József Hamvas

Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis

Objective The aim of this study was to analyse the clinical characteristics of acute pancreatitis (AP) in a prospectively collected, large, multicentre cohort and to validate the major recommendations in the IAP/APA evidence-based guidelines for the management of AP. Design Eighty-six different clinical parameters were collected using an electronic clinical research form designed by the Hungarian Pancreatic Study Group. Patients 600 adult patients diagnosed with AP were prospectively enrolled from 17 Hungarian centres over a two-year period from 1 January 2013. Main Results With respect to aetiology, biliary and alcoholic pancreatitis represented the two most common forms of AP. The prevalence of biliary AP was higher in women, whereas alcoholic AP was more common in men. Hyperlipidaemia was a risk factor for severity, lack of serum enzyme elevation posed a risk for severe AP, and lack of abdominal pain at admission demonstrated a risk for mortality. Abdominal tenderness developed in all the patients with severe AP, while lack of abdominal tenderness was a favourable sign for mortality. Importantly, lung injury at admission was associated with mortality. With regard to laboratory parameters, white blood cell count and CRP were the two most sensitive indicators for severe AP. The most common local complication was peripancreatic fluid, whereas the most common distant organ failure in severe AP was lung injury. Deviation from the recommendations in the IAP/APA evidence-based guidelines on fluid replacement, enteral nutrition and timing of interventions increased severity and mortality. Conclusions Analysis of a large, nationwide, prospective cohort of AP cases allowed for the identification of important determinants of severity and mortality. Evidence-based guidelines should be observed rigorously to improve outcomes in AP.

Clinical nutrition in gastrointestinal diseases

The association between nutrition and intestinal function is based on facts. The main function of the gut is to digest and absorb nutrients in order to maintain life. Consequently, chronic gastrointestinal diseases commonly result in malnutrition and increased morbidity and mortality. Chronic malnutrition impairs digestive and absorptive function. Parenteral and enteral nutritions are effective therapeutic modalities in several diseases. In cases of gastrointestinal malfunctions, nutrition has a direct therapeutic role. The benefit of nutrition therapy is similar to medical treatment in patients with pancreatitis, Crohn disease, hepatic failure, and in those with gastrointestinal fistulas. Nutrition has both supportive and therapeutic roles in the management of chronic gastrointestinal diseases. With the development of modern techniques of nutritional support, the morbidity and mortality associated with chronic gastrointestinal diseases can be reduced.A mesterseges taplalas szamos megbetegedesben a terapia reszet kepezi. Szerepe korabban a legtobb esetben elsősorban a taplalkozni nem tudo vagy nem akaro, illetve az attol eltiltott beteg tapanyagszuksegleteinek potlasara szoritkozott, de senyvesztő betegsegek eseten, kritikus allapotokban kiegeszitő taplalast is jelent. Ezekben az esetekben a tapanyag-bejuttatas modja alapvetően ketfele lehet, enteralis es parenteralis. A gasztroenterologiai betegsegek es a taplalkozas termeszetszerűleg osszetartoznak. A megbetegedeseket az emesztőrendszer egy vagy tobb szervenek, szakaszanak megbetegedese jellemzi. Felvetődik a kerdes, hogy a beteg szervek csokkent műkodese es tapanyag-feldolgozasi kepessege ellenere hogyan ertelmezzuk a taplalasterapiat, holott az emesztőrendszer kimeletere lenne szukseg? A kerdes magaban hordozza a valaszt, hiszen a beteg szerv kimelete jogos igeny, de napjainkban a celzott, szervspecifikus taplalas a csokkent funkcioju szerv műkodesenek helyreallitasat celozza. Orv. Hetil., 2014, 155(51), 2034–2040. | The association between nutrition and intestinal function is based on facts. The main function of the gut is to digest and absorb nutrients in order to maintain life. Consequently, chronic gastrointestinal diseases commonly result in malnutrition and increased morbidity and mortality. Chronic malnutrition impairs digestive and absorptive function. Parenteral and enteral nutritions are effective therapeutic modalities in several diseases. In cases of gastrointestinal malfunctions, nutrition has a direct therapeutic role. The benefit of nutrition therapy is similar to medical treatment in patients with pancreatitis, Crohn disease, hepatic failure, and in those with gastrointestinal fistulas. Nutrition has both supportive and therapeutic roles in the management of chronic gastrointestinal diseases. With the development of modern techniques of nutritional support, the morbidity and mortality associated with chronic gastrointestinal diseases can be reduced. Orv. Hetil., 2014, 155(51), 2034–2040.

