The MDR1/ABCB1 gene rs 1045642 polymorphism in colorectal cancer.

INTRODUCTION: Colorectal cancer (CRC) is one of the most frequently diagnosed tumors in Western countries. CRC is a heterogeneous group of tumors with regards to its molecular pathogenesis and genetic factors. Both genetic variations and anthropometric factors may affect morbidity in CRC patients. The aim of this study was to assess the impact of multidrug resistance 1/ATP-binding cassette sub-family B member 1 gene (MDR1/ABCB1) polymorphism rs1045642 and general anthropometric factors on the CRC risk. MATERIAL AND METHODS: The study included 250 patients who underwent colonoscopy and polypectomy between 2006 and 2013 in a single endoscopy unit in Warsaw, Poland. RESULTS: The CRC was diagnosed in 50 individuals, and 200 patients were included in the control group. Cases and controls were matched for mean age and sex (p > 0.05). Factors that were found to significantly increase the risk of CRC were ulcerative colitis (8/35 in the CRC group vs. 8/181 in the control group; p = 0.001), family history of CRC (11/33 vs. 26/172; p = 0.05), and diabetes mellitus (12/34 vs. 28/170; p = 0.04). Allele T of the rs 1045642 polymorphism was more frequently present in CRC cases (in both a co-dominant and recessive model) and in males (in a co-dominant model), although these associations were not statistically significant (p > 0.05). CONCLUSIONS: The MDR1/ABCB1 gene polymorphism rs 1045642 may be involved in the pathogenesis of CRC and this relationship may be sex-specific for males. However, further population studies are necessary to assess this relationship.

Effectiveness of Helicobacter pylori eradication established on the basis of examination of antibiotic resistance of the bacteria.

INTRODUCTION: The treatment of Helicobacter pylori (HP) tends to be empirical despite a high number of failures (over 20%). The efficacy of eradication therapies is declining, reaching in some countries 60%, which correlates inversely with the growing drug resistance of the bacteria. AIM: Given the frequent inefficacy of the hitherto proposed treatment schemes for HP infection, an attempt was made to assess the efficacy of a therapy based on the antibiotic resistance of the cultured bacteria, and to analyse factors with possible contribution to the inefficacy of HP eradication treatment. MATERIAL AND METHODS: The study covered patients from one region of Central Poland in the years 2005-2015. The total material for bacteriological assessment was collected from 154 patients who had previously been subject to HP eradication treatment at least two times, including 80 women and 74 men, reporting subsequently to the Clinic. RESULTS: The efficacy of the antibiogram-based treatment was merely 65.62%. A low, but slightly higher than expected, resistance to amoxicillin (3.48%) and tetracycline (2.27%), as well as to clarithromycin (27.27%) and metronidazole (70.69%), was established. CONCLUSIONS: In Polish patients resistance to clarithromycin and metronidazole of HP is high and becoming increasingly resistant; however, we found low bacterial resistance to tetracycline.

Fecal Microbiota Transplantation in Patients With Blood Disorders Inhibits Gut Colonization With Antibiotic-Resistant Bacteria: Results of a Prospective, Single-Center Study.

Background: Patients with blood disorders colonized with antibiotic-resistant bacteria (ARB) are prone to systemic infections that are difficult to treat. Reintroduction of commensal bacteria in a murine model of enterococcal colonization of the gut can lead to eradication of enterococci. We hypothesized that fecal microbiota transplantation (FMT) could be used to eradicate ARB in humans. Methods: Participants colonized with ARB were treated with intraduodenal FMT according to a prospective protocol (NCT02461199). The primary endpoint was complete ARB decolonization at 1 month after FMT. Secondary endpoints included safety assessment and partial ARB decolonization. Microbiome sequencing was performed to investigate the influence of microbial composition of the transplanted material on the outcome of FMT. Results: Twenty-five FMTs were performed in 20 participants (including 40% who had neutropenia) who were colonized by a median of 2 (range, 1-4) strains of ARB. The primary endpoint was reached in 15/25 (60%) of the FMTs and more frequently in cases in which there was no periprocedural use of antibiotics (79% vs 36%, P < .05). Among participants, 15/20 (75%) experienced complete ARB decolonization. There were no severe adverse events, and partial ARB decolonization was observed in 20/25 (80%) of the FMTs. The microbiota composition analysis revealed higher abundance of Barnesiella spp., Bacteroides, and Butyricimonas and greater bacterial richness in the fecal material, resulting in eradication of Klebsiella pneumoniae compared with nonresponders. Conclusions: FMT in patients with blood disorders is safe and promotes eradication of ARB from the gastrointestinal tract. Clinical Trials Registration: NCT02461199.

