Search

Background: Gastrointestinal injury caused by dextran sodium sulphate (DSS) is a reliable porcine experimental model of inflammatory bowel disease (IBD). The purpose of this study was to evaluate the effect of probiotic Lactobacillus casei DN 114001 (LC) on DSS-induced experimental IBD.Results: Eighteen female pigs (Sus scrofa f. domestica, weight 33–36 kg, age 4–5 months) were divided into 3 groups (6 animals per group): controls with no treatment, DSS, and DSS + LC. LC was administered to overnight fasting animals in a dietary bolus in the morning on days 1–7 (4.5 × 1010 live bacteria/day). DSS was applied simultaneously on days 3–7 (0.25 g/kg/day). On day 8, the pigs were sacrificed. Histopathological score and length of crypts/glands (stomach, jejunum, ileum, transverse colon), length and width of villi (jejunum, ileum), and mitotic and apoptotic indices (jejunum, ileum, transverse colon) were assessed. DSS increased the length of glands in the stomach, length of crypts and villi in the jejunum and ileum, and the histopathological score of gastrointestinal damage, length of crypts and mitotic activity in the transverse colon. Other changes did not achieve any statistical significance. Administration of LC reduced the length of villi in the jejunum and ileum to control levels and decreased the length of crypts in the jejunum. Conclusions: Treatment with a probiotic strain of LC significantly accelerated regeneration of the small intestine in a DSS-induced experimental porcine model of IBD.

Purpose of review Peutz-Jeghers syndrome is a rare, autosomal dominant, hereditary polyposis syndrome defined by gastrointestinal hamartomas and mucocutaneous pigmentations, caused by a germline mutation in the serine/ threonine kinase 11 or liver kinase B1 (STK11/LKB1) genes. Hamartomatous polyps located throughout the gastrointestinal tract can be complicated by bleeding and small bowel intussusception, potentially leading to the need for emergency surgery. Individuals suffering from Peutz-Jeghers syndrome have an increased lifetime risk of various forms of cancer (gastrointestinal, pancreatic, lung, breast, uterine, ovarian and testicular). Surveillance should lead to the prevention of complications and thus a reduction in mortality and morbidity of patients. Recent findings A combined approach based on wireless capsule endoscopy, magnetic resonance enterography and device-assisted enteroscopy is effective in reduction of the polyp burden and thus decreasing the risk of bleeding and intussusception. Current guidelines for screening and surveillance are mostly based on expert opinion rather than evidence. Summary Peutz-Jeghers syndrome is an emerging disease that significantly affects the quality of life enjoyed by patients. Despite of all the progress in improved early diagnostics, options for advanced endoscopic therapy and elaborate surveillance, acute and chronic complications decrease the life expectancy of patients suffering from Peutz-Jeghers syndrome.

Familial adenomatous polyposis (FAP) is a hereditary disease characterized by presence of numerous colorectal adenomas. It often exposes its carrier to absolute risk of colorectal cancer, but also to other extracolonic tumours (especially to duodenal cancer and desmoid). Screening and surveillance of FAP patients leads to reduction of colorectal cancer incidence and mortality. Colonoscopy/lower endoscopy and esophagogastroduodenoscopy (including use of side-viewing endoscope) are the principal examinations. Colectomy is the standard therapeutic procedure, but endoscopic therapy plays relevant role both in upper and lower gastrointestinal tract. Recent international guidelines and some new tools for severity classification enable effectively reduce the mortality related to this disease by individualized patient management. Key words: colorectal cancer - familial adenomatous polyposis.

Double balloon enteroscopy (DBE) was introduced 15 years ago. The complications of diagnostic DBE are rare, acute pancreatitis is most redoubtable one (incidence about 0.3%). Hyperamylasemia after DBE seems to be a rather common condition respectively. The most probable cause seems to be a mechanical straining of the pancreas. We tried to identify patients in a higher risk of acute pancreatitis after DBE. We investigated several laboratory markers before and after DBE (serum cathepsin B, lactoferrin, E-selectin, SPINK 1, procalcitonin, S100 proteins, alfa-1-antitrypsin, hs-CRP, malondialdehyde, serum and urine amylase and serum lipase). Serum amylase and lipase rose significantly with the maximum 4 hours after DBE. Serum cathepsin and procalcitonin decreased significantly 4 hours after DBE compared to healthy controls and patients values before DBE. Either serum amylase or lipase 4 hours after DBE did not correlate with any markers before DBE. There was a trend for an association between the number of push-and-pull cycles and procalcitonin and urine amylase 4 hours after DBE; between procalcitonin and alfa-1-antitrypsin, cathepsin and hs-CRP; and between E-selectin and malondialdehyde 4 hours after DBE. We found no laboratory markers determinative in advance those patients in a higher risk of acute pancreatitis after DBE.

