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Purpose: Incidence of pancreatic exocrine insufficiency in biliary pathology is estimated for about 30%. The objective was to assess pancreatic exocrine function in biliary tract pathology (cholelithiasis, strictures) before and after endoscopic treatment. Patients and methods: Twenty-eight patients with choledocholithiasis and its complications (19F/9M; aging 31-90 years, median: 69 years) were evaluated. Fecal elastase 1 concentration was measured using ELISA, before, early, and 6-8 weeks after endoscopic treatment. The inflammatory response of pancreas to the treatment was also assessed. Results: Initial fecal elastase 1 concentration in patients (median 454 µg/g) was not significantly different as compared to the control (median 357 µg/g). Nine patients (32%) had low fecal elastase 1 concentration (below 250 µg/g) and out of them 6 had the concentration below 200 µg/g, suggesting impairment of exocrine pancreatic function. Endoscopic treatment was successful in 82% of patients. Pancreatic inflammatory response was noted only in one patient. After 6-8 weeks fecal elastase 1 concentration in the whole group of patients did not significantly change in comparison to the initial level. However, out of 9 patients with initially low fecal elastase 1 concentration (median 191 µg/g) at least in 6 pancreatic function improved (median 310 µg/g), P<0.001. Conclusion: One third of the patients with biliary pathology had a low fecal elastase 1 concentrations, suggesting pancreatic dysfunction. In at least 2/3 of these patients successful endoscopic treatment of biliary pathology resulted in the significant increase of fecal elastase 1 concentration. Therefore, an additional positive effect of such treatment in some patients, could be an improvement of the exocrine pancreatic dysfunction. [ABSTRACT FROM AUTHOR]

Purpose: Increased expression of epidermal growth factor (EGF), its receptor (EGFR), and c-erb-B2 protein, which is homological with the EGF receptor, in gastric mucosa, may play a role in gastric carcinogenesis. We assessed if the infection and eradication of Helicobacter pylori (H. pylori) affects the gastric expression of growth factors and serum gastrin concentrations., Patients/methods: We examined immunohistochemically gastric EGF and both receptors' expression in: gastric cancer (GC; n=29), chronic gastritis with H. pylori infection (GHp+; n=40) before and after eradication and in patients without H. pylori infection (GHp-; n=42)., Results: Before the eradication therapy, gastric mucosal EGF and both receptor's expressions in GHp+ patients were increased compared to GHp- (p<0.05), but were similar to GC. After eradication, EGF and the receptor's expression significantly decreased in the gastric body. Both EGFR and c-erb-B2 expression in the antrum were still higher than in GHp- (p<0.05), and remained comparable to GC., Conclusions: In patients with H. pylori infection the gastric mucosal EGF, EGFR, and c-erb-B2 expressions are similar to those observed in gastric cancer. The persistence of the antral expression of receptors after eradication, at a level comparable to the gastric cancer group, suggests their eventual role in the progression of changes initiated by H. pylori toward carcinogenesis., (Copyright © 2014 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Background: Elevated serum concentrations of macrophage-colony stimulating factor (M-CSF) have been found in a variety of malignant diseases. The aim of our study was to assess correlations between serum levels of M-CSF and clinicopathological features and survival rates in patients with colorectal cancer (CRC)., Patients/methods: M-CSF and the established tumor markers (carcinoembryonic antigen - CEA and carbohydrate antigen - CA 19-9) were investigated in the sera of 116 colorectal cancer patients and correlated with the clinical parameters of the disease and with the survival of patients. We compared M-CSF serum levels in CRC with colorectal adenoma patients. M-CSF was determined using enzyme-linked immunosorbent assay (ELISA). Tumor markers were measured by microparticle enzyme immunoassays (MEIA)., Results: CRC patients had significantly higher M-CSF and tumor markers levels compared to healthy controls and colorectal adenoma patients, with a significant association between M-CSF levels, disease stage and lymph node metastasis. Serum levels of M-CSF and CEA decreased significantly after radical resection of the tumor. Moreover, the multivariate analysis showed that the serum level of M-CSF in CRC patients was an independent prognostic factor., Conclusion: These findings suggest the potential clinical use of circulating M-CSF measurements, particularly in estimating prognosis for patients with CRC.

Gastro-esophageal reflux disease (GERD) is one of the most important problems of gastroenterology at present. The symptoms of GERD have negative influence of patients' life on a daily basis. The principal aim of reflux disease treatment is to eliminate or alleviate the symptoms, to heal tissue damages and to reduce the frequency and duration of recurrences. Lifestyle and dietary modification are of only limited value in GERD treatment. Proton pump inhibitors (PPI) are the mainstay of GERD pharmacotherapy for both initial episode and long-term management. Surgical treatment is indicated in: complicated GERD, in patients who need high effective dose of medication, young patients who need lifelong PPI, patients with big hiatus hernia. Laparoscopic Nissen fundoplication has become the operation of choice. Nevertheless patients who have undergone fundoplication may experience adverse post operative complication. The useful alternatives in the management of GERD may indeed eventually prove the new endoscopic methods of minimally invasive treatment which are currently under thorough evaluation. The most promising methods of endoscopic treatment of GERD have been discussed: radiofrequency ablation (the Streett's procedure), endoscopic gastroplasty, endoscopic implantation of biopolymer hydrogel prosthesis.

Aim: To determine the correlation between episodes of ischaemia in ECG recordings with pathologic gastro-esophageal reflux during simultaneous 24 hour monitoring of ECG and oesophageal pH., Methods: Simultaneous 24 hour monitoring of ECG and oesophageal pH was performed in 30 patients (p) (26 M/4F, aged 39-74) with coronary artery disease of CCS class II-III, CAD was confirmed in coronary angiography. Analysis of the oesophageal pH was performed by using the Polygram programme (PW-version 2.04 Esophogram-version 2.01). ST depression > 1 mm and lasting at least 1 min was regarded as significant in ECG monitoring. Pathologic gastro-esophageal reflux was defined as a drop in pH < 4 lasting more than 5 min. Gastrooesophageal reflux disease (GERD) was diagnosed when a drop in pH < 4 lasted for more than 5% of the monitoring period. Gastro-oesophageal reflux dependent ST depression was defined as an ST depression that occurred during reflux episode and lasted up until 10 min from the end of the reflux., Results: 26 patients (87%) had a total of 116 episodes of ST depression and 21 out of the 116 episodes (18%) were Gastro-oesophageal reflux time dependent. Fifteen patients (50%), had at least one episode of ST depression, depending on the time of reflux. Pathologic gastro-esophageal reflux was present in 25 patients (85%). In 14 patients (46.6%), the GERD pH criteria were fulfilled. In this group of patients, there was a significantly longer time of total ST depression (total ischaemic burden)., Conclusions: 1. GERD is a frequent disease in patients with angiographically proven coronary artery disease. 2. Pathological gastroesophageal reflux can induce myocardial ischaemia, which can be determined by analysis of ST depression during 24 hour monitoring of ECG.