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

Argon plasma coagulation and proton pump inhibitors in a female patient with Barrett\u27s esophagus

Opisan je slučaj liječenja Barrettovog jednjaka (BJ) argon plazma koagulacijom (APK), nakon neuspješnog liječenja dvostrukom dozom inhibitora protonske pumpe (IPP) po smjernicama. Dijagnoza je postavljena patohistološki iz bioptičkog uzorka. Nakon dva (04/07, 09/07) tretmana APK-om, došlo je do potpunog oporavka sluznice ezofagogastričnog (EG) spoja, što je potvrđeno patohistološkom analizom bioptičkog uzorka (PHD). Kontrolna ezofagogastroduodenoskopija (EGD) nakon godinu dana, uz biopsije sluznice, ponovo je potvrdila dijagnozu Barrettovog jednjaka, ali je regresija nastupila na terapiju inhibitorima protonske pumpe (IPP) u terapijskoj dozi. Posljednja EGD u 05/09, uz nalaz PHD, govori u prilog kroničnog gastritisa.A treatment of Barrett¢s esophagus by argon plasma coagulation (APC) in a female patient is described, after unsuccessful treatment with double dose of proton pump inhibitors (PPI¢s) following guidelines. The diagnosis is confirmed by pathohistological (PHD) tissue analysis, that is obtained by biopsy of esophagogastric (EG) junction. After double treatement by APC, control biopsy was performed, and pathohistological diagnosis was chronic gastritis. After one year, control biopsy confirmed again the diagnosis of Barrett esophagus. PPI¢s were given to the patient, and complete regression was confirmed by biopsy of EG junction

Gastric adenomyoma

Bacground. Gastric adenomyoma is a rare, hamartomatous tumor localized most frequently in the gastric antrum. Review of the available literature shows only sporadic reports or smaller series. Case reports. We presented a 72-year-old woman admitted due to epigastric pain with dyspeptic difficulties. Biochemical parameters and tumor markers were within the referential limits. Diagnostic procedures (upper endoscopy, endoscopic ultrasonography and computerized tomography) revealed an intramural tumor prominence with intact mucosa on the posterior wall of gastric antrum, not accessible for biopsy. Surgical treatment was performed with total extirpation of the tumor. Histopathological examination verified adenomyoma with focal low grade epithelial dysplasia. Cytologic immunophenotype was consistent with smooth muscle stromal and epithelial tumor (CK7 and CK20 ++ immunophenotype). Stromal component revealed low proliferative index (Ki-67 protein immunoexpression level 3%), and p53 less than 0.1% in both epithelial and stromal components. Following the operation, the patient remained in good condition. Conclusion. Uncertain malignant potential of the gastric adenomyoma in the presented case indicates that timely diagnostics with adequate surgical treatment is crucial for an adequate treatment

Bleeding Meckel\u27s diverticulum: case report

Meckelov divertikul ispoljava svoje simptome u oko 4 - 30% bolesnika u dobi ispod 2 godine, a u starijih od 8 godina u oko 10% slučajeva. Dijagnostička scintigrafija tehnecij 99m pertehnetatom je zlatni standard dijagnostike. Osjetljivost pretrage je svega 62% u odrasloj populaciji. Iako je prva scintigrafija i u ovdje prikazanom slučaju negativna, ima načina kako se lažno negativni rezultati mogu smanjiti na najmanju moguću mjeru, odnosno kako se može povećati osjetljivost pretrage, a samim time i izbjeći ponavljana testiranja.Symptomatic presentation of Meckel\u27s diverticulum occurs in 4-30% of patients under 2 years of age and in 10% of cases where the patients are older than 8. Diagnostic Technetium-99m-Pertechnetate scintigraphy is the standard test for making this diagnosis. However, the sensitivity of the scan is only 62% in adult population. Although the Technetium Pertechnetate scan is falsely negative in this case report (and in a number of other cases) there are ways to increase its sensitivity and possibly avoid repeated testing

