Mucosal pattern of the upper gastrointestinal tract viewed by magnification Endoscopy in combination with narrow-band imaging

The introduction of white light endoscopy has improved dramatically the management of gastrointestinal tract disorders. Tissue sampling, however, is mandatory for accurate diagnosis, especially if dysplasia, cancer or H. pylori infection is suspected. It is also associated with high missing rates due to the uneven distribution of the mentioned pathology. Chromoendoscopy has proven to be superior to standard white light for detecting of lesions but requires different dyes and a long learning curve. On the other hand, narrow band imaging in combination with magnification endoscopy shortens the procedure time, allows close observation of the mucosal surface gaining excellent real-time images, and guides the endoscopist for target biopsies of suspected areas. This review will briefly cover the current knowledge of high quality endoscopy of the upper gastrointestinal tract

Management of hepatocellular carcinoma: a study on 240 patients in a single referral center

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death globally. Our study aimed to provide an understanding of the risk factors, pattern and management of HCC in a real-life practice.Materials and Methods: Two hundred and forty consecutive patients with HCC were evaluated for an 11-year period (from 2006 to 2016). During the last 5 years the patients were followed up prospectively from the time of the diagnosis to their death. Results: A hundred and seventy-two males and 68 females (mean age 66.4 ± 10.3 and 62.4 ± 9.5 years, respectively) were included in the observation. Hepatitis B virus (HBV) infection accounted for 40.4% and hepatitis C virus (HCV) infection - for 25.8% of the aetiology of liver disease. Cirrhosis is a baseline condition in 82%. HCC was found to be a first complication of liver disease in 2/3 of the studied patients. Using Barcelona Clinic Liver Cancer staging system HCC can be categorised as: stage 0 (n=3); stage A (n=32); stage B (n=52); stage C (n=75) and stage D (n=103). Therefore, the prevalence of very early and early HCC was 13%. Radical therapy (resection or ablation) was recommended in 28% of the patients. Importantly, 18 of 55 (32.7%) patients after surgical resection were followed for more than 3 years without tumour relapse. The median survival, based on the main treatment was: 36 months after surgical resection; 24 months after ablation; 10.5 months for patients on Sorafenib; 9.5 months after TACE and only 3 months for palliative care. Conclusion: Our study confirms the observed trends in underlying diseases, the heterogeneity of survival and underscores the need of early diagnosis of HCC

Clinical importance of microsatellite instability and promoter methylation of DNA in colorectal cancer // Клинично значение на микросателитната нестабилност и промоторното метилиране на ДНК при колоректален карцином

