Jiri Dolina

Spontaneous bacterial peritonitis in the Czech Republic: prevalence and aetiology.

&NA; The aim of the study was to determine the prevalence and detailed data concerning the incidence of spontaneous bacterial peritonitis in the Czech Republic. Ninety‐nine patients with liver cirrhosis and ascites were examined. Spontaneous bacterial peritonitis was diagnosed in 35 patients (35.4%). It was revealed more often in patients with alcoholic aetiology of cirrhosis whose anamnesis involved sub‐febrile or febrile states and the deterioration of ascites. Elevated serum leucocyte counts and increased levels of C‐reactive protein can contribute to the diagnosis. A low level of total protein and albumin in ascites predisposes to the increase of this infection. The reduction of the platelet count in a set of patients with spontaneous bacterial peritonitis indicates the influence of portal hypertension in the aetiology of the disease.

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.

The Use of Biomarkers in Early Diagnostics of Pancreatic Cancer

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal solid malignancies with increasing incidence. The poor prognosis is due to the aggressive nature of the tumor, late detection, and the resistance to chemotherapy and radiotherapy. A radical surgery procedure is the only treatment that has been shown to improve the 5-year survival rate to 20-25%. However, the majority of patients (80-85%) are diagnosed with locally advanced or metastatic disease and just 15-20% patients are diagnosed in an early stage allowing them to undergo the potentially curative surgical resection. The early detection of PDAC without the use of invasive methods is challenging and discovery of a cost-effective biomarker with high specificity and sensitivity could significantly improve the treatment and survival in these patients. In this review, we summarize current and newly examined biomarkers in early PDAC detection.

Qualitative Evaluation of the Composition of Refluxate by 24-Hour Multichannel Esophageal Intraluminal Impedance and pH-Monitoring and its Relationship to Extraesophageal Reflux Disease

We presented a study focused on qualitative evaluation of the composition of refluxate and its relationship with extraesophageal symptoms. Gastroesophageal reflux disease (GERD) is a disease caused by backflow of gastric contents into the esophagus due to the failure of physiological antireflux mechanisms and can lead to esophageal and extraesophageal symptomatology. Extraesophageal reflux (EER) is a condition where refluxate penetrate above the upper esophageal sphincter (UES) in to the oral cavity, pharynx, upper and lower respiratory tract and leads to pathological changes. The examinations in our study were carried out using 24-hour multichannel intraluminal impedance and pH esophageal monitoring (MII-pH), which compared to the more commonly used conventional pH-monitoring can accurately detect reflux episodes at all pH levels and divide the episodes to acid reflux, weakly acidic reflux and nonacid reflux, and also provides information of the composition of refluxate (liquid, gas and mixture). We evaluated results of the examinations from 200 patients in two groups. The first group included 100 patients with classic GERD and in the second group were 100 patients with EER symptoms. We evaluated DeMeester score, the number of reflux episodes by pH, simultaneously the state of matter and the rate of penetration in the UES area. Patients with EER symptoms have more weakly acid reflux episodes and fewer acid reflux episodes compared to a group of patients with classical GERD symptoms while we found minor differences in the frequency of individual components of refluxate. In the group with EER we also observed lower values of DeMeester score, a higher number of gaseous reflux episodes and generally significantly higher number of penetration of refluxate of all states of matter to the UES area.

The optimal bowel preparation intervals before colonoscopy: A randomized study comparing polyethylene glycol and low-volume solutions

BACKGROUND & AIMS The optimal duration of bowel preparation has only been assessed for polyethylene glycol (PEG). The aim of the study was to determine the intervals for achieving a satisfactory quality/tolerability of the preparation using PEG/ascorbic acid (PEGA) and sodium picosulphate/magnesium citrate (SPMC), and to compare them with 4L of PEG. METHODS A randomized, endoscopist-blinded, multicentre study. The 612 outpatients referred to a colonoscopy, were prepared using PEG, SPMC, PEGA. The quality, tolerability, duration of the preparation, and the interval from the end of the preparation to the colonoscopy was assessed. RESULTS Optimum duration of the preparation was similar for both PEG and SPMC (≥7.3 vs. ≥8.8 h, overall ≥8.4 h). Optimum interval to the colonoscopy was ≤11.8 h and did not differ between preparations (PEG, PEGA ≤ 11.8, SPMC ≤ 13.3 h). These times were the only predictors for a satisfactory preparation. The tolerability depends on the product type (SPMC) only. Timing of the preparation or the other factors had no impact on tolerability. CONCLUSION The optimum intervals for bowel preparation are identical for all preparations. Satisfactory preparation is achived at the preparation length ≥8.4 h and the time to colonoscopy ≤11.8 h.

Crohn disease and pregnancy: a case report of an acute abdomen

We present a 29-year-old patient with Crohn disease diagnosed in 2009 who underwent right side hemicolectomy in January 2014 (because of a stenosis of caecum and ascending colon). Side to side anastomosis was performed. The control colonoscopy did not show signs of CD recurrence, there were only three aphthous lesions near the base of the colon. Rutgeerts score was i1, so the step-up therapy was not indicated. After the procedure, the patient remained in remission on a conservative treatment using azathioprine. The patient is a non-smoker since 2010, before that she used to smoke five cigarettes per day and before conception she used per oral contraception for 8 years until August 2014. Because of the remission of CD and after a consensus with a gastroenterologist, the first pregnancy was planned. During the pregnancy, the medication remained on azathioprine.

Different clinical utility of oropharyngeal bacterial screening prior to percutaneous endoscopic gastrostomy in oncological and neurological patients.

Background. The aim of this study was to monitor oropharyngeal bacterial colonization in patients indicated for percutaneous endoscopic gastronomy (PEG). Methods. Oropharyngeal swabs were obtained from patients prior to PEG placement. A development of peristomal infection was evaluated. The analysis of oropharyngeal and peristomal site pathogens was done. Results. Consecutive 274 patients referred for PEG due to neurological disorder or cancer completed the study. Oropharyngeal colonization with pathogens was observed in 69% (190/274), dominantly in the neurologic subgroup of patients (P < 0.001). Peristomal infection occurred in 30 (10.9%) of patients and in 57% of them the correlation between oropharyngeal and peristomal agents was present. The presence of oropharyngeal pathogens was assessed as an important risk factor for the development of peristomal infection only in oncological patients (OR = 8.33, 95% CI: 1.66–41.76). Despite a high prevalence of pathogens in neurological patients, it did not influence the risk of peristomal infection with the exception for methicillin resistant Staphylococcus aureus (MRSA) carriers (OR 4.5, 95% CI: 1.08–18.76). Conclusion. During oropharyngeal microbial screening prior to the PEG insertion, the detection of pathogens may be a marker of the increased risk of peristomal infection in cancer patients only. In neurological patients the benefit of the screening is limited to the detection of MRSA carriers.

Swallowing Disorders Related to Vertebrogenic Dysfunctions

In recent years, a growing interest in functional gastrointestinal problems can be noticed. In Western Europe, there is prevalence of functional disorders of the gastrointestinal tract in nearly 40% of the population. In Great Britain, 8 to 10% of patients visiting general practitioners have gastrointestinal problems, and approximately 50% of these are functional disorders (Becker & Aroldo, 1990). In the United States, 14% of the population are treated annually for functional gastrointestinal disorders, and in 50 to 70% of patients sent to a gastroenterologist, no significant pathology is detected (Mathias & Clench, 1995).