The influence of Helicobacter pylori infection on the occurrence of gastroesophageal reflux in patients with renal insufficiency

Introduction/Aim. Gastric acid is a key factor in the pathophysiology of gastroesophageal reflux disease. A plausible mechanism by which the Helicobacter pylori infection might protect against reflux disease is by its propensity to produce atrophic gastritis. The aim of the study was to establish the influence of Helicobacter pylori infection on the occurrence of gastroesophageal reflux in patients with different stages of renal insufficiency. Methods. The examination was organized as a prospective, clinical study and involved 68 patients − 33 patients with preterminal stage of renal failure and 35 patients with terminal renal insufficiency. Due to dyspeptic difficulties, in all the patients there was preformed upper esophagogastroscopy and Helicobacter pylori infection was found by ureasa test. Results. The patients with preterminal renal insufficiency were significantly younger than patients with terminal renal failure (53.4±11.1 vs. 65.4±12.3 years; p = 0.014). There was found a statistically significant difference between the groups in Helicobacter pylori infection (p = 0.03), hiatal hernia (p = 0.008), gastroesophageal reflux disease (p = 0.007), and duodenal ulcer (p = 0.002). Using the multiple non-parametric correlative analysis there was confirmed a negative correlation between Helicobacter pylori infection and gastro-esophageal reflux disease (Kendal τB = -0.523; p = 0.003) and hiatal hernia (Kendal τB = 0.403; p = 0.021), while there was found a positive correlation between gastro-esophageal reflux disease and hiatal hernia (Kendal τB = 0.350; p = 0.044). Conclusion. Helicobacter pylori infection is a significant protective parameter of the incidence of gastro-esophageal reflux disease in patients with both pre-terminal and terminal renal insufficiency

Splenic artery pseudoaneurysm as a complication of pancreatic pseudocyst

Introduction. Pancreatic pseudocyst presented as pseudoaneurysm of the splenic artery is a potential serious complication in patients with chronic pancreatitis. Case report. A 42-year-old male patient with a long-standing evolution of chronic pancreatitis and 8-year long evolution of pancreas pseudocyst was referred to the Military Medical Academy, Belgrade due to worsening of the general condition. At admission, the patient was cachectic, febrile, and had the increased values of amylases in urine and sedimentation (SE). After clinical and diagnostic examination: laboratory assessment, esophagogastroduodenoscopy (EGDS), ultrasonography (US), endoscopic ultrasonography (EUS), multislice computed scanner (MSCT) angiography, pseudoaneurysm was found caused by the conversion of pseudocyst on the basis of chronic pancreatitis. The patient was operated on after founding pancreatic pseudocyst, which caused erosion of the splenic artery and their mutual communication. Postoperative course was duly preceded without complications with one year follow-up. Conclusion. Angiography is the most reliable and the safest method for diagnosing hemorrhagic pseudocysts when they clinically present as pseudoaneurysms. A potentially dangerous complication in the presented case was treated surgically with excellent postoperative results

Hereditary hemorrhagic teleangiectasis (Rendu-Osler-Weber Syndrome) as cause for stomach hemmorrhage - case report

U radu je prikazan sedamdesetcetverogodišnji bolesnik s krvarenjem iz probavnog trakta i posljedicnom sideropenicnom anemijom vjetovanom Rendu-Osler-Weber-ovom bolešcu. Gastroskopski je verificirano oskudno krvarenje iz angiodisplazija u želucu koje se smirilo, vjerojatno spontano. U terapiji je dobivao blokatore protonske pumpe.This paper shows a 74-year-old patient with gastrointestinal bleeding and sideropenic anaemia as consequence of Rendu-Osler-Weber illness. The patient was gastroendoscopically positive on bleeding from angiodysplasias in the stomach. Bleeding stopped most robably spontaneously. The patient was treated with proton pump inhibitors

