Przegla̜d Gastroenterologiczny最新文献

Clostridioides difficile infection (CDI) poses a persistent challenge in healthcare, with substantial morbidity and mortality implications. This comprehensive review explores current CDI management, emphasising guidelines from IDSA, SHEA, and ESCMID. Additionally, this study spotlights recent drug developments that have the potential to reshape CDI treatment paradigms. Within the current treatment landscape, fidaxomicin, vancomycin, bezlotoxumab, and faecal microbiota transplantation offer varied options, each with its unique strengths and limitations. Fidaxomicin, effective yet resource-constrained, presents a dilemma, with vancomycin emerging as a pragmatic alternative. Bezlotoxumab, though augmenting antibiotics, grapples with cost and safety concerns. Meanwhile, faecal microbiota transplantation, highly efficacious, confronts evolving safety considerations. The horizon of CDI treatment also features promising therapies such as SER-109 and Rebyota, epitomising the evolving paradigm. As CDI management advances, the critical role of standardised microbiome restoration therapies becomes evident, ensuring long-term safety and diversifying treatment strategies.

Gastrointestinal (GI) cancers cause major global morbidity and mortality, with over 5 million new cases and 3.5 million deaths in 2020. The most prevalent GI malignancies are colorectal, gastric, liver, oesophageal, and pancreatic cancers. Marked geographic variations exist, with high incidence in developed regions contrasting with high mortality in developing areas. These patterns reflect disparities in risk factors and cancer control capacities. However, GI cancer incidence is rising with economic growth and lifestyle changes. Poor prognosis and increasing burden underscore the critical need for expanded prevention and research. This review examines global epidemiology, risks, prevention, detection, treatment, and priorities for common GI cancers. Controlling the toll of GI malignancies requires coordinated global actions across prevention, screening, treatment access, and research. Key priorities include vaccination, reducing modifiable risks, improving screening, expanding care access, and advancing prevention/therapy research. Global commitments to evidence-based interventions and knowledge sharing are vital to curb the GI cancer epidemic.

This scoping review highlights the role of microbiota modifications in prehabilitation for surgical patients. It emphasises the importance of optimising gut microbiota through probiotics, synbiotics, and postbiotics to reduce surgical complications, such as surgical site infections (SSIs). The review highlights that gut dysbiosis, worsened by surgery, stress, antibiotics, and poor diet, can lead to increased infection risk and slower recovery. Evidence from systematic reviews, meta-analyses, and randomised controlled trials suggests that microbiota-targeted interventions can reduce SSIs, enhance immune responses, and promote quicker recovery. The review advocates for an individualised approach to prehabilitation, incorporating microbiota modifications based on patient-specific factors and surgery type. However, it also notes the need for further research to standardise therapeutic regimens and confirm the safety and efficacy of these interventions in clinical practice.

Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease, clinically characterised by symptoms of esophageal dysfunction and histologically by eosinophilic infiltration of its wall. The last 3 decades have seen a sharp increase in its incidence to the point that it is called the second most common esophageal disease after reflux disease in some recent studies. The main indicators of EoE are food allergens and in recent years the extremely important role of oral immunotherapy (OIT) in the development of this disease has also been increasingly raised. To date, the appearance of EoE in the course of OIT is an absolute indication for discontinuation of this procedure; however, other therapeutic options that do not require termination of this procedure are increasingly being advocated. Unfortunately, our knowledge of EoE is full of gaps and requires numerous studies to fill in the missing elements of the pathogenesis and clinic of the described disease.

Introduction: Functional gastrointestinal disorders (FGIDs) encompass a wide spectrum of disorders that may be diagnosed using the Rome criteria.

Aim: To identify the prevalence and risk factors for the development of FGIDs in Jordanian infants.

Material and methods: We conducted a cross-sectional study to investigate the prevalence of FGIDs among infants and characterise any possible risk factors. Between 1 January 2020, and 30 December 2020, patients who presented to the paediatric follow-up clinic at King Abdullah University Hospital were recruited. Parents were interviewed and asked to complete an Arabic version of the Rome IV diagnostic questionnaire for pediatric gastrointestinal disorders for neonates and toddlers. Data regarding the parents' gastrointestinal symptoms and children's medical history were collected. Children's electronic medical files were also reviewed.

