Search

Gastric bezoars may be formed in the stomach as a result of foreign body accumulation with inability to pass through the pylorus. Usually bezoars are found in patients with a history of previous gastric surgery. Phytobezoars are the most common type of bezoars. Major complications of bezoars include intestinal obstruction, gastric ulcer, gastric perforation, and bleeding. We present the case of a 51-year-old woman with the features of gastrointestinal bleeding due to a giant diospyrobezoar in the stomach. During endoscopy besides the bezoar, a giant acute ulcer was found. Histological examination of biopsy specimens from ulcer area revealed changes typical of superficial ischemic damage due to prolonged bezoar compression. The patient had undergone a vagotomy and pyloroplasty 13 years ago, and she used to eat two or three persimmons per week during the last six months. The bezoar was fragmented during two endoscopies, and the fragments drifted away through the intestine. We conclude that delayed gastric emptying due to previous gastric surgery and regular eating of persimmons caused the formation of a giant bezoar with ischemic ulcer of gastric mucosa and bleeding. Such pathology potentially could be prevented by dietary advice.

Unlabelled: The aim of present study was to evaluate relationships between degree of portal hypertension, severity of the disease, and bleeding status in patients with liver cirrhosis., Patients and Methods: All study patients with liver cirrhosis underwent hepatic venous pressure gradient measurements, endoscopy, clinical and biochemical evaluation. Liver function was evaluated according to Child-Turcotte-Pugh (Child's) scoring system. Patients with decompensated cirrhosis (presence of severe ascites, acute variceal bleeding occurring within 14 days, hepatorenal syndrome, cardiopulmonary disorders, transaminase levels >10 times higher the upper normal limit), active alcohol intake, use of antiviral therapy and/or beta-blockers were excluded from the study., Results: One hundred twenty-eight patients with liver cirrhosis (male/female, 67/61; mean age, 53.8+/-12.7 years) were included into the study. Etiology of cirrhosis was viral hepatitis, alcoholic liver disease, cryptogenic and miscellaneous reasons in 57, 49, 14, and 8 patients, respectively. Child's stages A, B, and C of liver cirrhosis were established in 28 (21.9%), 70 (54.9%), and 30 (23.4%) patients, respectively. The mean hepatic venous pressure gradient significantly differed among patients with different Child's classes: 13.8+/-5.3 mm Hg, 17.3+/-4.6 mm Hg, and 17.7+/-5.05 mm Hg in Child's A, B, and C classes, respectively (P=0.003). The mean hepatic venous pressure gradient in patients with grade I, II, and III varices was 14.8+/-4.5, 16.1+/-4.3, and 19.3+/-4.7 mm Hg, respectively (P=0.0001). Since nonbleeders had both small and large esophageal varices, patients with large varices were analyzed separately. The mean hepatic venous pressure gradient in patients with large (grade II and III) varices was significantly higher than that in patients with small (grade I) varices (17.8+/-4.8 mm Hg vs 14.6+/-4.8 mm Hg, P=0.007). Thirty-four (26.6%) patients had a history of previous variceal bleeding; all of them had large (20.6% - grade II, and 79.4% - grade III) varices. In patients with large varices, the mean hepatic venous pressure gradient was significantly higher in bleeders than in nonbleeders (18.7+/-4.7 mm Hg vs 15.9+/-4.7 mm Hg, P=0.006)., Conclusions: Hepatic venous pressure gradient correlates with severity of liver disease, size of varices, and bleeding status. Among cirrhotics with large esophageal varices, bleeders have a significantly higher hepatic venous pressure gradient than nonbleeders. Hepatic venous pressure gradient measurement is useful in clinical practice selecting cirrhotic patients at the highest risk of variceal bleeding and guiding to specific therapy.

Unlabelled: 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>0.05); in 12 (63%) and 8 (42%) group B patients, respectively (P>0.05); and in 9 (36%) and 5 (20%) group C patients, respectively (P>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>0.05); in 5 (26%) and 5 (26%) group B patients (P>0.05); in 4 (16%) and 3 (12%) group C patients (P>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.

