Przegla̜d Gastroenterologiczny最新文献

Introduction: Gastrointestinal-specific anxiety (GSA) is considered as an important factor in the course of irritable bowel syndrome (IBS). GSA may be evaluated by the visceral sensitivity index (VSI).

Aim: To translate original English version of the VSI into Ukrainian language (VSI-UA) and then to test its validity and reliability in patients with IBS.

Material and methods: 108 patients of both sexes, aged 18-44 years, with IBS were assessed by the VSI-UA, Patient Health Questionnaire-9 (PHQ-9), Beck's Depression Inventory (BDI), and the Hospital Anxiety and Depression Scale: depression (HADS-Dep) and anxiety (HADS-Anx). Reliability was checked by Cronbach's α and test-retest method with calculation of the intraclass correlation coefficient (ICC). Content validity was assessed by calculation of the content validity ratio (CVR) and content validity index (CVI). The construct validity was assessed by estimating Pearson`s correlation between VSI-UA, PHQ-9, BDI, HADS-Anx, and HADS-Dep.

Results: Cronbach's α for VSI-UA was 0.84; the ICC between the first measurement and the one repeated 4 weeks after administration of VSI-UA was 0.92 (95% CI: 0.87-0.95). The calculated CVR for each item of the VSI-UA was higher than the critical value of 0.56, and the CVI was 0.94. A moderate positive correlation was found between VSI-UA and PHQ-9 (r = 0.65), BDI (r = 0.69), HADS-Anx (r = 0.61), and HADS-Dep (r = 0.48); p < 0.05 in all correlations.

Conclusions: VSI-UA is a reliable and valid tool for the assessment of GSA in Ukrainian-language patients with IBS, and it could be implemented in routine clinical practice to manage patients with IBS.

Introduction: Around 200,000 new cases of pancreatic cancer are diagnosed yearly worldwide. It is the fourth most common cause of cancer deaths. Pancreatic cancer has a high mortality rate due to unspecific symptoms being responsible for late diagnosis.

Aim: In this study, the authors analysed selected nutritional parameters and the severity of anaemia in patients diagnosed with pancreatic head cancer.

Material and methods: Data were collected upon admission to the 2^nd Clinical Department of General, Gastrointestinal, and Oncological Surgery in the University Clinical Hospital in Bialystok, Poland and retrospectively with the help of correctly collected anamnesis.

Results: It has been shown that most patients with pancreatic cancer are malnourished at the time of diagnosis. Body mass index (BMI) is the least valuable parameter primarily. Weight loss has been determined to be the most accurate predictor of the patient's metabolic status, although it should never be the only parameter. Although these factors do not suggest an inflammatory process, serum protein levels and albumin concentration should be considered.

Conclusions: When assessing the nutritional status of patients with pancreatic cancer, many predictive factors should be considered. BMI seems to be the least accurate parameter for assessing nutritional status in patients diagnosed with cancer. However, when combined with weight loss and serum albumin levels, it can be quite useful as a prognostic factor.

Eosinophilic gastroenteritis (EGE) is a relatively rare disease, but it should be considered whenever a patient presents with unexplained gastrointestinal symptoms that cannot be explained by parasitic infection or other gastrointestinal diseases characterized by eosinophilic infiltration. A high coexistence of EGE and allergic diseases has been documented. Diagnosis of EGE is based primarily on clinical, endoscopic, and histopathological findings. Glucocorticosteroids and other immunomodulatory drugs are the mainstay of treatment, but currently the greatest hope lies in biological drugs, which are undergoing intensive research. This disease is troublesome for the patient and significantly reduces the quality of life.

Treatment of eosinophilic gastroenteritis (EGE) is mainly empirical and is based on the assessment of symptom severity and the experience of clinicians. Patients with mild disease can be treated symptomatically, while patients with more severe symptoms or malabsorption symptoms require more aggressive therapy. So far, several therapeutic options have been proposed, including the following: dietary treatment, glucocorticosteroids, inhibitors of leukotriene receptors, mast cell stabilizers, immunomodulating drugs, and biological drugs. Unfortunately, there is still a lack of well-designed, prospective. and randomized clinical trials involving large groups of patients with EGE and assessing the effectiveness of individual treatments. More research is needed to compare the efficacy and safety profiles of the various treatments available, and to select the prognostic factors of relapse, which in turn will be extremely important in making decisions about the initial treatment phase and maintenance therapy.

Metabolic-associated fatty liver disease (MAFLD), previously known as non-alcoholic fatty liver disease, is a significant epidemiological problem and a well-known cardiovascular risk factor. The increasing number of cases creates the need for new therapeutic methods aimed at improving patient outcomes. Recent studies have highlighted the relationship between MAFLD and proprotein convertase subtilisin/kexin type 9 (PCSK9). Based on the available data, PCSK9 inhibitors appear to have beneficial effects in patients with MAFLD, and they may be a treatment option in the future. Further research is necessary to better evaluate the efficiency of PCSK9 inhibitors in MAFLD treatment.

