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Collagenous gastritis is a rare type of chronic inflammation of the gastric mucosa. The diagnosis is based on histological proof of thickening of the subepithelial collagen layer in the lamina propria of the gastric mucosa. There are two known phenotypes of collagenous gastritis: paediatric and adult types. The adult-onset form is associated with collagenous colitis and other autoimmune disorders. The most common clinical presentations of the paediatric form are iron deficiency anaemia and epigastric pain. The pathogenesis of the disease remains unclear and hence no effective treatment has been found yet. We report a case of a girl who presented with collagenous gastritis and was treated in the Department of Gastroenterology, Hepatology and Nutrition of the University Children’s Hospital Ljubljana.

Vnetje požiralnika, povzročeno z virusom herpes simpleks (HSV), je stanje, ki se pri imunokompetentnih posameznikih pojavi redko, še zlasti v obdobju otroštva. Če so pri otroku prisotni simptomi v zgornjih prebavilih, opravimo endoskopijo požiralnika z biopsijami sluznice, s katerimi potrdimo prisotnost HSV. Zdravljenje je največkrat samo podporno, se pa v otroškem obdobju hitreje odločimo za protivirusno zdravljenje. Predstavljamo primer 9-letnega otroka z vnetjem požiralnika, povzročenega s HSV, ki je bil zaradi vztrajnega bruhanja in nezmožnosti hranjenja iz regionalne bolnišnice premeščen na Klinični oddelek za gastroenterologijo, hepatologijo in nutricionistiko Pediatrične klinike v Ljubljani. Ob sprejemu je bila ob kliničnem pregledu prisotna bolečina v spodnjem delu trebuha; deček je bil izsušen. V laboratorijskih preiskavah smo ugotavljali blago povišane kazalce vnetja. Po začetnih preiskavah, vključno z ultrazvočnim pregledom (UZ) trebuha, nismo uspeli pojasniti dečkovega stanja, zato je bila opravljena ezofagogastroduodenoskopija (EGDS), ki je pokazala izrazito vnetje v področju požiralnika. Biopsija je potrdila prisotnost HSV tip 1. Serološke preiskave so potrdile prisotnost HSV IgM in normalno vrednost HSV IgG, nadaljnje testiranje krvi pa ni potrdilo imunske pomanjkljivosti.

Priporočila za obravnavo rakov glave in vratu (RGV) v Sloveniji sledijo priporočilom in usmeritvam, povzetim v publikaciji neprofitne mreže 30 vodilnih severnoameriških inštitucij za obravnavo raka, National Comprehensive Cancer Network, in hkrati upoštevajo obstoječe zmožnosti slovenskega zdravstvenega sistema. Smernice predstavljajo poenoteno mnenje vseh štirih najpomembnejših deležnikov na področju obravnave rakov glave in vratu v državi: Klinike za otorinolaringologijo in cervikofacialno kirurgijo, Kliničnega oddelka za maksilofacialno in oralno kirurgijo ter Stomatološke klinike UKC Ljubljana, Klinike za otorinolaringologijo, cervikalno in maksilofacialno kirurgijo UKC Maribor ter Onkološkega inštituta Ljubljana.

Background: Collagenous gastritis is a rare disease defined histologically by the subepithelial deposition of collagen bands thicker than 10 μm and the infiltration of inflammatory mononuclear cells in the lamina propria. There are approximately 60 reported cases of collagenous gastritis in the English literature. Case report: We present a 41-year-old female patient with weight loss, postprandial abdominal discomfort, early satiety, flatulence and a change in bowel habits. Her current laboratory investigation reports showed mild sideropenic anemia. Esophagogastroduodenoscopy and corresponding histological examination showed findings, typical for collagenous gastritis. Gastric emptying scintigraphy and SPECT/CT of abdomen revealed gastroparesis.Conclusion: Collagenous gastritis is a diagnostically challenging disease and its exact etiology remains unclear. Even though collagenous gastritis is a histologic diagnosis, the combination of other key clinical and endoscopic findings should prompt consideration of this entity. No safe and effective treatment has been established. Therefore, better understanding of the disease and study of a larger number of patients will help to establish diagnostic criteria and therapeutic strategies.

Chronic gastritis is an inflammatory condition of the gastric mucosa, which may include glandular alterations. It is most frequently caused by infection with Helicobacter pylori, a smaller proportion is related to chemical agents and autoimmune mechanisms. Chronic gastritis may lead to the development of gastric adenocarcinoma, depending on environmental factors, bacterial strain and host immune response. The vast majority of gastric adenocarcinomas are the final step in a complex cascade process of cancerogenesis involving sequential steps of precancerous lesions – atrophy, intestinal metaplasia and dysplasia.The process of cancerogenesis is associated with progressive genetic and epigenetic alterations, these being more frequent in dysplasia than in atrophic gastritis and intestinal metaplasia. Despite extensive research of gastric cancerogenesis, there are no molecular markers to be used for detecting patients at risk for cancer development.Biopsy remains among the most reliable ways of detecting gastric precancerous lesions. Apart from the correct histologic diagnosis, the assessment of topography is important. Biopsies must be taken according to the updated Sydney protocol. For further classifying patients at risk for gastric cancer, two systems have been developed: OLGA (Operative Link for Gastritis Assessment) and OLGIM (Operative Link for Gastric Intestinal Metaplasia Assessment).Slovenian Society for Gastroenterology and Hepatology, and Slovenian Society for Pathology and Forensic Medicine have accepted guidelines for endoscopic and histologic management of patients with gastric precancerosis. The aim of these recommendations is to diagnose gastric cancer at an early stage and to improve survival of patients with gastric cancer in Slovenia.

Gastric cancer is the fourth most common cancer in the world and the second most common cause of cancer-related death. In the year 2009, 469 new cases of gastric cancer were found in Slovenia, 5-year survival rate was 24.5 %. Helicobacter pylori is a class I carcinogen and responsible for 60 %–80 % (by some authors up to 98 %) of all gastric cancers of intestinal and diffuse type, as well as gastric MALT lymphoma.Gastric cancer incidence can be reduced by population-based screening for Helicobacter pylori infection before the age of 30 years. When after several decades of infection chronic multifocal atrophic gastritis with intestinal metaplasia develops in 8 % of infected persons, this is a point of no return. Eradication of infection at this stage cannot entirely prevent gastric cancer development. In those patients, serial biopsies according to Sydney protocol and risk stratification by means of the OLGIM (Operative Link for Gastric Intestinal Metaplasia Assessment ) staging system should be performed. Patients with OLGIM stage III and IV should be subject to surveillance endoscopies. The European Society of Gastrointestinal Endoscopy, the European Helicobacter Study Group and the European Society of Pathology have developed evidence-based guidelines on the management of patients with precancerous conditions and lesions of the stomach. Patients with intestinal metaplasia in both corpus and antrum should undergo endoscopic and histological follow-up every three years. If low-grade dysplasia is present, controls should be performed every year. If high grade dysplasia is present, endoscopic and histologic follow-up should be performed every 6 months. All visible endoscopic lesions should be resected (endoscopically or surgically). Helicobacter pylori infection should be searched for with different diagnostic tests and all infected patients should be cured.It is only by this approach that gastric cancer can be diagnosed at an early stage and five-year survival can be improved. These recommendations were accepted by the Slovenian Society for Gastroenterology and Hepatology, and the Slovenian Society for Pathology and Forensic Medicine.

Background. Recent studies have shown that stromal reaction in cancer has a more important diagnostic and prognostic significance than previously thought. CD34-positive stromal cells and myofibroblasts may play an important role in host response to invasive cancer. The aim of our studies was therefore to analyze the distribution and immunohistochemical phenotype of stromal cells in epithelial hyperplastic lesions (EHL) and squamous carcinoma (SC) of the larynx, and to establish their diagnostic and prognostic significance.Methods. We investigated samples of 62 resected larynxes with SC, 50 laryngeal biopsies of EHL and SC, and 5 samples of normal laryngeal mucosa. Immunohistochemistry was performed using antibodies against vimentin, a-smooth muscle actin (SMA), desmin, CD34 and leucocyte common antigen (LCA).Results. The stroma of normal laryngeal mucosa and EHL contained scattered CD34-positive cells, but there were no SMApositive myofibroblasts. In contrast, the stroma of SC contained SMA-positive cells but there were no CD34-positive stromal cells. We observed two patterns of stromal reaction in SC: one was characterised by a marked proliferation of myofibroblasts and desmoplasia, with scarce lymphocytic infiltration; this pattern tended to be associated with well or moderately differentiated SC. The other was characterised by few myofibroblasts, weak desmoplasia, and dense lymphocytic infiltration; the latter pattern tended to be associated with moderately or poorly differentiated SC.Conclusions. Our studies show that disappearance of CD34positive cells and appearance of SMA-positive myofibroblasts in the stroma is associated with transformation of laryngeal EHL to SC. This pattern of stromal reaction should be regarded as an additional marker of invasion. Our results also suggest that characteristics of stromal reaction in SC could be of prognostic significance.