Artificial nutrition in gastrointestinal diseases

The association between nutrition and intestinal function is based on facts. The main function of the gut is to digest and absorb nutrients in order to maintain life. Consequently, chronic gastrointestinal diseases commonly result in malnutrition and increased morbidity and mortality. Chronic malnutrition impairs digestive and absorptive function. Parenteral and enteral nutritions are effective therapeutic modalities in several diseases. In cases of gastrointestinal malfunctions, nutrition has a direct therapeutic role. The benefit of nutrition therapy is similar to medical treatment in patients with pancreatitis, Crohn disease, hepatic failure, and in those with gastrointestinal fistulas. Nutrition has both supportive and therapeutic roles in the management of chronic gastrointestinal diseases. With the development of modern techniques of nutritional support, the morbidity and mortality associated with chronic gastrointestinal diseases can be reduced.A mesterseges taplalas szamos megbetegedesben a terapia reszet kepezi. Szerepe korabban a legtobb esetben elsősorban a taplalkozni nem tudo vagy nem akaro, illetve az attol eltiltott beteg tapanyagszuksegleteinek potlasara szoritkozott, de senyvesztő betegsegek eseten, kritikus allapotokban kiegeszitő taplalast is jelent. Ezekben az esetekben a tapanyag-bejuttatas modja alapvetően ketfele lehet, enteralis es parenteralis. A gasztroenterologiai betegsegek es a taplalkozas termeszetszerűleg osszetartoznak. A megbetegedeseket az emesztőrendszer egy vagy tobb szervenek, szakaszanak megbetegedese jellemzi. Felvetődik a kerdes, hogy a beteg szervek csokkent műkodese es tapanyag-feldolgozasi kepessege ellenere hogyan ertelmezzuk a taplalasterapiat, holott az emesztőrendszer kimeletere lenne szukseg? A kerdes magaban hordozza a valaszt, hiszen a beteg szerv kimelete jogos igeny, de napjainkban a celzott, szervspecifikus taplalas a csokkent funkcioju szerv műkodesenek helyreallitasat celozza. Orv. Hetil., 2014, 155(51), 2034–2040. | The association between nutrition and intestinal function is based on facts. The main function of the gut is to digest and absorb nutrients in order to maintain life. Consequently, chronic gastrointestinal diseases commonly result in malnutrition and increased morbidity and mortality. Chronic malnutrition impairs digestive and absorptive function. Parenteral and enteral nutritions are effective therapeutic modalities in several diseases. In cases of gastrointestinal malfunctions, nutrition has a direct therapeutic role. The benefit of nutrition therapy is similar to medical treatment in patients with pancreatitis, Crohn disease, hepatic failure, and in those with gastrointestinal fistulas. Nutrition has both supportive and therapeutic roles in the management of chronic gastrointestinal diseases. With the development of modern techniques of nutritional support, the morbidity and mortality associated with chronic gastrointestinal diseases can be reduced. Orv. Hetil., 2014, 155(51), 2034–2040.

Az endoszkópos ultrahang alkalmazása a gastrointestinalis betegségek diagnosztikájában és terápiájában

