UNLABELLED: We would like to provide an updated comprehensive perspective and identify the components linked to chronic spontaneous urticaria (CSU) without specific triggers in autoimmune atrophic gastritis (AAG). AAG is an organ-specific autoimmune disease that affects the corpus-fundus gastric mucosa. Although we lack a unified explanation of the underlying pathways, when considering all paediatric patients reported in the literature, alterations result in gastric neuroendocrine enterochromaffin-like (ECL) cell proliferation and paracrine release of histamine. Several mechanisms have been proposed for the pathogenesis of CSU, with much evidence pointing towards AAG and ECL cell responses, which may be implicated as potential factors contributing to CSU. The excessive production/release of histamine into the bloodstream could cause or trigger exacerbations of CSU in AAG, independent of Helicobacter pylori; thus, the release of histamine from ECL cells may be the primary modulator. CONCLUSION: Considering the understanding of these interactions, recognising the respective roles of AAG in the pathogenesis of CSU may strongly impact the diagnostic workup and management of unexplained/refractory CSU and may inform future research and interventions in the paediatric population. WHAT IS KNOWN: • Autoimmune atrophic gastritis is a chronic immune-mediated inflammatory disease characterised by the destruction of the oxyntic mucosa in the gastric body and fundus, mucosal atrophy, and metaplastic changes. • Autoimmune atrophic gastritis in paediatric patients is important because of the poor outcome and risk of malignancy and possibly underestimated entities primarily reported in single-case reports. WHAT IS NEW: • Upper gastrointestinal inflammatory disorders, independent of H. pylori, have been implicated as potential inducing factors in the development of chronic spontaneous urticaria. • If a paediatric patient presents with symptoms such as anaemia, reduced vitamin B12 levels, recurrent urticaria with no other detectable aetiology, positive anti-parietal cell antibodies, and elevated gastrin levels, autoimmune atrophic gastritis should be considered a possible cause of chronic urticaria.

• MeSH
• autoimunitní nemoci * komplikace   diagnóza   MeSH
• chronická nemoc MeSH
• chronická urtikarie * etiologie   patologie   MeSH
• dítě MeSH
• gastritida atrofická * komplikace   patologie   MeSH
• gastritida * komplikace   diagnóza   MeSH
• Helicobacter pylori * MeSH
• histamin MeSH
• infekce vyvolané Helicobacter pylori * komplikace   MeSH
• lidé MeSH
• žaludeční sliznice patologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Nádory gastroesophageální junkce (GEJ) a žaludku vzhledem k vysoké incidenci globálně představují závažný medicínský problém. Převážná část těchto onemocnění je diagnostikována v lokoregionálně pokročilém a/nebo metastatickém stadiu, které vyžaduje komplexní multidisciplinární přístup. Základem léčby lokoregionálně pokročilých stadií je systémová perioperační terapie, která prokazatelně zlepšuje prognózu pacientů. S cílem dalšího zlepšení je standardní perioperační chemoterapie kombinována s imunoterapií. Cílem tohoto sdělení je podat přehled současných doporučení a nových směrů léčby lokoregionálně pokročilých stadií nádorů GEJ a žaludku.

Given the high incidence of gastroesophageal junction (OGJ) and gastric tumours globally, they represent a major medical problem. The majority of these diseases are diagnosed at a locoregionally advanced and/or metastatic stage, which requires a comprehensive multidisciplinary approach. The mainstay of treatment of locoregionally advanced stages is systemic perioperative therapy, which has been shown to improve patient prognosis. With the aim of further improvement, standard periope­rative chemotherapy is combined with immunotherapy. The aim of this review is to provide an overview of current recommendations and new treatment guidelines for locoregionally advanced stages of OGJ and gastric cancer.

