Przegla̜d Gastroenterologiczny最新文献

Introduction: Portal hypertension is a common complication of liver cirrhosis. Varices are dilated collaterals that develop as a result of portal hypertension at the level of the porto-systemic connections and can cause a shift in the blood flow from high to low pressure. Common locations for porto-systemic shunts are the lower oesophagus and the gastric fundus. Ectopic varices are defined as dilated tortuous veins located at unusual sites other than the gastro-oesophageal junction.

Aim: This research aimed to study the endoscopic assessment of ectopic varices as well as necessary haemostatic interventions to our best knowledge. Also, to perform a review of the literature to compare our results to the most recent available data.

Material and methods: Our group extracted endoscopic reports of patients presenting to the emergency department with evidence of recent GI bleeding in whom ectopic varices were identified. We reported all interventions or procedures needed, details of hospitalization, radiological and laboratory results, as well as follow-up charts.

Results: Our study included 95 patients presenting to the emergency department with evidence of active GI bleeding. Ectopic varices were identified as the source of bleeding in 28 cases. Bleeding from duodenal varices was found in 17 patients and rectal varices in 9 patients. Endoscopic management was used for all cases with active bleeding. Rebleeding from ectopic varices was found in 5 cases, for whom interventional radiology was performed. All cases with rebleeding were duodenal varices. Early mortality occurred in 3 cases after re-intervention.

Conclusions: Our study describes a series of patients with ectopic varices discovered upon emergency endoscopy. Rectal varices were the most commonly found in our series. Bleeding and the need for re-intervention is more common in duodenal varices.

Introduction: Clostridioides difficile infection (CDI) is one of the most important challenges in contemporary gastroenterology. However, data from CDI studies are sometimes contradictory.

Aim: To analyse the risk factors for CDI in patients with inflammatory bowel disease (IBD).

Material and methods: This is a retrospective analysis of the medical records of 204 patients (77 IBD with CDI, 50 with IBD without CDI, and a control group of 77) hospitalised in a referral centre in Warsaw. Data were entered and analysed by using univariate logistic regression models.

Results: Patients with IBD and CDI had significantly longer hospitalisation time than patients with IBD without CDI. The population of patients with CDI and IBD was statistically significantly younger (p < 0.001). Patients with IBD and CDI had a lower body mass index (p < 0.001) and were more often treated with antibiotics (p < 0.001). Prior antibiotic use (< 1 month) was a risk factor for CDI (p = 0.003). Lower body mass index (p < 0.001) and lower levels of albumins (p = 0.036) were strong risk factors for CDI in the study group. Additional risk factors were young age (p < 0.001), length of hospitalisation (p = 0.001), treatment with glucocorticosteroids (p = 0.001), immunosuppressive treatment (p = 0.001), and gastritis and/or duodenitis (p = 0.002). The study did not confirm that proton pump inhibitors or biologic treatment affected the risk of CDI.

Conclusions: The risk factors for CDI in patients with IBD include younger age, female gender, low body mass index and hypoalbuminaemia, use of thiopurines, antibiotics, and glucocorticosteroids, prolonged hospitalisation, and gastritis and/or duodenitis.

Introduction: Stasis of bile flow can result in microbial colonization of the biliary tree. Cholangitis is a common adverse event linked to endoscopic retrograde cholangiopancreatography (ERCP).

Aim: To establish the bacterial profiles isolated from the bile sample and to evaluate the pre-ERCP risk factors predicting the microbial growth and development of post-ERCP cholangitis (PEC).

Material and methods: This was a prospective cohort study, which was conducted at the Department of Hepato-gastroenterology, SIUT from 1 January 2021 to 31 December 2021. Patients of either gender undergoing index ERCP procedure were included in the study. All the patients underwent ERCP, and bile culture (BC) aspirated immediately after cannulation was achieved prior to the contrast injection. There were 2 outcome variables. One was the presence or absence of organisms in bile culture, and the second one was the development of PEC.

Results: The total number of patients was 280. Bile culture was positive in 195 (69.6%) patients, and post-ERCP cholangitis developed in 187 (66.8%) patients. The most common organism in BC was Escherichia coli (E. coli), in 82 (42%) patients. History of jaundice, abdominal pain, and weight loss on admission along with ERCP performed for common bile duct (CBD) stricture were independent predictors of positive BC and PEC, while advanced age was an additional risk factor for PEC.

Conclusions: Microbial profile and risk factors for positive BC and PEC were evaluated. Advanced age, pre-operative jaundice, and prolonged biliary stasis are the independent risk factors for these conditions.

Introduction: Ingestion of foreign bodies is a significant problem among children, which necessitates early intervention and may lead to serious morbidity and even mortality.

Aim: To estimate the pattern of foreign body ingestion among children and identify the role of management and its outcomes in relation to the type and site of foreign bodies.

Material and methods: Our study was carried out on patients who attended the Emergency Department of the Rapareen Teaching Hospital for Paediatrics in Erbil city and were referred to the Paediatric Gastroenterology Unit during between March 2019 and January 2023. All clinical and demographic data were entered and then analysed using SPSS.

Results: Fifty-four patients visited or were admitted to the Rapareen Hospital Emergency Department with a history of ingestion of foreign bodies, with a median age of 4 years (mean age: 4.14 ±2.15 years) and a nearly equal male-to-female ratio (1.16 : 1). Most of the foreign bodies were radiopaque, and the majority were located in the oesophagus at the time of initial presentation. Disc batteries (27.8%) were the commonest foreign body, followed by coins (20.4%), of which 66.7% were retrieved endoscopically, while 4 patients needed surgical intervention. Cross-tabulation reveals a significant association between the site of materials and the early presentation, type of object, and outcome. Also, a significant association was established between the type of foreign body and gender, age, time of presentation, and outcome.

