Nutritional Status Indicators as a Predictor of Achieving Remission at Week 14 during Vedolizumab Therapy in Patients with Ulcerative Colitis: A Pilot Study.

Background: The loss of response or failure to achieve remission to vedolizumab in ulcerative colitis (UC) patients is currently a major clinical problem. Recently, Nutritional Risk Index (NRI), Controlling Nutritional Status (CONUT), and Malnutrition Universal Screening Tool (MUST) have been suggested as a new prognostic factor of UC activity. Here, we aimed at confirmation of hypotezis that NRI, CONUT and MUST may be used as inexpensive and efficient predictive biomarkers of response in UC patients treated with vedolizumab. Methods: This study was conducted in retrospective manner in 32 adult patients with UC of Caucasian origin (21 men and 11 women), who were qualified for 52-week therapy with vedolizumab and finished the 14-weeks from January 2020 to March 2022. Our study analyzed the 45 courses of vedolizumab therapy. Nutritional status indicators, i.e., the NRI, CONUT and MUST of each UC patient, were marked at the time of qualifying for biological treatment. Results: In our study, the MUST score was significantly lower in UC patients who positively achieved clinical remission at week 14 during vedolizumab induction therapy (0.33 ± 0.49 vs. 1.37 ± 0.83; p = 0.002). The analysis showed the lower baseline NRI and CONUT scores in patients with positive clinical remission at week 14 (NRI: 96.42 ± 4.29 vs. 101.41 ± 7.09; p = 0.024; CONUT: 1.00 ± 1.08 vs. 2.16 ± 1.46; p = 0.031). Conclusions: Nutritional status indicators (NRI, MUST and CONUT) may become valuable predictor of achieving remission at week 14 during vedolizumab therapy in UC patients.

Effects of Microencapsulated Sodium Butyrate, Probiotics and Short Chain Fructooligosaccharides in Patients with Irritable Bowel Syndrome: A Study Protocol of a Randomized Double-Blind Placebo-Controlled Trial.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease in the pathogenesis of which gut dysbiosis may play an important role. Thus, probiotics, prebiotics, or microbiota metabolites, such as butyric acid, are considered to be effective therapy for IBS. However, there are still no trials presenting the efficacy of these three biotic components administered simultaneously. This study aims to evaluate the effects of the product comprising sodium butyrate, probiotics, and short-chain fructooligosaccharides (scFOS) on the severity of clinical IBS symptoms and the quality of life (IBS-QOL). This is a randomized double-blind placebo-controlled trial conducted in 120 adults with IBS diagnosed according to Rome IV criteria. The intervention group (n = 60) will receive a mixture of the following components: 300 mg of colon-targeted microencapsulated sodium butyrate combined with probiotic Lactobacillus strains (L. rhamnosus and L. acidophilus) and Bifidobacterium strains (B. longum, B. bifidum, B. lactis), and 64 mg of prebiotic scFOS. The control group (n = 60) will receive a placebo (maltodextrin). The primary outcomes will be changes in IBS symptoms with the use of the IBS-Severity Scoring System (IBS-SSS), IBS-Global Improvement Scale (IBS-GIS), IBS-Adequate Relief (IBS-AR), and IBS-QOL after 12 weeks of intervention. The secondary outcomes will be the type of stools, patient-recorded symptoms, adverse events, anthropometric and nutritional parameters, and inflammatory cytokine levels. The findings will provide the first evidence of the use of a combination of three biotic compounds in IBS. The study was registered in the clinicaltrials.gov registry under the number NCT05013060.

[Effect of treatment with diet on reducing levels of sex hormones in perimenopausal women with overweight and obesity]. / Wplyw leczenia dieta redukcyjna na stezenie hormonów plciowych u kobiet w okresie okolomenopauzalnym z nadwaga i otyloscia.

UNLABELLED: Nowadays, fight against obesity is a big challenge for the developed countries. Perimenopausal women are especially prone to becoming overweight and obese. This is due to changes in hormone levels and alterations in the sex hormones synthesis pathway. AIM: The aim of this study was to evaluate the levels of sex hormones in overweight and obese women during menopause following the three month period of reducing diet. MATERIALS AND METHODS: The study involved women aged 55±4,75 years. Group I - 33 overweight women (BMI 28,06±1,00 kg/m(2)). Group II - 32 obese women (BMI 34,22±3,79 kg/m(2)). Anthropometric measurements, body composition tested with Bodystat QuadScan 4000 analyzer and levels of sex hormones in the blood was determined before and after the three-months of reducing diet in both groups. Statistical data analysis was performed. RESULTS: After three-months of reducing diet it was noticed that levels of BMI, body fat, FSH, DHEA-S and androstenedione were decreased in a statistically significant manner. A significant increase in estradiol levels after reduction of visceral adipose tissue in both groups, overweight and obese women, was observed. However, only in the group of obese women, a decrease in BMI correlated with a significant increase in estradiol levels. CONCLUSIONS: Application of appropriate reducing diet in perimenopausal overweight and obese women has positive impact on visceral adipose tissue distribution and causes an increase in sex hormones levels. Perimenopausal overweight and obese women should pursue weight reduction to improve their chances of contracting cardiovascular diseases.

