Doporučené diagnostické a terapeutické postupy pro všeobecné praktické lékaře
25 stran : ilustrace ; 30 cm
Směrnice a příručka, která se zaměřuje na diagnostiku a terapii nemocí horní části trávicího traktu. Určeno praktickým lékařům.
OBJECTIVE: Crohn's disease (CD) can be associated with a wide range of extraintestinal manifestations (EIMs), including neurological ones. Published studies differ in their conclusions about the epidemiology and etiopathogenesis of neurological EIMs. The aims of this study were to demonstrate the presence and find risk factors of peripheral (somatic and autonomic) neuropathy patients with severe CD on anti-TNFα biological therapy. MATERIAL AND METHODS: A clinical examination focusing on detection of peripheral sensor-motor nervous dysfunction (including Sudoscan) and examination of autonomic nervous system dysfunction (using Ewing ́s battery tests and spectral analysis) together with laboratory tests and collection of demographic data followed by administration of questionnaires were performed on a total of 30 neurologically asymptomatic outpatients with severe CD on anti-TNFα biological therapy. RESULTS: Peripheral sensor-motor nervous function via clinical neurological examination was pathological in 36.7% and Sudoscan in 33.3% of cases. Statistically significant associations between vibration perception test and age, CD and biological therapy duration, body mass index and Crohn's Disease Activity Index were proved while statistically significant associations between temperature perception test and age and BMI were proved as well. Additionally, a decrease of total protein in a patient ́s serum below the physiological cut-off in the 6 months prior to measurement was associated with a pathological result of a Sudoscan. Cardiovascular autonomic neuropathy based on Ewing ́s battery tests was present in 56.7% of patients, no statistically significant risk factors were found. Our peripheral neuropathy questionnaire correlated with the results of the Sudoscan test and some tests of the clinical examination of peripheral sensor-motor nervous function (discriminatory contact perception test, temperature perception test). CONCLUSIONS: This study demonstrated a relatively high prevalence of peripheral (especially autonomic) neuropathy and verified some risk factors for the development of peripheral somatic neuropathy in asymptomatic patients with severe form of CD on anti-TNFα biological therapy.
- MeSH
- autonomní nervový systém MeSH
- biologická terapie MeSH
- Crohnova nemoc * farmakoterapie epidemiologie komplikace MeSH
- lidé MeSH
- nemoci autonomního nervového systému * MeSH
- nemoci periferního nervového systému * MeSH
- TNF-alfa terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
PURPOSE: Fecal immunochemical test (FIT) once a year or colonoscopy once in 10 years is the option approved for colorectal cancer (CRC) screening for asymptomatic individuals aged ≥ 50 years in the Czech Republic. We analyzed participation in the screening program to determine possible improvements. METHODS: In this observational cross-sectional study, data were collected from 4044 randomly chosen individuals from the Czech population (1866 men, 2178 women) aged ≥ 50 years by questionnaires. Individuals who underwent colonoscopy within the last 10 years or/and FIT within the last 2 years were classified as participants in the screening. RESULTS: 1050 individuals underwent FIT, 464 colonoscopy, and 558 underwent both. Adjusted for age, gender, and education, a higher chance of participation in the screening was observed in groups of non-smokers (OR = 1.25; CI 1.05-1.48), ex-smokers (OR = 1.51; CI 1.26-1.83), consuming smoked meat products less than once a week (OR = 1.26; CI 1.09-1.45), practicing physical activity at least once a week (OR = 1.25; CI 1.03-1.51), hospitalized in the past 12 months (OR = 1.73; CI 1.47-2.05), or consulting a general practitioner (GP) in the past 12 months (OR = 2.26; CI 1.87-2.74). The chance of participation of individuals having a risk factor for CRC (obesity, smoking, diabetes, low physical activity, alcohol drinking) was not higher compared to those without the risk factors. CONCLUSION: Individuals with a tendency to a healthy lifestyle or being in recent contact with the healthcare system by various means, mainly visiting a GP, had a higher participation in the screening for CRC. Among groups with an increased risk for CRC, higher participation was not shown.
