Akromegalia może wiązać się z zaburzeniami rozkurczu dolnego zwieracza przełyku (LES)

  Introduction: Although prolonged small intestine and colonic transit time has been demonstrated in acromegaly patients, the influence of acromegaly on oesophagus motility and the pathological mechanisms involved are still not clarified. We aimed to investigate manometric measurements to ascertain whether oesophagus motility is affected in active acromegaly patients. Material and methods: The study was performed in an institutional referral centre at a tertiary care hospital. Twenty-three acromegaly patients (mean age 43.2 ± 13.2 years) and 25 sex- and age-matched healthy control subjects (mean age 48.6 ± 7.9 years) were recruited to a case-control study. Oesophageal manometry was performed using MMS (Medical Measurement Systems, Netherlands) Solar GI — Air Charged Intelligent Gastrointestinal Conventional Manometry. Results: In manometric measurements the lower oesophageal sphincter pressure was 18 ± 7 mmHg in acromegaly patients and 15.6 ± 4.4 mm Hg in controls, and there was no significant difference (p = 0.17). The percentage of relaxation was 64.8% and 81.8%, respectively, and it was significantly lower in acromegaly patients than in controls (p < 0.001). Additionally, the duration of relaxation was found to be 4 ± 1.9 seconds and 5 ± 1.7 seconds in patients and controls, respectively (p = 0.049). Conclusions: Our study has demonstrated a significant reduction in the percentage and duration of lower oesophageal sphincter relaxation in oesophagus motility even in acromegaly patients without any gastrointestinal symptoms. Further clinical and pathophysiological studies are required to clarify the underlying mechanisms of gastrointestinal motility disorders in acromegaly. (Endokrynol Pol 2015; 66 (4): 308–312)    Wstęp: Chociaż u pacjentów chorujących na akromegalię wykazano wydłużony czas pasażu żołądkowo-jelitowego, wpływ akromegalii na motorykę przełyku oraz powiązane z tym mechanizmy patologiczne nadal nie są wyjaśnione. Celem pracy było zbadanie za pomocą pomiarów manometrycznych czy motoryka przełyku ulega zmianie u pacjentów z aktywną akromegalią. Materiał i metody: Badanie przeprowadzono w ośrodku referencyjnym w szpitalu specjalistycznym. Dwudziestu trzech pacjentów chorujących na akromegalię (śr. wiek 43,2 ± 13,2 lat) oraz w grupie kontrolnej 25 osób dopasowanych pod względem płci i wieku (śr. wiek 48,6 ± 7,9 lat) zostało zakwalifikowanych do badania kliniczno-kontrolnego. Manometrię przełyku wykonano za pomocą MMS (Medical Measurement Systems, Holandia) Solar GI. Wyniki: W pomiarach manometrycznych u pacjentów ciepiących na akromegalię, ciśnienie dolnego zwieracza przełyku wynosiło 18 ± 7 mm Hg, a u osób kontrolnych wynosiło ono 15,6 ± 4,4 mm Hg, nie było więc znaczącej różnicy między grupami (p = 0,17). odsetek rozkurczu wynosił odpowiednio 64,8% i 81,8% i był on znacznie niższy u pacjentów z akromegalią (p < 0,001). Ponadto, długość trwania rozkurczu wynosiła odpowiednio 4 ± 1,9 sek. i 5 ± 1,7 sek. (p = 0,049). Wnioski: Niniejsze badanie wykazało znaczną redukcję odsetka i czasu trwania rozkurczu dolnego zwieracza przełyku w motoryce przełyku, nawet u pacjentów z akromegalią bez objawów żołądkowo-jelitowych. Należy przeprowadzić dalsze badania kliniczne i patofizjologiczne, aby wyjaśnić mechanizmy leżące u podłoża zaburzeń motoryki żołądkowo-jelitowej u pacjentów chorujących na akromegalię. (Endokrynol Pol 2015; 66 (4): 308–312)

Gastroenterology Cases of Cutaneous Leukocytoclastic Vasculitis

Rarely, leukocytoclastic vasculitis can result from ischemic colitis, inflammatory bowel disease, and cryoglobulinemia. There is no established standard for the treatment of leukocytoclastic vasculitis associated with gastroenterologic diseases. This paper presents three cases of leukoytoclastic vasculitis, each of which is associated with a different gastroenterologic condition: ischemic colitis, Crohn’s disease, and chronic hepatitis C. Each condition went into remission by treatment of leukocytoclastic vasculitis, regardless of the underlying disease

Wilson's disease

Wilson's disease is an autosomal-recessive disorder caused by mutation in the ATP7B gene. Absent or reduced function of ATP7B protein leads to decreased hepatocellular excretion of copper into bile. Subsequent copper accumulation, first in the liver but ultimately in the brain and other tissues, produces different clinical manifestations such as hepatic, neurological, hematological, ophthalmological, and psychiatric problems. Diagnosis is based on clinical suspicion, parameters of copper metabolism, ophthalmic examination (Kayser-Fleischer rings) and a liver biopsy. Genetic studies are of limited use. Early diagnosis and initiation of therapy with chelators and therapeutic plasma exchange therapy are essential for prognosis. Liver transplantation corrects the underlying pathophysiology and can be lifesaving in fulminant hepatic failure. Screening of siblings and 1st degree relatives of the patients is also important

Measurement of Gallbladder Volume with Ultrasonography in Pregnant Women

Fasting and postprandial gallbladder volumes were investigated using ultrasonography in three groups (10 subjects in each) of healthy women: third trimester pregnant women, postpartum women up to 10 days after giving birth and nonpregnant controls. The scans were performed at 09:00 after a 12 h fast. After the basal measurement was taken, gallbladder volumes were rescanned in 15 min intervals for 60 mins. At the end of this period, all volunteers received a standard liquid test meal, and scans were performed again for 1 h. The mean basal gallbladder volume was 22.2±4.2 mL in the nonpregnant (control) group. In the third trimester group, the basal volume was 37.8±10.5 mL – 70.5% higher than in the nonpregnant group (P<0.001). In the postpartum group, the mean basal volume was 37.9% lower (27.4±6.5 mL) than that of the third trimester group (P<0.02). This basal volume was 23.6% greater than that of the control group (P<0.05). After administration of a test meal, the postprandial gallbladder volumes decreased during the first few minutes compared with baseline values. The volumes decreased by 10.2% to 39.8% (23.5±7.3 to 34.0±10.2; P<0.01) in the third trimester group, by 14.9% to 43.2% (16.6±4.3 to 23.3±5.5; P<0.01, 0.001) in the postpartum group and by 19.2% to 51.6% (11.9±3.5 to 17.9±3.6; P<0.02, 0.05, 0.01, 0.001) in the control group. Postprandial mean gallbladder volumes of the third trimester (P<0.02) and postpartum groups (P<0.02 to 0.01) were significantly different from those of the control group. In conclusion, incomplete emptying of the gallbladder after eating during the third trimester of pregnancy may contribute to cholesterol-gallstone formation, and pregnancy may thus increase the risk of gallstones

The Oesophageal Involvement of Pemphigus Vulgaris Patients and Comparison with Skin Findings

Background and Design: The pemphigus family includes a number of disease which feature intraepidermal blisters with acantholysis. Pemphigus vulgaris(PV) is the most common form of pemphigus, affects the skin and mucous membranes. Although oral mucosa is the most commonly affected site, all stratified squamous epithelium can be involved like pharynx, larynx, oesophagus, conjunctiva, vaginal, penile, and anal mucosa. We planned our study aiming to find frequency of oesophagus involvement in PV patients and to compare them immunohistopathologically with skin findings