Jiří Dolina

Incidence of chronic pancreatitis in the Czech Republic.

There have been only a few studies dealing with the incidence of chronic pancreatitis published. Over the last 80 years, original studies describing the incidence of chronic pancreatitis were undertaken, including studies in Scandinavia, Switzerland, Hungary and Poland. Incidence varied geographically, from 1.6 new cases per year among 100,000 inhabitants in Switzerland to 23 new cases among 100,000 inhabitants in Finland. The aetiology of 70% of all cases was alcoholic pancreatitis. The incidence of chronic pancreatitis in the Czech Republic is 7.9 per 100,000 inhabitants per year, similar to that of Denmark and Germany, but higher than that of Poland or Switzerland. In our study, the main aetiological factor was alcohol (65.4% of all cases, with consumption of alcohol of > 75.0 g/day).

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.

Combined treatment of achalasia – botulinum toxin injection followed by pneumatic dilatation: long‐term results

Injection of botulinum toxin (BT) and pneumatic dilatation are available methods in nonsurgical treatment of achalasia. Authors anticipate beneficial effect of prior BT injection on the success of pneumatic dilatation and duration of its effect. There are no long-term data available to assess efficacy of combined treatment. From 1998 to 2007, 51 consecutive patients (20 men and 31 women, age 24-83) with achalasia were included and prospectively followed up. Each patient received injection of 200 IU of BT into the lower esophageal sphincter (LES) during endoscopy and 8 days later pneumatic dilatation (PD) under X-ray control was performed. The follow-up was established every 3 months first year and then annually. The efficacy was evaluated by a questionnaire concerning patients symptoms and manometry. Results were compared with 40 historical controls (16 men and 24 women, age 26-80) treated by PD alone using the same method and follow-up. Fifty-one patients underwent combined treatment. Four patients failed in follow-up and were not included for analysis. The mean duration of follow-up was 48 months with range 12-96 months. Thirty-four of forty-seven (72%) patients were satisfied with results with none or very rare and mild troubles at the time of the last visit. Forty-one patients were followed up more than 2 years. Effect of therapy lasted in 75% (31/41) of them. In 17 patients, more than 5 years after treatment, effect lasted in 12 (70%). Mean tonus of LES before therapy was 29 mm Hg (10-80), 3 months after therapy decreased to 14 mmHg (5-26). The cumulative 5 years remission rate (+/-95% CI) in combined treated patients 69% +/- 8% was higher than in controls 50% +/- 9%; however it, was not statistically significant (P= 0.07). In control group 1, case of perforation (2.5%) occurred. Eight patients (17%) with relapse of dysphagia were referred to laparoscopic Heller myotomy with no surgical complication. The main adverse effect was heartburn that appeared in 17 patients (36%). Initial injection of BT followed by PD seems to be effective for long-term results with fewer complications. But the combined therapy is not significantly superior to PD alone.

Radionuclide oesophageal transit scintigraphy – a useful method for verification of oesophageal dysmotility by cervical vertebropathy

We followed up a group of 43 patients suffering from cervical vertebropathy. Dynamic scintigraphy revealed a significant prolongation of oesophageal transit time of 10 ml of labelled liquid (mean transit time, MTT) in comparison with a control group. Patients treated with acupuncture showed a significant reduction in MTT in comparison with patients receiving a placebo needle application. The group of patients treated with manipulative techniques showed in addition to symptom alleviation a significant reduction in MTT. Dynamic scintigraphy facilitates verification of oesophageal dysmotility in patients suffering from vertebropathy and enables the success of therapy to be readily monitored.

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.

Capillary Electrophoretic Analysis of Exhaled Breath Condensate in the Diagnosis of Gastroesophageal Reflux Disease

Abstract In this work, capillary electrophoresis with contactless conductometric detection (CCD) was used for the analysis of the ionic content of exhaled breath condensate (EBC) to differentiate between healthy individuals and patients with gastroesophageal reflux disease (GERD). The exhaled breath condensate was collected using a miniature sample collection device and the content analyzed using a separation electrolyte composed of 20 mM 2-(N-morpholino)ethanesulfonic acid, 20 mM L-histidine, 2 mM 18-Crown-6 and 30 M cetyltrimethylammonium bromide. The separation of anions took less than 2.5 minutes, while the cations were separated in less than 1.5 minutes. The most significantly elevated ions in the group of patients suffering from gastroesophageal reflux disease were chloride, nitrate, propionate and butyrate. Although the number of subjects was too small to draw definite conclusions with regard to the discriminatory power of these ions, the pilot data are promising for EBC as a useful non-invasive alternative for other methods used in the diagnosis of gastroesophageal reflux disease

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).