Comparison of the Color Doppler Vascularity Index in Patients with Pancreatic Adenocarcinoma and Chronic Pancreatitis from a Single Center in Poland.

BACKGROUND Pancreatic cancer is one of the most common cancers in the world and a major cause of cancer mortality. Therefore, it is extremely important to distinguish between malignant and benign changes quickly and accurately. This single-center study aimed to assess the discriminatory properties of the color Doppler vascularity index (CDVI) in the diagnosis of focal chronic pancreatitis and malignant pancreatic tumors. MATERIAL AND METHODS Seventy-nine patients (42 men, 37 women; age 62.0±13.5 years; 46 adenocarcinomas; 33 pancreatitis) qualified for this study. During endosonographic examination, pancreatic tumors were assessed in the color Doppler option. The dynamic tissue perfusion measurement was used to calculate tissue flow velocity (TFV), tissue perfusion intensity (TPI), and vascularization as the CDVI. RESULTS TFV, TPI, and CDVI were significantly lower in the group with malignant tumors than in the group with pancreatitis (P<0.001). In the receiver operating characteristic analysis, results of TFV=2.181 cm/s, TPI=0.009 cm/s, and CDVI=0.268 allowed for significant prediction of malignant tumors (P<0.001), with sensitivity of 75.8%, 69.7%, and 72.7% and specificity of 91.3%, 93.5%, and 80.4%, respectively, without significant differences between perfusion parameters and CDVI (P=0.07). CONCLUSIONS The findings from this study showed that color Doppler imaging and the use of the CDVI could provide an adjunctive diagnostic approach to distinguish between pancreatic adenocarcinoma and focal chronic pancreatitis. Owing to the possibility of calculating vascularization by non-Doppler methods, the method may be an easier and more accessible diagnostic option for malignant pancreatic tumors than perfusion assessed in external software.

Application of the Molecular Adsorbent Recirculating System in Type 1 Hepatorenal Syndrome in the Course of Alcohol-Related Acute on Chronic Liver Failure.

BACKGROUND This study aimed to evaluate the Molecular Adsorbent Recirculating System (MARS) effectiveness in patients with alcohol-related acute-on-chronic liver failure (AoCLF) complicated with type 1 hepatorenal syndrome (HRS). So far, MARS efficacy and safety has been demonstrated in various acute liver failure scenarios. MATERIAL AND METHODS Data from 41 MARS procedures (10 patients with type 1 HRS, in the course of alcohol-related AoCLF were considered for this study. Biochemical tests of blood serum were performed before and after each procedure. The condition of patients was determined before and after the treatment with the use of the model for end-stage liver disease - sodium (MELD-Na) and the stage of encephalopathy severity based on the West Haven criteria. RESULTS During the observation period (20.5±13.9 days), 5 patients died, and the remaining 5 surviving patients were discharged from the hospital. In the group of 10, the 14-day survival, starting from the first MARS treatment, was 90%. The MARS procedure was associated with a 19% reduction in bilirubin (27.5±6.1 versus 22.3±4.0 mg/dL, P<0.001), 37% reduction in ammonia (44.1±22.5 versus 27.6±20.9 P<0.001), 27% reduction in creatinine (1.5±1.0 versus 1.1±0.6 mg/dL, P<0.001) and 14% reduction urea (83.8±36.1 versus 72.1±33.3, P<0.001) in blood serum samples, with stable hemodynamic parameters. In the group of patients discharged from the clinic (n=5), the MARS treatments resulted in an improvement in hepatic encephalopathy (West Haven; P=0.043), as well as a reduction in the MELD-Na score (P=0.015). CONCLUSIONS MARS is a hemodynamically safe method for supporting the function of the liver and the kidneys. Application of the MARS reduces the symptoms of encephalopathy in patients with alcohol-related type 1 HRS.

Elastography in the Diagnosis of Pancreatic Malignancies.

