Nevarikozinio kraujavimo iš viršutinės virškinimo trakto dalies gydymo rekomendacijos

Laimas Jonaitis, Kęstutis Adamonis, Jonas Valantinas, Juozas Stanaitis, Limas Kupčinskas Nevarikozinis kraujavimas iš viršutinės virškinimo trakto dalies yra dažna ir gyvybei grėsminga būklė, kurios diagnostikai ir gydymui reikia turėti žinių ir patirties. Šios patologijos diagnostika ir gydymas labai svarbus skubiosios pagalbos, intensyviosios terapijos skyrių gydytojų, endoskopuotojų, gastroenterologų ir chirurgų kasdieniame darbe. Straipsnyje pateikiamos Lietuvos gastroenterologų draugijos ekspertų posėdyje apsvarstytos tarptautiniu mastu priimtos rekomendacijos, stengiantis jas pritaikyti prie Lietuvos medicinos įstaigų situacijos. Recommendations for managing patients with nonvariceal gastrointestinal bleeding Laimas Jonaitis, Kęstutis Adamonis, Jonas Valantinas, Juozas Stanaitis, Limas Kupčinskas Nevarikozinis kraujavimas iš viršutinės virškinimo trakto dalies yra dažna ir gyvybei grėsminga būklė, kurios diagnostikai ir gydymui reikia turėti žinių ir patirties. Šios patologijos diagnostika ir gydymas labai svarbus skubiosios pagalbos, intensyviosios terapijos skyrių gydytojų, endoskopuotojų, gastroenterologų ir chirurgų kasdieniame darbe. Straipsnyje pateikiamos Lietuvos gastroenterologų draugijos ekspertų posėdyje apsvarstytos tarptautiniu mastu priimtos rekomendacijos, stengiantis jas pritaikyti prie Lietuvos medicinos įstaigų situacijos

Genotype Distribution and Characteristics of Chronic Hepatitis C Infection in Estonia, Latvia, Lithuania, and Ukraine : The RESPOND-C Study

Publisher Copyright: © 2023 by the authors.Background and objectives: Since 2013, highly effective direct-acting antiviral (DAA) treatment for chronic hepatitis C (CHC) has become available, with cure rates exceeding 95%. For the choice of optimal CHC treatment, an assessment of the hepatitis C virus (HCV) genotype (GT) and liver fibrosis stage is necessary. Information about the distribution of these parameters among CHC patients in Estonia, Latvia, and Lithuania (the Baltic states) and especially in Ukraine is scarce. This study was performed to obtain epidemiologic data regarding CHC GT and fibrosis stage distribution for better planning of resources and prioritization of patients for DAA drug treatment according to disease severity in high-income (the Baltic states) and lower-middle-income (Ukraine) countries. Materials and methods: The retrospective RESPOND-C study included 1451 CHC patients. Demographic and disease information was collected from medical charts for each patient. Results: The most common suspected mode of viral transmission was blood transfusions (17.8%), followed by intravenous substance use (15.7%); however, in 50.9% of patients, the exact mode of transmission was not clarified. In Ukraine (18.4%) and Estonia (26%), transmission by intravenous substance use was higher than in Lithuania (5%) and Latvia (5.3%). Distribution of HCV GT among patients with CHC was as follows: GT1—66.4%; GT3—28.1; and GT2—4.1%. The prevalence of GT1 was the highest in Latvia (84%) and the lowest in Ukraine (63%, p < 0.001). Liver fibrosis stages were distributed as follows: F0—12.2%, F1—26.3%, F2—23.5%, F3—17.1%, and F4—20.9%. Cirrhosis (F4) was more prevalent in Lithuanian patients (30.1%) than in Estonians (8.1%, p < 0.001). Conclusions: This study contributes to the knowledge of epidemiologic characteristics of HCV infection in the Baltic states and Ukraine. The data regarding the patterns of HCV GT and fibrosis stage distribution will be helpful for the development of national strategies to control HCV infection in the era of DAA therapy.Peer reviewe