- MeSH
- časná detekce nádoru * MeSH
- kolonoskopie MeSH
- kolorektální nádory * diagnóza epidemiologie prevence a kontrola MeSH
- lidé MeSH
- plošný screening MeSH
- průřezové studie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Hemobilie je vzácným typem krvácení do zažívacího traktu způsobeným nejčastěji iatrogenním poraněním, traumatem či neoplazií. Akutní cholecystitida jako příčina hemobilie je považována za raritní. V našem sdělení prezentujeme případ pacientky, u které byla zdrojem krvácení arodovaná sliznice žlučníku při těžké kalkulózní cholecystitidě. Pacientka v období před krvácením podstoupila akutní ERCP pro obstrukční ikterus s extrakcí konkrementů s následným rozvojem těžké akutní pankreatitidy. Tyto faktory zprvu sváděly k mylným předpokladům a diagnózám. Krvácení nebylo hemodynamicky závažné a běžné vyšetřovací metody neodhalily jeho přesný zdroj. Velkou pomocí bylo použití přímé choledochoskopie (SpyGlassTM), které vyloučilo poranění nebo tumorózní změny hlavních žlučových cest a výrazně posílilo domněnku zdroje krvácení z nitra žlučníku. Chirurgická revize pak tuto příčinu potvrdila a následná cholecystektomie potíže nemocné vyřešila.
Hemobilia is an unusual type of gastrointestinal bleeding most frequently due to iatrogenic injury, trauma, or neoplasia. Acute cholecystitis as a cause of hemobilia is rare. We present the case study of a patient with bleeding from eroded gallbladder mucosa in the setting of severe calculous cholecystitis. The hemorrhagic episode was preceded by acute ERCP due to obstructive icterus with extraction of the calculi, followed by the development of severe acute pancreatitis. These factors initially misled the diagnosis. The bleeding was not hemodynamically important and routine diagnostic methods did not reveal its exact source. Direct choledochoscopy (SpyGlassTM) proved to be helpful in determining the right diagnosis, as it ruled out any injury or tumor in the main bile ducts and considerably supported the assumption of intrabladder bleeding. Surgical revision confirmed the cause, and subsequent cholecystectomy solved the whole problem.
- Klíčová slova
- choledochoskopie,
- MeSH
- cholecystitida * chirurgie komplikace MeSH
- endoskopie trávicího systému metody MeSH
- hemobilie * etiologie MeSH
- lidé MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Z dostupné literatury vyplývá, že mezi nejvýznamnější bariéry k podstoupení kolonoskopie obecně patří "obava z bolesti a diskomfortu", "obava z přípravy střeva", ale i přímo nesouvisející vlivy jako "nedostatek podpory ze strany rodiny a přátel", "vytížení v rámci rodinných a pracovních záležitostí", "jiné zdravotní problémy" a aktuální "obava z toho, že se v nemocnici nakazí onemocněním covid-19". Pozitivní roli může hrát manželský svazek, naopak negativní předchozí nádorové onemocnění. Důležitým faktorem je i to, že pacienti nejsou o svých bariérách zvyklí hovořit spontánně - vhodným nástrojem je řízený rozhovor. Respondenti této kvalitativní studie ve svých odpovědích zmínili jako významné většinu těchto bariér.
The available literature suggests that the most significant barriers to undergoing colonoscopy in general include "fear of pain and discomfort", "fear of bowel preparation", as well as directly unrelated influences such as "lack of support from family and friends", "busy family and work schedules", "other health problems" and the current "fear of getting COVID-19 in hospital". A marital union may play a positive role, previous cancer a negative one. Another important factor is that patients are not used to talking about their barriers spontaneously; a guided conversation is a useful tool. Respondents in this qualitative study addressed these barriers as significant in their answers.