Serotonin and melatonin secretion in postmenopausal women with eating disorders.

INTRODUCTION: Postmenopausal women manifest emotional disorders associated with an increase in appetite. The aim of the study was to assess the serotonin and melatonin secretion and metabolism in postmenopausal women in relation to eating disorders. MATERIAL AND METHODS: Sixty postmenopausal women and 30 women without hormonal disturbances were enrolled into the study and divided into three groups: group I (control) - women without menstrual disorders, group II - postmenopausal women without appetite disorders and change in body weight, and group III - postmenopausal women with increased appetite and weight gain. Serum melatonin, serotonin, urinary 6-sulfatoxymelatonin (aMT6s), and 5-hydroxyindoleacetic acid (5-HIAA) excretion were measured. RESULTS: Serum serotonin and melatonin levels in groups II and III were lower compared to group I. Urinary 5-HIAA and aMT6s excretion was lower in overweight women. In group III the correlation between the serum level of serotonin, melatonin, and BMI was negative; a high statistical significance was found between BMI and urinary aMT6s excretion. CONCLUSIONS: Melatonin supplementation and use of drugs modulating the serotonin homeostasis together with female hormones have a beneficial effect in complex treatment of disorders of eating in postmenopausal women. (Endokrynol Pol 2016; 67 (3): 299-304).

Melatonin and female hormone secretion in postmenopausal overweight women.

Estrogen deficiency is considered to be the main cause of increased appetite and increased weight in postmenopausal women. In this period, reduced secretion of melatonin (MEL) was also observed. The aim of the study was to evaluate the secretion of melatonin, 17-ß estradiol and follicle-stimulating hormone (FSH) in relation to body mass index (BMI) in pre- and postmenopausal women. The study included 90 women divided into three equal groups: group I (control)-women without menstrual disorders, group II-postmenopausal women without change in appetite and body weight, group III-postmenopausal women experiencing increased appetite and weight gain. In each patient, serum melatonin, 17-ß-estradiol, FSH and urine a 6-sulfatoxymelatonin (aMT6s) were determined. Compared to the control group, the level of melatonin and estradiol was statistically lower. The FSH level was higher than in the groups of postmenopausal women. No significant correlation was found in all groups between the level of melatonin and the levels of estradiol and FSH. A negative correlation was found between aMT6s excretion and BMI, and a positive correlation between the level of FSH and BMI, mainly in overweight women. The obtained results indicate a significant effect of melatonin deficiency on the process of weight gain in postmenopausal women and justify its use in treatment of these disorders.

[The effect of fluoxetine and tianeptine on emotional and eating disorders in postmenopausal women]. / Wplyw fluoksetyny i tianeptyny na stan emocjonalny i zaburzenia odzywiania u kobiet po menopauzie.

UNLABELLED: In postmenopausal period, there occur a variety of psychosomatic symptoms in a female organism, which include deterioration of mood, anxiety, fear, sleep disorders, excessive irritability, impaired concentration and memory, overt depression with psychomotor retardation, decreased interest and life activity, decreased or increased appetite. Fluoxetine -selective serotonin reuptake inhibitor (SSRI) is used in the treatment of obesity and depression. Tianeptine--selective serotonin reuptake enhancer (SSRE) is used in the treatment of depressive episodes. Metabolic effects of prolonged tianeptine use are not well known. The aim of the study was the evaluation of the effect of long-term use of fluoxetine and tianeptine on emotional state and eating disorders in postmenopausal women. MATERIAL AND METHODS: The study was conducted in two groups of 30 postmenopausal women each, aged 52-66 years. The patients took fluoxetine for 6 months at a dose of 1 x 20 mg in the morning (group I) or tianeptine at a dose of 3 x 12.5 mg/daily (group II). Follow-up visits were conducted at 2, 4, 8, 12, 16 and 20 weeks. At week 24, extended tests were performed, including the assessment of the level of anxiety (Hamilton Anxiety Rating Scale-HARS) and depression (Beck Depression Inventory-BDI), the body mass index (BMI) and the waist/ hip ratio (WHR), which were compared with the corresponding results prior to the treatment with fluoxetine and tianeptine. RESULTS: After 6 months, in the group receiving fluoxetine, the reduction of the level of anxiety was obtained from 22.92 +/- 4.08 points to 12.36 +/- 2.43 points (p < 0.001) and a decrease in depression symptoms from 19.28 +/- 2.53 points to 10, 44 +/- 2.02 points (p < 0.001), but no reduction in body mass index was obtained -respectively 29.4 +/- 3.54 and 29.7 +/- 3.26 (p > 0.05) nor in the waist/ hip ratio--respectively 0.886 +/- 0.03 and 0.879 +/- 0.03 (p > 0.05). After 6 months, in the group receiving tianeptine, the reduction of the level of anxiety was achieved from 22.00 +/- 3.35 points to 15.20 +/- 3.42 points (p < 0.001) and a decrease in depression symptoms from 18.80 +/- 2.45 points to 14,16 +/- 4.06 points (p < 0.001), whereas no reduction in body mass index was obtained- respectively 27.7 +/- 2.81 and 27.4 +/- 2.65 (p > 0.05), even though slightly reduced waist/ hip ratio--from 0.877 +/- 0.03 to 0.863 +/- 0.03 (p < 0.05) was observed. Fluoxetine was more effective than tianeptine in the reduction of the level of anxiety (chi2 = 17.459, p < 0.01) as well as the reduction in the symptoms of depression (chi2 = 17.469, p < 0.01). CONCLUSIONS: Both tianeptine and fluoxetine are effective in the treatment of emotional disturbances in postmenopausal women. Both drugs may decrease appetite but long-term treatment does not alter body weight to the desired extent and they do not match the standards as monotherapy for obesity.