Once versus three times daily dosing of oral budesonide for active Crohn's disease : A double-blind, double-dummy, randomised trial

Note: J.Pokrotnieks is in the list of the main authors of the article, as well as in the list of International Budenofalk Study Group collaboration list. His surname is made visible as the main author in this bibliographic record. Funding Information: The study was funded by Dr Falk Pharma GmbH, Freiburg, Germany . The study sponsor contributed to the design of the study in collaboration with the authors, funded the analysis of the data by an independent biostatistics company, worked in conjunction with the authors to interpret the data, and reviewed the draft manuscript. The sponsor was not involved in data collection. The final decision to publish was made by the first author (AD).Background: Oral budesonide 9. mg/day represents first-line treatment of mild-to-moderately active ileocolonic Crohn's disease. However, there is no precise recommendation for budesonide dosing due to lack of comparative data. A once-daily (OD) 9. mg dose may improve adherence and thereby efficacy. Methods: An eight-week, double-blind, double-dummy randomised trial compared budesonide 9. mg OD versus 3. mg three-times daily (TID) in patients with mild-to-moderately active ileocolonic Crohn's disease. Primary endpoint was clinical remission defined as CDAI < 150 at week 8 (last observation carried forward). Results: The final intent-to-treat population comprised 471 patients (238 [9 mg OD], 233 [3 mg TID]). The confirmatory population for the primary endpoint analysis was the interim per protocol population (n = 377; 188 [9 mg OD], 189 [3 mg TID]), in which the primary endpoint was statistically non-inferior with budesonide 9. mg OD versus 3. mg TID. Clinical remission was achieved in 71.3% versus 75.1%, a difference of - 3.9% (95% CI [- 14.6%; 6.4%]; p = 0.020 for non-inferiority). The mean (SD) time to remission was 21.9 (13.8) days versus 21.4 (14.6) days with budesonide 9 mg OD versus 3. mg TID, respectively. In a subpopulation of 122 patients with baseline SES-CD ulcer score ≥ 1, complete mucosal healing occurred in 32.8% (21/64) on 9 mg OD and 41.4% (24/58) on 3 mg TID; deep remission (mucosal healing and clinical remission) was observed in 26.6% (17/64) and 32.8% (19/58) of patients, respectively. Treatment-emergent suspected adverse drug reactions were reported in 4.6% of 9 mg OD and 4.7% of 3 mg TID patients. Conclusions: Budesonide at the recommended dose of 9 mg/day can be administered OD without impaired efficacy and safety compared to 3 mg TID dosing in mild-to-moderately active Crohn's disease.publishersversionPeer reviewe

Etiology and Outcome of Adult and Pediatric Acute Liver Failure in Europe

Acute liver failure (ALF) is rare but life-threatening. Common causes include intoxications, infections, and metabolic disorders. Indeterminate etiology is still frequent. No systematic data on incidence, causes, and outcome of ALF across Europe are available. Via an online survey we reached out to European Reference Network Centers on rare liver diseases. Numbers and etiology of ALF cases during 2020 were retrieved and diagnostic and treatment availabilities assessed. In total, 455 cases (306 adult, 149 pediatric) were reported from 36 centers from 20 countries. Intoxication was the most common cause in adult and pediatric care. The number of cases with indeterminate etiology is low. Diagnostic tools and specific treatment options are broadly available within this network. This is the first approach to report on etiology and outcome of ALF in the pediatric and adult population in Europe. High diagnostic yield and standard of care reflects the expert status of involved centers.</p

Diagnostic sensitivity and specificity of laryngoscopic signs of reflux laryngitis

