Przegla̜d Gastroenterologiczny最新文献

Introduction: Solid pancreatic lesions (SPL)s can be due to various etiologies, and their management depends on the histologic diagnosis.

Aim: The aim of this study was to document the etiology, morphology, and utility of macroscopic on-site evaluation (MOSE) in predicting good yield of endoscopic ultrasound (EUS)-guided biopsy.

Material and methods: All patients with SPLs referred for EUS-guided biopsy were included in the study. Etiology, morphology and results of EUS-guided biopsy were recorded. Rapid on-site evaluation (ROSE) was not available; therefore, MOSE was performed by an endoscopist. Macroscopically, MOSE was considered satisfactory if at least 1 tissue core at least 1 inch long was secured. Histopathologically, a biopsy specimen was considered to have a good yield if it was sufficient to establish a diagnosis. Factors predicting good yield of biopsy (GYB) were identified.

Results: Of the total 176 patients included in the study, 111 (63.1%) were male (mean age 53.8 (±12.6) years; range: 14-80 years). Good yield biopsies (GYB) numbered 144 (81.8%); among them, 97 (67.4%) were neoplastic and 47 (32.6%) non-neoplastic SPLs. The commonest neoplastic SPLs were pancreatic ductal adenocarcinoma (PDA) (76; 78.3%), neuroendocrine tumors (NETs) (13; 13.4%), metastasis (5; 5.1%), and others (3; 3.1%), while the commonest non-neoplastic SPLs were mass-forming chronic pancreatitis (MFCP) (33; 70.2%), autoimmune pancreatitis (AIP) (5; 10.6%), and tuberculosis (2; 4.3%). PDAs were more common in older patients (65/76; 85.5%) and in the head region of the pancreas (47; 61.8%), while NETs were more common in younger patients 7/13 (53.8%) and in the body of the pancreas 5/13 (38.5%). Factors predicting GYB were SPL size > 15 mm (p = 0.045), use of fine needle biopsy (FNB) needles (p = 0.001), ≥ 2 passes (p = 0.001), and satisfactory MOSE (p ≤ 0.0001) on univariate analysis; and FNB use (p = 0.049) and satisfactory MOSE (p = 0.001) on multivariate analysis. Our criteria for satisfactory MOSE had high sensitivity (85.4%), positive predictive value (95.35%), and diagnostic accuracy (84.7%).

Conclusions: The commonest neoplastic SPLs are PDA and NET, and the commonest non-neoplastic SPLs are MFCP and AIP. PDAs have a predilection for the head region and older age, while NETs have a predilection for younger patients and the body of the pancreas. A good biopsy yield is likely with use of FNB needles and satisfactory MOSE.

Introduction: Metabolic-associated fatty liver disease (MAFLD) is a new disease definition. The development of hepatic steatosis is complex and may also be influenced by apoptotic mechanisms.

Aim: We aimed to assess serum concentrations of selected apoptosis markers, cytokeratin-18 fragments (M30) and agiopoietin-2 (Ang2) in children and adolescents with obesity and to evaluate the association of these parameters with paediatric MAFLD.

Material and methods: The prospective study included 76 overweight/obese children with suspected liver disease. MAFLD was diagnosed according to the latest consensus. The concentrations of M30 and Ang2 in serum were measured using an enzyme-linked immunosorbent assay (ELISA).

Results: Liver steatosis was diagnosed in abdominal ultrasound in 45 obese patients (59.2%) who were classified as the MAFLD group. Children with MAFLD had elevated levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), uric acid and M30 in comparison to non-MAFLD children. M30 positively correlated with ALT, AST, GGT, uric acid, Ang2 and the stage of liver steatosis. In receiver operating characteristic (ROC) analysis, M30 (cut-off = 173.74 IU/ml with sensitivity = 76.9% and specificity = 69.6%) allowed overweight/obese patients with and without MAFLD to be differentiated.

Conclusions: Our results suggest that the mechanism of apoptosis may play an important role in the development of MAFLD in children. There is a need for further studies in children to determine whether the M30 concentration may be an indicator of MAFLD progression and whether inhibition of apoptosis may become one of the therapeutic options for this disease.

Introduction: Vitamin D deficiency is one of the most common nutritional deficiencies worldwide. Chronic functional constipation is one of the most common gastrointestinal disorders in childhood in developing and developed countries. Vitamin D has been linked to different systemic diseases. The medical domain has recently been interested in the role of vitamin D.

Aim: To screen for vitamin D deficiency and insufficiency among children with chronic functional constipation.

Material and methods: It was a cross-sectional study. Two groups of children were collected at the outpatient clinic at Alexandria University. Children who fulfilled Rome IV criteria of chronic functional constipation were assigned to the first group (Constipation group). Children who did not have chronic functional constipation were considered as the second group (Healthy control group). Vitamin D level was measured in both groups. Statistical analysis used: Data were fed to the computer and analysed using IBM SPSS software package version 20.0. Quantitative data were described using range (minimum and maximum), mean, standard deviation, and median.

Results: Vitamin D levels were significantly deficient or at least insufficient in the group of children with chronic functional constipation.

Conclusions: Chronic functional constipation is associated with vitamin D deficiency and insufficiency in children.

