Filip Marek

Polymorphisms of glutathione S-transferase M1, T1 and P1 in patients with reflux esophagitis and Barrett’s esophagus

AbstractReflux esophagitis (RE) and Barretts esophagus (BE) belong to the most common esophageal complications of gastroesophageal reflux disease. Glutathione S-transferase (GST) enzymes play an important role in cellular protection against oxidative stress and toxic foreign chemicals. Therefore, we investigated the hypothesis that polymorphisms in genes for these detoxifying enzymes could influence susceptibility to RE and BE. GSTM1, GSTT1 and GSTP1 loci were analyzed by PCR-based methods in 64 patients with RE (and an additional group of 22 subjects with BE as the fourth grade of esophagitis) and 173 unrelated controls. There were no significant differences in the distributions of GSTM1 and GSTT1 genotypes between the controls and patients with RE or BE. Similarly, frequencies of GSTP1 alleles were non-significantly different between the control and RE groups. However, GSTP1 B allele carriers were more frequent among the patients with BE compared to those in the reflux esophagitis group (P = 0.04, OR = 2.10, 95% CI 0.99-4.44) and most significantly when compared to the controls (P = 0.0067, Pcorr < 0.05, OR = 2.56, 95%CI 1.30-5.05). Although the GSTM1 and GSTT1 genes did not show any relationship with reflux disease, the GSTP1 gene might be one of the risk factors associated with susceptibility to RE, especially to BE.

Haplotypes of the IL-1 gene cluster are associated with gastroesophageal reflux disease and Barrett’s esophagus

OBJECTIVES Gastroesophageal reflux (GERD) is a one of the major public health problem that can lead to reflux esophagitis (RE), Barretts esophagus (BE), and esophageal adenocarcinoma (EAC). The aim of our study was to determine the impact of IL-1 gene polymorphisms on the development of GERD, RE and BE. METHODS Three hundred and thirty-three Czech patients with gastroesophageal reflux and 165 healthy controls were included in this case-control study. Four polymorphisms in the genes of the IL-1 cluster [IL-1A(-889C/T), IL-1B(-511C/T), IL-1B(+3953C/T), and IL-1RN(VNTR)] were analyzed. RESULTS Significant differences were found in IL-1RN 1/2 genotype between patients with GERD/RE and controls and in IL-1B+3953 T allele between patients with BE and healthy subjects. In addition, complex analysis revealed differences in IL-1 haplotype frequencies between the groups. Specifically, the haplotype TCCL was significantly more frequent (p = 0.016) in GERD patients than in controls and the haplotype CCCL more frequent (p = 0.008) in RE patients than in controls. However, in patients with BE, frequency of haplotype TCTL was lower (p = 0.05) and haplotypes CTCL and TCCL were higher (p = 0.03 and p = 0.02) in comparison with the controls. CONCLUSIONS Our results suggest that IL-1 haplotypes may be associated with susceptibility to GERD, RE and BE.

Spontaneous duodenal intramural haematoma imitating pancreatic pseudocyst.

Abstract Spontaneous intramural duodenal haematoma develops mostly as a complication of anticoagulation therapy. Other causes were reported only as case reports. CT diagnostics has some typical features in an intramural haematoma of the small bowel. This is especially hyperdensity of the bowel wall during the first 10 days from the onset of symptoms (30–80 HU), which could contribute to the differentiation from other infiltrative processes. These features are fully expressed only in a certain part of patients. We reported a 54 year-old female treated for epigastric pain. The patient’s history, laboratory data, ultrasonography and CT findings resulted in a mistaken diagnosis of acute pancreatitis, necrosis of the pancreatic body with a subsequent development of pancreatic pseudocyst. The CT guided drainage was performed. The correct diagnosis was made one year later-surgical treatment was indicated for clinical signs of GI obstruction and CT findings of pseudocyst recurrence. During the operation, there was a finding of intramural haematoma in the duodenojejunal border. We performed an evacuation of the haematoma and gastroenteroanastomosis.

Achalasia-Which method of treatment to choose for senior patients?

