Analysis of the grade of esophagitis, chromendoscopical and histological findings of esophagus in patients with gastroesophageal reflux disease before and after the therapy

Background/Aim. The symptoms of gastroesophageal reflux desease (GERD) are among the most common complaints for which patients are indicated for visiting gastroenterologist. It occurs as a result of the effect made by gastric reflux contents that moves into the esophagus. The prevalence of all forms of GERD is 40%. The aim of this study was to analyze the grade of esophagitis, chromendoscopical and histological findings of esophagus in patients with GERD before and after the therapy. Methods. A prospective study included 90 patients with symptoms of GERD, divided into 2 groups depending on whether they had endoscopic signs of gastroezophageal reflux (group ERD), or not (group NERD). All the patients had esophagogastroduodenoscopy, chromoendoscopy staining, test for Helicobacter pylori and histological findings of the esophagus. In the patients with Helicobacter pylori infection eradication therapy was done. Results. Esophagitis-B level was present in most of the patients. Among the groups, roughly the same number responded to positive findings on chromoendoscopy. After the therapy, chromoendoscopy was significantly negative in both groups of the patients comparing to chromoendoscopy before the therapy (p = 0.00001). Multiplication and elongation of papilla, basal cell hyperplasia, vascular dilatation, increasing of mitotic activity and the presence of polymorphonuclear leukocyte cells were statistically more frequent histological findings in the group ERB compared to the group NERB. After the therapy, the patients in both groups had statistically less histological findings of appropriate esophageal parameters. Conclusion. Chromoendoscopy combined with the standard endoscopy increases the sensitivity and specificity for reflux disease. Histology in the reflux disease is associated with endoscopic and clinical findings so that the localization of taking biopsies and histological criteria of pathohistological changes must be clearly defined. Multiplication and elongation of papilla, basal cell hyperplasia and the presence of polymorphonuclear leukocytes are the most relevant criteria in the diagnosis NERD

IRRITABLE BOWEL SYNDROME, ANXIETY, DEPRESSION AND PERSONALITY CHARACTERISTICS

Background: Numerous studies have suggested that 54%-100% of patients with IBS may have associated psychiatric illness and personality pathology. This transversal controlled study was realized in order to evaluate anxiety and depression levels, as well as the personality characteristics of patients with IBS and to compare the results obtained with patients with episodes of depression and healthy individuals. Subjects and methods: The experimental group consisted of 30 IBS patients, while two control groups consisted of the same number of inpatients with episodes of depression and healthy individuals from the general population. There were equal number of men and women in the study sample and all subjects were aged between 25 to 65 years. Standard psychometric instruments employed included Hamilton anxiety scale, Zung depression scale, Hamilton depression scale, Minnesota Multiphasic Personality Inventory (MMPI), Eysenck Perosonality Inventory (EPI). Results: The average Hamilton and Zung depression scores were significantly higher in patients with depressive episodes compared with the IBS patients, while the mentioned scores among them were also significantly higher compared with the healthy controls. There were no significant differences between IBS and the group with depressive episodes in the average Hamilton anxiety levels, EPI neuroticism and extraversion levels and MMPI neurotic scales levels (Hs, D, and Hy). The significant differences were observed comparing the IBS patients to healthy individuals. Conclusion: The patients suffering from irritable bowel syndrome who asked for medical help (consulters) because of their intestinal symptoms, presented emotional problems such as depression and anxiety and expressed neurotic personality characteristics

FOLLOW-UP OF BIOCHEMICAL PARAMETERS AND INTENSITY OF OXIDATIVE STRESS IN PATIENTS WITH EXTRAHEPATHIC CHOLESTASIS

In cholestasis, due to impossibility of gall flow into duodenum, there occurs a subsequent return of gall constituents to hepatocytes and circulation. Extrahepatic cholestasis is the result of mechanic obstacle of gall flow through ductus hepaticus, choledochus or papilla Vateri, leading to the occurrence of manifest icterus. In cases leading to liver damage, hydrophobic gall salts and non-conjugated bilirubins have the most important toxic effects.The aim of this study was to follow up the biochemical parameters, enzyme activity AST, ALT, *-GT and AF, bilirubin concentration and albumins, and intensity of oxidative stress in blood plasma in patients with different types of extrahepatic cholestasis.The study included 60 subjects divided into two groups. The first one was control group (30 healthy subjects), while II group involved 30 patients with intraluminar extrahepatic obstruction.Significant increase of enzyme activity of AST, ALT, *-GT and AF in plasma of cholestatic patients was present in comparison to the control group (p< 0,001). The levels of total direct and indirect bilirubin in plasma of cholestatic patients increased (p<0,001) when compared to the control group. The level of albumin in plasma of cholestatic patients significantly decreased in comparison to the control group (p<0,05). The intensity of oxidative stress measured through the levels of malondialdehide (MDA) and carbonyl group concentration in plasma of cholestatic patients increased (p<0,001) when compared to the control group.Significant increase of cholestasis enzyme markers (AST, ALT, *-GT and AF) and bilirubin levels in blood plasma was noticed in patients with extrahepatic cholestasis. Cholestasis leads to significant disorders of synthetic function of the liver that are manifested by decrease of albumin concentration in plasma