- MeSH
- adherence pacienta MeSH
- kolonoskopie * MeSH
- kolorektální nádory * prevence a kontrola MeSH
- komunikace MeSH
- lidé MeSH
- senioři MeSH
- úzkost z výkonu MeSH
- výsledek terapie MeSH
- vztahy mezi lékařem a pacientem MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
BACKGROUND AND AIMS: SARS-CoV-2 is a worldwide serious health problem and vaccination seems to have a crucial role in managing the COVID-19 pandemic. The aim of this prospective observational study was to monitor the trend of antibodies against SARS-CoV-2 after vaccination with BNT162b2 (COMIRNATY) in patients with inflammatory bowel disease treated by immunosuppressive and/or biological therapy, demonstrate whether any type of this therapy is associated with poorer production of antibodies against COVID-19 and evaluate the safety of vaccination against COVID-19 in these patients. METHODS: Eighty-seven eligible patients from one tertiary gastroenterological center with inflammatory bowel disease (60 with CD, 27 with UC) treated by immunosuppressive and/or biological therapy from the antiTNFα group were indicated to vaccination against SARS-CoV-2. Effectiveness of vaccination was evaluated by the values of antibodies before and 4 weeks after 2nd dose of vaccine. Additional goal was to evaluate adverse events of vaccination. RESULTS: Before the 2nd dose of vaccine, geometric mean of SARS-CoV-2 IgG antibodies were 40.7 U/ml in the biological therapy group, 34.8 U/ml in the azathioprine group and 44.8 U/ml in the combination therapy group of patients. The geometric means were 676.5.7 U/ml in the biological therapy group, 614.4 U/ml in the azathioprine group and 500.1 U/ml in the combination therapy group of patients four weeks after 2nd dose. Statistically significant differences between these groups were not proved. Several non-severe local and general adverse events were present in our patients with a majority of these events on the day of vaccine administration and the day after, no anaphylactic reactions were present. CONCLUSIONS: Our measurements proved the efficacy and safety of vaccination against SARS-CoV-2 in patients with inflammatory bowel disease treated by immunosuppressive and/or biological therapy. Statistically significant differences between our groups of patients were not proved.
- MeSH
- azathioprin MeSH
- COVID-19 * prevence a kontrola MeSH
- idiopatické střevní záněty * chemicky indukované farmakoterapie MeSH
- lidé MeSH
- pandemie MeSH
- protilátky virové MeSH
- SARS-CoV-2 MeSH
- vakcína BNT162 MeSH
- vakcinace MeSH
- vakcíny proti COVID-19 škodlivé účinky MeSH
- virové vakcíny * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
OBJECTIVE: The adalimumab biosimilars FKB327 and GP2017 were approved for the therapy of patients with inflammatory bowel disease (IBD). Relatively few prospective studies with biosimilar adalimumab in patients with IBD have been published. The aim of this prospective observational study was to evaluate the effectiveness and safety of the biosimilar adalimumab. MATERIAL AND METHODS: Adalimumab biosimilars FKB327 (Hulio®) and GP2017 (Hyrimoz®) were indicated to 50 naive patients in terms of biological therapy with Crohn's disease (CD) or ulcerative colitis (UC). Effectiveness of therapy was evaluated via the Crohn's Disease Activity Index [CDAI] or the Mayo Scoring System [MSS] in patients with CD or UC, respectively, before and after 12 weeks. Additional goals were to evaluate weight changes, laboratory tests and complications or adverse events of this therapy. RESULTS: In CD patients, remission (CDAI <150) was achieved in 73.5% of cases, partial response (≥70-point decrease in CDAI score from baseline) in 11.8%, no response in 11.8% and 2.9% patients discontinued therapy. In UC patients, remission (total score on partial Mayo index ≤2 points) was achieved only in 18.8% of cases, partial response (≥2-point decrease in partial Mayo score from baseline) in 43.8%, no response in 25.0% and 12.5% patients discontinued therapy. There were statistically significant improvements in CDAI, MSS, haemoglobin, fecal calprotectin, albumin and CRP serum levels after 12 weeks of therapy. Seven adverse events were identified, three of which resulted in therapy being discontinued. CONCLUSIONS: This prospective observational study proved the effectiveness of the adalimumab biosimilars FKB327 and GP2017 in IBD.
