Peptic Ulcer Disease

Peptička ulkusna bolest karakterizirana je oštećenjem sluznice gornjeg dijela probavnog sustava sa sklonošću stvaranju defekata – ulkusa (hrvatski: čir, vrijed), koji prodiru kroz muskularis mukoze, a nastaju autodigestijom te iste sluznice agresivnim djelovanjem želučanog soka (želučane kiseline i pepsina). Peptički ulkusi mogu nastati na svim dijelovima probavnog trakta gdje postoji aktivnost želučanog soka, poglavito na jednjaku, želucu ili dvanaesniku, a rijetko se mogu naći i u proksimalnom jejunumu te u ileumu u području Meckelova divertikula. Prirodni tijek bolesti kreće se od potpunog zacjeljenja ulkusa i bez liječenja, do razvoja komplikacija sa značajnim morbiditetom i mortalitetom, kao što su krvarenje i perforacija. Najčešći uzroci peptičke ulkusne bolesti su: infekcija bakterijom Helicobacter pylori, konzumiranje nesteroidnih antireumatika (NSAR) i kronični stres. Postoji i niz drugih dobro defi niranih uzroka peptičkih ulkusa koji su znatno rjeđi, ali, s padom prevalencije infekcije H. pylori u razvijenim zemljama, postaju sve uočljiviji. Procijenjena godišnja incidencija peptičkog ulkusa varira između 0,1-0,3% u neinfi ciranoj, do 1% u populaciji infi ciranoj H. pylori. Životna prevalencija ulkusne bolesti također je viša među osobama infi ciranim H. pylori (prosječno 10-20%, prema 5-10% u općoj populaciji). Prvi korak u liječenju ulkusa je otkrivanje postojanja infekcije H. pylori ili uzimanja NSAR. Liječenje započinje eradikacijom infekcije H. pylori u svih infi ciranih osoba. Kamen temeljac terapije svih neinfi ciranih bolesnika je uporaba antisekretornih lijekova, prihvatljiva i kao terapija održavanja u određenih bolesnika. Ako je to moguće, nužno je prekinuti uzimanje svih ulcerogenih lijekova kao što su NSAR i salicilati. Ne postoji potreba za posebnim dijetalnim ograničenjima, bolesnicima se samo preporučuje izbjegavanje hrane koja im uzrokuje dispeptičke smetnje. Tijekom posljednjih dvaju desetljeća, razvojem djelotvornih protusekretornih medikamenata (blokatora H2-receptora i inhibitora protonske pumpe) i eradikacijom infekcije H. pylori, moguće je djelotvorno spriječiti recidiviranje uglavnom većine ulkusa. Operacija je u liječenju ulkusne bolesti danas izuzetno rijetko potrebna – uglavnom samo pri liječenju za život opasnih komplikacija agresivne i uznapredovale bolesti koje nije bilo moguće riješiti primjenom konzervativnih metoda.Peptic ulcer disease is characterised by mucous damage in the upper gastrointestinal tract with tendency to developed defects – ulcers in the gastrointestinal mucosa that extend through the muscularis mucosae, caused by autodigestion of the same mucosa as a function of the acid or peptic activity in gastric juice. Peptic ulcers can develop thought all parts of gastrointestinal tract with gastric juice activity, fi rst of all in oesophagus, stomach and duodenum. Some times they can occur in the proximal jejunum, and in ileum in Meckel’s diverticula’s. The natural history of peptic ulcer ranges from resolution without intervention to the development of complications with the potential for signifi cant morbidity and mortality, such as bleeding and perforation. Peptic ulcer disease is associated with three major etiologic factors: Helicobacter pylori infection, the consumption of nonsteroidal antiinfl ammatory drugs (NSAIDs), and chronic stress. There are also a number of other defi ned mechanisms for peptic ulcer that are much less common but becoming more evident as the prevalence of H. pylori declines in developed countries. Estimates of the annual incidence of peptic ulcer range from 0.1 to 0.3 percent in noninfected population. The ulcer incidence in H. pylori-infected individuals is about 1 percent per year, a rate that is 6 to 10-fold higher than for uninfected subjects. The lifetime prevalence is also higher in H. pylori-positive subjects (approximately 10 to 20 percent compared to 5 to 10 percent in the general population). The fi rst steps in ulcer management are to identify H. pylori infection and users of NSAIDs. Treatment of peptic ulcer begins with the eradication of H. pylori in all infected individuals. Antisecretory therapy is the mainstay of therapy in uninfected patients, and is appropriate for maintenance therapy in selected cases. If is possible, it is essential to withdraw potential offending or contributing agents such as NSAIDs, and salicilates. No fi rm dietary recommendations are necessary; patients should avoid foods that precipitate dyspepsia. Over the last two decades, the development of potent antisecretory agents (H2 blockers and proton pump inhibitors) and the recognition that treatment for H. pylori infection can eliminate most ulcer recurrences. Peptic ulcer disease nowadays only infrequently requires operation. Surgery is still required as the emergency therapy of life-threatening complications of aggressive and advanced disease, not treatable by others conservative methods