Objectives: Acute liver failure (ALF) is a life-threatening condition that can rapidly progress into coma and death due to the cerebral edema and multi-organ dysfunction. The ALF etiology and risk factors have been investigated in West Europe, North America, and Asia; however, there are still no published data about the causes and prognosis of ALF in Central and East European countries. The aim of our study was to analyze the causes, outcomes, and prognostic factors of ALF in patients referred to tertiary care center in Lithuania., Material and Methods: A total of 28 consecutive patients admitted to the tertiary care center (one of two university-level medical centers in Lithuania) over the period of January 1996 and December 2004 and who fulfilled the entry criteria of ALF (presence of hepatic encephalopathy (HE) and prothrombin international normalized ratio (INR) >1.5) were included into a prospective study., Results: In our study the most frequent causes of ALF were acute viral hepatitis B (21.4 %), drug-induced hepatitis (21.4%), and indeterminate hepatitis (17.9%); other etiologies included Budd-Chiari syndrome (10.7%), ischemic hepatitis (10.7%), Wilson's disease (7.1%), Amanita phalloides-induced liver damage (3.6%), acute fatty liver of pregnancy (3.6%), and malignant infiltration of the liver (3.6%). Among patients with drug-induced liver injury, only one case of acetaminophen poisoning was diagnosed. Clinical status of 9 persons in all patients with ALF corresponded to criteria for liver transplantation (LT) (one liver transplantation was performed), 6 of them had contraindications, and 13 patients did not fulfill requirements for urgent LT. The patients' survival rate in these groups was 11.1%, 16.7% and 69.2%, respectively. In 27 non-transplanted patients univariate analysis revealed the grade of HE on the day of enrolment, total serum bilirubin, pH, and prothrombin INR as risk factors for death from ALF. Multivariate logistic regressive analysis determined only prothrombin INR >3.24 and serum pH

Objective: Perturbed immune homeostasis elicited by misbalanced production of proinflammatory and anti-inflammatory cytokines is characteristic of inflammatory bowel disease. The aim of this study was to evaluate cytokine profile in patients with different forms of inflammatory bowel disease - ulcerative colitis and Crohn's disease - during clinical remission phase., Material and Methods: Production of proinflammatory Th1 cytokines (tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma)) and anti-inflammatory Th2 cytokines (interleukin-10 (IL-10) and interleukin-13 (IL-13)) was analyzed in peripheral blood mononuclear cells of patients with inflammatory bowel disease (9 with ulcerative colitis and 9 with Crohn's disease) and control subjects (n=11) by enzyme-linked immunosorbent assay (two-site ELISA)., Results: The results of the study revealed that the level of TNF-alpha after stimulation with phytohemagglutinin in patients with Crohn's disease was significantly higher in comparison to both patients with ulcerative colitis and controls (P<0.001 and P<0.01, respectively). The secretion of IFN-gamma both in patients with Crohn's disease and ulcerative colitis was lower than that in controls (P=0.05 and P<0.01, respectively), but it normalized after stimulation with phytohemagglutinin. The levels of IL-10 and IL-13 were significantly (P<0.01) higher in patients with Crohn's disease than in patients with ulcerative colitis and control group before and after stimulation with phytohemagglutinin., Conclusions: The results of our study provide evidence that in patients with inflammatory bowel disease, the imbalance between production of proinflammatory Th1 and anti-inflammatory Th2 cytokines persists even during remission of the disease, and disturbances of immune homeostasis are significantly more expressed in patients with Crohn's disease than in patients with ulcerative colitis.

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<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.

