Non-alcoholic fatty liver disease in Poland: how and at what stage is diagnosed, and how is treated. A survey study.

INTRODUCTION: Epidemiological studies show an increasing incidence of overweight and obesity all over the world, leading to an increase in the number of patients consulted due to liver damage. AIM: Assesement to which doctors (general practitioners or specialist) refer patients with elevated liver enzymes in Poland, how they are diagnosed and treated. MATERIAL AND METHODS: We conducted questionnaire surveys among 1322 doctors of various specialties to find the most common causes of liver disease, at which stage of the disease patients reported to doctors, and what schemes of management are followed. RESULTS: Non-alcoholic fatty liver disease (NAFLD) was the most common cause of abnormal liver enzymes (59.7%). Patients with liver damage most often reported to internal medicine specialists (59%) and gastroenterologists (27.5%). The diagnosis was based on abnormal aminotransferases (80.8%) and abdominal ultrasound examination (89.9%). Computed tomography/magnetic resonance imaging (50.2%) and liver biopsy (22.4%) were used to assess fibrosis. Almost all respondents recommended reduction of body mass and lifestyle changes, and less than half (46.4%) recommended pharmacological treatment. CONCLUSIONS: NAFLD was the most common liver disease that was the reason for medical consultations, but its incidence seems to be underestimated due to referral for further diagnostics only in patients with abnormal aminotransferases. The diagnostic methods used to assess the severity of the liver fibrosis and the recommended pharmacological treatment varied depending on the physician's specialisation and the centre's reference level.

Non-invasive diagnosis of steatosis, inflammatory changes and liver fibrosis in patients with non-alcoholic fatty liver diseases. Pilot study.

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of abnormal liver enzymes in adult patients consulted by hepatologists. Due to the high prevalence of this disease, most often associated with obesity, it is necessary to assess the risk of NAFLD, monitoring the progression of the disease and the effectiveness of treatment. MATERIAL AND METHODS: We evaluated the intensity of steatosis, inflammatory activity and fibrosis in 36 patients with NAFLD (fatty liver in abdominal ultrasound examination), using non-invasive tests: SteatoTest, ActiTest and FibroTest. We compared the prevalence of metabolic disorders and hypertension between women and men. RESULTS: There were no significant differences in analysed parameters of metabolic disorders between women and men. In both studied groups, the intensity of steatosis and inflammatory changes was similar. However, in the male group, the intensity of liver fibrosis was higher. CONCLUSIONS: The tests helped to detect advanced liver fibrosis in patients who were diagnosed with liver steatosis in ultrasound examination. Non-invasive diagnostics of liver injury may be useful in screening to select groups of patients requiring liver biopsy, as well as in monitoring the course of the disease and assessment of the treatment effectiveness. Early detection of liver disease may improve the prognosis of these patients.

A novel approach to genome-wide association analysis identifies genetic associations with primary biliary cholangitis and primary sclerosing cholangitis in Polish patients.

BACKGROUND: Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are forms of hepatic autoimmunity, and risk for both diseases has a strong genetic component. This study aimed to define the genetic architecture of PBC and PSC within the Polish population. METHODS: Subjects were 443 women with PBC, 120 patients with PSC, and 934 healthy controls recruited from Gastroenterology Departments in various Polish hospitals. Allelotyping employed a pooled-DNA sample-based genome-wide association study (GWAS) approach, using Illumina Human Omni2.5-Exome BeadChips and the following novel selection criteria for risk loci: blocks of at least 10 single nucleotide polymorphisms (SNPs) in strong linkage disequilibrium, where the distance between each adjacent SNP pair in the block was less than 30 kb, and each SNP was associated with disease at a significance level of P < 0.005. A selected index SNP from each block was validated using TaqMan SNP genotyping assays. RESULTS: Nineteen and twenty-one SNPs were verified as associated with PBC and PSC, respectively, by individual genotyping; 19 (10/9, PBC/PSC) SNPs reached a stringent (corrected) significance threshold and a further 21 (9/12, PBC/PSC) reached a nominal level of significance (P < 0.05 with odds ratio (OR) > 1.2 or < 0.83), providing suggestive evidence of association. The SNPs mapped to seven (1p31.3, 3q13, 6p21, 7q32.1, 11q23.3, 17q12, 19q13.33) and one (6p21) chromosome region previously associated with PBC and PSC, respectively. The SNP, rs35730843, mapping to the POLR2G gene promoter (P = 1.2 × 10-5, OR = 0.39) demonstrated the highest effect size, and was protective for PBC, whereas for PSC respective SNPs were: rs13191240 in the intron of ADGRB3 gene (P = 0.0095, OR = 0.2) and rs3822659 (P = 0.0051, OR = 0.236) along with rs9686714 (P = 0.00077, OR = 0.2), both located in the WWC1 gene. CONCLUSIONS: Our cost-effective GWAS approach followed by individual genotyping confirmed several previously identified associations and discovered new susceptibility loci associated with PBC and/or PSC in Polish patients. However, further functional studies are warranted to understand the roles of these newly identified variants in the development of the two disorders.