Conclusions: The button battery was the most common foreign body ingested among the children, and the majority were located in the oesophagus and extracted by endoscopy.

Introduction: Haemorrhoidal disease is one of the most common nowadays. It is often associated with a sedentary lifestyle. The leading cause of its development is also a functional disorder of the intestine and chronic constipation. To date, there is a steady growth rate of this disease, leading to its "rejuvenation". The current stage of development indicates the need for further improvement of surgical treatment and optimisation of patient management methods and the creation of uniform standards of care for this contingent of patients.

Aim: To evaluate the clinical effectiveness of the use of platelet-rich plasma therapy and the biologically active substance "ozoyl" in the treatment of haemorrhoidal disease.

Material and methods: The main group included 100 patients with chronic haemorrhoids who were operated on in the period from March 2021 to March 2022. For this group, autoplasma was used during surgery, and an ozoyl-based drug in the postoperative period. The remaining 100 participants of this study, assigned to the control group, underwent a conventional haemorrhoidectomy operation and standard patient management using a hydrophilic ointment based on chloramphenicol.

Results: After the conducted clinical studies, it was established that in the main group, the pain syndrome decreased by about 30%, considering the period from the first day of the postoperative period compared to the control group. The postoperative wound healed in the main group in the third week after the operation, unlike the control group, in which this event was noted in the fourth week. The patients did not complain during the examination 3 months later.

Conclusions: This study is of practical significance because haemorrhoidal disease today has a high prevalence, and an integrated approach is required for the treatment of such patients. Ozoyl is a powerful cell and tissue repairer.

Introduction: Inflammatory bowel diseases (IBD) are characterised by chronic inflammation of the gastrointestinal tract. There aetiopathogenesis has not yet been fully elucidated. Faecalibacterium prausnitzii is one of the most abundant in human gut, and it is found in about 5% of the gut microbiota.

Aim: To study the role of F. prausnitzii in Egyptian patients with ulcerative colitis (UC) and Crohn's disease (CD) and to assess its relationship with the disease activity.

Material and methods: This study includes 80 patients divided as follows: group I: 30 patients with UC; group II: 30 patients with CD; and group III: 20 healthy patients as control. DNA execration was performed using a faecal extraction kit and quantitative SYBR green real time PCR to identify the core of F. prausnitzii.

Results: In group 1 of UC patients, the level of bacteria was reduced by a mean of 1.68E-01, and in the control group by a mean of 2.72E-01 (p ₂ = 0.004, significant). Regarding F. prausnitzii in UC patients according to Mayo score, in severe patients the level of bacteria was reduced significantly by a median of 4.80E-02. Regarding F. prausnitzii in group 2 of CD, the level of bacteria was significantly reduced by mean of 1.70E-01, and in the control group by a mean of 2.72E-01 (p ₃ = 0.037, significant).

Conclusions: There was a significant difference between CD and UC patients and the control group in F. prausnitzii. There was a significant reduction in the level of F. prausnitzii in severe UC cases.

Introduction: Decreased bone mineral density (BMD) is one of the most frequent extraintestinal symptoms of celiac disease (CD).

Aim: The study aimed to investigate BMD, body composition, 25(OH)D, and ionised calcium blood parameters, and to compare them between women with CD and healthy individuals.

Material and methods: The study covered 30 adult women with CD and 28 healthy controls. Densitometric measurements of the lumbar spine (L1-L4) and femoral neck (FN) were conducted using dual-energy X-ray absorptiometry (DXA). Body mass was measured with the use of the bioimpedance method. Furthermore, serum 25(OH)D and ionised calcium concentration were determined. All patients completed a questionnaire referring to vitamin D and calcium supplementation.

Results: Significant differences were found between the groups for body mass, body mass index (BMI), BMD, T-score, and Z-score of the FN, BMD, and T-score of the L1-L4, and 25(OH)D concentration. Osteopaenia affected 23.33% (n = 7) and 36.67% (n = 11) of patients in the FN and L1-L4, respectively, and osteoporosis in L1-L4 affected 13.33% (n = 4) of patients with CD. There were no cases of osteoporosis in FN. CD patients more often declared vitamin D and calcium supplementation than healthy participants. None of the patients reported a history of fractures.

Conclusions: Although patients with CD more often declare supplementing vitamin D and calcium, the prevalence of osteopaenia and osteoporosis is higher in this group compared to healthy controls. At the same time, patients with CD present with lower body mass, BMI, fat tissue, muscle mass, and fat-free mass and higher 25(OH)D concentration.

Introduction: Common clinical problems are frequently seen in medical students. Gastroesophageal reflux disease (GERD) is increasingly seen in clinics and is taken seriously into consideration; from this point, we start discussing this disorder. The most important part is to find out the prevalence of GERD among medical students and determine the most dominant risk factors that affect the prognosis of the disease.

Aim: We aim at getting enough information about the best lifestyle modifications to alleviate symptoms.

Material and methods: This was a cross-sectional study conducted on medical students in Jordan through a well- structured questionnaire to assess the frequency of symptoms and if there are specific risk factors for medical students.

Results: The prevalence of GERD in medical students was found to be 42.3%, and of these 36% also had associated heartburn symptoms. The potential risk factors were psychological stress and bad dietary habits. Personal life stress was found to be the main cause of stress (65%). GERD patients had sleep problems which had a troublesome impact on them.

Conclusions: GERD symptoms are frequently encountered among the population, with increased prevalence in medical students. The most common symptom was heartburn. However, most of the students were asymptomatic. Multiple potential risk factors were identified including psychological stress and bad dietary habits.