The place and role of serologic methods in detecting Helicobacter pylori infection

The aim of the study was to determine the place and role of serologic methods in detecting Helicobacter pylori (H. pylori) infection, on the basis of estimated enzyme-linked immunosorbent assay (ELISA) and complement fixation test (CFT) sensitivity and specificity. A total of 549 patients were included in the study. ELISA and CFT as serologic methods were compared with invasive methods (rapid urease test--CLO test, culture, histology). The sensitivity of serologic methods was above 90%, and their specificity was around 80%. Study results confirmed the value, reliability and usefulness of serologic methods in the detection of H. pylori infection

Urea Breath Test

Infekcija bakterijom Helicobacter pylori (H. pylori) izrazito je česta diljem svijeta. Njom je zaraženo 40- 50% populacije u razvijenim zemljama te čak 80-90% populacije u zemljama u razvoju. Ta gram-negativna bakterija ima presudnu ulogu u razvitku svih vrsta kroničnoga gastritisa, stvara predispoziciju za nastanak gotovo 80% želučanih ulkusa i više od 95% ulkusa na dvanaesniku, a prepoznata je i kao želučani karcinogen I. reda. Razvijene su brojne invazivne i neinvazivne tehnike dijagnosticiranja. Tradicionalno se dijagnostika bazirala na endoskopskom pregledu jednjaka, želuca i dvanaesnika, s biopsijama želučane sluznice, a za potrebe histološke i mikrobiološke dijagnostike (invazivne metode). U traženju jednostavnijeg pristupa razvijene su i brojne neinvazivne dijagnostičke metode za otkrivanje same infekcije i za kontrolu uspjeha eradikacijske terapije. Najpopularniji neinvazivni test je urejni izdisajni test, baziran na otkrivanju oznaćenog ugljičnog dioksida (označenog izotopom ugljika - 13C ili 14C) u uzorku izdahnutog zraka, kao rezultat enzimske ureazne aktivnosti bakterije H. pylori. RazliËite vrste izdisajnih testova uspjeπno su testirane i vrednovane, a njihova je osjetljivost i specifičnost najčešće viša od 95%. Testovi su izbora za neinvazivnu dijagnostiku infekcije H. pylori, kao i za kontrolu uspjeha eradikacijske terapije.Infection with Helicobacter pylori (H. pylori) is very common throughout the world, occurring in 40-50% of the population in developed countries and 80-90% of the population in developing regions. This Gram-negative bacterium plays a decisive role in the development of all kind of chronic gastritis, predisposes to almost 80% of gastric and over 95% of duodenal ulcers, and has been recognised as a class I gastric carcinogen. Several techniques, both invasive and noninvasive, have been developed to diagnose H. pylori infection. The diagnosis has been traditionally based on endoscopy with biopsies of the gastric mucosa for histology and culture (invasive technique). In search for less intrusive methods, various non-invasive H pylori testing have been developed, both for diagnostic investigation, and for therapeutic monitoring after eradication therapy. The most popular non-invasive test is urea breath test (UBT), based on the detection of labelled carbon dioxide (labelled with carbon-13 or carbon-14) in expired air as a result of H pylori urease activity. Numerous variations of the UBT have been successfully tested and validated, with a sensitivity and specificity of over 95%. It is the non-invasive test of choice for diagnosing active H. pylori infection as well as for confirming eradication after treatment

