Functional gastrointestinal disorders and pain.

Funkční gastrointestinální onemocnění jsou nejčastějšími diagnózami v gastroenterologii. Jde o poruchy motility, viscerální hypersenzitivity, alteraci slizničních a imunitních funkcí, střevní mikrobioty a procesů v centrální nervové soustavě. U funkčního původu bolestí břicha musí být vyloučena organická příčina bolesti. U bolesti v gastrointesti-nálním traktu musí být vyloučena organická příčina bolesti. V Římských kritériích IV je termín bolest obsažen v následujících heslech: funkční bolest na hrudi, refluxní hypersenzitivita, epigastrický bolestivý syndrom, syndrom dráždivého střeva, centrálně zprostředkovaný břišní bolestivý syndrom, narkotický střevní syndrom, biliární bolest a funkční anorektální bolest. Dále je uváděna bolest v kritériích funkčních poruch užívaných v našich krajích.

[The evolution of knowledge about the inflammatory bowel diseases]. / Vývoj znalostí o idiopatických strevních zánetech.

Crohns disease and ulcerative colitis has affected people for many centuries however its incidence most likely used to be very low. The knowledge of the idiopathic intestinal inflammation at that time was also very limited - an interest about the disease has emerged since the second half of 19th century. Despite all the progress in medicine its etiology still remains unclear.Diagnosis had for a long been based only on clinical investigation and later radiography, endoscopy came in to use in the 1970s. First significant advances in therapy came during the 1940s and 1950s with the invention of aminosalicylates, antibiotics and corticoids. The most advanced conservative therapy today is biological treatment although the importance of gastrointestinal surgery should not be overlooked.The aim of this article is to briefly review the development of knowledge of the idiopathic intestinal inflammation with an emphasis on the 20th century.

[Ordinary disease - appendicitis]. / Obycejná nemoc - apendicitida.

Appendicitis is the most common abdominal emergency. While the clinical diagnosis may be easy in patients who present with classic signs and symptoms. Atypical presentations may result in diagnostic embarrassment and delay in treatment. Typical sign is abdominal pain. Furthermore, it can be nausea, vomiting and anorexia. Abdominal examination reveals localised tenderness and muscular rigidity in the right lower abdominal quadrant. Laboratory data usually reveal an elevated leukocytosis with a left shift and elevated C-reactive protein. To establish the diagnosis greatly help native abdominal X-ray, ultrasound or CT. In 1889, an appendectomy was accepted as the standard treatment, because they save lives and since then dictum: removal of the inflamed appendix changed, it is necessary!

[The story of Appendix]. / Príbeh apendixu.

Acute appendicitis is the most frequent acute abdominal emergency. Appendicitis may have been recorded by Aretaeus the Cappadocean in 30 AD. A description of the appendix was provided by the anatomist Berengario de Carpi in 1521. The first appendicectomy was performed by Claudius Amyand in 1735. Turning point in the story of appendix was public lecture of pathologist-physician Reginald Fitz in 1886. Fitz used the term "appendicitis". The area of maximal tenderness with appendicitis was immortalised by Charles McBurney. In the story of appendicitis many names figure, for example Niels Thorkild Rovsing, Jacob Moritz Blumberg, Otto Lanz, Frederic Treves and other. Kurt Semm introduced laparoscopic appendicectomy in 1988.

[Microscopic colitis]. / Mikroskopické zánety tlustého streva.

Microscopic colitis is characterized by chronic or intermittent watery diarrhoea. Microscopic colitis is a common cause of chronic diarrhoea in predominantly older adults. The underlying mechanism in the pathogenesis of microscopic colitis remains unspecified. Microscopic colitis including colitis collagenous, lymphocytic, microscopic colitis with incomplete findings, minimal change colitis, eosinophilic colitis, Brainerd´s diarrhoea, graft-versus-host disease, mastocytic enterocolitis and postinfectious irritable bowel syndrome. Careful consideration of the clinical features and colonic mucosal biopsies usually lead to correct diagnosis. Treatments of microscopic colitis were based primarily on case reports and personal experience. Many medications have been proposed that either offer symptomatic relief (loperamide, cholestyramine) or had anti-inflammatory or immunosuppressive properties (aminosalicylates, steroids, adalimumab, azathioprine).