Endoscopic ultrasound is one of those diagnostic methods in gastrointestinal endoscopy which has developed rapidly in the last decade and has became exceedingly available to visualize the walls of the internal organs in details corresponding to histological layers, or analyze the adjacent structures. Fine needles and other endoscopic accessories can be introduced into the neighbouring tissues under the guidance of endoscopic ultrasound, and diagnostic and minimally invasive therapeutic interventions can be performed. The endoscopic ultrasound became more widely available in Hungary in recent years. This review focuses on the indications, benefits and complications of diagnostic and therapeutic endoscopic ultrasound. We recommend this article to gastroenterologists, surgeons, internists, pulmonologists, and to specialists in oncology and radiology. This recommendation was based on the consensus of the Board members of the Endoscopic Ultrasound Section of the Hungarian Gastroenterological Society.Az endoszkopos ultrahang az elmult evtizedben a gastrointestinalis endoszkopos diagnosztikai es operativ technikak egyik legdinamikusabban fejlődő terulete, amely kivaloan alkalmas az emesztőrendszer jelentős reszeben a szovettani retegeknek megfelelő kepi megjelenitesre, az ureges szervek kozvetlen szomszedsagaban levő kepletek es mas szervek reszletdus abrazolasara. Az endoszkopos ultrahang soran diagnosztikus es terapias beavatkozasok vegzesere alkalmas tűket es mas tartozekokat juttathatunk a kornyező szovetekbe minimalisan invaziv beavatkozasok elvegzese celjabol. A modszer az utobbi evekben hazankban is egyre tobb helyen valt elerhetőve. Az alabbi szakmai javaslat celja a diagnosztikus es terapias endoszkopos ultrahang legfontosabb indikacioinak es alkalmazasi szabalyainak attekintese. Az osszefoglalot nem kizarolag gasztroenterologus, hanem belgyogyasz, sebesz, pulmonologus, onkologus es radiologus szakorvosok figyelmebe is ajanljuk, hiszen ennek a modern diagnosztika nelkulozhetetlen reszet kepező modszernek a megfelelő alkalmazasaval es terapias modalitaskent is elerhetőve valasaval uj tavlatok nyilhatnak mindannyiunk szamara. A szakmai javaslat a Magyar Gasztroenterologiai Tarsasag Endoszkopos Ultrahang Szekcio 2012. es 2013. evi vezetősegenek a konszenzusa alapjan keszult. Orv. Hetil., 2014, 155(14), 527–541. Kulcsszavak: diagnosztikus endoszkopos ultrahang, gastrointestinalis daganatok, staging, endoszkopos ultrahang vezerelte mintavetel, terapias endoszkopos ultrahang The role of endoscopic ultrasound in the diagnosis and therapy of gastrointestinal disorders Endoscopic ultrasound is one of those diagnostic methods in gastrointestinal endoscopy which has developed rapidly in the last decade and has became exceedingly available to visualize the walls of the internal organs in details corresponding to histological layers, or analyze the adjacent structures. Fine needles and other endoscopic accessories can be introduced into the neighbouring tissues under the guidance of endoscopic ultrasound, and diagnostic and minimally invasive therapeutic interventions can be performed. The endoscopic ultrasound became more widely available in Hungary in the recent years. This review focuses on the indications, benefits and complications of diagnostic and therapeutic endoscopic ultrasound. We dedicate this article for gastroenterologists, surgeons, internists, pulmonologists, specialists in oncology and radiology. This recommendation was based on the consensus of the Board members of the Endoscopic Ultrasound Section of the Hungarian Gastroenterological Society.

The role of endoscopic ultrasound in the diagnosis and therapy of gastrointestinal disorders

Endoscopic ultrasound is one of those diagnostic methods in gastrointestinal endoscopy which has developed rapidly in the last decade and has became exceedingly available to visualize the walls of the internal organs in details corresponding to histological layers, or analyze the adjacent structures. Fine needles and other endoscopic accessories can be introduced into the neighbouring tissues under the guidance of endoscopic ultrasound, and diagnostic and minimally invasive therapeutic interventions can be performed. The endoscopic ultrasound became more widely available in Hungary in recent years. This review focuses on the indications, benefits and complications of diagnostic and therapeutic endoscopic ultrasound. We recommend this article to gastroenterologists, surgeons, internists, pulmonologists, and to specialists in oncology and radiology. This recommendation was based on the consensus of the Board members of the Endoscopic Ultrasound Section of the Hungarian Gastroenterological Society.Az endoszkopos ultrahang az elmult evtizedben a gastrointestinalis endoszkopos diagnosztikai es operativ technikak egyik legdinamikusabban fejlődő terulete, amely kivaloan alkalmas az emesztőrendszer jelentős reszeben a szovettani retegeknek megfelelő kepi megjelenitesre, az ureges szervek kozvetlen szomszedsagaban levő kepletek es mas szervek reszletdus abrazolasara. Az endoszkopos ultrahang soran diagnosztikus es terapias beavatkozasok vegzesere alkalmas tűket es mas tartozekokat juttathatunk a kornyező szovetekbe minimalisan invaziv beavatkozasok elvegzese celjabol. A modszer az utobbi evekben hazankban is egyre tobb helyen valt elerhetőve. Az alabbi szakmai javaslat celja a diagnosztikus es terapias endoszkopos ultrahang legfontosabb indikacioinak es alkalmazasi szabalyainak attekintese. Az osszefoglalot nem kizarolag gasztroenterologus, hanem belgyogyasz, sebesz, pulmonologus, onkologus es radiologus szakorvosok figyelmebe is ajanljuk, hiszen ennek a modern diagnosztika nelkulozhetetlen reszet kepező modszernek a megfelelő alkalmazasaval es terapias modalitaskent is elerhetőve valasaval uj tavlatok nyilhatnak mindannyiunk szamara. A szakmai javaslat a Magyar Gasztroenterologiai Tarsasag Endoszkopos Ultrahang Szekcio 2012. es 2013. evi vezetősegenek a konszenzusa alapjan keszult. Orv. Hetil., 2014, 155(14), 527–541. Kulcsszavak: diagnosztikus endoszkopos ultrahang, gastrointestinalis daganatok, staging, endoszkopos ultrahang vezerelte mintavetel, terapias endoszkopos ultrahang The role of endoscopic ultrasound in the diagnosis and therapy of gastrointestinal disorders Endoscopic ultrasound is one of those diagnostic methods in gastrointestinal endoscopy which has developed rapidly in the last decade and has became exceedingly available to visualize the walls of the internal organs in details corresponding to histological layers, or analyze the adjacent structures. Fine needles and other endoscopic accessories can be introduced into the neighbouring tissues under the guidance of endoscopic ultrasound, and diagnostic and minimally invasive therapeutic interventions can be performed. The endoscopic ultrasound became more widely available in Hungary in the recent years. This review focuses on the indications, benefits and complications of diagnostic and therapeutic endoscopic ultrasound. We dedicate this article for gastroenterologists, surgeons, internists, pulmonologists, specialists in oncology and radiology. This recommendation was based on the consensus of the Board members of the Endoscopic Ultrasound Section of the Hungarian Gastroenterological Society.