Results: The study included 127 children, 78 (61%) were males. The median age was 40 days. According to the Rome IV criteria eighty-two (64%) of the infants fit the diagnosis for at least one disorder. The most prevalent disorder was functional constipation (n = 78, 95%) followed by infant dyschezia (n = 11, 13%). Compared to infants who did not meet the diagnostic criteria, herb intake and circumcision rates were significantly higher among those who did. Univariate analyses revealed that Infants with FGIDs were more likely to ingest herbs.

Conclusions: FGIDs were common among young infants. Functional constipation was the most commonly diagnosed FGID. Infants with with FGIDs were more likely to intake herbs to ease the symtpoms.

Introduction: Although the phenomenon of cytokine storm is well described in patients with severe COVID-19, little is known about the role of the immune system in asymptomatic patients, especially in the group with autoimmune diseases, such as inflammatory bowel disease (IBD).

Aim: To assess the stimulation of the immune system expressed through the production of cytokines in IBD patients with asymptomatic COVID-19.

Material and methods: This is a multi-centre, prospective study in which the concentration of many cytokines (IL-1a, IL-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, IL- 15, IL-17, IL-23, IFN-γ, TNF-α, TNF-β) was assessed in patients with IBD and asymptomatic SARS-CoV-2 infection diagnosed by serological tests.

Results: In the group of patients with a recent SARS-CoV-2 infection, defined as positive antibodies in the IgA + IgM class, a higher percentage of patients with the presence of interleukin (IL) 2 (IL-2) was found. No association with other cytokines or effects of IBD activity or treatment was found. However, the effect of the applied treatment on the concentration of some cytokines was found: a negative association of infliximab, vedolizumab, and prednisone with IL-2, a positive correlation of steroids, thiopurines with IL-10, and in the case of tumor necrosis factor-α (TNF-α), negative with infliximab, and positive with vedolizumab.

Conclusions: The increased concentration of IL-2 may result from its regulatory role in inhibiting excessive activation of the immune system; however, considering the studies of patients with severe COVID-19, its role in the initial phase of SARS-CoV-2 infection requires further research.

Introduction: The primary objective was to demonstrate the efficacy and safety of itopride as an add-on therapy to a proton pump inhibitor (PPI) in the treatment of gastroesophageal reflux disease.

Aim: Reflux disease affects the largest percentage of the population worldwide, symptoms overlap with many other conditions which hamper diagnostic and therapy presenting challenges in treating patients and prompting an intensive search for new, more effective therapeutic regimens.

Material and methods: A retrospective study was undertaken with 140 enrolled patients with reflux disease, confirmed by 24-hour pH impedance previously treated with PPIs without any significant improvement. Itopride was added to the PPI therapy in a dose of 150 mg/day, after which the severity of reflux disease symptoms was reassessed.

Results: The greatest improvement after the combined treatment (p < 0.001) was experienced in the context of heartburn, nausea and laryngopharyngeal symptoms. There was also a high percentage of statistically significant (p < 0.01) improvement in burning in the oesophagus and stomach and regarding postprandial fullness, gastric retention and swallowing disorders. No adverse effects were noted.

Conclusions: The presented study clearly demonstrates that in patients ineffectively treated with PPIs, the addition of itopride to the therapy for 8 weeks without changing the PPI dose, significantly improves the efficacy of treatment of reflux disease and thus shortens the need for medication usage and reduces the costs of therapy, potential side effects of PPI, improves the patient's quality of life and decreases the frequency of medical appointments.

Aim: To assess the association of the apparent diffusion coefficient (ADC) of the psoas muscles and psoas muscle index (PMI) with the activity and behaviour of Crohn's disease (CD).

