Przegla̜d Gastroenterologiczny最新文献

Introduction: Studies comparing proximal and distal colon tumours undergoing emergent surgery for obstruction are limited.

Aim: The purpose of our study was to compare the clinical and oncological outcomes of patients with proximal and distal colon cancer, who underwent emergent surgery for obstruction.

Material and methods: From January 2012 to June 2022, patients with colon cancer presenting with obstruction and undergoing emergent surgery were analysed. The 2 groups were defined as proximal and distal according to the tumour location with respect to the splenic flexure. Postoperative early and long-term clinical and oncological outcomes were analysed.

Results: Of the 118 patients included in the study, there were 46 patients (38.9%) in the proximal group and 72 patients (61.1%) in the distal group. Single-session surgery including resection and anastomosis was performed on 31 (67.4%) and 29 (40.3%) patients in the proximal and distal groups, respectively (p = 0.007). The global mortality rate was 11%, and there was no difference between the groups. Five-year survival was similar in the proximal and distal groups, being 80.4% and 68.1%, respectively. In the analysis of patients who did not develop early mortality and underwent R0 resection, 3-year disease-free survival was 89.5% in the proximal group and 81.5% in the distal group; the difference was not significant (p = 0.165).

Conclusions: Mortality is high in emergent surgeries for obstructed proximal and distal colon cancers. If curative resection is achieved, oncological results are good and tumour localisation does not affect survival.

Introduction: Helicobacter pylori is a globally prevalent infection, particularly in developing countries, with significant implications for gastrointestinal health in children. Recent studies suggest a potential link between vitamin D and its metabolites in enhancing the effectiveness of H. pylori eradication therapies through their bactericidal properties.

Aim: To investigate the correlation between the vitamin D levels and their influence on clinical management and treatment results of children patients, tested for H. pylori.

Material and methods: The study was conducted on a cohort of 128 paediatric patients. They were divided into 2 groups, depending on whether positive (first group - A) or negative (second group - B) for H. pylori. To determine vitamin D levels, venous blood was taken from all participants from both groups. Group 1 included patients whose indexes were up to 10 ng/ml; Group 2 included patients whose indexes were from 10 ng/ml to 20 ng/ml; Group 3 levels were from 20 ng/ml to 30 ng/ml; and Group 4 indexes were over 30 ng/ml. The efficiency of the H. pylori eradication scheme in participants of these groups was evaluated.

Results: The mean values in Group A were higher than those in Group B: 17.1 and 14.9, respectively, p-value 0.03. Helicobacter pylori prevalence was higher in participants with vitamin D levels below 30 ng/ml. As a result of the study, it was established that vitamin D levels below 30 ng/ml in blood serum could be a predisposing factor in the spread of H. pylori in paediatric patients. At the same time, different levels of deficiency below 30 ng/ml did not affect the frequency of H. pylori infection.

Conclusions: The obtained data can be used in developing guidelines for clinical management of children patients who are primarily diagnosed with H. pylori and require eradication therapy.

Introduction: Gastric cancer remains one of the leading causes of cancer-related death. Many frequently used drugs (proton pump inhibitors (PPI), statins, metformin, and non-steroidal anti-inflammatory drugs (NSAID)) can play a role in the development of gastric cancer or attenuate Helicobacter pylori's adhesion (cysteine derivatives).

Aim: To analyse the patterns and dynamics of consumption of PPIs, statins, metformin, NSAIDs and cysteine derivatives in Ukraine in comparison with global trends, and to explore their potential impact on the gastric cancer morbidity in Ukraine.

Material and methods: The consumption of PPIs, statins, metformin, NSAIDs, and cysteine derivatives (by mean of daily defined doses (DDDs)/100 000 habitants per year, 2014-2020) and gastric cancer epidemiological indices, such as the incidence rate (per 100 000 habitants per year, 2014-2021), main forms, and age prevalence, were estimated in Ukraine.

Results: Levels of PPI, statins, metformin, NSAID, and cysteine derivative consumption increased by 98.61% (p < 0.0001), 199.15% (p < 0.0001), 141.29% (p < 0.0001), 23.51% (p < 0.0001), and 42.06% (p < 0.0001), respectively, in 2020 compared to 2014 whereas the gastric cancer incidence rate decreased by 26.56% (p < 0.0001) in 2021 compared to 2014 in Ukraine.