Electrogastrography (EGG) is a non-invasive method for the assessment of gastric myoelectrical activity. Porcine EGG is comparable with human one. There are no data on the impact of moderate to high doses of atropine on EGG, neither in humans nor experimental pigs. The purpose of this study was to evaluate the effect of different doses of atropine on EGG in experimental pigs. Six fasting pigs entered the study three times in a random order. The baseline EGG recording lasted 20 min, followed by a 105-min EGG trial recording. Intramuscular atropine 1.5 mg (part 1), 3.0 mg (part 2) and 4.5 mg (part 3) was administrated after the baseline EGG. Atropine doses of 1.5 and 3.0 mg revealed a similar pattern in the EGG power course. After an initial increase (at the first 15-min interval), the areas of amplitudes decreased back to values comparable with basal levels and subsequently increased significantly again to the maximum at 105 min. The EGG power was quite different after the administration of 4.5 mg of atropine. Areas of amplitudes decreased gradually to the minimum values at 105 min after atropine administration. In conclusion, different dose-dependent changes in the EGG pattern were found after moderate to high doses of atropine.

Pneumatosis cystoides is a rare gastrointestinal condition characterised by the presence of gas in the wall of the gastrointestinal tract, predominantly the small and large intestine. This phenomenon occurs in three forms: 1) primary pneumatosis cystoides, 2) a secondary form, which accompanies a wide range of gastrointestinal and systemic diseases, and 3) pneumatosis complicating intestinal ischaemia. The pathogenesis is not clearly known and is most likely multifactorial; hydrogen overproduction represents what is probably the most consistent theory of PCI formation. PCI is often an incidental finding during colonoscopy — endoscopic suspicion on PCI based on collapse during the puncture can be supported by the typical cytological findings. Computerised tomography is the most sensitive radiodiagnostic method, which can also detect possible underlying disease. Oxygen inhalation and antibiotics is the mainstay in conservative therapy, together with therapy of the underlying disease. Candidates for surgical and/or radiological intervention are mainly recruited from the third group of PCI accompanying abdominal catastrophe such as intestinal ischaemia.

Testing antilaminaribioside (ALCA) and antichitobioside (ACCA) antibodies in 89 Crohn's disease (CD), 31 ulcerative colitis (UC) and 50 controls, mean values were 38.6 and 53.0 ELISA units for CD, 34.0 and 32.6 for UC, 34.5 and 36.4 for controls, respectively. There was no significant difference of ALCA values between CD and UC (p = 0.401), CD and control subjects (p = 0.698) or UC and controls (p = 0.898). ACCA were significantly higher in CD compared with UC (p = 0.011) but not with the controls (p = 0.095). No significant difference of ACCA values between UC and controls (p = 0.107) was found. ALCA and ACCA values significantly correlated in CD (r = 0.548, p < 10 -4 ) and UC (r = 0.885, p < 10 -4 ) but not in controls (r = 0.153, p = 0.287). The positive predictive value for CD was only 20 (ALCA) and 8 % (ACCA), the negative ones (to exclude CD) 25 (ALCA) and 86 % (ACCA). Small and/or large bowel involvement or dis- ease type (i.e. stenosing, perforating or inflammatory) of CD did not differ in the two values. The idea that ALCA and ACCA may be useful either to differentiate between CD, UC and healthy subjects or to stratify CD was not confirmed.