ZusammenfassungAusgangscharakteristik: Achalasie ist eine selten aufkommende Erkrankung, die jährlich 1 Person per 100.000 betrifft. Diese schließt eine rare primäre motorische Störung des distalen Ösophagus ein.Methoden: Im Verlauf der Zeitperiode 1998–2006 wurden 115 Patienten verschieden Heilungsarten der Achalasie unterzogen, eine Teilgruppe der Senioren zählte 26 Patienten. Davon 6 Patienten (Alter 69,7 J.) wurden der modifizierten Heller’schen Kardiomyotomie unterzogen, und zwar als Folge des Mißerfolgs vorhergehender endoskopischer Interventionen. Die Standardmanometrie des Ösophagus, sowie die 24 Stunden dauernden pH-Messungen, wurden prä- und postoperativ durchgeführt.Ergebnisse: Sechs an Achalasie leidende Patienten im Seniorenalter wurden der laparoskopischen Heller’schen Myotomie unterzogen. Der durchschnittliche präoperative LES-Tonus war 55mmHg, der postoperative Tonus ist auf 11mHg gefallen. Bei allen Patienten haben wir die Toupet’sche Teilfundoplikation durchgeführt, durch die präoperative Ösophagoskopie wurde keine Mikroperforierung des Ösophagus gefunden. Wir haben einen minimalen pathologischen gastroösophagischen Reflux in der pH Messung registriert - der durchschnittliche präoperative DeMeester’sche Score war 8, der postoperative dann 10,5. Die prolongierte Dysphagie kam bei keinem Patienten vor - der präoperative GIQLI Score war 94 pts., der postoperative Score dann 106 pts. In der Patientengruppe der Operierten wurde keine Mortalität oder Morbidität beobachtet.Schlußfolgerungen: Unsere Operationsergebnisse und die postoperative Patientenbeobachtung zeigen, dass die laparoskopische Heller’sche Myotomie mit der Toupet’schen Teilfundoplikation eine sichere und effektive Heilungsmethode darstellen und als die Methode der ersten Wahl für die keine Kontraindikationen für die laparoskopische Operation aufweisenden Patienten im Seniorenalter empfohlen werden können.AbstractBackground Achalasia is an uncommon illness affecting 1 per 100,000 patients a year. It encompasses a rare, primary motor disorder of the distal esophagus. Methods Over the period 1998-2006, 115 patients underwent various treatments for achalasia; the subgroup of seniors consisted of 26 patients. Six patients of these (age 69.7 y) underwent a modified Heller cardiomyotomy due to failure of previous endoscopic interventions. Standard esophageal manometry and 24 hour pH metry were performed pre- and postoperatively. Results Six senior patients with achalasia underwent a laparoscopic Heller myotomy. Average preoperative tonus of the LES was 55 mmHg, postoperative tonus of the LES decreased to 11 mmHg. We performed Toupet partial fundoplication in all patients; no microperforation of the esophagus was found in the preoperative esophagoscopy. We recorded minimal pathological gastroesophageal reflux in pH metry – the average preoperative DeMeester score was 8, postoperatively 10.5. Prolonged dysphagia was not present in any patient – preoperative GIQLI score was 94, postoperative score was 106. There was no mortality or morbidity in the group of the operated patients. Conclusion Our operational results and postoperative follow-up show that laparoscopic Heller myotomy with Toupet partial fundoplication is a safe and effective treatment and can be recommended as the method of first choice for senior patients with no contraindication for laparoscopic operation.

Comparison of cervical anastomotic leak and stenosis after oesophagectomy for carcinoma according to the interval of the stomach ischaemic conditioning

BACKGROUND Stomach preparation by ischaemic conditioning prior to oesophageal resection represents a potential method of reducing the risk of anastomotic complications. This study compares the results of the anastomotic complications of cervical anastomosis after oesophagectomy with a short interval after ischaemic conditioning (group S) and a long interval (group L). METHODS Subjects undergoing oesophagectomy for carcinoma after ischaemic conditioning were divided into two groups. Group S had a median interval between ischaemic conditioning and resection of 20 days, while for group L the median interval was 49 days. Anastomotic leak and anastomotic stenosis in relation to the interval between ischaemic conditioning and actual resection were followed. RESULTS After ischaemic conditioning, 33 subjects in total underwent surgery for carcinoma; 19 subjects in group S and 14 subjects in group L. Anastomotic leak incidence was comparable in both groups. Anastomotic stenosis occurred in 21% of cases in group S and 7% of cases in group L (not statistically significant). CONCLUSIONS A long interval between ischaemic conditioning and oesophagectomy does not adversely affect the postoperative complications. A lower incidence of anastomosis stenoses was found in subjects with a longer interval, however, given the size of our sample, the statistical significance was not demonstrated. Both groups seem comparable in surgical procedure course and postoperative complications.

