[Characteristic and endoscopic evaluation of dyspeptic patients]. / Charakterystyka chorych na dyspepsje z uwzglednieniem roli badania endoskopowego.

UNLABELLED: Dyspeptic sypmtoms are common in our population and are typical for upper gastrointestinal tract disease. Endoscopy is commonly performed to evaluate symptoms of dyspepsia, especially in older patients after 45 years or with alarm symptoms. The aim of this study was to charaterize patients who receive endoscopy for dyspepsia and to analyse their endoscopic findings. MATERIAL AND METHODS: Endoscopic egzamination was performed first time in 230 patients without alarm symptoms, without history earlier history of gastrointestinal pathology, with normal abdomen ultrasonography. According to Rome II criteria (at least 12 months of symptoms) all patients were classified as dyspeptic. RESULTS: Only in 23% of this group no endoscopic changes were noticed. Functional dyspepsia was diagnosed mostly before 45 year, but organic changes mostly after 45 year, however in both groups (after and before 45 years) we found almost similar percent of serious organic changes (ulcers and neoplasm). Summarising, we found organic changes in 69% of patients before 45 years in comparison to 80% after 45 years (ns). CONCLUSION: We conclude that in the case of long lasting dyspeptic symptoms (at least 12 months), endoscopy should be performed to exclude organic pathology in all patients.

N-acetylcysteine does not prevent post-endoscopic retrograde cholangiopancreatography hyperamylasemia and acute pancreatitis.

AIM: Acute pancreatitis (AP) is the most common and often severe complication of endoscopic retrograde cholangiopancreatography (ERCP). The early step in the pathogenesis of acute pancreatitis is probably the capillary endothelial injury mediated by oxygen-derived free radicals. N-acetylcysteine - a free radical scavenger may be potentially effective in preventing post-ERCP acute pancreatitis and it is also known that N-acetylcysteine (ACC) can reduce the severity of disease in experimental model of AP. METHODS: One hundred and six patients were randomly allocated to two groups. Fifty-five patients were given N-acetylcysteine (two 600 mg doses orally 24 and 12 h before ERCP and 600 mg was given iv, twice a day for two days after the ERCP). The control group consisted of 51 patients who were given iv. isotonic saline twice a day for two days after the ERCP. Serum and urine amylase activities were measured before ERCP and 8 and 24 h after the procedure. The primary outcome parameter was post-ERCP acute pancreatitis and the secondary outcome parameters were differences between groups in serum and urine amylase activity. RESULTS: There were no significant differences in the rate of post-ERCP pancreatitis between two groups (10 patients overall, 4 in the ACC group and 6 in the control group). There were also no significant differences in baseline and post-ERCP serum and urine amylase activity between ACC group and control group. CONCLUSION: N-acetylcysteine fails to demonstrate any significant preventive effect on post-ERCP pancreatitis, as well as on serum and urine amylase activity.

[Progress in endoscopic antireflux procedures]. / Postepy w endoskopowym leczeniu choroby refluksowej.

Gastroesophageal reflux disease (GERD) is a widespread morbid condition that adversely affects quality of life and results in great utilization of healthcare resources. Recently medical therapy has improved with the introduction of the proton pump inhibitors, but patients must take medicine rather indefinitely often on a daily basis. Surgical therapy with the application of laparoscopic fundoplication has improved too, but still is associated with invasiveness and morbidity. Now third option has emerged--endoscopic antireflux procedures. Three novel forms of endoscopic procedures are under development: plication of the gastroesophageal junction by endoscopic suturing, thermoablation of the muscle of lower esophageal sphincter and gastric cardia (the Stretta procedure), endoscopic implantation of a biopolymer (Enteryx). These procedures seem effective and rather safe, but they are in the early stages of development and the magnitude of their efficacy is yet undetermined. It is necessary to validate these methods and assess safety by long-term placebo-controlled studies.

[Intragastric balloons--the new hope in bariatry?]. / Balony dozoladkowe--nowa nadzieja w leczeniu otylosci?

The concept of intragastric space-occupying balloon developed from observations in psychiatric patients with gastric bezoars. Several gastric balloons consisting of different materials were developed. The BioEnterics Intagastric Balloon System (BIB) is a smooth, spherical, silicone elastomer balloon inducing satiety and restricting food intake. The balloon is indicated to induce weight loss in patients before surgery, to reduce the surgical risk, to select the patients for gastric restrictive surgery. Our experience showed that patients who had good results with the balloon they are good candidates for gastric restrictive surgical procedures. There were few complications: balloon intolerance, spontaneous deflation, oesophagitis, gastritis and rarely gastric ulcers. Conclusion is that in selected patients intragastric balloon can be used as effective and safe approach and could be a great help to induce weight loss and to prepare for surgery.

Therapeutic and prophylactic management of bleeding from oesophageal and gastric varices - recommendations of the Working Group of the National Consultant for Gastroenterology.

Gastroesophageal varices are one of the most serious consequences of portal hypertension. One-third of patients with varices will develop variceal haemorrhage. Despite significant improvements in the outcomes of treatment, mortality due to bleeding from gastro-oesophageal varices still remains very high. These recommendations present optimal management of patients with non-bleeding and bleeding varices.

The results of severe acute pancreatitis treatment with continuous regional arterial infusion of protease inhibitor and antibiotic: a randomized controlled study.

OBJECTIVES: A randomized controlled trial was conducted to clarify whether continuous regional arterial infusion (CRAI) of protease inhibitor and antibiotic could reduce mortality rate of severe acute pancreatitis (SAP). METHODS: Seventy-eight patients with SAP were included in the study. Thirty-nine patients were treated with CRAI, 31 patients completed the study; and another group of 39 patients was treated without CRAI therapy. Groups were well matched in clinical characteristics. The CRAI patients were treated continuously with nafamostat mesylate 240 mg/d and imipenem 1 g/d for 5 days via one of the arteries perfusing the pancreas. Later, imipenem was given intravenously (0.5 g every 8 hours) for 9 days. The non-CRAI patients received imipenem (0.5 g every 8 hours) intravenously for 14 days. Statistical analysis of the intention-to-treat (ITT) group was performed. RESULTS: Lack of septic complications was observed in 23 patients with CRAI therapy and 20 non-CRAI patients (not significant). The additional antibiotics were applied in 8 of CRAI patients and in 18 non-CRAI (ITT, P = 0.02). Mortality rate was 5.1% in CRAI and 23.1% in non-CRAI group (ITT, P = 0.02). Urgent surgical intervention was necessary in 10.3% CRAI patients and in 33.3% non-CRAI (ITT, P = 0.01). CONCLUSIONS: The results show that CRAI of protease inhibitor and antibiotic is effective in preventing complications and in reducing mortality rate in SAP.