The experience with colorectal cancer screening in the Czech Republic: the detection at earlier stages and improved clinical outcomes.

OBJECTIVES: Colorectal cancer (CRC) remains a major health burden. Although screening is recommended and considered beneficial, further data on its positive effects are needed for worldwide implementation. STUDY DESIGN: The aim of our national multicentre prospective observational study was to reveal and document clinicopathological differences in CRC diagnosed by screening and presented by disease symptoms as well as assess the efficiency of the screening programme in the Czech Republic. METHODS: Between March 2013 and September 2015, a total of 265 patients were enrolled in 12 gastroenterology centres across the Czech Republic. Patients were divided into screening and symptomatic groups and compared for pathology status and clinical characteristics. Screening was defined as a primary screening colonoscopy or a colonoscopy after a positive faecal occult blood test in an average-risk population. RESULTS: The distribution of CRC stages was significantly (statistically and clinically) favourable in the screening group (predominance of stages 0, I and II) compared with the non-screening group (P < 0.001). The presence of distant and local metastases was significantly less frequent in the screening group than in the symptomatic group (P < 0.001). Patients in the screening group had a higher probability of radical surgery (R0) than those diagnosed based on symptoms (P < 0.001). Systemic palliative treatment was indicated in two patients in the screening group compared with 23 patients in the non-screening group (P = 0.018). CONCLUSION: CRC diagnosed by screening disclosed less advanced clinicopathological characteristics and results in patients with a higher probability of radical surgery (R0) than diagnoses established based on symptoms, with subsequent management differing accordingly between both groups. These results advocate the implementation of a suitable worldwide screening programme.

Comparison of efficacy of low-volume bowel cleansers prior to colonoscopy: a randomised, prospective, open-label trial.

INTRODUCTION: The aim of the study was to compare the efficacy and tolerability of polyethylene glycol/ascorbic acid (PEGA), sodium picosulfate/magnesium citrate (SPMC) and the oral sulfate formula (SIR) in a single- or split-dose regimen for bowel preparation prior to colonoscopy. METHODS: Randomised, multicentre, open-label study. The subjects received either PEGA, SPMC or SIR in the single- or split-dose regimen before the colonoscopy. Quality and tolerability of the preparation and complaints during preparation were recorded using a 5 point scale. RESULTS: 558 subject were analysed. Preparation quality was comparable in the single-dose regimen. The rate of satisfactory bowel cleansing (Aronchick score 1+2) was higher for split-dose SIR and PEGA compared to SPMC (95.6%, 86.2% vs. 72.5%, p.

Vitamin D supplementation in inflammatory bowel disease: the role of dosage and patient compliance.

OBJECTIVES: Vitamin D substitution is recommended in patients with inflammatory bowel disease. Specific guidelines are lacking. The aim of this study was to assess the effect of vitamin D supplementation with respect to dosage and patient compliance. METHODS: A prospective cohort study of 167 Crohn disease/ulcerative colitis outpatients. Patients were screened for serum vitamin D (25OHD2+3) at the end of summer and in late winter. Demographic data, history of vitamin D supplementation were recorded and matched with prescription records. RESULTS: A total of 57 subjects used vitamin D supplementation (mean dose 1104 IU/day). 25OHD2+3 levels were lower (p < 0.001) in winter both in substituted and unsubstituted group, without any differences between groups within the same season. 25OHD2+3 levels did not correlate with the substitution dose. 52.1 % of subjects were fully compliant with substitution. 25OHD2+3 and prevalence of vitamin D deficit in this group were comparable with unsubstituted subjects except a higher prevalence of vitamin D insufficiency (p < 0.02). CONCLUSION: Fixed dosage of 1100 IU/day of vitamin D was insufficient to correct the deficiency. Patient compliance with vitamin D supplementation was low, however this fact did not significantly contribute to the degree of vitamin D deficiency in this dosage (Tab. 3, Fig. 1, Ref. 21).

[Pulmonary hypertension--unusual complication of haemolysis and the bacterial overgrowth syndrome]. / Plictní hypertenze--neobvyklá komplikate hemolýzy a syndromu bakteriálniho prerustání.

The authors describe a case of a patient with celiac disease in whom a secondary bacterial overgrowth had developed in the small intestine. Vitamin B12 and folic acid consumption deficiency resulted in a development of macrocytary anaemia and non-immune haemolysis. Subsequently, within a few weeks, a significant pulmonary hypertension has developed, the cause of which was first unclear. Haemolysis as well as pulmonary hypertension ceased following bacterial overgrowth treatment and B12 and, later on, folic acid substitution. Retrospectively, the authors infer that this could have been the haemolytic anaemia-associated pulmonary hypertension syndrome.

Levels of adhesion molecules bear a relationship to triglyceride levels in type 2 diabetic subjects with proven silent ischemia.

