Differential diagnosis between benign and malignant biliary stenosis can be difficult in clinical practice. Histology of biopsy specimens is often indeterminate. Laboratory markers (serum bilirubin > 75 μmol/L, carbohydrate antigen 19-9 > 400 U/mL) and the length of stenosis (>15 mm) can be helpful but are not specific enough. The aim of this study was to investigate bile acids in liver bile of patients with benign and malignant biliary stenosis and controls without stenosis. A total of 73 patients entered the study: 7 subjects with benign biliary stenosis (6 men, 1 woman; 68 ± 13 years old), 21 with malignant biliary stenosis (15 men, 6 women; 72 ± 14 years old), and 45 patients without biliary stenosis (22 men, 23 women; 70 ± 13 years old); out of those, 25 subjects have and 20 do not have choledocholithiasis. Twenty-three different bile acids were investigated by high-performance liquid chromatography/mass spectrometry. Serum total bilirubin was significantly higher in patients with malignant biliary stenosis compared with nonstenotic controls (p = 0.005). Significant relationship (r > 0.7) was found between several pairs of bile acids. Significantly lower bile acid concentrations in malignant biliary stenosis compared to controls without stenosis were found for GLCA (p = 0.032), GUDCA (p = 0.032), GCDCA (p = 0.006), GDCA (p = 0.031), GHCA (p = 0.005), TUDCA (p = 0.044), and TDCA (p = 0.036). Significant difference in cholic acid was found between benign and malignant stenosis (p = 0.022). Analysis of bile acids might be helpful in the differential diagnosis of malignant and benign biliary stenosis. More patients need to be enrolled in further studies so that the real diagnostic yield of bile acids can be determined.
- Publication type
- Journal Article MeSH
OBJECTIVE: The epidemiology of uninvestigated dyspepsia was studied in the Czech Republic for the first time in 2001. The aim of the current multicenter prospective study was to evaluate dyspepsia using the same methods in a representative sample of general unselected population from the same geographical areas 10 years later. PARTICIPANTS AND METHODS: A total of 38 147 individuals comprised the general population for a random two-step selection process. A total of 1836 participants (863 males and 973 females; aged 5-98 years) took part in the questionnaire-based study. Helicobacter pylori status was investigated in all participants by means of C-urea breath test. RESULTS: The overall prevalence of dyspepsia was 2.6% among children and adolescents aged 5-17 years and 16.0% among adults aged 18-98 years. We did not detect any statistically significant sex differences in the prevalence of total dyspepsia or its subtypes. Overall, 2.4% of H. pylori-negative children and adolescents aged less than 18 years reported dyspepsia, and 16.8% of H. pylori-negative adults reported it. Among H. pylori-positive children and adolescents and adults, dyspepsia was present in 8.3 and 15.8%, respectively. Type A dyspepsia (as the only long-lasting symptom) was statistically significantly associated with H. pylori status among children and adolescents. Among adults aged 18 years or older, we noted a lower prevalence of dyspepsia in adults with elementary education compared with university education. Current use of antibiotics was associated with an increased prevalence of dyspepsia in adults. CONCLUSION: Despite the substantial decrease of H. pylori infection in the Czech Republic over the past 10 years, the prevalence and sociodemographic determinants of uninvestigated dyspepsia did not change significantly.
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Time Factors MeSH
- Residence Characteristics MeSH
- Child MeSH
- Adult MeSH
- Dyspepsia diagnosis epidemiology microbiology MeSH
- Helicobacter pylori isolation & purification MeSH
- Helicobacter Infections diagnosis epidemiology microbiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Child, Preschool MeSH
- Prevalence MeSH
- Prognosis MeSH
- Prospective Studies MeSH
- Risk Factors MeSH
- Sex Distribution MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Sex Factors MeSH
- Socioeconomic Factors * MeSH
- Educational Status MeSH
- Age Factors MeSH
- Age Distribution MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Child, Preschool MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Czech Republic epidemiology MeSH
První epidemiologickou studii nevyšetřené dyspepsie v České republice provedla naše skupina v roce 2001. V roce 2011 jsme provedli novou prospektivní multicentrickou studii stejnou metodikou. V 22 centrech bylo zařazeno 1 836 osob (ve věku 5–98 let). Celková prevalence dlouhodobou dyspepsie byla 12 %, a to 3,5 % u lidí ve věku 5–24 let, 18 % mezi 25–64letými a 15 % u lidí ≥ 65 let. Přestože v posledních 10 letech došlo k významnému poklesu prevalence infekce Helicobacter pylori, prevalence a sociodemografické determinanty dyspepsie se signifikantně nezměnily.
Epidemiology of uninvestigated dyspepsia was studied in the Czech Republic for the first time in 2001. The aim of our current multi-centre prospective study was to evaluate dyspepsia using the same methods in a representative sample of general unselected population from the same geographical areas 10 years later. A total of 22 centres entered the study. A total of 1,836 subjects (aged 5–98 years) were enrolled. The overall prevalence of dyspepsia was 12 %; namely 3.5 % in subjects aged 5–24 years, 18 % among 25–64-year-old persons and 15 % in subjects ≥ 65 years. Despite the substantial decrease of Helicobacter pylori infection in the Czech Republic over the past 10 years, the prevalence and basic socio-demographic determinants of uninvestigated dyspepsia did not change significantly.
- Keywords
- nevyšetřená dyspepsie,
- MeSH
- Abdominal Pain epidemiology MeSH
- Dyspepsia * history epidemiology etiology classification MeSH
- Helicobacter pylori MeSH
- Helicobacter Infections diagnosis epidemiology MeSH
- Humans MeSH
- Multicenter Studies as Topic MeSH
- Prevalence MeSH
- Signs and Symptoms, Digestive MeSH
- Irritable Bowel Syndrome epidemiology MeSH
- Terminology as Topic MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
Rozpoznání adenomů a časných karcinomů při endoskopickém vyšetření představuje praktickou realizaci sekundární prevence slizničních karcinomů gastrointestinálního traktu. Slizniční neoplazie se odlišují od okolní sliznice změnou barvy, reliéfu a abnormalitami v průběhu povrchových cév. Moderní endoskopické metody usnadňují lékařům jejich identifikaci zvýrazněním těchto odchylek. Další krok představuje určení biologické povahy, odlišení léze nenádorové od nádorové, což je důležité pro další postup. Léze nádorové je zapotřebí odstranit endoskopicky nebo chirurgicky, nenádorové lze ponechat na místě. Mikroendoskopické techniky umožňují posouzení strukturálních i buněčných atypií a tak dosažení přesnější diferenciace mezi nádorovou a nenádorovou lézí.
Identifying adenomas and early carcinomas during an endoscopic examination represents a practical realisation of secondary prevention of mucosal carcinomas of the gastrointestinal tract (GIT). Mucosal neoplasms differ from the surrounding tissues by their colour, texture and abnormalities in the course of surface blood vessels. Modern endoscopic methods make it easier for the physician to identify these by highlighting the irregularities. The next step is to determine the biological nature of the findings, distinguishing tumour and non-tumour lesions, which is important for the consequent procedures. It is necessary to remove tumour lesions either via endoscopy or surgically, non-tumour lesions can be left alone. Micro-endoscopic techniques enable evaluation of structural and cellular irregularities and thus helps achieve the possibility of distinguishing tumour and non-tumour lesions more precisely.
- Keywords
- endocystoskopie, konfokální laserová endomikroskopie, neoplazie trávicí trubice, karcinom tračníku,
- MeSH
- Financing, Organized MeSH
- Endoscopy, Gastrointestinal methods instrumentation utilization MeSH
- Gastrointestinal Neoplasms diagnosis MeSH
- Microscopy, Confocal methods instrumentation utilization MeSH
- Microscopy methods instrumentation utilization MeSH
- Colonic Neoplasms diagnosis MeSH
Biodegradable stents, which are made of various synthetic polymers, such as polylactide or polyglycolide, or co-polymers, such as polydioxanone, can be used for the treatment of benign refractory stenoses of the gastrointestinal tract. Here we report 11 patients (median age 41) with stenosing Crohn's disease of the small and/or large intestine. Endoscopic insertion of a biodegradable stent was successful at the first attempt in all patients except one. Subsequent follow-up was for a mean of 16 months, median 17 months, range 12-29 months. Early stent migration (between 2 days and 8 weeks) was seen in three patients. Mucosal overgrowth (epithelial hyperplasia) was not observed in any of the patients during the follow-up period. The high rate of early stent migration might be solved by appropriate tailoring and further improvements in the design of the biodegradable stents. Proof of long-term efficacy and safety requires further studies.
- MeSH
- Crohn Disease complications MeSH
- Adult MeSH
- Colon pathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Intestinal Diseases etiology therapy MeSH
- Prospective Studies MeSH
- Prosthesis Failure MeSH
- Constriction, Pathologic etiology therapy MeSH
- Stents MeSH
- Intestine, Small pathology MeSH
- Absorbable Implants MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Bio-degradable stents are be made of different synthetic polymers (like polylactide or polyglycolide) or their co-polymers (polydioxanone). They can be used for treating benign stenoses of the small and large intestine, particularly in Crohn's disease. Endoscopic introduction of bio-degradable stents into small and large intestinal stenoses is feasible and relatively simple. Initial results are encouraging and the complication rate is low. However, there are still some difficulties that need to be overcome. The rate of early stent migration is still rather high (up to one third of patients). This might be solved by changes in the shape or rigidity of the stents as well as by further improvement in the design. Proof of long-term efficacy and safety requires further studies.
- MeSH
- Biocompatible Materials MeSH
- Crohn Disease surgery complications MeSH
- Adult MeSH
- Endoscopy, Gastrointestinal MeSH
- Humans MeSH
- Polymers MeSH
- Stents MeSH
- Intestinal Obstruction MeSH
- Absorbable Implants MeSH
- Animals MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Animals MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
