Radosław Kempiński

Antimicrobial susceptibility of Helicobacter pylori isolates from Lower Silesia, Poland.

Introduction In recent years the failure of standard therapy for Helicobacter pylori infections has been observed, which results primarily from the increasing resistance of H. pylori strains to antibiotics. The aim of the study was to estimate the prevalence of antimicrobial resistance of H. pylori strains isolated from adult symptomatic patients with primary infection in the Lower Silesia Region in Poland. Material and methods One hundred and seventy-eight adults aged 19–89 years with dyspeptic symptoms suggesting gastroduodenal pathology were enrolled in the study. The study was performed in the years 2008–2011. Fifty H. pylori strains were isolated from gastric biopsy samples of examined patients. Antimicrobial susceptibility to 6 drugs (amoxicillin (AM), clarithromycin (CH), metronidazole (MZ), tetracycline (TC), levofloxacin (LEV), and rifabutin (RB)) was tested by the gradient-diffusion method (E-test method). Results The incidence of H. pylori infection among examined patients was 35%. From 50 isolated H. pylori strains, 24% showed resistance to CH, 42% to MZ and 8% to LEV alone. Multidrug resistance was detected in 26% of strains, whereas 20% of isolates were resistant to MZ and CH. Examined strains were fully susceptible to AM, TC and RB. Conclusions Resistance to clarithromycin strains isolated from adults of the Lower Silesia Region in Poland is high and is almost always associated with resistance to metronidazole (CH + MZ). It is necessary to continuously monitor H. pylori resistance to drugs used in therapy, especially to clarithromycin. Verification of the existing recommendations of eradication therapy is also needed.

13C-Methacetin Breath Testing in Patients with Non-Alcoholic Fatty Liver Disease.

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a very common chronic liver condition which may potentially develop into fibrosis and cirrhosis. Liver biopsy is still the gold standard for liver fibrosis detection in these patients. However, non-invasive tools for liver assessment in NAFLD patients, like the (13)C-methacetin breath test, may be useful. OBJECTIVES The aim of the study was to evaluate the utility of the (13)C-methacetin breath test in NAFLD patients, especially in predicting significant fibrosis. MATERIAL AND METHODS Thirty three patients (24 male and 9 female (average age 47.9)) with histologically proven NAFLD had the (13)C-methacetin breath test performed. RESULTS Different forms of NAFLD were found during the histology phase, from simple steatosis to advanced fibrosis. Simple steatosis (SS) was found in 18 subjects (54.5%), in another 15 (45.5%) signs of inflammation and fibrosis (NASH) were observed. However, more than half of the patients with liver fibrosis had only minimal changes described (0/1). The sensitivity of the test was highest for cumulative recovery after 10 min of the test and for a combination of two parameters (the cumulative recovery after 40 min and the time of maximal momentary recovery). The positive predictive value was low for all the parameters under consideration, but the negative predictive value was over 0.8 in significant fibrosis detection. CONCLUSIONS The (13)C-methacetin breath test could be a promising noninvasive tool for excluding at least F1 fibrosis in NAFLD patients.

Non-medical costs of colonoscopy

Colorectal cancer is one of the most common malignancies in Europe and North America. Colonoscopy done every 10 years beginning at age 50 is the preferred method of screening. In Poland and some other countries examinations are offered to subjects free of charge. However, as well as direct medical costs there are direct non-medical costs, which include the cost of transportation and costs related to caregivers’ time, and indirect costs, which are costs related to patients’ time. These costs essentially augment the total societal costs of colonoscopy.

Disease duration and age influence CARD15 expression in Crohn's disease.

One of the susceptibility genes in Crohns disease (CD) is CARD15. Our study examined the relationship between peripheral CARD15 expression and phenotype and duration of CD, treatment methods and inflammatory indices. Sixty patients with CD and 30 healthy volunteers as controls were enrolled in the study. Total RNA was isolated from peripheral blood mononuclear cells (PBMCs) with E.Z.N.A. Total RNA Kit (Omega Bio-tek) then quantitative real-time PCR was performed on the ABI Prism 7900 HT Real-Time PCR System. CARD15 gene expression in PBMCs in CD was significantly higher than in the control group. The highest level of gene expression was found in CD patients in the fourth decade of life. The mRNA level of the CARD15 gene was higher in patients with disease duration between 12 and 60 months. A positive correlation was found between erythrocyte sedimentation rate (ESR) and gene expression level. Gene expression increased with increasing level of C-reactive protein and ESR, but it was not statistically significant. CARD15 expression significantly decreased in CD patients treated with anti-TNFα agents compared to azathioprine or steroid treatment groups. Expression of the CARD15 gene in Crohn›s disease is higher than in healthy individuals. Disease duration and age of patients seem to be the most important factors influencing CARD15 expression.

A Case of Severe Ulcerative Colitis with Colonic Dilatation caused by Renal Mucinous Tubular and Spindle Cell Carcinoma

ABSTRACT We present a case of ulcerative colitis (UC) in a patient during the first severe relapse with colonic dilatation and coexisting of giant renal tumor. Kidney tumor was constricting on colon and imitating toxic megacolon (TM). The patient with severe acute colitis (SAC) was admitted to the Department of Gastroenterology and Hepatology with inflammatory bowel disease (IBD) diagnosed in the previous month, based on clinical symptoms, endoscopy, and histopathology results. Computed tomography (CT) revealed a giant left kidney tumor without evidence of infiltration, a dilatation of the transverse colon up to 6 cm, and narrow light of the descending colon. There were no signs of intestinal obstruction or perforation. The control X-rays revealed maintaining megacolon, with dilatation of splenic flexure projection up to 6.5 to 7.5 cm. The patient was treated conservatively with no apparent improvement and finally operated on. Intraoperatively, a large tumor of the kidney (12 cm) constricting intestine was revealed. Left-sided nephrectomy and partial resection of the colon with the emergence of a colostomy was performed. The histopathology exam revealed renal mucinous tubular and spindle cell carcinoma (RMTSCC), a very rare malignant kidney tumor of low malignant potential and relative good prognosis. It was identified in the past 20 years. To date, approximately 100 such cases of cancer have been described. How to cite this article Kukulska M, Smola I, Halon A, Paradowski L, Poniewierka E, Kempinski R, Annabhani A. A Case of Severe Ulcerative Colitis with Colonic Dilatation caused by Renal Mucinous Tubular and Spindle Cell Carcinoma. Euroasian J Hepato-Gastroenterol 2016;6(2):190-193.