Is triggering receptor expressed on myeloid cell 1 (TREM-1) protein a new marker of serious infectious complications in colorectal surgery?: case-matched pilot study.

PURPOSE: The purpose of the study was to evaluate the usefulness of the triggering receptor expressed on myeloid cell 1 (TREM-1) protein as a marker for serious infectious complications during laparoscopic colorectal surgery. METHODS: Sixty-four patients with colon or rectal cancer, who underwent an elective laparoscopic colorectal cancer surgery from November 2018 to February 2020, were included in the analysis. Blood samples of the TREM-1 protein testing were collected four times from each patient: before and on three following postoperative days (PODs). Patients were divided into two groups according to the presence of infectious complications. Subsequently, patients with infectious complications (group 1) were matched 1:1 with patients without complications (group 2). The case-matched analysis was done by selecting patients from the control group by age, ASA scale, cancer stage, and type of surgery. RESULTS: There was no significant difference in demographic and operative characteristics between the two groups. The median length of hospital stay was longer in group 1 than in group 2 (11 days vs. 5 days, p < 0.001). Preoperative measurements of TREM-1 protein did not differ between the two groups. There were no significant differences in the measurements on the first and third postoperative days. However, the median TREM-1 measurement was higher in group 1 on the second postoperative day (542 pg/ml vs. 399 pg/ml; p = 0.040). The difference was more apparent when only severe postoperative complications were considered. When compared to the group without any complications, the median TREM-1 level was significantly higher in the group with severe infection complications in POD 1, POD 2, and POD 3 (p < 0.05). The receiver operating characteristic (ROC) curve demonstrated that TREM-1 readings in POD 2 had a sensitivity of 83% and a specificity of 84% for the presence of severe infection complications at a value of 579.3 pg/ml (AUC 0.8, 95%CI 0.65-0.96). CONCLUSION: TREM-1 measurements might become a helpful predictive marker in the early diagnosis of serious infectious complications in patients following laparoscopic colorectal surgery.

Is ITP really a desirable indication for teaching laparoscopic splenectomy? Cohort study.

Background: We aimed to evaluate the outcomes of laparoscopic splenectomy (LS) in patients with immune thrombocytopenic purpura (ITP) compared with operated for other indications. Methods: Retrospective cohort study of patients who underwent LS in 1998-2017. Group 1 consisted of 256 patients operated for ITP, and Group 2 of 231 operated for other indications. Primary outcome was procedure difficulty. Secondary was perioperative course (30 days of surgery). Results: Patients in Group 1 were younger (p < .001) with lower ASA (p < .001). The spleen was larger in Group 2 (p < .001). Operative time was longer in Group 2 [110 (80-150) vs. 90 (65-115) min; p < .001)]. Intraoperative blood loss was greater in Group 2 (p < .001). Conversions were higher in Group 2 (4.76 vs. 6.93%, p = .037), as were intraoperative complications (7.79 vs. 3.91%, p = .048). Morbidity, reoperations and mortality did not differ between groups (respectively, p = .899, .697, and .999). Median length of stay was similar (p = .211). Among the first 10 LSs performed by trainees, 63.66% were done for ITP. Later (after 11+ procedures) this dropped to 48.12% (p = .002). Conclusions: ITP may be a preferred indication for surgeons training for LS. Patients' characteristics and intraoperative factors allow an expectation for a relatively easy and hassle-free operation in those patients.

Analysis of Laparoscopic Sleeve Gastrectomy Learning Curve and Its Influence on Procedure Safety and Perioperative Complications.

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) has become an attractive bariatric procedure with promising treatment effects yet amount of data regarding institutional learning process is limited. MATERIALS AND METHODS: Retrospective study included patients submitted to LSG at academic teaching hospital. Patients were divided into groups every 100 consecutive patients. LSG introduction was structured along with Enhanced Recovery after Surgery (ERAS) treatment protocol. Primary endpoint was determining the LSG learning curve's stabilization point, using operative time, intraoperative difficulties, intraoperative adverse events (IAE), and number of stapler firings. Secondary endpoints: influence on perioperative complications and reoperations. Five hundred patients were included (330 females, median age of 40 (33-49) years). RESULTS: Operative time in G1-G2 differed significantly from G3-G5. Stabilization point was the 200th procedure using operative time. Intraoperative difficulties of G1 differed significantly from G2-G5, with stabilization after the 100th procedure. IAE and number of stapler firings could not be used as predictor. Based on perioperative morbidity, the learning curve was stabilized at the 100th procedure. The morbidity rates in the groups were G1, 13%; G2, 4%; G3, 5%; G4, 5%; and G5, 2%. The reoperation rate in G1 was 3%; G2, 2%; G3, 2%; G4, 1%; and G5, 0%. CONCLUSION: The institutional learning process stabilization point for LSG in a newly established bariatric center is between the 100th and 200th operation. Initially, the morbidity rate is high, which should concern surgeons who are willing to perform bariatric surgery.

