Kęstutis Adamonis

Efficacy of the natural antioxidant astaxanthin in the treatment of functional dyspepsia in patients with or without Helicobacter pylori infection: A prospective, randomized, double blind, and placebo-controlled study

OBJECTIVES The aim of this study was to evaluate the efficacy of the natural antioxidant astaxanthin in functional dyspepsia in different doses and compared with placebo. DESIGN The study was a controlled, prospective, randomized, and double blind trial. PARTICIPANTS Patients with functional dyspepsia, divided into three groups with 44 individuals in each group (placebo, 16mg, or 40mg astaxanthin, respectively). INTERVENTIONS Participants were asked to accept gastroscopy before treatment, together with questionnaires: GSRS and SF-36. Urea breath test (UBT) was done before the treatment. MAIN OUTCOME The primary objective was to test the hypothesis that the antioxidant astaxanthin at two doses regimens compared to placebo should ameliorate gastrointestinal discomfort measured as GSRS in patients with functional dyspepsia, who were either positive or negative for Helicobacter pylori, after 4 weeks of treatment. RESULTS At the end of therapy (week 4) no difference between the three treatment groups was observed regarding mean Gastrointestinal Symptom Rating Scale (GSRS) scores of abdominal pain, indigestion and reflux syndromes. The same results were observed at the end of follow-up. However reduction of reflux syndrome before treatment to week 4 was significantly pronounced in the higher (40mg) dose compared to the other treatment groups (16mg and placebo, p=0.04). CONCLUSION In general, no curative effect of astaxanthin was found in functional dyspepsia patients. Significantly greater reduction of reflux symptoms were detected in patients treated with the highest dose of the natural antioxidant astaxanthin. The response was more pronounced in H. pylori-infected patients.

Quality of Life in Laryngopharyngeal Reflux Patients

Objectives: To evaluate and compare quality of life (QL) parameters in patients with laryngopharyngeal reflux (LPR) versus healthy controls, to determine the impact of clinical signs to QL, and to assess changes in QL parameters after treatment.

Lactase nonpersistence is directed by DNA-variation-dependent epigenetic aging

The inability to digest lactose, due to lactase nonpersistence, is a common trait in adult mammals, except in certain human populations that exhibit lactase persistence. It is not known how the lactase gene is dramatically downregulated with age in most individuals but remains active in some individuals. We performed a comprehensive epigenetic study of human and mouse small intestines, by using chromosome-wide DNA-modification profiling and targeted bisulfite sequencing. Epigenetically controlled regulatory elements accounted for the differences in lactase mRNA levels among individuals, intestinal cell types and species. We confirmed the importance of these regulatory elements in modulating lactase mRNA levels by using CRISPR–Cas9-induced deletions. Genetic factors contribute to epigenetic changes occurring with age at the regulatory elements, because lactase-persistence and lactase-nonpersistence DNA haplotypes demonstrated markedly different epigenetic aging. Thus, genetic factors enable a gradual accumulation of epigenetic changes with age, thereby influencing phenotypic outcome.

Associations between NOD2, IRGM and ORMDL3 polymorphisms and pediatric-onset inflammatory bowel disease in the Lithuanian population

BACKGROUND AND OBJECTIVE Recent GWAS and meta-analyses have revealed about 200 susceptibility genes/loci for inflammatory bowel diseases (IBD). However, only a small number of studies were performed in early-onset IBD. The aim of this study was to assess the association between NOD2, IL23R, ATG16L1, IRGM, IL10, NKX2-3 and ORMDL3 variants and early-onset IBD. MATERIALS AND METHODS A total of 76 affected individuals (30 with Crohns disease [CD] and 46 with ulcerative colitis [UC]) at the age of ≤17 years and 158 matched controls recruited in Lithuania were genotyped for the known genetic susceptibility variants in NOD2 (Arg702Trp (rs2066844), Gly908Arg (rs2066845) and Leu1007insC (rs2066847)), IL23R (rs11209026), ATG16L1 (rs2241880), IRGM (rs4958847), IL10 (rs3024505), NKX2-3 (rs11190140) and ORMDL3 (rs2872507) genes. RESULTS Variants in NOD2 (Leu1007insC) and IRGM genes increased risk for CD (OR=6.56, 95% CI: 2.54-16.91, P=1.21×10-5 and OR=2.32, 95% CI: 1.05-5.14, P=0.033; respectively); whereas a variant in ORMDL3 gene was strongly associated with UC (OR=1.99, 95% CI: 1.23-3.20, P=4.15×10-3). CONCLUSIONS The results confirmed that polymorphisms in NOD2 (Leu1007insC) and IRGM genes are associated with increased risk of CD; whereas the ORMDL3 variant is associated with susceptibility to UC in the Lithuanian early-onset IBD population.

