Cytokeratins in gastroenterology. Systematic review.

Keratins are proteins that form intermediate filaments of epithelial cell cytoskeleton. The utility of keratin expression determination is based on the fact that epithelial cells acquire a specific pattern of keratin expression during differentiation and maturation, which reflects the specificity of the tissue and the degree of maturation, and generally remains stable during carcinogenesis. Determination of the pattern makes it possible to identify the origin of cells in diagnosing neoplastic lesions as well as in research on pathophysiology or the possibility to apply keratin-positive cell detection in the process of cancer staging and treatment planning. As keratins undergo degradation during apoptosis as caspase substrate the identification of the caspase-derived K18 fragment by the use of specific monoclonal antibody allows us to estimate the apoptosis/necrosis ratio, especially in liver pathology, e.g. nonalcoholic steatohepatitis, chronic hepatitis or graft-versus-host disease or in assessing response to antiviral or antitumour therapy.

Elastography in pancreatic solid tumours diagnoses.

INTRODUCTION: Pancreatic solid tumour diagnoses remain a challenge for modern medicine. However, using endosonography together with elastography helps to examine the elasticity of tissues and therefore may allow definition of the nature of pancreatic tumours. AIM: To evaluate the usefulness of elastography with the strain ratio method and quantitative evaluation of pancreatic solid tumours. MATERIAL AND METHODS: A total of 54 patients with pancreatic solid tumours were treated with ultrasound endosonography with fine-needle aspiration biopsy. The control group contained 26 patients with normal pancreas. Pancreatic solid tumours and normal pancreas were analysed with elastography and elasticity evaluation of the interest area (A), reference (B), and the strain ratio factor (B/A). Postoperative histopathological or cytological examinations were the final diagnoses. Both postoperative and cytological diagnoses were compared with average elasticity parameters (A) and strain ratio factors (B/A). RESULTS: Average elasticity parameters (A) and the strain ratio factors (B/A) were: 0.025% (0.01-0.05%) for malignant process, and (B/A) 33.93 (18.23-75.45); (A) - 0.26% (0.14-0.35%), and (B/A) 5.35 (3.47-7.8) for inflammatory process; (A) 0.54% (0.35-0.82%), and (B/A) 1.79 (1.02-2.05) for normal pancreatic tissue. CONCLUSIONS: Malignant tumours have higher tightness factor compared to inflammatory tumours and normal pancreatic tissue. Elasticity parameters reach the highest levels in normal pancreatic tissue, lower in inflammatory tumours, and the lowest in malignant tumours.

Hepatoprotective effect of nitric oxide in experimental model of acute hepatic failure.

AIM: To evaluate the effect of nitric oxide (NO) on the development and degree of liver failure in an animal model of acute hepatic failure (AHF). METHODS: An experimental rat model of galactosamine-induced AHF was used. An inhibitor of NO synthase, nitroarginine methyl ester, or an NO donor, arginine, were administered at various doses prior to or after the induction of AHF. RESULTS: All tested groups developed AHF. Following inhibition of the endogenous NO pathway, most liver parameters improved, regardless of the inhibitor dose before the induction of liver damage, and depending on the inhibitor dose after liver damage. Prophylactic administration of the inhibitor was more effective in improving liver function parameters than administration of the inhibitor after liver damage. An attempt to activate the endogenous NO pathway prior to the induction of liver damage did not change the observed liver function parameters. Stimulation of the endogenous NO pathway after liver damage, regardless of the NO donor dose used, improved most liver function parameters. CONCLUSION: The endogenous NO pathway plays an important role in the development of experimental galactosamine-induced AHF.

[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.

[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.

[Treatment and prophylaxis of alimentary tract lesions caused by non-steroid anti-inflammatory drugs]. / Profilaktyka i leczenie uszkodzen przewodu pokarmowego spowodowanych niesteroidowymi lekami przeciwzapalnymi.

Non steroidal anti-inflammatory drugs (NSAIDs) are of common use. Apart from indisputable advantages their use is associated with adverse events. Those in alimentary tract are the most common and could be serious. Although alimentary tract damage can happen without warning, it is possible to anticipate them and are dependent on known risk factors. Therefore it is advisable to assess gastroenterologic and cardiac risk factors in all patients planned to be treated with those drugs. If there are gastric risk factors prophylactic proton pump inhibitors should be prescribed. The same should be in case of patients receiving small dose of acetylsalicylic acid. In patients with high risk of gastric adverse events and low cardiac, selective COX-2 inhibitors could be used but with proton pump inhibitors. In patients planned with protracted NSAIDs treatment it is advisable to use Helicobacter pylori infection test and in case of eradication should be introduced. After successful Helicobacter pylori treatment in case of other risk factors existence inhibitor proton pump should be used. In paper authors presented prevalence of adverse events associated with non-steroidal anti-inflammatory drugs and possibility of their treatment and prophylaxis.