Laparoscopic Gastrectomy with Enhanced Recovery After Surgery Protocol: Single-Center Experience.

BACKGROUND Surgery remains the mainstay of gastric cancer treatment. It is, however, associated with a relatively high risk of perioperative complications. The use of laparoscopy and the Enhanced Recovery After Surgery (ERAS) protocol allows clinicians to limit surgically induced trauma, thus improving recovery and reducing the number of complications. The aim of the study is to present clinical outcomes of patients with gastric cancer undergoing laparoscopic gastrectomy combined with the ERAS protocol. MATERIAL AND METHODS Fifty-three (21 female/32 male) patients who underwent elective laparoscopic total gastrectomy due to cancer were prospectively analyzed. Demographic and surgical parameters were assessed, as well as the compliance with ERAS protocol elements, length of hospital stay, number of complications, and readmissions. RESULTS Mean operative time was 296.4±98.9 min, and mean blood loss was 293.3±213.8 mL. In 3 (5.7%) cases, conversion was required. Median length of hospital stay was 5 days. Compliance with ERAS protocol was 79.6±14.5%. Thirty (56.6%) patients tolerated an early oral diet well within 24 h postoperatively; in 48 (90.6%) patients, mobilization in the first 24 hours was successful. In 17 (32.1%) patients, postoperative complications occurred, with 7 of them (13.2%) being serious (Clavien-Dindo 3-5). The 30-day readmission rate was 9.4%. CONCLUSIONS The combination of laparoscopy and the ERAS protocol in patients with gastric cancer is feasible and allows achieving good clinical outcomes.

Laparoscopic transperitoneal adrenalectomy in morbidly obese patients is not associated with worse short-term outcomes.

OBJECTIVES: To evaluate the impact of obesity and morbid obesity on short-term outcomes after laparoscopic adrenalectomy. METHODS: The study included 520 consecutive patients undergoing laparoscopic adrenalectomy for adrenal tumor. The entire study group was divided depending on the body mass index: group 1 (normal weight), <25 kg/m2 ; group 2 (overweight), 25-30 kg/m2 ; and group 3 (obese) 30-40 kg/m2 . Additionally, group 4 (morbidly obese) was distinguished. Study end-points were: operative time, intraoperative blood loss, total length of hospital stay, morbidity rate and 30-day readmission rate. RESULTS: The mean operative times were 88.8, 94.7, 93.5, and 99.9 min in groups 1, 2, 3 and 4, respectively (P = 0.1444). Complications were comparable between groups (12.8% vs 8.8% vs 8.2% vs 11.5%, P = 0.5295). The mean intraoperative blood loss was 66.8 versus 78.3 versus 60.7 versus 92.4, P = 0.1399. There were no differences in conversion rate between groups. CONCLUSIONS: Obesity has no influence on short-term outcomes of laparoscopic transperitoneal adrenalectomy. This procedure is feasible regardless of the body mass index. Therefore, it can be offered to all patient groups including those morbidly obese individuals in whose case preoperative weight loss seems unnecessary.

Laparoscopic approach to splenic aneurysms.

Background Splenic artery aneurysm is a rare disease with possibly mortal complications. For years, the main method of treatment was excision of aneurysm with spleen. In recent years, several methods have been developed in order to salvage the spleen such endovascular techniques and aneurysmectomy. Objective The aim of our study was to determine the feasibility of laparoscopic aneurysmectomy with spleen salvage in cases of splenic artery aneurysm. Materials Analysis of prospectively gathered data containing records of patients operated laparoscopically due to diseases of the spleen in 1998-2016 in our department. Inclusion criteria were attempted laparoscopic aneurysmectomy with intent to salvage spleen. Results Out of 11 patients, seven patients underwent aneurysmectomy with spleen preservation, one patient had partial-splenectomy, two patients had intra-operative splenectomies and one patient had a re-operation on post-op day 1 with splenectomy. Re-operation with splenectomy was the only recorded complication. Conclusions Laparoscopic aneurysmectomy of SAA may be considered as a safe treatment method, with good short- and long-term results; however, a complete evaluation requires further research on a larger study group. It allows permanent treatment of SAA with maintaining spleen function.

Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study.

BACKGROUND: Although the relation between adherence to the ERAS protocol and clinical outcomes was extensively studied, there is still ongoing discussion on the need and feasibility of full compliance in laparoscopic colorectal surgery. In this study, we aimed to verify whether a strict adherence to the protocol (>90%) leads to further improvement in clinical outcomes compared to high (70-90%) and low (<70%) compliance groups. MATERIALS AND METHODS: The analysis included consecutive prospectively registered patients operated laparoscopically for colorectal cancer between January 2012 and December 2015. Patients were divided into three groups depending on the compliance with the ERAS protocol: <70% (Group 1), 70-90% (Group 2), >90% (Group 3). The measured outcomes were: complication rate, readmission rate, recovery parameters (tolerance of early oral diet on 1st postoperative day and mobilization of a patient on the day of surgery), length of stay (LOS). RESULTS: Group 1 consisted of 70, Group 2 of 65 and Group 3 of 116 patients. There were no statistical differences between the groups based on demographic parameters, stage of cancer and operative parameters (operative time, blood loss, conversion rate). The overall compliance with the protocol in the study group was 85.6 ± 11.9%. There was a significant decrease in complication rate with increasing compliance (35.7% vs. 36.4% vs. 16.4%, p = 0.0024) and severity of complications according to the Clavien-Dindo classification (p = 0.0198). Moreover, we observed differences in recovery parameters between the groups: tolerance of oral diet on the 1st postoperative day (52.8% vs. 79.5% vs. 87.9%, p < 0.0001), mobilization of a patient on the day of surgery (68.6% vs. 92.3% vs. 99.1%, p < 0.0001), respectively. We also observed that with compliance increase, the median LOS decreased (6 vs. 4 vs. 3 days, p < 0.0001). CONCLUSION: Full implementation of the ERAS protocol significantly improves short term outcomes both in comparison to the high- and low-compliant groups.

Changes in levels of selected incretins and appetite-controlling hormones following surgical treatment for morbid obesity.

INTRODUCTION: The hormonal brain-gut axis is a crucial element in appetite control and the response to surgical treatment for super obesity. However, mechanisms underlying the metabolic response to surgical treatment for morbid obesity are still not clearly specified. AIM: To evaluate and compare the effects of surgical treatment for super obesity by laparoscopic sleeve gastrectomy (LSG) and by laparoscopic Roux-en-Y gastric bypass (LRYGB) on selected incretins and appetite-controlling hormones. MATERIAL AND METHODS: Thirty-five patients were enrolled in a prospective study. Laparoscopic sleeve gastrectomy was performed in 45.8% of patients, and LRYGB in the remaining 54.2% of patients. Before the procedure fasting blood serum was collected from patients and preserved, to determine levels of selected incretins and brain-gut hormones: glucagon-like peptide 1 (GLP-1), peptide YY (PYY), leptin, and ghrelin. RESULTS: Twenty-eight patients came to a follow-up visit 12 months after the surgery. In these patients selected parameters were determined again. The percentage weight loss was 58.8%. The ghrelin levels had decreased, and no statistically significant difference was observed between the two procedures. After both surgical procedures a statistically significant reduction in the leptin level was also observed. Peptide YY levels statistically significantly increased in the whole studied group. The GLP-1 level increased after the surgical procedure. However, the observed change was not statistically significant. CONCLUSIONS: Both treatment methods result in modification of secretion patterns for selected gastrointestinal hormones, and this was considered to be a beneficial effect of bariatric treatment. The laparoscopic sleeve gastrectomy, being a procedure resulting in a metabolic response, seems to be an equally effective method for treatment of super obesity and comorbidities as the laparoscopic gastric bypass.

Incidence of true short esophagus among patients submitted to laparoscopic Nissen fundoplication.

