[The outcomes of treatment of gastroesophageal reflux disease with laparoscopic "floppy" fundoplication]. / Ocena wyników leczenia choroby z zarzucania zoladkowo-przelykowego laparoskopowa metoda pelnej luznej fundoplikacji.

UNLABELLED: Gastroesophageal reflux disease (GERD) has been a serious health and social problem. Population based survey revealed that around 40 per cent of the whole population reported monthly GERD related symptoms. When not treated properly GERD can lead to severe complications such as Barrett's oesophagus (BE) and adenocarcinoma as a consequence. Various methods can be useful in diagnosis of GERD but only gastroscopy is a widespread investigation that enables to establish the diagnosis of reflux disease. The symptoms of reflux disease can be effectively treated by drugs, surgical procedures remain the way of curing the cause of gastroesophageal reflux. Nowadays the laparoscopic fundoplication is a standard in operative treatment of the ailment. AIM OF STUDY: was to evaluate of GERD treatment with laparoscopic "floppy" Nissen fundoplication (LFN). MATERIAL AND METHODS: A group of 41 patients who underwent LNF were recruited for the study. All qualified patients underwent pre and post-surgical upper GI endoscopy and were requested to answer the questions in a GERD-related quality of life questionnaire. The main group of patients was divided into two subgroups--those with concomitant hiatal hernia and those without hernia. The outcomes of treatment were then compared between the subgroups. RESULTS: After the procedure the endoscopic improvement of reflux oesophagitis and better symptoms self-assessment were found. CONCLUSIONS: Laparoscopic "floppy" Nissen fundoplication is an effective method of treatment of erosive oesophagitis and its symptoms.

[Non-erosive reflux disease in endoscopy and histopathology]. / Nienadzerkowa choroba refluksowa przelyku w obrazi endoskopowym i histopatologicznym.

THE AIM: Non-erosive reflux disease is presented in reflux diseases classifications not adequately Many esophageal lesions were described in different endoscopic techniques but not one classification was proposed. In many patients with signs of prolonged gastro-esophageal reflux in endoscopic assessment pale mucosa above gastro-esophageal junction was observed. In some patients color of esophagus in distal part becomes white and grey. We decided to check what histological lesions appear in all endoscopically visible lesions. MATERIAL AND METHODS: We analyzed 29 patients with chronic reflux disease and with endoscopic assessment of upper alimentary tract in which white color was observed in distal part of esophagus was observed. Biopses were taken from sites at least 2 cm from Z-line. Endoscopic assessment was performed by one endoscopist specialized in reflux disease. Biopsies were assessed by one pathologist specialized in upper alimentary tract diseases assessment. RESULTS: In all cases biopsies taken from distal esophageal, white-coloured mucosa were assessed by pathologist as esophagitis caused by gastro-esophageal reflux. CONCLUSIONS: White color of the distal part of esophagus in patients with chronic reflux disease is unanimously associated with microscopic lesions associated with reflux disease.

[Oligosymptomatic alimentary tract perforation in course of Crohn's disease in patient treated with anti-TNF alfa antibodies]. / Skapoobjawowa perforacja przewodu pokarmowego u pacjentki z choroba Lesniowskiego-Crohna leczona przeciwcialem anty-TNF alfa.

Successful Crohn's disease conservative treatment is often associated with use of few, sometimes new drugs. Their clinical use apart from inflammatory process decrease is associated with some risk. In the paper we report a case of 23-year-old woman suffering from Crohn's disease treated successfully with anti-TNF antibodies. Apart from successful anti-inflammatory there were observed not symptomatic perforation of the alimentary tract. Patients treated with strong anti-inflammatory drugs require especially careful monitoring also because of possibility of occurrence of not symptomatic life-threatening conditions.

[Gastroesophageal reflux disease--diagnosis and management]. / Choroba refluksowa przelyku--rozpoznawanie i leczenie.

Gastroesophageal reflux disease is a serious clinical problem. In clinical classification of gastroesophageal reflux disease we differentiate esophageal and non-esophageal syndromes. In case of esophageal syndromes we differentiate based on clinical signs and syndromes with esophageal mucosal lesions based diagnosed on base of upper alimentary tract endoscopic and histopathologic assessment. In clinical diagnosis establishing basics are clinical symptoms as heartburn, regurgitation. Usually, recently found typical symptoms of light intensification can be concluded with diagnosis gastroesophageal reflux disease and without other diagnostic tools treatment could be introduced. Helpful diagnostic test is a test with proton pump inhibitors. Endoscopic assessment should be performed at least once in every patient with chronic gastroesophageal reflux disease in order to eliminate complications (Barrett disease). Main impedance advantage is possibility of reflux diagnosis disregarding ph value. Continuous monitoring of impedance in many segments of esophagus can help to establish direction of reflux and its characteristics and extent establishment. (liquid, gaseous, mixed). The main role in pharmacological gastroesophageal reflux disease treatment plays drugs decreasing acid output, proton pump inhibitors (PPI). Dosage of chronic use should be assess individually. The Basic rule is the use of possibly minimal therapeutic dose of PPI. In this paper authors presented basics of gastroesophageal reflux disease diagnosing, monitoring and treatment.