Objective. To assess the diagnostic sensitivity and specificity of the laryngoscopic signs of reflux laryngitis. Material and methods. Using original quantitative evaluation system, the laryngoscopic signs of 108 patients with reflux laryngitis and 90 healthy people were subjected to comparative analysis in this study. Summing up all evaluations of laryngeal changes, laryngoscopic reflux index was proposed. Results. Mucosal lesions and edema of vocal cords along with mucosal lesions of the interarytenoid notch were found to be most significant for diagnostics of reflux laryngitis. Presence of mucosal lesions of the interarytenoid notch (roughness, hypertrophy, keratosis, granuloma) increases the odds ratio to attribute the patient to the reflux laryngitis patient group 21 times (OR=21.32, 95% CI 4.38–103.93; P&lt;0.001). Mucosal lesions (hypertrophy, keratosis, granuloma) and edema of vocal cords were determined as the most sensitive and rather specific laryngoscopic signs. Roughness and grade II hypertrophy of interarytenoid notch were found to be the most specific (98%) and sensitive (56%) laryngoscopic signs of reflux laryngitis. Abnormal values of laryngoscopic reflux index (higher than 5 points) reflect a diagnostic sensitivity of 96% and specificity of 97% differentiating patients with reflux laryngitis from healthy persons. Conclusions. Mucosal lesions and edema of vocal cords along with mucosal lesions of the interarytenoid notch are found to be the most significant laryngoscopic signs for diagnostics of reflux laryngitis. Laryngoscopic reflux index was found to be the most sensitive and specific diagnostic criterion for reflux laryngitis

Erozinį stemplės uždegimą sergantiesiems dvylikapirštės žarnos opalige predisponuoja gastroezofaginio refliukso ligos simptomai, rūkymas ir vyresnis amžius, bet ne Helicobacter pylori išnaikinimas (vienerių metų stebėjimo studija)

It remains unclear whether the Helicobacter pylori eradication may cause or provoke gastroesophageal reflux disease. Therefore, we aimed to elucidate the role of H. pylori eradication and other factors in the development of erosive esophagitis in patients with duodenal ulcer. Materials and methods. We enrolled 183 H. pylori-positive duodenal ulcer patients without erosive esophagitis. Final endoscopy was performed 12 months later or in case if ulcer relapse was suspected. H. pylori was diagnosed by the urease test and histology if the results of at least one of the tests were positive. A total of 142 patients were assigned to the eradication treatment. The control group included 41 volunteers – 20-mg omeprazole b.i.d. for 4 weeks was administered. Results. A total of 150 patients completed the study. Of the 119 patients, 70 (58.8%) were cured from H. pylori, and in 49 (41.2%) of patients, treatment of H. pylori was unsuccessful. All 31 controls remained H. pylori-positive. At the final endoscopy, erosive esophagitis was found in 19 (12.7%) patients. Erosive esophagitis developed in 8 (11.4%) successfully eradicated patients, in 9 (18.4%) unsuccessfully treated patients, and in 2 (6.5%) controls (P>0.05 comparing the groups). Multivariate logistic regression analysis revealed 3 factors at baseline, which were significant (P<0.05) in predicting the occurrence of erosive esophagitis: age more than 43 years (OR, 4.96; 95% CI, 1.47–16.71), nonerosive gastroesophageal reflux disease (OR, 3.96; 95% CI, 1.34–11.68), and smoking (OR, 3.17; 95% CI, 1.01–9.17). Conclusions. H. pylori eradication did not influence the incidence of erosive esophagitis in patients with duodenal ulcer during a one-year follow-up period. Pre-existing nonerosive gastroesophageal reflux disease, smoking, and older age are important predictors of de novo development of erosive esophagitis

Evaluation of a novel 14C-urea breath test “Heliprobe” in diagnosis of Helicobacter pylori infection

Background. At present, 14C-urea breath test is considered a gold standard for diagnosis of Helicobacter pylori infection, but they are time-consuming, comparably expensive, and usually not portable tests. The aim of our study was to establish the diagnostic value of the novel, inexpensive, quick, and convenient to use 14C-urea breath test “Heliprobe”, Noster AB, Sweden.Material and methods. Helicobacter pylori testing using “Heliprobe” was performed in 108 consecutive patients. Helicobacter pylori was also investigated using rapid urease test and Giemsa stained histological specimens according to Sydney system.Results. The diagnostic values of “Heliprobe” assuming the Helicobacter pylori positivity, if the results of two tests (rapid urease test and histology) are positive, were: sensitivity – 97%, specificity – 87%, positive predictive value – 93%, negative predictive value – 95%, accuracy – 94%. The diagnostic values of “Heliprobe” assuming the Helicobacter pylori positivity, if at least the results of one test are positive: sensitivity – 92%, specificity – 100%, positive predictive value – 100%, negative predictive value – 84%, accuracy – 94%.Conclusions. The novel, quick, convenient to use 14C-urea breath test “Heliprobe” is accurate, reliable, and useful for the diagnosis of Helicobacter pylori infection in routine clinical practic