S299 – Videolaryngoscopy in Patients with Obstructive Sleep Apnea

Objectives To evaluate symptoms and videolaryngoscopic findings common in reflux in patients with obstructive sleep apnea (OSA) and to determine the relationship between laryngeal inflammation and OSA severity. Methods Data of 38 adult outpatients with first-proven OSA verified in overnight polysomnography during 2006–2007 were prospectively analyzed. Symptoms common in laryngopharyngeal reflux were self-rated using reflux symptoms index (RSI). Videolaryngoscopic laryngeal changes were evaluated with reflux finding score (RFS). Body mass index (BMI) was calculated for all patients. Results 30 males and 8 females with mean age of 49.5 years were assessed. BMI of patients ranged from 23.1 to 46.6 kg/cm2 showing 86.8% of patients overweight. 52.6% of selected patients had mild OSA, 10.5%- moderate, 36.8- severe. Mean value of self-rated RSI was 13.8 points. Abnormal RSI was detected in 52.6% of patients. The most common symptoms indicated medium to severe problem were chronic throat clearing-; 48.6% of patients, increased amount of mucus coming into the nasopharynx-; 40.5%, and globus sensation-; 35.1%. The inflammation of the larynx was diagnosed for 78.9% of patients with mean RFS value of 10.1 points. The pronounced findings were vestibular folds hypertrophy-; 81.6%, posterior commissure hypertrophy- 73.7%, thick endolaryngeal mucus-; 63.2%, and vocal folds edema-; 44.7% of patients. Only diffuse laryngeal edema showed significant positive correlation with increasing of AHI. Conclusions A high prevalence of laryngeal symptoms and inflammation indicating reflux in OSA patients was identified. Direct significant correlation between laryngeal inflammation and OSA severity was not determined.

Endoskopinis ūminės storosios žarnos obstrukcijos gydymas

Kestutis Adamonis, Dainius Pavalkis, Žilvinas Saladžinskas, Algimantas Tamelis KMU Gastroenterologijos klinika, KMU Chirurgijos klinika Siuolaikis virskinimo trakto piktybinės obstrukcijos gydymas vis labiau tampa minimaliai invazinis. Ligoniai, sergantys storosios žarnos vėžiu, komplikuotu obstrukcija, į gydymo įstaigas patenka skubos tvarka, neretai sunkios būklės, ir nėra idealūs kandidatai chirurginei operacijai. Siuolaikinėje medicinos literatūroje gausėja mokslinių straipsnių apie sėkmingą ir saugų endoskopiniu būdu įkisamų savaime issipleciancių metalinių stentų naudojimą proktologijoje. Nors stentai ir yra brangūs, taciau proktologinis stentavimas yra rentabili procedūra, leidžianti ligoniams, sergantiems storosios žarnos vėžiu, komplikuotu ūminė storosios žarnos obstrukcija, isvengti neatidėliotinos operacijos, o esant nerezektabiliam vėžiui, – kolostomos. Straipsnyje aprasomas KMU Chirurgijos klinikoje atliktas pirmasis Lietuvoje sėkmingas endoskopinis ūminės žarnų obstrukcijos gydymas stentuojant žarnyną. Prasminiai žodžiai: žarnyno obstrukcija, kolorektinis vėžys, endoskopija, stentavimas. Acute colonic obstruction: endoscopical management Kestutis Adamonis, Dainius Pavalkis, Žilvinas Saladžinskas, Algimantas Tamelis Management of malignant gastrointestinal obstruction presents a significant challenge. Most patients are in a profoundly decompensated state due to underlying malignancy and are not ideal candidates for invasive surgical procedures. In recent years, self-expandable metal stents have emerged as an effective and safe, less invasive alternative for the treatment of malignant intestinal obstruction. Although stents are expensive, the procedure appears to be cost-effective, since emergency surgery can be avoided in patients with acute bowel obstruction, and in those with advanced disease no resection of the colon is necessary. Here we report a retrospective analysis of a first self-expandable metal stent placed for colorectal obstruction at Kaunas Medical University Hospital, as well as review the literature published on self-expandable metal stent placement. Our first data confirm self-expandable metal stent efficacy in palliation of malignant intestinal obstruction. Keywords: intestinal obstruction, colorectal cancer, endoscopy, endoluminal stenting.