[The importance of functional tests in gastroesophageal reflux disease diagnosing, monitoring and treatment]. / Znaczenie badan czynnosciowych w rozpoznawaniu, monitorowaniu i leczeniu choroby refluksowej przelyku.

Gastroesophageal reflux disease has become recently an important question, especially in developed countries. Untreated or improperly treated could in chronic disease or can lead to serious complications including esophageal cancer. Early diagnosis establishment basing on clinical symptoms and diagnosing methods. Typical signs of gastroesophageal reflux diseases are acidity, regurgitation, especially after heavy meals or body position change. Those signs are basic for diagnosing establishment. It is recommended to introduce empiric treatment and more diagnostics should be employed if the treatment is not successful. Among diagnosing methods constant development is taking place what is associated with technology progress along with clinical trials. Authors in the paper basic diagnosing tools are presented showing their possibilities and limitations. Proper use of those diagnosing tools that should lead to quick diagnosis establishment.

[Non-erosive gastroesophageal reflux disease]. / Nienadzerkowa choroba refluksowa przelyku.

Non-erosive gastroesophageal reflux disease (NERD) is still underappreciated type of gastroesophageal reflux disease (GERD). It is not a homogenous group of patients with real reflux, oversensitivity of esophagus and functional dyspepsia. Nowadays often in classifications of GERD patients with NERD are omitted. Many endoscopic lesions are found in esophagus in NERD, especially color change of mucosa. Erythrema is nowadays taken into account. Unequivocal are also opinions about histological image. Many histological lesions are found but not a specific lesions were typified. Probably it is the best to associate NERD with clinical symptoms, endoscopic and histological image.

[Conditions and limits of radiological examinations of the digestive tract]. / Warunki i ograniczenia badan radiologicznych przewodu pokarmowego.

The rising incidence of alimentary tract diseases forces imaging metod development. Developing radiologic diagnostics changed imaging methods role and increased quality demand. X-ray based methods are still used in diagnosing many illnesses. Basic abdominal x-ray in nightshift condition is necessary to diagnose perforation or obstruction. Ultrasonographic, computed tomography and magnetic resonance imaging methods are the most important nowadays. The most popular and non-invasive method of imaging is ultrasonography. It is irreplaceable thanks to its availability and precision diagnosing many internal organs. One of the newest method is magnetic resonance and imaging in all possible scans. Complimentary method is computed tomography. It is based on human body layers analysis. Method is based on x-rays and assessing all tissues absorption. It can produce three dimensional imaging. The newest software can produce virtual imaging of all body cavities as well as colon. Basic and highly specialistic methods should be carefully planned in diagnostic-therapeutic process. In decision making what method should be used, medical doctor and patient should take part, taking into account all indication and cotraindications as well as method limitations.

[Ultrasonographic elastography in alimentary tract lesions diagnostics]. / Znaczenie elastografii ultrasonograficznej w rozpoznawaniu patologii przewodu pokarmowego.

Technology development in data processing in ultrasonography let new imaging method feasible. New method of imaging is elastography (elastosonography, ultrasonographic elastography). It relays on the presumption that pathologically changed tissues have different elasticity and change their shape in different way than health tissue. Elastography is used in lesions in alimentary tract diagnostics. Sensitivity and specificity in malignant lesions differentiation is 85% and 90%. In elastography there is used conventional ultrasonography device that is equipped with additional transformator that is located in probe. Examination is performed with multiple pressing the organ. Imaging is acquired in real-time regime they are colour-coded and they are created during compression. As a result of computer analysis images are generated in two colours. On the basis of character of normal and increased rigidity images were classified in five point scale from one to five. Indication to elastography is suspicion of malignant lesions in traditional ultrasonography and monitoring of liver cirrhosis and fibrosis. More trials are required to evaluate this method more reliably. Then it could be recommended for everyday clinical use.

[Mucosal healing in Crohn disease]. / Gojenie sluzówkowe w chorobie Lesniowskiego-Crohna.

Crohn disease treatment is a considerable challenge for a medical doctor. Gaining clinical remission is not enough. The important factor taken into account in treatment is gaining clinical remission and complete mucosal healing. Treatment useful in mucosal healing consists of immunosupresants as azathioprine, 6-markaptopurin, methotrexate and biological treatment. Important factors influencing mucosal healing is choice of medical treatment and its proper timing. More aggressive treatment in top-down scheme appears to be more successful in this aspekt than classical treatment with use of steroids. This data requires verification with more clinical trials.

