Gastroenterologie a Hepatologie最新文献

{"title":"Hidradenitis suppurativa, intestinal microbiome and SIBO – a comprehensive overview of the issue","authors":"Barbara Ivanková, Janette Baloghová","doi":"10.48095/ccgh202441","DOIUrl":"https://doi.org/10.48095/ccgh202441","url":null,"abstract":"Hidradenitis suppurativa (HS) is a chronic immune-mediated infl ammatory skin disease. It is characterized by an infl ammation that aff ects apocrine gland bearing skin in axillae, groin and under the breasts with the formation of painful nodules, abscesses and purulent discharge, sinuses and scaring. Patients with HS have an increased incidence of infl ammatory bowel disease (IBD), which also indicates their cross-sections in the pathogenesis of dysregulation congenital and adaptive immunity. Recently, there has been a signifi cant increase of interest in the intestinal microbio me and skin disease, as much as its role in the pathogenesis of HS. According to literature, intestinal dysbio sis promotes the production of proinfl ammatory cytokines and consequently the formation of HS lesions. Overgrowth of bacteria in the small intestine (SIBO) is a condition characterized by an increased concentration of bacteria in the large intestine. Eradication of SIBO was able to improve psoriasis measured by the psoriasis severity index. In this context, it is hypothesized that eredication of SIBO may have a benefi cial eff ect on the severity of manifestations in infl ammatory immune-mediated skin diseases, including HS.","PeriodicalId":38577,"journal":{"name":"Gastroenterologie a Hepatologie","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140412094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methotrexate is the re-discovered drug for Crohn’s disease","authors":"Milan Lukáš","doi":"10.48095/ccgh202437","DOIUrl":"https://doi.org/10.48095/ccgh202437","url":null,"abstract":"Methotrexate, the analog of folic acid, was introduced for clinical practice more than 60 years ago being utilized for immune- -mediated disorders including also Crohn’s disease. In the diff erence from rheumatoid arthritis patients, methotrexate in Crohn’s disease patients is used in higher dosages and preferable route of administration is parenteral (subcutaneous) application. Indication for methotrexate therapy is a mild to moderate severity of Crohn’s disease after induction the remission due to topic or systemic corticosteroids therapy. Other indication for methotrexate therapy is concomitant immunosuppressive therapy with anti-TNF drugs. The cotemporary application of methotrexate is associated with higher trough level of infl iximab and in less frequent of anti-drugs antibody production. Comparing to thiopurins, methotrexate therapy is associated with lower risk of severe side eff ects and there is no contraindication to start therapy in those patients with a history of malignancy.","PeriodicalId":38577,"journal":{"name":"Gastroenterologie a Hepatologie","volume":"6 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140410124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic hypereosinophilic syndrome with gastrointestinal involvement","authors":"Dagmar Husáková, Štefan Konečný","doi":"10.48095/ccgh202447","DOIUrl":"https://doi.org/10.48095/ccgh202447","url":null,"abstract":"Idiopathic hypereosinophilic syndrome (iHES) is a rare disorder with an unclear cause that is characterized by a persistent increase in the number of eosinophilic granulocytes in the peripheral blood and organ damage. The differential dia­gnosis of hypereosinophilia is broad – the cause may be primary (clonal), secondary (reactive – most often in the context of allergic, parasitic, autoimmune or malignant diseases), genetic (familial) or idiopathic (determined per exclusionem). This case report describes a patient with recurrent episodes of abdominal pain, ascites, and leukocytosis with hypereosinophilia, who underwent extensive examinations over the years, including two dia­gnostic laparoscopies. CT scans revealed abnormalities in the small bowel and stomach region, and histological and cytological examinations confirmed an increased number of eosinophils in the duodenal villi and eosinophilic ascites. Gastroscopy raised suspicion of eosinophilic esophagitis and stomach involvement, but this was not confirmed histologically. The ethiology of mild hepatopathy with elevated transaminases remains unclear, as the patient refused liver bio­psy, repeatedly. After ruling out primary and secondary causes of hypereosinophilia, the idiopathic hypereosinophilic syndrome was dia­gnosed and corticotherapy was initiated with good clinical and laboratory outcome and normalization of eosinophil