[The role of endoscopic ultrasound in digestive tract diseases in era of advanced techniques of computed tomography]. / Uloga endoskopskog ultrazvuka u bolestima probavnog sustava u eri naprednih tehnika kompjutorizirane tomografije.

During the last 20 years endoscopic ultrasound (EUS) has been established as a highly accurate method in the diagnosis of digestive tract diseases. This method enables analysis of the lesions within the bowel wall, pancreas, and biliary system with utmost precision. Good results have also been achieved in evaluation of regional lymphadenopathy in staging of malignant diseases. Principal limitations of this method originate from its low accesibility and technical complexity which requires well trained sinologist and scientific evaluation of results in order to achieve adequate level of skill. Complications occur rarely with numbers comparable to other endoscopic procedures. With new software and hardware device introduced, computerized tomography (CT) (this refers in the first place to multidetector row CT) has been tremendously upgraded approaching the EUS in diagnostic accuracy in mentioned indications, and overcoming it in detection of distant metastases. Implementation of 3D reconstruction techniques allowed CT to enter the area of classic endoscopy, as in the case of virtual gastroscopy and/or colonoscopy. CT is a noninvasive method, very acceptable to majority of patients, and therefore popular and more prevalent compared to EUS. Although comparable in diagnostic accuracy in majority of indications, endosonography retains advance in evaluation of lesions within GI tract wall (including the early stages of carcinoma), detection of small biliary stones and small pancreatic tumors. Moreover, EUS is indespensable in therapeutic indications. Experiences with fine needle aspiration, punctions and drainage of cysts and abscesses, celiac plexus neurolysis and creation of digestive anastomosis confirm its place and value among the minimally invasive procedures which minimize the need for surgical intervention, patients' trauma and treatment costs.

[Doxycycline induced esophageal ulcers: report of two cases and review of the literature]. / Vrijedovi jednjaka prouzroceni doksiciklinom: prikaz dvaju bolesnika i pregled literature.

Doxycycline-induced esophageal ulcers (DIEU) are rarely observed in endoscopy units. On the other hand doxycycline itself has been claimed as an offending drug in 1/4 out of about 1000 cases of drug induced esophageal ulcers reported in the literature so far. In this article we present two patients with typical history and endoscopic features of esophageal ulcers as an consequence of doxycycline therapy. The therapy consisted of doxycycline withdrawal along with treatment with proton pump inhibitors and sucralfate which had led to disappearance of chest discomfort within one week period. Fourteen days of the tratment beginning complete recovery of the mucosal defects has occurred in both patients. In conclusion, in case of chest pain and painful swallowing occurring in a person who takes doxycycline, DIEU has to be considered followed by the esophagoscopy which would confirm clinical suspicious with high specificity leading to correct diagnosis and treatment of this condition.

[Morphology of gastritis and Helicobacter pylori infection]. / Morfoloska slika gastritisa i infekcije Helicobacterom pylori.

Helicobacter pylori infection almost invariably results in chronic gastritis. The Sydney System (1990) emphasised the importance of combining topographical, morphological and etiological aspects in attempt to make clinical useful diagnosis of chronic gastritis. The aims of revised Sydney System in Houston (1994), Texas, were to improve terminology of chronic gastritis emphasising distinction between nonatrophic and atrophic gastritis, and in addition to determinate special forms of gastritis. The special forms of gastritis were described and diagnostic criteria were provided. Principles and grading of histological division of Sydney System were only slightly modified, grading being improved by the provision of a visual scale. Endoscopy and histological findings of 1062 patients from University Hospital Merkur were compared to evaluate the value of endoscopic division of Sydney System, and the modified grading proposed by Houston classification. There was no correlation between endoscopic and histological findings. Localisation of inflammatory cells was either 1) superficial or 2) diffuse in the mucosa, respectively. In Helicobacter pylori positive patients the most common finding was chronic active gastritis, and in Helicobacter pylori negative superficial and inactive chronic gastritis.

[Extra-gastrointestinal tract diseases and Helicobacter pylori infection]. / Bolesti izvan zeluca i probavnog sustava i infekcija Helicobacterom pylori.

Helicobacter pylori infection is linked to conditions of the upper gastrointestinal tract, including peptic ulcer and gastric adenocarcinoma na MALT lymphoma. It has also been associated with wide variety of extragastric and non-gastrointestinal conditions. However, the evidence in support of Helicobacter pylori infection as a cause of the non-gastrointestinal tract diseases is not widely understood. We reviewed the medical literature in regard to putative association of Helicobacter pylori infection and non-gastrointestinal tract condition, notably cardiovascular, autoimmune and dermatological diseases. The majority of published papers examining the potential causal relationship were case-control studies, cross-sectional and cohort studies while only a few recent articles that did not confirm the evidence of causal relationship represent well designed population-based prospective studies. The lack of clear evidence for etiopathogenetic associations of Helicobacter pylori infection and non-gastrointestinal tract conditions should focus our attention on appropriate testing and treatment of Helicobacter pylori infection in patients with conditions that are of proven association such as peptic ulcer disease.