[Could the cytokines concentration be a marker of IBD activity and be useful in evaluation of IBD differentiation?]

Background: In inflammatory bowel disease (IBD) the imbalance between cytokines pro- and antinflammatory is observed. The aim of this study was the assessment of interleukin-10 (IL-10), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentration usefulness in the evaluation of the activity of ulcerative colitis (UC) and Cohn's disease (CD). Methods: 35 patients diagnosed with UC and 39 with CD were examined. The control group (CG) consisted of 35 healthy volunteers. Diagnosis of the disease was confirmed by videocolonoscopy and histopathological evaluation of intestinal biopsies. Disease activity of UC was assessed according to the Mayo Scoring System and by the Crohn Disease Activiti Index (CDAI) in CD patients. Among patients with UC 18 (51%) had severe, 14 (40%) moderate and 3 (9%) mild disease. Among patients with CD 7 (18%) was diagnosed with high, 27 (69%) moderate, and 5 (13%) with low activity of the disease. WBC, PLT, serum concentration of TNF-α, IL-6 i IL-10 were determined. Results: The average concentration of TNF-α in UC patients was: 14.3 (IQR=12.6), in CD: 12.6 (IQR=11.9), in the CG: 3.1 (IQR=1.7). The average concentration of IL-6 in UC was: 19.6 (IQR=21), in CD: 10.8 (IQR=7.6), in CG : 3.2 (IQR=1.6). The average concentration of IL-10 in UC was: 14.4 (IQR=5.9), in CD: 10.4 (IQR=9.3), in the CG: 3.3 (IQR=2.5). In the IBD TNF-α, IL-6 and IL-10 concentration was significantly higher than in CG. However, IL-10 was significantly higher in UC than CD. In patients with UC statistically significant positive correlation between the concentration of TNF-α, IL-6 and IL-10 and disease activity was noticed. There were no correlation between TNF-α, IL-6 and IL-10 concentration and CD activity. Conclusion: Determination of TNF-α, IL-6 and IL-10 serum concentration can be used for noninvasive evaluation of inflammation activity in patients with IBD. IL-10 concentration may be helpful in differentiation of UC and CD.

TGF-ß1 and granulocyte elastase in the evaluation of activity of inflammatory bowel disease. A pilot study.

INTRODUCTION: The aim was to assess the usefulness of TGF-ß1 and elastase in the evaluation of activity of ulcerative colitis (UC) and Crohn's disease (CD). MATERIAL AND METHODS: 32 patients diagnosed with UC, 31 with CD and 30 healthy volunteers were enrolled in this study. Diagnosis of the disease was confirmed by videocolonoscopy and histopathological evaluation of intestinal biopsies. Disease activity was assessed by use of the Mayo Scoring System for Assessment of Ulcerative Colitis Activity in UC patients and by CDAI in CD patients. hsCRP was determined by the immunonephelometric method, TGF-ß1 and elastase plasma concentration by ELISA. The results of the study were analyzed using Statistica and R statistical language. RESULTS: In UC a positive correlation between disease activity and platelet level, hsCRP and TGF-ß1 concentration was noted. Elastase concentration in UC patients was significantly higher than in CD, but there was no correlation with the activity of the disease. In CD patients we observed a positive correlation between disease activity and leukocytes, platelet levels and elastase concentration, and a very low correlation with hsCRP and TGF-ß1. DISCUSSION: Determination of TGF-ß1 can be used for evaluation of inflammatory activity in UC and it is connected with elevated concentrations of CRP and platelets. To a lower extent TGF-ß1 can also be used for evaluation of inflammatory activity in CD. Examination of elastase concentration may be useful in the assessment of CD activity. Plasma elastase concentration may be helpful in UC and CD differentiation. The preliminary results of this investigation seem promising; nevertheless, more studies are necessary.