The Place and Role of Serologic Methods in Detecting Helicobacter Pylori Infection

The aim of the study was to determine the place and role of serologic methods in detecting Helicobacter pylori (H. pylori) infection, on the basis of estimated enzyme-linked immunosorbent assay (ELISA) and complement fixation test (CFT) sensitivity and specificity. A total of 549 patients were included in the study. ELISA and CFT as serologic methods were compared with invasive methods (rapid urease test – CLO test, culture, histology). The sensitivity of serologic methods was above 90%, and their specificity was around 80%. Study results confirmed the value, reliability and usefulness of serologic methods in the detection of H. pylori infection

Urea Breath Test

Infekcija bakterijom Helicobacter pylori (H. pylori) izrazito je česta diljem svijeta. Njom je zaraženo 40- 50% populacije u razvijenim zemljama te čak 80-90% populacije u zemljama u razvoju. Ta gram-negativna bakterija ima presudnu ulogu u razvitku svih vrsta kroničnoga gastritisa, stvara predispoziciju za nastanak gotovo 80% želučanih ulkusa i više od 95% ulkusa na dvanaesniku, a prepoznata je i kao želučani karcinogen I. reda. Razvijene su brojne invazivne i neinvazivne tehnike dijagnosticiranja. Tradicionalno se dijagnostika bazirala na endoskopskom pregledu jednjaka, želuca i dvanaesnika, s biopsijama želučane sluznice, a za potrebe histološke i mikrobiološke dijagnostike (invazivne metode). U traženju jednostavnijeg pristupa razvijene su i brojne neinvazivne dijagnostičke metode za otkrivanje same infekcije i za kontrolu uspjeha eradikacijske terapije. Najpopularniji neinvazivni test je urejni izdisajni test, baziran na otkrivanju oznaćenog ugljičnog dioksida (označenog izotopom ugljika - 13C ili 14C) u uzorku izdahnutog zraka, kao rezultat enzimske ureazne aktivnosti bakterije H. pylori. RazliËite vrste izdisajnih testova uspjeπno su testirane i vrednovane, a njihova je osjetljivost i specifičnost najčešće viša od 95%. Testovi su izbora za neinvazivnu dijagnostiku infekcije H. pylori, kao i za kontrolu uspjeha eradikacijske terapije.Infection with Helicobacter pylori (H. pylori) is very common throughout the world, occurring in 40-50% of the population in developed countries and 80-90% of the population in developing regions. This Gram-negative bacterium plays a decisive role in the development of all kind of chronic gastritis, predisposes to almost 80% of gastric and over 95% of duodenal ulcers, and has been recognised as a class I gastric carcinogen. Several techniques, both invasive and noninvasive, have been developed to diagnose H. pylori infection. The diagnosis has been traditionally based on endoscopy with biopsies of the gastric mucosa for histology and culture (invasive technique). In search for less intrusive methods, various non-invasive H pylori testing have been developed, both for diagnostic investigation, and for therapeutic monitoring after eradication therapy. The most popular non-invasive test is urea breath test (UBT), based on the detection of labelled carbon dioxide (labelled with carbon-13 or carbon-14) in expired air as a result of H pylori urease activity. Numerous variations of the UBT have been successfully tested and validated, with a sensitivity and specificity of over 95%. It is the non-invasive test of choice for diagnosing active H. pylori infection as well as for confirming eradication after treatment

Detection of virulence gene belonging to cag pathogenicity island in Helicobacter pylori isolates after multiple unsuccessful eradication therapy in Northwest Croatia