Current research in gastroenterology and hepatology (both clinical and experimental) made great and rapid progress in new methods, in biomedical technology, and last but not least in practical application of basic scientific achievements during the last decade. Original research articles focusing on new, advanced studies in clinical and experimental research in gastroenterology and hepatology that have a potential to influence our daily practice and further clinical and experimental research were sent to this journal to be published by many leading gastroenterology specialists. We bring ten articles in this special issue focused on the most interesting topics in gastroenterology and hepatology research. One of the leading areas of advanced studies in gastroenterology is cancer research. Colorectal cancer is one of the most common malignancies worldwide in terms of incidence and mortality. Although clear progress in both diagnosis and treatment has been achieved, efficacy of surgery and chemotherapy remains unsatisfactory due to late diagnosis. A possible new prognostic marker and therapeutic target in this disease is discussed in the article “ATAD2 Overexpression Identifies Colorectal Cancer Patients with Poor Prognosis and Drives Proliferation of Cancer Cells.” The aim of another article dealing with the colorectal cancer “Molecular Features and Methylation Status in Early Onset (≤40 Years) Colorectal Cancer: A Population Based, Case-Control Study” was to define the frequency of known hereditary colorectal syndromes and to characterise genetic and epigenetic features of early nonhereditary tumours in order to elucidate possible pathogenetic mechanisms. Colonoscopy plays an important role in colorectal cancer screening in many countries worldwide. Quality of colonic cleansing achieved is crucial for good quality of colonoscopy screening. Possible improvements in the field of low volume colonoscopy cleansing were described in the article “A Randomized Controlled Trial Evaluating a Low-Volume PEG Solution Plus Ascorbic Acid versus Standard PEG Solution in Bowel Preparation for Colonoscopy.” Second malignancy, which is discussed in a special issue in more detail, is the third most common cause of cancer-related death in the world: the gastric cancer. In the article “The Prevalence of Gastric Intestinal Metaplasia and Distribution of Helicobacter pylori Infection, Atrophy, Dysplasia, and Cancer in Its Subtypes,” the prevalence of the precancerous gastric lesions (intestinal metaplasia especially) in a large cohort of patients within the region with a high risk of gastric cancer was described. The metastatic involvement of the posterior lymph nodes along the common hepatic artery (the extra-regional lymph nodes called No.8p) was identified as a prognostic factor in the retrospective study: “Prognostic Value of Metastatic No.8p LNs in Patients with Gastric Cancer.” The research based on the use of experimental animals still plays an important role in gastroenterology and the rat is one of the most extensively used experimental animal models. The study “Surgical Anatomy of the Gastrointestinal Tract and Its Vasculature in the Laboratory Rat” investigated the functional anatomy and vasculature of the stomach, liver, and intestine in the laboratory rat and compared it with human morphology. Nonsteroidal anti-inflammatory drug-induced gastropathy and ulcers represent an important complication related to one of the most commonly used drugs worldwide. Possible mucosal protective effect of Syzygium cumini (L.) Skeels aqueous extract in experimental mice model of indomethacin-induced gastric damage was proven in article “Anti-Inflammation Property of Syzygium cumini (L.) Skeels on Indomethacin-Induced Acute Gastric Ulceration.” Research in hepatology is represented in three articles: “Assessing the Effect of Leptin on Liver Damage in Case of Hepatic Injury Associated with Paracetamol Poisoning,” “Lower Viral Response to Pegylated Interferon Alpha 2a Treatment of Chronic Hepatitis B in Roma People in Eastern Slovakia,” and “Serum Liver Fibrosis Markers for Predicting the Presence of Gastroesophageal Varices in Liver Cirrhosis: A Retrospective Cross-Sectional Study.” The special issue cannot be a complete overview of research in the field of gastroenterology and hepatology. However, we believe that it is an interesting look at this area and provides a preview with an important impact on clinical medicine. Ilja Tacheci Jithinraj Edakkanambeth Varayil Zuzana Zelinkova Marcela Kopacova Miroslav Zavoral

Background Double-balloon enterocopy (DBE) is still under evaluation, including its yield and safety aspects. Objective Our purpose was to consider the relationship between DBE and hyperamylasemia. Design Single-center prospective study. Setting Tertiary referral hospital, conducted from March to October 2006. Patients Thirty-five oral DBEs were carried out in 31 patients (17 men, 14 women). Serum amylase, lipase, C-reactive protein (CRP), and urine amylase were taken before the procedure and 4 and 24 hours after the investigation. Abdominal pain was evaluated with a 3-step scale. Main Outcome Measurements Only 1 patient had acute pancreatitis after DBE. Results An elevation of amylase levels after the procedure was found in 51.4% and abdominal pain or nausea or vomiting in 34.3%, but 8.6% of these patients had no hyperamylasemia after DBE. CRP was determined in 25 procedures and the serum lipase level in 14 of these 25 DBEs; elevation of both factors after the procedure was found in 36%. The CRP level was elevated in 60% after the procedure. We found a positive correlation between abdominal pain and serum lipase level ( r = 0.72, P = .0032) and negative correlation between abdominal pain and age ( r = –0.445, P = .0076). Significant hyperamylasemia seems to be associated with longer duration of DBE (borderline statistically significant, P = .045; 95% CI for difference of means 0.985-82.306). Limitations Nonblinded nonrandomized study. Conclusions Hyperamylasemia after DBE seems to be rather common, mainly in the longest examinations. Although association of significant hyperamylasemia and acute pancreatitis is possible, it is not obligatory.