The ß-fibrinogen -455G/A gene polymorphism and the risk of ischaemic stroke in a Polish population.

BACKGROUND AND PURPOSE: Ischaemic stroke is considered to be multifactorial and interactions between environmental and genetic factors play an important role. Although vascular risk factors are well known, the genetic ones are still undiscovered. In the present study, we assessed the significance of the ß-fibrinogen -455G/A gene polymorphism and the risk of ischaemic stroke in a Polish population. MATERIAL AND METHODS: 426 ischaemic stroke patients classified according to stroke aetiologies (small vessel disease, large vessel disease or cardioembolic stroke) and 234 controls were included in the study. The association of the ß-fibrinogen genotypes with ischaemic stroke was tested using logistic regression analysis under dominant, recessive or additive models of inheritance. RESULTS: The allele and genotype distributions of the ß-fibrinogen -455G/A gene polymorphism did not differ significantly between patients and controls (patients: G - 75%, GG - 56.6%, GA - 36.8%, AA - 6.6%; controls: G - 73.7%, GG - 57.3%, GA - 32.9%, AA - 9.8%; p > 0.05, χ2). In addition, logistic regression analysis adjusted for the known risk factors, i.e. hypertension, ischaemic heart disease, myocardial infarction, hypercholesterolaemia, diabetes mellitus and smoking, did not show a role of the studied polymorphism in ischaemic stroke. CONCLUSIONS: The ß-fibrinogen -455G/A gene polymorphism is not a risk factor for ischaemic stroke in a Polish population.

Cognitive functions in patients with liver cirrhosis: a tendency to commit more memory errors.

BACKGROUND: Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy (HE). For diagnostic purposes, 2 alternative batteries of psychometric screening tests are recommended. They differ from each other in terms of the cognitive domains assessed. The research was designed to provide a profile of cognitive functioning in patients with liver cirrhosis, using an assessment that covers a wider range of cognitive functions than the usual screening battery. MATERIAL AND METHODS: We examined 138 persons, including 88 with liver cirrhosis and 50 healthy volunteers. The Mini Mental State Examination (MMSE) was used for screening and excluding advanced cognitive impairment. Then, to assess cognitive functions in more detail, the following tests were used: Auditory Verbal Learning Test (AVLT), Letter and Semantic Fluency Tests (LF and SF), Trail Making Test (TMT A&B), Digit Symbol Test (DST), Block Design Test (BDT), and Mental Rotation Test (MRT). The MRT task has not been used in MHE diagnosis so far. Finally, 57 patients and 48 controls took part in the entire study. RESULTS: Patients with liver cirrhosis commit significantly more errors of intrusions in the AVLT during the delayed free recall trial. Results significantly deviating from the norm in at least 2 tests were found only in 7 cirrhosis patients. CONCLUSIONS: The results do not provide any specific profile of cognitive disturbances in MHE, but suggest that cirrhosis patients have a tendency to commit more memory errors, probably due to subtle impairments of executive function.

Does magnetic resonance spectroscopy identify patients with minimal hepatic encephalopathy?

