Przegla̜d Gastroenterologiczny最新文献

Numerous physiological processes occurring in the digestive system are subject to circadian rhythms, which are regulated by the endogenous biological clock. The motor activity of the small intestine, large intestine, and rectum operates in a 24-hour system, with significant differences between day and night periods. It is primarily correlated with the time of meals, hormone secretion rhythms, and other activities undertaken by the organism. In recent years, numerous scientific reports have emerged about the fundamental role of circadian rhythms in the proper functioning of the gut microbiota. In addition, the microbiota and its metabolites also influence the host's daily cycles, which affects the overall state of their organism. The aim of this review is to outline the mechanisms of action and interactions between biological rhythms, gut motility, and the functioning of the gut microbiota.

Introduction: Bleeding, especially non-variceal upper gastrointestinal bleeding (NVUGIB), remains the most common cause of readmission in left ventricular assist device (LVAD) patients. Any readmission after NVUGIB carries a worse prognosis.

Aim: To compare readmission outcomes in NVUGIB patients with and without LVAD.

Material and methods: We identified adult NVUGIB patients using the National Readmission Database 2018 employing International Classification of Diseases, Tenth Revision (ICD-10) codes. The patients were grouped based on LVAD history. Proportions were compared using the Fisher exact test, and multivariate Cox proportional regression analysis was used to compute adjusted p-values. We used Stata version 14.2 to perform analyses considering 2-sided p < 0.05 as statistically significant.

Results: The analysis included 322,342 NVUGIB patients, 1403 had a history of LVAD (mean age 64.25 years). The 30-day all-cause readmission rate in NVUGIB with LVAD was higher (24.31% vs. 13.92%, p < 0.001). Gastrointestinal bleeding as a readmission cause was more prevalent in the LVAD group. In patients with LVAD, NVUGIB readmissions required more complex endoscopic procedures, either requiring intervention during endoscopy or enteroscopy. There was no difference in mortality in NVUGIB readmissions (1.51% vs. 4.49%, p = 0.36); however, the length and cost of stay were higher in the LVAD group. Additionally, we identified novel independent predictors of readmission from NVUGIB in patients with LVADs.

Conclusions: Readmissions in NVUGIB patients after LVAD require complex haemostatic intervention and are associated with greater resource utilization. To reduce readmissions and associated healthcare costs, it is essential to identify high-risk patients.

Introduction: Inflammatory bowel disease (IBD) patients use a wide variety of immunosuppressive drugs, including biologics, but their effect on SARS-CoV-2 vaccine antibody levels remains a mystery.

Aim: We analysed whether the drugs used in the treatment of IBD patients could affect the concentration of SARS-CoV-2 antibodies.

Material and methods: This is a prospective, single-centre evaluation of the persistence of SARS-CoV-2 antibodies after vaccination at various time points: every 2 months throughout the 6^th month after the first dose.

Results: We included a total of 346 vaccinated IBD patients in the study. A negative correlation between antibody level and time from full vaccination was confirmed for the following types of therapy: infliximab (rho = -0.32, p < 0.001), adalimumab (rho = -0.35, p = 0.025), and vedolizumab (rho = -0.50, p < 0.001). In the case of other, long-term drug administration, a negative correlation between antibody level and time from full vaccination was confirmed for mesalazine (rho = -0.35, p < 0.001), budesonide (rho = -0.58, p = 0.004), systemic glucocorticoids (rho = -0.58, p < 0.001), and azathioprine (rho = -0.44, p < 0.001).

Conclusions: Due to the immunosuppressive and biological treatment, IBD patients are exposed to a shorter persistence of SARS-CoV-2 antibodies and require booster doses. The role of gastroenterologists in educating patients about the need to continue SARS-CoV-2 vaccination remains crucial.

Introduction: Gastroesophageal reflux disease (GERD) is a common disease that negatively affects the quality of life, and its pathophysiology is multifactorial.