Discussion: The gastric cancer incidence rate decreased, and its epidemiological structure was stable, in Ukraine between 2014 and 2021. The consumption of PPIs, statins, metformin, NSAIDs, and cysteine derivatives might play a complex role in the development of gastric cancer.

Conclusions: The trends of the gastric cancer incidence rate, its epidemiological structure, and the increased consumption of PPIs, statins, metformin, NSAIDs, and cysteine derivatives in Ukraine between 2014 and 2021 correspond to global trends. Statins, metformin, NSAIDs, and cysteine derivatives might lead to a decline in gastric cancer in the population despite the increased consumption of PPIs.

Introduction: Studies have indicated the high effectiveness of faecal microbiota transplantation (FMT) in the treatment of recurrent Clostridioides difficile infection (rCDI). However, there is still a lack of data from different subpopulations regarding FMT and the factors related to it.

Aim: The aim of the study was to retrospectively evaluate the efficacy and safety of FMT in rCDI.

Material and methods: In all cases, FMT was performed using a nasoenteric tube. A good response following a single FMT was considered an improvement, whereas requiring more than one FMT was considered a suboptimal response.

Results: In the analysed period, FMT was performed on a total of 98 patients, including 74 with rCDI (of whom 23 received 2 FMTs, 6 received 3 FMTs, and 1 received 5 FMTs). The average age of the patients was 68 years. 42 (56%) patients were women, 41 (55.4%) had previously used antibiotics, 2 (2.7%) had used steroids, and 4 (5.4%) had used proton pump inhibitors (PPI). Following the first FMT procedure, clinical improvement was observed in 44 (59.4%) patients. The odds of a suboptimal effect of the therapy (needing more than 1 FMT) were associated with prior use of metronidazole. Among all analysed factors, cardiovascular risk factors (such as hypertension and hyperlipidaemia) were associated with a threefold increased likelihood of requiring more than 1 FMT (p = 0.038).

Conclusions: In our study, FMT was found to be an effective and safe treatment of recurrent CDI. Use of metronidazole was identified as a risk factor for a suboptimal response to FMT in the studied cohort.

Despite advances in medicine, upper gastrointestinal cancers remain a significant global concern. In Poland, regardless of the increase in performed esophagogastroduodenoscopies, the rate of missed cancers is around 6%. This is related to the insufficient quality measures during the performed examinations. Our paper discusses key endoscopy quality indicators that can enhance the detection of precancerous lesions and cancers. We categorized the indicators into three sections: pre-procedural (fasting time, premedication), intra-procedural (sedation, photodocumentation, virtual chromoendoscopy, quality metrics, biopsy sampling) and post-procedural (coordinated care, training). Some of them, such as chromoendoscopy and premedication in the upper segment, have been widely studied and popularized in recent years. For several years, we have had strict protocols on how to take specimens depending on the condition. Most of the assumptions presented can be easily implemented into daily routine practice, which can improve health care. These are successfully, routinely used in Japan and Korea. We believe that a collective improvement in the quality of esophagogastroduodenoscopies performed will increase the detection rates of precancerous lesions and early cancers. However, further research in this area is still needed.

Introduction: Drug-induced liver injury (DILI) is a significant clinical event, associated with notable morbidity and mortality. The paucity of DILI diagnostic and/or prognostic biomarkers still represents an unmet need.

Aim: We aimed to evaluate the role of glutamate dehydrogenase (GLDH) as a diagnostic and prognostic marker in patients with DILI.

Material and methods: A case-control study was conducted on 40 acute DILI patients and 40 acute viral hepatitis patients, in addition to a healthy control group (20). Clinical and laboratory characteristics were evaluated including ELISA assay of GLDH, along with RUCAM score and liver biopsy whenever feasible. All cases were followed up for 6 months.