The study aimed to determine the usefulness of the elastography in the diagnosis of malignancy of solid pancreatic tumors. There were 123 patients (F/M; 51/72, aged 62 ± 14) enrolled into the study with the diagnosis of pancreatic masses. Malignant pancreatic adenocarcinoma was identified in 78 patients and an inflammatory mass corresponding to chronic pancreatitis in the remaining 45 patients. The mass elasticity of a tumor (A-elasticity) and a reference zone (B-elasticity) and the B/A strain ratio were measured. All these elastographic parameters differed between groups and correlated significantly with malignancies (r = 0.841; r = -0.834; r = 0.487, respectively). Receiver operating characteristic (ROC) analysis showed that A-elasticity between 0.05% and 0.14% alone, as well as the B/A strain ratio between 7.87 and 18.23 alone, enabled the recognition of all malignant pancreatic tumors with 100% sensitivity and ≥ 97.8% specificity. Surprisingly, B-elasticity alone also was helpful in recognizing malignant tumors (71% sensitivity, 80% specificity, 0.74 accuracy, and 0.792 area under the curve), although it appeared worse than A-elasticity and B/A strain ratio (p < 0.001). In multivariable regression analysis, A-elasticity identified 89.5% of malignancies (p < 0.001). A-elasticity and B-elasticity were the only significant independent factors influencing the tumor identification (r2 = 0.927; p < 0.001). The assessment of tumor elasticity appears sufficient to identify malignant tumors of the pancreas.

Left Ventricular Strain and Relaxation Are Independently Associated with Renal Cortical Perfusion in Hypertensive Patients.

Renal perfusion, which depends on cardiac function, is a factor conditioning the work of kidneys. The objective of the study was to assess the influence of cardiac function, including left ventricular contractility and relaxation, on renal cortical perfusion in patients with hypertension and chronic kidney disease treated pharmacologically. There were 63 patients (7 F and 56 M; aged 56 ± 14) with hypertension and stable chronic kidney disease enrolled into the study. Serum cystatin C, with estimated glomerular filtration rate (eGFR), ambulatory blood pressure monitoring, carotid intima-media thickness (cIMT), echocardiography with speckle tracking imaging and the calculation of global longitudinal strain (GLS), diameter of vena cava inferior (VCI), and an ultrasound dynamic tissue perfusion measurement of the renal cortex were performed. We found that the renal cortical perfusion correlated significantly with age, renal function, cIMT, GLS, left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), diastolic peak values of early (E) and late (A) mitral inflow velocities ratio (E/A) and E to early diastolic mitral annular tissue velocity (E/E'), but not with VCI, or the right ventricle echocardiographic parameters. In multivariable regression analysis adjusted to age, only eGFR, E/E', and GLS were independently related to renal cortical perfusion (r 2 = 0.44; p < 0.001). In conclusion, the intensity of left ventricular strain and relaxation independently influence renal cortical perfusion in hypertensive patients with chronic kidney disease. A reduction in left ventricular global longitudinal strain is superior to left ventricular ejection fraction in the prediction of a decline in renal cortical perfusion.

Doppler tissue perfusion parameters in recognizing pancreatic malignant tumors.

BACKGROUND: Histopathology, radiological imaging methods with the administration of contrast agents are efficient to differentiate focal lesions of the pancreas. Invasiveness, contrast toxicity, and limited accessibility ameliorate their application. Noninvasive and contrast-agent-free method could improve diagnostics and accelerate treatment. AIMS: The aim of the study is to evaluate the diagnostic properties of ultrasound parameters of organ perfusion in the detection of malignant tumors of the pancreas. METHODS: Thirty-six patients with a focal lesion of the pancreas underwent endosonography with color flow imaging and biopsy for histological evaluation. Five patients were excluded because of the absence of the Doppler signal in pancreatic lesion. In the dynamic tissue perfusion measurement (DTPM) means of flow velocity (FV), resistive index, pulsatility index, and perfusion relief intensity (PR) were estimated. RESULTS: In the group with malignant tumors FV was significantly lower compared with the group with inflammatory changes. In receiver operating characteristic (ROC) analysis FV below the optimal cut-off point of 2.382 cm/s identified patients with malignant lesions with a sensitivity of 92% and specificity of 90%. In the group with malignant tumors significantly lower values of PR in all considered percentiles were observed. Based on the ROC analysis in the group with solid tumors, it was found that PR25 ≤ 0.057 allowed to recognize malignancies with a sensitivity of 100% and specificity of 80%, and in the groups with solid and cystic tumors with a sensitivity of 100% and specificity of 79%. CONCLUSIONS: FV and PR intensity derived from DTPM are reliable markers in recognition of pancreatic malignant masses.

[Hereditary pancreatitis]. / Dziedziczne zapalenie trzustki.

