Przegla̜d Gastroenterologiczny最新文献

The diagnosis, treatment, and follow-up of pancreatic cystic tumors require a careful expert consensus approach due to their diverse nature and variable potential for malignancy. In view of these challenges, a panel of experts from the Polish Pancreatic Club has developed comprehensive recommendations. These guidelines are based on the most recent literature data and reflect current advances in diagnostic imaging and therapeutic interventions. The panel conducted an extensive review of available publications, meticulously formulating each recommendation and subsequently voting on them using the GRADE system (providing the quality of evidence and recommendation strength for each statement). The guidelines emphasize the importance of advanced imaging modalities (such as computed tomography, magnetic resonance, and endoscopic ultrasound), fine needle aspiration biopsy in selected situations and applicable laboratory tests to improve diagnostic accuracy. Furthermore, treatment strategies are carefully tailored to match individual risk profiles and specific lesion characteristics. Management options range from conservative treatment with routine follow-up examinations to surgical interventions when clinical indications require such an approach. Overall, these expert recommendations provide clinicians with a valuable and reliable framework, firmly anchored in current scientific data and consensus among specialists, for effectively managing pancreatic cystic tumors in clinical practice. Ultimately, these guidelines will lead to improved patient outcomes.

Introduction: While the COVID-19 pandemic disrupted everyday life for all individuals, its impact was especially pronounced in patients with chronic illnesses. Among them, individuals undergoing biological therapy experienced additional difficulties related to continuity of care and access to medical professionals.

Aim: We aimed to evaluate the health-related quality of life (HRQoL) in inflammatory bowel disease (IBD) patients, who were receiving biological therapy, before and during the COVID-19 pandemic.

Material and methods: To our knowledge, this is the first study in the Balkans to examine the HRQoL exclusively in IBD patients treated with intravenous biological therapy, in the context of the COVID-19 epidemic. The cross-sectional study was conducted in two acts; in 2019 and during the second wave of the COVID-19 pandemic in 2020. All examinees filled out the short quality of life questionnaire. Patients were assessed for clinical disease activity using clinical activity indices. Also, they completed a questionnaire for the presence of depression - the Patient Health Questionnaire.

Results: There were 90 patients in the group before the pandemic, and 94 IBD patients were examined during the pandemic. The proportion of patients with a poorer HRQoL increased during the pandemic (16.7% vs. 26.6%), but not statistically significantly (p = 0.103). The greatest impact on HRQoL in multivariate analysis both before and during the COVID-19 outbreak was shown by disease activity (p = 0.014; p = 0.023) and the presence of depressive symptoms (p = 0.001; p = 0.002). The percentage of employed IBD patients decreased significantly during the pandemic (from 64.4% before the pandemic to 47.9%; p = 0.024).

Conclusions: An active disease and the presence of depressive symptoms had the greatest impact on impairment of the HRQoL of IBD patients, regardless of the pandemic. Mental health should be given more comprehensive attention in these patients.

In Poland, there has been a steady increase in the number of patients receiving factor Xa (FXa) inhibitors as part of anticoagulant therapy. Despite their high therapeutic efficacy and the lack of a need for dose monitoring, these agents are responsible for serious bleeding (including gastrointestinal bleeding) in approximately 1-4% of patients. Until recently, the management of gastrointestinal bleeding in patients receiving FXa inhibitors relied on non-specific measures, such as fluid resuscitation, blood product transfusions, and the administration of prothrombin complex concentrate or recombinant factor VIIa. Andexanet alfa is a recombinant, inactive analogue of human FXa which specifically and effectively reverses the activity of FXa inhibitors, namely rivaroxaban and apixaban. Previous research has demonstrated the efficacy of andexanet alfa in achieving haemostasis and reducing mortality. This agent should be used in patients receiving an FXa inhibitor who present with life-threatening or uncontrolled gastrointestinal bleeding, accompanied by hypovolaemia and haemodynamic instability, and who fail to respond to initial fluid resuscitation or experience persistent bleeding despite endoscopic intervention. This article presents the position of the experts of the Polish Society of Gastroenterology regarding the management of patients with gastrointestinal bleeding taking FXa inhibitors and the indications for the use of andexanet alfa.

Introduction: Appendicitis represents a prevalent surgical emergency globally, posing a significant risk of severe complications. These complications encompass a spectrum of conditions, including ileus, peritonitis, abscess formation, and, in extreme cases, mortality.

Aim: The present study aims to assess the association of existing risk scores for the diagnosis of acute appendicitis and patient characteristics with the diagnosis of acute appendicitis, the odds of operative vs non-operative management, and postoperative outcomes.

Material and methods: In total, 109 patients assessed for acute appendicitis were included in this study.

Results: Sex (p = 0.99, OR = 1.01, 95% CI: 0.87-1.17) and age (p = 0.23, OR = 1.01, 95% CI: 0.98-1.04) were not found to be significantly associated with the diagnosis of appendicitis. Patients with radiating pain were significantly less likely to be diagnosed with appendicitis compared to those with localized pain (p = 4.05 × 10^-6, RR = 0.0918, 95% CI: 0.039-0.217). The duration of symptoms did not significantly influence the diagnosis (p = 0.12, RR = 1.04, 95% CI: 0.98-1.11). Increased ALVARADO scores were significantly associated with operative treatment, with patients receiving an appendicectomy having a mean score of 7.56 (SD 1.91) and patients undergoing conservative management having a mean score of 4.92 (SD 1.56) (p-value < 0.001).

Conclusions: The results of this study highlight the importance of clinical presentation, physical examination findings, and specific laboratory markers in the diagnosis of appendicitis. While demographic factors and certain biomarkers did not show significant associations, the combination of clinical and laboratory data can aid in accurate diagnosis and timely intervention.

The gastrointestinal endothelin system regulates vital processes including motility, secretion, sensation, and inflammation. Endothelin-1 acts via endothelin A and B receptors expressed on diverse intestinal cells. Dysregulation of endothelin signaling underlies common gastrointestinal disorders such as inflammatory bowel disease and irritable bowel syndrome. Aberrant endothelin-1 production and endothelin A receptor activation contribute to the inflammation, pain hypersensitivity, impaired epithelial function, and smooth muscle hypercontractility characteristic of these diseases. Endothelin receptor antagonists may provide therapies for managing related symptoms. However, knowledge gaps exist regarding cell-specific signaling pathways, regulatory factors, and precise roles in intestinal pathologies. Elucidating these details and translating insights into improved endothelin-targeted treatments could enable novel strategies for restoring homeostasis and improving patient outcomes. Advancing understanding of tissue-specific endothelin system functions represents a promising research avenue for unraveling disease mechanisms and developing new therapies for gastrointestinal disorders involving dysfunction of this regulatory axis.

Many patients with inflammatory bowel disease (IBD) either do not respond or lose response to dedicated pharmacotherapy; therefore, physical exercise is gaining attention as a potential treatment adjunct. Recent research has highlighted the favorable relationship between physical activity and patient-reported outcomes. The reviewed studies suggest that structured exercise programs are safe and effective in the management of IBD. Yet the benefits of training trials need to be interpreted with caution due to the heterogeneity of the study methods and interventions, small sample sizes, and the absence of long-term follow-ups.

Introduction: Minimal hepatic encephalopathy (MHE) is an overlooked impairment of central nervous system function in patients with acute and chronic liver diseases. Its impact on patients' quality of life, prognosis, and the incidence of overt hepatic encephalopathy has been proven. Due to diagnostic difficulties, searching for a serum biomarker for MHE appears to be extremely important.

Aim: The aim of the study was to demonstrate a potential correlation between the serum levels of SB100P protein in patients with MHE symptoms and the levels of SB100P protein in patients with MHE.

Material and methods: Given the association of hepatic encephalopathy with central nervous system damage, the study used the serum level of S100B protein in patients diagnosed with MHE based on the Psychometric Hepatic Encephalopathy Score (PHES) test.

Results: The study results showed a statistically significant correlation between the serum S100B protein level and the PHES test result. It was also found that the S100B protein level was higher than the norm for the healthy population, as provided by the test manufacturer, in 83% of the patients.

Conclusions: These results are promising, suggesting that further research is needed to verify the significance of S100B protein as a biomarker for MHE.

Introduction: Functional heartburn (FH) and non-erosive reflux disease (NERD) are two prevalent diseases, with mean nocturnal baseline impedance (MNBI) and the post-reflux swallow-induced peristaltic wave (PSPW) index being used in their differentiation.

Aim: We explored the clinical diagnostic value of MNBI and PSPW index on identifying FH and NERD.

Material and methods: In total, 106 NERD and 82 FH patients were selected, and clinical data were collected. The mean low esophageal sphincter (LES) tone, distal contractile integral (DCI), contractile front velocity (CFV), and integrated relaxation pressure (IRP) were acquired. Acid exposure time (AET), total monitoring time, baseline impedance level, number of swallow-induced peristaltic wave reflux episodes within 30 s, total number of reflux episodes, and number of acid reflux episodes of NERD and FH patients were monitored, with AET, MNBI and the PSPW index being calculated. Correlations between MNBI and the PSPW index and pathological indicators of subjects, and the influence and diagnostic value of MNBI and the PSPW index for NERD and FH identification were analyzed.

Results: The two groups differed significantly in AET, LES tone, total reflux episodes, acid reflux episodes and episodes of non-acid reflux. The NERD group displayed reduced MNBI and PSPW index levels. MNBI and the PSPW index were negatively associated with subject pathological indicators. MNBI, PSPW, LES tone, total reflux episodes and acid reflux episodes contributed to distinguishing NERD from FH. MNBI > 1975 and PSPW > 47.12 had high clinical application value for identifying NERD and FH.

Conclusions: MNBI and PSPW, LES tone, total reflux episodes and acid reflux episodes aided in distinguishing NERD and FH. MNBI and PSPW combinative detection had high clinical application value for distinguishing NERD from FH.

The global epidemic of obesity has led to a surge in metabolic-associated steatotic liver disease (MASLD), which poses a significant global health burden. Current therapeutic strategies primarily focus on lifestyle modifications, weight loss interventions, and the use of pharmacological agents such as glucagon-like peptide-1 receptor agonists (GLP-1RAs). Recently, the FDA approved resmetirom, a selective thyroid hormone receptor-β agonist. Both GLP-1RAs and resmetirom have individually demonstrated promising results in managing MASLD and associated metabolic disorders. However, the potential synergistic effects of combining these agents remain unexplored. This paper discusses the rationale for exploring the combination therapy of resmetirom and GLP-1RAs for managing MASLD.