Introduction: Malnutrition is a common condition in liver cirrhosis (LC), which is associated with poor survival. Despite the wide range of tools, there is no agreement on a standard nutritional assessment method applicable to LC.

Aim: To determine the validity and prognostic value of the Patient-Generated Subjective Global Assessment (PG-SGA) as a nutritional assessment tool in LC patients.

Material and methods: In 2019-2021, 161 patients with LC (aged 55.2 ±11.6 years) were involved, of whom 23, 57, and 81 patients were classified as Class A, B, and C Child-Turcotte-Pugh (CTP), accordingly. Fifty patients died during follow-up (489 (293-639) days). The PG-SGA, Controlling Nutritional Status (CONUT), handgrip strength, and skeletal muscle index (SMI) were used to assess nutritional status.

Results: According to the PG-SGA 29.8% of patients were moderately malnourished and 29.8% were severely malnourished. 50.6% of CTP C patients were severely malnourished. Numerical PG-SGA correlated with CTP, Model for End-Stage Liver Disease, CONUT, SMI, and handgrip strength. Low SMI and handgrip strength were present in 87.5% and 66.7% of severely malnourished patients, respectively. PG-SGA predicted mortality (AUC = 0.775, p < 0.001). Severely malnourished patients had significantly lower survival than moderately malnourished and well-nourished patients in the Kaplan-Meier analysis. Hepatic encephalopathy (HR = 2.29, p = 0.046), hypoalbuminemia (HR = 2.27, p = 0.022), and severe malnutrition according to PG-SGA (HR = 2.39, p = 0.016) were independent predictors of mortality in Cox proportional hazards regression analysis.

Conclusions: The PG-SGA is a reliable nutritional assessment tool and can predict mortality in LC patients.

SARS-CoV-2 infection manifests mainly by involving the respiratory system. Due to the presence of abdominal symptoms, the digestive system is clearly involved in the expression, transmission, and possible pathogenesis of COVID-19. There are many theories regarding the development of abdominal symptoms, including angiotensin 2 receptor, cytokine storm, and disturbances of the intestinal microbiome. This paper provides an overview of the most important meta-analyses and publications on gastrointestinal symptoms and the gut microbiome in COVID-19.

Introduction: It is assumed that up to 50% of patients with functional bowel disorders with diarrhoea may suffer from bile acid (BA) malabsorption, which is considered as an underrecognized cause of chronic diarrhoea.Aim: To evaluate the indicators of BA metabolism in patients with irritable bowel syndrome (IBS).

Material and methods: The study population included 28 healthy adults (control group), 108 patients with IBS with diarrhoea (IBS-D) and 37 with constipation (IBS-C), aged 18-44 years. All participants were assessed by symptoms questionnaires: VSI and FBDSI. High-performance liquid chromatography - mass spectrometry (HPLC-MS) was used to measure serum and faecal BA (sBA and fBA). Ultra-performance liquid chromatography - mass spectrometry (UPLC-MS) was used to evaluate the relative activity (RA) of gut bacterial bile salt hydrolase (BSH).

Results: Primary sBA in absolute and percentages, total fBA, and primary fBA in absolute and percentages were higher, and secondary sBA and fBA in percentages were lower in the IBS-D group compared to the control and IBS-C groups (p < 0.01). The RA of gut bacterial BSH was lower in IBS-D compared to the control and IBS-C groups (p < 0.01). RA of gut bacterial BSH, secondary sBA and fBA correlated negatively with abdominal pain, bloating, stool frequency, Bristol scale, VSI, and FBDSI (p < 0.05 in all). Total fBA, primary sBA, and fBA correlated positively with the same clinical parameters (p < 0.05 in all).

Conclusions: IBS-D patients had altered parameters of BA metabolism that were associated with the severity of clinical symptoms, disease severity, visceral sensitivity, and stool appearance and frequency.

Brain-derived neurotrophic factor (BDNF) is highly expressed throughout the gastrointestinal (GI) tract and plays a critical role in the regulation of intestinal motility, secretion, sensation, immunity, and mucosal integrity. Dysregulation of BDNF signalling has been implicated in the pathophysiology of various GI disorders including inflammatory bowel disease, irritable bowel syndrome, functional dyspepsia, and diabetic gastroenteropathy. This review provides a comprehensive overview of BDNF localization, synthesis, receptors, and signalling mechanisms in the gut. In addition, current evidence on the diverse physiologic and pathophysiologic roles of BDNF in the control of intestinal peristalsis, mucosal transport processes, visceral sensation, neuroimmune interactions, gastrointestinal mucosal healing, and enteric nervous system homeostasis are discussed. Finally, the therapeutic potential of targeting BDNF for the treatment of functional GI diseases is explored. Advancing knowledge of BDNF biology and mechanisms of action may lead to new therapies based on harnessing the gut trophic effects of this neurotrophin.