Melanosis coli in patients with colon cancer.

INTRODUCTION: Melanosis coli is a benign lesion affecting the mucosa of the large intestine. There is a relationship between the presence of melanosis and anthraquinone laxative use. Melanosis coli is also observed in patients with colon cancer, but there is doubt whether these two conditions are related. AIM: To analyze the correlation between melanosis and colon cancer. MATERIAL AND METHODS: We analyzed retrospectively 436 patients undergoing colon cancer surgery. There were 246 women and 190 men. Patients were divided into three age groups: under 50 years, between 51 and 65 years, and over 66 years. We analyzed sections of the cancer and intestinal mucosa from the tumor's proximal (2-5 cm) and distal (8-10 cm) zone. RESULTS: Melanosis coli was present in 52 patients, which represents 11.9% of patients with colon cancer. More often it was present in women. The most common location of melanosis and colon cancer was the terminal part of the large intestine. In patients below 50 years of age in both sexes melanosis coli did not occur. In men, melanosis was more common in the age group over 66 years. Intensity of pigmentation was higher in the tumor's distal zone. CONCLUSIONS: The incidence of melanosis coli increases with age, similar to that of colon cancer. Melanosis was not present inside tumors, in almost half of the cases it was not present in the proximal zone, and the degree of pigmentation increased in distal zone. The cause-effect relationship between melanosis coli and colon cancer remains uncertain.

[The prevalence of human papillomaviruses in patients with colon polyps].

INTRODUCTION: Potential role of HPV infection in pathogenesis of colon polyps and cancer remains undetermined. The aim of the study was to investigate the prevalence of DNA of HPV- 6, -11, -16 and -18 in the biopsies from colon polyps. MATERIAL AND METHODS: We investigated the biopsies from 24 patients (23 from colon polyps and I from colon cancer) of Department of Gastroenterology Medical University of Warsaw using Real time PCR HPV-6/11. Real-TM (Sacace Biotechnologies) was performed on termocycler Smart Cycler Dx. RESULTS: We didn't detect oncogenic HPV16 and HPV18 in any of the investigated specimens, HPV-11 was present in 11 patients including all patients with adenoma tubule-villosum. We detect HPV6 in 5 samples from polyps and 1 from colon cancer. CONCLUSIONS: HPV 6 and HPV 11 could play a role in pathogenesis some colon polyps but the final conclusions demand further investigations. Oncogenic HPV 16 and 18 probably don't play any role in colon polyps pathogenesis.

Fecal Microbiota Transplantation Inhibits Multidrug-Resistant Gut Pathogens: Preliminary Report Performed in an Immunocompromised Host.

Colonization of the gastrointestinal tract with multidrug-resistant (MDR) bacteria is a consequence of gut dysbiosis. We describe the successful utilization of fecal microbiota transplantation to inhibit Klebsiella pneumoniae MBL(+) and Escherichia coli ESBL(+) gut colonization in the immunocompromised host as a novel tool in the battle against MDR microorganisms. ClinicalTrials.gov identifier NCT02461199.

Gastritis - facts and doubts.

INTRODUCTION: Many clinicians consider chronic gastritis to be equivalent to Helicobacter pylori infection. However, it is known that there are numerous other causes of the condition. AIM: Determination of the incidence of gastritis in patients with dyspepsia referred for diagnostic endoscopy of the upper part of the digestive tract, identification of the parts of the stomach most frequently affected by the inflammation, as well as the impact of an insufficient number of collected samples on the correct diagnosis. MATERIAL AND METHODS: Upper gastrointestinal endoscopy due to dyspepsia was performed in 110 patients. In the course of gastroscopy two biopsy specimens were collected for histopathological examination and towards H. pylori infection from the lesser and greater curvature in the antrum 3 cm from the pyloric sphincter, in the body - 4 cm proximally to the stomach angular incisure on the lesser curvature, and in the middle of the greater curvature, as well as in the subcardiac region on the side of the lesser and greater curvature. RESULTS: In patients with dyspepsia H. pylori-negative chronic gastritis is more common than gastritis with accompanying H. pylori infection. Collection of too small a number of biopsy specimens results in failure to detect inflammatory changes and/or H. pylori infection, which may be limited to one part of the stomach. Biopsy specimens of gastric mucosa should be collected in compliance with the assumptions of the Sydney System. Helicobacter pylori infection in people with dyspepsia is now being reported more rarely than in the past (36%). CONCLUSIONS: In patients with dyspepsia chronic H. pylori-negative gastritis is more common than gastritis with an accompanying H. pylori infection. Helicobacter pylori infection is not always equivalent to the presence of chronic gastritis.

