[Video capsule endoscopy--preliminary experience in university hospital setting]. / Endoskopska kapsula za tanko crijevo--pocetna iskustva u klinickoj bolnici.

INTRODUCTION: The use of video capsule endoscopy (VCE) started in late 2001 when it was approved by the Food and Drug Administration (FDA). Since then, we are able to visualize small bowel mucosa with a minimally invasive technique, very comfortable for patients, with very few complications and without the need of hospitalization. At Dubrava University Hospital, we have been using VCE since October 2006, and by February 2008 we examined 30 patients. AIM: The aim of the study was to present our preliminary results in the use of VCE during a period of one year and five months. We also report indications and contraindications for VCE, and patient preparation. METHODS: In this retrospective study we reviewed records on 30 patients that had undergone VCE at Dubrava University Hospital, Zagreb, Croatia, between October 2006 and February 2008. The indications for VCE were restricted to the investigation of obscure gastrointestinal bleeding (OGIB) (n = 10), iron deficiency anemia (n = 2), suspected Crohn's disease (n = 1), assessment of known small bowel Crohn's disease (n = 5), unexplained diarrhea (n = 6), chronic abdominal pain (n = 3), suspected ganglioneurinoma (n = 1) and suspected polyposis syndrome (n = 2). To be eligible for VCE, patients had to have previously undergone usual diagnostic methods of upper endoscopy, colonoscopy and small bowel follow-through, without discovering the cause of their symptoms. Before swallowing the capsule, patients were instructed not to eat anything the day before VCE and to drink 4 L of liquids, and additional 2 L magnesium sulfate. In all patients we used Olympus EndoCapsule Software (Tokyo, Japan). Results were interpreted by one specialist, gastroenterologist. RESULTS: Definitive diagnosis was made in 15 patients. Suspect findings were noted in 2 patients, whereas no diagnosis could be established in 13 patients. According to our experience, VCE is a promising new method that has a high diagnostic yield in patients with OGIB and known Crohn's disease. Use of VCE enabled definitive diagnosis to be made in 6 of 10 patients with OGIB after all previously used diagnostic methods had failed to reveal any pathological finding. In the group of OGIB patients, angiodysplasia was the most common findings (4 of 10 patients). In the group of patients with Crohn's disease, progression of the disease to neotherminal ileum was recorded in 3 of 5 patients. Our experience also confirmed the VCE to be a very safe method; capsule retention was recorded in only one patient. DISCUSSION: Although VCE enabled us to visualize the small bowel mucosa and therefore helped us establish the diagnosis in cases where other diagnostic methods had failed, it still has some important limitations, the major one being the impossibility to take biopsies and to perform any therapeutic procedures. However, it has a high diagnostic yield in cases of OGIB and Crohn's disease, is very comfortable for patients, and has a low incidence of complications (capsule retention). When making definitive diagnosis, one should always consider patient's history and physical examination findings as well as other possible causes of small bowel mucosal impairment. CONCLUSION: VCE is a promising new technique that has a high diagnostic yield in patients with OGIB and Crohn's disease. However, more studies need to be done to establish definitive indications, cost-effectiveness and the best way of patient preparation for VCE.

The association between upper gastrointestinal lesions and high-sensitivity C-reactive protein in coronary artery disease patients.

BACKGROUND: Although high-sensitivity C-reactive protein (hs-CRP) testing is not specific for coronary atherosclerosis, elevated hs-CRP is recently accepted as an independent predictor of future cardiovascular events. Also, a connection between upper gastrointestinal lesions (UGILs) and coronary artery disease (CAD) has been observed. The authors hypothesized that UGILs increase hs-CRP in CAD patients. MATERIAL/METHODS: One hundred fifty patients with stable CAD were enrolled in the study. Demographic and clinical variables and chronic medication used were gathered from a structured questionnaire. UGIL severity was determined by a modified Lanza score, H. pylori status by histology of the gastric mucosa, and the severity of CAD by a modified Gensini score. Independent correlation between hs-CRP and UGIL was tested by logistic regression analysis. RESULTS: The overall hs-CRP value was higher in patients with UGIL than in those with normal endoscopic results (8.14+/-4.53 mg/l vs. 4.64+/-3.06 mg/l, P<0.0001). hs-CRP level positively correlated with UGIL severity (r=0.434, P<0.0001). Correlation between UGIL and hs-CRP level remained significant after adjustment for coronary risk factors, medication used, CAD severity, and H. pylori status (standardized coefficient beta=1.272, P<0.0001). However, when hs-CRP level was used as a categorical variable, multivariate analysis revealed independent correlation only between UGIL and hs-CRP categories > or =6.1 mg/l. CONCLUSIONS: Elevated hs-CRP levels may be predictive of UGIL; thus endoscopy should be considered in CAD patients with elevated hs-CRP even with no dyspeptic symptoms. Because CRP plays an active role in atherothrombosis, UGILs with subsequent elevated CRP levels could increase cardiovascular risk in those patients.