[EN] The study included 189 patients with colorectal cancer (CRC), of them 98 Bulgarian and 81 German. Data regarding familial history for cancer, tumor location along the colon, histology and stage according to TNM classification were gathered. Post-operative 5-year survival and type of adjuvant chemotherapy were assessed in 82 patients. The following methods were used: questionnaire, colonoscopy, immunostaining of hMLHl and CDKN2A(pl6INK), microsatellite instability analysis (MSI) and quantitative analysis of promoter methylation of the genes hMLHl, pl6INK, TIMP3 and TPEF/HPP1 by pyrosequencing. According to our results CRC is classified as sporadic in 77 percent of the cases, familial in 22 percent and hereditary in 1 percent. Incidence of MSI was 15 percent, while hMLHl, pl6INK, TIMP3 e TPEF/HPP1 were methylated in 21.6 percent, 44.4 percent, 49 percent and 84.7 percent, respectively. DNA methylation represents a quantitative process since pyrosequencing revealed that low methylation levels (below 26 percent for hMLHl and below 18 percent for pl6INK) were insufficient for complete gene inhibition. MSI was associated with age of patients, low differentiated tumor, mucin production and lymphocyte infiltration. CIMP-phenotype was associated with advanced age, proximal location, low level of differentiation and bowel wall infiltration. Shorter survival was observed in tumors with methylated hMLHl, CIMP-phenotype and mucin production. Adjuvant chemotherapy was more effective in patients with absence of MSI. The latter elevated the risk for metachronous CRC.[BG] Проучват се проспективно 189 пациента с колоректален карцином (КРК), от които 98 българи и 81 германци. Събрани са данни относно фамилната обремененост с карцином, локализацията на КРК по хода на дебелото черво, хистологията и стадия по TNM класификацията. При 82 пациенти е проследена 5 г. преживяемост и вида на адювантна химиотерапия. Използвани са следните методи: анкетен метод, фиброколоноскопия, имунохистохимия на гените hMLH и CDKN2A (pl6), екстракция на ДНК, анализ на микросателитна нестабилност (МСН) и количествено изследване на промоторното метилиране на гените hMLH, pie, TIMP3 и TPEF/ НРР1 чрез пиросеквениране. Според резултатите в 77 процента от случаите КРК е спорадичен, в 22 процента -фамилен и в 1 процента - наследствен. Честотата на МСН е 15 процента , a hMLHl, pie, TIMP3 и TPEF/HPP1 са метилирани съответно в 21,6 процента , 44,4 процента , 49 процента и 84,7 процента . ДНК метилирането представлява количествен процес: чрез пиросеквенирането се установи, че ниски нива (за hMLH - под 26 процента , а за pie - под 18 процента ) не са в състояние напълно да потиснат генната функция. МСН се асоциира с възрастта на пациентите, с тумори с ниска степен на диференциация, продукция на муцин и лимфоцитна реакция. CIMP-фенотипът се асоциира с напреднала възраст, проксимална локализация, ниска степен на диференциация и инфилтрация в чревната стена. По-ниска преживяемост е налице при туморите с метилиран hMLH, CIMP-фенотип и секреция на муцин. Адювантната химиотерапия е по-ефектива при пациентите без МСН. Последната повишава риска за поява на метахронен КРК

CARDIAC GASTRIC CANCER IN A PATIENT WITH A BLADDER NEOPLASM: CASE REPORT

Introduction: The incidence of cardiac gastric cancer is increasing with a general tendency of reducing the severity of gastric cancer in the world. The risk factors for cancers of the cardia are also different; the role of genetic factors of Barrett`s esophagus and smoking is being discussed, while Helicobacter pylori infection is established as not being a carcinogen.Materials and Methods: The aim of this report is to present a case of synchronous development of gastric adenocarcinoma and transitional cell carcinoma of the bladder.Results: A 71-year-old man was admitted at the Department of Gastroenterology with complaints of progressive loss of appetite and asthenoadynamia, abdominal pain in the left hypochondrium and postprandial epigastric fullness. Recently, the condition has started to present also with dysphagia to solids and quickly after that to liquid foods. The patient has a history of Barrett`s esophagus and moderately differentiated papillary transitional cell carcinoma of the bladder (T1N1M0, G2), managed with surgery and 2 courses of chemotherapy in the summer of 2016. Laboratory tests showed hypochromic microcytic anemia (Hb 108 g/l), a tendency to thrombocytosis and elevated CA 19-9 (4x the upper limit of normal). An abdominal ultrasonography found: gastric wall (high part of the stomach body) - 6 mm, rough and focal bladder wall thickening with polypoid masses. Contrast-enhanced ultrasonography and computed tomography didn`t register liver metastases. During the upper endoscopy a carcinoma of the gastroesophageal junction was established: infiltration near the Z-line of a tumor formation, which causes incomplete obturation, and in retroflexed view was seen an oval tumor formation in cardia, histologically confirmed as highly to moderately differentiated adenocarcinoma. Following a decision of an Oncology Commission, the patient was referred for surgical treatment.Conclusion: We analyzed the current recommendations for the behavior of cardia carcinoma of the stomach and the gastroesophageal junction and the mechanisms for synchronous development of gastric adenocarcinoma and transitional cell carcinoma of the bladder

ROLE AND IMPORTANCE OF MICROBIOLOGY TESTING IN THE DIAGNOSIS AND TREATMENT OF HELICOBACTER PYLORI INFECTION.