[Efficacy of sulpiride and itopride in the treatment of functional dyspepsia in women with emotional and eating disorders]. / Ocena skutecznosci sulpirydu i itoprydu w leczeniu dyspepsji czynnosciowej u kobiet z zaburzeniami emocji i laknienia.

UNLABELLED: Functional dyspepsia is often accompanied by emotional disturbances, especially in postmenopausal women. Impaired homeostasis of the dopaminergic system maybe one of the common pathogenetic factors. The aim of the study was to assess the effect of drugs which block dopamine D2 receptors on psychosomatic condition in postmenopausal women. MATERIAL AND METHODS: The study was conducted in a group of 60 women, aged 53-61 years, with postprandial distress syndrome (PDS) that met the Rome Criteria III. The severity of dyspeptic symptoms was determined statistically using a 10-point Visual Analogue Scale (VAS). The emotional state was estimated with the Hamilton Anxiety Rating Scale (HARS) and the Beck Depression Inventory (BDI), whereas the body mass index (BMI) was the indicator of the nutritional status. Sulpiride (2 x 50 mg) was administered to 30 women for 16 weeks and itopride (2 x 50 mg) to 30 others. RESULTS: After sulpiride and itopride treatment equal decrease of dyspeptic symptoms was observed, respectively from 9.08 to 4.76 pts and from 9.02 to 4.64 pts. Significant reduction in the level of anxiety (p < 0.001) and depression (p < 0.01) was obtained in both groups, slightly higher after sulpiride. However, no significant change in BMI was found. CONCLUSIONS: Sulpiride and itopride are effective in the treatment of dyspepsia in the form of postprandial distress syndrome. These drugs in the several-month treatment have no significant effect on body weight.

[Estimation of small intestinal bacterial overgrowth in patients with constipation and diarrhea irritable bowel syndrome]. / Ocena przerostu flory bakteryjnej w jelicie cienkim u osób z zaparciowa i biegunkowa postacia zespolu jelita nadwrazliwego.

UNLABELLED: Irritable bowel syndrome (IBS) is one of the most common reason for gastroenterology consultations. The diverse in symptomatology of the disease comes from its rich etiopathogenesis. Recently studies talk about infectious etiology of IBS and because of that it is necessary to expand its diagnostics by small intestinal bacterial overgrowth (SIBO) test. The aim of this study was to evaluate the prevalence of small intestinal bacterial overgrowth in patients with constipation (IBS-C) and diarrhea (IBS-D) irritable bowel syndrome with regard to nutrition. MATERIALS AND METHODS: The study involved 46 subjects (33 women and 13 men) in average age of 44 years, which were divided into two groups: diarrhea and constipation IBS. All patients underwent hydrogen breath test studying bacterial overgrowth in the small intestine. In addition, each person had fulfilled a feeding questionnaire. STATISTICAL ANALYSIS: Student's t-test, Pearson test. RESULTS: It has been shown that there is no statistical significances between the prevalence of SIBO in form of diarrheal IBS and constipation IBS and gender. Average value of increments of hydrogen in breath during the test was higher in IBS-C in comparison with IBS-D, which was the highest in the intestine bacterial overgrowth in patients with IBS-C. STATISTICAL ANALYSIS showed that there is no relationship between the type and frequency of consumption of milk, meat, fruit and vegetables, sweets and coffee and the prevalence of SIBO in form of diarrhea and constipation IBS. CONCLUSIONS: The occurrence of constipation or diarrhea irritable bowel syndrome is not related to gender. SIBO is more common in patients with IBS-C than in IBS-D group. There is no relationship between the type of food consumed and the amount of SIBO in people with IBS. Type of food intake do not affect the status of the intestinal flora of people with IBS.

Protective role of melatonin in liver damage.

The liver plays a key role in the detoxification of numerous molecules which results in the formation of an excessive number of toxic reactive oxygen species. This results in oxidative damage to the hepatocytes, which when severe, compromises the function of this critical organ. A variety of antioxidants protect the liver from free radical-mediated damage, one of the best of which is melatonin. Clinical studies have confirmed the melatonin, as well as it precursor tryptophan, protect the liver from non-alcoholic liver disease and also during the surgical procedure of partial liver resection.

