Przegla̜d Gastroenterologiczny最新文献

Aim: The aim was to compare the efficacy of high-dose amoxicillin and pantoprazole dual therapy for Helicobacter pylori (HP) eradication in comparison with the clarithromycin-based quadruple regimen.

Material and methods: The study was designed as a double blind, randomized controlled trial (RCT) on patients with confirmed HP infection referring to 8 medical centers in three countries - Iran, Egypt, and Vietnam - during October 2021 to March 2022. After obtaining written consent, the participants were randomly divided into two groups to receive either high-dose amoxicillin and pantoprazole dual therapy (group A) or the clarithromycin-based quadruple regimen (group B) for 2 weeks and followed by 4 weeks of therapy with pantoprazole. Then the rate of HP eradication in each group was determined and compared.

Results: Finally, 619 patients with confirmed HP infection were included and randomly divided into two groups. Eradication rates in groups A and B were 68.3% and 85.6%, respectively, based on intention-to-treat (ITT) analysis, and 72.2% and 89.8% according to per-protocol (PP) analysis (p < 0.0001). Group A had a lower rate of adverse events than group B (22.0% vs. 40.1%, p < 0.0001). There was no significant difference in the complete compliance rate between groups A and B (90.7% vs. 89.0% respectively, p = 0.718).

Conclusions: The results of the current study show that for treating HP infection, high-dose amoxicillin-PPI dual therapy failed to achieve high eradication rates compared with a clarithromycin-based quadruple regimen. Clarithromycin-based quadruple therapy for H. pylori eradication has a higher eradication rate despite more side effects, and similar compliance compared to high-dose dual therapy.

Introduction: Inflammatory bowel diseases (IBD) significantly influence sexual function due to their symptoms. The impact of the disease on sexuality and intimacy is a predominant concern for IBD patients, though data on sexual (SD) and erectile dysfunction (ED) and their determinants remain scarce.

Aim: The aim of this study was to evaluate sexual function and identify predictors of SD among patients with IBD during biological treatment.

Material and methods: This prospective study included 135 adult patients with Crohn's disease (n = 106) and ulcerative colitis (n = 29) who were selected for biological treatment based on established criteria (CD: CDAI > 300; UC: Total Mayo score > 6). Participants completed validated questionnaires on their sexual function: the Female Sexual Function Index (FSFI) and the International Index of Erectile Function-5 (IIEF-5), with a question from the Inflammatory Bowel Disease Questionnaire (IBDQ).

Results: 43.7% of patients reported SD, with similar proportions in men and women (p = 0.536). There was no significant correlation between the duration of IBD, type of medication or calprotectin levels and the results of the FSFI and IIEF-5 questionnaires. Self-reported limitations were greater for women compared to men (p < 0.001), with a significant correlation between them and both IIEF-5 and FSFI scores across both disease types (p < 0.001).

Conclusions: SD and ED among patients treated with biologics were associated with psychological factors but not disease severity. The type of medication used to treat the underlying disease did not influence the development of SD. These findings underscore the need for a comprehensive understanding of sexual health and psychological support for IBD patients.

Introduction: Malignant polyps are primarily adenocarcinomas arising from adenomatous polyps, with the potential to metastasize to regional lymph nodes and distant sites. In our institute, significant gaps in knowledge about the histopathological characteristics of malignant colorectal polyps continue to exist despite their recent increase in prominence.

Aim: This study aims to describe the demographic and pathological features of malignant polyps and investigate the correlation between the Haggitt level and various parameters.

Material and methods: This retrospective study included patients who underwent colonoscopy and polypectomy with the diagnosis of adenocarcinoma arising from an adenomatous polyp between January 2018 and December 2022.

Results: The correlation between the Haggitt level and variables was assessed using the χ² test. The study included 53 patients with a 2 : 1 male-to-female ratio and a mean age of 66 years. Malignant polyps were primarily located in the sigmoid colon and rectum. The presence of lymphatic and perineural invasion was correlated with a deeper level of invasion.

Conclusions: The rectosigmoid colon is the predilection site for malignant polyps, and a deeper level increases the risk of lymphatic and perineural invasion.