The (13)C-urea breath test ((13)C-UBT) is the most accurate non-invasive method for diagnosis of Helicobacter pylori infection. However, several methodological issues have not been resolved yet. The aim of this study was to test different protocols of (13)C-UBT to find the optimal test drink and sampling interval.(13)C-UBT was performed at 3-day intervals in 27 healthy volunteers using citric acid (test A), orange juice (B) and still water (C) as test drinks. Breath samples were collected from time 5 to 60 min. A total number of 2106 breath samples were analysed by isotope ratio mass spectrometry (cut-off value 3.5).Differences in delta values were greater than would be expected by chance (A versus B and A versus C at times 20, 25, 30, 35 and 40 min, p0.05, Dunnett's method). There were no grey zone- or false-negative results among H. pylori-positive persons in test A at any time, but some were found in tests B and C. Optimal intervals for breath sampling are at times 20 or 25 min after (13)C-urea ingestion.Citric acid solution as a test drink and 20- or 25-min breath sampling intervals are optimal for the (13)C-UBT in healthy volunteers.

To evaluate vital signs and body indices in Helicobacter pylori (H. pylori) positive and negative persons. A total of 22 centres entered the study. They were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1818 subjects (aged 5-98 years) took part in the study, randomly selected out of 38147 subjects. H. pylori infection was investigated by means of a 13C-urea breath test. Data on height, weight, systolic and diastolic blood pressure and heart rate were collected at the clinics of general practitioners. The overall prevalence of H. pylori infection was 30.4% (402/1321) in adults (≥ 18 year-old) and 5.2% (26/497) in children and adolescents (≤ 17 year-old). Once adjusted for age and gender, only a difference in body mass index remained statistically significant with H. pylori positive adults showing an increase of 0.6 kg/m(2) in body mass index. Once adjusted for age and gender, we found a difference in height between H. pylori positive and H. pylori negative children and adolescents. On further adjustment for place of residence, this difference became statistically significant, with H. pylori positive children and adolescents being on average 3.5 cm shorter. H. pylori positive adults were significantly older compared to H. pylori negative subjects. Once adjusted for age and gender, H. pylori infection had no impact on body weight, body mass index and vital signs either in adults or children and adolescents. Chronic H. pylori infection appeared to be associated with short stature in children. H. pylori infection did not influence blood pressure, body weight and body mass index either in adults or children and adolescents.

Whipple’s disease is a chronic infectious systemic disease caused by the bacteriumTropheryma whipplei. Nondeforming arthritis is frequently an initial complaint. Gastrointestinal and general symptoms include marked diarrhoea (with serious malabsorption), abdominal pain, prominent weight loss, and low-grade fever. Possible neurologic symptoms (up to 20%) might be associated with worse prognosis. Diagnosis is based on the clinical picture and small intestinal histology revealing foamy macrophages containing periodic-acid-Schiff- (PAS-) positive material. Long-term (up to one year) antibiotic therapy provides a favourable outcome in the vast majority of cases. This paper provides review of the literature and an analysis of our 5 patients recorded within a 20-year period at a tertiary gastroenterology centre. Patients were treated using i.v. penicillin G or amoxicillin-clavulanic acid + i.v. gentamicin for two weeks, followed by p.o. doxycycline (100 mg per day) plus p.o. salazopyrine (3 g per day) for 1 year. Full remission was achieved in all our patients.

Background. The purpose of study was to evaluate the diagnostic yield of capsule endoscopy for NSAID-induced enteropathy and clinical, laboratory, and endoscopic characteristics of disease in patients with rheumatoid arthritis.Methods. 37 rheumatoid arthritis patients (30 women; mean age 55) treated with NSAIDs (>1 month), presented with anaemia and/or positive faecal occult blood testing, entered the study and underwent capsule endoscopy (EndoCapsule; Olympus), laboratory tests, and filled in questionnaires.Results. The prevalence of NSAID-induced enteropathy diagnosed by capsule endoscopy was 68% (25/37), classified as mild (red spots or erosions) in 18 (49%), moderate (10–20 erosions) in 4 (11%), and severe enteropathy (>20 erosions or ulcers) in 3 (8%) patients. We did not find statistically significant relationship between the enteropathy and gender, age, haemoglobin, leukocytes, albumin and CRP, or dyspepsia. The difference between subgroups of NSAIDs according to the COX specificity was not statistically significant.Conclusions. Capsule endoscopy is a highly accurate noninvasive method for evaluation of NSAID-induced enteropathy. It was revealed in a substantial section of the patients with rheumatoid arthritis and occult gastrointestinal bleeding, mostly classified as mild damage. No simple clinical or laboratory markers of the presence or severity of NSAID-induced enteropathy were recognised. This trial is registered withDRKS00004940.