Objective: Clinical outcome of Helicobacter pylori (H. pylori) infection might be associated with specific virulence-associated bacterial genotypes. The distribution of different bacterial genotypes varies geographically. The aim of this study was to assess the relationship between cagPAI, vacA, and iceA status and severity of the disease in patients from Lithuania, infected by H. pylori., Material and Methods: H. pylori from 81 patients (37 with duodenal ulcer and 44 with chronic gastritis) was isolated from gastric biopsy specimens and cultured. Bacterial genotypes cagPAI, vacA (s and m subtypes) and iceA were analyzed by polymerase chain reaction using specific primers., Results: The cagPAI was identified in 59.3% of Lithuanian H. pylori strains investigated. H. pylori strains cultured from duodenal ulcer (DU) patients more frequently (P<0.01) contained cagPAI and vacA s1 genotypes (75.7% and 75.7%, respectively) in comparison to isolates from chronic gastritis (CG) patients (45.5% and 40.9%, respectively). Evaluation of nucleotide sequence of the vacA middle-region revealed that vacA s2/m2 genotype was more frequent in CG than in DU patients (56.8% and 24.3%, respectively; P<0.05). We have not found any differences in the frequency of iceA1 genotype between the DU and CG patients (46.0% and 40.9%, respectively; P>0.05)., Conclusion: Our study suggests that cagPAI and vacA s1 genotypes are associated with peptic ulceration in Lithuanian patients infected by H. pylori.

The aim of this review article is to improve knowledge of the liver disease in pregnancy. The article summarizes the results of own experience and the recent reviews of liver disorders unique to pregnancy. Abnormalities in liver tests occur in 3% of pregnancies with causes ranging from self-limiting to rapidly fatal. In Kaunas University of Medicine Hospital, a retrospective analysis disclosed a rate of 0.52% of liver diseases in 16252 pregnant women over a 5-year period. Several liver diseases occur only during pregnancy and are considered to be associated with the pregnant state. The liver disorders unique to pregnancy have characteristic clinical features and timing of onset. Hyperemesis gravidarum occurs in the first trimester, intrahepatic cholestasis of pregnancy in the second or third trimester, preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and acute fatty liver of pregnancy usually in the third trimester. The disorders of late pregnancy - preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy - may progress to severe liver dysfunction. The correct diagnosis is critical, as any delay can result in morbidity or mortality of both the mother and fetus. Early delivery and advances in supportive management are the only available option for improving the prognosis.

Unlabelled: The aim of the study was to compare the prevalence and severity of precancerous condition--gastric atrophy and intestinal metaplasia (IM) between Eastern European (Lithuania and Latvia) and Asian (Taiwan) countries in population older than 55 years., Methods: Patients aged 55 years and older, referred for upper endoscopy due to dyspeptic symptoms, were included in the study. Gastric biopsies were histological investigated according modified Sydney classification. Helicobacter pylori (H. pylori) was detected if any two of three methods (urease test, histology, and serology) were positive., Results: Overall 322 patients included: 52 from Taiwan (TW), 171 from Latvia (LV) and 99 from Lithuania (LT). There were 227 (70%) females and 95 (30%) males. The mean age of TW patients was significantly lower (61.0+/-5.8 years), than of LV (68.1+/-7.3 years) and LT (66.5+/-7.5 years) patients. H. pylori was established in 224 (69.6%) patients. H. pylori positivity was established in 43 (82.7%) TW patients, in 112 (65.5%) LV patients, and in 69 (69.7%) LT patients (P>0.05). In H. pylori-infected patients, any atrophy either in the corpus or in the antrum of the stomach was detected in 26 (60.5%) TW patients, in 40 (35.7%) LV patients, and in 36 (52.2%) LT patients (between TW and LV patients P<0.005). Severe atrophy (grade 2 or 3) detected in 8 (18.6%) TW patients, in 17 (15.2%) LV patients, and in 18 (26.1%) LT patients (P>0.05). Intestinal metaplasia was detected in 22 (51.2%) TW patients, in 37 (33.0%) LV patients and in 31 (44.9%) LT patients among countries (P>0.05). There were no significant differences in proportions of different degrees of both atrophy and intestinal metaplasia among countries. Intestinal metaplasia was found in 79 (77.5%) of 102 patients with any degree of atrophy and in 11 (9.0%) of 122 patients without atrophy (P<0.0001). We found strong statistically significant correlations between atrophy and intestinal metaplasia in antrum (r=0.89), P<0.01, and corpus (r= 0.73), P<0.01., Conclusions: The prevalence of H. pylori in the elderly population is still high in LT, LV, and TW. There are no significant differences in prevalence of gastric atrophy and intestinal metaplasia among TW, LT, and LV. There is a strong correlation between gastric atrophy and intestinal metaplasia.