INTRODUCTION: The last two decades have observed development of surgical treatment of benign conditions of the gastroesophageal junction (GEJ), including anti-reflux surgery, due to the growing popularity of the laparoscopic approach. Migration of the fundoplication band and recurrent hiatal hernia are a result of the lack of correct diagnosis and appropriate management of the so-called short esophagus. According to various authors, short esophagus is present in up to 60% of patients qualified for anti-reflux surgery. However, some researchers question the existence of this condition. AIM: To analyze the prevalence of short esophagus in patients subjected to laparoscopic Nissen fundoplication. MATERIAL AND METHODS: The study included 202 patients who were subjected to laparoscopic Nissen fundoplication. RESULTS: As many as 96% of the patients qualified for the surgical treatment showed supradiaphragmatic location of the high pressure zone. The extent of GEJ protrusion ranged from 0 cm to 3 cm (mean: 2 cm). The extent of dissection within the mediastinum was determined by the level of GEJ protrusion, and ranged from 5 cm to 12 cm (mean: 6 cm). Upon complete mobilization of the esophagus within the mediastinum, no cases of significantly shortened esophagus, precluding downward retraction of at least a 2.5-cm segment below the diaphragmatic crura, were documented. Therefore, none of the patients required Collis gastroplasty. CONCLUSIONS: The presence of "true" short esophagus is a sporadic finding among patients qualified for anti-reflux surgery. Mediastinal dissection of the esophagus and its mobilization at an appropriate, individually defined level seems a sufficient treatment in the vast majority of these patients.

Enhanced recovery after colorectal surgery in elderly patients.

INTRODUCTION: The elderly will soon constitute 20% of the population. Their number is constantly rising, particularly in developed countries. It was found that they particularly benefit from the use of minimally invasive surgery. The Enhanced Recovery After Surgery (ERAS) protocol may further improve clinical outcomes in this group of patients. AIM: To assess the implementation of the ERAS protocol in elderly patients submitted to laparoscopic colorectal surgery. MATERIAL AND METHODS: Ninety-two patients who underwent elective laparoscopic colorectal surgery were included in the study. Patients were divided into group 1 (≤ 65 years) and group 2 (> 65 years). Perioperative care was based on ERAS Society guidelines. Length of hospital stay, time of first stool passage, perioperative complications and readmissions were analyzed. RESULTS: Group 2 patients had higher ASA grades in comparison to group 1. In all cases, oral fluid intake started on the day of surgery. The groups did not differ according to oral fluid tolerance, first stool passage time or length of hospital stay. Number and character of perioperative complications were comparable between the two groups. Four patients were readmitted within 30 days after discharge. One patient required reoperation. CONCLUSIONS: Implementation of the ERAS protocol is possible regardless of the age of surgical patients. Its use in the elderly allows the length of hospitalization to be shortened and is not associated with higher risk of postoperative complications or readmissions.

The first total laparoscopic pancreatoduodenectomy in Poland.

We present a case of a 55-year-old female patient with pancreatic head cancer who was treated with total laparoscopic pylorus-preserving pancreatoduodenectomy (TLPD) on 13.12.2013. The procedure as well as the postoperative course was uncomplicated. The patient was mobilized on the day of surgery; a liquid diet was introduced on day 1 and a full hospital diet on day 2 postoperatively. Drains were removed on the 3(rd) day after the procedure. Length of hospital stay was 6 days. The final pathology report confirmed the diagnosis of cancer. According to our knowledge this is the first report on total laparoscopic pancreatoduodenectomy in Poland performed by an entirely Polish team of surgeons. In our opinion, TLPD is feasible and similarly to other laparoscopic operations may improve postoperative recovery.

Adrenal incidentalomas: should we operate on small tumors in the era of laparoscopy?

Tumor size smaller than 4 cm as an indication for surgical treatment of incidentaloma is still a subject of discussion. Our aim was the estimation of the incidence of malignancy and analysis of treatment outcomes in patients with incidentaloma smaller than 4 cm in comparison to bigger lesions. 132 patients who underwent laparoscopic adrenalectomy for nonsecreting tumors were divided into two groups: group 1 (55 pts., size < = 40 mm) and group 2 (77 pts., size > 40 mm). Operation parameters and histopathological results were analyzed. No differences in group characteristics, mean operation time, and estimated blood loss were noted. Complications in groups 1 and 2 occurred in 3.6% and 5.2% of patients, respectively (P = 0.67). Malignancy in groups 1 and 2 was present in 1 and 6 patients, respectively (P = 0.13). Potentially malignant lesions were identified in 4 patients in group 1 and 4 patients in group 2 (P = 0.39). The results do not allow for straightforward recommendations for surgical treatment of smaller adrenal tumors. The safety of laparoscopy and minimal, but impossible to omit, risk of malignancy support decisions for surgery. On the other hand, the risk of malignancy in smaller adrenal tumors is lower than surgical complications, which provides an important argument against surgery.