GIANT COLONIC POLYPS IN PEDIATRIC PATIENT WITH FAMILIAL ADENOMATOUS POLYPOSIS

This article describes a 16-year-old girl with signs of malnutrition, rectal bleeding, hypoalbuminemia and anemia. At the age of 6 months she was operated on for hepatoblastoma. Last two years she has been followed by endocrinologist because of amenorrhea. Her family history was unremarkable. Esophagogastroduodenoscopy revealed multiple small gastric polyps. Colonoscopy showed a few polyps in rectum and hundreds of them  (3-25 mm in diameter) in sigmoid and descending colon. Giant colonic polyps at splenic flexure region prevented further passage of the scope. The diagnosis of FAP was established based on the endoscopy and pathology of colonic polyps removed by snare polypectomy. Extraintestinal manifestations of FAP have not been detected. The patient underwent prophylactic surgery (restorative proctocolectomy). The post-operative course was uneventful. In our knowledge, this is the first report of giant colonic polyps in a pediatric patient suffering from FAP. This clinical syndrome can be presented not only with different genetic backgrounds and diverse clinical pictures but also with intriguing endoscopic findings

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

Background Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH,non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2–F3, or F1 with at least oneaccompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpointsfor the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2–F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1–F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2–F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1–F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes

Endoscopic mucosal resection of colorectal tumors: Our first experience

Background/Aim. Endoscopic mucosal resection (EMR) or mucosectomy is an interventional procedure for minimal invasive endoscopic removal of benign and malignant digestive tract tumors. Mucosectomy removes flat and sessile neoplasms, early colorectal cancer (CRC) confined to mucosa or submucosa and lateral spreading tumors. The aim of the study was to show our first experience in application of this procedure in everyday practice in regarding completeness and efficacy of the procedure, complication rate and incidence of recurrent adenomas. Methods. In the prospective study 51 colorectal adenomas were removed in 44 patients by EMR. Results. Single mucosectomy was done in 43 patients, while multiple (8) in one patient. Complete resection was obtained in all procedures. In 36 (68.62%) procedures „en block“ resection was done, but in 15 (31.37%) procedures „piece meal“ resection was performed. Synchronous colorectal tumors (benign or malignant) were detected in 20 (45.45%) patients. Moderate dysplasia was found in 30 (58.82%) adenomas, but high grade dysplasia in 9 (17.64%) of adenomas. Intramucosal CRC was detected in 11.77% of adenomas. A total of 37 (72.54%) advanced adenomas were removed. There were 3 (5.88%) of recurrent adenomas, 6-30 months after the EMR. Only one (2.2%) case of post procedure bleeding was observed. Conclusion: EMR is a safe and efficious method for removal of flat, sessile adenomas, as well as early CRC. EMR is a routine endoscopic procedure in everyday practice of interventional endoscopist

Observational study in primary health care: Symptoms control of gastroesophageal reflux disease and influence on the quality of life

Introduction. Gastroesophageal reflux disease (GERD) is a common disease in primary care. The most effective medicamentous treatment is proton pump inhibitors (PPI). Objective. Observational study conducted in 13 primary health care centers from the whole Serbia with the aim to collect local epidemiology data on GERD and to investigate the intensity and frequency of disease symptoms and the quality of life of patients treated with proton pump inhibitors by using a Patient’s Questionnaire. Methods. Adult GERD patients treated with PPI were under follow-up for two months. The investigators evaluated typical symptoms and gave global assessment of disease severity. The patients filled-in the Patient’s Questionnaire on disease symptoms and quality of life. At the study end, the investigators evaluated the importance of the Patient’s Questionnaire in the management of these patients. Results. The study included 828 patients (66.3% female) of mean age 54.8 years. The most common life habits were coffee consumption (86.1%), exposure to stress (81.7%), smoking (45.7%) and alcohol consumption (25%). With PPI therapy a statistically significant reduction of typical GERD symptoms of any intensity was detected as evaluated by the investigators (p<0,001), as well as the reduction in the frequency of all symptoms and accompanying discomforts of the quality of life, as estimated by the patients (p<0.001). In 92.2% of the patients the investigators evaluated the Patient’s Questionnaire to be of significant help. Conclusion. Primary health care physicians evaluated the Patient’s Questionnaire as an important tool in the investigation of the disease symptoms and the quality of life of patients with GERD. The intensity and frequency of symptoms were reduced, and the quality of life of patients with GERD was improved by therapy with PPI

Synchronous colorectal adenomas

Introduction Colorectal adenomas which are discovered simultaneously or 6 months after the diagnosis of primary adenoma or colorectal cancer (CRC) are called synchronous adenomas. The presence of synchronous adenomas increases the probability of adenomas with severe dysplasia as well as CRC. Objective The aim of the study is to show the characteristics of synchronous colorectal adenomas and to present the relation between the index rectal adenoma and the proximal synchronous tumours. Methods The research included 114 synchronous colorectal adenomas diagnosed in 58 patients. Total colonoscopy was performed on all patients. Results The largest number of patients had two adenomas (p&lt;0.001). Synchronous adenomas were more often diagnosed in men older than 50 (p&lt;0.001). The largest number of adenomas was localized in the sigma (52 patients, 43.0%) (p&lt;0.001). The biggest number of tumours was localized in the combination of rectum-sigma segments (p&lt;0.001). There were 31 (25.6%) synchronous, that is index tumours of the rectum and 90 (74.4%) the so-called proximal synchronous tumours of the proximal part of the colon. In 33 (56.9%) patients, who did not have the index tumour, the prevalence of proximal synchronous tumours was the highest (57.0%) (p&lt;0.001). Conclusion The probability of adenoma multiplication is higher in men, and it increases with age. Beside the fact that synchronous adenomas are more often found distally, a great probability of finding proximal tumours shows that total colonoscopy is the method of choice for the discovery of colorectal tumours. Complete colonoscopic mapping of all colorectal adenomas and their removal prevents the development of metachronous, overlooked benign CRC already present at the moment of initial diagnostics that could be the cause of the development of metachronous CRC.