) were used to assess fibrosis. Almost all respondents recommended reduction of body mass and lifestyle changes, and less than half (46.4%) recommended pharmacological treatment. Conclusions NAFLD was the most common liver disease that was the reason for medical consultations, but its incidence seems to be underestimated due to referral for further diagnostics only in patients with abnormal aminotransferases. The diagnostic methods used to assess the severity of the liver fibrosis and the recommended pharmacological treatment varied depending on the physician's specialisation and the centre's reference level.
TL;DR: Perioperative NLR and PLR might be good predictors for prognosis in CRC patients who have undergone curative surgery, which could guide the customised therapeutic strategy.
Abstract: Introduction Perioperative inflammatory markers, including the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), are associated with oncological prognosis. However, their changes in colorectal cancer surgery for predicting the prognosis are rarely investigated. Aim To compare perioperative changes to evaluate the prognostic significance of patients' survival. Material and methods Retrospective clinical data and baseline laboratory parameters of 183 colorectal cancer (CRC) patients who underwent curative surgery were collected between January 2007 and January 2013. The clinicopathological characteristics were compared. Statistical analysis was used to identify the predictive changes of perioperative NLR and PLR associated with survival prognosis. Results ROC analysis indicated that perioperative NLR/PLR showed higher predictive accuracy for prognosis, and the optimal cut-off values of pre-NLR, post-NLR, pre-PLR, and post-PLR were 2.94, 4.32, 184.29, and 212.37, respectively. Kaplan-Meier analysis suggested that the four groups stratified by perioperative changes had significantly different recurrence-free survival and overall survival (p < 0.05). Univariate and multivariable analysis revealed that patients with higher cancer stage, lymph node metastasis, and perioperative change of NLR/PLR (HH, LH) had significant association with poor prognosis of RFS and OS (all p < 0.05). Conclusions Perioperative NLR and PLR might be good predictors for prognosis in CRC patients who have undergone curative surgery, which could guide the customised therapeutic strategy. Furthermore, their assessment could contribute to accurately predicting oncologic outcomes and provide an in-depth understanding of the patients, which could guide the operational strategy.
TL;DR: A patient with primary sclerosing cholangitis with features of autoimmune hepatitis (AIH) and associated with ulcerative colitis is presented, who developed a severe elevation of liver enzymes following the use of melatonin in two separate courses.
Abstract: Melatonin (N-acetyl-5-methoxy-triptamine) is the major product of the pineal gland; however, it has also been identified in a large number of extrapineal organs including the gastrointestinal tract, cornea, bone marrow, lymphocytes, etc. [1]. Melatonin has well-known anti-oxidative, oncostatic, and anti-aging properties and numerous experimental and clinical data have established its beneficial effects [2–4]. Melatonin exerts some of its physiological effects in immune cells through two G-protein-coupled specific membrane receptors: MT1 (cAMP signalling pathway) and MT2 (cGMP signalling pathway). There is now evidence that melatonin possesses important immunoenhancing properties, mostly underlined in immunodepressed situations [3], and it may counteract the immunosuppressive effect of corticotherapy. Melatonin promotes a Th1-mediated response (Th1 cells produce far more interferon g (IFN-g) and interleukin 2 (IL-2) than Th2 cells), thereby activating inflammatory pathways. However, melatonin can also stimulate Th2 cells which produce far more IL-4 and IL-10 than do the Th1 cells. Th2 cells stimulate antibody production via B lymphocytes and down regulate Th1 cells, and thus they may inhibit some Th1-mediated inflammatory responses [5–7]. Although melatonin is one of the least toxic substances known, its pharmacological effect on some autoimmune diseases such as rheumatoid arthritis and Crohn’s disease at this point is controversial [8]. In 1997, Hong et al. [9] reported a patient who developed autoimmune hepatitis after beginning melatonin therapy for the treatment of insomnia. Recently, Fourman et al. [10] reported a case of autoimmune hepatitis that developed in a 50-year-old man after starting ramelteon, a melatonin agonist, for insomnia. Here we present a patient with primary sclerosing cholangitis (PSC) with features of autoimmune hepatitis (AIH) and associated with ulcerative colitis, who developed a severe elevation of liver enzymes following the use of melatonin in two separate courses. The patient was a 25-year-old female with a history of autoimmune hepatitis diagnosed at the age 23 years in a local hospital and treated with corticosteroids and azathioprine for 2 years. She denied taking any other medications as well as supplements for depression including St John’s wort, which has been known to cause serious interactions with some drugs. Because she experienced no response to the therapy she was referred to our hospital. On admission, she was asymptomatic. There was no history of risk factors for liver disease such as malnutrition, prior blood transfusion or surgical procedures, alcohol or drug abuse, or contact with high-risk individuals. Her family history was noncontributory, and her physical examination was unremarkable. Gynaecological and neurological examination also revealed no abnormalities. Laboratory tests are presented in Table I. The immunological profile was positive for anti-nuclear antibody and anti-smooth muscle antibody at titres of 1 : 160 and 1 : 320, respectively, and seronegative for anti-mitochondrial antibody, anti-liver/ kidney microsomal antibody, and perinuclear anti-neutrophil cytoplasmic antibody (done by indirect immunofluorescence). Results of serologic tests for hepatitis A, B, and C viruses and for antibodies to cytomegalovirus (CMV) and Epstein-Barr viruses were negative. The result of polymerase chain reaction (PCR) testing for HCV-RNA was also negative. Normal values were obtained for the following parameters: α1-antitrypsin, ceruloplasmin, ferritin, albumin, triglycerides, and glucose.
