Short-chain fatty acids in the saliva of patients with gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is a condition characterized by persistent symptoms and complications resulting from reflux of gastric contents into the esophagus. Short-chain fatty acids (SCFAs) are fermentation products of dietary fibres by the gut microbiota and are often studied for their anti-inflammatory and anticancer effects. The presence of SCFAs in the upper gastrointestinal tract, including in patients with GERD, has not been previously studied. The aim of this study was to investigate the relationship between the concentrations of SCFAs in the saliva of different age groups of patients with GERD. The study included 86 patients diagnosed with GERD, divided into two groups according to age: under and over 60 years of age, treated in the Gastroenterology and Hepatology Outpatient Clinic of the University Hospital in Cracow and 39 patients without gastrointestinal tract diseases. After clinical examination, blood was drawn to determine complete blood count, haemoglobin, and CRP. The oral cavity was examined, and unstimulated mixed saliva was collected. The SCFAs analysis was made by liquid chromatography-tandem mass spectrometry after facile derivatization coupled with liquid-liquid extraction. Of the six SCAFs studied, the highest median concentrations of acetic acid and propionic acid were observed in the saliva of patients with GERD and in the control group, in both the younger and older groups of patients. The concentrations of acetic acid and propionic acid were also higher compared with the four other fatty acids in the saliva of patients with GERD and in the control subjects. There were no correlations between salivary SCFAs levels and selected clinical and endoscopic parameters, including chronic inflammatory changes of the esophagus and stomach. In conclusions: SCFAs are present in the saliva of patients with GERD and in the control healthy persons. With the exception of valeric and isovaleric acids, salivary levels of SCFAs were significantly higher in patients with GERD compared to the control group. The highest concentrations of acetic acid and propionic acid were observed in patients with GERD and in both the younger and older patient groups. There were no differences in the concentrations of SCFAs in the saliva of female and male groups. We found no correlations between salivary SCFAs levels and selected clinical, laboratory and endoscopic changes of the oesophagus and stomach.

Serum galectin 3, galectin 9 and galectin 3-binding proteins in patients with active and inactive inflammatory bowel disease.

Galectins are lectins involved in physiological processes such as cell proliferation, apoptosis and migration, immune responses, inflammation, signalling, and angiogenesis. This study assessed the serum levels of galectin-3 (Gal-3) and galectin-3 (Gal-9) and galectin 3 binding protein (Gal-3BP), and evaluated their associations with the clinical characteristics and levels of inflammatory markers in patients with inflammatory bowel disease (IBD). A total of 48 patients with ulcerative colitis (UC), 77 with Crohn's disease (CD), and 30 healthy volunteers participated in the study. Complete blood counts, C-reactive protein, fibrinogen, albumin, glucose, creatinine, Gal-3, Gal-9, and Gal-3BP were measured. The median Gal-3 and Gal-9 levels did not differ between patients and controls. The median level of Gal-3BP was significantly higher in patients with CD than in controls (8084.6 (5637.8 - 11494.4) ng/ml versus 5962.2 (5280.15 - 7247.92) ng/ml, P = 0.02). No significant differences in Gal-3, Gal-9, and Gal-3BP between active and inactive CD and UC subgroups were found. The median Gal-3BP was higher in subgroups with active CD than in controls (8175.9 (5736.4 - 12871.62) ng/ml versus 5962.2 (5280.15 - 7247.92) ng/ml, P = 0.004). Our results showed that serum Gal-3 and Gal-9 should not be considered biomarkers of IBD. Despite not being a specific marker for CD, serum Gal-3BP might be used as an adjuvant biomarker for disease activity. However, further studies using a larger cohort are required to confirm its clinical usefulness.

Alterations in glutathione peroxidase and superoxide dismutase activities in plasma and saliva in relation to disease activity in patients with Crohn's disease.

