Use of electrogastrography in preclinical studies of cholinergic and anticholinergic agents in experimental pigs.

Electrogastrography (EGG) is a non-invasive method for the assessment of gastric myoelectrical activity. Porcine EGG is comparable with human one. The purpose of this study was to evaluate the effect of atropine and neostigmine on the EGG in experimental pigs. Adult female pigs were administrated atropine (1.5 mg i.m., n=6) and neostigmine (0.5 mg i.m., n=6) after the baseline EGG, followed by a 90-min trial recording (MMS, Enschede, the Netherlands). Running spectral analysis was used for the evaluation. The results were expressed as dominant frequency of slow waves and EGG power (areas of amplitudes). Neostigmine increased continuously the dominant frequency and decreased significantly the EGG power. Atropine did not change the dominant frequency significantly. However, atropine increased significantly the EGG power (areas of amplitudes) from basal values to the maximum at the 10-20-min interval. After that period, the areas of amplitudes decreased significantly to the lowest values at the 60-90-min interval. In conclusion, cholinergic and anticholinergic agents affect differently EGG in experimental pigs.

The importance of upper gastrointestinal lesions detected with capsule endoscopy in patients with obscure digestive bleeding.

STUDY AIMS: Small bowel capsule endoscopy (SBCE) is the first line procedure for detecting small bowel lesions in patients with an obscure gastrointestinal bleeding (OGIB). Missed upper gastrointestinal (UGI) lesions at the initial endoscopy may account for the so-called OGIB. This retrospective study was designed to assess the role of SBCE in detecting missed UGI lesions. METHODS: All consecutive SBCE that were performed in the last year for patients with OGIB were included in our study. We evaluated the visibility of the gastric mucosa, the anatomic landmarks, the presence of UGI lesions as well as their clinical importance. The SBCE findings were compared with the reports of previous UGI endoscopies. RESULTS: 118 patients (45 males, 73 females, mean age 61 +/- 19 years) were included in the analysis. The indication for SBCE was obscure overt and occult OGIB in 60 and in 58 patients, respectively. SBCE identified lesions in the small bowel in 42% of the patients. An excellent visibility of gastric mucosa was observed in 83/118 cases (703%). SBCE identified gastric lesions with potential clinical significance (high bleed potential) in 25/118 (21.2%) patients. In 12/118 (10.2%) patients the UGI lesions detected by SBCE were considered as the only potential source of bleeding. CONCLUSIONS: In patients with OGIB, SBCE detected not only small bowel lesions but also significant UGI lesions that were missed or underestimated at the initial endoscopy in 21% of cases. It is therefore necessary to carefully read the gastric images when performing an SBCE.

[Motility disorders and gastric emptying in diabetes mellitus. Current diagnostics and treatment]. / Poruchy motility a evakuace zaludku u diabetika. Soucasné moznosti diagnostiky a lécby.

Autonomic neuropathy of the gastrointestinal tract is a common complication of diabetes mellitus. However, it is seldom recognised properly as it is rarely considered. In some patients, it might be asymptomatic or hardly compensatable diabetes can be the only one sign. There are non-invasive diagnostic methods to assess gastric emptying rate (13C-octanoic acid breath test) or myoelectric activity of the stomach (electrogastrography). The principle treatment comprises optimal control of diabetes and use of prokinetics.

Biodegradable stents for the treatment of benign stenoses of the small and large intestines.

Biodegradable stents, which are made of various synthetic polymers, such as polylactide or polyglycolide, or co-polymers, such as polydioxanone, can be used for the treatment of benign refractory stenoses of the gastrointestinal tract. Here we report 11 patients (median age 41) with stenosing Crohn's disease of the small and/or large intestine. Endoscopic insertion of a biodegradable stent was successful at the first attempt in all patients except one. Subsequent follow-up was for a mean of 16 months, median 17 months, range 12-29 months. Early stent migration (between 2 days and 8 weeks) was seen in three patients. Mucosal overgrowth (epithelial hyperplasia) was not observed in any of the patients during the follow-up period. The high rate of early stent migration might be solved by appropriate tailoring and further improvements in the design of the biodegradable stents. Proof of long-term efficacy and safety requires further studies.

Morphometric analysis of the porcine gastrointestinal tract in a 10-day high-dose indomethacin administration with or without probiotic bacteria Escherichia coli Nissle 1917.