[Differential diagnosis of the ileum diseases]. / Diferenciální diagnostika onemocnení ilea*

Inflammation of the ileum - ileitis - is classically connected with Crohn's disease. But a wide variety of diseases is associated with inflammation of the ileum. These include inflammatory bowel disease, infections, spondyloarthropathies, vascular diseases, drug-related enteritis, infiltration (e.g. sarcoidosis, amyloidosis), postirradiation enteritis, tumors, endometriosis, celiac disease and collagenosis.

[Idiopathic inflammatory bowel disease--prediction and treatment]. / Idiopatické strevní zánety--predikce prubehu a vcasná lécba.

Currently the strongest predictors of disease course in Crohn's disease and ulcerative colitis are the age at diagnosis, disease location and smoking habit. Younger age at the onset is associated with more aggressive disease both in Crohn's disease and ulcerative colitis. Disease location in Crohn's disease is associated with different types of complications: surgery and recurrence in upper gastrointestinal and proximal small bowel disease; and surgery in distal small bowel disease and peri-anal lesions in rectal disease. In ulcerative colitis, extensive colitis is clearly associated with more severe disease. Active smoking globally increases disease severity in Crohn's disease but decreases it in ulcerative colitis. In Crohn's disease, proximal small bowel and upper gastrointestinal tract location is associated with risk of recurrence and surgery; small bowel disease with risk of surgery; and colonic disease, and particularly rectal disease, is associated with increased risk of peri-anal lesions. In ulcerative colitis, extensive colitis is associated with increased risk of colorectal cancer and colectomy. Individual treatment of patients with inflammatory bowel disease depends on disease location and severity. There is increasing evidence that early intervention with immunosuppressives or biologic agents aimed at tumor necrosis factor-alpha usually has rapid and prolonged benefits, including steroid sparing, reductions in hospitalizations and, reductions in the need for surgery.

[Postoperative recurrence of Crohn's disease]. / Pooperacní rekurence Crohnovy nemoci.

Postoperative recurrence of Crohn's disease of the bowel is the appearance of objective signs--defined endoscopically, radiologically or pathologically. New lesion can be visualized endoscopically within weeks to months after ileal resection and ileocolonic anastomosis in the neoterminal ileum. Risk factors are smoking, bacterial flora, environmental factors, immune response and genetic variants. Immunomodulators or biological agents are effective in the prophylaxis of postoperative recurrence.

[Inflammatory bowel disease and pregnancy]. / Idiopatické strevní zánety a tehotenství.

Inflammatory bowel disease (IBD) commonly affects women during the reproductive years. Opinion on the effect of IBD on fertility, conception, pregnancy and breastfeeding is varied. IBD does not have probably adverse effect on the outcome of pregnancy. Pregnancy in IBD patients should be closely monitored. This review provides the most current information on the inheritance, fertility, pregnancy, outcomes, foetal development and management of disease during pregnancy, and safety of medications in pregnancy and breastfeeding.

Different patterns of cytokeratin expression in Barrett's esophagus--what is beyond?

Barrett's esophagus (BE) was recently defined by the presence of metaplastic intestinal mucosa (specialized columnar epithelium) in the distal esophagus. However, different epithelial types that were classified by histological criteria occur at the gastro-esophageal region. The purpose of this study was to evaluate the expression of different subtypes of cytokeratins in Barrett's mucosa (BM) and to contribute to the discussion about the significance of cytokeratin expression patterns within the gastro-esophageal junction. Immunohistochemical detection of a wide spectrum of cytokeratins (CK7, CK10, CK19, CK20, CKHW, CK116 and CKAE1/AE3) was performed in bioptic samples obtained from 10 adults with BE and in nine samples of gastric mucosa from the same patients. Cytokeratin immunoreactivity of epithelial cells appearing in BM was particularly dependent on the differentiation degree of these cells. Less differentiated cells were positive for CK7 and CK10, as were the cells of the necks of gastric mucosa and the ducts of esophageal glands. In contrast, differentiated goblet cells showed only weak or negative immunoreactivity for CK7 and CK10. CK20 was positive predominantly in superficial parts of BM. Immunostaining with antibodies detecting a wider spectrum of cytokeratins (CK116, CKAE1/AE3) revealed prominent irregularities, particularly regarding the intensity of immunoreaction. BM showed only weakly positive staining for high molecular weight keratins. Our findings suggest that the mode of CK expression in BM is closely related to the differentiation degree of cells forming BM, and that the cytokeratin inmmunoreactivity pattern in BM is similar to that in the cells forming the necks of gastric glands and ducts of esophageal glands. However, it differs from squamous epithelium of esophageal mucosa.