• MeSH
• gastrointestinální endoskopie * MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• úvodní články MeSH
• úvodníky MeSH

Donor-specific antibodies (DSA) cause antibody-mediated rejection (AMR); however, their pathogenic role has not yet been adequately investigated after liver transplantation. The aim of our study was to analyse the clinical significance of DSA and complement-binding DSA for the prediction of AMR after liver transplantation. Our cohort included 120 liver recipients with assessed protocol biopsies one year post-transplant. All patients had defined HLA-specific and complement-binding (C1q + and C3d+) antibodies before and in regular intervals after transplantation. The incidence of DSA was evaluated in relation with clinical and histopathological data in the liver allografts. A higher occurrence of acute AMR was observed in recipients with preformed complement-binding DSA to HLA Class I antigens. Patients who developed chronic AMR had more frequently de novo-produced antibodies against HLA Class II antigens (P = 0.0002). A correlation was also found between de novo-formed C1q + and C3d+-binding antibodies to HLA Class II antigens and the development of chronic AMR (P = 0.043). Our study implies that preformed complement-binding DSA to HLA Class I antigens are related to increased risk of acute antibody-mediated rejection, while chronic AMR is more frequent in patients with de novo-produced antibodies to HLA Class II antigens after liver transplantation.

• MeSH
• dárci tkání MeSH
• HLA antigeny MeSH
• isoprotilátky MeSH
• komplement C1q MeSH
• lidé MeSH
• přežívání štěpu MeSH
• rejekce štěpu MeSH
• retrospektivní studie MeSH
• transplantace jater * škodlivé účinky   MeSH
• transplantace ledvin * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND AND AIM: Probe-based confocal laser endomicroscopy (pCLE) provides real-time microscopic visualisation. Our aim was to compare the diagnostic accuracy of pCLE with standard biopsies in patients with visible oesophageal or gastric lesions. METHODS: This was a single-centre, prospective, pathologist-blinded study. Patients underwent high-resolution endoscopy, and lesions were examined by pCLE followed by standard biopsies. A definitive diagnosis was determined from resection specimen. Main outcomes were overall diagnostic accuracy, sensitivity, specificity and positive and negative predictive values. RESULTS: We examined 74 lesions in 67 patients. Definitive diagnoses revealed 34 malignant and 40 non-malignant lesions. pCLE diagnosis was correct in 89.2% (66/74), while diagnosis based on biopsy was correct in 85% (57/67; p = 0.6). The overall diagnostic accuracy of biopsies was 85% (76-94%) and that of pCLE was 89% (79-96%). pCLE correctly diagnosed malignant lesions, comprising oesophageal adenocarcinoma, oesophageal squamous-cell cancer or gastric adenocarcinoma, in 88.2% (30/34) of cases, while biopsy was correctly diagnosed in 75.9% (22/29; p = 0.3). Sensitivity and specificity to diagnose a malignant lesion were 75.9% (95% confidence interval (CI) 56-89%) and 100% (95% CI 90-100%) for biopsies and 88.2% (95% CI 72-97%) and 92% (95% CI 79-98%) for pCLE. No differences between biopsies and pCLE were found with regard to sensitivity, specificity to diagnose dysplastic and benign lesions (p > 0.2). CONCLUSION: pCLE provides satisfactory diagnostic accuracy comparable with standard biopsies in patients with oesophageal or gastric lesions. ClinicalTrials.gov identifier: NCT0292049).

• MeSH
• adenokarcinom diagnóza   patologie   MeSH
• biopsie statistika a číselné údaje   MeSH
• dospělí MeSH
• gastrointestinální endoskopie přístrojové vybavení   metody   statistika a číselné údaje   MeSH
• konfokální mikroskopie přístrojové vybavení   metody   statistika a číselné údaje   MeSH
• lasery MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory jícnu diagnóza   patologie   MeSH
• nádory žaludku diagnóza   patologie   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• sliznice jícnu diagnostické zobrazování   patologie   MeSH
• spinocelulární karcinom diagnóza   patologie   MeSH
• žaludeční sliznice diagnostické zobrazování   patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