Hereditary pancreatitis (HP) is a rare, heterogeneous familial disease and should be suspected in any patient who has suffered at least two attacks of acute pancreatitis for which there is no underlying cause and unexplained chronic pancreatitis with a family history in a first- or second degree relative. with an early onset, mostly during childhood. Genetic factors have been implied in cases of familial chronic pancreatitis. The most common are mutations of the PRSS1 gene on the long arm of the chromosome 7, encoding for the cationic trypsinogen. The inheritance pattern is autosomal dominant with an incomplete penetrance (80%). The inflammation results in repeated DNA damage, error-prone repair mechanisms and the progressive accumulation of genetic mutations. Risk of pancreatic adenocarcinoma is a major concern of many patients with hereditary chronic pancreatitis, but the individual risk is poorly defined. Better risk models of pancreatic cancer in individual patients based on etiology of pancreatitis, family history, genetics, smoking, alcohol, diabetes and the patient's age are needed.

[Autoimmune pancreatitis as an element of autoimmune polyglandular syndrome]. / Autoimmunologiczne zapalenie trzustki jako skladowa autoimmunologicznego zespolu wielogruczolowego.

Autoimmune pancreatitis constantly belongs to diseases which often causes significant diagnostic problem and often runs out with surgical intervention as considered to be a pancreatic cancer. Important although usually underestimated problems are polyglandular syndromes, which may consist of autoimmune pancreatitis (AIP) problem as well. This case report is an example of autoimmune polyglandular syndrome (APS), which was connected with the surgical treatment with biliary bypass anastomosis because of the unresectable lesion in the head of pancreas. The definite remission of the pancreatic lesion finally came after a steroid therapy. Differentiation between neoplastic and inflammatory pancreatic tumors very often remains a serious clinical problem. On grounds of imaging and cytopathology exams it is often difficult to decide about the nature of a lesion. The negative result of cytopathological biopsy examination does not finally settle straightforward diagnosis. Diagnostic problems affect also autoimmune pancreatitis. It is worth to undertake attempts to differentiate pancreatic lesions especially in cases of concomitance with other autoimmune polyglandular syndromes. That is because it is connected with completely different treatment and outcome. We should remember about diagnostic criteria of autoimmune pancreatitis. Appropriate diagnosis for patients with AIP gives them a chance to avoid serious surgical resection and possible complications.

D-Galactosamine Intoxication in Experimental Animals: Is it Only an Experimental Model of Acute Liver Failure?

BACKGROUND: Short-term administration of Galactosamine to experimental animals causes liver damage and acute liver failure (ALF), as well as acute renal failure in some cases. The aim of our study was to describe kidney disorders that developed in the course of galactosamine-induced liver failure. MATERIAL AND METHODS: Sprague-Dawley rats were randomly divided into 2 groups: a study group administered galactosamine intraperitoneally and a control group administered saline. RESULTS: All the animals in the study group developed liver damage and failure within 48 h, with significant increase of alanine (p<0.001), aspartate aminotransferases (p<0.0001), bilirubin (p<0.004), and ammonia (p<0.005) and decrease of albumin (p<0.001) concentrations. Acute renal failure was observed in all test animals, with a significant increase in creatinine (p<0.001) and urea (p<0.001) concentrations and a decrease in creatinine clearance (p<0.0012). Moreover, osmotic clearance (p<0.001), daily natriuresis (p<0.003), and fractional sodium excretion (p<0.016) decreased significantly in this group of animals. The ratio of urine osmolality to serum osmolality did not change. Histopathology of the liver revealed massive necrosis of hepatocytes, whereas renal histopathology showed no changes. CONCLUSIONS: Acute renal failure that developed in the course of galactosamine-induced ALF was of a functional nature, with the kidneys retaining the ability to concentrate urine and retain sodium, and there were no renal changes in the histopathological examination. It seems that the experimental model of ALF induced by galactosamine can be viewed as a model of hepatorenal syndrome that occurs in the course of acute damage and liver failure.

[The diagnostic impact and limitations of 24 hour pH monitoring with multichannel intraluminal impedance]. / Znaczenie diagnostyczne i ograniczenia 24 godzinnej pH-metrii przelyku z impedancja.