[The occurrence of human papillomavirus--HPV in the biopsies from colon polyps and cancer]. / Wystepowanie wirusów brodawczaka ludzkiego--Hpv w wycinkach z polipów i raka jelita grubego.

Human papillomaviruses (HPV) infection can be associated with benign (warts) and malignant (precancer and cancer) genital, perianal and oral lesions. The role of HPV in the pathogenesis of colonorectal cancer and adenomas is still undetermined. We investigated the occurrence of nononcogenic HPV 6/11 and oncogenic 16/18 DNA in colon cancer, polyps and normal tissue using PCR. HPV 16/18 were detected more frequently in colon cancers (67%) and adenomas (56%) than in normal colon mucosa (28%). In case of HPV 6/11 the differences were not significant. The results suggest the possible role of HPV 16/18 in pathogenesis of colon cancers and polyps.

[Is Helicohacter pylori infection associated with CRS occurrence?]. / Czy zakazenie Helicobacter pylon ma zwiazek z wystepowaniem idiopatycznej centralnej chorioretinopatii surowiczej?

Upper gastrointestinal tract endoscopy was performed in 14 patients with clinically determined central serous chorioretinopathy to detect eventual Helicobacter pylori infection. In 11 patients Helicobacter pylori infection was detected using urease test and histopathological examination. Obtained results confirm suggestions that Helicobacter pylori infection may be a factor associated with CRS etiopathogenesis. To understand those correlations large studies and large patients population are to be performed.

Impaired glucose metabolism in colorectal cancer.

OBJECTIVE: Some studies have found that people with type 2 diabetes mellitus are at increased risk of neoplasms, especially colorectal cancer (CRC). In other studies it is also suggested that there is a higher incidence of diabetes mellitus in patients with CRC. The aims of this study were to assess whether the incidence of type 2 diabetes mellitus and impaired glucose tolerance (IGT) are higher in subjects with CRC and to determine the difference between diabetic subjects and healthy controls regarding glucose metabolism (glycaemia, insulinaemia, serum levels of C-peptide) as well as insulin resistance and sensitivity. MATERIAL AND METHODS: The study included a total of 80 subjects: 40 enrolled patients (20 M, 20 F) with newly diagnosed sporadic colorectal cancer and 40 subjects with endoscopically excluded CRC or adenomas serving as controls. Subjects were matched for gender, age and body mass index (BMI) (age +/- 5 years BMI +/- 1 kg/m2). A 75-g oral glucose tolerance test was performed after an overnight fast. Samples for glycaemia, serum levels of C-peptide and insulin were taken at 0, 30, 60, 90, 120 and 150 min of the study. HOMA-IR, EIR, EIR/HOMA-IR indexes were calculated. RESULTS: There was a significantly higher incidence of impaired glucose metabolism (IGM-diabetes mellitus or IGT) in CRC subjects. No differences were found in levels of glucose, insulin or C-peptide. Insulinaemia and C-peptide curves showed a shift typical of diabetes, in the form of a delayed insulin release peak. The HOMA-IR, EIR as well as the EIR/HOMA-IR indexes showed no differences between groups. CONCLUSIONS: A significantly higher incidence of IGM appears to occur in CRC patients than in the healthy population. This phenomenon is not dependent on age and body-weight, which may suggest that it is cancer that predisposes to diabetes rather than the other way round. The neoplastic process in the colon is not associated with hyperinsulinaemia or insulin resistance, but in CRC patients, pancreatic B-cell dysfunction typical of the early stages of diabetes is seen.

[Serum lipids concentration and colorectal cancer]. / Stezenie lipidów w surowicy a rak jelita grubego.

The authors present current concepts concerning the relationships between plasma lipid concentration and incidence of colorectal cancer. Pharmacological reduction of cholesterolaemia may decrease mortality of cardiovascular causes' simultaneously increasing mortality of non-vascular causes. Discussion concerns the idea of preclinical action of the neoplasm on lowering cholesterol level as well as hypothesis of increased biliary secretion of cholesterol metabolites, that may have cancerogenic effect. Cholesterol plasma concentration and its impact on aetiopathogenesis of colorectal cancer still need to be investigated.