[Biochemical markers in assessment of severity and prognosis of acute pancreatitis]. / Biokemijski parametri u procjeni tezine i prognoze akutnog pankreatitisa.

The authors reveal and discuss the role of novel biochemical parameters in early diagnosis of acute pancreatitis and assessment of the severity of the disease. These biochemical parameters, beside routinely used amilase and lipase, might enable us to early identify those patients who are at risk of developing severe form of pancreatitis or complications. These parameters include trypsinogen activation peptide (TAP), C-reactive protein (CRP, tripsinogen-2, procalcitonin, phospholipase-A2 (PLA2), carboxypeptidase activation peptide (CAPAP) and interleukin-6 and 8 (IL-6, IL-8). Although these markers are still not incorporated in routine clinical practice, IL-6, IL-10, procalcitonin and trypsinogen activation peptide seem to have a good chance to be used as a new biochemical markers in assessment of severity and prognosis of acute pancreatitis.

[Gastroduodenal mucosal lesions and coronary atherosclerosis severity in patients with coronary artery disease]. / Ostecenje gastroduodenalne sluznice i tezina koronarne ateroskleroze u bolesnika s koronarnom bolescu srca.

AIM: Due to high metabolic activity and oxygen demands, ischemia of gastroduodenal (GD) mucosa is an important factor in the pathogenesis of its impairment. Comparing the degree of coronary atherosclerosis, for evaluation of severity of atherosclerosis, with the prevalence and severity of GD mucosal lesions, we wanted to investigate the possible ischemia of GD mucosa could contribute to its impairment. PATIENTS AND METHODS: This prospective study included 150 coronary artery disease (CAD) patients, 109 (72.7%) male and 41 (27.3%) female, average age 62.61 +/- 10.23 years. We noted clinical and anthropometric parameters, standard laboratory findings, treatment until inclusion into the study and standard cardiovascular risk factors. The severity of CAD was assessed by several parameters: 1) number of coronary arteries affected with atherosclerosis, 2) modified Gensa score, and 3) number of coronary arteries with stenosis > 50%. The severity of GD mucosal lesions was assessed by modified Lanza score, and Helicobacter pylori infection was confirmed by biopsy and pathohistological analysis of GD mucosa. Predictive value of different independent factors regarding the presence of GD mucosal lesions was assessed by multivariate analysis. RESULTS: The severity of CAD in patients with or without GD mucosal lesions did not differ by any of used scoring methods: 1) number of coronary arteries affected by atherosclerosis (2.15 +/- 0.85 vs. 2.00 +/- 0.87, p = 0.292), 2) modified Gensa score (71.22 +/- 51.78 vs. 69.89 +/- 54.18, p = 0.881), 3) number of coronary arteries with stenosis > 50% (3.89 +/- 2.05 vs. 3.47 +/- 2.25, p = 0.244). We also noticed that there had been no correlation between severity of CAD and severity of GD mucosal lesions. Correlation of number of coronary arteries affected with atherosclerosis with Lanza score resulted in r = 0.029, p = 0.721, correlation of Genza score with Lanza score resulted in r = 0.019, p = 0.082, and correlation of the number of coronary arteries with stenosis > 50% with Lanza score resulted in r = 0.079, p = 0.337. CONCLUSION: According to available method for evaluating the severity of CAD, in CAD patients ischemia has no or very minor role in pathogenesis of GD mucosa impairment.