RESUMEN
THE AIM: Non-erosive reflux disease is presented in reflux diseases classifications not adequately Many esophageal lesions were described in different endoscopic techniques but not one classification was proposed. In many patients with signs of prolonged gastro-esophageal reflux in endoscopic assessment pale mucosa above gastro-esophageal junction was observed. In some patients color of esophagus in distal part becomes white and grey. We decided to check what histological lesions appear in all endoscopically visible lesions. MATERIAL AND METHODS: We analyzed 29 patients with chronic reflux disease and with endoscopic assessment of upper alimentary tract in which white color was observed in distal part of esophagus was observed. Biopses were taken from sites at least 2 cm from Z-line. Endoscopic assessment was performed by one endoscopist specialized in reflux disease. Biopsies were assessed by one pathologist specialized in upper alimentary tract diseases assessment. RESULTS: In all cases biopsies taken from distal esophageal, white-coloured mucosa were assessed by pathologist as esophagitis caused by gastro-esophageal reflux. CONCLUSIONS: White color of the distal part of esophagus in patients with chronic reflux disease is unanimously associated with microscopic lesions associated with reflux disease.
Asunto(s)
Esofagitis/patología , Esofagoscopía/métodos , Esófago/patología , Mucosa Gástrica/patología , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/patología , Biopsia , Enfermedad Crónica , Esofagitis/etiología , Unión Esofagogástrica/patología , Femenino , Reflujo Gastroesofágico/complicaciones , Humanos , Masculino , Persona de Mediana EdadRESUMEN
UNLABELLED: Inflammatory bowel diseases including ulcerative colitis are associated with prolonged inflammatory process, that is dependent on cytokine production. Among them crucial role plays tumor necrosis factor TNF-alpha. There is proven association between single nucleotyde polimorphism and ability to produce cytokines. AIM: We analyzed association between TNF-alpha (-308) promoter polymorphism and extension of lesions in ulcerative colitis. TNF-alpha (-308) promoter polymorphism. MATERIALS AND METHODS: Analysis was performed using polymerase chain reaction with sequence specific primers method (PCR-SSP) in 48 patients suffering from ulcerative colitis and association between TNF-alpha (-308) promoter polymorphism and ulcerative colitis macroscopic lesions classified according Montreal classification was investigated. RESULTS: No statistically significant association among groups of patients and TNF-alpha (-308) promoter polymorphism was observed. More cases of TNF-alpha (-308) promoter polymorphism associated with low TNF-alpha production were observed in patients with E2 and E3 lesions according to Montreal classification. CONCLUSIONS. There is no direct association between TNF-alpha (-308) promoter polymorphism and ulcerative colitis macroscopic inflammatory lesions evaluated on basis of Montreal classification. There is statistically irrelevant tendency of more cases of pancolitis in group of patient with TNF-alpha (-308) promoter polymorphism associated with low TNF-alpha production.
Asunto(s)
Colitis Ulcerosa/genética , Polimorfismo de Nucleótido Simple , Factor de Necrosis Tumoral alfa/genética , Colitis Ulcerosa/patología , Femenino , Humanos , Masculino , Factor de Necrosis Tumoral alfa/biosíntesisRESUMEN
Successful Crohn's disease conservative treatment is often associated with use of few, sometimes new drugs. Their clinical use apart from inflammatory process decrease is associated with some risk. In the paper we report a case of 23-year-old woman suffering from Crohn's disease treated successfully with anti-TNF antibodies. Apart from successful anti-inflammatory there were observed not symptomatic perforation of the alimentary tract. Patients treated with strong anti-inflammatory drugs require especially careful monitoring also because of possibility of occurrence of not symptomatic life-threatening conditions.
Asunto(s)
Antiinflamatorios/efectos adversos , Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Perforación Intestinal/inducido químicamente , Adalimumab , Adulto , Anticuerpos Monoclonales Humanizados , Enfermedad de Crohn/complicaciones , Femenino , Humanos , Perforación Intestinal/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Factor de Necrosis Tumoral alfa/inmunología , UltrasonografíaRESUMEN
Gastroesophageal reflux disease is a serious clinical problem. In clinical classification of gastroesophageal reflux disease we differentiate esophageal and non-esophageal syndromes. In case of esophageal syndromes we differentiate based on clinical signs and syndromes with esophageal mucosal lesions based diagnosed on base of upper alimentary tract endoscopic and histopathologic assessment. In clinical diagnosis establishing basics are clinical symptoms as heartburn, regurgitation. Usually, recently found typical symptoms of light intensification can be concluded with diagnosis gastroesophageal reflux disease and without other diagnostic tools treatment could be introduced. Helpful diagnostic test is a test with proton pump inhibitors. Endoscopic assessment should be performed at least once in every patient with chronic gastroesophageal reflux disease in order to eliminate complications (Barrett disease). Main impedance advantage is possibility of reflux diagnosis disregarding ph value. Continuous monitoring of impedance in many segments of esophagus can help to establish direction of reflux and its characteristics and extent establishment. (liquid, gaseous, mixed). The main role in pharmacological gastroesophageal reflux disease treatment plays drugs decreasing acid output, proton pump inhibitors (PPI). Dosage of chronic use should be assess individually. The Basic rule is the use of possibly minimal therapeutic dose of PPI. In this paper authors presented basics of gastroesophageal reflux disease diagnosing, monitoring and treatment.