The laryngopharyngeal form of gastroesophageal disease represents one of the atypical manifestations of supraesophageal gastroesophageal reflux disease characterized by morphologic and functional changes in the larynx and pharynx with the associated clinical symptoms. The article presents diagnostic algorithm (guidelines) for laryngopharyngeal form of gastroesophageal disease, elaborated by the group of Lithuanian experts in otorhinolaryngology and gastroenterology. The guidelines are based on the data of evidence-based medicine and results of the scientific studies in Lithuania. Diagnostics of laryngopharyngeal form of gastroesophageal disease has to be based on: (1) patient's complaints (permanent hoarseness, throat itching and clearing, cough, heartburn, "globus" sensation) for more than 3 months; (2) typical laryngoscopic findings (edema, erythema, roughness, hypertrophy of mucosa of the posterior glottis); (3) detection of reflux esophagitis as a subsequence of pathological gastroesophageal reflux; (4) assessment of relationship between reflux and morphological/functional changes. The guidelines are designed for the otorhinolaryngologists, gastroenterologists, and general practitioners.

The aim of this article is to introduce Lithuanian clinical practice guidelines for the management of laryngopharyngeal form of gastroesophageal reflux disease for standardization of the diagnosis and treatment of the disease and prevention of its complications. Composed guidelines provide recommendations for primary care physicians as well as otorhinolaryngologists and gastroenterologists for the management of adults with uncomplicated laryngopharyngeal form of gastroesophageal reflux disease. Committee composed of experts from Lithuanian Otorhinolaryngological and Gastroenterological Societies developed guidelines based on a comprehensive review of the evidence-based literature related to laryngopharyngeal form of gastroesophageal reflux disease and guidelines of other countries. The guidelines provide description of each medicine groups with emphasis on proton pump inhibitors as the most effective drugs for the treatment of laryngopharyngeal form of gastroesophageal reflux disease. Indications for empirical treatment with proton pump inhibitors are described, as well as duration of treatment, doses, optimal regimen of use, and assessment of treatment efficacy. The therapy should begin with the application of proton pump inhibitors twice daily, before meal for three months. Combined therapy for nonresponders is described. Algorithm for stopping the medication is recommended. These recommendations may provide an efficient and economical approach to the management of this problem.

Background: At present, (14)C-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 (14)C-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 (14)C-urea breath test "Heliprobe" is accurate, reliable, and useful for the diagnosis of Helicobacter pylori infection in routine clinical practice.

Objective: To evaluate nutritional status and dietary habits of Lithuanian patients with ulcerative colitis and Crohn's disease and to compare with those of healthy controls., Materials and Methods: A case-control study was conducted in the Department of Gastroenterology, Kaunas University of Medicine Hospital. A total of 101 patients with ulcerative colitis, 44 with Crohn's disease, and 178 healthy controls were examined with the help of standard self-report questionnaire about daily dietary habits. Healthy controls were evaluated in primary care centers during preventive examinations. Body mass index was calculated for all patients in a standard way., Results: There was no statistically significant difference between patients and controls concerning consumption of coffee, tea, chewing gum, type of fat for meal preparation, white bread, cooked potatoes and sausages, non-carbonated water. Patients with inflammatory bowel diseases statistically significantly less frequently consumed fresh milk, cheese, fish, fried potatoes, and soda drinks. Patients with Crohn's disease statistically significantly less frequently consumed fresh fruits and patients with ulcerative colitis--fresh vegetables as compared to controls. Body mass index of patients with inflammatory bowel diseases was significantly lower compared to controls, and patients with Crohn's disease had significantly lower body mass index than ulcerative colitis patients., Conclusions: Patients with inflammatory bowel diseases have lower body mass index than healthy controls. Patients consume fresh milk, cheese, canned and fresh vegetables and fruits less frequently; therefore, primary care physicians and patients should be provided with teaching and more information about nutrition issues.