The effect of melatonin supplementation on the quality of sleep and weight status in postmenopausal women.

AIM OF THE STUDY: We evaluated the effect of melatonin supplementation on the nutritional status of postmenopausal women. MATERIAL AND METHODS: The study included 56 women (51-65 years) and 25 healthy women (27-36 years). The emotional state was assessed using Hamilton Depression Rating Scale (HAM-D), the quality of sleep using Insomnia Severity Index (ISI). Body mass index (BMI) and waist-hip ratio (WHR) were also calculated. The patients were divided into 3 groups: group I (control) - 25 women with normal body weight, group II - 26 postmenopausal women with normal body weight, group III - 30 postmenopausal women with high body weight. In women from group II and III, routine laboratory tests, levels of thyroid-stimulating hormone (TSH), 17ß-estradiol, prolactin, follicle-stimulating hormone (FSH) and the concentration of 6-hydroxymelatonin sulphate (6-HMS) in day/night urine fractions were determined. On the day of the examination, women remained on a liquid diet (1800 kcal). Next, a balanced diet of 1500 kcal and 5 mg of melatonin administration were recommended. The follow-up examinations were performed after 4, 8, 12, 16, 20 and 24 weeks. RESULTS: The patients from groups II and III showed similar mild levels of anxiety and depression and a significant degree of sleep disorders. In group III, lower urinary 6-HMS excretion was observed at night. In both groups a negative correlation was found between urinary 6-HMS excretion and the degree of sleep disorders. After 24 weeks, a statistically significant improvement of quality of sleep was obtained. A negative correlation was detected between urinary 6-HMS excretion and BMI. CONCLUSION: Melatonin supplementation contributed to body weight reduction.

Influence of melatonin on symptoms of irritable bowel syndrome in postmenopausal women.

INTRODUCTION: Melatonin (MEL) exerts beneficial effects on the gut partly by myorelaxative properties upon the smooth muscle. Its secretion decreases with age, particularly in postmenopausal women. This study was aimed at evaluating the effect of MEL on the symptoms of irritable bowel syndrome (IBS) in this group of patients. MATERIAL AND METHODS: The investigations were carried out in 80 postmenopausal women, aged 48-65 years, divided into two equal groups, diagnosed according to Rome Criteria III: i.e. patients with IBS with constipation predominant (IBS-C), and patients with IBS with diarrhoea predominant (IBS-D). The control group (C) included healthy women aged 46-65 years. In all subjects, 6-sulfatoxymelatonin (6-HMS) concentration urine was measured using ELISA assay. Patients in both groups over the course of six months were given melatonin (at a dose of 3 mg fasting and 5 mg at bedtime) or a placebo (double blind trial). Disease activity was evaluated after two, four and six months, using a ten-point scale to assess the main somatic symptoms: visceral pain, abdominal bloating, etc. RESULTS: The amounts of 6-HMS urine excretion (µg/24 h) were: C 11.4 ± 3.0, IBS-C 10.2 ± 3.2, IBS-D 14.0 ± 6.3 (p 〈 0.05). Correlation between values of symptoms score and contrary excretion of 6-HMS: IBS-C r = -0.714, IBS-D r = 0.409. After six months in the IBS-C group, the intensity of visceral pain and abdominal bloating had decreased in 70% of patients (p 〈 0.01) and constipation in 50% of patients (p 〈 0.05). Beneficial changes in the IBS-D group were noted in 45% of patients, but this was not better compared to the placebo. CONCLUSIONS: Melatonin can be used as part of the treatment of IBS, particularly in patients with constipation-predominant IBS.

Serotonin and melatonin secretion and metabolism in patients with liver cirrhosis.

INTRODUCTION: Hepatic encephalopathy is one of the symptoms of liver failure. The exact causes of encephalopathy are complex and still unclear. Apart from elevated blood ammonia levels, the role of numerous other factors is being considered. OBJECTIVES: The aim of the study was to determine the serum level of serotonin and melatonin and the urinary excretion of their metabolites (5-hydroxyindoleacetic acid [5-HIAA] and 6-sulfatoxymelatonin [6-HMS]) in patients with various stages of liver cirrhosis. PATIENTS AND METHODS: The study comprised 75 patients with alcohol-induced liver cirrhosis and 25 healthy subjects (control group). Based on the Child-Pugh classification, 3 groups of 25 patients each were distinguished - group A, B, and C with grade A, B, and C of liver failure, respectively. Blood samples were drawn at fasting at 9 a.m., and 24-hour urine collection was performed. Immunoenzymatic assays were used to determine serum melatonin and serotonin levels as well as urine 5-HIAA and 6-HMS concentrations. RESULTS: Serum serotonin levels were 159.8 ± 23.1 ng/ml in controls, 179.3 ± 21.1 ng/ml in group A (P >0.05), 143.2 ± 22.8 ng/ml in group B (P >0.05), and 114.5 ± 37.6 ng/ml in group C (P <0.01). Serum melatonin levels were 10.6 ± 1.7 in controls, 31.2 ± 9.8 pg/ml in group A (P <0.01), 49.8 ± 12.2 pg/ml in group B (P <0.001), and 94.8 ± 22.6 pg/ml in group C (P <0.001). Urinary 5-HIAA excretion was 5.9 ± 2.1 mg/24 h in controls, 5.9 ± 1.9 mg/24 h in group A (P >0.05), 4.8 ± 1.2 mg/24 h in group B (P >0.05), and 4.6 ± 1.4 mg/24 h in group C (P <0.05). Urinary 6-HMS excretion was 26.6 ± 15.1 µg/24 h in controls, 23.2 ± 7.9 µg/24 h in group A (P >0.05), 18.3 ± 10.6 µg/24 h in group B (P >0.05), and 6.5 ± 3.6 µg/24 h in group C (P <0.001). CONCLUSIONS: Disturbances in serotonin and melatonin homeostasis observed in patients with liver cirrhosis may be associated with advanced encopaholopathy.

