Capsule Enteroscopy (CE) is a fundamentally new method in diagnostic endoscopy. However, there are several factors influencing the quality of this procedure, including impermeable fluids, food remains etc. The aim of the study was to assess one of the most popular currently used bowel preparation methods and evaluate possible effects of various factors. 136 CE examinations were analysed. Each patient was prepared using 2 litres of polyethylene glycol (PEG) one day prior to examination. There was a special form filled in for each patient, which included relevant parameters (anamnesis, CE data etc.). Of 136 CE cases, 84 (61.8%) were female patients and 52 (38.2%) were male. The small bowel (SB) transit time in 112 patients varied from 39 to 502 minutes, but in 24 cases the capsule did not reach caecum. The degree of bowel cleanliness was as follows: very good — 30 (22.1%) patients, satisfactory — 97 (71.3%), and poor — 9 (6.6%). A positive correlation was observed between the degree of SB cleanliness and the SB transit time (p = 0.015). A longer SB transits time was associated with poor SB cleanliness. The results obtained in this study showed that the quality of SB cleanliness is affected by SB transit time. A relatively large percentage of cases rated as satisfactory bowel cleanliness and comparatively small percentage of bowel cleanliness cases rated as “very good” were observed when 2 litres of PEG were used prior to CE, indicating an important issues in preparation of the bowel prior to CE.
We report a case of Dunbar syndrome, May–Thurner syndrome and Nutcracker syndrome diagnosed in one patient with clinical presentation and imaging findings on Doppler ultrasonography. Dunbar syndrome or truncus coeliacus compression syndrome is an under-diagnosed vascular compression syndrome with a lot of controversy around it because of insufficient differentiation from celiac artery stenosis. May–Thurner syndrome or iliac vein compression syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression by the right common iliac artery as it crosses the iliac vein anteriorly. In Nutcracker syndrome due to compression the outflow from the left renal vein into the inferior vena cava is obstructed. The combination of all these syndromes in one patient was not described before.
Treatment strategies for acute uncomplicated appendicitis have evolved and now conservative antibacterial treatment is recommended over surgical treatment, especially for paediatric patients. The aim of this study was to evaluate microbiota in paediatric patients with acute uncomplicated and complicated appendicitis, and antibacterial susceptibility of the causative microorganisms. Bacteriological identification was conducted using the VITEK2 analyser. Antibacterial susceptibility tests were performed and the results were evaluated in accordance with the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) “Clinical breakpoints and dosing of antibiotics” (Version 7.0, January 2019). Serodiagnosis of Yersinia enterocolitica was performed using indirect haemagglutination. The results revealed differences in microbiota in cases of acute complicated and acute uncomplicated appendicitis. Pseudomonas aeruginosa was identified more frequently in cases of acute complicated appendicitis. Mixed culture was prevalent in cases of both acute complicated and acute uncomplicated appendicitis. Very few positive extended spectrum beta-lactamase (ESBL) Escherichia coli cultures were identified. Most of strains of Pseudomonas aeruginosa were resistant to amoxicillin with clavulanic acid, ertapenem, ampicillin and cefotaxime. Some of E. coli isolates were resistant to ampicillin and to amoxicillin with clavulanic acid.
The article discusses the possible relationships between intestinal microbiota and the therapeutic efficacy of 5-aminosalicylic acid (5-ASA) in inflammatory bowel diseases. Intestinal microbiota may be involved in 5-ASA enzymatic biotransformation, but the metabolism of drugs by the intestinal microbiota has been studied in less detail, and little is known about the relationships between anti-inflammatory efficacy of 5-ASA with bacterial viability, quantity and activity. It remains unclear whether 5-ASA affects the microbiota depending on the different segments of gastrointestinal tract. Drugs and diet can both improve and worsen the composition of the intestinal microbiota. However, it is not known whether drugs affect the intestinal microbiota regardless of diet. Further research is needed to answer these questions.
Liver cirrhosis is the end stage of chronic liver diseases. The current gold standard for diagnosing this condition, liver biopsy, has too many drawbacks, and research for better alternatives is ongoing. One major diagnostic arsenal includes various serological composition scores or so-called formulas. They are constantly being validated for development of new formulas. In our retrospective study of 215 patients case files who had confirmed cirrhosis of various etiologies, we examined the sensitivity and set new cut-offs for five of the most well-documented formulas. Data was obtained from the Rīga East University Hospital from 2012 to 2017 and analysed using SPSS V.22.00. In our study we found that FIB-4 at cut-off > 1.45 had over 95% sensitivity for excluding advanced fibrosis regardless of cirrhosis etiology. None of evaluated formulas had high sensitivity for detecting cirrhosis of alcohol etiology. For the viral hepatitis C genesis group, the best choice was deRitis index with almost 90% sensitivity. FIB-4 at cut-off > 2.75 was the best choice for the combined alcohol and viral hepatitis C group; BONACINI at score 8+ and FIB-4 at > 3.25 were the most sensitive in the main group containing all patients irrespective of cirrhosis etiology.