Gastroesophageal reflux disease (GERD) is a result of reflux of gastric contents into the esophagus. Gastroscopy is often the first examination performed in GERD diagnosis. Some patients have macroscopic lesions, namely erosions, in the esophagus above the cardia of stomach. It enables to diagnose gastroesophageal reflux disease. However, many patients have no macroscopic lesions of the esophageal mucosa in endoscopy. That is why 24-hour pH monitoring with multichannel intraluminal impedance is the gold standard in diagnosis establishing of GERD and make feasible to distinguish acid, weakly acid and nonacid reflux and its correlation with reported symptoms. Impedance-pH is used to establish diagnosis of GERD, in patient qualification to anti-reflux surgery, to find the cause of not efficient reflux disease treatment as well as the cause of extra-esophageal symptoms of reflux disease. During impedance-pH test catheter connected with the recorder is placed in patient's esophagus. Recorded data is analyzed with the computer program. The examination is safe, the only complication that can occur is nasal bleeding, which can be a result of mucosa damage caused while catheter implementation. Nowadays disposable catheters are used, that excludes the risk of catheter related infection. On the basis of pH-impedance results it is possible to divide patients into 3 groups: patients with functional heartburn, patients with esophageal hypersensitivity and abnormal esophageal acid exposure. This classification is very helpful in the choice of treatment - antireflux surgery, proton pump inhibitor or prokinetic therapy.

[Groove pancreatitis--case report]. / Zapalenie trzustki okolicy "bruzdy"--opis przypadku.

Groove pancreatitis is an uncommon type of chronic pancreatitis. Most patients with groove pancreatitis are middle-aged men, smokers with excessive alcohol consumption. The describing patient is male admitted to hospital for fourth time during last six months because of recurrent abdominal pain, vomiting and lost weight. He has abused an alcohol in the history. The preliminary diagnosis of chronic pancreatitis was made. During hospitalization it was ordinated spasmolitic and analgesic therapy, antibiotic and enteral nutrition. The result of the implemented conservative therapy was successful, but the symptoms recurrented in very short period of time. Due to lack of long term improvement, patient was treated by pancreatoduodenectomy (Whipple's operation). The postoperative material was assessed by the patologist, and it was described focal chronic inflammation of the head of pancreas with fibrosis involving the wall of the duodenum. To diagnose groove pancreatitis in this case many diagnostic test, including endoscopy, imaging were required, but the histopathology was crucial. The patients should be diagnosed very carefully, because of the risk of the overlook of the cancer, which can be very similar in symptoms. The operation is recommended therapy in situation when improvement is short-period, with frequent recurrences or additional examination are uncertain.

Dynamic Doppler Ultrasound Assessment of Tissue Perfusion Is a Better Tool than a Single Vessel Doppler Examination in Differentiating Malignant and Inflammatory Pancreatic Lesions.

Dynamic tissue perfusion measurement (DTPM) and single vessel flow measurement (SVFM) were assessed in differentiating inflammatory and malignant lesions of the pancreas. Sixty-nine patients (age 62.0 ± 14.7; 33 Female and 36 Men; 40 with malignant and 29 with inflammatory lesions) in whom during the endoscopic ultrasound (EUS) of focal pancreatic lesions it was possible to adequately evaluate the flow in the color Doppler, and then perform a biopsy, were qualified for the study. The assessed DTPM parameters flow velocity (TFV), perfusion intensity (TPI), and resistive index (TRI) as well as the following SVFM parameters: flow velocity (FV), volume flow (VolF), and resistive index (RI) differed significantly between the malignant and inflammatory lesions (p < 0.005). TFV and TPI have slightly better discriminatory properties than the corresponding FV and VolF parameters (p < 0.10). Considering the Doppler parameters usually evaluated in a given method, the TPI = 0.009 cm/s (sensitivity 79%, specificity 92%, AUC 0.899, p < 0.001) was significantly better (p = 0.014) in differentiating between inflammatory and malignant pancreatic lesions in comparison to FV = 2.526 cm/s (sensitivity 79%, specificity 70%, AUC 0.731, p < 0.001). Tissue perfusion has better discriminatory properties in the differentiation of solid pancreatic lesions than the Doppler blood flow examination in the single vessel within the tumor.

Diabetic kidney disease: Are the reported associations with single-nucleotide polymorphisms disease-specific?