[Evaluation of the influence of tianeptine on the psychosomatic status of patients with ulcerative colitis in remission]. / Ocena wplywu tianeptyny na stan psychosomatyczny.

UNLABELLED: In order to maintain ulcerative colitis (UC) in remission, chronic use of aminosalicylates is recommended. All patients have a fear of the recurrence of symptoms, which makes their mental state and quality of life worse. Because of this a number of patients are recommended to use different sorts of anxiolytic drugs and antidepressants. AIM OF THE STUDY: Evaluation of the influence of tianeptine (selective serotonin reuptake enhancer) on the mental and somatic status in the group of patients. MATERIAL AND METHOD: The research was conducted in two groups of thirty patients, with benign form of ulcerative colitis in remission, aged 24-46 years. Patients, during a period of 12 months, were given aminosalicylates in a daily doses 2 x 1.0 g and tianeptine in a doses 3 x 12.5 mg (group I) or placebo (group II). During the treatment every three months anxiety (Hamilton Anxiety Rating Scale-HARS), depression (Back Depression Inventory-BDI), The Mayo Clinic Disease Activity Index (MCDAI), hemoglobin and C-reactive protein (CRP) level were evaluated. RESULTS: After 12 months in a group of patients who took tianeptine decrease in anxiety (from 20.35 +/- 4.03 to 12.65 +/- 3.78 points) and depression (from 19.95 +/- 4.49 points to 9.60 +/- 2.76 points) was obtained; difference compared with placebo was statistically significant (p < 0.01). At the same time significant decrease compared with placebo (p < 0.05) of disease activity index (respectively 3.05 +/- 1.36 and 4.65 +/- 1.69), insignificantly lower level of CRP (7.00 5.65 and 9.41 +/- 10.12) and higher level of hemoglobin (11.93 +/- 0.83 and 11.0 +/- 0.70) was observed. CONCLUSIONS: Tianeptine has a positive influence on mental and somatic status of patients with UC. Results give the support for tianeptine apllication in UC as adjuvant drug.

[Gastrin secretion in patients with functional dyspepsia]. / Wydzielanie gastryny u osób z dyspepsja czynnosciowa.

UNLABELLED: The pathogenesis of functional dyspepsia is very complicated and its etiology is still not clear. One of the supposed pathophysiological mechanisms are disturbences of gastric acid secretion and gastric motility. Recently, it has been recognized, that in the pathogenesis of above disturbances may play a role enterohormones, like gastrin. AIM: To establish if in patients with functional dyspepsia the level of gastrin concentration changes and wheather it correlates with type and grade of symptom's intensity. MATERIAL AND METHODS: The study included 50 subjects between of 20 to 54 years with diagnosed functional dyspepsia (according to the Rome III Criteria). The study group was divided into two subgroups: group I--25 subjects with Epigastric Pain Syndrome--EPS and group II--25 subjects with Postprandial Distress Syndrome--PDS. Control group comprised 20 healthy subjects (without any clinical or morphological symptoms of digestive tract disease). In each patient due to gastrointestinal tract organic disease exclusion the gastroscopy, histological examination of gastric mucosa, ultrasonography of abdomen and laboratory tests were performed. H. pylori infection was detected using fast urea test (CLO-test), confirmed by histopathological examination (stained Giemsa method) and non-invasive urea breath test (UBT-13C) using mass spectrophotometer FANci 2 (Fisher Analyser Instrumente GmbH). In each patient the level of gastrin concentration in blood serum, in fasting state, was determined, based on ELISA method considering the length of the weave lamda=430 nm. The study group was also divided into 3 subgroups, using 10-points scale of symptom's intensity: --grade 1--mild (1-3 points); --grade 2--moderate (4-6 points); --grade 3--severe (7-10 points). RESULTS: The concentration of gastrin in blood serum in healthy subjects was 2.4 +/- 1.23 pmol/L. In patients with functional dyspepsia was significantly higher; in patients with Epigastric Pain Syndrome--7.51 +/- 2.46 pmol/L (p < 0.05), in patients with Postprandial Distress Syndrome - 6,92 +/- 2.18 pmol/L (p < 0.05). There were no significant differences in dependence on pain's intensity in EPS--the concentrations in subgroups 1, 2 and 3 were: 7.36 +/- 1.4 pmol/L, 7.53 +/- 2.43 pmol/L and 7.64 +/- 2.55 pmol/L. The gastrin concentration in PDS in dependence on symptom's intensity in subgroup 1 was 6.34 +/- 1.2 pmol/L, in subgroups 2 and 3 were higher: 6.99 +/- 2.31 pmol/L and 7.42 +/- 2.2 pmol/L, but the differences were not statistically significant. In patients with functional dyspepsia, infected with H. pylori the gastrin concentration was significantly higher and was 15.28 +/- 5.3 pmol/L (p < 0.05). There were no significant differences in dependence on type of dyspepsia. CONCLUSIONS: The gastrin concentration in blood serum in fasting state in patients with functional dyspepsia is higher than in control subjects, both in patients with Epigastric Pain Syndrome--EPS as well as with Postprandial Distress Syndrome--PDS. The grade of symptom's intensity does not correlate with increase of gastrin concentration.