Achalasie – welche Heilungsmethode soll für ältere Patienten gewählt werden?

ZusammenfassungAusgangscharakteristik: Achalasie ist eine selten aufkommende Erkrankung, die jährlich 1 Person per 100.000 betrifft. Diese schließt eine rare primäre motorische Störung des distalen Ösophagus ein.Methoden: Im Verlauf der Zeitperiode 1998–2006 wurden 115 Patienten verschieden Heilungsarten der Achalasie unterzogen, eine Teilgruppe der Senioren zählte 26 Patienten. Davon 6 Patienten (Alter 69,7 J.) wurden der modifizierten Heller’schen Kardiomyotomie unterzogen, und zwar als Folge des Mißerfolgs vorhergehender endoskopischer Interventionen. Die Standardmanometrie des Ösophagus, sowie die 24 Stunden dauernden pH-Messungen, wurden prä- und postoperativ durchgeführt.Ergebnisse: Sechs an Achalasie leidende Patienten im Seniorenalter wurden der laparoskopischen Heller’schen Myotomie unterzogen. Der durchschnittliche präoperative LES-Tonus war 55mmHg, der postoperative Tonus ist auf 11mHg gefallen. Bei allen Patienten haben wir die Toupet’sche Teilfundoplikation durchgeführt, durch die präoperative Ösophagoskopie wurde keine Mikroperforierung des Ösophagus gefunden. Wir haben einen minimalen pathologischen gastroösophagischen Reflux in der pH Messung registriert - der durchschnittliche präoperative DeMeester’sche Score war 8, der postoperative dann 10,5. Die prolongierte Dysphagie kam bei keinem Patienten vor - der präoperative GIQLI Score war 94 pts., der postoperative Score dann 106 pts. In der Patientengruppe der Operierten wurde keine Mortalität oder Morbidität beobachtet.Schlußfolgerungen: Unsere Operationsergebnisse und die postoperative Patientenbeobachtung zeigen, dass die laparoskopische Heller’sche Myotomie mit der Toupet’schen Teilfundoplikation eine sichere und effektive Heilungsmethode darstellen und als die Methode der ersten Wahl für die keine Kontraindikationen für die laparoskopische Operation aufweisenden Patienten im Seniorenalter empfohlen werden können.AbstractBackground Achalasia is an uncommon illness affecting 1 per 100,000 patients a year. It encompasses a rare, primary motor disorder of the distal esophagus. Methods Over the period 1998-2006, 115 patients underwent various treatments for achalasia; the subgroup of seniors consisted of 26 patients. Six patients of these (age 69.7 y) underwent a modified Heller cardiomyotomy due to failure of previous endoscopic interventions. Standard esophageal manometry and 24 hour pH metry were performed pre- and postoperatively. Results Six senior patients with achalasia underwent a laparoscopic Heller myotomy. Average preoperative tonus of the LES was 55 mmHg, postoperative tonus of the LES decreased to 11 mmHg. We performed Toupet partial fundoplication in all patients; no microperforation of the esophagus was found in the preoperative esophagoscopy. We recorded minimal pathological gastroesophageal reflux in pH metry – the average preoperative DeMeester score was 8, postoperatively 10.5. Prolonged dysphagia was not present in any patient – preoperative GIQLI score was 94, postoperative score was 106. There was no mortality or morbidity in the group of the operated patients. Conclusion Our operational results and postoperative follow-up show that laparoscopic Heller myotomy with Toupet partial fundoplication is a safe and effective treatment and can be recommended as the method of first choice for senior patients with no contraindication for laparoscopic operation.

Achalasie – welche Heilungsmethode soll für ältere Patienten gewählt werden?@@@Achalasia – Which method of treatment to choose for senior patients?