Asunto(s)
Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/tratamiento farmacológico , Esófago de Barrett/etiología , Esófago de Barrett/prevención & control , Enfermedad Crónica , Enfermedades del Esófago/diagnóstico , Enfermedades del Esófago/etiología , Enfermedades del Esófago/patología , Esofagoscopía , Reflujo Gastroesofágico/complicaciones , Humanos , Inhibidores de la Bomba de Protones/uso terapéuticoRESUMEN
Gastroesophageal reflux disease has become recently an important question, especially in developed countries. Untreated or improperly treated could in chronic disease or can lead to serious complications including esophageal cancer. Early diagnosis establishment basing on clinical symptoms and diagnosing methods. Typical signs of gastroesophageal reflux diseases are acidity, regurgitation, especially after heavy meals or body position change. Those signs are basic for diagnosing establishment. It is recommended to introduce empiric treatment and more diagnostics should be employed if the treatment is not successful. Among diagnosing methods constant development is taking place what is associated with technology progress along with clinical trials. Authors in the paper basic diagnosing tools are presented showing their possibilities and limitations. Proper use of those diagnosing tools that should lead to quick diagnosis establishment.
Asunto(s)
Reflujo Gastroesofágico/diagnóstico , Enfermedad Crónica , Neoplasias Esofágicas/etiología , Neoplasias Esofágicas/prevención & control , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/tratamiento farmacológico , Reflujo Gastroesofágico/fisiopatología , Humanos , Monitoreo FisiológicoRESUMEN
Non-erosive gastroesophageal reflux disease (NERD) is still underappreciated type of gastroesophageal reflux disease (GERD). It is not a homogenous group of patients with real reflux, oversensitivity of esophagus and functional dyspepsia. Nowadays often in classifications of GERD patients with NERD are omitted. Many endoscopic lesions are found in esophagus in NERD, especially color change of mucosa. Erythrema is nowadays taken into account. Unequivocal are also opinions about histological image. Many histological lesions are found but not a specific lesions were typified. Probably it is the best to associate NERD with clinical symptoms, endoscopic and histological image.
Asunto(s)
Esófago/patología , Reflujo Gastroesofágico/patología , Eritema/patología , Esofagoscopía , Reflujo Gastroesofágico/clasificación , HumanosRESUMEN
The rising incidence of alimentary tract diseases forces imaging metod development. Developing radiologic diagnostics changed imaging methods role and increased quality demand. X-ray based methods are still used in diagnosing many illnesses. Basic abdominal x-ray in nightshift condition is necessary to diagnose perforation or obstruction. Ultrasonographic, computed tomography and magnetic resonance imaging methods are the most important nowadays. The most popular and non-invasive method of imaging is ultrasonography. It is irreplaceable thanks to its availability and precision diagnosing many internal organs. One of the newest method is magnetic resonance and imaging in all possible scans. Complimentary method is computed tomography. It is based on human body layers analysis. Method is based on x-rays and assessing all tissues absorption. It can produce three dimensional imaging. The newest software can produce virtual imaging of all body cavities as well as colon. Basic and highly specialistic methods should be carefully planned in diagnostic-therapeutic process. In decision making what method should be used, medical doctor and patient should take part, taking into account all indication and cotraindications as well as method limitations.
Asunto(s)
Diagnóstico por Imagen/métodos , Enfermedades Gastrointestinales/diagnóstico , Tracto Gastrointestinal/diagnóstico por imagen , Tracto Gastrointestinal/patología , Humanos , Radiografía , UltrasonografíaRESUMEN
Technology development in data processing in ultrasonography let new imaging method feasible. New method of imaging is elastography (elastosonography, ultrasonographic elastography). It relays on the presumption that pathologically changed tissues have different elasticity and change their shape in different way than health tissue. Elastography is used in lesions in alimentary tract diagnostics. Sensitivity and specificity in malignant lesions differentiation is 85% and 90%. In elastography there is used conventional ultrasonography device that is equipped with additional transformator that is located in probe. Examination is performed with multiple pressing the organ. Imaging is acquired in real-time regime they are colour-coded and they are created during compression. As a result of computer analysis images are generated in two colours. On the basis of character of normal and increased rigidity images were classified in five point scale from one to five. Indication to elastography is suspicion of malignant lesions in traditional ultrasonography and monitoring of liver cirrhosis and fibrosis. More trials are required to evaluate this method more reliably. Then it could be recommended for everyday clinical use.