Crohn's disease (CD) is a chronic inflammatory condition with uncertain aetiology. Dysfunction of immunoregulatory factors and overproduction of reactive oxygen species (ROS) may contribute to the damage of the gastrointestinal tract. Superoxide dismutase (SOD) and glutathione peroxidase (GPx) are involved in protection of cells from the damaging effects of ROS. The aim of the study was to assess activity of antioxidative stress enzymes, GPx and SOD, in plasma and saliva of patients with active and inactive forms of CD. Forty-seven patients with CD were prospectively enrolled in the study. The control group comprised 25 healthy volunteers. Patients' demographics, clinical features, localization of inflammatory changes, CD history, and treatment were recorded. SOD and GPx were assayed in plasma and saliva samples by ELISA method. CD activity index (CDAI) scores correlated inversely with SOD in plasma (r = - 0.46; P = 0.0012), but not in saliva. No correlations were observed in respect to GPx activities in both plasma and saliva and CDAI. Higher activity of plasma SOD was observed in patients with inactive CD in comparison with active CD (P = 0.004). No significant differences in SOD and GPx activity both in plasma and saliva were found between CD remission group and the control group. We concluded that in active CD the antioxidant defence system was diminished and returned to normal values in remission. Results of SOD and GPx assays in saliva are not conclusive, suggesting that saliva seems to be not an appropriate material for further similar studies.

[Barrett's metaplasia]. / Metaplazja Barretta.

Reflux oesophagitis is a chronic disorder with one important complication--Barrett's esophagus, which is also called Barrett's metaplasia (BM). It is not known why only a part of the patients develops BM. In BM the normal squamous mucosa of the esophagus is replaced by columnar epithelium of intestinal type. BM is frequently diagnosed during endoscopical examination, particularly in man over 60 years of age with symptoms of heartburn. This type of epithelium is a recognized risk factor of the esophageal adenocarcinoma. The incidence of this carcinoma is increasing in the last years. Based on the literature, we review the current pathogenesis, rules of diagnosis, surveillance and treatment of BM as well as the problem of connections between BM and esophageal adenocarcinoma.

[Myoelectric activity of the stomach and esophageal pH changes in reflux disease]. / Aktywnosc mioelektryczna zoladka a zmiany pH w przelyku w chorobie refluksowej.

UNLABELLED: The oesophageal inflammation during gastrointestinal reflux disease (GERD) has been considered to be an acid and pepsine related disorder. The oesophagus remains under the prolonged exposure of gastric acid, which damages the mucosa and causes an esophagitis. Amongst the most important pathogenetic factors of GERD, the delayed gastric emptying and transient episodes of low esophageal sphincter (LES) relaxation have been described. The examinations like electrogastrography (EGG) and 24-hours pH-metry are useful for the evaluation of these disturbances. AIM: The aim of the study was to confirm the co-existence among the abnormal gastric myoelectric activity and the esophageal pH changes in patients with GERD. METHODS: Ten patients (8 m., 2 f.) 20-61 years of age (mean 46 +/- 15.3 years) with GERD were examined. The EGG recording lasted one hour: 30 min. in fasting state and 30 min. after a standard meal. The 24-hours pH-metry measurement, five cm above the upper edge of LES, was done on separate days. A control group, matched for number and age, for the comparison of the EGG recording, was recruited. RESULTS: Amongst the patients suffering from GERD the results of fasting EGG showed the lower normogastria (mean 45.3 +/- 21.9% vs. 86.5 +/- 8.8%: p < 0.01) and the high dysrrhytmia time period (mean 54.7 +/- 21.9% vs. 13.5 +/- 9.6%: p < 0.01), than in the control group. After the meal, the dysrrhytmia persisted (mean 43.5 +/- 24.3% vs. 9.6 +/- 11.5%: p < 0.01). The mean increase of the slow waves amplitude after the meal was 0 +/- 55% vs. 80 +/- 146%; p < 0.05. The recording of the 24-hours pH-metry showed an increase of the pH < 4 episodes number (mean 329 +/- 246) and time percentage (mean 12.2 +/- 6.6%). The patients obtained mean 65.5 +/- 61 points in the De Meester and Johnson scoring. A significant correlation among the postprandial dysrrhytmia and reflux episodes time percentages was observed (p < 0.05). CONCLUSIONS: The results of our studies suggest the importance of the gastric myoelectric activity disturbances in pathogenesis of GERD.

[Hemochromatosis--report of 2 cases]. / Hemochromatoza--opis 2 przypadków.