BACKGROUND AND PURPOSE: The results of a few studies suggest that magnetic resonance spectroscopy of the brain could allow detection of minimal hepatic encephalopathy. The goal of this study was to assess the ability of magnetic resonance spectroscopy to differentiate between cirrhotic patients with and without minimal hepatic encephalopathy. MATERIAL AND METHODS: Localized magnetic resonance spectroscopy was performed in the basal ganglia, occipital gray matter and frontal white matter in 46 patients with liver cirrhosis without overt encephalopathy and in 45 controls. Neurological and neuropsychological examination was performed in each participant. RESULTS: The patients with liver cirrhosis had a decreased ratio of myoinositol to creatine in occipital gray matter and frontal white matter (mean: 0.17 ± 0.05 vs. 0.20 ± 0.04, p = 0.01 and 0.15 ± 0.05 vs. 0.19 ± 0.04, p < 0.01, respectively) and a decreased ratio of choline to creatine in occipital gray matter (mean: 0.32 ± 0.07 vs. 0.36 ± 0.08, p = 0.03). Minimal hepatic encephalopathy was diagnosed in 7 patients. Metabolite ratios did not differ significantly between patients with and without minimal hepatic encephalopathy. Metabolite ratios did not differ significantly between patients with Child-Pugh A and those with Child-Pugh B. CONCLUSIONS: Magnetic resonance spectroscopy does not allow accurate diagnosis of minimal hepatic encephalopathy. A similar profile of metabolites in the brain is observed in cirrhotic patients without cognitive impairment.

Intrahepatic expression of genes related to metabotropic receptors in chronic hepatitis.

AIM: To screen for genes related to metabotropic receptors that might be involved in the development of chronic hepatitis. METHODS: Assessment of 20 genes associated with metabotropic receptors was performed in liver specimens obtained by punch biopsy from 12 patients with autoimmune and chronic hepatitis type B and C. For this purpose, a microarray with low integrity grade and with oligonucleotide DNA probes complementary to target transcripts was used. Evaluation of gene expression was performed in relation to transcript level, correlation between samples and grouping of clinical parameters used in chronic hepatitis assessment. Clinical markers of chronic hepatitis included alanine and aspartate aminotransferase, γ-glutamyltranspeptidase, alkaline phosphatase and cholinesterase activity, levels of iron ions, total cholesterol, triglycerides, albumin, glucose, hemoglobin, platelets, histological analysis of inflammatory and necrotic status, fibrosis according to METAVIR score, steatosis, as well as anthropometric body mass index, waist/hip index, percentage of adipose tissue and liver size in ultrasound examination. Gender, age, concomitant diseases and drugs were also taken into account. Validation of oligonucleotide microarray gene expression results was done with the use of quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: The highest (0.002 < P < 0.046) expression among genes encoding main components of metabotropic receptor pathways, such as the α subunit of G-coupled protein, phosphoinositol-dependent protein kinase or arrestin was comparable to that of angiotensinogen synthesized in the liver. Carcinogenesis suppressor genes, such as chemokine ligand 4, transcription factor early growth response protein 1 and lysophosphatidic acid receptor, were characterized by the lowest expression (0.002 < P < 0.046), while the factor potentially triggering hepatic cancer, transcription factor JUN-B, had a 20-fold higher expression. The correlation between expression of genes of protein kinases PDPK1, phosphoinositide 3-kinase and protein kinase A (Spearman's coefficient range: 0.762-0.769) confirmed a functional link between these enzymes. Gender (P = 0.0046) and inflammation severity, measured by alanine aminotransferase activity (P = 0.035), were characterized by diverse metabotropic receptor gene expression patterns. The Pearson's coefficient ranging from -0.35 to 0.99 from the results of qRT-PCR and microarray indicated that qRT-PCR had certain limitations as a validation tool for oligonucleotide microarray studies. CONCLUSION: A microarray-based analysis of hepatocyte metabotropic G-protein-related gene expression can reveal the molecular basis of chronic hepatitis.

Pathogenesis of hepatic encephalopathy.

Hepatic encephalopathy can be a serious complication of acute liver failure and chronic liver diseases, predominantly liver cirrhosis. Hyperammonemia plays the most important role in the pathogenesis of hepatic encephalopathy. The brain-blood barrier disturbances, changes in neurotransmission, neuroinflammation, oxidative stress, GABA-ergic or benzodiazepine pathway abnormalities, manganese neurotoxicity, brain energetic disturbances, and brain blood flow abnormalities are considered to be involved in the development of hepatic encephalopathy. The influence of small intestine bacterial overgrowth (SIBO) on the induction of minimal hepatic encephalopathy is recently emphasized. The aim of this paper is to present the current views on the pathogenesis of hepatic encephalopathy.