BACKGROUND: The genetic backgrounds of diabetic kidney disease (DKD) and end-stage kidney disease (ESKD) have not been fully elucidated. AIM: To examine the individual and cumulative effects of single-nucleotide polymorphisms (SNPs) previously associated with DKD on the risk for ESKD of diabetic etiology and to determine if any associations observed were specific for DKD. METHODS: Fourteen SNPs were genotyped in hemodialyzed 136 patients with diabetic ESKD (DKD group) and 121 patients with non-diabetic ESKD (NDKD group). Patients were also re-classified on the basis of the primary cause of chronic kidney disease (CKD). The distribution of alleles was compared between diabetic and non-diabetic groups as well as between different sub-phenotypes. The weighted multilocus genetic risk score (GRS) was calculated to estimate the cumulative risk conferred by all SNPs. The GRS distribution was then compared between the DKD and NDKD groups as well as in the groups according to the primary cause of CKD. RESULTS: One SNP (rs841853; SLC2A1) showed a nominal association with DKD (P = 0.048; P > 0.05 after Bonferroni correction). The GRS was higher in the DKD group (0.615 ± 0.260) than in the NDKD group (0.590 ± 0.253), but the difference was not significant (P = 0.46). The analysis of associations between GRS and individual factors did not show any significant correlation. However, the GRS was significantly higher in patients with glomerular disease than in those with tubulointerstitial disease (P = 0.014) and in those with a combined group (tubulointerstitial, vascular, and cystic and congenital disease) (P = 0.018). CONCLUSION: Our results suggest that selected SNPs that were previously associated with DKD may not be specific for DKD and may confer risk for CKD of different etiology, particularly those affecting renal glomeruli.

[TNF alfa polymorphism and course of ulcerative colitis]. / Wplyw polimorfizmu TNF alfa na przebieg wrzodziejacego zapalenia jelita grubego.

UNLABELLED: Inflammatory bowel diseases including ulcerative colitis are associated with prolonged inflammatory process, that is dependent on cytokine production. Among them crucial role plays tumor necrosis factor TNF-alpha. There is proven association between single nucleotyde polimorphism and ability to produce cytokines. AIM: We analyzed association between TNF-alpha (-308) promoter polymorphism and extension of lesions in ulcerative colitis. TNF-alpha (-308) promoter polymorphism. MATERIALS AND METHODS: Analysis was performed using polymerase chain reaction with sequence specific primers method (PCR-SSP) in 48 patients suffering from ulcerative colitis and association between TNF-alpha (-308) promoter polymorphism and ulcerative colitis macroscopic lesions classified according Montreal classification was investigated. RESULTS: No statistically significant association among groups of patients and TNF-alpha (-308) promoter polymorphism was observed. More cases of TNF-alpha (-308) promoter polymorphism associated with low TNF-alpha production were observed in patients with E2 and E3 lesions according to Montreal classification. CONCLUSIONS. There is no direct association between TNF-alpha (-308) promoter polymorphism and ulcerative colitis macroscopic inflammatory lesions evaluated on basis of Montreal classification. There is statistically irrelevant tendency of more cases of pancolitis in group of patient with TNF-alpha (-308) promoter polymorphism associated with low TNF-alpha production.

[Oligosymptomatic alimentary tract perforation in course of Crohn's disease in patient treated with anti-TNF alfa antibodies]. / Skapoobjawowa perforacja przewodu pokarmowego u pacjentki z choroba Lesniowskiego-Crohna leczona przeciwcialem anty-TNF alfa.

Successful Crohn's disease conservative treatment is often associated with use of few, sometimes new drugs. Their clinical use apart from inflammatory process decrease is associated with some risk. In the paper we report a case of 23-year-old woman suffering from Crohn's disease treated successfully with anti-TNF antibodies. Apart from successful anti-inflammatory there were observed not symptomatic perforation of the alimentary tract. Patients treated with strong anti-inflammatory drugs require especially careful monitoring also because of possibility of occurrence of not symptomatic life-threatening conditions.

[Non-erosive gastroesophageal reflux disease]. / Nienadzerkowa choroba refluksowa przelyku.

Non-erosive gastroesophageal reflux disease (NERD) is still underappreciated type of gastroesophageal reflux disease (GERD). It is not a homogenous group of patients with real reflux, oversensitivity of esophagus and functional dyspepsia. Nowadays often in classifications of GERD patients with NERD are omitted. Many endoscopic lesions are found in esophagus in NERD, especially color change of mucosa. Erythrema is nowadays taken into account. Unequivocal are also opinions about histological image. Many histological lesions are found but not a specific lesions were typified. Probably it is the best to associate NERD with clinical symptoms, endoscopic and histological image.

[Conditions and limits of radiological examinations of the digestive tract]. / Warunki i ograniczenia badan radiologicznych przewodu pokarmowego.

The rising incidence of alimentary tract diseases forces imaging metod development. Developing radiologic diagnostics changed imaging methods role and increased quality demand. X-ray based methods are still used in diagnosing many illnesses. Basic abdominal x-ray in nightshift condition is necessary to diagnose perforation or obstruction. Ultrasonographic, computed tomography and magnetic resonance imaging methods are the most important nowadays. The most popular and non-invasive method of imaging is ultrasonography. It is irreplaceable thanks to its availability and precision diagnosing many internal organs. One of the newest method is magnetic resonance and imaging in all possible scans. Complimentary method is computed tomography. It is based on human body layers analysis. Method is based on x-rays and assessing all tissues absorption. It can produce three dimensional imaging. The newest software can produce virtual imaging of all body cavities as well as colon. Basic and highly specialistic methods should be carefully planned in diagnostic-therapeutic process. In decision making what method should be used, medical doctor and patient should take part, taking into account all indication and cotraindications as well as method limitations.

[Ultrasonographic elastography in alimentary tract lesions diagnostics]. / Znaczenie elastografii ultrasonograficznej w rozpoznawaniu patologii przewodu pokarmowego.

Technology development in data processing in ultrasonography let new imaging method feasible. New method of imaging is elastography (elastosonography, ultrasonographic elastography). It relays on the presumption that pathologically changed tissues have different elasticity and change their shape in different way than health tissue. Elastography is used in lesions in alimentary tract diagnostics. Sensitivity and specificity in malignant lesions differentiation is 85% and 90%. In elastography there is used conventional ultrasonography device that is equipped with additional transformator that is located in probe. Examination is performed with multiple pressing the organ. Imaging is acquired in real-time regime they are colour-coded and they are created during compression. As a result of computer analysis images are generated in two colours. On the basis of character of normal and increased rigidity images were classified in five point scale from one to five. Indication to elastography is suspicion of malignant lesions in traditional ultrasonography and monitoring of liver cirrhosis and fibrosis. More trials are required to evaluate this method more reliably. Then it could be recommended for everyday clinical use.

[Mucosal healing in Crohn disease]. / Gojenie sluzówkowe w chorobie Lesniowskiego-Crohna.

Crohn disease treatment is a considerable challenge for a medical doctor. Gaining clinical remission is not enough. The important factor taken into account in treatment is gaining clinical remission and complete mucosal healing. Treatment useful in mucosal healing consists of immunosupresants as azathioprine, 6-markaptopurin, methotrexate and biological treatment. Important factors influencing mucosal healing is choice of medical treatment and its proper timing. More aggressive treatment in top-down scheme appears to be more successful in this aspekt than classical treatment with use of steroids. This data requires verification with more clinical trials.

[Non-erosive reflux disease in endoscopy and histopathology]. / Nienadzerkowa choroba refluksowa przelyku w obrazi endoskopowym i histopatologicznym.

THE AIM: Non-erosive reflux disease is presented in reflux diseases classifications not adequately Many esophageal lesions were described in different endoscopic techniques but not one classification was proposed. In many patients with signs of prolonged gastro-esophageal reflux in endoscopic assessment pale mucosa above gastro-esophageal junction was observed. In some patients color of esophagus in distal part becomes white and grey. We decided to check what histological lesions appear in all endoscopically visible lesions. MATERIAL AND METHODS: We analyzed 29 patients with chronic reflux disease and with endoscopic assessment of upper alimentary tract in which white color was observed in distal part of esophagus was observed. Biopses were taken from sites at least 2 cm from Z-line. Endoscopic assessment was performed by one endoscopist specialized in reflux disease. Biopsies were assessed by one pathologist specialized in upper alimentary tract diseases assessment. RESULTS: In all cases biopsies taken from distal esophageal, white-coloured mucosa were assessed by pathologist as esophagitis caused by gastro-esophageal reflux. CONCLUSIONS: White color of the distal part of esophagus in patients with chronic reflux disease is unanimously associated with microscopic lesions associated with reflux disease.

[Perspectives in inflammatory bowel diseases treatment]. / Perspektywy leczenia nieswoistych chorób zapalnych jelit.

Development in immunology and better understanding of prolonged inflammatory process is basic in inflammatory bowel diseases treatment development. The new generation of drugs could be included infliximab and adalimumab. To the same group we include tumour necrosis factor inhibitors (infliximab, adalimumab, etanercept, certolizumab, onercept), selective adhesive molecules inhibitors (natalizumab, alicaforsen), Th1 dependent reaction inhibitors (anti-il-12, tacrolismus, il-10), lymphocytes migration inhibitors (natalizumab). Those drug are under development or in various clinical trials phases and are the future of inflammatory bowel diseases treatment.