• MeSH
• antitumorózní látky * aplikace a dávkování   MeSH
• chemoradioterapie MeSH
• farmakoterapie metody   MeSH
• gastroezofageální junkce patologie   MeSH
• gastrointestinální nádory * chirurgie   farmakoterapie   terapie   MeSH
• imunoterapie metody   MeSH
• klinická studie jako téma MeSH
• klinické zkoušky, fáze II jako téma MeSH
• kombinovaná farmakoterapie metody   MeSH
• kombinovaná terapie metody   MeSH
• lidé MeSH
• nádory žaludku chirurgie   farmakoterapie   terapie   MeSH
• neoadjuvantní terapie MeSH
• perioperační péče metody   MeSH
• randomizované kontrolované studie jako téma MeSH
• Check Tag
• lidé MeSH

Malabsorpční syndromy představují rozsáhlou skupinu onemocnění, pro která je typická porucha intraluminálního trávení či vstřebávání živin. Klinicky se manifestují jako průjem, steatorea, nadýmání anebo neprospívání. Některé jednotky mohou být doprovázeny i specifickými příznaky, jako jsou např. otoky, paličkovité prsty a perianální exantém. Článek má za cíl na základě recentních poznatků malabsorpční syndromy přehledně klasifikovat a shrnout jejich etiologii, etiopatogenezi a klinickou manifestaci. Nedílnou součástí textu je rovněž přiblížení aktuálních diagnostických a léčebných postupů. V souladu se zaměřením rubriky budou diskutovány zejména nozologické jednotky s častějším výskytem. Vzácnější choroby (např. malabsorpce při reakci štěpu proti hostiteli) budou zmíněny jen okrajově a čtenáři budou poskytnuty recentní zdroje s podrobnějšími informacemi.

Malabsorption syndromes represent a large group of diseases characterized by impaired intraluminal digestion or nutrient absorption and typically manifest as diarrhea, steatorrhea, bloating and/or failure to thrive. Some diseases may be accompanied by specific symptoms such as oedema, digital clubbing and perianal exanthema. This article aims to classify malabsorption syndromes based on recent findings and summarize their etiology, etiopathogenesis and clinical manifestation. We review current diagnostic and therapeutic approaches. In accordance with the section in which the text will be published, frequent nosological entities will be discussed. Rarer diseases (such as malabsorption due to graft versus host disease) will be mentioned briefly, we direct readers to relevant and detailed sources.

• MeSH
• celiakie diagnóza   etiologie   komplikace   MeSH
• cholestáza diagnóza   etiologie   MeSH
• diferenciální diagnóza MeSH
• exsudativní enteropatie diagnóza   etiologie   komplikace   MeSH
• lidé MeSH
• malabsorpční syndromy * diagnóza   etiologie   farmakoterapie   klasifikace   patofyziologie   MeSH
• nemoci žaludku diagnóza   klasifikace   komplikace   patofyziologie   MeSH
• střevní sliznice patologie   MeSH
• žaludeční sliznice patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Introduction: Na experimentálnu verifikáciu vitality žalúdočného tubulu pred ezofagektómiou je nevyhnutná existencia jednoduchého modelu. Ischémia je hlavná príčina dehiscencie ezofagogastrickej anastomózy a následného leaku anastomózy. Ischemická príprava žalúdočného tubulu pred ezofagektómiou je potencionálna možnosť ako zamedziť rozvoju nežiaducich komplikácií. Avšak technika ako aj optimálne načasovanie ischemizácie ostávajú nejasné. Metody: Samce potkanov plemena Sprague-Dawley (n=24) boli náhodne rozdelené do štyroch skupín: ischemická skupina s odberom vzoriek po 1 hodine od ischémie (I1H), ischemická skupina s odberom vzoriek 1 deň od ischémie (I1D), ischemická skupina s odberom vzoriek 7 dní od ischémie (I7D) a kontrolná skupina (C). Ischémia bola navodená ligáciou a. gastrica sinistra a aa. gastricae breves. Vzorky boli histologicky a makroskopicky verifikované a stanovený bol počet a percentuálne zastúpenie jednotlivých imunokompetentných buniek. Výsledky: V skupine I1H bola pozorovaná ischemická denudácia s mukozálnymi eróziami a celkový počet eozinofilov bol signifikantne vyšší (p<0.05) v tejto skupine v porovnaní so skupinami I1D a I7D. V skupine I1D bola pozorovaná redukcia zápalu a parciálna regenerácia žalúdočnej mukózy. V skupine I7D bola pozorovaná takmer kompletná architektonická regenerácia žalúdočného epitelu a počet polymorfonukleárov bol signifikantne nižší (p<0,05) ako v skupine I1D. Záver: Ischemické poškodenie ligáciou žalúdočných tepien bolo predominantne pozorované v skupinách I1H a I1D avšak nie v skupine I7D. Táto práca prezentuje jednoduchú metódu verifikácie ischemických zmien žalúdočného tubulu.