BACKGROUND: Nonsteroidal anti-inflammatory drugs may cause severe injury to all parts of the gastrointestinal tract. It has been hypothesised that probiotic bacteria might reduce this adverse effect. The aim of this study was to perform a morphometric evaluation of the gastrointestinal tract in experimental pigs treated using a 10-day high-dose of indomethacin with or without Escherichia coli Nissle 1917 (EcN). METHODS: Twenty-four healthy mature pigs were included: Group A (controls; 6 animals), Group B (EcN; n = 6), Group C (indomethacin; n = 6) and Group D (EcN & indomethacin; n = 6). EcN (3.5 × 10(10) live bacteria/day for 14 days) and/or indomethacin (15 mg/kg/day for 10 days) were administered. Specimens of the stomach, small and large bowel were routinely processed for microscopic examination. The height of glandular mucosa, height and width of interfoveolar spaces and villi and basement size of epithelial cells were evaluated. RESULTS: Different effects of indomethacin and EcN on particular parts of the gastrointestinal tract were shown. The indomethacin and probiotics group demonstrated a significantly lower height of cryptal mucosa and colonocytes and widening of the basement size of colonocytes compared to controls (p = 0.004; p < 0.001; p = 0.025). The height of cryptal mucosa was significantly higher in the EcN group compared to controls (p = 0.001). CONCLUSIONS: Indomethacin alone induced marked adaptation of the gastric mucosa. EcN alone provided a significant favourable trophic effect on the colonic mucosa. However, indomethacin and probiotics administered together comprise the worst impact on all porcine stomach, small and large bowel.

[Epidemiology of Helicobacter pylori infection]. / Epidemiologie Helicobacter pylori.

Helicobacter pylori (Hp) is the most common chronic bacterial infection in humans worldwide. The prevalence of Hp infection is high in developing countries (80-90%) and lower in developed countries (10-30%). In vast majority of infected individuals, the infection is acquired early in life. The risk of Hp infection is related to low socio-economic status and living conditions at early childhood (density of housing, overcrowding, number of siblings, sharing a bed, and lack of running water, low education of parents). Smoking is a risk factor of Hp infection in adults. In developed countries including the Czech Republic, the overall prevalence of Hp infection has fallen dramatically over recent decades. This decrease can be explained mostly by the relatively favourable and improving socio-economic conditions. However, it is necessary to consider also the fundamental determinants of "modern times" that could cause gradual disappearing of Hp from the human "microbiome".

Confocal laser endomicroscopy in experimental pigs. Methods of ex vivo imaging.

BACKGROUND: Confocal laser scanning endomicroscopy (CLSE) enables online in vivo cellular surface and subsurface imaging of normal and pathological tissue at high resolution and magnification. The aim of this study was to work out a method of ex vivo in vitro CLSE in experimental pigs and to compare CLSE images with those of "classic" histology. MATERIAL AND METHODS: Five mature female pigs entered the study. CLSE on an ex vivo in vitro basis was started 10 minutes after pharmacological euthanasia and carried out for 30 minutes. Fluorescein was administrated i.v. as a fluorescence substance. RESULTS: CLSE was successful in all tissue samples of all animals (the oesophagus, stomach, small intestine, large bowel). We have succeeded to obtain high quality images within the first 30 minutes that means 40 minutes after the euthanasia of experimental animals. CLSE images corresponded well with those of haematoxylin-eosin staining. CONCLUSIONS: CLSE on an ex vivo in vitro basis in experimental pigs is feasible.

[Double-balloon enteroscopy]. / Dvojbalónová enteroskopie, její moznosti a alternativy.

Double-balloon enteroscopy (DBE) is a new technique, firstly published in 2001 by Yamamoto, inventor of this unexceptionable method. DBE allows complete visualisation, biopsy, and treatment in the small bowel. The procedure is safe and useful. The DBE has a potential to be a standard of enteroscopy by replacing conventional push enteroscopy. DBE together with the capsule endoscopy are the essential modalities for the management of small intestinal diseases.

Hiatal hernia and Barrett's oesophagus impact on symptoms occurrence and complications.