Material and methods: This was a retrospective study of 88 CD patients who underwent magnetic resonance enterography. Patients were classified according to the Montreal Classification in uncomplicated (non-stricturing, non-penetrating, B1), and complicated (structuring [B2] and penetrating disease [B3]). At the level of the third lumbar vertebra, the ADC and PMI were estimated. CD activity was analysed using the Magnetic Resonance Index of Activity (MaRIA), and depending on its values patients were categorized as high or low activity. Additionally, the presence of creeping fat (CrF) was used to evaluate activity. ADC and PMI were using Student's t-test.

Results: Our study included 47 males and 41 females (mean age of 38.69 ±14.4 years). The ADC in uncomplicated (B1, n = 45) and complicated disease (B2 + B3, n = 43) were 1.11 ±0.19 and 1.03 ±0.10 (10^-3*mm²/s), respectively, (p = 0.02). ADC was significantly lower in patients with stricturing disease than in patients without strictures (1.02 ±0.11 and 1.10 ±0.18 [10^-3 mm²/s], respectively, p = 0.01). The group with non-penetrating disease showed higher PMI than those with penetrating disease (5.71 ±1.88 vs. 4.42 ±1.55 cm²/m², respectively, p = 0.10). There was no significant difference in PMI and ADC between patients with low and high MaRIA or positive and negative CrF.

Conclusions: The ADC of the psoas muscles is significantly lower in CD patients with uncomplicated disease, particularly those with stricturing disease. Therefore, ADC can be considered as an imaging biomarker of myopathic changes in CD patients.

Introduction: Colon adenocarcinoma (COAD) is one of the most frequently identified cancers of the digestive system. It is worth noting that the 5-year survival rates for patients diagnosed early are approximately 90%, whereas for patients with advanced diagnosis it is only 10%. It may indicate that metastasis is a critical cause of death for cancer patients.

Aim: The current study investigated the immunohistochemical expression of MnSOD in individuals living in Poland, who were diagnosed as colon adenocarcinoma patients, to assess its prognostic significance by correlating its expression with the clinicopathological factors and overall survival (OS).

Material and methods: Paraffin-embedded adenocarcinoma samples were assessed immunohistochemically for MnSOD protein. The relationship between MnSOD immunoexpression and clinicopathological factors including the 5-year overall survival (OS) were evaluated.

Results: Immunohistochemical expression of MnSOD protein was detected in colon adenocarcinoma samples and non-pathological samples of colon tissues. As demonstrated, the level of the MnSOD immunohistochemical reactivity was not correlated with clinicopathological factors. A multivariate analysis demonstrated that the grade of tumour differentiation and MnSOD immunoexpression in healthy tissues were independent risk factors for worse survival of patients.

Conclusions: The high level of MnSOD immunoexpression in cancerous tissue was not associated with malignancy-related clinicopathological factors and 5-year overall survival of patients.

Introduction: Proton pump inhibitors (PPIs) are effective drugs used for multiple gastrointestinal complications. They are commonly used in both hospitalised and outpatients. However, little is known about its utilisation pattern in ambulatory patients.

Aim: To evaluate the inexpedient continuous use of PPIs in patients with respect to treatment duration.

Material and methods: A cross-sectional observational study was conducted from January 2018 to November 2019 in Khyber Pakhtunkhwa, Pakistan. Regular proton pump inhibitor users were identified through patient histories.

Results: During the study period, 171 patients were included using a non-probability consecutive sampling technique, who were using regular proton pump inhibitors for a longer duration, i.e. from 3 months to 15 years. The highest proportion (42.8%) were using PPI regularly from 3 months to 1 year followed by 22.9% for 1-2 years, 12.0% for 2-3 years, 7.8% for 3-4 years, 4.2% for 4-5 years, and 10.24% for > 5 years. Omeprazole and esomeprazole were the most commonly used drugs, with 71.1% and 23.5% prevalence, respectively. A total of 33.73% of patients had continued PPI use on their own after initially being prescribed by the physician.

Conclusions: It can be deduced that PPIs are used in outpatients beyond standard treatment guidelines. The inexpedient continuous use of proton pump inhibitors is of concern due to the risk of developing adverse effects. Therefore, patient counselling and periodic monitoring must be carried out to prevent the irrational use of PPIs.