Introduction: A reproducible and simple model is essential for verifying gastric conduit vitality before esophagectomy. Ischemia is a major cause of esophagogastric anastomotic dehiscence and leakage. Ischemic conditioning of the stomach prior to esophageal surgery has been shown to lower the incidence of postoperative complications, including anastomotic leakage. However, the optimal timing and technique of ischemization remain uncertain. Methods: Male Sprague-Dawley rats (n=24) were randomly divided into four groups: ischemic group – samples collected 1 hour after ischemia (I1H), ischemic group – samples collected 1 day after ischemia (I1D), ischemic group – samples collected 7 days after ischemia (I7D), and control group (C). Ischemia was induced by ligation of the left gastric (LGA) and short gastric arteries (SGA). The samples were verified using histological and macroscopic analysis, and the number and percentage of immunocompetent cells were determined. Results: One hour after ischemization (I1H), ischemic denudation with mucosal erosion was observed, and the total number of eosinophils was significantly higher (p<0.05) in the I1H group compared to the I1D and I7D groups. One day after ischemia (I1D), there was a reduction in the inflammatory response with partial regeneration of gastric mucosa. In the I7D group, nearly complete architectural regeneration of mucosal epithelium was documented. The total count of polymorphonuclears was significantly lower (p<0.05) compared to the I1D group. Conclusion: Ischemic mucosal injury after LGA and SGA ligation was observed dominantly in the I1H and I1D groups, but not in I7D group. In conclusion, this study presents a simple method for verifying gastric ischemic changes.

• MeSH
• anastomóza chirurgická * MeSH
• ezofagektomie metody   MeSH
• ezofágus chirurgie   krevní zásobení   patologie   MeSH
• ischemický postconditioning metody   MeSH
• krysa rodu rattus MeSH
• netěsnost anastomózy etiologie   prevence a kontrola   MeSH
• potkani Sprague-Dawley MeSH
• žaludek chirurgie   krevní zásobení   patologie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• zvířata MeSH

INTRODUCTION: Long-term outcome data are limited for non-achalasia esophageal motility disorders treated by peroral endoscopy myotomy (POEM) as a separate group. We investigated a subset of symptomatic patients with hypercontractile esophagus (Jackhammer esophagus). METHODS: Forty two patients (mean age 60.9 years; 57% female, mean Eckardt score 6.2 ± 2.1) treated by primary peroral myotomy for symptomatic Jackhammer esophagus 2012-2018 in seven European centers were retrospectively analyzed; myotomy included the lower esophageal sphincter but did not extend more than 1 cm into the cardia in contrast to POEM for achalasia. Manometry data were re-reviewed by an independent expert. The main outcome was the failure rate defined by retreatment or an Eckardt score >3 after at least two years following POEM. RESULTS: Despite 100% technical success (mean intervention time 107 ± 48.9 min, mean myotomy length 16.2 ± 3.7 cm), the 2-year success rate was 64.3% in the entire group. In a subgroup analysis, POEM failure rates were significantly different between Jackhammer-patients without (n = 22), and with esophagogastric junction outflow obstruction (EGJOO, n = 20) (13.6% % vs. 60%, p = 0.003) at a follow-up of 46.5 ± 19.0 months. Adverse events occurred in nine cases (21.4%). 14 (33.3%) patients were retreated, two with surgical fundoplication due to reflux. Including retreatments, an improvement in symptom severity was found in 33 (78.6%) at the end of follow-up (Eckardt score ≤3, mean Eckardt change 4.34, p < 0.001). EGJOO (p = 0.01) and frequency of hypercontractile swallows (p = 0.02) were predictors of POEM failure. The development of a pseudodiverticulum was observed in four cases within the subgroup of EGJOO. CONCLUSIONS: Patients with symptomatic Jackhammer without EGJOO benefit from POEM in long-term follow-up. Treatment of Jackhammer with EGJOO, however, remains challenging and probably requires full sphincter myotomy and future studies which should address the pathogenesis of this variant and alternative strategies.