Inflammatory bowel disease (IBD) is a chronic, relapsing–remitting, inflammatory condition of the gastrointestinal tract which consists of Crohn’s disease (CD), ulcerative colitis (UC) and undifferentiated IBD. Epidemiology of IBD is changing worldwide, but a significant gap remains in the description of the IBD population in Latvia. The aim of the study was to determine the incidence and prevalence rates of IBD in Latvia in the period between 2013 and 2017. Retrospective analysis of reimbursed medicines claims for IBD diagnoses from the Latvian National Health Service database (NHS) was conducted for the period of 2012 to 2017. From CD patients, 53.7% were female and the area of residency strongly favoured urban areas vs rural districts of Latvia, 59.1% vs 40.9%, respectively. A similar demographic pattern was observed in UC patients, where 56.2% were female and 55.1% of the total UC population lived in urban areas. The overall age- and sex-adjusted incidence rates for CD and UC were 16.45 (CI95% [14.68, 18.21]) and 70.53 (CI95% [66.88, 74.19]) per 100 000 population, respectively, for the entire 2013–2017 period. The prevalence of CD and UC in 2012 was 12.4 and 54.8 cases per 100 000 persons, respectively, compared to 15.5 and 79.5 cases per 100 000 persons in CD and UC in 2017, resulting in a 25% increase in prevalence of CD and 41% increase in UC over the 5-year period. For the first time temporal trends in IBD incidence and prevalence as well as differences across age groups and gender over a five-year period are reported for Latvia.
The study represents a comprehensive retrospective morphological profiling of gastric carcinoma in order to reveal associations between certain tumour-infiltrating inflammatory cells and clinical and/or pathological parameters. Patients’ age and gender, the extent of local tumour spread (pT), presence of metastases in regional lymph nodes (pN), tumour grade (G) as well as type according to World Health Organisation (WHO) and Lauren classifications were assessed in 211 consecutive surgically resected gastric carcinomas. Tumour-infiltrating inflammatory cells including eosinophils, neutrophils and lymphocytes were counted within the cancer stroma in five randomly selected high-power fields representative of the tumour. Descriptive statistics, Mann–Whitney and Kruskal–Wallis tests were applied; p < 0.05 was considered significant. Higher number of stromal eosinophils was associated with absence of metastases in regional lymph nodes (pN0) and histological structure of adenocarcinoma by WHO classification (p = 0.005 and p = 0.002, respectively). Higher count of stromal neutrophils showed significant associations with younger age (less than 65 years), and intestinal type by Lauren classification (p = 0.029 and p = 0.007, respectively). The density of stromal lymphocytes lacked any statistically significant association with the evaluated clinical or morphological parameters. In conclusion, the current study highlights the links between certain innate immune system cells and morphological features of gastric carcinoma.
There are about 2 billion people in the world who suffer from anaemia, mostly iron deficiency anaemia (IDA), by WHO data. Iron deficiency without anaemia is three times more common than IDA. In such patients, the condition of the small intestine should be evaluated, and malabsorption excluded. The aim of the study was to evaluate potential correlation between different types of enteropathy and iron absorption disturbances. The study was performed at the Latvian Maritime Medical Center “Gastroklinika” between the years 2014 and 2018. Iron absorption tests with 50 mg of oral iron gluconate were performed for each patient. Patients had filled in a FACIT questionnaire and had underwent video capsule endoscopy (VCE). A total of 48 patients were enrolled for analysis — 41 (85.4%) female and 7 (14.6%) male. Enteropathy was diagnosed in 35 cases: erosive — 17, erythematous — 12 and congestive — 6. By the time of VCE, 24 patients were suffering from anaemia. A total of 33 (68.7%) patients had problems with iron absorption, of whom 8 had no signs of enteropathy and 25 were diagnosed with enteropathy during VCE. IDA did not show a statistically significant correlation with enteropathy. However, the obtained results suggest that this should be studied further in association with small intestine malabsorption, to determine the precise role of enteropathy in IDA patients.
Cytokeratin 18 (CK18) is a specific marker of hepatocellular apoptosis, which is a useful noninvasive indicator of liver fibrosis in the HIV/HCV group. However, data on the CK18 level in serum are limited for this group. This study demonstrated CK18 levels in serum in HIV/HCV co-infected and HIV mono-infected patients; investigated the association of CK18 levels with other non-invasive markers of liver fibrosis; and presents CK18 dynamics in a four-month-long period. The sample included 273 patients with HIV infection (128 of them were with HIV/HCV co-infection) aged from 23 to 65 (35% females). Levels of hyaluronic acid, CK18, ALT, and AST were determined in serum, and the FIB4 index was calculated. All markers had higher levels in the HIV/HCV group than in the HIV mono-infection group. The HIV/HCV group demonstrated coherent correlations among the markers and their associations with the level of CK18 than the HIV mono-infection group. During the four-month-long period, the CK18 level in serum showed no significant changes.