Objective. Balloon enteroscopy (BE) and capsule enteroscopy (CE) are enteroscopy methods that allow examination and treatment of the small bowel. Before the CE and BE era, the small intestine was difficult to access for investigation. Small intestinal tumours are infrequent conditions, but about half of them are malignant. Materials and Methods. A total of 303 BEs were performed in 179 patients. Oral insertion was performed in 240 and anal in 63 BEs. Indications for the procedure in our patients with small bowel tumours were anaemia and/or bleeding, obstruction, suspicion of carcinoid tumour, or suspicion of Peutz-Jeghers syndrome. Results. In 50 of our 179 patients (28%), we diagnosed some small intestinal tumours: hamartomas in Peutz-Jeghers syndrome in 16 patients, adenocarcinoma in 7, lymphoma in 6, carcinoid tumour in 4, melanoma and stromal tumour in 3, adenoma, lipoma, and inflammatory polyps in 2, and granular cell tumour, cavernous lymphangioma, fibrolipoma, Cronkhite-Canada polyps, and metastatic involvement in individual cases. Conclusion. BE facilitates exploration and treatment of the small intestine. The procedure is generally safe and useful. BE and CE are essential modalities for the management of small intestinal diseases.

Background: Nonsteroidal anti-inflammatory drugs may cause severe injury to all parts of the gastrointestinal tract. It has been hypothesised that probiotic bacteria might reduce this adverse effect. The aim of this study was to perform a morphometric evaluation of the gastrointestinal tract in experimental pigs treated using a 10-day high-dose of indomethacin with or without Escherichia coli Nissle 1917 (EcN). Methods: Twenty-four healthy mature pigs were included: Group A (controls; 6 animals), Group B (EcN; n = 6), Group C (indomethacin; n = 6) and Group D (EcN & indomethacin; n = 6). EcN (3.5 × 1010 live bacteria/day for 14 days) and/or indomethacin (15 mg/kg/day for 10 days) were administered. Specimens of the stomach, small and large bowel were routinely processed for microscopic examination. The height of glandular mucosa, height and width of interfoveolar spaces and villi and basement size of epithelial cells were evaluated. Results: Different effects of indomethacin and EcN on particular parts of the gastrointestinal tract were shown. The indomethacin and probiotics group demonstrated a significantly lower height of cryptal mucosa and colonocytes and widening of the basement size of colonocytes compared to controls ( p = 0.004; p < 0.001; p = 0.025). The height of cryptal mucosa was significantly higher in the EcN group compared to controls ( p = 0.001). Conclusions: Indomethacin alone induced marked adaptation of the gastric mucosa. EcN alone provided a significant favourable trophic effect on the colonic mucosa. However, indomethacin and probiotics administered together comprise the worst impact on all porcine stomach, small and large bowel.

The paper provides a basic review of intestinal microflora and its importance in liver diseases. The intestinal microflora has many important functions, above all to maintain the microbial barrier against established as well as potential pathogens. Furthermore, it influences the motility and perfusion of the intestinal wall, stimulates the intestinal immune system and therefore also the so-called common mucosal immune system, reducing bacterial translocation and producing vitamins. Immune homeostasis at mucosal level results from a controlled response to intestinal luminal antigens. In liver cirrhosis, there are many changes in its function, mostly an increase in bacterial overgrowth and translocation. In this review, probiotics and their indications in hepatology are generally discussed. According to recent knowledge, these preparations are indicated in clinical practice only for cases of hepatic encephalopathy. Probiotics are able to decrease the permeability of the intestinal wall, and decrease bacterial translocation and endotoxemia in animal models as well as in clinical studies, which is extremely important in the prevention of complications of liver cirrhosis and infection after liver transplantation. Probiotics could limit oxidative and inflammatory liver damage and, in some situations, improve the histological state, and thus non-alcoholic steatohepatitis could be considered as another possible indication.

This report presents a survey of current knowledge concerning one of the relatively frequent and severe complications of liver cirrhosis and associated ascites-spontaneous bacterial peritonitis. Epidemiology, aetiology, pathogenesis, clinical manifestation, diagnosis and present possibilities of treatment are discussed.

The aim of this study is to evaluate the diagnostic yield of capsule endoscopy in nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy in pigs. Indomethacin (400 mg/day) was administrated orally for 10 days to eight female pigs weighing 36.3 ± 2.4 kg. Afterwards, capsule endoscopy was performed, using the EndoCapsule system (Olympus Optical Co., Tokyo, Japan). The following morning, pharmacological euthanasia and immediate autopsy were performed. Small bowel injury compatible with NSAID-induced enteropathy was observed in 7/8 animals. The most common lesions were red spots and erosions. Ulcers and small intestinal bleeding were identified sporadically. Sensitivity and specificity of capsule endoscopy were 83.3% and 95.8%, respectively. Our results indicate that wireless capsule endoscopy is a highly accurate noninvasive method for evaluation of experimental NSAID-induced enteropathy.