[Morphological changes of the colon in patients with irritable bowel syndrome]. / Zmiany morfologiczne jelita grubego u osób z zespolem jelita drazliwego.

INTRODUCTION: Irritable bowel syndrome (IBS) is a common disease belonging to the group of chronic functional gastrointestinal disorders. Variety of symptoms and lack of macroscopic and structural pathologies in colon, make IBS a challenge both in diagnosis and in medication. According to the last reports, the role of chronic minimal inflammation in colon mucosa is becoming more relevant. AIMS: The aim of this study was to verify the microscopic and macroscopic changes in colon mucosa in patients with IBS. METHODS: A retrospective study of microscopic changes and macroscopic lesions in colon, due to endoscopy biopsies in the group of 89 patients diagnosed with IBS in an average age of 47 years. RESULTS: Mild inflammation of colonic mucosa in lamina propria was observed in 92% patients, 34% presented other inflammatory cells. No statistical relationship between macroscopic lesions (in 44% cases) and lymphatic infiltration was observed. CONCLUSIONS: Low grade inflammation of lamina propria in colon was observed among patients with IBS. Beside the edema of the lamina propria, no correlation between macroscopic and microscopic changes was found. Despite the fact that IBS is a functional disorder, in many patients occur morphological changes in colon mucosa. Further studies are necessary.

Efficacy of pegylated interferon alfa-2a or alfa-2b in combination with ribavirin in the treatment of chronic hepatitis caused by hepatitis C virus genotype 1b.

INTRODUCTION: Treatment of chronic hepatitis C (CHC) with pegylated interferon (Peg-IFN) and ribavirin leads to sustained virological response (SVR) in approximately 50% of the patients. SVR depends on hepatitis C virus (HCV) and host factors, including IL28B genotypes. OBJECTIVES: The aim of the study was to investigate the therapeutic efficacy of the difficult-to-treat HCV genotype 1b in patients from the south of Poland. PATIENTS AND METHODS: A total of 260 adult patients with CHC and HCV genotype 1b were treated with Peg-IFN alfa-2a or Peg-IFN alfa-2b with ribavirin for 48 weeks. Efficacy was assessed at 12 weeks (early virological response - EVR), 48 weeks (end-of-treatment response - ETR), and at 6 months (SVR). HCV-RNA, alanine transaminase (ALT), and other biochemical parameters were measured in serum at baseline and at 12, 48, and 72 weeks of therapy. RESULTS: HCV-RNA levels were 3.72 ±1.17 × 106 IU/ml at baseline and decreased significantly at 12 weeks (0.02 ±0.17 × 106 IU/ml); there were no differences between the group treated with Peg-INF alfa-2a and the group treated with Peg-INF alfa-2b. ALT was 94.1 ±7.6 IU/l at baseline and decreased significantly at 12 weeks (42.5 ±3.1 IU/l). The overall EVR, ETR, and SVR were achieved by 63.9%, 77.7%, and 48.1% of the patients, respectively. Tolerance of therapy was similar in both groups. CONCLUSIONS: Efficacy of Peg-IFN alfa-2a with ribavirin is not significantly different from that of Peg-IFN alfa-2b with ribavirin, and SVR was achieved in 48.3% and 44.3% of the patients, respectively. Our study confirms that the efficacy of treatment of patients with HCV genotype 1b from the southern region of Poland is similar to that observed in the overall Polish population.

[Application of chosen granulocyte markers in diagnostics of Lesniowski-Crohn's disease and ulcerative colitis--preliminary research]. / Zastosowanie wybranych wskazników granulocytarnych w diagnostyce wrzodziejqcego zapalenia jelita grubego i choroby Lesniowskiego-Crohna--doniesienie wstepne.