UNLABELLED: The aim of the study was to evaluate the influence of sliding hiatal hernia over the Barrett's oesophagus, including symptoms rate and complications. METHODS: A total of 520 (4.6%) cases of Barrett's oesophagus were found out of 18.276 upper gastrointestinal endoscopies, performed in 11.276 patients at a single tertiary centre in a period from 1994 to 2004. RESULTS: Sliding hiatal hernia was found in 58% of patients with Barrett's oesophagus, more frequently in men (60%). The association between hernia and some complications of Barrett's oesophagus was significant (94% of Barrett's ulcer, 77% of low-grade dysplasia with p < 0.01). However, there was no significant association with adenocarcinoma (54%; p > 0.05). The other complications of Barrett's oesophagus (i.e. bleeding, stenosis, high-grade dysplasia) were identified in small number (less than 10), so they were not evaluated statistically. Association between the presence of hiatal hernia and occurrence of symptoms (reflux symptoms, dysphagia, odynophagia, dyspeptic and other symptoms) was significant with p < 0.01. CONCLUSIONS: Our study suggests that sliding hiatal hernia may play a significant role as a pathophysiologic factor in Barrett's oesophagus. Complications rate of Barrett's oesophagus were not equally frequent in particular cases with hiatal hernia. The occurrence of symptoms is getting more pronounced in those with sliding hiatal hernia.

Antilaminaribioside and antichitobioside antibodies in inflammatory bowel disease.

Testing antilaminaribioside (ALCA) and antichitobioside (ACCA) antibodies in 89 Crohn's disease (CD), 31 ulcerative colitis (UC) and 50 controls, mean values were 38.6 and 53.0 ELISA units for CD, 34.0 and 32.6 for UC, 34.5 and 36.4 for controls, respectively. There was no significant difference of ALCA values between CD and UC (p = 0.401), CD and control subjects (p = 0.698) or UC and controls (p = 0.898). ACCA were significantly higher in CD compared with UC (p = 0.011) but not with the controls (p = 0.095). No significant difference of ACCA values between UC and controls (p = 0.107) was found. ALCA and ACCA values significantly correlated in CD (r = 0.548, p < 10(-4)) and UC (r = 0.885, p < 10(-4)) but not in controls (r = 0.153, p = 0.287). The positive predictive value for CD was only 20 (ALCA) and 8 % (ACCA), the negative ones (to exclude CD) 25 (ALCA) and 86 % (ACCA). Small and/or large bowel involvement or disease type (i.e. stenosing, perforating or inflammatory) of CD did not differ in the two values. The idea that ALCA and ACCA may be useful either to differentiate between CD, UC and healthy subjects or to stratify CD was not confirmed.

[Decrease of the prevalence of Helicobacter pylori infection in the Czech Republic]. / Pokles prevalence infekce Helicobacter pylori v Ceské republice.

Helicobacter pylori (Hp) is the most common chronic bacterial infection in humans. Hp has been demonstrated worldwide and in individuals of all ages. The overall prevalence of Hp infection has fallen dramatically in the Czech Republic over recent 15 years (from 70% in 1993 to 35% in 2006). This decrease can be explained mostly by the relatively favourable and improving socioeconomic conditions after the fall of communist regime. However, it is necessary to consider also the fundamental determinants of "modern times" that could cause gradual disappearing of Hp from the human "microbiome".

[The influence of inflammatory bowel disease on the period of conceiving]. / Vliv idiopatického strevního zánetu na interval potrebný pro pocetí pacientek.

INTRODUCTION: Crohn's disease (CD) and ulcerative colitis (UC) influence women fertility in many ways. OBJECTIVE: We tried to determine the influence of the inflammatory bowel disease on conceiving. The date of the diagnosis, localisation, form and activity at time of conception were involved. DESIGN: Retrospective study. METHODS: We assessed data from 81 patients with inflammatory bowel disease. 56 patients were diagnosed before conceiving (41 with CD, 15 with UC), 25 patients were diagnosed after pregnancy (14 with CD, 11 with UC). We assessed the period of conceiving (in months) depends on previous abdominal operation, localisation, form and activity of the disease at time of conception. The data were obtained from the questionnaire and hospital cards. RESULTS: The previous abdominal operation, the diagnosis, localisation, and the form of the disease did not influence the period necessary to conceive in patient with inflammatory bowel disease. The anoperineal localisation and activity of Crohn's disease at the time of conception extended the period necessary to conceive. CONCLUSION: Fertility of the patients with Crohn's disease depends on the activity of the disease at time of conception and anoperineal involvement. Previous abdominal operation does not influence the fertility.