count.","PeriodicalId":38577,"journal":{"name":"Gastroenterologie a Hepatologie","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140414527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous robotic resection of colorectal cancer and liver metastases – first experience","authors":"Vladimír Teplan, Jiří Chrobok, Aaron Rulseh, Ronald Pospíšil","doi":"10.48095/ccgh202453","DOIUrl":"https://doi.org/10.48095/ccgh202453","url":null,"abstract":"Robotic surgery is a rapidly emerging surgical technique worldwide, which has a number of advantages in comparison to the majority of surgical procedures used so far (shorter hospital stay, faster recovery, less pain at the surgical site, fewer surgical site infections, lower risk of incisional hernia and fewer conversions). We present a patient with colorectal cancer in the hepatic flexure and solitary hepatic metastasis (segment 2). Right-sided hemicolectomy with intracorporeal side-to-side anastomosis was performed with the DaVinci Xi robotic system, as well as robotic resection of the second hepatic segment, without the necessity of changing the location (docking) of the robotic instruments. Use of the minimally invasive robotic technique and ERAS protocol significantly accelerated postoperative recovery, including recovery of peristalsis, reduced the need for analgesics, and the patient was discharged on the 5th postoperative day.","PeriodicalId":38577,"journal":{"name":"Gastroenterologie a Hepatologie","volume":"3 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140410667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urolithiasis in patients with inflammatory bowel disease – possibilities of prevention and metabolic influence","authors":"Vladimír Teplan, Radek Netušil, Milan Lukáš","doi":"10.48095/ccgh2023437","DOIUrl":"https://doi.org/10.48095/ccgh2023437","url":null,"abstract":"Inflammatory bowel diseases (IBD) are typically accompanied by diarrhoea and frequently by malabsorption, both of which are predisposing factors for the formation of renal calculi. In patients who have not undergone bowel surgery the prevalence of urolithiasis has ranged from 1.5 to 5%, but after surgery, stone prevalence can increase to up to 16%. Enteric hyperoxaluria is a frequent complication of inflammatory bowel diseases after ileal-coecal resection, ileostomy, colostomy resection and bariatric surgery. The excess of oxalate is primarily excreted by the kidneys. Increased urinary excretion of oxalate results in urinary calcium oxalate supersaturation, leading to crystal aggregation, urolithiasis, and/or nephrocalcinosis. Prevention of oxalate lithiasis includes high fluid intake, nutritionally balanced low-oxalate, low-fat, low-salt diet, prescription of oral citrate and magnesium, calcium supplement, and also biological manipulation of intestinal flora (microbiota). In IBD patients, urolithiasis can be associated with serious urinary tract infection – in some cases asymptomatic – which can lead to chronic renal insufficiency and failure. New therapeutic approaches to patients with inflammatory bowel diseases have completely changed the natural history of these diseases with reduced number of bowel surgery. Whether this has changed the prevalence and risk factors for urinary calculi in patients with inflammatory bowel diseases is still unknown.","PeriodicalId":38577,"journal":{"name":"Gastroenterologie a Hepatologie","volume":"46 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in premature mortality from digestive system cancers in Slovakia in the years 2011–2020: 8 diagnoses over 10 years","authors":"Tomáš Koller, Anna Baráková","doi":"10.48095/ccgh2023394","DOIUrl":"https://doi.org/10.48095/ccgh2023394","url":null,"abstract":"Introduction and objectives: Slovakia ranks among the leaders in preventable deaths, but a systematic analysis of the share of digestive system cancers (DSCs) and their trends has been lacking. We analyzed data on mortality from DSCs in Slovakia in the years 2011–2020 with an emphasis on premature deaths, sex differences, and trends for individual locations. Material and methods: Data in the years 2011–2020 by ICD-10 codes C15–C26 aggregated by age subgroups (<50 years, <65 years, <75 years), sex, and individual locations were available. The crude death rate was calculated per 100,000 inhabitants and linear regression was used for the annual percentage change in mortality. Results: We recorded 46,508 deaths; 27,146 were men and 19,362 women with an average age of 70,5 ±11,6. Deaths under the age of 50, 65, and 75 made up 4.1%, 29.8%, and 60.4% of all deaths from DSCs. Among all deaths due to cancer under the age of 65, deaths from DSCs accounted for one-third in men and one-quarter in women. Under