[Perspectives in inflammatory bowel diseases treatment]. / Perspektywy leczenia nieswoistych chorób zapalnych jelit.

Development in immunology and better understanding of prolonged inflammatory process is basic in inflammatory bowel diseases treatment development. The new generation of drugs could be included infliximab and adalimumab. To the same group we include tumour necrosis factor inhibitors (infliximab, adalimumab, etanercept, certolizumab, onercept), selective adhesive molecules inhibitors (natalizumab, alicaforsen), Th1 dependent reaction inhibitors (anti-il-12, tacrolismus, il-10), lymphocytes migration inhibitors (natalizumab). Those drug are under development or in various clinical trials phases and are the future of inflammatory bowel diseases treatment.

[The analysis of hiatal hernia occurrence in connection with GERD]. / Ocena wystepowania endoskopowych cech przepukliny wslizgowej rozworu przelykowego przepony w powiazaniu z cechami choroby refluksowej przelyku.

UNLABELLED: Hiatal hernia seems to be one of the significant clinical problems. The criteria of its diagnosis, occurrence and possible influence on esophageal reflux disease are still controversial. The aim of this paper is to research the incidence of hiatal hernia based on endoscopic criteria of its diagnosis and its influence on other esophageal diseases. MATERIAL AND METHODS: More than 729 patients, to whom endoscopy was made, were examined. The accepted endoscopic features of hiatal hernia and other lesions which could be related to it and other characteristic features of esophageal reflux disease were searched. RESULTS: On the basis of accepted diagnostic criteria the hiatal hernia was diagnosed in 44.16% of men and in 42.77% of women. There were no difference in hiatal hernia occurrence in relation to age, gender and weight. The endoscopic features of esophageal reflux disease were found in 36.14% of women and 61.47% of men. The statistically significant incidence was observed in patients with hernia 55.99% women and 74.51% men and without hernia respectively in 22.81% and 51.16%. Similar differences took place in specific types of gastroesophageal disease, especially endoscopic features characteristic for Barrett's esophagus were observed nine times more frequently in men with hernia. Types with erosions were observed twice as much in patients with hernia of both sex. Esophagus mucosae cloudiness was observed three times more frequently in women with hernia and 50% more frequently in women. CONCLUSIONS: All the data suggests there is a significant coincidence between hiatal hernia and esophageal reflux disease.

[Comparison of the results of surgical treatment of patients suffering from gastroesophageal reflux disease with unanatomical and anatomical dysfunction of gastroesophageal junction]. / Porównanie wyników leczenia chirurgicznego chorych z choroba refluksowa przelyku na tle nieanatomicznych i antomicznych dysfunkcji polaczenia przelykowo-zoladkowego.

UNLABELLED: The evolution of surgery of no neoplastic diseases of the gastroesophageal junction, particularly gastroesophageal reflux disease (GERD), is an unquestionable factor for further analysis of indications for treatment and treatment results. Full-symptomatic GERD with coexisting sliding hiatal hernia is an indication for surgical treatment for a long time. The question is when to operate functional disorders of the esophagus and lower esophageal sphincter (LES) and what the results of the treatment are. Aim of study was to analyze results of surgical treatment of patients with GERD on the background of functional disorders and patients with sliding and mixed hiatal hernia. MATERIAL AND METHODS: This study retrospectively analyzed the data of 49 patients operated in Department of General, Oncological and Thoracic Surgery. Patients were divided into two groups. First group: patients with symptomatic GERD with confirmed 24 hour pH monitoring night-time and after-meal acid refluxes--23 subjects. Second group: patients with symptomatic GERD with type I and III hiatal hernia proven by gastroscopy, radiological tests and intraoperative examinations--26 subjects. There was no sign of decreased esophageal propulsive function among examined patients. For surgical intervention from the first group were qualified patients after ineffective conservative management. All patients underwent Nissen procedure--laparoscopy, hernioplasty and floppy fundoplication, and agreed on follow-up evaluation after 3, and some after 6 and 12 months which included case history, gastroscopy and 24 hour pH monitoring. RESULTS: Operative management resulted in withdrawal of suffered subjective symptoms and remission of lesions in lower part of esophagus. 10% of the patients had LES motor activity dysfunction not qualified for surgical consultation. There was no case of recurrence of hiatal hernia. CONCLUSIONS: Patients suffering from LES functional disorders and type I and III hiatal hernia can be effectively treated with surgical management.

[Basic diagnostic methods in gastro-esophageal reflux disease]. / Podstawowe metody diagnostyczne w chorobie refluksowej przelyku.