Aim: Our study aims to investigate the relationship between histological and topographic characteristics of Helicobacter pylori (H. pylori) gastritis and the symptoms, presence, and severity of oesophagitis in patients with reflux symptoms.

Material and methods: The symptoms, demographic data, and physical examination results of the patients admitted with gastrointestinal complaints were recorded and oesophagogastroduodenoscopies were performed. Biopsies were taken from the antrum and corpus.

Results: Of the 171 patients, 113 were in the reflux group and 58 were in the non-reflux group. 103 (60%) of the patients were female and 68 (40%) were male. The mean age was 40 ±14 years in the GERD group and 49 ±16 years in the non-reflux group. There were no statistically significant differences between both groups in terms of endoscopic results or the presence and degree of oesophagitis. The total H. pylori frequency was found to be 73%; 75% in the GERD group and 69% in the non-reflux group. There was no significant relationship between the presence and degree of reflux oesophagitis. Chronic inflammation and neutrophil activity were higher in the antrum and corpus in the H. pylori-positive group, and gland atrophy was detected more frequently in the antrum in the H. pylori-negative group.

Conclusions: The histological type of gastritis caused by H. pylori rather than the presence of H. pylori may be associated with GERD.

Artificial intelligence (AI) and image processing are revolutionising the diagnosis and management of liver cancer. Recent advancements showcase AI's ability to analyse medical imaging data, like computed tomography scans and magnetic resonance imaging, accurately detecting and classifying liver cancer lesions for early intervention. Predictive models aid prognosis estimation and recurrence pattern identification, facilitating personalised treatment planning. Image processing techniques enhance data analysis by precise segmentation of liver structures, fusion of information from multiple modalities, and feature extraction for informed decision-making. Despite progress, challenges persist, including the need for standardised datasets and regulatory considerations.

Introduction: Portal hypertension is a common complication of liver cirrhosis. Varices are dilated collaterals that develop as a result of portal hypertension at the level of the porto-systemic connections and can cause a shift in the blood flow from high to low pressure. Common locations for porto-systemic shunts are the lower oesophagus and the gastric fundus. Ectopic varices are defined as dilated tortuous veins located at unusual sites other than the gastro-oesophageal junction.

Aim: This research aimed to study the endoscopic assessment of ectopic varices as well as necessary haemostatic interventions to our best knowledge. Also, to perform a review of the literature to compare our results to the most recent available data.

Material and methods: Our group extracted endoscopic reports of patients presenting to the emergency department with evidence of recent GI bleeding in whom ectopic varices were identified. We reported all interventions or procedures needed, details of hospitalization, radiological and laboratory results, as well as follow-up charts.

Results: Our study included 95 patients presenting to the emergency department with evidence of active GI bleeding. Ectopic varices were identified as the source of bleeding in 28 cases. Bleeding from duodenal varices was found in 17 patients and rectal varices in 9 patients. Endoscopic management was used for all cases with active bleeding. Rebleeding from ectopic varices was found in 5 cases, for whom interventional radiology was performed. All cases with rebleeding were duodenal varices. Early mortality occurred in 3 cases after re-intervention.

Conclusions: Our study describes a series of patients with ectopic varices discovered upon emergency endoscopy. Rectal varices were the most commonly found in our series. Bleeding and the need for re-intervention is more common in duodenal varices.

Introduction: Gastric cancer is one of the world's leading causes of death due to oncological diseases. Gastric cancer comprises a diverse group of diseases that includes several oncological units.

Aim: To analyse the nosological structure of epidemiological data related to gastric cancer in Ukraine and compare it with global trends from 2003 to 2020.

Material and methods: The data were retrieved from the National Cancer Registry of Ukraine and analysed using MedCalc for Windows, version 20.218 (MedCalc Software, Ostend, Belgium).