AIM: The aim of the study was to examine the levels of adhesion molecules, high-sensitivity C-reactive protein (hs-CRP) and lipid spectrum of type 2 diabetic subjects with proven silent myocardial ischemia. METHODS: We included in the study 19 patients with ischemia (Group 1) and 16 patients without ischemia (Group 2). We documented silent ischemia by an exercise-myocardial single photon emission computed tomography. We examined the levels of total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, vascular cell adhesion molecule 1, intercellular adhesion molecule 1, E-selectin, HbA1c, microalbuminuria (MAU), hs-CRP and carotid intima-media thickness. RESULTS: The differences among the values of lipids, adhesion molecules, HbA1c, hs-CRP, MAU between the groups were not statistically significant. E-selectin levels positively correlated with triglyceride levels in the group 1 (Spearman correlation, P<0.05). This correlation was not proven in the Group 2. CONCLUSION: Statistically differences between the study groups were not significant. Levels of E-selectin positively correlated with high triglyceride levels in type 2 diabetic subjects with silent ischemia. This correlation documents a disturbance of the reverse cholesterol transport system.

[Clinically manifest gastrointestinal bleeding in patients subject to coronary angiography]. / Klinicky manifestní gastrointestinální krvácení u koronarografovaných nemocných.

UNLABELLED: PATIENT SET AND METHODOLOGY: The authors evaluated the incidence of acute bleeding from the upper gastrointestinal tract in 5,955 patients (of which 3,684 men and 2,271 women) during hospitalisation for coronary angiography, and the incidence of potential sources of bleeding from the upper gastrointestinal tract in the patients without bleeding. RESULTS: Bleeding occurred in 9 persons, within 3.4 +/- 3.6 days of the coronary angiography (the median of 1.0 day), with a 33% mortality rate. An ulcer of the duodenal bulbus or bulbitis were detected in four cases (44%), esophagitis in one case (11%), esophageal varices in one case, stomach carcinoma in one case, and the source of bleeding could not be detected in 2 cases. Patients with bleeding were significantly older than those without bleeding (73.6 +/- 4.4 years vs. 65.8 +/- 10.6 years, p < 0.001). Treatment with clopidogrel or abciximab was not associated with a higher incidence of bleeding (p > 0.05). In 42 patients without bleeding, the following pathologies were detected by gastroscopy: esophagitis (31%), mouth and stomach ulcers (36%), duodenal ulcers (21%), (12%), esophageal varices (2%) The incidence of mouth ulcers, stomach ulcers and duodenal ulcers was significantly higher in patients taking acetylsalicylic acid on a regular basis (p < 0.025). CONCLUSION: Bleeding from the upper gastrointestinal tract is not frequent shortly after coronary angiography, but the related mortality is high. The most frequent source of bleeding are duodenal peptic lesions most likely caused by previous treatment by acetylsalicylic acid.

[Diabetic gastroparesis and gastropathy]. / Diabetická gastroparéza a gastropatie.

Dysfunction of gastrointestinal tract affects about 30-60 % diabetic patients. The gastroparesis occurs only in part of patients. Dysfunction has different manifestations from quantitative and qualitative changes of motility to alterations of visceral sensitivity. Pathogenesis of the disturbances is multifactorial - autonomic neuropathy, quality of metabolic control, function of enteric nervous system and others. Scintigraphy is a standard for making diagnosis. Due to its multifactorial natural history, therapy is difficult. It encompasses dietary modifications, good control of diabetes, prokinetic drugs. New drugs and treatment techniques are beeing developed.

[Recurrent spontaneous pneumomediastinum as a cause of recurrent diabetic ketoacidosis?]. / Recidivující spontánní pneumomediastinum jako prícina opakovaných diabetických ketoacidóz?

The author describes the case of a female patient with repeated ketoacidoses associated with the presence of spontaneous pneumomediastinum. In the discussion the author summarizes briefly contemporary knowledge on the incidence, symptoms and course of spontaneous pneumomediastinum. The possible interrelation of relapses of pneumomediastinum and diabetic ketoacidoses is discussed.

[Helicobacter pylori in patients with diabetes mellitus]. / Helicobacter pylori u nemocných s diabetes mellitus.

The authors assessed the frequency of Helicobacter pylori in diabetic patients with gastroduodenal ulceration and non-ulcerative dyspepsia. They evaluated a group of 91 hospitalized type II diabetics which non-ulcerative dyspepsia, endoscopically confirmed ulceration of the duodenal bulbus and gastric ulceration. The control group was formed by 98 hospitalized non-diabetic subjects. Between the two groups there was no difference in the frequency of Helicobacter pylori in non-ulcerative dyspepsia (61.1% as compared with 56.0% in non-diabetics) and gastric ulceration (75.0% as compared with 77.7% in non-diabetics). There is a significantly (p > 0.005) lower incidence of HP infection in diabetics with active duodenal ulceration (46.6%), as compared with non-diabetics (87.5%). The authors assume that active duodenal ulceration in diabetics could be more frequently caused by other factors than Helicobacter pylori.