Introduction Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract. Authors present a 67-year-old woman treated for iron deficiency anemia for the past 5 years. Suddenly, her disease was presented with painless severe gastrointestinal bleeding (fresh melena). Inverted Meckel’s diverticulum with ectopic pancreatic tissue as a source of severe gastrointestinal bleeding was diagnosed by intraoperative enteroscopy. Conclusion A combination of inversion of Meckel’s diverticulum with ectopic pancreatic tissue is extremely rare, particularly in elderly patient. Capsule endoscopy, double balloon enteroscopy, and ultimately intraoperative enteroscopy may be helpful in timely diagnosis.

Colonic mucosal abnormalities associated with sodium phosphate colonic preparations have been described. The aim of this prospective study was to determine the frequency at which these occur and to define the endoscopic and histopathologic patterns of these changes.Within a 16-month period, 730 of patients referred for elective colonoscopy entered the study. Patients with known inflammatory bowel disease and those taking non-steroidal anti-inflammatory drugs were excluded. A sodium phosphate solution was ingested orally 14 and 8 hours before endoscopy. After standard colonoscopy, a 3-year clinical follow-up program was conducted.Endoscopically, mucosal lesions, possibly associated with sodium phosphate ingestion, were visible in 24 patients (3.3%). Erosions were found in 3 patients, aphthoid lesions in 21 patients, and an ulcer in one patient. Lesions often were multiple. Histopathologically, findings included focal active inflammation in 14 of 24 patients, mucosal disruption and erosion (7/24), edema of the lamina propria (5/24), mucosal hyperemia or focal hemorrhage (5/24), lymphoid nodules (5/24), and ulceration (1/24).Orally administered sodium phosphate-associated colonic mucosal abnormalities are infrequent but can mimic an non-steroidal anti-inflammatory drug-induced injury or inflammatory bowel disease, and in particular must be differentiated from Crohn's disease.

Objective The causal mechanism of acute pancreatitis after oral double balloon enteroscopy (DBE) is still uncertain. The most probable cause seems to be a mechanical straining of the endoscope with an over-tube on the pancreas. Hyperamylasemia and hyperlipasemia after DBE are frequent and usually asymptomatic. They do not represent the immediate risk factor of acute pancreatitis. The aim of this prospective study was to investigate several laboratory markers to predict patients in a higher risk of hyperamylasemia and hyperlipasemia and/or possible DBE-associated acute pancreatitis. Methods A total 38 patients (18 men and 20 women, mean age 51 years) with 44 DBEs and 30 matched healthy controls with no endoscopy entered the study. Following laboratory markers were investigated before, 4 hours and 24 hours after DBE and once in controls: serum hs-CRP, prokalcitonin, total S100 protein, cathepsin B, SPINK1, lactoferrin, E-selectin, alfa-1-antitrypsin, malondialdehyde, amylase and lipase. The mean time of DBE was 80 min. (range 20 210 min.), the mean number of push-and-pull cycles was 14 (range 1 41). We have not recorded any DBEassociated acute pancreatitis in this series. Results Serum amylase and lipase rose significantly with the maximum 4 hours after DBE, with increased abnormal values in 31/44 (70%) of serum amylase and 29/44 (66%) of serum lipase (p < 0.001 and p < 0.001). Serum cathepsin and procalcitonin decreased significantly 4 hours after DBE compared to healthy controls and patients' values before DBE (p = 0.018 and p = 0.031). There was a statistically significant, but clinically irrelevant, difference in malondialdehyde between males and females 4 hours after DBE (0.33±0.20 vs. 0.20±0.13 μmol/L; p = 0.012). No other gender-associated difference was recorded. There was a trend for an association between number of push-and-pull cycles in DBE and procalcitonin (r = -0.384; p = 0.011) and urine amylase (r = 0.313; p = 0.043) 4 hours after DBE; between procalcitonin and alfa-1-antitrypsin (r = 0.358; p = 0.021), cathepsin (r = 0.362; p = 0.020) and hs-CRP (r = 0.358; p = 0.021); and between E-selectin and malondialdehyde (r = 0.364; p = 0.019) 4 hours after DBE. Either serum amylase or lipase 4 hours after DBE did not correlate with any markers before DBE. Conclusions Our current results support our previous hypothesis that endoscope-induced mechanical straining during DBE is the most important factor responsible for the increase of amylase and lipase or even for progression to acute pancreatitis. We found no laboratory predictive markers that would identify in advance those patients in a higher risk. This study was supported by the research grant MH CZ NT11524-5/2010 and by the programme PRVOUK 37-08.