Results: Eight forms of gastric cancer were diagnosed every year. The lowest incidence rate was in 2020, with 8.99 per 100,000 people/year. This was a 33.71% drop compared to 2005 (p < 0.0001). Adenocarcinoma constituted the largest part of the cases over the 2003 to 2020 period: 96.38% (95% CI: 95.02-97.05%). All the other types of gastric cancer together comprised 2.97% (95% CI: 2.34-3.76%) of the cases. The number of adenocarcinoma cases as well as its incidence rate decreased in 2003-2020 in Ukraine. The incidence rate of all types of gastric cancer was seen to decrease over the 2003-2020 timeframe in Ukraine. Adenocarcinoma was the leading form of gastric cancer in the country, and other types were uncommon in both Ukraine and the rest of the world. There was a change in the incidence rates of the other forms of gastric cancer, but those incidences did not notably affect the structure of the epidemiological data.

Conclusions: The total number of cases of gastric cancer, as well as its incidence rate, decreased in Ukraine from 2003 to 2020. This situation corresponds with global tendencies.

Introduction: Clostridioides difficile infection (CDI) is one of the most important challenges in contemporary gastroenterology. However, data from CDI studies are sometimes contradictory.

Aim: To analyse the risk factors for CDI in patients with inflammatory bowel disease (IBD).

Material and methods: This is a retrospective analysis of the medical records of 204 patients (77 IBD with CDI, 50 with IBD without CDI, and a control group of 77) hospitalised in a referral centre in Warsaw. Data were entered and analysed by using univariate logistic regression models.

Results: Patients with IBD and CDI had significantly longer hospitalisation time than patients with IBD without CDI. The population of patients with CDI and IBD was statistically significantly younger (p < 0.001). Patients with IBD and CDI had a lower body mass index (p < 0.001) and were more often treated with antibiotics (p < 0.001). Prior antibiotic use (< 1 month) was a risk factor for CDI (p = 0.003). Lower body mass index (p < 0.001) and lower levels of albumins (p = 0.036) were strong risk factors for CDI in the study group. Additional risk factors were young age (p < 0.001), length of hospitalisation (p = 0.001), treatment with glucocorticosteroids (p = 0.001), immunosuppressive treatment (p = 0.001), and gastritis and/or duodenitis (p = 0.002). The study did not confirm that proton pump inhibitors or biologic treatment affected the risk of CDI.

Conclusions: The risk factors for CDI in patients with IBD include younger age, female gender, low body mass index and hypoalbuminaemia, use of thiopurines, antibiotics, and glucocorticosteroids, prolonged hospitalisation, and gastritis and/or duodenitis.

Introduction: Stasis of bile flow can result in microbial colonization of the biliary tree. Cholangitis is a common adverse event linked to endoscopic retrograde cholangiopancreatography (ERCP).

Aim: To establish the bacterial profiles isolated from the bile sample and to evaluate the pre-ERCP risk factors predicting the microbial growth and development of post-ERCP cholangitis (PEC).

Material and methods: This was a prospective cohort study, which was conducted at the Department of Hepato-gastroenterology, SIUT from 1 January 2021 to 31 December 2021. Patients of either gender undergoing index ERCP procedure were included in the study. All the patients underwent ERCP, and bile culture (BC) aspirated immediately after cannulation was achieved prior to the contrast injection. There were 2 outcome variables. One was the presence or absence of organisms in bile culture, and the second one was the development of PEC.

Results: The total number of patients was 280. Bile culture was positive in 195 (69.6%) patients, and post-ERCP cholangitis developed in 187 (66.8%) patients. The most common organism in BC was Escherichia coli (E. coli), in 82 (42%) patients. History of jaundice, abdominal pain, and weight loss on admission along with ERCP performed for common bile duct (CBD) stricture were independent predictors of positive BC and PEC, while advanced age was an additional risk factor for PEC.

Conclusions: Microbial profile and risk factors for positive BC and PEC were evaluated. Advanced age, pre-operative jaundice, and prolonged biliary stasis are the independent risk factors for these conditions.