[Electrogastrography in various clinical forms of functional dyspepsia]. / Elektrogastrografia w róznych postaciach klinicznych dyspepsji czynnosciowej.

Electrogastrography (EGG) is simple, noninvasive, painless and repeatable method of assessment of gastric myoelectrical activity. By means of cutaneous electrodes placed on the abdomen skin we can record and then using computer evaluate the slow waves of the stomach and this is one of the methods for the assessment of gastric myoelectrical activity that makes its possible to draw inferences about gastric motility. The pathogenesis of functional dyspepsia is still not clear, but the disorders of the motility and myoelectrical activity of the stomach probably play here very important role. AIM OF OUR STUDY: To evaluate gastric myoelectrical activity in patients suffering from functional dyspepsia (FD) and to answer the question if there are some differences between two clinical forms of the functional dyspepsia. MATERIAL AND METHODS: A group of 60 patients diagnosed with functional dyspepsia, aged 18-65 years (x = 34.8, SD = +/-12.1), and a reference group of 30 healthy volunteers aged 18-65 years (x = 38.2, SD = +/- 18.4) were tested. Dyspepsia was diagnosed on the basis of a detailed medical history taken according to the Roman Criteria III. A half of the patients with functional dyspepsia,. i.e., 30 persons tested, was composed of the patients with postprandial distress syndrome (PDS), whereas the other half (30 patients) included the patients with epigastric pain syndrome (EPS). The occurrence of Helicobacter pylori was excluded by a 13C-urea breath test and a urease test performed during gastroscopy. Cutaneous electrogastrography was recorded by electrodes placed on the abdomen skin for six hours. After an hour of recording of the gastric myoelectrical activity in patients on an empty stomach a solid or liquid test meal was served. Test meals, both solid and liquid, were of approximately the same energy value of about 300 kcal. RESULTS: In the patients with functional dyspepsia gastric myoelectrical disorders occur with dominating dysrhythmia (p < 0.001), especially bradygastria, both in the record on an empty stomach and after a meal. The EGG records were different in the two forms of dyspepsia: in the group of patients with postprandial distress syndrome (PDS) there was statistically significant larger number of tachygastria both in the total record period (t = 2.719; p < 0.01) and after a meal (t = 2.164; p < 0.05) than in the group of patients with epigastric pain syndrome (EPS). CONCLUSIONS. (1) In the patients with functional dyspepsia gastric myoelectrical disorders occur with dominating dysrhythmia, especially bradygastria. (2) The EGG records are different in the two clinical forms of dyspepsia and this may be used for differential diagnostics of this disease: in epigastric pain syndrome bradygastria prevails whereas in postprandial distress syndrome bradygastria is dominant and an essential proportion of tachygastria is observed.

[The assessment of nitric oxide metabolites in gastric juice in Helicobacter pylori infected subjects in compliance with grade of inflammatory lesions in gastric mucosa]. / Ocena stezenia metabolitów tlenku azotu w soku zoladkowym u zakazonych Helicobacter pylori z uwzglednieniem stopnia zmian zapalnych w blonie sluzowej zoladka.