Objectives Epidemiology of uninvestigated dyspepsia was studied in the Czech Republic for the first time in 2001 (1). The aim this current multi-centre prospective study was to evaluate dyspepsia using the samemethods in a representative sample of general unselected population from the same geographical areas 10 years later. Methods A total of 22 centres entered the study. They were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1,836 subjects (863 males and 973 females; aged 5-98 years) took part in the study and responded to the question on prevalence of dyspepsia. Complete data on variables used in our analysis was available for 1,685 subjects. The proportion of subjects reporting dyspepsia did not differ significantly between the restricted sample and the group excluded from multivariable analyses. Helicobacter pylori (Hp) status was investigated in all subject by means of 13C-urea breath test. Results In subjects aged 5-24 years, when we analyzed determinants of dyspepsia by type (subgroup A: dyspepsia as the only long-lasting symptom vs. subgroup B: dyspepsia as a part of the complex of other complaints or previously recognized diseases), we noted somewhat stronger increase in risk of dyspepsia A with age (OR 1.15 per 1 year of age, 95% CI 1.05-1.26, adjusted for gender) and with current use of antibiotics (OR 3.23 in users vs. non-users, 95% CI 0.87-11.9). In subjects aged 25+ years, when analyzed by type of dyspepsia, a statistically significant negative association of age with dyspepsia of type A became apparent (OR 0.95 per 1 year of age, 95% CI 0.94-0.97) while the association between age and dyspepsia type B was also statistically significant albeit positive (OR 1.02 per 1 year of age, 95% CI 1.01, 1.04). Furthermore, subjects who were single were at lower risk of dyspepsia type B (OR 0.46 in single vs. married, 95% CI 0.21-0.99, adjusted for age and gender). The unexpected protective effect of elementary education appeared also to be stronger for dyspepsia type B (OR for elementary vs. university educated 0.25, 95% CI 0.07-0.86, adjusted for age and gender). Hp negative subjects reported dyspepsia in 4.1% (aged 5-24 years) and 18.1 % (aged 25+ years). In Hp positive subjects, dyspepsia was present in 7.1% (aged 5-24 years; OR 1.45, 95% CI 0.41, 5.16) and 16.3% (aged 25+ years; OR 0.85, 95% CI 0.60, 1.21, adjusted for gender and age). Conclusions Despite the substantial decrease of Hp infection in the Czech Republic over the past 10 years, the prevalence and basic socio-demographic determinants of uninvestigated dyspepsia did not change significantly. Reference: Rejchrt et al. Eur J Gastroenterol Hepatol 2008; 20: 898-905. This study was supported by the research grant MH CZ NT115245/ 2010 and by the programme PRVOUK 3708.

Human intestinal microbiota create a complex polymicrobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO). SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacteriostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insufficiency, immunodeficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Non-invasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be complex, addressing all causes, symptoms and complications, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO.

Peutz-Jeghers syndrome (PJS) is an inherited, autosomal dominant disorder distinguished by hamartomatous polyps in the gastrointestinal tract and pigmented mucocutaneous lesions. Prevalence of PJS is estimated from 1 in 8300 to 1 in 280 000 individuals. PJS predisposes sufferers to various malignancies (gastrointestinal, pancreatic, lung, breast, uterine, ovarian and testicular tumors). Bleeding, obstruction and intussusception are common complications in patients with PJS. Double balloon enteroscopy (DBE) allows examination and treatment of the small bowel. Polypectomy using DBE may obviate the need for repeated urgent operations and small bowel resection that leads to short bowel syndrome. Prophylaxis and polypectomy of the entire small bowel is the gold standard in PJS patients. Intraoperative enteroscopy (IOE) was the only possibility for endoscopic treatment of patients with PJS before the DBE era. Both DBE and IOE facilitate exploration and treatment of the small intestine. DBE is less invasive and more convenient for the patient. Both procedures are generally safe and useful. An overall recommendation for PJS patients includes not only gastrointestinal multiple polyp resolution, but also regular lifelong cancer screening (colonoscopy, upper endoscopy, computed tomography, magnetic resonance imaging or ultrasound of the pancreas, chest X-ray, mammography and pelvic examination with ultrasound in women, and testicular examination in men). Although the incidence of PJS is low, it is important for clinicians to recognize these disorders to prevent morbidity and mortality in these patients, and to perform presymptomatic testing in the first-degree relatives of PJS patients.