• MeSH
• achalázie jícnu chirurgie   diagnóza   patofyziologie   MeSH
• dolní jícnový svěrač chirurgie   patofyziologie   MeSH
• dospělí MeSH
• endoskopické operace přirozenými otvory metody   škodlivé účinky   MeSH
• ezofágoskopie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• manometrie * metody   MeSH
• myotomie * metody   MeSH
• následné studie MeSH
• poruchy motility jícnu * chirurgie   diagnóza   etiologie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

PURPOSE: Open-label phase II study (RELATIVITY-060) to investigate the efficacy and safety of first-line nivolumab, a PD-1-blocking antibody, plus relatlimab, a lymphocyte-activation gene 3 (LAG-3)-blocking antibody, plus chemotherapy in patients with previously untreated advanced gastric cancer (GC) or gastroesophageal junction cancer (GEJC). METHODS: Patients with unresectable, locally advanced or metastatic GC/GEJC were randomly assigned 1:1 to nivolumab + relatlimab (fixed-dose combination) + chemotherapy or nivolumab + chemotherapy. The primary end point was objective response rate (ORR; per RECIST v1.1 by blinded independent central review [BICR]) in patients whose tumors had LAG-3 expression ≥1%. RESULTS: Of 274 patients, 138 were randomly assigned to nivolumab + relatlimab + chemotherapy and 136 to nivolumab + chemotherapy. Median follow-up was 11.9 months. In patients with LAG-3 expression ≥1%, BICR-assessed ORR (95% CI) was 48% (38 to 59) in the nivolumab + relatlimab + chemotherapy arm and 61% (51 to 71) in the nivolumab + chemotherapy arm; median progression-free survival (95% CI) by BICR was 7.0 months (5.8 to 8.4) versus 8.3 months (6.9 to 12.1; hazard ratio [HR], 1.41 [95% CI, 0.97 to 2.05]), and median overall survival (95% CI) was 13.5 months (11.9 to 19.1) versus 16.0 months (10.9 to not estimable; HR, 1.04 [95% CI, 0.70 to 1.54]), respectively. Grade 3 or 4 treatment-related adverse events (TRAEs) occurred in 69% and 61% of all treated patients, and 42% and 36% of patients discontinued because of any-grade TRAEs in the nivolumab + relatlimab + chemotherapy and nivolumab + chemotherapy arms, respectively. CONCLUSION: RELATIVITY-060 did not meet its primary end point of improved ORR in patients with LAG-3 expression ≥1% when relatlimab was added to nivolumab + chemotherapy compared with nivolumab + chemotherapy. Further studies are needed to address whether adding anti-LAG-3 to anti-PD-1 plus chemotherapy can benefit specific GC/GEJC patient subgroups.

• MeSH
• adenokarcinom * farmakoterapie   patologie   mortalita   MeSH
• doba přežití bez progrese choroby MeSH
• dospělí MeSH
• gastroezofageální junkce * patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory jícnu * farmakoterapie   patologie   mortalita   MeSH
• nádory žaludku * farmakoterapie   patologie   mortalita   MeSH
• nivolumab * terapeutické užití   aplikace a dávkování   škodlivé účinky   MeSH
• protein genu 3 aktivace lymfocytů * MeSH
• protokoly antitumorózní kombinované chemoterapie * terapeutické užití   škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• senioři 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, fáze II MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

• MeSH
• gastroezofageální junkce patologie   MeSH
• lidé MeSH
• metastázy nádorů MeSH
• nádory jícnu * terapie   MeSH
• nádory mozku chirurgie   radioterapie   sekundární   MeSH
• paclitaxel farmakologie   terapeutické užití   MeSH
• protokoly antitumorózní kombinované chemoterapie MeSH
• ramucirumab farmakologie   terapeutické užití   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Gastroparesis (GP) can be a severe and debilitating disease. Its pathophysiology is complex and not completely understood. Two principal mechanisms are responsible for the development of symptoms - gastric hypomotility and pylorospasm. Pylorus targeted therapies aim to decrease presumably elevated pyloric tone - pylorospasm. There is a growing body of evidence about their role in the treatment algorithm of GP. G-POEM (endoscopic pyloromyotomy) is an extensively studied pylorus targeted therapy. Its efficacy ranges between 56 and 80% and the number of recurrences among those with treatment effect seems low. G-POEM is a safe procedure with very low frequency of severe adverse events. At present, G-POEM should not be considered as an experimental approach and may be offered to all patients with refractory and severe GP. Nevertheless, G-POEM is not a first line treatment. Conservative measures such as diet modification and pharmacotherapy should always be tried before G-POEM is considered. Further research must focus on better patient selection as at present there are no standardized criteria. Functional imaging such as impedance planimetry (EndoFlip) may hold promise in this regard.