About 15% of cases of nonspecific inflammatory bowel diseases are difficult to diagnose based on clinical, radiological and histopatological criteria. In this study we tried to find a biochemical marker helpful in differential diagnostics and assessment of activity of Lesniowski-Crohn's disease and ulcerative colitis. Plasma concentrations of leukocyte elastase and calprotectin (neutrophiles' proteins), eotaxin (eosinophils chemoatractant) and C-reactive protein were measured in 22 patients with Lesniowski-Crohn's disease and 28 patients witch ulcerative colitis. Significantly higher plasma levels of leukocyte elastase and calprotectin in patients witch ulcerative colitis as compared to Lesniowski-Crohn's disease were found. Thus leukocyte elastase and calprotectin can be considered additional markers differentiating these two diseases. Moreover, plasma concentrations of CRP and leukocyte elastase were associated with the clinical activity of Lesniowski-Crohn's disease whereas CRP and calprotectin concentrations were related to the clinical activity of colitis ulcerosa.

[Pathogenesis and diagnosis of subclinical hepatic encephalopathy]. / Patogeneza i rozpoznawanie subklinicznej encefalopatii watrobowej.

Subclinical hepatic encephalopathy (SHE) is a serious clinical problem in patiens with liver damage and precise pathophisiological mechanisms resonsible for encephalopathy are not fully understood. Is definied as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction after exclusion of other known brain disease. Recent date have shown that increased CNS (central nervous system) ammonia concentration and presence of mild diffuse brain oedema plays a key role in the pathogenesis of SHE. Diagnosis of manifest HE (hepatic encephalopathy) is made on the basis of clinical symptoms, whereas psychometric or neurophisiological tests are required for detection of SHE. PET, MRI, H-MRS allow the rapid and noninvasive evaluation of structural, phisiologic and biochemical features of the brain.

[Neopterin in assessing the activity of inflammatory bowel diseases: ulcerative colitis and Crohn's disease]. / Neopteryna w ocenie aktywnosci nieswoistych chorób zapalnych jelit: wrzodziejacego zapalenia jelita grubego i choroby Lesniowskiego-Crohna.

UNLABELLED: The increase in the incidence of non-specific inflammatory bowel disease (IBD): ulcerative colitis (UC) and Crohn's disease (CD) makes the research of finding new biochemical markers, which were characterized by a high sensitivity and specificity for an objective assessment of severity of the inflammatory process and the effectiveness of treatment of patients. The aim of this study was to estimate the usefulness of neopterin in serum in assessing the disease activity in comparison to other markers of inflammation such as C-reactive protein (CRP) and TNF-alpha in patients with exacerbation of IBD and healthy volunteers. The study included 32 patients with UC and 31 with CD. The control group consisted of 30 healthy volunteers matched for age and gender. Disease activity in patients with UC was assessed based on a point system Mayo. In patients with CD disease activity was calculated based on the CDAI (Crohn's Disease Activity Index). Serum concentrations of neopterin, CRP and TNF-alpha were measured. For determination of CRP were used immunochemical nephelometric method. TNF-alpha and neopterin was measured by ELISA. RESULTS: In patients with UC and CD increased concentration of serum neopterin was significantly higher compared to the control group (p < 0.005). We observed a positive correlation between increased concentrations of neopterin in serum and increased levels of TNF-alpha and CRP, increasing the number of leukocytes and platelets count and the degree of disease activity in patients with both UC and CD, but was no statistically significant differences between the two groups of patients. CONCLUSIONS: Measurement of neopterin concentration in serum may be a useful marker to assess disease activity in patients with IBD.

Myoelectric and autonomic nervous system activity in patients with irritable bowel syndrome.

Explanation of the main causes of symptoms and dysfunctions in the FGIDs is focused on visceral hypersensitivity. Sympathetic stimulation increases sensitivity of visceral receptors. Thus overall influences of the autonomic nervous system are important not only in regulation of secretion and motility of the gastrointestinal tract but also in visceral sensation. The aim of this study was to evaluate gastric motility disturbances and changes in the autonomic nervous system (ANS) activity in irritable bowel syndrome patients (IBS). Our results show changes of the autonomic system activity in patients with IBS: decreased parasympathetic and increased sympathetic activity. The patients with autonomic dysfunction had also high percentage of dysrrhythmia time. We conclude that dyspeptic symptoms in patients with autonomic dysfunction are caused mostly by high adrenergic drive resulting in dysrrhythmias and decrease in the EGG amplitude.

[Etiopathogenetic factors of esophagitis in patients with gastroesophageal reflux disease]. / Czynniki etiopatogenetyczne w zapaleniu przelyku u pacjentów z choroba refluksowa przelyku.