Hereditary hemochromatosis is an iron metabolism disorder known for a century, leading to iron overload and dysfunction of the major organs of the body. Early diagnosis and treatment result in a normal life expectancy. Authors present a report of two cases (the father and his son) in early stadium of the disease.

Met-enkephalins in patients with inflammatory bowel diseases.

PURPOSE: Opioid peptides provide a link between the neuroendocrine and immune systems. They modify the inflammatory process through their effect on the synthesis and secretion of cytokines and on the proliferation of leukocytes to the inflammatory lesion. The evaluation analyzed changes in free met-enkephalin concentration values in the serum and colon mucosal biopsy specimens of patients with inflammatory bowel disease (IBD). MATERIAL AND METHODS: In serum and colon mucosal biopsy specimens, free met-enkephalin levels were determined in 43 patients with ulcerative colitis (UC) and 38 individuals with Crohn's disease (CD). The evaluation analyzed the effect of disease activity, inflammatory lesions of the colon and laboratory parameters, on the level of the investigated marker. The control group consisted of 45 healthy volunteers. RESULTS: Serum free met-enkephalin levels were depressed in patients with CD (85.4pg/ml) and UC (101.5pg/ml) as compared to the controls (119.4pg/ml). Met-enkephalin levels in colonic biopsies collected from inflammatory lesions in IBD patients were significantly higher as compared to sections without inflammatory lesions (6.59pg/mg vs. 2.89pg/mg, p < 0.01 in the CD group and 6.12pg/mg vs. 3.47pg/mg, p < 0.05 in the UC group) and their level correlated with disease activity. CONCLUSIONS: The present investigation is the first study that demonstrates changes in free met-enkephalin levels in IBD that may play a role in the pathogenesis and course of the disease. Further studies are necessary to assess the anti-inflammatory effect of opioid peptides.

Optimal maintenance therapy in patients with non-erosive reflux disease reporting mild reflux symptoms--a pilot study.

PURPOSE: This pilot study aimed at finding trend for further investigation of the optimal maintenance therapy with lansoprazole in patients with non-erosive reflux disease (NERD) suffering from mild symptoms. MATERIAL AND METHODS: Sixty consecutive patients with diagnosed NERD reporting mild symptoms were included in the study. After successfully finishing a four-week treatment with lansoprazole (30 mg daily), the patients were randomized into three groups administered: 1--lansoprazole 30 mg "on-demand", 2--lansoprazole 15 mg daily, 3--lansoprazole 30 mg in four-week courses during a relapse. The intensity of symptoms was assessed with the Visual Analogue Scale (VAS) at the baseline, as well after 4 weeks, 3, 6 and 12 months of therapy. The general satisfaction of treatment was evaluated with the Verbal Rating Scale (VRS) at the same time. RESULTS: At the baseline, the mean intensity of symptoms assessed by VAS was 2.8 +/- 1.0 points and fell to 0.4 +/- 0.5 points after a 4-week therapy. In Group 1, after 3, 6 and 12 months, it was 0.85 +/- 0.6, 1.0 +/- 0.8 and 1.0 +/- 0.8, in Group 2: 0.65 +/- 0.7, 0.65 +/- 0.7, 0.5 +/- 0.3, and in Group 3: 1.1 +/- 0.6, 1.55 +/- 0.7, 1.65 +/- 0.8 points, respectively. No significant differences were observed between Groups 1 and 2. Intermittent therapy (Group 3) showed a significantly lower efficacy in comparison to other groups (p < 0.05). "On-demand" therapy was 30% cheaper whereas intermittent therapy was 55% cheaper than the most expensive daily treatment. However, general satisfaction of treatment assessed by VRS was non-significantly different between any of the groups. CONCLUSIONS: In patients with NERD and mild symptoms, both on-demand and daily treatment models of maintenance therapy showed a similar high efficacy, whereas intermittent therapy was significantly less effective. However, general satisfaction of each treatment options was high and non-significantly different between the groups. Due to a pilot character of this study further investigation based on a larger number of patients is necessary to confirm the clinical value of cheaper models of maintenance therapy which could be then recommended as more cost-effective.