Introduction: Diverticulosis is an anatomical condition with increasing incidence. Diverticula are common findings during screening colonoscopies, making diagnosis and treatment challenging in routine clinical practice. Nutritional factors have been identified as significant risk factors, and it has been suggested that diets recommended for the prevention of cardiovascular and other chronic diseases may also positively influence the clinical course of diverticulosis.

Aim: To analyse dietary patterns in various groups of patients with diverticular disease and to identify potential differences that may affect the types of symptoms presented.

Material and methods: A group of 100 patients, including 71 women and 29 men aged 40 to 90 years, were analysed using the FFQ-6 form and a 24-hour nutritional interview. The most common condition among individuals with diverticulosis was symptomatic uncomplicated diverticular disease (SUDD), which occurred with similar frequency in both sexes.

Results: Analysis of dietary components revealed higher fat intake in the SUDD group and reduced vitamin E consumption, particularly in the group with segmental colitis associated with diverticulosis (SCAD). Additionally, there was a significant reduction in the intake of calcium, magnesium, and zinc across all analysed groups, along with a nearly one-third reduction in dietary fibre intake.

Conclusions: Based on the nutritional data, the factors that may contribute to the development of diverticular disease include high intake of animal protein, fat, cholesterol, deficiencies in microelements such as zinc, excess sodium, and excessive consumption of B vitamins, particularly vitamin B₆.

Fecal microbiota transplantation (FMT) is a medical procedure that allows to establish a stable and healthy intestinal microbiota in various diseases believed to be related to a gut dysbiosis. Currently, FMT is successfully used to treat recurrent Clostridioides difficile infection. However, in recent years there has been evidence that changes in composition of gut microbiota may also be relevant in the pathogenesis of several neuropsychiatric and neurodevelopmental conditions including Alzheimer's disease, multiple sclerosis, Parkinson's disease, autism spectrum disorders and schizophrenia. This review focuses on exploring the complex connection between gut microbiota and pathogenesis of these neurological conditions. It also presents current research on a possible use of FMT as a therapeutic intervention targeting the gut-brain axis.

Introduction: Nonalcoholic fatty liver disease is a leading cause of liver cirrhosis and portal hypertension, which can be complicated by oesophageal varices and variceal bleeding. Screening for oesophageal varices is essential for initiating bleeding prophylaxis. Several noninvasive parameters for predicting oesophageal varices have been suggested (e.g., Baveno VI, expanded Baveno VI, and platelet count/spleen diameter ratio), although with variable efficacy in patients with nonalcoholic fatty liver disease.

Aim: This study aimed to compare the non-invasive predictors of oesophageal varices.

Material and methods: We retrospectively analyzed the medical records of patients with nonalcoholic fatty liver disease-related compensated liver disease who underwent screening endoscopy at a tertiary care unit in United Arab Emirates. The accuracy of the established (Baveno VI and expanded Baveno VI) and newly devised (platelet count)/(spleen diameter) + liver stiffness × (40 - albumin) noninvasive parameters in predicting oesophageal varices and the presence of large oesophageal varices was assessed in our population.

Results: We found that the (platelet count)/(spleen diameter) + liver stiffness × (40 - albumin) formula had a higher accuracy than both Baveno VI (p = 0.030) and expanded Baveno VI criteria (p = 0.050) in predicting the presence of oesophageal varices. The (platelet count)/(spleen diameter) + liver stiffness × (40 - albumin) formula was associated with a higher number of spared endoscopies than Baveno VI (n = 16, 21.9%) and expanded Baveno VI (n = 9, 12.3%) criteria.

Conclusions: The new formula could provide superior predictive value than the currently practiced noninvasive predictors of oesophageal varices. However, large-scale studies are warranted to confirm its predictive performance in patients with nonalcoholic fatty liver and other etiologies of chronic liver disease.

Introduction: Orexin regulates food intake, as well as the development and progression of neoplasms.

Aim: The aim of this study was to determine associations between nutritional risk and status and neoplasm stage and prognosis in patients who underwent surgery for colorectal cancer (CRC).

Material and methods: In 84 consecutive patients undergoing surgery for CRC, serum orexin, nutritional risk and body composition (assessed by bioelectrical impedance analysis and cross-sectional area determined using abdominal CT) were evaluated before the operation and 3 months after the surgery. The long-term follow-up lasted 1296.0 ±617.7 days.

Results: Compared to CRC patients with a serum orexin concentration lower than the cutoff value (197.9 pg/ml) determined in ROC curve analysis in prediction of all-cause mortality during long-term follow-up, those with orexin concentrations equal to or higher than the cutoff value were, at baseline and at the 3-month visit, more likely to have a lower score on the nutritional NRS2002 and a higher score on functional scales, greater handgrip strength, and higher skeletal muscle mass, and were less likely to suffer perioperative complications and all-cause mortality (OR = 0.34; 95% CI: 0.13-0.89; p = 0.026) during the follow-up period. No statistically significant differences in tumor size, histopathological grade or clinical stage were found between CRC patient groups divided according to orexin blood concentration.

Conclusions: Serum orexin concentrations were found to be statistically significantly associated with patients' nutritional risk and status before surgery and at a 3-month follow-up visit, and with all-cause mortality during the 3.6-year follow-up.