Laparoscopic adrenalectomy by the lateral transperitoneal approach in patients with a history of previous abdominal surgery.

INTRODUCTION: Even the half of patients undergoing laparoscopic adrenalectomy has history of previous abdominal surgeries. However, it is still uncertain if this fact has an impact on the operation itself as well as the postoperative course. AIM: To analyze the effects of previous abdominal surgery on surgical outcomes in adrenal tumor patients subjected to laparoscopic adrenalectomy. MATERIAL AND METHODS: This study included 268 patients with adrenal gland tumors operated on by means of laparoscopic lateral transperitoneal adrenalectomy: 1) previously subjected to at least one abdominal surgery (group A, n = 101), or 2) with no history of previous abdominal operations (group B, n = 167). RESULTS: Groups A and B did not differ in terms of tumor size (p = 0.132), mean operation time (p = 0.456), mean intraoperative blood loss (p = 0.754), or perioperative complication rate (p = 0.833). Dissection of intraperitoneal adhesions was considered difficult in 32 patients from group A (31.6%) and 8 subjects from group B (4.7%, p < 0.001). Conversion was required in three subjects from group A (2.9%) and 3 patients from group B (1.8%, p = 0.529). CONCLUSIONS: Previous abdominal surgery does not constitute a contraindication to laparoscopic transperitoneal adrenalectomy.

Prevention of early infective complications after laparoscopic splenectomy with the Garamycin sponge.

INTRODUCTION: Surgical site infection (SSI) appear to be more frequent in splenectomized patients than might be expected and its incidence can be explained neither by the extent of surgery nor by the risk of bacterial contamination of the operating field. AIM: Evaluation the local antibiotic prophylaxis using a gentamicin surgical implant in order to reduce SSI, particularly subphrenic abscesses. MATERIAL AND METHODS: WE CONDUCTED A PROSPECTIVE, RANDOMIZED STUDY OF TWO GROUPS OF PATIENTS UNDERGOING LAPAROSCOPIC SPLENECTOMY WHO WERE CONSIDERED AT HIGH RISK OF INFECTIVE COMPLICATIONS: patients with idiopathic thrombocytopenic purpura (ITP) pre-treated chronically with systemic steroids and patients with non-Hodgkin lymphoma (NHL). Out of 98 laparoscopic splenectomies performed during the study period, 40 patients with ITP and 20 with NHL met the inclusion criteria and were enrolled in the study. In 20 randomly selected patients with ITP and 10 with NHL, a gentamicin-collagen implant was left in the splenic bed. RESULTS: Infective complications occurred in 4 (6.67%) among 60 patients from the entire study group; 2 in patients with ITP and a gentamicin implant who developed fever of unknown cause which resolved after systemic antibiotics, and 2 in patients with NHL and gentamicin prophylaxis who developed a subphrenic abscess. In all patients operated on without a gentamicin implant, the postoperative course was uncomplicated. CONCLUSIONS: Gentamicin surgical implants not only fail to reduce the risk of subphrenic abscesses in splenectomized patients, but may contribute to the increase in its incidence, which puts into question the possible benefits of this form of prophylaxis.

[Lumbar hernia]. / Przepuklina Iedzwiowa.

Lumbar region constitutes one of the least common localizations for hernia formation. There are only slightly more than 300 cases found in English literature till the end of the 20th century, while there are only 8 cases presented in Polish literature. Exceptionally rare incidence together with diagnostic dilemma related to it made us to present cases of 2 patients operated on in the 2nd Chair of Surgery of Jagiellonian University Medical College due to lumbar hernia.

Ghrelin and gastrin in advanced gastric cancer before and after gastrectomy.