• MeSH
• gastroparéza * chirurgie   patofyziologie   terapie   etiologie   MeSH
• lidé MeSH
• pyloromyotomie * metody   škodlivé účinky   MeSH
• pylorus * chirurgie   patofyziologie   MeSH
• recidiva MeSH
• výběr pacientů MeSH
• vyprazdňování žaludku MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Both anastomotic leak (AL) and conduit necrosis (CN) after oesophagectomy are associated with high morbidity and mortality. Therefore, the identification of preoperative, modifiable risk factors is desirable. The aim of this study was to generate a risk scoring model for AL and CN after oesophagectomy. METHODS: Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018-December 2018. Definitions for AL and CN were those set out by the Oesophageal Complications Consensus Group. Univariate and multivariate analyses were performed to identify risk factors for both AL and CN. A risk score was then produced for both AL and CN using the derivation set, then internally validated using the validation set. RESULTS: This study included 2247 oesophagectomies across 137 hospitals in 41 countries. The AL rate was 14.2% and CN rate was 2.7%. Preoperative factors that were independent predictors of AL were cardiovascular comorbidity and chronic obstructive pulmonary disease. The risk scoring model showed insufficient predictive ability in internal validation (area under the receiver-operating-characteristic curve [AUROC] = 0.618). Preoperative factors that were independent predictors of CN were: body mass index, Eastern Cooperative Oncology Group performance status, previous myocardial infarction and smoking history. These were converted into a risk-scoring model and internally validated using the validation set with an AUROC of 0.775. CONCLUSION: Despite a large dataset, AL proves difficult to predict using preoperative factors. The risk-scoring model for CN provides an internally validated tool to estimate a patient's risk preoperatively.

• MeSH
• anastomóza chirurgická * MeSH
• chronická obstrukční plicní nemoc MeSH
• ezofagektomie * MeSH
• ezofágus chirurgie   patologie   MeSH
• hodnocení rizik MeSH
• index tělesné hmotnosti MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory jícnu * chirurgie   patologie   MeSH
• nekróza * MeSH
• netěsnost anastomózy * epidemiologie   etiologie   MeSH
• rizikové faktory MeSH
• ROC křivka MeSH
• senioři MeSH
• žaludek chirurgie   patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

With technical progress of gastrointestinal functional testing, there has been a demand for more comprehensive examination of esophageal physiology and pathophysiology beyond high-resolution manometry. A new interventional technology based on impedance planimetry, the functional lumen imaging probe (FLIP), enables intraluminal measurement of distensibility and compliance of hollow organs. EndoFLIP uses balloon catheters to measure diameter and distension pressure to calculate cross-sectional area and distensibility in different organs (mostly esophagus, stomach, anorectal region) and can be used in wide variety of indications (diagnostics, pre- and post-treatment evaluation) and currently serves as a helpful adjunctive tool in ambiguous clinical cases. EsoFLIP is a therapeutic variation that uses a stiffer balloon catheter allowing for dilation. The trend to simplify the clinical process from diagnosis to treatment tends to a one-session procedure combining diagnostics and therapeutic interventions. In specified conditions like e.g. achalasia or gastroparesis, a combination of EndoFLIP and EsoFLIP procedures may therefore be useful. The aim of this narrative review is to introduce the clinical use of FLIP and its potential benefit in combined diagnostic-therapeutic procedures.

• MeSH
• achalázie jícnu * diagnóza   MeSH
• gastrointestinální endoskopie MeSH
• lidé MeSH
• manometrie metody   MeSH
• žaludek MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH