Przegla̜d Gastroenterologiczny最新文献

Plantago ovata is a common medicinal plant widely cultivated in tropical regions of the world. The outer seed coat of P. ovata, obtained by cleaning the seeds, contains soluble and insoluble fibre in a ratio of 7:3, making products containing P. ovata husk an ideal source of health-beneficial fibre. The results of clinical trials demonstrate the therapeutic efficacy of psyllium husk for various gastrointestinal disorders. It has also been documented that psyllium ingestion exhibits antioxidant, immunomodulatory, antiproliferative, anticancer, and antiviral effects. Such pleiotropic effects of P. ovata husk are related to the presence in its composition of arabinoxylan, which forms a gel in an aqueous environment, as well as bioactive compounds and their metabolites. This article presents the evidence available in the literature on the therapeutic potential and possible mechanisms of action of psyllium in the treatment of irritable bowel syndrome and ulcerative colitis, and prevention of colorectal cancer.

Introduction: Colorectal cancer (CRC) is a rising threat, necessitating accurate early diagnosis.

Aim: This meta-analysis scrutinised methylated septin 9 (SEPT9) and carcinoembryonic antigen (CEA) in CRC.

Methods: From January 2012 to December 2022, databases including PubMed and Google Scholar were explored for English publications.

Results: The meta-analysis revealed SEPT9's superior diagnostic potential, boasting 71% sensitivity and 91% specificity, outshining CEA (49% and 53%). Notably, an 8-study analysis found a positive correlation between tumour grade and elevated CEA and SEPT9 levels, particularly in stages 3 and 4.

Conclusions: This meta-analysis supports SEPT9 as a potent CRC marker, urging its integration into diagnostic frameworks for enhanced precision and early intervention. The observed link between tumour grade and biomarker levels enhances clinical relevance. Implementing these findings promises improved CRC diagnosis precision, contributing to enhanced treatment outcomes and patient survival. Advocating for SEPT9's inclusion alongside traditional markers like CEA, this study pioneers more effective colorectal cancer management strategies.

Introduction: Primary sclerosing cholangitis (PSC) is an uncommon, chronic liver disease characterised by fibrosis and strictures of a bile ducts, causing cholestasis. In the long term it can lead to complete stenosis leading in turn to liver cirrhosis. In patients with severe form of the disease, the recommended treatment is liver transplantation. Because PSC frequently coexists with ulcerative colitis (UC), it is crucial to determine the effect of liver transplantation on the course of UC.

Aim: The aim was to determine the impact of liver transplantation on intestinal and systemic inflammation markers with UC concomitant with PSC (PSC-UC).

Material and methods: Sixty-three patients with PSC-UC were enrolled, 25 of whom underwent liver transplantation (OLTx) due to PSC progression. Clinical symptoms, faecal calprotectin levels, C-reactive protein (CRP) serum concentration, erythrocyte sedimentation rate, and white blood cell count (WBC) were obtained.

Results: Faecal calprotectin was significantly higher in the post-OLTx group. Mean calprotectin values were 163% higher - 474 ng/ml and 180 ng/ml (p = 0.024) in the post-OLTx group and in the PSC-UC group without the transplantation, respectively. Calprotectin levels exceeded the upper limit of normal (defined as 200 ng/l) in 66% of liver recipients and in 18% of non-transplanted patients (OR = 9.33, p = 0.011). In the post-OLTx group, also CRP concentration (11.01 mg/l vs. 6.54 mg/l, p = 0.30) and WBC (7.58 K/ml vs. 5.72 K/ml, p = 0.006) were higher than in the PSC-UC group without transplantation.

Conclusions: We found significantly higher inflammation markers in PSC-UC patients who underwent liver transplantation due to PSC. The effect was strongest in faecal calprotectin levels. In PSC-UC patients after liver transplantation, intensification of UC treatment may be needed, despite the lack of worsening of clinical symptoms.

Introduction: The gut microbiome maintains the mucus membrane barrier's integrity, and it is modulated by the host's immune system.

Aim: To detect the effect of microbiota modulation using probiotics, prebiotics, symbiotics, and natural changes on colorectal cancers (CRCs).

Methods: A PubMed search was conducted to retrieve the original and in vivo articles published in English language from 2010 until 2021 containing the following keywords: 1) CRCs, 2) CRCs treatment (i.e. surgical, chemotherapy, radiotherapy and/or immunotherapy), and 3) microbiota probiotic(s), prebiotic(s), symbiotic(s), dysbiosis and/or nutritional treatment. A total of 198 PubMed records/articles were initially identified. 108 articles were excluded at the initial screening, and another 29 articles were excluded after reviewing the abstracts, and finally 61 studies were analysed for this systematic review.

Results: The gut microbiota metabolites and (SCFAs) short-chain fatty acids (i.e. acetate and butyrate) have a protective effect against CRCs. SCFAs reduce the inflammatory cytokines, inhibit colonocyte proliferation, and promote malignant cell apoptosis. Butyrate maintains the integrity of the mucus membrane barrier and reduces intestinal mucosal inflammation. Reduced butyric acid level and increased inflammatory cytokines were observed after reduced Bacteroides fragilis and Bacteroides vulgatus species in the colon. Akkermansia muciniphila bacterium decreased in patients with CRCs.

Conclusions: Prebiotics (i.e. inulin and resistant starch, SCFAs producers) and consumption of unprocessed plant products are useful for developing and maintaining healthy gut microbiota. The pro-, pre- and/or symbiotics may be useful when carefully selected for CRC patients, to restore beneficial gut microbiota and support treatment efficacy.

Patients with liver cirrhosis constitute a critically ill and unique population, and their stability relies on a well-coordinated multidisciplinary team with a carefully structured plan. Overlooking any aspect of this plan can expedite disease progression, leading to severe complications. The lack of disease-specific nutritional guidance, the prevalent sedentary lifestyle among patients, and insufficient screening for hepatocellular carcinoma, oesophageal varices, sarcopaenia, minimal hepatic encephalopathy, and diabetes mellitus, along with fibrosis progression and cirrhosis decompensation, can add further complexities. Additionally, devaluing the impact of obesity in triggering liver cirrhosis can be disadvantageous. Prolonged and inappropriate use of proton pump inhibitors also poses a significant challenge with a wide range of complications. These often-unheeded aspects in the care of liver cirrhosis patients represents the unseen culprits of progression from bad to worse and warrant serious consideration.

Introduction: In an effort to treat patients with malignant hilar obstruction (MHO), both percutaneous trans-hepatic biliary stenting (PTBS) and endoscopic biliary stenting (EBS) strategies have been implemented in the clinic, but the relative advantages of these techniques remain to be clarified.

Aim: This meta-analysis was designed to compare the relative clinical efficacy of PTBS and EBS in MHO patients.Material and methods: Relevant studies were identified through searches of the PubMed, Web of science, and Wanfang databases, and pooled analyses of these studies were then performed.

Results: In total, this meta-analysis included 11 studies enrolling 530 and 645 patients who underwent PTBS and EBS, respectively. Pooled rates of technical success in the PTBS patients were significantly higher than those for EBS patients (p < 0.0001). PTBS patients also exhibited significantly lower pooled cholangitis (p = 0.03) and pancreatitis (p < 0.0001) rates as compared to individuals in the EBS group. However, there were no significant differences in pooled clinical success rates (p = 0.45), haemorrhage rates (p = 0.57), stent patency (p = 0.96), or overall survival (p = 0.73) when comparing these groups. In a subgroup analysis, PTBS was not found to be superior to EBS as a treatment for Bismuth type III/IV MHO patients. However, PTBS did exhibit superior technical success and complication rates relative to EBS when treating hilar cholangiocarcinoma patients.

Conclusions: PTBS is superior to EBS with respect to many technical success and safety criteria when employed for the management of MHO patients.

Introduction: Exercise is a simple, safe, and affordable solution that can be easily taught to men with chronic illnesses to improve their psychological burden and sexual health.

Aim: Since the role of exercise in ameliorating the psychological burden associated with erectile dysfunction (ED) in hepatitis C (HC) men was not explored, this research aimed to explore this role.

Material and methods: This HC study was a randomized-controlled exercise-rehabilitation trial. Recruitment of HC men with ED was conducted from El-Sahel Teaching Hospital, Cairo, Egypt. Men (n = 46) were randomly assigned to a 12-week walking-exercise group (WEG, n = 23 HC men with ED received a 1-hour treadmill walking 3 times weekly) or a control group (n = 23 HC men with ED, who did not change their daily physical activity during the research period). Besides Beck's Depression Inventory (BDI), Arabic Version of the Five-Item Version International Index of Erectile Function (IIEF-5), Profile of Mood States Questionnaire (POMSQ), and Ten-Statement Rosenberg self-esteem scale (TSRSE), HC participants' liver enzymes, alanine transaminase (ALT), and aspartate transaminase (AST) were assessed.

Results: Significant improvements of POMSQ, BDI, AST, IIEF-5, ALT, and TSRSE within the WEG only were seen. No significant changes occurred in the control group's parameters.

Conclusions: Exercise (walking) is a good modality to improve liver enzymes, ED, and ED-associated psychological burden (depression, low self-esteem, and mood disturbances) in HC men with ED.

Introduction: Colorectal cancer have been one of the most common malignant neoplasm in the world. In most patients with this cancer, we can observe both redox homeostasis and nutritional disorders.

Aim: To assess the occurrence of oxidative stress in patients with colorectal cancer and its severity depending on the nutritional status of patients.

Material and methods: The study group consisted of 50 patients with colorectal cancer. In the control group, samples were obtained from 40 healthy subjects. Basal metabolic index and nutrition risk screening (NRS) 2002 scale was completed. The total antioxidant capacity (TAC), total oxidant status (TOS), malondialdehyde (MDA) were determined yielding the oxidative stress index (OSI) determined by the TOS/TAC ratio and TAC/MDA ratio.

Results: There were statistically significant differences (p < 0.05) in the levels of not only TAC, TOS, OSI, but also MDA and TAC/MDA. In healthy patients, the TAC and TAC/MDA level was significantly higher (p < 0.05) compared to the cancer patients, while the TOS, OSI and MDA level was significantly lower (p < 0.05). In patients with BMI < 24.9 kg/m², the level of TAC was significantly higher and the level of TOS was significantly lower (p < 0.05) compared to patients with BMI > 24.9 kg/m². In patients with features of malnutrition according to the NRS 2002 scale, TOS and OSI were statistically significantly higher (p < 0.05).

Conclusions: Neoplastic disease, such as colorectal cancer, precipitates an increase in oxidative stress. Concurrently, the nutritional status of patients, especially malnutrition, further intensifies this process.