Przegla̜d Gastroenterologiczny最新文献

Introduction: Ulcerative proctitis is a chronic disease, characterized by lower risk of complications and less aggressive treatment in comparison to other forms of ulcerative colitis. Therefore, the key issue is to predict the natural course of the disease and protect against proximal spread of inflammatory lesions in the future.

Aim: To identify risk factors for progression of ulcerative proctitis and investigate the natural history of the disease.

Material and methods: We performed a retrospective study and included patients with ulcerative proctitis, diagnosed between January 2010 and December 2020, who suffered from ulcerative proctitis for at least 1 year. The collected data were then subjected to statistical analysis.

Results: We identified 116 cases of ulcerative proctitis in patients aged between 19 and 84 years. Proximal extension of the disease occurred in 65 (56%) people - left sided colitis developed in 55 (85%) and pancolitis in 10 (15%) patients. We detected many progression risk factors of ulcerative proctitis, among which the most meaningful were Mayo Endoscopic Score at levels 2 and 3 at onset (p < 0.05), high stress level (p < 0.05), more than one exacerbation in the first year of the disease (p < 0.05), and the use of systemic glucocorticosteroids during exacerbations in mild-to-moderate activity of the disease (p < 0.05).

Conclusions: According to our study, early identification of progression risk factors in ulcerative proctitis is crucial for the future outcomes of the disease. The proper treatment at onset is relevant in preventing the progression of inflammatory lesions and the development of disease complications.

Introduction: Relationships between redox homeostasis, nutritional status, and postoperative complications in patients with colorectal cancer are still unexplained.

Aim: This study aimed to evaluate selected parameters of oxidative stress and nutritional status in colorectal cancer patients and their impact on postoperative complications.

Material and methods: The study included 50 patients with colorectal cancer. In all patients, body mass index (BMI), body weight loss, and the Nutritional Risk Screening tool (NRS 2002) were assessed. The levels of total protein and albumin, complete blood count (CBC), total antioxidant capacity (TAC), total oxidant status (TOS), and malondialdehyde (MDA) level were measured. Oxidative stress index (OSI) and the TAC/MDA ratio were calculated.

Results: We detected a significantly higher TAC level (p = 0.0017) and lower TOS level in patients with normal BMI compared to those with increased BMI. We observed a higher TAC level in patients without weight loss (p = 0.0407), whereas the MDA concentration was higher in patients with weight loss than in those without weight loss (p = 0.0025). TAC was significantly higher whereas TOS, OSI, and TAC/MDA ratio were significantly lower in patients without symptoms of malnutrition (p < 0.05). Patients without postoperative complications had higher levels of TOS and MDA, and a lower level of TAC (p < 0.05).

Conclusions: The occurrence of postoperative complications may be associated with increased oxidative stress in patients with colorectal cancer.

Introduction: Functional dyspepsia (FD) is mainly caused by gastric hypersensitivity and impaired gastric motility.

Aim: The aim of the study was to evaluate the effect of a meal on autonomic nervous system (ANS) activity and gastric function in patients with dyspepsia.

Material and methods: The study included 38 patients with functional dyspepsia (age: 37.8 ±11.2 years) and 38 healthy volunteers (age: 39.8 ±11.1 years). Simultaneous recordings of electrogastrography (EGG) and electrocardiography (ECG) with heart rate variability (HRV) analysis were performed in the fasting state and after administration of a standard meal.

Results: EGG. In fasting dyspepsia group, lower normogastria (51.62 ±19.62 vs. 79.13 ±14.12%; p = 0.004) and average percentage of slow wave coupling (APSWC) (51.11 ±13.25 vs. 69.22 ±14.18%; p = 0.001) were observed compared to the control group. After a meal, in FD patients bradygastria increased from 5.6 ±3.1% to 12.2 ±6.3% (p = 0.01); APSWC increased but did not reach the value of the control group (77.3 ±14.1%); and the increase in the amplitude of slow waves after a meal was smaller (by 49%) than that in the control group (by 215%; p = 0.0001). ANS. Preprandially, the parameters of HRV spectral analysis were significantly lower in FD patients than in the control group (LF; p = 0.03; HF; p = 0.01). Postprandially, FD patients showed an increase in LF (p = 0.001) and HF (p = 0.02) indices, similar to the control group, but the parameters values were lower.

Conclusions: The postprandial parasympathetic response was reduced in patients with dyspepsia. The decreased reactivity of the ANS in functional disorders contributes to gastric myoelectric dysfunction as manifested by clinical signs of dyspepsia.

Malignancies are one of the most important problems of healthcare systems worldwide. Late diagnosis makes the treatment, therapeutic or not, difficult and constitutes an important obstacle to the orderly functioning of the healthcare systems in terms of financial and human resources. The prevention of certain types of cancer offers the general population, through screening tests, the ability to achieve early diagnosis and treatment. The healthcare workforce constitutes a part of the general population that should be aware of the screening tests and the consequences of cancer. Here, we investigated whether healthcare workers in Greek hospitals are well informed about the screening tests used as gold standards for the prevention of colon cancer. Moreover, we studied whether they screen themselves for the prevention of this type of cancer.