Results: Diclofenac was the most incriminated drug in DILI (40%). GLDH was higher in the DILI than control and acute viral hepatitis patients (18.5 ±10.4, 0.89 ±0.6, 1.5 ±1.2 U/l) respectively (p < 0.001). Moreover, it was strongly correlated with aminotransferases, alkaline phosphatase, prothrombin concentration (PC), and bilirubin. The GLDH level in hepatocellular injury was 24.5 ±4.4 U/l, while it was 1.5.5 ±0.6 U/l in mixed and 3.5 ±1.1 U/l in cholestatic injury (p < 0.001). The AUC for GLDH level was 0.936 (p < 0.001) at a cutoff of 2.1 U/l, where the sensitivity was 90%, specificity 85%, positive predictive value 91.08% and negative predictive value 83.31% in prediction of DILI. GLDH was higher in patients who died than those who survived (32.36 ±1.1 vs. 15.36 ±10.1 U/l, respectively) (p = 0.000). Multivariate analysis defined age, bilirubin, and GLDH as independent predictors of poor outcomes in DILI.

Conclusions: GLDH is a highly specific, simple, real-time, and inexpensive diagnostic and prognostic marker of DILI and shows potential to address this unmet need.

Introduction: Pediatric feeding disorders (PFDs) refer to the impaired consumption of food that is inappropriate for a child's age group. Understanding the causes and influencing factors of PFDs is crucial for managing these disorders.

Aim: This study aimed to analyze the factors associated with PFDs using the path analysis method.

Material and methods: A cross-sectional study was conducted on 500 children aged 6 months to 18 years who visited gastroenterology and child nutrition clinics. Data were collected through interviews with mothers and physicians, and analyzed using the path analysis method. The model included latent variables such as feeding disorders and birth status, as well as observed variables such as socio-economic status, food group, feeding practices, destructive behaviors, sleep, and body mass index (BMI) z-score.

Results: We conducted three path analyses. The socio-economic status (SES) directly and indirectly plays a role in feeding disorders in children; the total effect on feeding disorders was positive (β = 0.075). The direct effect of SES on the intake of food groups was positive (β = 0.190), on BMI z-score was positive (β = 0.100), and it was generally associated with a negative effect on feeding disorders (β = -0.05). The total effect of destructive behaviors on body mass was negative (β = 0.262) and on feeding disorders was positive (β = -0.041). Children who had regular sleep had significantly fewer feeding disorders (total effect: -0.369).

Conclusions: Socio-economic status, destructive behaviors, sleep, and BMI were found to be factors influencing eating disorders in children.

Introduction: Bariatric surgery has become one of the most prominent treatment modalities for obesity. Esophagogastroscopy (EGD) with Helicobacter pylori testing is a part of the preoperative work-up. There are no guidelines defining the preferred method of detecting H. pylori.

Aim: The study aimed to establish the prevalence of H. pylori infection among bariatric patients and compare the two commonly used invasive diagnostic tests: the rapid urease test (RUT) and histopathology. The secondary aim was to evaluate the usefulness of EGD and histology in diagnosing gastritis.

Material and methods: A retrospective analysis was performed among patients with obesity undergoing bariatric surgery. As part of the preoperative work-up, EGD was performed with RUT using the Lencomm GOLD Hp dry CLO test and a histopathology sample taken from the gastric antrum and body. The Cohen's kappa inter-rated reliability test was used for concordance calculation.

Results: 280 patients were analyzed, of whom 98 (35.00%) were diagnosed with H. pylori infection with at least one method. The Cohen's kappa inter-rated agreement between the RUT and histology sampling was 0.80. Macroscopic gastritis was present in 76 (77.56%) of infected patients. Histology showed microscopic gastritis in 99 (99%) of those patients. 161 (57.50%) of the study group were diagnosed with macroscopic gastritis; among these, histology confirmed inflammation in 119 (73.91%).

Conclusions: There is a good concordance between RUT and histopathology diagnosis of H. pylori among the bariatric population. Additionally, there is a low accuracy rate in EGD assessments of gastric mucosa changes.

The results of numerous clinical studies available in the literature allow us to conclude that the fiber deserving the name of the gold standard in regulating bowel movements is the psyllium husk obtained from Plantago ovata. The physicochemical properties of psyllium, related to its ability to form a gel in an aqueous environment and its ability to retain water in this mucous-gel structure, mean that preparations containing P. ovata husk show therapeutic effects in both constipation (including occasional and chronic) and diarrhea (acute and chronic). Moreover, the results of studies and clinical experiments indicate that the use of P. ovata husk in the treatment of bowel disorders is distinguished by significantly higher efficacy compared to pharmacological preparations such as sodium docusate or loperamide. This article presents the evidence available in the recent literature on the therapeutic potential and possible mechanisms of action of Plantago ovata husk in the treatment of constipation and diarrhea.