Unlabelled: Indices for predicting of survival are essential tools for assessing prognosis and establishing priority for liver transplantation. Our aim was to investigate the survival and prognostic significance of Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) scale for short and long-term survival prognosis in waitlist of patients selected for liver transplantation., Material and Methods: The group of 236 patients with diagnosis of different chronic liver disease was investigated in period of 4.5 years. Persons with CTP scoring > or =10 were included into the waitlist for liver transplantation. Other inclusion criteria were based on CTP scoring > or =7 plus one or more liver cirrhosis complications. The cumulative and mean survivals were evaluated according to the Kaplan-Meier statistical analysis. The distribution and the survival data for the patients were based on biochemical variables. The clinical status of waitlist patients was evaluated by applying the CTP and MELD scales. The short and long-term survival prognosis was assessed. The odds ratios with 95% confidence interval univariate analysis were evaluated., Results: During the period of 4.5 years 45 persons were selected for waitlist group. Mortality rate was 51.1%, average survival--17.9 months. The significant trends towards higher cumulative proportion of survival were observed for the patients with low serum bilirubin, creatinine and low blood urea. The highest mortality rate was in the group with CTP scores > or =12. The highest mortality and the shortest average of survival were in the group of cases with the highest scores. It was established the significant difference for short-term survival (less than 3 months) prognosis in MELD scale. CTP scores had no predictive influence for survival during 3 months. Also both scoring had high prognostic value for prediction of the long-term survival (more than 3 months). Deterioration of cumulative survival and overall survival were affected by increase of serum bilirubin, blood urea and creatinine. Increase of scores in CTP and MELD scale had the direct positive correlation with increased mortality. MELD scale has higher capability to predict short-term mortality risk in patients with end-stage liver disease. CTP and MELD scales have proven good prognostic capabilities both for short and long-term survival in patients with chronic liver disease.

Unlabelled: Aim of the study is to establish the efficacy of treatment of chronic hepatitis C with interferon alpha-2b and ribavirin in treatment-naive patients, in non-responders to interferon monotherapy, in relapsers after interferon monotherapy, and to evaluate the possible predictors of treatment response., Material and Methods: One hundred thirty one patients with chronic hepatitis C were included and assigned to 24-week course of interferon alpha-2b with ribavirin. At the end of 24-week combination therapy biochemical, histological, virological and complete end-of-treatment responses were evaluated. Patients with virological end-of-treatment response were treated with interferon alpha-2b and ribavirin for further 24 weeks and followed-up for the next 6 months after stopping therapy., Results: End-of-treatment response was assessed in 119 patients: 57.1% were treatment-naive, 28.6% were non-responders, and 14.3%--relapsers. Overall virological end-of-treatment response rate was 35.3%, biochemical--64.7%, histological--80.9% and complete--33.3%. Treatment-naive patients have better end-of-treatment response than non-naive patients in all dimensions, but statistical significance is reached only evaluating histological end-of-treatment response. Sustained virological response of overall 119 patients was in 23.6%. There was no statistically significant difference in sustained virological response rate among all patient groups. None of pre-treatment demographic, clinical, biochemical and morphological parameters was found as possible response predicting factors. Hepatitis C virus genotype was assessed in 40 patients. Hepatitis C virus genotype 1 was found in 34 (85%), genotype 2 in 3 (7.5%), and genotype 3 in 3 (7.5%) patients. In conclusion, in our studied population with high prevalence of hepatitis C virus genotype 1 (85%), there is low sustained virological response rate (23.6%) to interferon alpha-2b in combination with ribavirin therapy.