the age of 75, colorectal (41%), pancreatic (21%), stomach (12.8%), and liver (10%) cancers dominated the proportions of locations. The average age of death was significantly lower in men and increased over the decade for all locations. In women, the trend was identical, except for the liver, intrahepatic bile ducts (decrease by 1 year), bile ducts, and stomach (no change). Under the age of 65 in all cases, the average annual mortality rate decreased by 1.7%. In men, it decreased for locations in the esophagus, stomach, colorectum (–1.8%/year), liver, and gallbladder. In women, for colorectum (–1.8%/year) and gallbladder (–6%/year). In contrast, in the entire population mortality increased for locations in the pancreas (+2.3 to 2.8%/year) and bile ducts (+4.4 to 7.3%/year). Conclusion: DSCs are significant burden causing preventable deaths. Some favorable trends (stomach, gall bladder) are simultaneously followed by unfavorable ones (biliary tract, pancreas). In the global context of an aging population and increasingly longer exposure to risk factors, we need to introduce effective societal preventive measures as well as flexible adaptation of our healthcare systems.","PeriodicalId":38577,"journal":{"name":"Gastroenterologie a Hepatologie","volume":"46 S1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcutaneous infliximab in the treatment of refractory Crohn‘s disease patients – a pilot study of drug immunogenicity","authors":"Karin Černá, Dana Ďuricová, Martin Lukáš, Naděžda Machková, Veronika Hrubá, Kristýna Kaštylová, Katarína Mitrová, Marta Kostrejová, Kristýna Kubíčková, Štěpán Peterka, Martin Kolář, Jakub Jirsa, Gabriela Vojtěchová, Milan Lukáš","doi":"10.48095/ccgh2023419","DOIUrl":"https://doi.org/10.48095/ccgh2023419","url":null,"abstract":"Introduction: Despite infliximab (IFX) still being the “gold standard” of biological therapy for Crohn’s disease (CD), its effectiveness may vary depending on many factors. One of these factors is the individual patient’s reaction to the drug. A significant clinical problem is the immunogenicity of IFX, where up to 60% of treated patients may develop antibodies against the drug, leading to a loss of response to treatment and/or adverse reactions to therapy. Since 2020, subcutaneous infliximab (IFX-SC) has been available for treating CD patients, characterized by its stable and high trough level (TL) concentration in blood. It is possible that one consequence of this property of IFX-SC is its lower rate of immunogenicity. We present a prospective study of patients diagnosed with CD with severe to refractory courses, treated with IFX-SC. The aim of the study was to monitor the immunogenicity of IFX-SC, including the dynamics of TL and anti-drug antibodies (anti-IFX). The dynamics of clinical, imaging, and laboratory markers of CD over one year of monitoring and treatment are described. Materials and methods: The study included 23 patients diagnosed with CD who had failed 2 to 6 previous lines of biological therapy, one of which was intravenous infliximab (IFX-IV). Patients were divided into two arms of induction therapy based on the presence of anti-IFX. Maintenance therapy consisted of 120 mg s.c. every 14 days, and intensification was 240 mg s.c. every 14 days if necessary. Patients were monitored at weeks W0, W4, W14, W30, and W52, recording Harvey-Bradshaw Index (HBI), serum C-reactive protein (CRP), fecal calprotectin (FC) concentrations, drug trough levels (TL IFX) and serum anti-drug antibodies (anti-IFX). Endoscopic and ultrasonographic disease scores (SES-CD and IUS) were determined, and HLA DQA1*05 haplotype was examined in all patients. Data were analyzed using MedCalc® Statistical Software with non-parametric statistical methods and binary logistic regression. Results: 52-week persistence on IFX-SC treatment was recorded in 13 out of 23 patients (56.5%), with a significant decrease in all monitored clinical, imaging, and laboratory markers of CD activity. During the therapy, 8 out of 16 initially anti-IFX positive individuals seroconverted to negative anti-IFX (50%). None of the patients treated with IFX-SC in W52 needed concomitant immunomodulator treatment. No new sensitization to infliximab was recorded in the cohort during the 52-week therapy. Conclusion: The subcutaneous route of infliximab administration may be a suitable and successful solution in situations where reinduction of infliximab therapy is desired, including patients with the presence of neutralizing antibodies against the drug.","PeriodicalId":38577,"journal":{"name":"Gastroenterologie a Hepatologie","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results from the evaluation of colorectal cancer screening in