Gastro-esopgageal reflux disease (GERD) incidence increase in most developed countries. It concerns 5 to 15% of the population. It requuires life style modification as well as prolonged medicamentd intake. The current situation requires development of new techniques of diagnosing and treatment as well as enhancement of old ones. The effective care of the patient suffering from GERD requires interdisciplinary cooperation. It means general practicioner, gastroenterologist, diatary specialist and sometimes psychologist and recently more commonly surgeon. Despite development of new dianostic methods still basic medical care should be based on anamnesis, physical assessment, endoscopic and radiological procedures. Other methods are designed to treat more complicated or associated with the higher risk of complication manifestations of GERD. Still individual assessment is of all given results allow the proper choice of proceeding and method of treatment. Ph-metry and manometry of esophagus or nowadays more commonly used ph-metry with impedancy and its combination with manometry does not answer all the diagnostic questions. Authors present possibilities and limitations of basic diagnostic methods used in GERD.

[Endoscopic methods of gastro-esophageal reflux disease (GERD) treatment and their complications]. / Metody endoskopowe leczenia choroby refluksowej przelyku i jej powiklan.

Tretament in gastro-esophageal reflux disease (GERD) is in constant change. It is caused by the fact of change and development of diagnostic and therapeutic methods. Alternative methods of treatment are still searched beacause patients do not accept many years long drug treatment or surgical procedures. New methods are developed. Some of them as endoscopic fundoplication or methods of polimerizing substances injection in the area of lower esophageal sphincer have been abandoned because of low quickly diminishing efficacy Endoscopic sewing that implicate all layers of gaster is still under clinical trials and is considered as interesting. Stertt's procedure that is based on electromagnetic wave application in the area of lower esophageal sphincter is used in clinical practice. Despite effective methods of diagnosing and treatment of GERD there is no evidence of lowering incidence of complications of GERD. It is still common to find esophagus stricture as the first illness manifastation. Chronic character of GERD is associated with intestinal metaplasia and adenocarcinoma of the esophagus in its distal part. The most effective endoscopic methods of the treatment include: endoscopic dilation of the strictures and endoscopic methods of patological epithelium removal in Barrett's esophagus. These are: photodynamic therapy, argon coagulation, laser thermoablation, multipolar ablation and endoscpic mucosectomy. The paper is the review of the methods aimed at GERD and its complication treatment.

[Dietary treatment in acute pancreatitis]. / Leczenie iywieniowe w ostrym zapaleniu trzustki.

Proper nourishment is one of the basic elements in treatment patients suffering from acute pancreatitis and that's why it should be introduced in early phase of the disease. Patients suffering from light pancreatitis don't need dietary treatment because regular nourishment being.introduced a few days after the disease has developed itself. The proper supply of nourishing elements is crucial to patients with acute or chronic pancreatities. In this group of patient intravenous feeding or enteral nutrition methods are being used. They work as self sufficient and independent methods or they complete one another. The most recommended is the oligomeric diet with glutamine. Despite constant controversy over nourishment, early enternal nutrition is said to be better than intravenous feeding. Due to protection of intestinal barrier the enternal nutrition decrease the translocation of bacteria and endotoxin and as a result decrease the possibility of pancreaties parenchyma. The analysis of randomized clinical studies shows the improvement of clinical treatment and the improvement of prognosis in the group of patients using enternal nutrition. The number of complications and mortality rate has also decreased in this group. It allows also to shorten the hospitalization and cut the treatment costs. The patients, which do not tolerate internal nutrition or which cannot put up with intestinal entrance are to be fed with intravenous feeding. Presented above positive results of acute panctreatitis treatment, which were achieved after using internal nutrition, are the best basis for introducing this method in clinical practice.

[Antireflux endoscopic procedures]. / Endoskopowe zabiegi antyrefluksowe.

In recent few years there took place a significant development of endoscopic antireflux procedures. There appeared a need for review of these procedures. There could be distinguished three basic directions in treatment; endoscopic sewing, injection and implantation technique based on administering polymer-based, biologically neutral substances and the technique based on applying radiation of radiowave length in the region of lower esophageal sphincter.

[The contemporary endoscopic methods of treatment of gastroesophageal reflux disease complications]. / Wspólczesne mozliwosci endoskopowego leczenia powiklan choroby refluksowej przelyku.

Gastroesophageal reflux disease (GERD) is one of the most common publication subjects in gastroenterology field for more than twenty years. The following article is a review of endoscopic methods of treatment of GERD complications. It is interesting that complications of disease are quite common despite the constant development of diagnostics and treatment methods. It is still common to diagnose the disease when the first manifestation is the esophagus constriction. The complication of GERD is the intestinal metaplasia and adenocarcinoma of the distal part of the esophagus. There are effective endoscopic methods of GERD complications treatment. The most effective are esophagus dilations and endoscopic pathological mucosae layer removal like photodynamic therapy, laser ablation, argon coagulation, multipolar coagulation or mucosectomy.