UNLABELLED: The infection of H. pylori causes inflammatory lesions in gastric mucosa--until atrophic gastritis, intestinal metaplasia, dysplasia (precancerous states) and finally to gastric cancer or lymphoma. The mechanism of mentioned disturbances is complicated, no doubt that nitric oxide plays here very important role. It is proved, that H. pylori causes essential oxygen metabolism disturbances by activation of inflammatory infiltration's cells to oxide reactive forms as nitric oxide formation. Nitric oxide as oxide radical could react with other free radicals and contribute to oxidative lesions of gastric mucosa and alterations of its structure. The aim of the study was try to answer the question: 1. Is this the relationship between NO metabolites concentrations in gastric juice and morphological state of gastric mucosa? 2. Does H. pylori eradication influence on NO metabolites concentrations in gastric juice? 3. Does H. pylori eradication influence on grade of inflammatory lesions in gastric mucosa? MATERIAL AND METHODS: The study included 75 subjects between of 21 to 60 years, infected with H. pylori with diagnosed (according to the Sydney system) different stages of chronic gastritis progression. The type of inflammation, activity, the presence of atrophy, intestinal metaplasia and H. pylori infection were assessed. The study group was divided into 3 subgroups: group I--25 subjects with chronic active gastritis, group II--25 subjects with chronic atrophic gastritis without intestinal metaplasia, group III--25 subjects with chronic atrophic gastritis with intestinal metaplasia. Control group comprised 20 healthy subjects, without H. pylori infection. In each patient during gastroscopy 5 biopsy specimens for histopathologic examination and for urea test and 3 ml gastric juice were collected. The concentration of nitric oxide metabolites in gastric juice was determined with spectrophotometric method, based on Griess reaction. H. pylori infection was detected using fast urea test (CLO--test), confirmed by histopathological examination (stained Giemsa method) and non-invasive urea breath test (UBT-13C). In H. pylori--infected patients the above mentioned investigations were performed three times -before, in 8 weeks and in 12 months after antibacterial treatment's finish. In antibacterial therapy we use 7-days three-drugs therapy (omeprasole, amoksycillin and clarythromycin). RESULTS: The concentration of nitric oxide metabolites in gastric juice in healthy subjects was 6.81 +/- 2.23 micromol. In patients with chronic gastritis, H. pylori infected was significantly higher--in patients with chronic active gastritis was 9.29 +/- 2.19 micromol/l, in patients with chronic atrophic gastritis--10.25 +/- 2.31 micromol/l (p < 0.01), in patients with intestinal metaplasia--11.89 +/- 2.46 micromol/l (p < 0.01). 8 weeks after antibacterial treatment's finish the concentration of nitric oxide metabolites in gastric juice in each group decreased and were: in patients with chronic active gastritis was 8.18 +/- 1.63 micromol/l, in patients with chronic atrophic gastritis--10.02 +/- 2.28 micromol/l, in patients with intestinal metaplasia--10.83 +/- 2.32 micromol/l. The differences were not statistically significant. 12 months after antibacterial treatment's finish the concentration of nitric oxide metabolites in gastric juice in each group decreased and were: in patients with chronic active gastritis was 6.90 +/- 1.43 micromol/l, in patients with chronic atrophic gastritis--7.22 +/- 2.01 micromol/l, in patients with intestinal metaplasia--7.56 +/- 1.98 micromol/l. The differences were statistically significant--p < 0.05, p < 0.01. 8 weeks after antibacterial treatment's finish in each patient also the gastroscopy was performed and another biopsy specimen for histopathologic examination were collected. Only in group I in microscopic image the decreased of inflammation intensity was find (both in antrum and in corpus)--however the differences were not statistically significant. In the other groups the alterations in gastric mucosa do not improve significantly. The gastroscopy was performed again in 12 months after antibacterial treatment's finish. In group I the significant decrease or regression of inflammatory infiltration (in corpus and in antrum) was found. Also in group II the significant decrease of the grade of atrophy and similarly in III group the improvement of histopathological state were observed. CONCLUSIONS: 1. The increase of NO metabolites concentration demonstrates positive correlation with grade of inflammatory lesions in gastric mucosa. 2. The effective antibacterial therapy causes the decrease of NO metabolites concentration in gastric juice, especially in patients with chronic active gastritis. 3. Eradication influence on decrease of grade of lesions' progression in gastric mucosa just in 12 months after effective antibacterial therapy.

[The influence of melatonin on concentration of nitric oxide metabolites in gastric juice in subjects with functional dyspepsia]. / Wplyw melatoniny na stezenie metabolitów tlenku azotu w soku zoladkowym u osób z dyspepsja czynnosciowa.