Background: Unsuccessful treatment of H. pylori (HP) infection is constantly rising. Antibiotic susceptibility testing and selection of individualized therapy are expected to improve eradication of HP. Aim: To assess the diagnostic accuracy of microbiology testing for HP and to assess the effectiveness of culture-guided susceptibility tested antibiotic therapy. Materials and methods: A total of 62 HP infected patients, 35 with unsuccessful eradication and 27 treatment naive were subjected to culture testing and 3 endoscopy-based methods. In isolated НР colonies strain susceptibility and resistance were determined by disc-diffusion method. A triple therapy in the naïve group and quadruple in the unsuccessfully treated group was applied. The effectiveness of eradication was evaluated after 2 months by stool antigen test and/or urea breath test. Fisher’s exact test for comparison of therapeutic efficacy was used. Results: НР colonies were isolated in 13 patients - 9 naïve and 4 unsuccessfully treated. Higher sensibility (100%) was shown towards UBT and high specificity between 95% - 100% compared to other methods. Its accuracy was 91.9%. In all patients with proven resistance culture-guided eradication was successful. Conclusions: Microbiology and antibiotic susceptibility testing allows optimal diagnosis and therapy of HP infection

Immune-Based Therapies and the Role of Microsatellite Instability in Pancreatic Cancer

Pancreatic cancer is one of the most aggressive malignancies with limited treatment options thus resulting in high morbidity and mortality. Among all cancers, with a five-year survival rates of only 2–9%, pancreatic cancer holds the worst prognostic outcome for patients. To improve the overall survival, an earlier diagnosis and stratification of cancer patients for personalized treatment options are urgent needs. A minority of pancreatic cancers belong to the spectrum of Lynch syndrome-associated cancers and are characterized by microsatellite instability (MSI). MSI is a consequence of defective mismatch repair protein functions and it has been well characterized in other gastrointestinal tumors such as colorectal and gastric cancer. In the latter, high levels of MSI are linked to a better prognosis and to an increased benefit to immune-based therapies. Therefore, the same therapies could offer an opportunity of treatment for pancreatic cancer patients with MSI. In this review, we summarize the current knowledge about immune-based therapies and MSI in pancreatic cancer

Circulating miR-618 Has Prognostic Significance in Patients with Metastatic Colon Cancer

The present study evaluated the prognostic role of circulating miRNA-618 in patients with metastatic colon cancer (mCC) and whether miR-618 gene rs2682818 single nucleotide polymorphisms (SNP) are associated with colon cancer susceptibility and expression levels of mature miR-618. In total, 104 patients with mCC before starting the chemotherapy were investigated. The expression status of circulating miR-618 in mCC was evaluated by quantitative PCR. TaqMan PCR assay was used for rs2682818 SNP genotyping. miR-618 was overexpressed in serum of mCC patients. Patients with high and intermediate expression of miR-618 had a significantly longer mean overall survival (OS) of 21 months than patients with low expression—16 months. In addition, multivariate Cox regression analysis confirmed the association between high/intermediate levels of miRNA-618 and longer OS, HR = 0.51, 95% CI: 0.30–0.86, p = 0.012. miR-618 rs2682818 SNP significantly decreased the risk of colon cancer susceptibility in both heterozygous codominant (AC vs. CC, OR = 0.39, 95% CI: 0.17–0.88, p = 0.024) and overdominant (AC vs. CC + AA, OR = 0.37, 95% CI: 0.16–0.85, p = 0.018) genetic models. Our data suggest that circulating miRNA-618 could be useful as a prognostic biomarker in mCC. Patients harboring AC rs2682818 genotype have a decreased risk for colon cancer in comparison with patients with CC and AA genotypes