ZusammenfassungAusgangscharakteristik: Achalasie ist eine selten aufkommende Erkrankung, die jährlich 1 Person per 100.000 betrifft. Diese schließt eine rare primäre motorische Störung des distalen Ösophagus ein.Methoden: Im Verlauf der Zeitperiode 1998–2006 wurden 115 Patienten verschieden Heilungsarten der Achalasie unterzogen, eine Teilgruppe der Senioren zählte 26 Patienten. Davon 6 Patienten (Alter 69,7 J.) wurden der modifizierten Heller’schen Kardiomyotomie unterzogen, und zwar als Folge des Mißerfolgs vorhergehender endoskopischer Interventionen. Die Standardmanometrie des Ösophagus, sowie die 24 Stunden dauernden pH-Messungen, wurden prä- und postoperativ durchgeführt.Ergebnisse: Sechs an Achalasie leidende Patienten im Seniorenalter wurden der laparoskopischen Heller’schen Myotomie unterzogen. Der durchschnittliche präoperative LES-Tonus war 55mmHg, der postoperative Tonus ist auf 11mHg gefallen. Bei allen Patienten haben wir die Toupet’sche Teilfundoplikation durchgeführt, durch die präoperative Ösophagoskopie wurde keine Mikroperforierung des Ösophagus gefunden. Wir haben einen minimalen pathologischen gastroösophagischen Reflux in der pH Messung registriert - der durchschnittliche präoperative DeMeester’sche Score war 8, der postoperative dann 10,5. Die prolongierte Dysphagie kam bei keinem Patienten vor - der präoperative GIQLI Score war 94 pts., der postoperative Score dann 106 pts. In der Patientengruppe der Operierten wurde keine Mortalität oder Morbidität beobachtet.Schlußfolgerungen: Unsere Operationsergebnisse und die postoperative Patientenbeobachtung zeigen, dass die laparoskopische Heller’sche Myotomie mit der Toupet’schen Teilfundoplikation eine sichere und effektive Heilungsmethode darstellen und als die Methode der ersten Wahl für die keine Kontraindikationen für die laparoskopische Operation aufweisenden Patienten im Seniorenalter empfohlen werden können.AbstractBackground Achalasia is an uncommon illness affecting 1 per 100,000 patients a year. It encompasses a rare, primary motor disorder of the distal esophagus. Methods Over the period 1998-2006, 115 patients underwent various treatments for achalasia; the subgroup of seniors consisted of 26 patients. Six patients of these (age 69.7 y) underwent a modified Heller cardiomyotomy due to failure of previous endoscopic interventions. Standard esophageal manometry and 24 hour pH metry were performed pre- and postoperatively. Results Six senior patients with achalasia underwent a laparoscopic Heller myotomy. Average preoperative tonus of the LES was 55 mmHg, postoperative tonus of the LES decreased to 11 mmHg. We performed Toupet partial fundoplication in all patients; no microperforation of the esophagus was found in the preoperative esophagoscopy. We recorded minimal pathological gastroesophageal reflux in pH metry – the average preoperative DeMeester score was 8, postoperatively 10.5. Prolonged dysphagia was not present in any patient – preoperative GIQLI score was 94, postoperative score was 106. There was no mortality or morbidity in the group of the operated patients. Conclusion Our operational results and postoperative follow-up show that laparoscopic Heller myotomy with Toupet partial fundoplication is a safe and effective treatment and can be recommended as the method of first choice for senior patients with no contraindication for laparoscopic operation.

Tailored antireflux surgery

Background: With increasing age, the functional condition of the lower esophageal sphincter is getting weaker. Recent progress in peri-operative intensive care and the development of laparoscopic technique makes antireflux surgery a safe choice of GERD treatment in the elderly.Aim: This work evaluated the long-term results of tailored antireflux surgery in a group of elderly (more than 60 years old) patients.Results: Five hundred and eighty one patients underwent antireflux surgery in our department from 1999 to 2005. Seventy of them (12,0%) were older than 60 years. Exclusion criteria of surgery were ASA IV classification and high grade esophageal dysmotility. Toupet’s wrap was offered to patients with esophageal dysmotility or esophageal sphincter pressure higher than 15mm Hg (16 cases). The rest were offered Nissen-Rossetti’s complete wrap (54 cases). There was zero mortality and no further significant dysphagia. Pathological gastro-esophageal reflux after the surgery was detected in 6 patients (8,6%), which was a higher proportion than in the group of patients under 60 years.Conclusion: Good results of antireflux surgery with zero mortality and low morbidity can be achieved even in the elderly (more frequent use of incomplete Toupet’s wrap).