Genetic variants of transferrin in cystic fibrosis.

BACKGROUND: Genetic polymorphism of serum transferrin (Tf) was studied in order to differentiate between protein genetic variants and congenital disorders of glycosylation (CDG), further focusing on unusual findings. METHODS: Screening of Tf hypoglycosylation was carried out by isoelectric focusing with direct immunofixation and Coomassie blue staining in 100 healthy controls and a group of 1247 patients with various symptoms and diagnoses. RESULTS: Of the seven different genotypes detected, a significantly higher (p = 0.004) frequency of Tf C1C2 was found among 92 patients with cystic fibrosis; only the most severe DF508 mutation (in either homozygous or heterozygous form) was regularly present in the carriers of this Tf genotype, in contrast to those with the Tf C1C1 variant. CONCLUSIONS: Association of Tf C2 allele with various malfunctions has been noticed before, but is so far unresolved. This is the a report on increased frequency of Tf C1C2 genotype found in cystic fibrosis. Analysis of larger samples and independent confirmation of our results are needed.

[Significance of serum antibodies ANCA, ASCA, ABBA in diagnostics of idiopathic intestinal inflammations]. / Význam sérových protilátek ANCA, ASCA, ABBA u idiopatických strevních zánetu.

BACKGROUND: Crohn's disease and ulcerative colitis still remain a heterogeneous group of diseases with an unclear aetiology. Serologic methods play important role in their diagnosing though there is still not an ideal marker. We tried to determine the importance of serological testing of ASCA IgA, IgG, ANCA, ABBA antibodies in patients with ulcerative colitis and Crohn's disease. METHODS AND RESULTS: ASCA IgG, ASCA IgA; ANCA, ABBA antibodies and C-reactive protein were detected by indirect fluorescence assay. ASCA IgA, ASCA IgG, ABBA, ANCA were examined in 40 patients (28 Crohn's disease, 12 ulcerative colitis, 32 health controls). Specificity of ASCA IgA, IgG in CD patients was high (both 96.2%), specificity ANCA in UC 100%. ABBA antibodies had low sensitivity and specificity in both diseases. Combination of ASCA, ANCA, ABBA makes the specificity higher. CONCLUSIONS: We showed the importance of combination ASCA, ANCA with ABBA antibodies to improve the serological diagnosing of IBD.

Intraoperative enteroscopy: ten years' experience at a single tertiary center.

BACKGROUND AND METHODS: Intraoperative enteroscopy is an invasive technique for small bowel investigation. It enables us to investigate the entire small intestine and to treat pathological findings by endoscopic or surgical means at the same time. The investigation is invasive and that is why the proper indication is mandatory. RESULTS: Forty-one intraoperative enteroscopies were performed at our center within a 10-year period. The procedure was diagnostic in 37/41 patients (90.2%); in 3 patients no pathology was found, and in 1 patient we found only previously diagnosed celiac disease. The investigation was therapeutic in 35/41 (85.4%) patients; 2 patients with small bowel ulcers did not require any intraoperative therapy. The pathological findings were arteriovenous malformations (found in 12 patients), small bowel NSAID-induced or Crohn's ulcers (8 patients)--ulcerations and arteriovenous malformations were simultaneously found in three patients; carcinoid of the small intestine (5 patients); Peutz-Jeghers syndrome (5 patients); bleeding polyps (2 gastrointestinal stromal tumors, 1 paraganglioma, and 1 lipoma--in 4 patients); Rendu-Osler-Weber disease (2 patients); multiple cavernous hemangiomas in blue rubber bleb nevus syndrome (1 patient); Henoch-Schönlein purpura (1 patient); aortoenteral fistula (1 patient); and retrograde intussusception of Meckel's diverticulum (1 patient). In five patients with Peutz-Jeghers syndrome, 6-22 hamartomas (median of 18 per session) were removed by means of endoscopic polypectomy during intraoperative enteroscopy. There were no major procedure-related complications in our series. CONCLUSIONS: Intraoperative enteroscopy is accepted as the ultimate diagnostic procedure for complete investigation of the small bowel. Despite the introduction of double-balloon enteroscopy into clinical practice, intraoperative enteroscopy will be reserved for those cases where double-balloon enteroscopy cannot be performed or fails to investigate the entire small intestine, especially to prevent excessive bowel resection.