Background: Small bowel pathology is often difficult to be diagnosed. Enteroscopy is an important diagnostic and/or therapeutic method. Aim of the study is to evaluate significance of push enteroscopy in diagnostics of metastatic involvement of small bowel Methods. Within 5 years (1995- 1999) 458 enteroscopy investigations were done (using push enteroscope Olympus SIF100 with or without overtube). Results. Metastatic involvement of small bowel was found in 8 patients (1.7 %). Two cases of malignant melanoma were found (the first one presenting as melena, the second one as a rapid weight loss). Other cases were as follows: pulmonary cancer metastasis (presenting as melena), teratoma (with microcytic anaemia), gastrinoma (MEN-I syndrome, hypergastrinaemia), carcinoid (melena, no endocrine activity), abdominal carcinomatous lymphadenopathy (with weight loss) and metachronous colon cancer (examined because of ileus). Conclusions: Metastatic involvement of small bowel is a rare condition, usually presenting of melena. Other clinical manifestation (microcytic anaemia, ileus, endocrine tumour activity or accidental finding) are less common.

It has been hypothesized that Helicobacter pylori (Hp) infection may contribute to reduced stature, risk of hypertension or obesity. The aim was to evaluate body indices in Hp positive and negative persons. A total of 2436 subjects (4-100 years old) were tested for Hp status by (13)C-urea breath test. Data on height and weight were collected for 84%, and blood pressure for 80% of the study subjects. The prevalence of Hp infection was 41.6%. The odds ratio for a 10-year increase in age was 1.21 (95% CI 1.17-1.25, p-value0.001). Statistically significant negative association of Hp positivity with body height was most pronounced in the younger age groups, while a positive association of Hp positivity with body mass index was only seen in those aged 15+ years. There was a negative effect of Hp positivity on systolic and diastolic blood pressure in subjects below 25 and a relatively strong positive effect on blood pressure in subjects over 65 years. Residual confounding by social characteristics as a possible explanation for the associations of Hp positivity with height and blood pressure cannot be excluded. Unmeasured factors related to social and family environment may cause the apparent association between Hp positivity and children's growth and blood pressure.

Background We hypothesised that different solutions for submucosal injection may influence early healing of endoscopic mucosal resection (EMR). The aim of this study was to evaluate histological and immunological changes after EMR in experimental pigs. Materials and methods Two parallel EMRs on the anterior and posterior wall of the gastric body were performed by means of the cap technique in 21 female pigs. A glycerol-based solution (anterior EMR) and hydroxypropyl methylcellulose solution (posterior EMR) were applied for submucosal injection. The animals were sacrificed 7 days later, and tissue sections of all EMRs were stained using combined trichrome. Computer image analysis was used for objective evaluation of elastic and collagen fibres content. Two-colour indirect immunophenotyping of blood and gastric samples were performed using mouse anti-pig monoclonal antibodies. Results The values of collagen fibre content 7 days after EMR were significantly higher in lesions after the use of solution A in comparison with solution B (2.10 ± 0.25% versus 1.57 ± 0.25%, p = 0.009). Concordant results were found in elastic fibres (3.23 ± 0.49% versus 2.93 ± 0.61%, p = 0.018). No systemic changes in major leukocyte subpopulations were found. In gastric tissue, lymphocyte subsets exhibited only minor changes. CD4+ T-lymphocytes were increased in the healing tissue after EMR using solution A (17.08 ± 9.24% versus 9.76 ± 7.97%, p = 0.011). Significant increase of SWC3+ leukocytes was observed after EMR using solution B (47.70 ± 25.41% versus 18.70 ± 12.16%, p = 0.001). Conclusions The use of glycerol-based solution for submucosal injection was associated with more pronounced histological signs of early healing of EMRs compared with hydroxypropyl methylcellulose.

Electrogastrography (EGG) is a non-invasive method for the assessment of gastric myoelectrical activity. Porcine EGG is comparable with human one. The purpose of this study was to evaluate the effect of atropine and neostigmine on the EGG in experimental pigs. Adult female pigs were administrated atropine (1.5 mg i.m., n=6) and neostigmine (0.5 mg i.m., n=6) after the baseline EGG, followed by a 90-min trial recording (MMS, Enschede, the Netherlands). Running spectral analysis was used for the evaluation. The results were expressed as dominant frequency of slow waves and EGG power (areas of amplitudes). Neostigmine increased continuously the dominant frequency and decreased significantly the EGG power. Atropine did not change the dominant frequency significantly. However, atropine increased significantly the EGG power (areas of amplitudes) from basal values to the maximum at the 10-20-min interval. After that period, the areas of amplitudes decreased significantly to the lowest values at the 60-90-min interval. In conclusion, cholinergic and anticholinergic agents affect differently EGG in experimental pigs.