Epidemiological characteristic of duodenal erosions

Na Internoj klinici Opće bolnice Osijek učinjena je prospektivna studija gdje je napravljeno 3950 ezofagogastroduodenoskopija i u 238 bolesnika nađene su duodenalne erozije. U 99 bolesnika one su bile udružene s peptičkim ulkusom. Bolesnici s duodenalnim erozijama (u obje grupe) bili su uglavnom u dobi od 30 do 59 godina. Omjer muškaraca prema ženama u bolesnika s nezavisnim erozijama bio je 4,8:1, a u bolesnika koji su imali erozije udružene s peptičkim ulkusom 6,1:1. Duodenalne erozije su u 143 bolesnika diseminirane, a u 81 bolesnika zonalno raspoređene (uglavnom na prednjoj i stražnjoj stijenci). Pojedinačne erozije nađene su u 14 bolesnika. Pojava duodenalnih erozija u obje grupe bila je najčešća u jesen, a najrjeđa ljeti. Pojava konzumiranja alkoholnih pića, crne kave i pušenja cigareta slični su u bolesnika s duodenalnim erozijama i u općoj populaciji podvrgnutoj ezofagogastrođuodenoskopiji. Ti rezultati pokazuju da su epidemiološke karakteristike duodenalnih erozija dosta slične onima kod duodenalnog ulkusa i zbog toga ova patologija treba biti uključena u široko poglavlje peptičke bolesti.In the prospective investigation on the Internal Clinic of General Hospital Osijek 3950 endoscopic examinations has been done and in 238 patients duodenal erosions has been found. In 99 patients duodenal erosions coexist with ulcerative peptic disease. The patients with duodenal erosions (in both groups) were predominantly between 30 and 59 years old. The ratio of men to woman in patients with autonomous erosions was 4,8:1, and in patients with erosions connected with ulcerative peptic disease was 6,1:1. In 143 patients duodenal erosions werde disseminated and in 81 patients were zonally disributed (mainly in the anterior and posterior walls). In 14 patients single erosions have been found. In both groups duodenal erosions were mainly observed in autumn, and rarely in summer. The intake of alcohol, coffe and cigarettes were quite similar in patients with duodenal erosions and in the general population submitted to endoscopic examinations. In conclusion, the analysis of our data presen epidemiological characteristics of duodenal erosions very similar to those pertaining to duodenal ulcer and therefore this pathology has to be included in the wide chapter of the peptic diseases

Economic and medical advantages of digestive tract endoscopy

U ovom radu analizirana je medicinska i financijska vrijednost određenih dijagnostičkih i opera tivno-terapijskih zahvata (kod gastroenterohepatoloških bolesnika) koji se mogu obaviti endoskopskim i rendgenološkim, odnosno kirurškim putem. To je dosta važno s obzirom na sve lošije financijsko stanje u zdravstvu. U pogledu dijagnostike digestivnih bolesti, endoskopiji treba dati primat nad rendgenologijom, jer osim medicinskih prednosti (nema žračenja bolesnika, mogućnost vizualnog pregleda i uzimanja uzorka za histološku analizu), ona je i jeftinija. S obzirom na doktrinski stav da, iako imamo pozitivan rendgenološki nalaz, produženje dijagnostike mora biti endoskopijom uz uzimanje uzoraka za histološku analizu, dolazi do dupliranja pretraga, a time do gubitka velike sume novca. Iz toga je jasno da je ušteda više nego očita primjenom samo primarne endoskopije. Prednost operativno-terapeutskih endoskopskih zahvata nad kirurškim su očite, kako u medicinskom (niska smrtnost, manje komplikacija, kraći period rehabilitacije, humaniji pristup), tako i u financijskom pogledu. Iz svega toga proizlazi da svako ulaganje u razvoj endoskopije znači više obavljenih dijagnostičkih i operativnih endoskopskih zahvata, a time ukidanje rendgenoloških i kirurških, što će doprinijeti ogromnoj uštedi novca.The paper analyzes medical and financial values of certain diagnostic and therapeutic procedures in patients with gastroenterohepatic diseases which can be performed endoscopically, radiographically or surgically. Considering the miserable financial condition of the health care system, this comparison is very important. In the diagnostics of digestive diseases endoscopy must be preferred to radiography, since in addition to medical advantages (no radiation of the patients, possibility of visual examination and sampling for histological analysis), it is cheaper, as well. Besides, following of the doctrine that in case of positive radiograms the diagnostics must be continued by endoscopy and taking samples for histological analysis duplicates the examinations and causes a considerable loss of money. Thus, primary endoscopy evidently means economization. The therapeutical endoscopic procedures have the advantage over surgery, both from the medical (low mortality, less complications, shorter period of rehabilitation and humane treatment) and the financial point of view. Accordingly, any investment into the development of endoscopy means more diagnostic and therapeutical endoscopic procedures performed as well as the abolition of radiographic and surgical procedures, which would contribute to saving considerable amounts of money