Gastroesophageal reflux disease after Helicobacter pylori eradication in gastric ulcer patients: A one-year follow-up study

The aim of this study was to evaluate the course of gastroesophageal reflux disease in gastric ulcer patients after successful Helicobacter pylori eradication (group A), in patients with persistent infection after attempt to eradicate Helicobacter pylori (group B), and in control group without Helicobacter pylori eradication treatment (group C). Materials and methods. Gastric ulcer patients (n=88) were assigned either to the group receiving Helicobacter pylori eradication treatment (54 patients) or to the control group (34 patients; omeprazole treatment for 4 weeks) and were followed up for 1-year or until gastric ulcer relapsed. Gastroesophageal reflux disease was diagnosed in patients who had erosive esophagitis and/or without esophagitis if they experienced heartburn and/or regurgitation at least 2 times a week and it was associated with impairment of daily activities (Genval consensus). Results. The study was completed by 69 patients: 25 in group A, 19 in group B, and 25 in group C. At the beginning and at the end of the follow-up, gastroesophageal reflux disease was diagnosed in 10 (40%) and 9 (36%) group A patients, respectively (P&gt;0.05); in 12 (63%) and 8 (42%) group B patients, respectively (P&gt;0.05); and in 9 (36%) and 5 (20%) group C patients, respectively (P&gt;0.05). At the beginning and at the end of the follow-up, reflux esophagitis was found in 3 (12%) and 5 (20%) group A patients, respectively (P&gt;0.05); in 5 (26%) and 5 (26%) group B patients (P&gt;0.05); in 4 (16%) and 3 (12%) group C patients (P&gt;0.05). Conclusion. There was no statistically significant difference regarding the development of gastroesophageal reflux disease in gastric ulcer patients after Helicobacter pylori eradication, in the patients with persistent infection after attempt to eradicate, and in the control group without Helicobacter pylori eradication treatment

Health-related quality of life measurement in chronic liver disease patients

Background and objective: Health-related quality of life (HRQOL) is an important health indicator in medical outcome research and clinical practice. This issue tends to attract even more attention with the recent improvements of patient survival after liver transplan- tation. This review article aims at providing a deeper insight into practices used for evaluating HRQOL in chronic liver diseases (CLDs) and especially cirrhosis patients during different stages of the disease including liver transplantation. Materials and methods: A systematic review of the MEDLINE database and Cochrane library was conducted. A search using the Medical Subject Headings (MeSH) major terms ‘‘liver disease’’ AND ‘‘quality of life’’ was applied for the period from 1966 to 2012. Results: Our review identified 1483 publications. The searched showed that significant increase of publications (from 362 to 1018) was observed during last decade (period 2003–2012) in comparison with previous. The majority of publications were in English (n = 1179). The literature search and analysis provided information on the most common generic and disease-specific HRQOL instruments, which are used in CLD patients: Medical Outcomes Study Short Form-36, the National Institute of Diabetes and Digestive and Kidney Diseases Quality of Life questionnaire, the Chronic Liver Disease questionnaire, the Liver Disease Quality of Life questionnaire, and other. Conclusions: Quality of life instruments are potentially powerful tools for evaluating the functional status, presenting gains of treatment and reflecting patients' ability to return to a normal lifestyle in CLD patients. More attention should be paid by clinicians for integrated use of clinical tests together with HRQOL instruments in liver transplantation for establish- ing the reference levels of mental, physical, and role-social functioning