• Publikační typ
• úvodníky MeSH

Endoscopic submucosal dissection or widespread endoscopic resection allow the radical removal of circumferential or near-circumferential neoplastic esophageal lesions. The advantage of these endoscopic methods is mini-invasivity and low risk of major adverse events compared to traditional esophagectomy. The major drawback of these extensive resections is the development of stricture - the risk is 70-80% if more than 75% of the circumference is removed and almost 100% if the whole circumference is removed. Thus, an effective method to prevent post-ER/ESD esophageal stricture would be of major benefit, because treatment of strictures requires multiple sessions of endoscopic dilatation and may carry a risk of perforation. Moreover, not all strictures are easy to treat and some patients may develop refractory strictures. There are several techniques and methods, which have been tested in both experimental and/or clinical studies but no one has received general acceptance based on results of high-quality evidence. The studies are usually small with a limited number of patients, there is a lack of randomized controlled trials and some techniques have been described only in experimental studies. Thus, prevention of post-ESD strictures remains an unresolved issue. On the other hand, because of the high risk of stricture and partially proven effectiveness of some preventive techniques, a preventive strategy should be considered in patients undergoing extensive ER/ESD in the esophagus. There is, however, no evidence about the superiority or inferiority of a particular preventive strategy compared to other techniques, moreover, there is paucity of data assessing the effectiveness of the combination of different preventive methods. The best preventive strategies known so far include 1) oral or local administration of corticosteroids; and 2) preventive stenting. Other strategies (preventive sessions of endoscopic dilatation or tissue engineering methods) have unproven efficacy or are too demanding for practical use. Nevertheless, the use of (any) preventive strategy after extensive ER/ESD of the esophagus probably reduces the risk of stricture and the number of endoscopic dilatations, therefore, it should be considered in these patients. However, there is a need for high quality evidence as well as for new ideas and approaches to resolve this important clinical problem.

• MeSH
• endoskopická mukózní resekce * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace etiologie   prevence a kontrola   MeSH
• rizikové faktory MeSH
• stenóza jícnu etiologie   prevence a kontrola   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Esophageal symptoms can arise from gastroesophageal reflux disease (GERD) as well as other mucosal and motor processes, structural disease, and functional esophageal syndromes. GERD is the most common esophageal disorder, but diagnosis may not be straightforward when symptoms persist despite empiric acid suppressive therapy and when mucosal erosions are not seen on endoscopy (as for nonerosive reflux disease, NERD). Esophageal physiological tests (ambulatory pH or pH-impedance monitoring and manometry) can be of value in defining abnormal reflux burden and reflux-symptom association. NERD diagnosed on the basis of abnormal reflux burden on ambulatory reflux monitoring is associated with similar symptom response from antireflux therapy for erosive esophagitis. Acid suppression is the mainstay of therapy, and antireflux surgery has a definitive role in the management of persisting symptoms attributed to NERD, especially when the esophagogastric junction is compromised. Adjunctive approaches and complementary therapy may be of additional value in management. In this review, we describe the evaluation, diagnosis, differential diagnosis, and management of NERD.

• MeSH
• ezofágoskopie metody   MeSH
• gastroezofageální junkce * metabolismus   patofyziologie   MeSH
• gastroezofageální reflux * diagnóza   metabolismus   patofyziologie   MeSH
• lidé MeSH
• manometrie metody   MeSH
• monitorování jícnového pH metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Achalasia is an esophageal motility disorder associated with abnormalities in peristalsis and lower esophageal sphincter (LES) relaxation. The etiology of the disease remains elusive. It is often misdiagnosed initially as gastroesophageal reflux disease. Patients with achalasia often complain of dysphagia to solids and liquids but may focus on regurgitation as the primary symptom, leading to the early misdiagnosis. Chest pain, weight loss, and occasional vomiting may be additional symptoms encountered in those with achalasia. The disease may be suspected on the basis of clinical presentation, but diagnosis depends on classic findings using high-resolution manometry, showing either failed or simultaneous contractions with associated normal or high LES pressures with no or incomplete relaxation with swallows. There are no cures for achalasia, and, in most patients, treatments have to be repeated over time. Definitive treatment options in achalasia include pneumatic dilation, surgical myotomy, and the new technique of per-oral endoscopic myotomy. Botulinum toxin (Botox) or other medical therapies are often reserved for those who cannot have definitive therapies owing to comorbid conditions.

• MeSH
• achalázie jícnu diagnóza   patofyziologie   terapie   MeSH
• bolesti na hrudi komplikace   diagnóza   terapie   MeSH
• botulotoxiny terapeutické užití   MeSH
• ezofágoskopie metody   MeSH
• gastroezofageální reflux diagnóza   patofyziologie   terapie   MeSH
• lidé MeSH
• management nemoci * MeSH
• manometrie metody   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

There is scarce evidence regarding the use of iron chelators in patients with hereditary hemochromatosis who are intolerant of phlebotomy or erythrocytapheresis. A 52-year-old man with genetically confirmed HFE hemochromatosis presented with liver disease and heart failure with severe left ventricular systolic dysfunction. Because of anemia after initial treatment, we added intravenous deferoxamine followed by oral deferiprone to less frequent erythrocytapheresis, which normalized systolic function within 1 year. Repeated cardiac magnetic resonance imaging revealed improvement of the T2* relaxation time. This report illustrates the beneficial effect of iron chelators in individuals with HFE hemochromatosis and poor tolerance of erythrocytapheresis.