TL;DR: An overview of published studies conducted on helminths – parasites of the human gastrointestinal tract shows that as medical knowledge on the cells and mediators participating actively in inflammatory processes accumulates, clinical trials focus on ever more specific areas concerning the pathomechanisms of autoimmune diseases.
Abstract: This paper presents an overview of published studies conducted on helminths - parasites of the human gastrointestinal tract. Making use of their ability for immunomodulation may lead to the introduction of effective therapies for autoimmune diseases. This paper presents chronologically attempts to treat autoimmune diseases not only of the gastrointestinal tract, but also of the nervous and endocrine systems, which have been undertaken for decades. The overview of analysed reports demonstrates that as medical knowledge on the cells and mediators participating actively in inflammatory processes accumulates, clinical trials focus on ever more specific areas concerning the pathomechanisms of autoimmune diseases. The outcomes of clinical trials conducted both on animals and humans give reasons to assume that the modification of the human intestinal microflora may be the key to fighting against these diseases.
TL;DR: According to the findings, simultaneous use of PEG and Motilium had the best therapeutic effect for chronic constipation among CP children, however,Motilium alone was nearly ineffective, and PEG alone had a moderate therapeutic effect.
Abstract: Introduction Cerebral palsy (CP) is a permanent non-progressive movement disorder, which is due to brain injuries during brain development. Constipation is one of the prevalent conditions in children with CP that can adversely affect the psychological health, appetite, and overall health of these patients. Aim To compare three therapeutic methods in the treatment of chronic constipation in CP children. Material and methods In this randomised clinical trial (RCT), paediatric CP patients with chronic constipation were randomly divided into three groups (groups A, B, and C). Group A received polyethylene glycol (PEG), group B received PEG with Motilium, and group C received Motilium for 2 weeks. Motilium was administered at 0.2 mg/kg/dose and PEG at 0.5 g/kg/dose three times daily. To compare the therapeutic effect the McNemar test was used and a significance level of 0.05 was considered. Results The highest rate of improvement in chronic constipation was seen in group B and the lowest rate belonged to group C. Satisfactory response frequency was seen in 10 patients in group A (58.8%), 17 patients in group B (94.4%), and 1 patient in group C (6.6%); p Conclusions According to the findings, simultaneous use of PEG and Motilium had the best therapeutic effect for chronic constipation among CP children. However, Motilium alone was nearly ineffective, and PEG alone had a moderate therapeutic effect.
TL;DR: A weak relation was detected between the presence of gastritis or its severity and MPV, and platelet values, which was determined to be low at a significant level in the HP(+) group, although no significant differences were detected between all the cases who had and who did not have gastritis in terms of MPV.
Abstract: Introduction Helicobacter pylori (HP) is an infectious agent worldwide and is detected frequently. Aim We examined whether there is a relationship between HP positivity and gastritis, mean platelet volume (MPV), and platelet level. Material and methods A total of 309 patients who presented to the Paediatric Gastroenterology Polyclinic with dyspeptic complaints, who received upper gastrointestinal endoscopy, and whose gastric biopsies were carried out were included in the present study. MPVs, thrombocyte, presence of HP, and histopathological presence of gastritis in the patients were examined. The MPV and thrombocyte values were compared between the patients who were HP positive and negative, and between the cases who had and who did not have gastritis. Results A total of 36% of the cases who were included in the present study were HP(-), and 64% were HP(+). No gastritis was detected in 22% of the cases. No significant differences were detected between the HP(+) and HP(-) cases in terms of MPV values. The platelet values were determined to be low at a significant level in the HP(+) group, although no significant differences were detected between all the cases who had and who did not have gastritis in terms of MPV. Conclusions A weak relation was determined between the HP and MPV and platelet values. Although no relations were detected between the presence of gastritis or its severity and MPV, a weak relation was detected between the presence of gastritis and platelet values.
TL;DR: Within the last 20 years, tumour necrosis factor inhibitors have been proven to be effective in achieving and maintaining clinical and endoscopic remission in patients with Crohn’s disease and ulcerative colitis.
Abstract: Within the last 20 years, tumour necrosis factor inhibitors have been proven to be effective in achieving and maintaining clinical and endoscopic remission in patients with Crohn's disease and ulcerative colitis. Since 2013, when infliximab originator lost its patent protection, patients with inflammatory bowel diseases (IBDs) in Poland have also been treated with biosimilar drugs. Biosimilars are drugs with high similarity to their reference products in terms of physicochemical properties, including structure, safety, and efficacy. Biosimilars are approved for use on the basis of the same rigorous quality standards as their reference products. In 2018, also biosimilars of adalimumab have become available. Studies published to date have shown that biosimilars do not differ from reference drugs in terms of the efficacy and safety. There are numerous data to confirm that a single switch of biological drugs (mainly from reference to biosimilar drugs) has no effect on therapy efficacy and safety. However, a significantly lower cost of therapy with biosimilars not only allows us to treat a much larger number of patients but may also necessitate multiple switches from reference drugs to biosimilars (including biosimilars produced by different manufacturers). Recently, the first results have been published concerning multiple switches in patients with psoriasis and rheumatoid arthritis. However, no such data are currently available for patients with IBDs.