Przegla̜d Gastroenterologiczny最新文献

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.

Introduction: Toll-like receptors (TLRs) play a key role in activating the immune system response after liver injury.

Aim: This experimental study aimed to investigate the expression of TLRs and their connecting signaling molecules in liver regeneration.

Material and methods: Eighty C57BL/6J mice were divided into eight equal groups: four groups underwent partial hepatectomy (liver resection, LR), and four groups underwent an abdominal incision without hepatectomy (sham, Sh). One group of each type was sacrificed at 12 h (LR12 and Sh12), 24 h (LR24 and Sh24), 36 h (LR36 and Sh36), and 168 h (LR168 and Sh168). Histological and immunohistochemical analyses, blood tests, and quantitative real-time polymerase chain reaction (qRT-PCR) were performed.

Results: The qRT-PCR tests indicated significant differences in all immune response proteins (TLR1, TLR2, TLR6, IRAK4, TIRAP, NF-kB, MYD88) between all LR and Sh groups. A progressive increase in the expression of TLRs was observed in the first three pairs, with stabilization of their expression in the last group. Histological examination of liver specimens revealed regeneration of liver tissue in the LR groups. Immunohistochemical analysis revealed increased expression of signaling proteins (TLR1, TLR2, MYD88, IRAK4, TIRAP, NF-kB) in the LR groups as compared to the control groups. White blood, red blood cell count and liver function tests were significantly different between LR and Sh groups.

Conclusions: TLR expression was significantly higher in mice that underwent partial hepatectomy than the controls. Further research is required to investigate their potential as therapeutic targets in the management of acute or chronic liver failure after partial hepatectomy.

Introduction: Chronic liver damage is one of the most important and complex problems in modern gastroenterology. The relevance of studying chronic hepatitis of various aetiologies is associated with its high socio-economic and medical significance due to the steady progressive course, with the development of fibrosis, and then cirrhosis of the liver.

Aim: The purpose of this study was to search for and analyse new biotechnological methods for the treatment of diffuse liver diseases to improve patient survival, since the main contingent of patients is typically the able-bodied, socially active part of the population.

Material and methods: To achieve this goal, general theoretical methods of scientific knowledge were used, such as analysis, generalization, questioning, and systematization.

Results: The article presents a meta-analysis of the results of studies conducted in the field of cellular technologies by leading scientists in the field of the treatment of liver diseases. The issues of transdifferentiation, the mechanisms of action of stem cells in hepatology, as well as the possible risks of this therapy (pro-oncogenic effect, increased fibrosis), are covered.

Conclusions: Cell therapy in embryonic, mononuclear, and mesenchymal stromal cells is the most advanced area of modern biotechnology and medicine. Its therapeutic application in chronic liver diseases is base on the possibility of regulating disturbed intercellular interactions in the liver, influencing the mechanisms of cell death (necrosis, apoptosis) and fibrogenesis, which makes this method the most relevant and promising in hepatology.

Introduction: Probiotics potentially mitigate diarrhea incidence and severity, but their effectiveness in antibiotic-associated diarrhea (AAD) remains debated.

Aim: This meta-analysis aimed to enhance evidence on probiotic use for AAD.Methods: A systematic search of randomized controlled trials (RCTs) from 2010 to 2023 in PubMed, EMBASE, Scopus, and Google Scholar was conducted. Eligible studies underwent risk assessment with the RoB-2 tool and data extraction using the random effects model. Subgroup analyses evaluated age, sample size, and probiotic strains' influence.

Results: Fifteen trials with 7427 participants were included. Overall quality was moderate. Pooled analysis favored probiotics, reducing AAD incidence by 40% (RR = 0.60, 95% CI: 0.43-0.82). This effect was consistent across subgroup analyses. Multistrain probiotics showed superior protection (RR = 0.40 vs. 0.9 or 0.6 for dual or single strains).

Conclusions: This review suggests that probiotics, especially multistrain combinations, mitigate AAD incidence. Future large-scale RCTs will address heterogeneity.

Psychometric hepatic encephalopathy score (PHES) has established itself as one of the most used tests for detecting minimal hepatic encephalopathy. To use it in a certain population one needs to determine what the norms are, and have a proper set of inclusion and especially exclusion criteria. When performing the test (either for validating or as a search tool) authors may benefit from a little guidance. All the 5 tests - DST (Digital Symbol test), Number Connection Test A (NCT A), Number Connection Test B (NCT B), Serial Dotting Test (SDT), Line Drawing Test (LDT) - have certain parameters to follow. In time, deviations have appeared, and comparability between different samples has become somehow limited. As new tests are emerging, and in order to compare, one must be familiar with the tests' variants, benefits, and limitations.

Celiac disease is an autoimmune disorder induced by consumption of gluten protein present in foods such as wheat and rye. In recent years there has been increasing evidence that changes in composition of gut microbiota may play a significant role in the pathogenesis of celiac disease. Multiple methods of bacterial identification may be used to find microbiota changes characteristic for celiac disease, and the latest methods such as next generation sequencing offer new possibilities of detecting previously unknown bacterial groups that may play a role in the occurrence of celiac disease. This review focuses on multiple methods of identifying bacterial gut microbiome and presents results of recent studies exploring the link between gut microbiota composition and celiac disease.

Introduction: Rapid urbanization and constant technological progress contribute to a change in lifestyle in terms of physical activity. Lack of free time and reluctance to engage in physical activity may lead to impaired functioning of internal organs, including the digestive system.

Aim: In the present study, by creating an exercise regimen, an attempt was made to demonstrate the impact of this activity on the symptoms of patients with irritable bowel syndrome (IBS).

Material and methods: Forty-one women with diagnosed irritable bowel syndrome were included in the study. To assess the effectiveness of the method used, the validated IBS-SSS questionnaire was used. The study used an original training programme based on fitness lessons, yoga positions improving intestinal motility and relaxation techniques: autogenic training developed by Schultz and progressive muscle relaxation developed by Jacobson. Twenty-nine women completed the entire 2-month training cycle, in line with the assumptions of the study. The following methods were used: t-test for dependent samples, Wilcoxon pairwise order test, McNemar's χ² test and Spearman's R correlation coefficient.

Results: It was found that nearly 80% of the study participants experienced abdominal pain before participating in the study. The training cycle caused pain in 52% of the surveyed women. The intensity of pain in the subjects decreased by 20%. After the study, the incidence of flatulence decreased by 38% and the severity of flatulence by 30%.

Conclusions: The relationship between physical activity and the severity of symptoms of irritable bowel syndrome in the surveyed women was confirmed. The study group of women showed a reduction in IBS-related symptoms after 8 weeks of training.