Background: Some of the genes belonging to cag pathogenicity island (cagPAI) in Helicobacter pylori were found to be associated with an increased severity of gastric mucosal inflammation that might lead to the development of gastroduodenal disease. Aim: The aim of our study was to define a group of patients based on the frequency of virulence genes of cagPAI island and comparison with pathohistological alterations of gastric mucosa who need to be subjected to further eradication therapy after previous unsuccessful eradication therapy and in spite of benign endoscopic findings. Material and methods: In total 103 H. pylori isolates were analysed. Genes encoding virulence factors were detected by PCR with primers for 10 loci in cagPAI: Apcag (cagA promotor region), cagA1, cagA2, cagA3, cagM, cagT, cagE, LEC, tnpA and tnpB. The patients who provided isolates were classified into three clinical categories: non-ulcer dyspepsia (n=69), erosio/ulcus ventriculi (n=22) and erosio/ulcus duodeni (n=12). Results: 16 strains (15.5%) were negative for all tested genes. 87 (84.5%) of the isolates had parcially deleated cagPAI. None of the isolates possessed all 10 genes. The frequency of single cagPAI genes were as follows: Apcag 63.1%, cagA1 71.8%, cagA2 69.9%, cagA3 5.8%, cagM 71.8%, cagE 75,7%, cagT 68%, tnpA 9.7%, tnpB 7.8% i LEC 48.5%. No statistically significant difference was observed between the presence of any cagPAI genes and endosopic diagnosis (p>0.16). The presence of CagA2, Apcag and cagM showed statistically significant correlation with higher level of patohistological parameters of gastritis (p<0.05). Conclusions: H. pylori isolates with positive cagA, Apcag and cagM genes are correlated to higher degree of patohistological lesions of gastric mucosa; without statistically significant correlation with endoscopic diagnosis

The Influence of the Different Morphological Changes on Gastric Mucosa on Somatostatin Cell Number in Antrum Mucosa and Serum Somatostatin

The aim of our paper was to investigate the influence of the different morphological changes on gastric mucosa on somatostatin D-cell number in antral mucosa and serum Somatostatin. We analyzed according to Sydney classification to what extent the severity of gastritis affect the observed hormonal values. somatostatin D-cell number in antral mucosa and serum Somatostatin values were compared between three grups of patients; mild, moderate and severe cronic gastritis. The average number of somatostatin cell in biopsy sample of antrum mucosa was 30.41±35.38 (N=17) in the case of middle form, 18.69±26.65 (N=56) in moderate and in severe case of chronic gastritis 5.23±5.93 (N=7) cells in mm² of mucosa. The level of somatostatin in the serum of middle form gastritis were 26.43±28.76, moderate 19.95±35.93 and severe 17.88±17.66 pg/mL. In order to determine the number of somatostatin cells in antrum mucosa and serum somatostatin with present morphological changes of mucosa, it might helpful to exclude the patients with non-ulcer dyspepsia, but with the higher risk of premalignant and malignant changes

Importance of early detection of colorectal cancer

SAŽETAK. Tijekom posljednjih dvadesetak godina zabilježen je značajan porast učestalosti i smrtnosti od kolorektalnog karcinoma. Unatoč stručnom i znanstvenom napretku medicine, nije se bitno promijenila činjenica da bolesnici žive dulje od pet godina. Spoznaja da je adekvatnom organizacijom zdravstvene skrbi i prevencijom moguće umanjiti ove poražavajuće podatke, potaknula je pokretanje nacionalnih programa s ciljem ranog otkrivanja karcinoma debelog crijeva. Nova saznanja na području dijagnostike i endoskopije omogućuju brže i sigurnije postavljanje dijagnoze. Osnovu liječenja čini kirurško liječenje poduprto stalnim tehničkim napretkom, a dodatnu i ne manje bitnu ulogu ima nova i sve učinkovitija kemoterapija i radioterapija. Navedene metode i saznanja ukazuju na mogućnost izlječenja sve većeg broja bolesnika i uspjeh u borbi protiv karcinoma debelog crijeva.ABSTRACT. A significant increase in the incidence and mortality of colorectal cancer has been detected during the last twenty years. Despite the progress in medical practice and science there has been no indicative change in the 5-year survival of patients. The knowledge that an adequate health care organization and prevention can decrease these defeating data, prompted the start of national programs for early detection of colorectal cancer. New cognitions in the fields of diagnostics and endoscopy make diagnosis faster and more accurate. Surgical therapy, which is supported by constant technical progress, represents the basis of cancer treatment, while the new and more effective chemotherapy and radiotherapy have an additional and important therapeutical role. The above mentioned methods and knowledge indicate that there is a possibilty in curing a large number of patients and succeeding in the struggle against colorectal cancer

The Influence of the Different Morphological Changes on Gastric Mucosa on Somatostatin Cell Number in Antrum Mucosa and Serum Somatostatin