Asunto(s)
Diagnóstico por Imagen de Elasticidad/métodos , Enfermedades Gastrointestinales/diagnóstico por imagen , Elasticidad , Diagnóstico por Imagen de Elasticidad/instrumentación , Tracto Gastrointestinal/diagnóstico por imagen , Tracto Gastrointestinal/fisiopatología , Humanos , Procesamiento de Imagen Asistido por Computador , Sensibilidad y EspecificidadRESUMEN
Crohn disease treatment is a considerable challenge for a medical doctor. Gaining clinical remission is not enough. The important factor taken into account in treatment is gaining clinical remission and complete mucosal healing. Treatment useful in mucosal healing consists of immunosupresants as azathioprine, 6-markaptopurin, methotrexate and biological treatment. Important factors influencing mucosal healing is choice of medical treatment and its proper timing. More aggressive treatment in top-down scheme appears to be more successful in this aspekt than classical treatment with use of steroids. This data requires verification with more clinical trials.
Asunto(s)
Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/fisiopatología , Mucosa Intestinal/fisiopatología , Regeneración , Humanos , Inmunosupresores/uso terapéutico , Regeneración/efectos de los fármacos , Inducción de Remisión , Resultado del TratamientoRESUMEN
Development in immunology and better understanding of prolonged inflammatory process is basic in inflammatory bowel diseases treatment development. The new generation of drugs could be included infliximab and adalimumab. To the same group we include tumour necrosis factor inhibitors (infliximab, adalimumab, etanercept, certolizumab, onercept), selective adhesive molecules inhibitors (natalizumab, alicaforsen), Th1 dependent reaction inhibitors (anti-il-12, tacrolismus, il-10), lymphocytes migration inhibitors (natalizumab). Those drug are under development or in various clinical trials phases and are the future of inflammatory bowel diseases treatment.
Asunto(s)
Antiinflamatorios/uso terapéutico , Fármacos Gastrointestinales/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Adalimumab , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Inhibición de Migración Celular , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Inflamatorias del Intestino/inmunología , Infliximab , Natalizumab , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
Gastrointestinal cancer poses a major clinical challenge in the developed world where the disease is common. Cancer chemoprevention is defined as the use of natural, synthetic or chemical agents to reverse, suppress or prevent carcinogenic progression to invasive cancer. The success of several clinical trials in preventing cancer in high-risk populations suggests that chemoprevention can be rational strategy. Besides, in population-based observational studies, people had lower rates of colorectal cancer if they were taking various agents, including nonsteroidal anti-inflammatory drugs, calcium, folate. Cyclooxygenase-2 inhibitors and NSAIDs reduce the incidence of colonic adenomas. However, these agents are associated with important cardiovascular events and gastrointestinal harms. Contemporary, the balance of benefits to risk does not favor chemoprevention in average-risk individualse.
Asunto(s)
Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/prevención & control , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Enfermedades Cardiovasculares/inducido químicamente , Colecalciferol/uso terapéutico , Inhibidores de la Ciclooxigenasa 2/efectos adversos , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Ácido Fólico/uso terapéutico , Enfermedades Gastrointestinales/inducido químicamente , Humanos , Medición de RiesgoRESUMEN
The aim of the work was laboratory assessment of energy and nutritional value of general and light diets used in patients of selected clinical department in the Military Medical Institute in Warsaw alimentation. Using questionnaire method the assessment of diets was done by patients too. Meals given to patients in hospital not always fulfilled nutritional requirements. Additional consumption of supplementary products did not always meet the requirements of proper nutrition. Half of examined patients appraised nutrition variety as good but at the same time claimed the there was not enough fruits and vegetables.
Asunto(s)
Encuestas sobre Dietas , Ingestión de Energía , Servicio de Alimentación en Hospital/normas , Hospitales Militares , Evaluación Nutricional , Estado Nutricional , Dieta/estadística & datos numéricos , Conducta Alimentaria , Implementación de Plan de Salud/métodos , Humanos , Necesidades Nutricionales , Ciencias de la Nutrición , Polonia , Encuestas y CuestionariosRESUMEN
Inflammatory bowel diseases are challenging in many respects. To this group of diseases we include Crohn disease, microscopic small bowel disease and ulcerative colitis. In order to establish diagnosis, monitoring the course and treatment as well as to conduct oncological surveillance there is employed a variety of imaging methods: endoscopic, radiologic and ultrasonography. Endoscopic method allows the assessment of mucosal layer as well as lesions identification and specimen biopsies that is the requirement for the ultimate diagnose establishing. Quite new methods of endoscopic methods are double-balloon enteroscopy and endoscopic capsule that allows macroscopic assessment of intestine and increase diagnostic possiblities in these diseases. Radiologic methods include contrast methods, computed tomography and magnetic resonance. Despite its effectiveness classic radiologic methods are often replaced by new more advanced methods as virtual colonoscopy based on computed tomography or magnetic resonance. The following paper include possibilities and limitations of imaging methods currently used in inflammatory bowel diseases diagnosing. Proper use of such methods allows safe and accurate therapeutic proceeding.