Unlabelled: Aim of the study was to evaluate the effect of interferon and ribavirin combination therapy on liver histopathological outcomes., Material and Methods: Pre-treatment and post 24-week treatment liver biopsy specimens were available in 68 naive patients, 37 nonresponders and 18 relapsers after interferon monotherapy. For all patients paired liver biopsies (6-month interval) were assessed for necroinflammation (according to the method by K. Ishak), fibrosis (according to METAVIR score) and steatosis at the end of 24-week treatment., Results: Virological end-of-treatment response was: 36.8% in naive patients, 24.3% in nonresponders and 22.2% in relapsers. Out of 38 patients, who achieved virological end-of-treatment response, sustained virological response was in 65.8%. There was obvious drop of histological activity features scores in all treated patients at the end of 24-week treatment period. According to the baseline findings, only confluent necrosis was found to be significantly lower in patients, who achieved virological end-of- treatment response (p<0.05). The fibrosis and steatosis has not been influenced at least by 24-week treatment success. But in patients, who achieved sustained virological response, fibrosis was lower at baseline and after 24-week of interferon and ribavirin therapy (p<0.001). In conclusion, assessment of liver histopathology has real value in the evaluation of therapeutic response. Grade of pre-treatment confluent necrosis could predict virological end-of-treatment response. Lower stage of fibrosis both at baseline and after 24-week treatment period seems to be a predictor of sustained virological response.

Hemodialysis patients are a high-risk group for hepatitis B and C virus infections. The aim of the study was to evaluate the prevalence of B and C viral hepatitis, level of its control among patients on hemodialysis. In December of 1997, 1998, 1999, 2000, 2001 we visited all hemodialysis centers of Lithuania and gathered information about these infections in patients on hemodialysis. Eleven percent (11.4%) of all hemodialysis patients were not examined for HB(s)Ag and 15.2% for anti-HCV, 67.3%--for anti-HB(s) and 57.7% for anti-HBc in 2001. The number of examined patients for the markers of hepatitis had increased in 2001 in comparison with 1997. The same number of hemodialysis patients with HB(s)Ag was found in each year of study (14% in 1997, 14.4% in 2001). We observed the decrease in percentage of anti-HCV positive patients from 23% in 1998 till 15.4% (p<0.01) in 2001. Only 10.6% hepatitis B virus vaccinated patients was registered in 2001 and this percentage increased if compared to 6.3% in 1999. About (1/4) of anti-HB(c) positive patients were HB(s)Ag positive in 2000-2001. Chronic hepatitis B could be diagnosed for them. The duration of hemodialysis of HB(s)Ag and anti-HCV positive patients was longer compared to HB(s)Ag and anti-HCV negative patients (p<0.001).

With the observation of spiral organism in the stomach about one hundred years ago a long history of a bacterium started ending up in a worldwide research programs, studies and consensuses. With this bacterium rediscovered by Marshall and Warren and later named Helicobacter pylori, a milestone of research was laid nearly twenty years ago. Helicobacter pylori is now recognized as the main cause of most cases of gastritis and ulcer disease in the stomach and the duodenum. In the course of the Helicobacter pylori research, Helicobacter pylori was found to trigger neoplastic alterations on the ground of the inflammation in the stomach. At first, a large number of publications served to describe the connection between Helicobacter pylori and the low malignant B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) of the stomach. Furthermore, on the basis of numerous seroepidemiological studies, researchers succeeded in documenting the participation of H. pylori, at least as a co-factor, in the development of gastric carcinoma. From large epidemiological studies made during the last twenty years as well as from microbiological research we have learned much more about this in the beginning nameless and mysterious bacterium.

Consistent patterns of inflammatory bowel diseases (IBD), difficulties of diagnosis Crohn's disease and ulcerative colitis and peculiarities of their treatment have been studied on the basis of retrospective analysis of IBD patient case histories during 1995-2001 in the Department of Gastroenterology of Kaunas University of Medicine Hospital. Ulcerative colitis and Crohn's disease are chronic diseases that influence the quality of life, mortality and number of hospitalizations with their course varying in different countries. The number of cases hospitalized during the five years period was 273; 80% of which was ulcerative colitis, whereas the percentage of Crohn's disease was 20. The number of cases of ulcerative colitis increased every year while that of Crohn's disease started to grow in 2001. IBD is more common among males than females. It was at the expanse of young females that patients with Crohn's disease were statistically significantly younger than those with ulcerative colitis. Proctosigmoiditis (45.9%) and left colitis (27.1%) are common predominants in ulcerative colitis, while ileocolitis (63.6%) predominates in Crohn's disease. Ulcerative colitis correlates with stool frequency and extent of disease. Course of IBD is rather grave and relapses are quite frequent.