Dieulafoy`s lesion as the cause of bleeding from the gastrointestinal system

Dieulafoy lezija rijedak je, ali važan uzrok krvarenja iz probavnog sustava. To je arterija koja unatoč perifernom submukoznom tijeku unutar stjenke gastrointestinalnog sustava zadržava konstantan promjer, što ju čini podložnom oštećenju. Većina lezija nalazi se u proksimalnom dijelu želuca, duž male krivine zbog posebne vaskularne arhitekture tog područja, ali nalazimo ih i u jednjaku te tankom i debelom crijevu. Karakteristična klinička prezentacija je burna sa simptomima poput melene i hematemeze koje nerijetko prati hemodinamska nestabilnost te su potrebne transfuzije krvnih derivata. Prije nastupa krvarenja pacijenti su u potpunosti bez simptoma. Zlatni standard dijagnostike je endoskopija, ali zbog male veličine i neupadljivosti lezije izrazito ju je teško uočiti te ih do 30% ostaje neotkriveno. Endoskopija se tada može ponoviti ili se primjene druge metode poput angiografije, scintigrafije ili endoskopske kapsule. Osim što se koristi u dijagnostičke svrhe, endoskopija je važna i u terapiji. Nakon stabilizacije pacijenta, važno je pravovremeno zaustaviti krvarenje. Djelotvorne metode endoskopske hemostaze ponajprije uključuju termalne u koje ubrajamo elektrokoagulaciju, argon plazma koagulaciju i lasersku fotokoagulaciju te mehaničke metode poput podvezivanja i postavljanja hemostatskih kopči. Ne postoji konsenzus koji bi izdvojio određenu terapijsku metodu kao najbolju pa izbor ovisi o dostupnosti opreme, iskustvu i vještini liječnika. Kod neuspjeha endoskopskih metoda spasonosna terapija je kirurška i to, u pravilu, klinasta resekcija.Dieulafoy's lesion is a rare, but significant cause of gastrointestinal hemorrhage. This is an artery that despite its peripheral, submucosal course within the gastrointestinal wall, remains the same caliber, which makes it susceptible to damage. The majority of these lesions are located in the proximal part of the stomach, along the lesser curve, and this is due to the special vascular architecture of the area. Approximately only one third of lesions are extragastric and we can find them in the esophagus, and the small and large intestine. The typical clinical presentation is fierce: patients present with melena and hematemesis, frequently followed by hemodynamic instability which requires blood transfusions. Endoscopy is considered the gold standard in diagnosis as well as in therapy. Up to 30% of Dieulafoy’s lesions remain undetected because they are very small and inconspicuous. Endoscopy can then be repeated or other methods such as angiography, scintigraphy or endoscopic capsules are applied. In therapy the first step should be to stabilize a bleeding patient and only afterwards attend to the hemostasis. Methods available during endoscopy include local injection of epinephrine or sclerosing agents, thermocoagulation that includes electrocoagulation, argon plasma coagulation and laser photocoagulation, and finally, mechanical methods such as band ligation and hemoclip. There is no consensus that would distinguish a particular therapeutic method as the best, and for that reason the choice depends on the availability of equipment, experience, and physicians' skills. When these methods fail to achieve hemostasis, the last choice in the therapy is surgical