UNLABELLED: Gastroesophageal reflux disease (GERD) is one of the most common disorders of the gastrointestinal tract. Reflux oesophagitis is observed in about 30-50% of GERD patients. Factors leading to development of mucosal damage remain still unclear. This study aimed at determinating of possible etiopathological factors in the development of oesophagitis in GERD patients. METHODS: 60 consecutive patients with erosive oesophagitis and 60 consecutive patients with reflux disorder were included in the study. All patients had been suffering from both at least two episodes of typical reflux symptoms in the last week and for a minimum of three months. The accurate history with a focus on life style was taken. The patients underwent mandatory endoscopy with the assessment of oesophagitis (according to Los Angeles classification), presence of hiatal hernia, macroscopical changes in upper GI tract and presence of Helicobacter pylori. Subsequently patients underwent 24-hour pH-monitoring and oesophageal clearance test. RESULTS: No significant differences were noticed in the mean age, sex, life style, disease's duration. In the patients with oesophagitis hiatal hernia was observed more frequently and the infection of H. pylori was less frequently observed. The results of pH-metry showed that the degree of esophagitis correlated only with the number of long-lasting reflux episodes, duration of the time with pH lower than 4.0 and esophageal clearance time. CONCLUSIONS: In patients with GERD both hiatal hernia and prolonged esophageal clearance time increase number of long-lasting reflux episodes and in consequence lead to the damage of oesophageal mucosa.

[Serum cytokine concentration as prognostic factor in patients with alcoholic liver disease]. / Zastosowanie oznaczania cytokin w ocenie rokowania u chorych z alkoholowa choroba watroby.

AIM OF THE STUDY: Estimation if the serum concentration of cytokines: IL-2, IL-4, IL-6, IL-8, IL-10, TNF-alfa and CRP can be useful in the assessment of prognosis in patients with alcoholic hepatitis (ALH) and alcoholic liver cirrhosis (ALC). Attempt to find their correlation with clinical stage and life prognosis in all patients. MATERIALS AND METHODS: We examined 24 patients with alcoholic liver disease, hospitalised in Department of Gastroenterology: 13 male and 11 female at the age 26-72 years. According to clinical symptoms and laboratory tests in 15 of them alcoholic hepatitis (in 9 confirmed by liver biopsy) and in 9 - liver cirrhosis (2 confirmed by liver biopsy) were diagnosed. The interview, physical examination, abdominal ultrasound, biochemical tests and viral tests were performed in all patients. We excluded patients treated with steroids and cytostatics. Serum concentration of cytokines and CRP were established three times during the first week of hospitalisation. RESULTS AND CONCLUSIONS: In all patients IL-2 and IL-4 concentration were in a range characteristic for healthy people. There was statistically important correlation between the severe clinical stage and high concentration of serum IL-6 (p<0.000319), IL-8 (p<0.000708), TNF-alfa (p<0.000018) and CRP (p< 0.001611) in patients with ALC. High concentration of serum IL-6, IL-8, TNF-alfa and CRP were correlated with poor prognosis (3 patients with ALC and the highest concentration died). High concentration of IL-6, IL-8, TNF-alfa and CRP were correlated with heavy clinical stage and poor prognosis so their evaluation can be helpful in the assessment of prognosis in patients with ALC and ALH.

[Investigation of immunologic dysfunction in patients with alcoholic liver cirrhosis]. / Analiza zaburzen immunologicznych u chorych z alkoholowa marskoscia watroby.

Alcohol abuse is an important social and medical problem in Poland and leads to many different medical complications. The aim of the study was examination of immunological disturbances in patients with alcoholic liver cirrhosis. Tests were conducted on 70 patients with diagnosed alcoholic liver cirrhosis. In addition to conventional treatment, ubiquitous biotherapy was introduced in 40 patients. The control group consisted of 30 patients, they were treated according to generally accepted principles. Prior to the commencement of treatment, after a month, and then every 3 months, immunological tests were conducted, the state of health, the subjective improvement of patient's health and the time of hospitalization were assessed. The results were subject to statistical analysis using the Statistical program.