Przegla̜d Gastroenterologiczny最新文献

Diseases affecting the peritoneum are diverse, ranging from reactive to neoplastic. The abdomen with its peritoneal cavity is part of the body in which diseases are usually thought to be diagnosed and treated almost exclusively by surgeons. However, it is often the general physician who is faced with the initial diagnosis of many of the common diseases of the region, the diagnosis of which may be very difficult. In addition, many chronic lesions that may require surgical treatment may first be seen by the general physician or gastroenterologist. For these reasons, some of the common peritoneal disorders, their presentation, and treatment are reviewed.

Introduction: An anastomotic leak is a life-threatening complication after gastrectomy. A fully covered, self-expandable, metal stent (FC-SEMS) can be used as an alternative to traditional surgical re-intervention. However, stent migration can be worrisome.

Aim: To evaluate the feasibility and effectiveness of anchoring of the distal flare of the FC-SEMS to the jejunum by using through-the-scope (TTS) endoclips to prevent stent migration.

Material and methods: Patients, who received a FC-SEMS capable of being fixed to the jejunum by using TTS endoclips due to an anastomotic leak after gastrectomy, were reviewed retrospectively. Demographic and clinical characteristics, the properties of the deployed stents, and outcomes were evaluated.

Results: A total of 7 patients underwent FC-SEMS placement. The mean age was 59 ±13.8 years, and the mean body mass index was 29.8 ±8.4 kg/m². All patients' American Society of Anesthesiologists scores were between II and IV. The mean time between gastrectomy and stent insertion was 6.7 ±6.1 days. Technical success was achieved in all patients. Stent migration was not observed in any of the patients. All but one were removed between 4 and 6 weeks after placement. The mean stent removal time was 37 ±4.6 days. Complete resolution of the leak was achieved in 6 patients.

Conclusions: Anchoring of the distal flare of the FC-SEMS to the jejunum with TTS endoclips is feasible and may reduce the risk of migration. This inexpensive and safe technique may be proposed to patients with factors predictive of FC-SEMS migration.

High alcohol intake leads to an inadequate diet and impaired absorption, transport, and utilization of nutrients in the body, which results in malnutrition. Micronutrient supplementation, such as vitamins A, E, group B vitamins, folic acid zinc, and selenium may have a positive effect on those patients. In this article, the actual supplementation recommendations for vitamins and microelements in ethanol-induced liver disease patients are presented.

Introduction: Familial Mediterranean fever (FMF) is an autosomal recessive disease with an autoinflammatory nature. It affects mainly Turkish, Armenian, Arab, and Jewish people. The clinical presentation and the development of complication as amyloidosis. Early diagnosis and predilection of disease severity according to gene mutation facilitates adequate treatment and disease control.

Aim: To our knowledge, few studies were done to evaluate FMF in lower Egypt.

Material and methods: This is a prospective study that was carried out at Kafrelsheikh University Hospital Outpatient Clinic between March 2019 and February 2020. We recruited all patients who came to our outpatient clinic with symptoms suggestive of FMF (recurrent attacks of abdominal pain and fever), and diagnosis of FMF was confirmed by gene study. One hundred and nine patients were included; however, 9 patients refused to participate in the study, so final analysis was done for 100 patients only. Patients also underwent abdominal ultrasound examination for measurement of the spleen longitudinal diameter.

Results: E148Q mutant allele was the most encountered mutation in our studied patients at Kafrelsheikh, with a frequency of 31%; the number of attacks was greater in patients with positive family history and in homozygous patients. Most patients required a dose between 1.5 and 3 mg/day.

Conclusions: Patients with positive family history and those with homozygous mutation have more attacks with greater severity and higher amyloid deposition. E148Q mutant allele was the most commonly encountered in the studied patients, with a frequency of 31%, followed by M6801 (G/A), which was associated with the highest amyloid A level.

Introduction: Gastrointestinal (GI) symptoms can be considered as a manifestation of coronavirus disease 2019 (COVID-19).

Aim: Our study analysed GI symptoms depending on their occurrence, and their possible causes and impact on the course of COVID-19.

Material and methods: A retrospective, single-centre assessment of the frequency, risk factors, and impact of GI symptoms in 441 patients with COVID-19.

Results: A statistically significant reduction in the length of stay (LOS) (15 days vs. 17 days; p = 0.04), intensive care unit admission (ICU) (16.9% vs. 26.8%; p = 0.02), and need for mechanical ventilation (14.1% vs. 23.4%; p = 0.02) in the group who had experienced GI symptoms before hospitalization was noticed. For comparison, patients who developed GI symptoms during hospitalization had statistically significantly longer LOS (21 days vs. 15 days; p = 0.0001), were more frequently admitted to the ICU (38.1% vs. 18.6%; p = 0.0003), and had a higher need for mechanical ventilation (32.7% vs. 16.2%; p < 0.001). Risk factors for GI symptoms during hospitalization in COVID-19 patients included age, Clostridioides difficile infection, and receiving certain treatment (antibiotics and lopinavir + ritonavir).

Conclusions: The GI symptoms that developed before admission to hospital correlated with reduced severity of the course of COVID-19. However, in the group of patients who developed GI symptoms during hospitalization, attention should be paid to concomitant treatment. The use of antibiotics should be limited because they are associated with the deterioration of the course of COVID-19; one of the reasons might be changes in the intestinal microbiome.

Magnetic resonance enterography (MRE) is a commonly used method for non-invasive diagnosing and following of inflammatory bowel disease (IBD). Numerous reviews that compare and discuss MRE-based Crohn's disease (CD) activity indices for adults have been published; however, no reviews of this kind have been published for children. Following a PubMed database literature search (January 2008 - November 2021), out of 316 research papers, 10 original papers about MRE-CD activity indices were included in the analysis. Four MRE-based scoring systems were discussed: Magnetic Resonance Index of Activity (MARIA), the Crohn's Disease Magnetic Resonance Imaging Index (CDMI), the Magnetic Resonance Enterography Global Score (MEGS) and the Visual Analogue Scale (VAS). This review revealed that in the last 13 years, studies have proven that MRE-based CD activity indices correspond with endoscopic findings and clinical scores of CD activity.

Introduction: Although potassium-competitive acid blockers (P-CABs) prompted safety concerns when first developed, they ultimately proved to have a favourable safety profile.

Aim: To assess the safety of vonoprazan in the management of gastroesophageal reflux disease (GERD), peptic ulcers, or gastroduodenal mucosal lesions induced by chronic use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs).

Material and methods: From March to June 2021, a literature search was conducted using Medline via PubMed, Cochrane library, Lilacs, SciELO, and Centre for Reviews and Dissemination (CRD) electronic databases. After applying the eligibility criteria, 10 studies were included in this review. Of these 10 articles, vonoprazan was used as initial therapy in 6 and as maintenance therapy in 4. Adverse event rates were similar for vonoprazan and proton-pump inhibitors (PPIs).

Conclusions: Our findings suggest that vonoprazan is a safe option for the management of erosive oesophagitis, gastric/peptic ulcers, or peptic ulcers induced by chronic use of aspirin or NSAIDs.