the Czech Republic","authors":"Ngo Ondřej, Chloupková Renata, Suchánek Štěpán, Ambrožová Monika, Hejcmanová Kateřina, Dvořák Petr, Zavoral Miroslav, Hejduk Karel, Dušek Ladislav, Májek Ondřej","doi":"10.48095/ccgh2023385","DOIUrl":"https://doi.org/10.48095/ccgh2023385","url":null,"abstract":"Introduction: Colorectal cancer screening, which was introduced in the Czech Republic in 2000, plays an important role in reducing the population burden. It is necessary to continuously evaluate the organised population-based program and introduce necessary adjustments to ensure its high effectiveness, which in the long term leads to a reduction in the incidence and mortality of the disease. The aim of this article is to summarise and discuss the key results of the evaluation of the National Colorectal Cancer Screening Program based on available national data. Material and methods: The evaluation used the registries of the National Health Information System, the Registry of Preventive Colonoscopies, and data on population demographics managed by the Czech Statistical Office. The analysis was carried out on available data up to 2021. Basic indicators were calculated in accordance with international recommendations, which were adapted for the Czech environment. Results: A number of performance indicators for colorectal screening demonstrate the negative impact of the COVID-19 pandemic in 2020 and 2021. Coverage of the target population by screening has stabilised at around 30% before the pandemic. Considering a three-year interval, the full coverage of the target population by screening reaches around 50%. Participation rates for follow-up colonoscopy after a positive faecal occult blood test (FOBT) screening ranged between 60 and 70% over time. FOBT screening positivity increased in the recent years up to 10%, which is reflected in the increase in the average waiting time for follow-up FOBT+ colonoscopy. Despite the identified limitations of the screening program, there has been a clear long-term decline in colorectal cancer incidence and mortality. Conclusion: The comprehensive screening information system enables the evaluation of colorectal screening. The evaluated indicators show that despite the positive impact of the screening program on the population burden, it still has its opportunities for improvement, and therefore it is essential to continue its monitoring in order to improve the quality of the whole program. Keywords colonoscopy, colorectal neoplasms, mass screening, occult blood, program evaluation, performance indicators, registries","PeriodicalId":38577,"journal":{"name":"Gastroenterologie a Hepatologie","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mixed adenoneuroendocrine carcinoma of the stomach – a case report","authors":"Marek Drab, Eva Tomsová, Juraj Marček, Tomáš Klinger","doi":"10.48095/ccgh2023409","DOIUrl":"https://doi.org/10.48095/ccgh2023409","url":null,"abstract":"Neuroendocrine tumours represent a heterogeneous group of neoplasia arising from different anatomical locations, with approximately 50% of gastrointestinal origin. Main parameters in the evaluation of each case include tumour morphology, mitotic cell count, and Ki-67 index. Mixed adeno-neuroendocrine carcinomas (MANECs) are rare aggressive neoplasms consisting of both adenocarcinomatous and neuroendocrine cells, each component constituting at least 30% of the lesion. Our case represents 77-year-old polymorbid patient who, due to signs of acute bleeding in the upper gastrointestinal tract with anaemic syndrome, underwent a gastroscopic examination for melena with the finding of an ulcer lesion on the front wall of the stomach at the junction of the body and the antrum. The control gastroscopic examinations with biopsies, at first only signs of chronic gastritis with Helicobacter pylori positivity were histologically proven, then fragments of high-grade tubular to tubulovillous adenoma and structures of moderately differentiated tubular adenocarcinoma were found. Histological analysis of the gastric resection showed mixed adeno-neuroendocrine carcinoma with lymphangioinvasion.","PeriodicalId":38577,"journal":{"name":"Gastroenterologie a Hepatologie","volume":"46 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic monitoring of levels of biological treatment of IBD - recommendations for practice","authors":"Laura Gombošová, Zuzana Zelinková, Barbora Kadlečková, Peter Lietava, Miloš Greguš, Erika Barlová, Lucia Novotná","doi":"10.48095/ccgh2023427","DOIUrl":"https://doi.org/10.48095/ccgh2023427","url":null,"abstract":"","PeriodicalId":38577,"journal":{"name":"Gastroenterologie a Hepatologie","volume":"46 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}