[Carcinoma hepatoides of the stomach --case report and literature review]. / Rak zoladka z róznicowaniem watrobowokomórkowym (carcinoma hepatoides)--opis przypadku i przeglad literatury.

UNLABELLED: Hepatoid differentiation in neoplastic tumors occurs not only in primary hepatic carcinoma but also in other malignant tumors, especially carcinomas. Stomach is the most frequent site of such tumors. Usually, at the time of diagnosis liver metastases are found and it is difficult to establish what was the primary site of hepatoid-like carcinoma. CASE REPORT: 83-year-old man was admitted to the hospital due to upper gastrointestinal haemorrhage. Beside weight loss (11 kg during the period of 3 months) he did not complain of any symptoms. Urgent gastroscopy revealed in the middle portion of the gastric corpus two ulcers 12 and 3 mm in diameters and just above them polyp 1.5 cm in diameter. The other parts of gastrointestinal tract were normal. Neoplastic infiltration of the whole thickness of the gastric wall was found in the histopathologic examination of the specimens taken from all these lesions. The lesion consisted of the hepatocyte-like cells with the droplets of bile visible among them. Morphological examination and immunohistochemical results (CKMNF+, CKhepatocyte+, Vimentin and CD68 negative) were consistent with very rare hepatoid type of gastric cancer--carcinoma hepatoides. The following investigations (USG, CT) showed tumor in the II, III and IV segments of the liver and thromboses in the left branch of vena porta and middle hepatic vena. The serum level of AFP was high (5837 ng/l). The possibility of gastric infiltration by primary hepatic tumor and primary gastric hepatoides carcinoma were considered in the differential diagnosis. CONCLUSION: Morphological characteristics of primary hepatic carcinoma may be identical with primary gastric hepatoides carcinoma. When the biopsy specimens are very small even immunohistochemical examination does not allow to establish the diagnosis.

[Pancreastatin secretion stimulation in healthy volunteers]. / Stymulacja wydzielania pankreastatyny u zdrowych ochotników.

According to animal studies pancreastatin (PST), a peptide that is secreted by numerous neroendocrine cells, inhibits insulin secretion and has a hyperglycaemic and glycogenolytic effect. However, physiologic role of PST in carbohydrate metabolism remains unclear. In order to determine the best stimulus of PST secretion, four different stimulations of GI tract were carried out in 10 healthy volunteers: oral glucose loading test, intravenous glucose loading test, intravenous glucagon infusion and standard meal loading test. Serum PST concentration was measured radioimmunologically at established intervals after each stimulation. It was found that either oral or intravenous glucose loading test do not increase serum PST concentration; intravenous glucagon infusion decreases serum PST concentration and a standard meal increases serum PST concentration.

[Gastric emptying disorders in diabetes mellitus]. / Zaburzenia oprózniania zoladka w cukrzycy.

OBJECTIVE: 1. To find out the prevalence of gastroperesis and of accelerated gastric emptying in long-standing and recently diagnosed diabetic patients. 2. and to determine the relationship between the percentage of gastric retention of the test meal to the gastric symptoms, degree of metabolic control, cardiovascular autonomic neuropathy, and late diabetic complication. RESEARCH DESIGN AND METHODS: We studied the gastric emptying of technetium labeled digestible solid test meal in 81 diabetic patients (51 long-standing and 30 recently diagnosed diabetic patients) and in 44 healthy controls. Diabetic patients were divided roto 2 groups according to the type and duration of diabetes. All patients were evaluated for gastric symptoms, glycemic control, peripheral neuropathy, retinopathy and cardiovascular autonomic neuropathy. RESULTS: Delayed gastric emptying was found in 21 long-standing diabetic patients and in 3 recently diagnosed type 2 diabetic patients. Accelerated gastric emptying was found in 10 patients mainly recently diagnosed type 2 diabetic patients. The rate of gastric emptying was related to CANP but not gastric symptoms or actual glycemic control. CONCLUSIONS: 1. Diabetics gastroparesis is a common disorder affecting both type 1 and type 2 long-standing diabetes mellitus in about 40% usually in the setting of late diabetic complications and can be manifested in recently diagnosed type 2 diabetes mellitus. 2. Accelerated gastric emptying is another gastrointestinal disorder manifested in about 20% of recently diagnosed diabetic patients (maimy type 2) but can be present in long-standing diabetic patients. 3. The rate of gastric emptying is related to cardiovascular autonomic neuropathy but not to gastric symptoms or actual metabolic control.