- MeSH
- adalimumab škodlivé účinky MeSH
- biosimilární léčivé přípravky * škodlivé účinky MeSH
- Crohnova nemoc * MeSH
- idiopatické střevní záněty * farmakoterapie MeSH
- indukce remise MeSH
- lidé MeSH
- prospektivní studie MeSH
- ulcerózní kolitida * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: Anorectal dysfunction (ARD), especially bowel incontinence, frequently compromises the quality of life in multiple sclerosis (MS) patients. The effect of rehabilitation procedures has not been clearly established. OBJECTIVE: To determine the effect of an individualized rehabilitation approach on bowel incontinence and anorectal pressures. METHODS: MS patients with ARD underwent 6-months of individually targeted biofeedback rehabilitation. High resolution anorectal manometry (HRAM) and St. Mark's Fecal Incontinence Scores (SMIS) were completed prior to rehabilitation, after 10 weeks of supervised physiotherapy, and after 3 months of self-treatment. RESULTS: Ten patients (50%) completed the study. Repeated measures analysis of variance (ANOVA) demonstrated significant improvement in the SMIS questionnaire over time [14.00 baseline vs. 9.70 after supervised physiotherapy vs. 9.30 after self-treatment (p = 0.005)]. No significant improvements over time were noted in any HRAM readings: maximal pressure [49.85 mmHg baseline vs. 57.60 after supervised physiotherapy vs. 60.88 after self-treatment (p = 0.58)], pressure endurance [36.41 vs. 46.89 vs. 49.95 (p = 0.53)], resting pressure [55.83, vs 52.69 vs. 51.84 (p = 0.704)], or area under the curve [230.0 vs. 520.8 vs. 501.9 (p = 0.16)]. CONCLUSIONS: The proposed individualized rehabilitation program supports a positive overall effect on anorectal dysfunction in MS patients.
- MeSH
- biofeedback (psychologie) MeSH
- fekální inkontinence * etiologie MeSH
- kvalita života MeSH
- lidé MeSH
- manometrie MeSH
- pilotní projekty MeSH
- roztroušená skleróza * komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Diabetes mellitus (zejména diabetes mellitus 2. typu) a kolorektální karcinom jsou v naší populaci relativně častými onemocněními. Tyto jednotky zároveň sdílejí některé společné rizikové faktory, jako je např. obezita, nedostatek fyzické aktivity a hyperinzulinemie. Dostupná data ukazují, že pacienti s diabetem mají zvýšené riziko výskytu kolorektálního adenomu a karcinomu, zvýšené riziko výskytu kolorektálního karcinomu v nižším věku, jakož i zvýšené riziko recidivy a zvýšenou mortalitu při karcinomu kolorekta. Článek předkládá aktuální pohled na vztah diabetu a kolorektálního karcinomu s důrazem na informace podstatné pro klinickou praxi, zejména na screening kolorektálního karcinomu a režimová doporučení pro pacienty s diabetem.
Diabetes mellitus (type 2 diabetes in particular) and colorectal carcinoma are relatively frequent diseases in our population. At the same time, these units share some common risk factors, for example obesity, lack of physical activity and hyperinsulinemia. Available data show patients with diabetes have increased risk of colorectal adenoma and carcinoma, increased risk of colorectal carcinoma at a lower age, as well as increased risk of relapse and increased mortality with colorectal cancer. The aim of this article is to point out the relationship between diabetes and colorectal carcinoma, with emphasis on the information important for clinical practice, particularly the screening of colorectal carcinoma and lifestyle recommendations for patients with diabetes. Therefore, we offer an overview of the important available publications which consider this topic.