Introduction: Inflammatory bowel disease (IBD) is mainly treated medically, especially with the availability of biological agents. Although anti-TNF drugs have been the only biological drugs available to treat ulcerative colitis (UC) and Crohn's disease (CD) patients for too many years, recently novel biological therapies have been approved for therapy. Using these novel agents as second-line biological therapies has proven to have a good effect on the induction and maintenance of remission of these diseases.

Aim: To evaluate the effectiveness of second-line biologics (ustekinumab and vedolizumab) after an anti-TNF agent failure.

Material and methods: From 50 IBD patients receiving biological therapy, 26 patients with severe UC and CD receiving vedolizumab and ustekinumab for 1 year were chosen for this observational and cross-sectional study.

Results: 80% of CD patients received vedolizumab, while 75% of UC patients received ustekinumab. UC activity as indicated by the Mayo Scoring Index significantly decreased during follow-up, while CD activity as indicated by Crohn's Disease Activity Index (CDAI) did not significantly decrease with the rise of inflammatory markers, which could be due to the small number of IBD patients who received vedolizumab and ustekinumab.

Conclusions: There was superior effectiveness of ustekinumab compared to vedolizumab in treating UC patients with prior anti-TNF treatment failure.

Numerous physiological processes occurring in the digestive system are subject to circadian rhythms, which are regulated by the endogenous biological clock. The motor activity of the small intestine, large intestine, and rectum operates in a 24-hour system, with significant differences between day and night periods. It is primarily correlated with the time of meals, hormone secretion rhythms, and other activities undertaken by the organism. In recent years, numerous scientific reports have emerged about the fundamental role of circadian rhythms in the proper functioning of the gut microbiota. In addition, the microbiota and its metabolites also influence the host's daily cycles, which affects the overall state of their organism. The aim of this review is to outline the mechanisms of action and interactions between biological rhythms, gut motility, and the functioning of the gut microbiota.

Introduction: Bleeding, especially non-variceal upper gastrointestinal bleeding (NVUGIB), remains the most common cause of readmission in left ventricular assist device (LVAD) patients. Any readmission after NVUGIB carries a worse prognosis.

Aim: To compare readmission outcomes in NVUGIB patients with and without LVAD.

Material and methods: We identified adult NVUGIB patients using the National Readmission Database 2018 employing International Classification of Diseases, Tenth Revision (ICD-10) codes. The patients were grouped based on LVAD history. Proportions were compared using the Fisher exact test, and multivariate Cox proportional regression analysis was used to compute adjusted p-values. We used Stata version 14.2 to perform analyses considering 2-sided p < 0.05 as statistically significant.

Results: The analysis included 322,342 NVUGIB patients, 1403 had a history of LVAD (mean age 64.25 years). The 30-day all-cause readmission rate in NVUGIB with LVAD was higher (24.31% vs. 13.92%, p < 0.001). Gastrointestinal bleeding as a readmission cause was more prevalent in the LVAD group. In patients with LVAD, NVUGIB readmissions required more complex endoscopic procedures, either requiring intervention during endoscopy or enteroscopy. There was no difference in mortality in NVUGIB readmissions (1.51% vs. 4.49%, p = 0.36); however, the length and cost of stay were higher in the LVAD group. Additionally, we identified novel independent predictors of readmission from NVUGIB in patients with LVADs.

Conclusions: Readmissions in NVUGIB patients after LVAD require complex haemostatic intervention and are associated with greater resource utilization. To reduce readmissions and associated healthcare costs, it is essential to identify high-risk patients.

Introduction: Inflammatory bowel disease (IBD) patients use a wide variety of immunosuppressive drugs, including biologics, but their effect on SARS-CoV-2 vaccine antibody levels remains a mystery.

Aim: We analysed whether the drugs used in the treatment of IBD patients could affect the concentration of SARS-CoV-2 antibodies.

Material and methods: This is a prospective, single-centre evaluation of the persistence of SARS-CoV-2 antibodies after vaccination at various time points: every 2 months throughout the 6^th month after the first dose.

Results: We included a total of 346 vaccinated IBD patients in the study. A negative correlation between antibody level and time from full vaccination was confirmed for the following types of therapy: infliximab (rho = -0.32, p < 0.001), adalimumab (rho = -0.35, p = 0.025), and vedolizumab (rho = -0.50, p < 0.001). In the case of other, long-term drug administration, a negative correlation between antibody level and time from full vaccination was confirmed for mesalazine (rho = -0.35, p < 0.001), budesonide (rho = -0.58, p = 0.004), systemic glucocorticoids (rho = -0.58, p < 0.001), and azathioprine (rho = -0.44, p < 0.001).

Conclusions: Due to the immunosuppressive and biological treatment, IBD patients are exposed to a shorter persistence of SARS-CoV-2 antibodies and require booster doses. The role of gastroenterologists in educating patients about the need to continue SARS-CoV-2 vaccination remains crucial.

Introduction: Gastroesophageal reflux disease (GERD) is a common disease that negatively affects the quality of life, and its pathophysiology is multifactorial.

Aim: Our study aims to investigate the relationship between histological and topographic characteristics of Helicobacter pylori (H. pylori) gastritis and the symptoms, presence, and severity of oesophagitis in patients with reflux symptoms.

Material and methods: The symptoms, demographic data, and physical examination results of the patients admitted with gastrointestinal complaints were recorded and oesophagogastroduodenoscopies were performed. Biopsies were taken from the antrum and corpus.

Results: Of the 171 patients, 113 were in the reflux group and 58 were in the non-reflux group. 103 (60%) of the patients were female and 68 (40%) were male. The mean age was 40 ±14 years in the GERD group and 49 ±16 years in the non-reflux group. There were no statistically significant differences between both groups in terms of endoscopic results or the presence and degree of oesophagitis. The total H. pylori frequency was found to be 73%; 75% in the GERD group and 69% in the non-reflux group. There was no significant relationship between the presence and degree of reflux oesophagitis. Chronic inflammation and neutrophil activity were higher in the antrum and corpus in the H. pylori-positive group, and gland atrophy was detected more frequently in the antrum in the H. pylori-negative group.

Conclusions: The histological type of gastritis caused by H. pylori rather than the presence of H. pylori may be associated with GERD.

Artificial intelligence (AI) and image processing are revolutionising the diagnosis and management of liver cancer. Recent advancements showcase AI's ability to analyse medical imaging data, like computed tomography scans and magnetic resonance imaging, accurately detecting and classifying liver cancer lesions for early intervention. Predictive models aid prognosis estimation and recurrence pattern identification, facilitating personalised treatment planning. Image processing techniques enhance data analysis by precise segmentation of liver structures, fusion of information from multiple modalities, and feature extraction for informed decision-making. Despite progress, challenges persist, including the need for standardised datasets and regulatory considerations.

Introduction: Gastric cancer is one of the world's leading causes of death due to oncological diseases. Gastric cancer comprises a diverse group of diseases that includes several oncological units.

Aim: To analyse the nosological structure of epidemiological data related to gastric cancer in Ukraine and compare it with global trends from 2003 to 2020.

Material and methods: The data were retrieved from the National Cancer Registry of Ukraine and analysed using MedCalc for Windows, version 20.218 (MedCalc Software, Ostend, Belgium).

Results: Eight forms of gastric cancer were diagnosed every year. The lowest incidence rate was in 2020, with 8.99 per 100,000 people/year. This was a 33.71% drop compared to 2005 (p < 0.0001). Adenocarcinoma constituted the largest part of the cases over the 2003 to 2020 period: 96.38% (95% CI: 95.02-97.05%). All the other types of gastric cancer together comprised 2.97% (95% CI: 2.34-3.76%) of the cases. The number of adenocarcinoma cases as well as its incidence rate decreased in 2003-2020 in Ukraine. The incidence rate of all types of gastric cancer was seen to decrease over the 2003-2020 timeframe in Ukraine. Adenocarcinoma was the leading form of gastric cancer in the country, and other types were uncommon in both Ukraine and the rest of the world. There was a change in the incidence rates of the other forms of gastric cancer, but those incidences did not notably affect the structure of the epidemiological data.

Conclusions: The total number of cases of gastric cancer, as well as its incidence rate, decreased in Ukraine from 2003 to 2020. This situation corresponds with global tendencies.