The aim of our paper was to investigate the influence of the different morphological changes on gastric mucosa on somatostatin D-cell number in antral mucosa and serum Somatostatin. We analyzed according to Sydney classification to what extent the severity of gastritis affect the observed hormonal values. somatostatin D-cell number in antral mucosa and serum Somatostatin values were compared between three grups of patients; mild, moderate and severe cronic gastritis. The average number of somatostatin cell in biopsy sample of antrum mucosa was 30.41±35.38 (N=17) in the case of middle form, 18.69±26.65 (N=56) in moderate and in severe case of chronic gastritis 5.23±5.93 (N=7) cells in mm² of mucosa. The level of somatostatin in the serum of middle form gastritis were 26.43±28.76, moderate 19.95±35.93 and severe 17.88±17.66 pg/mL. In order to determine the number of somatostatin cells in antrum mucosa and serum somatostatin with present morphological changes of mucosa, it might helpful to exclude the patients with non-ulcer dyspepsia, but with the higher risk of premalignant and malignant changes

CROATIAN GUIDELINES FOR GASTRIC CANCER PREVENTION BY ERADICATION OF HELICOBACTER PYLORI INFECTION

Želučani je rak četvrti po učestalosti karcinom u svijetu i drugi po učestalosti uzrok mortaliteta izazvanog malignim bolestima. Iako je etiologija tog karcinoma multifaktorska, infekcija Helicobacterom pyloriizrazito je povezana sa želučanom karcinogenezom. Na karcinogenezu utječu i neki čimbenici okoliša, kao i genska raznolikost, koji mogu dovesti do različitih upalnih odgovora te time utjecati na klinički ishod bolesti. Kronični gastritis izazvan infekcijom Helicobacterom pylori najjači je poznati čimbenik rizika od razvoja adenokarcinoma distalnog dijela želuca premda učinak bakterijske eradikacije na samu karcinogenezu ostaje zasad nedovoljno istražen. Iako se čini da eradikacija infekcije Helicobacterom pylori smanjuje rizik od nastanka želučanog karcinoma, više novijih terapijskih pokušaja prevencije nastanka tog tumora eradikacijom infekcijeHelicobacterom pylori postiglo je razočaravajuće rezultate. U pokušaju razjašnjenja tog problema u populacijama s visokim rizikom istraživači su započeli provoditi prospektivne randomizirane, dvostruko slijepe populacijske studije. Rezultati prethodnih studija upozorili su na važnost dugotrajnog i pomnog praćenja bolesnika nakon provedene eradikacijske terapije. Čini se da je eradikacija infekcije u svrhu prevencije želučanog karcinoma djelotvorna samo onda kada se provede prije razvoja premalignih promjena/lezija: atrofije, metaplazije i displazije želučane sluznice. Osim toga, značajna učinkovitost izlječenja uočena u mlađih bolesnika sugerira potrebu provođenja eradikacije infekcije Helicobacterom pylori što je moguće ranije.Gastric cancer is the fourth most common type of cancer and the second leading cause of cancer-related death in the world. Although gastric cancer has a multifactorial etiology, infection with Helicobacter pyloriis highly associated with gastric carcinogenesis. Carcinogenesis is also influenced by some environmental factors and host genetic diversity, which engenders differential host inflammatory responses that can influence clinical outcome. Chronic gastritis induced by H. pylori is the strongest known risk factor for adenocarcinoma of the distal stomach, but the effects of bacterial eradication on carcinogenesis have remained unclear up to now. Although eradication of H. pylori infection appears to reduce the risk of gastric cancer, several recent controlled interventional trials by H. pylori eradication to prevent gastric cancer have yielded disappointing results. To clarify this problem in a high-risk population, the investigators conducted a prospective, randomized, double-blind, placebo-controlled, population-based studies. The results of previous studies highlight the importance of longer and careful follow-up after eradication therapy. It seems that eradication treatment is effective in preventing gastric cancer if it is given before preneoplastic conditions/lesions, gastric atrophy, metaplasia, and dysplasia, have had time to develop. Furthermore, the significant efficacy of treatment observed in younger patients suggests the need to eradicate H. pylori as early as possible. This consensus aimed to propose guidelines for the diagnosis, management and control of individuals with chronic gastritis, atrophy, intestinal metaplasia, or dysplasia