AIM: To investigate plasma ghrelin, gastrin and growth hormone secretagogue receptor (GHS-R) expression in advanced gastric cancer (GC) before and after resection. METHODS: Seventy subjects in whom endoscopy of the upper gastrointestinal tract was performed in the Department of General Surgery at Cracow University during the past decade: (1) 25 patients with GC associated with Helicobacter pylori (H. pylori) infection; (2) 10 patients with GC 4-5 years after (total or subtotal) gastrectomy; (3) 25 healthy H. pylori-negative controls, matched by age and BMI to the above two groups; and (4) 10 GC patients 4-5 years after total gastrectomy. Ghrelin and gastrin plasma concentrations were measured by specific radioimmunoassay under fasting conditions and postprandially at 60 and 90 min after ingestion of a mixed meal. GHS-R expression was examined in biopsy samples from intact healthy mucosa and GC tissue using semi-quantitative reverse transcription-polymerase chain reaction. RESULTS: In healthy controls, fasting plasma ghrelin levels were significantly elevated and declined markedly at 60 and 90 min after a mixed meal. The concomitant enhanced ghrelin, GHS-R and gastrin expression in GC tissue over that recorded in intact mucosa, and the marked rise in plasma gastrin in these subjects under fasting conditions indicate the role of these hormonal factors in GC formation. Fasting plasma levels and postprandial response of ghrelin and gastrin appear to be inversely correlated in healthy subjects. Feeding in the controls resulted in a significant fall in plasma ghrelin with a subsequent rise in plasma gastrin, but in H. pylori-positive GC patients submitted to total or distal gastrectomy, feeding failed to affect significantly the fall in plasma ghrelin that was recorded in these patients before surgery. Fasting ghrelin concentrations were significantly lower in patients 4-5 years after total gastrectomy compared to those in healthy controls and to these in GC patients before surgery. CONCLUSION: Elevated plasma gastrin and suppression of fasting ghrelin in patients with GC suggest the existence of a close relationship between these two hormones in gastric carcinogenesis.

Sclerosing angiomatoid nodular transformation of the spleen treated by laparoscopic partial splenectomy.

The authors describe a case of sclerosing angiomatoid nodular transformation (SANT) of the spleen treated at the 2(nd) Department of Surgery, Jagiellonian University, Medical College. The patient was a 23-year-old woman. Clinically she presented with 2-year history of recurrent mild fever, diffuse joint pain, abdominal discomfort and iron deficiency anaemia of chronic disease. The laboratory tests revealed a non-characteristic chronic inflammatory response. A splenic solid lesion 9 cm in diameter was found on abdominal computed tomography. The patient underwent uneventful laparoscopic resection of the upper half of the splenic parenchyma. The resected tumour showed characteristic histological and immunophenotypical findings of SANT as previously described in the literature. In long-term follow-up, improvement of preoperative symptoms and abnormalities in the blood tests was documented.

Ghrelin in diseases of the gastric mucosa associated with Helicobacter pylori infection.

BACKGROUND: Ghrelin is a hormone produced by neuroendocrine cells of gastric mucosa. Its concentration changes in cases of Helicobacter pylori (H. pylori) infection of stomach, but the relation between the expression of plasma and mucosal ghrelin content and H. pylori infection is not completely defined. This study was designed to determine the changes in plasma and gastric mucosa ghrelin concentrations in diseases of gastric mucosa depending upon the H. pylori infection. MATERIAL/METHODS: The following groups were included; Group 1. patients with gastric cancer and concomitant H. pylori infection (N=25); Group 2. patients with antral gastritis with H. pylori infection and concomitant duodenal peptic ulcer (N=18); Group 3. patients with atrophic gastritis of both the fundus and the body of the stomach without H. pylori infection (N=10); Group 4. control group consisting of patients without morphological and histological lesions of gastric mucosa and without H. pylori infection (n=25). Endoscopic biopsies of gastric mucosa of fundus, body and pyloric region were obtained in all tested groups. In patients suffering from gastric cancer biopsies of tumor were also taken. The ghrelin concentrations were measured by specific RIA. Biopsy specimens were examined to assess ghrelin mRNA expression in intact gastric mucosa and gastric cancer. RESULTS: The study showed significant influence of H. pylori infection on ghrelin plasma concentrations. The highest ghrelin concentrations were found in patients of the group 2 (average 503 pg/mL (95% CI: 285-886). Ghrelin concentrations were found to fall to the lowest values in the group 3 (average 144 pg/mL (95% CI: 93-222). In the group 1, the ghrelin concentration averaged 203 pg/mL (95% CI: 161-257), while in the group 4 (control group) - 255 pg/mL; 95% (CI: 160-406). The study proved that gastric cancer does not exert any ghrelin-production activity, as confirmed by RT-PCR examination of biopsy specimens of the cancer. CONCLUSIONS: This study shows that the presence of H. pylori in the stomach with peptic ulcer increases plasma ghrelin levels, whereas in gastric cancer and atrophic gastritis it is accompanied by a marked decrease in plasma and cancer tissue levels of ghrelin.