Introduction: SARS-CoV-2 infection has been associated with respiratory distress syndrome and hepatic injury. The mechanism of liver injury is not fully understood and may be a combined effect of viral hepatitis, systemic inflammation, gut barrier disruption, microbiome alterations or drug toxicity.

Aim: We carried out a systematic review and meta-analysis to determine whether SARS-CoV-2 infection affects the level of liver-produced molecules: alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transferase (GGTP), bilirubin, total protein, albumin, and prothrombin (with INR).

Methods: Ten authors independently searched PubMed and Embase from their inception until 04/03/2021 for observational studies to evaluate whether SARS CoV-2 infection influences the level of liver-produced molecules. This early search aimed to capture changes associated with the initial variants of SARS-CoV-2 before widespread vaccination efforts. Full-text studies in adult humans in which the aim was liver damage were included. Eligible studies included adult populations with more than 30 subjects, and the analysis adhered to PRISMA guidelines. Data extraction involved a thorough process to ensure accuracy, with inconsistencies resolved by senior clinicians. Statistical analysis was conducted using random effects meta-analysis of outcomes for which ≥ 2 studies contributed data, and the risk of bias was assessed using the New Ottawa Scale. The study protocol was registered in the PROSPERO database (CRD42021242958).

Results: The initial search yielded 3180 hits. 2644 studies were excluded as duplicates and/or after evaluation on the title/abstract level. No additional articles were identified via hand search. There were 536 full-text articles reviewed. Overall, the search strategy yielded 252 studies that were included in the meta-analysis.

Conclusions: The overall mean liver parameter values were not altered compared to physiological values, except for GGTP, lactate dehydrogenase activity, and INR values. In the case of AST, ALT and albumin levels, mean point estimates were close to limit values of standards. SARS-CoV-2 infection triggers gut barrier defects, which results in transient elevation of liver enzymes and clotting times.

Introduction: Infliximab (IFX) and vedolizumab (VDZ) are monoclonal antibodies used for the treatment of inflammatory bowel diseases (IBD), such as Crohn's disease (CD) and ulcerative colitis (UC). The concentration of biologic drugs must be high enough for a therapeutic response.

Aim: To evaluate the association of VDZ or IFX concentrations with the clinical condition of patients with IBD during therapy.

Material and methods: We examined 82 patients with IBD treated with VDZ or IFX. Blood samples were before the administration of the drug dose. Serum drugs were determined by ELISA with RIDASCREEN kits from R-Biopharm AG.

Results: The highest median serum VDZ concentrations were observed in patients with UC and endoscopic response or remission. The median serum VDZ concentration during the maintenance phase in patients with endoscopic remission remained at similar levels, while in patients without remission, a decrease was shown. Additionally, analysis of VDZ concentrations in the group of patients without endoscopic remission showed a significant decrease in drug concentration in the maintenance phase compared the induction phase (p = 0.037). VDZ concentration of 26.4 µg/ml differentiated patients with endoscopic remission from patients who did not respond. In the group of CD patients, up to 91% of the patients responded to IFX treatment in the maintenance phase.

Conclusions: The sustained serum concentrations of VDZ in patients with IBD determined in the maintenance phase confirmed a positive response to this therapy, which in practice may have significance in optimising the dosage of biological treatment.

Introduction: Dysregulation of the hypothalamic-pituitary-adrenal axis is an essential factor in developing metabolic syndrome. Dysregulation of the hypothalamic-pituitary-adrenal axis increases cortisol levels, which is associated with increased abdominal body fat accumulation, triglyceride storage in the adipose cell, insulin resistance, and development of hypertension.

Aim: To understand the relationship between dietary habits, salivary cortisol levels and metabolic syndrome in children.

Material and methods: This case-controlled study included 46 subjects selected from primary schools in Ismailia city, Egypt. The study subjects were divided into two matched age and gender groups: Group 1: Children with metabolic syndrome as a patient group. Group 2: Normal age- and sex-matched children as a control group. All children were subjected to history taking, measurements, and laboratory investigations (total lipid profile, fasting blood sugar, circadian salivary cortisol in the day and at night).

Results: There was a statistically significantly lower HDL level in the patient group compared to the control group, while there were statistically significantly higher levels of triglycerides, cholesterol, and fasting blood sugar in the patient group compared to the control group (p < 0.05). There was a statistically significant positive correlation between salivary cortisol level in the day and both systolic and diastolic blood pressure levels in the patient group (r = 0.554, p = 0.006 and r = 0.485, p = 0.019, respectively). Similarly, there was a statistically significant positive correlation between salivary cortisol level in the day and waist circumference in the patient group (r = 0.500, p = 0.018). On the other hand, in the control group there was no statistically significant correlation between salivary cortisol level and triglycerides, low-density lipoprotein, high-density lipoprotein, FBS, body mass index, waist circumference, and blood pressure.

Conclusions: Dietary habits, family history, and salivary cortisol levels during the day are more strongly correlated with components of metabolic syndrome, especially central obesity and blood pressure. Dietary habits have a great impact on developing metabolic syndrome; thus a healthy lifestyle is advised. Further studies, with a larger number of participants, are encouraged to confirm our observations.