[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.

[Non-variceal bleeding from the upper gastrointestinal tract]. / Krwawienie niezylakowe z górnego odcinka przewodu pokarmowego.

UNLABELLED: Bleeding from the upper part of gastrointestinal tract is very often complication of gastrointestinal diseases. Bleeding is one of the most common cause of hospitalisation in surgical wards. It's found in 15-20% gastric and duodenal ulcer. Bleeding's occurrence is 50-100 on 100,000 citizens. AIM OF THE STUDY: Answers on questions: what was the best procedure with bleeding patient, what were indications to urgent endoscopy in bleeding, what was the best time to endoscopy and what was influence of endoscopy for volume of transfused blood in bleeding patient. MATERIAL AND METHODS: In the years 1999-2003 81 patients were treated by endoscopy because of bleeding from the upper gastrointestinal tract in Ward of General Surgery in hospital in Zyrardow. There were 31 women in medium age 68 and 50 men in medium age 57. All group was divided on 3 smaller groups: A--patients endoscoped in 6 hours from admitting, B--6-12 hours from admitting and C--12-24 hours from admitting. Each place and kind of bleeding was diagnosed in every case and each bleeding was classified to appropriate group according to Forrest's scale, each was treated by an injection endoscopic therapy (adrenalin was used in concentration 1:10.000 in 0.9% of natrium chloratum). RESULTS: Full hemostasis was achieved in 95.1% cases. The recurrence of bleeding was stated in 6 cases (7.4%), in 2 cases (2.5%) hemostasis was obtained by endoscopy (second-look endoscopy), 4 patients (5%) were operated on because of the recurrence and the dynamics of bleeding as well as the lack of possibility of carrying out the endoscopy. Four deaths (5%) were stated although the bleeding of the upper gastrointestinal tract was not the direct reason. The bleeding in each patient was restrained in our own capacity and nobody was directed to a hospital of higher level of reference.It was stated that the endoscopy of upper gastrointestinal tract gave the best effects if it was done as quickly as possible after the patient had been admitted to hospital - in this material 6 hours from admitting. It allows us to diagnose the cause of bleeding and to treat the disease at the time of diagnosing as well as to reduce of the amount of transfused blood. It also makes possible to prepare elective operation, that is to say "buy" time needed for operation when the endoscopy is not sufficient for successful healing. CONCLUSIONS: Endoscopy is the right and repeatable diagnostic and therapeutic tool for treating the bleeding from the upper part of the gastrointestinal tract which allows us to avoid the unnecessary laparotomy. It also makes possible to plan and control the procedure in the circumstances of bleeding from the upper part of gastrointestinal tract. In relation to not numerous contradictions endoscopic therapy of bleeding from the upper gastrointestinal tract should be fundamental diagnostic and healing method in bleeding from the upper part of gastrointestinal tract in each medical unit, which posseses suitable equipment and qualified staff.

[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.

[Abdominal angina syndrome--case report]. / Zespól anginy brzusznej--opis przypadku.

Bowel atherosclerotic ischemia is one of the type of clinical presentation of this general inflammatory arterial disease. In this article was depicted a case of 58-year-old female with clinical presentation of chronic bowel ischemia, e.g., chronic stomach pain, defecation disturbance and cachexia. Diagnostic process, difficulties during diagnostic and therapy were presented. The patient was referred to the surgery The diagnostic process and surgical treatment performed in our hospital were compared with actual recommendations of specialists and standards.

[Combined management of pancreatic injury after airgunshot--case report]. / Skojarzone leczenie obrazenia trzustki po postrzale z broni pneumatycznej--opis przypadku.

Pancreatic trauma is a big diagnostic and therapeutic challenge for physicians. Because of retroperitoneal localization pancreas is protected from damages. Isolated pancreatic injury is rare. Usually it is connected with a multiple trauma. Damages of the other organs mask the symptoms of pancreas disorders and delay the diagnosis. On the other hand the prognosis is strictly connected with the state of the other organs. Early diagnosis and precise evaluation of the trauma extensiveness determines the appropriate method of the treatment. Surgery is a main therapy but the combined method of management is often necessary, including endoscopy. Computed tomography (CT) is the first diagnostic method showing the pancreatic parenchymas damage and its complications. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the best tool to show the major ductal injury. The status of the major pancreas duct determines surgery management. Often the placement of stents is required. This therapy can save the patient from pancreatectomy. In this article was depicted a case of 19th patient with pancreatic injury who sustained airgun shot. Despite laparotomy and surgery external drainage the pancreatocutaneous fistula appeared. It was successfully treated by endoscopic placement of stent during ERCP.