Asunto(s)
Endoscopía Capsular , Colonografía Tomográfica Computarizada , Enfermedades Inflamatorias del Intestino/diagnóstico por imagen , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Algoritmos , Colitis Ulcerosa/diagnóstico por imagen , Colitis Ulcerosa/patología , Enfermedad de Crohn/diagnóstico por imagen , Enfermedad de Crohn/patología , Endoscopía del Sistema Digestivo , Humanos , Enfermedades Inflamatorias del Intestino/patología , UltrasonografíaRESUMEN
Acute pancreatitis is an illness of unpredictable course and in order to implement optimal treatment requires quick assessment of its probable severity and course. The development of prognostic systems was caused to determine patients of high risk of severe course of the illness, that require intensive care and proper treatment. This is the reason of development of prognostic systems based on clinical criteria, lab results and imaging procedures. Yet, none of them does fulfill all requirements. In the paper author presented and evaluated the clinical usefulness of various methods of predicting the course of pancreatitis in historical view. Although commonly used are multifactor clinical scales, current literature shows changing requirements to any scale evaluating the illness that come from better knowledge of biological mechanisms and technological development. Yet still commonly used are simple and and of practical use in any hospital ward multifactor scale with additional C-reactive protein assessment. Based on these there is high probability of correct assessment the future course of acute pancreatitis within 48 hours. Important element of evaluation of pancreatitis is current level of morphological distortion and pancreatic necrosis with use of computed tomography with contrast used in CTS index. The ultimate outcome of our assesment would be the result of the treatment of acute pancreatitis that is dependant on the skill of predicting the severity of illness course and in the end optimal treatment of the patient
Asunto(s)
Biomarcadores de Tumor , Pancreatitis/diagnóstico , Enfermedad Aguda , Algoritmos , Proteína C-Reactiva/análisis , Indicadores de Salud , Humanos , Pancreatitis/epidemiología , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos XRESUMEN
Endoscopic procedures are considered to be a standard element of diagnosing establishing as well as curative measure undertaken in many illnesses of digestive tract. Common use of such potent tool means higher incidence of complications associated with such procedures. In order to qualify a patient to a proper procedure it is essential to reconsider the probability of complications and possibilities of its prevention. To evaluate the risk of the procedure the character of the possible complication and its frequency should be taken into account. Author presents the general complications which are independent of endoscopic procedure and the group of complications typical for a various kind of endoscopic procedures, which are closely related to the procedure. General complications are associated with preparation for the procedure, infections revealing as a result of the procedure and sedation. Specific complications, which are not related to the scale of the procedure, include perforations and bleedings. They are relatively common and might be dangerous, but unfortunately those complications result from improper qualification and preparation the patient to the procedure. Acute pancreatitis is one of the specific complications connected to ERCP. Because of the fact that the risk of this complication is very high the proper qualification of the patient to the procedure is crucial. Nowadays ERCP procedure is being used only in approved therapeutic procedure. This paper focus on basic enoscopic complications and their occurrence conditions. Special interest is placed upon prevention of various types of complications, especially those that incidence is higher in every day clinical practice.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colonoscopía/efectos adversos , Endoscopía Gastrointestinal/efectos adversos , Perforación del Esófago/etiología , Perforación Intestinal/etiología , Pancreatitis/etiología , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangitis Esclerosante/epidemiología , Colangitis Esclerosante/terapia , Colonoscopía/métodos , Endoscopía Gastrointestinal/métodos , Perforación del Esófago/epidemiología , Perforación del Esófago/prevención & control , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/prevención & control , Humanos , Incidencia , Perforación Intestinal/epidemiología , Perforación Intestinal/prevención & control , Pancreatitis/epidemiología , Pancreatitis/prevención & control , Pancreatitis/terapia , Probabilidad , Factores de Riesgo , Esfinterotomía Endoscópica/efectos adversos , Esfinterotomía Endoscópica/métodosRESUMEN
Endoscopic procedures became the widely accepted standard diagnostic tool used in diagnostics and treatment of gastrointestinal tract diseases. There are complications associated these procedures are quite rare but can be very serious and even life-threatening. The following paper presents the current knowledge about the prevalence, risk factors and the character of these complications. We should distinguish complications connected with the upper GI endoscopy, complications of colonoscopy and complications connected with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincteropapillotomy (ES) procedures.