Az endoszkópos ultrahang alkalmazása a gastrointestinalis betegségek diagnosztikájában és terápiájában@@@The role of endoscopic ultrasound in the diagnosis and therapy of gastrointestinal disorders

Endoscopic ultrasound is one of those diagnostic methods in gastrointestinal endoscopy which has developed rapidly in the last decade and has became exceedingly available to visualize the walls of the internal organs in details corresponding to histological layers, or analyze the adjacent structures. Fine needles and other endoscopic accessories can be introduced into the neighbouring tissues under the guidance of endoscopic ultrasound, and diagnostic and minimally invasive therapeutic interventions can be performed. The endoscopic ultrasound became more widely available in Hungary in recent years. This review focuses on the indications, benefits and complications of diagnostic and therapeutic endoscopic ultrasound. We recommend this article to gastroenterologists, surgeons, internists, pulmonologists, and to specialists in oncology and radiology. This recommendation was based on the consensus of the Board members of the Endoscopic Ultrasound Section of the Hungarian Gastroenterological Society.Az endoszkopos ultrahang az elmult evtizedben a gastrointestinalis endoszkopos diagnosztikai es operativ technikak egyik legdinamikusabban fejlődő terulete, amely kivaloan alkalmas az emesztőrendszer jelentős reszeben a szovettani retegeknek megfelelő kepi megjelenitesre, az ureges szervek kozvetlen szomszedsagaban levő kepletek es mas szervek reszletdus abrazolasara. Az endoszkopos ultrahang soran diagnosztikus es terapias beavatkozasok vegzesere alkalmas tűket es mas tartozekokat juttathatunk a kornyező szovetekbe minimalisan invaziv beavatkozasok elvegzese celjabol. A modszer az utobbi evekben hazankban is egyre tobb helyen valt elerhetőve. Az alabbi szakmai javaslat celja a diagnosztikus es terapias endoszkopos ultrahang legfontosabb indikacioinak es alkalmazasi szabalyainak attekintese. Az osszefoglalot nem kizarolag gasztroenterologus, hanem belgyogyasz, sebesz, pulmonologus, onkologus es radiologus szakorvosok figyelmebe is ajanljuk, hiszen ennek a modern diagnosztika nelkulozhetetlen reszet kepező modszernek a megfelelő alkalmazasaval es terapias modalitaskent is elerhetőve valasaval uj tavlatok nyilhatnak mindannyiunk szamara. A szakmai javaslat a Magyar Gasztroenterologiai Tarsasag Endoszkopos Ultrahang Szekcio 2012. es 2013. evi vezetősegenek a konszenzusa alapjan keszult. Orv. Hetil., 2014, 155(14), 527–541. Kulcsszavak: diagnosztikus endoszkopos ultrahang, gastrointestinalis daganatok, staging, endoszkopos ultrahang vezerelte mintavetel, terapias endoszkopos ultrahang The role of endoscopic ultrasound in the diagnosis and therapy of gastrointestinal disorders Endoscopic ultrasound is one of those diagnostic methods in gastrointestinal endoscopy which has developed rapidly in the last decade and has became exceedingly available to visualize the walls of the internal organs in details corresponding to histological layers, or analyze the adjacent structures. Fine needles and other endoscopic accessories can be introduced into the neighbouring tissues under the guidance of endoscopic ultrasound, and diagnostic and minimally invasive therapeutic interventions can be performed. The endoscopic ultrasound became more widely available in Hungary in the recent years. This review focuses on the indications, benefits and complications of diagnostic and therapeutic endoscopic ultrasound. We dedicate this article for gastroenterologists, surgeons, internists, pulmonologists, specialists in oncology and radiology. This recommendation was based on the consensus of the Board members of the Endoscopic Ultrasound Section of the Hungarian Gastroenterological Society.