[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.

[Historical schedule of management of bleeding from the upper part of gastrointestinal tract]. / Rys historyczny postepowania w krwawieniu z górnego odcinka przewodu pokarmowego.

Treatment of bleeding from the upper part of gastrointestinal tract were changed many times. First there were waiting (Hipocrates, Sydenham, Stahl), next transfusion of the blood were initiated (Denis, Blundell, Dieffenbach, Bierkowski, Dungren, Hirszfeld). Big (Rydygier) and small (Dragstedt) operations procedures were attempted. Discovery of endoscopy of gastrointestinal tract (Mikulicz) and initiation of elastic scopes (Hirschowitz) and exploration inhibitor of histamine receptors (H2) and proton pump inhibitors with recognition of role Helicobacter pylori in bleeding were permitted elaborate actual schemas of proceedings.

[Gastroesophageal reflux disease--diagnosis and management]. / Choroba refluksowa przelyku--rozpoznawanie i leczenie.

Gastroesophageal reflux disease is a serious clinical problem. In clinical classification of gastroesophageal reflux disease we differentiate esophageal and non-esophageal syndromes. In case of esophageal syndromes we differentiate based on clinical signs and syndromes with esophageal mucosal lesions based diagnosed on base of upper alimentary tract endoscopic and histopathologic assessment. In clinical diagnosis establishing basics are clinical symptoms as heartburn, regurgitation. Usually, recently found typical symptoms of light intensification can be concluded with diagnosis gastroesophageal reflux disease and without other diagnostic tools treatment could be introduced. Helpful diagnostic test is a test with proton pump inhibitors. Endoscopic assessment should be performed at least once in every patient with chronic gastroesophageal reflux disease in order to eliminate complications (Barrett disease). Main impedance advantage is possibility of reflux diagnosis disregarding ph value. Continuous monitoring of impedance in many segments of esophagus can help to establish direction of reflux and its characteristics and extent establishment. (liquid, gaseous, mixed). The main role in pharmacological gastroesophageal reflux disease treatment plays drugs decreasing acid output, proton pump inhibitors (PPI). Dosage of chronic use should be assess individually. The Basic rule is the use of possibly minimal therapeutic dose of PPI. In this paper authors presented basics of gastroesophageal reflux disease diagnosing, monitoring and treatment.

[The importance of functional tests in gastroesophageal reflux disease diagnosing, monitoring and treatment]. / Znaczenie badan czynnosciowych w rozpoznawaniu, monitorowaniu i leczeniu choroby refluksowej przelyku.

Gastroesophageal reflux disease has become recently an important question, especially in developed countries. Untreated or improperly treated could in chronic disease or can lead to serious complications including esophageal cancer. Early diagnosis establishment basing on clinical symptoms and diagnosing methods. Typical signs of gastroesophageal reflux diseases are acidity, regurgitation, especially after heavy meals or body position change. Those signs are basic for diagnosing establishment. It is recommended to introduce empiric treatment and more diagnostics should be employed if the treatment is not successful. Among diagnosing methods constant development is taking place what is associated with technology progress along with clinical trials. Authors in the paper basic diagnosing tools are presented showing their possibilities and limitations. Proper use of those diagnosing tools that should lead to quick diagnosis establishment.

[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.

[New methods of identification and screening of Barrett's esophagus]. / Nowe mozliwosci rozpoznawania i monitorowania przelyku Barretta.

The increase of patients number suffering from neoplastic esophageal diseases bring about application of most modern technics aiming at the earliest possible detection of pathology and the possibility of its efficient screening. The new technics detecting pathology on the cellular level join with the well-known chromo- and magnifying endoscopy. These include the spectroscopy analysis, getting 3D view of magnifying esophageal mucosa. Nowadays, we observe the gradual come back of chromoendoscopy methods that can be enhanced by the picture magnification. High sensitivity and specificity feature the most modern technics though we notice restrictions associated with these methods. In the years to come we believe that some of these methods will become standard with regards to detection and screening of esophageal metaplasia.

[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.

[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.