UNLABELLED: The pathogenesis of functional dyspepsia is very complicated and its etiology is still not clear. One of the supposed pathophysiological mechanisms is the deficiency of melatonin. The deficiency of melatonin leads to increase the oxide reactive form's concentration as nitric oxide metabolites and to decrease of antyoxidative enzymes activity. This last factor seems to be very important in correct digestive tract function. The aim of our study was answer the question if is the difference between NO metabolites concentraction in gastric juice in patients with functional dyspepsia and in healthy subjects and wheather the treatment with melatonin plays the role in normal digestive tract function. MATERIAL AND METHODS: The study included 60 subjects between of 18 to 48 years with diagnosed functional dyspepsia (according to the Rome III Criteria). The study group was divided into two subgroups: group I--30 subjects with Epigastric Pain Syndrome-EPS and group II--30 subjects with Postprandial Disorders Syndrome-PDS. Control group comprised 25 healthy subjects (without any clinical or morphological symptoms of digestive tract disease). In each patient the gastroscopy was performed. During gastroscopy 5 ml gastric juice was collected. The juice was centrifuged for 15 min (4500 rotations). The undiluted supernatant was frozen in the temperature -70 degrees C. The concentration of nitric oxide metabolites in gastric juice was determined with spectrophotometric based on ELISA test (540 nm wavelength) using a microplates reader (Multiscan, Labsystems). In patients with functional dyspepsja the investigations were performer twice before and after 6 weeks treatment with melatonin. Melatonin was applied in dose 5 mg daily, in the evening. RESULTS: The concentration of nitric oxide metabolites in gastric juice in healthy subjects was 6.81 +/- 2.23 microM. In patients with functional dyspepsia was significantly higher; in patients with Epigastric Pain Syndrome--10.99 +/- 2.46 microM (p < 0.05), in patients with Postprandial Disorders Syndrome--9.28 +/- 2.18 microM (p < 0.05). After treatment with melatonin the concentration of nitric oxide metabolites in gastric juice in both groups decreased and were 8.21 +/- 1.83 microM in patients with Epigastric Pain Syndrome and 6.93 +/- 1.61 microM in patients with Postprandial Disorders Syndrome. CONCLUSIONS: In patients with functional dyspepsia the concentration of nitric oxide metabolites in gastric juice was significantly higher than in control group. After treatment with melatonin the concentration of nitric oxide metabolites in gastric juice in both groups decreased--in patients with Epigastric Pain Syndrome as well as in patients with Postprandial Disorders Syndrome. The treatment with melatonin seems to be suitable in combined therapy of functional dyspepsia.

[Secretion of serotonin and melatonin in patients with functional dyspepsia]. / Wydzielanie serotoniny i melatoniny u osáb z dyspepsja czynnosciowa.

UNLABELLED: It was confirmed that enterochromaffin cells (EC) in the digestive system are a source of serotonin and melatonin. Both hormones possess an important, but opposed, influence on secretory and motoric function of gut. The aim of our study was to evaluate fasting secretion of serotonin and melatonin in patients with functional dyspepsia. Material and methods. 25 healthy subjects (K, group I), 25 patients with epigastric pain syndrome (EPS, group II) and 25 patients with postprandial distress syndrome (PDS, group III), aged 18-50 years, were included in this study. Diagnosis of functional dyspepsia was established according to the Rome Criteria III. Organic diseases of gut, H. pylori infection and another disorders were excluded. Seven days before the examinations the patients were told to abstain from drugs intake and equal diet was applied. On the day of investigation the subjects remained in a red-light room at night and received standard liquid diet (Nutridrink, 4 x 200 ml, 1800 kcal). Blood samples were taken for examination at 8 am on the subsequent day and serum was frozen in -80 degrees C. The concentration of serotonin and melatonin was measured by ELSA, using antibodies from IBL (catalogue no. RE 59121, RE 54021). RESULTS: The mean concentration of serotonin in group I (K) was 162.9 +/- 49.1 ng/ml, in group II (EPS)--225.8 +/- 111.3 ng/ml (p < 0.05) and in group III (PDS)--152.7 +/- 83.2 ng/ml (p > 0.05). The concentration of melatonin was in group I--7.3 +/- 4.0 pg/ml, in group II 8.7 +/- 8.0 (p > 0.05) and in group III 14.3 +/- 10.1 (p < 0.01). CONCLUSIONS: During fasting time secretion of serotonin is higher in patients with EPS, and similarly higher secretion of melatonin in patients with PDS, compared to healthy subjects.

[The influence of Helicobacter pylori eradication on oesophageal pH-metry and bilimetry results in patients with nonulcer dyspepsia]. / Wplyw eradykacji Helicobacter pylori na wyniki pH-metrii i bilimetrii przelyku u osób z czynnosciowa dyspepsja wrzodopodobna.

Substernal, fasting and night pains with no endoscopic findings in the upper gastrointestinal tract are the leading symptoms of nonulcer dyspepsia (NUD). Our study aimed at determining whether there is duodenogastroesophageal reflux in patients with NUD and to evaluate what role Helicobacter pylori plays in NUD pathophysiology. The study comprised 40 patients, in whom endoscopy, breath test (UBT-13C), 24-hour pH-metry (Digitrapper III) and bilimetry (Bilitec 2000) of the esophagus were performed before and after 7-day antibacterial treatment (pantoprazole 2 x 40 mg, amoxicillin 2 x 1000 mg, clarithromycin 2 x 500 mg). Eradication was achieved in 29 patients, in whom total index of acid reflux (t% pH < 4.0) decreased from 23.1+/-10.4% to 13.1+/-6.2% (p<0.05) and alkaline reflux index (t% abs > 0.14) from 12.9+/-6.3 to 8.1+/-5.7% (p>0.05). Positive correlations between urea breath test results and the indexes of acid (r=0.692) and alkaline refluxes (r=0.246) were observed. In patients with nonulcer dyspepsia infected with Helicobacter pylori complex functional disorders are present. They are expressed as duodenogastroesophageal reflux. The refluxes intensity depends on the extent of Helicobacter pylori infection, which should be remembered when planning antibacterial treatment.