• MeSH
• chelátory železa aplikace a dávkování   MeSH
• deferoxamin aplikace a dávkování   MeSH
• dysfunkce levé srdeční komory diagnóza   etiologie   MeSH
• ferritiny analýza   MeSH
• hemochromatóza * krev   diagnóza   farmakoterapie   patofyziologie   MeSH
• kardiomyopatie * diagnóza   etiologie   patofyziologie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonance kinematografická metody   MeSH
• nemoci jater diagnóza   etiologie   MeSH
• přetížení železem krev   komplikace   MeSH
• protein hemochromatózy genetika   MeSH
• pyridony aplikace a dávkování   MeSH
• srdeční selhání * diagnóza   farmakoterapie   etiologie   MeSH
• stupeň závažnosti nemoci MeSH
• tepový objem MeSH
• transferin analýza   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Exciting new developments-pharmacologic, endoscopic, and surgical-have arisen for the treatment of many esophageal diseases. Refractory gastroesophageal reflux disease presents a therapeutic challenge, and several new options have been proposed to overcome an insufficient effectiveness of proton pump inhibitors. In patients with distal esophageal spasm, drugs and endoscopic treatments are the current mainstays of the therapeutic approach. Treatment with proton pump inhibitors (or antireflux surgery) should be considered in patients with Barrett's esophagus, since a recent meta-analysis demonstrated a 71% reduction in risk of neoplastic progression. Endoscopic resection combined with radiofrequency ablation is the standard of care in patients with early esophageal adenocarcinoma. Mucosal squamous cancer may also be treated endoscopically, preferably with endoscopic submucosal dissection. Patients with upper esophageal cancer often refrain from surgery. Robot-assisted, thoracolaparoscopic, minimally invasive esophagectomy may be an appropriate option for these patients, as the robot facilitates a good overview of the upper mediastinum. Induction chemoradiotherapy is currently considered as standard treatment for patients with advanced squamous cell carcinoma, while the role of neoadjuvant therapy for adenocarcinoma remains controversial. A system for defining and recording perioperative complications associated with esophagectomy has been recently developed and may help to find predictors of mortality and morbidity.

• MeSH
• Barrettův syndrom diagnóza   terapie   MeSH
• ezofagektomie metody   trendy   MeSH
• ezofágoskopie metody   trendy   MeSH
• gastroezofageální reflux diagnóza   terapie   MeSH
• inhibitory protonové pumpy terapeutické užití   MeSH
• lidé MeSH
• nádory jícnu diagnóza   terapie   MeSH
• nemoci jícnu diagnóza   terapie   MeSH
• výsledek terapie MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Malignant gastric outlet obstruction is often treated by stent placement. OBJECTIVE: To investigate the outcomes of stent placement in the palliative treatment of malignant neoplasms. DESIGN: Prospective, observational, multicenter registry. SETTING: Six tertiary care centers in 5 countries. PATIENTS: A total of 108 adult patients with malignant gastric outlet obstruction. INTERVENTIONS: Placement of an uncovered, self-expandable, metal duodenal stent. MAIN OUTCOME MEASUREMENTS: The primary endpoint was stent patency at 14 days after stent implantation. Secondary endpoints included stent patency at 1, 2, 3, and 6 months, gastric outlet obstruction scoring system (GOOSS) scores at 14 days and 1, 2, 3, and 6 months after stent deployment, technical success, adverse events, and patient survival (ie, confirmed duration of the implant). RESULTS: Technical success was achieved in 99.1% of stent placements. Stent patency at 14 days was 94.6%. Kaplan-Meier estimates of stent patency were 92.9% at 1 month, 86.2% at 2 months, 81.9% at 3 months, and 63.4% at 6 months. At 14 days, GOOSS scores increased by a median of 1 point. The overall GI adverse event rate was 32.4%; however, the stent-related adverse event rate was 19.4%. The median implant duration was 47 days (range 0-195 days). LIMITATIONS: Observational study, no control group. CONCLUSIONS: Duodenal stent placement resulted in prompt relief of malignant gastric outlet obstruction and improved GOOSS scores. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT00991614.).

• MeSH
• časové faktory MeSH
• dospělí MeSH
• gastrointestinální endoskopie škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory trávicího systému komplikace   MeSH
• obstrukce vyprazdňování žaludku etiologie   terapie   MeSH
• paliativní péče * MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenty * škodlivé účinky   MeSH
• stupeň závažnosti nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH