Haemorrhage in the course of subcardial gastrointestinal stromal tumor - a case description.

This paper is a discussion of the case of a 51-year-old female patient admitted urgently for haemorrhage from the upper gastrointestinal tract and increased dysphagia. After preliminary treatment, the patient was qualified for surgery, during which a large lesion was discovered in the shape of a stromal tumor closely connected with the oesophago-gastric junction. A resection of the tumor and part of the oesophagus was carried out, and a cervical fistula was formed. After a 4-month period, the continuity of the gastrointestinal tract was restored by forming a substitute organ out of the ascending colon and the end of the small intestine, anastomosed on the cervix. The patient was discharged in good overall condition.

The usefulness of the original questionnaire in the evaluation of quality of life in patients with gastroesophageal reflux disease.

UNLABELLED: Gastroesophageal reflux disease (GERD) constitutes a significant health problem in societies of high socioeconomic status. The notion of quality of life is broader than the definition of health and encompasses two aspects: the subjective and objective one. The tools used for the evaluation of quality of life are questionnaires. The aim of the study was the evaluation of the original quality of life questionnaire in patients with gastroesophageal reflux disease treated for 4 weeks with a single dose of omeprazole at 20 mg daily. MATERIAL AND METHODS: The original quality of life questionnaire was formulated based on the Likert method. Four time levels of complaint persistence were introduced. The patients were asked 10 questions with earlier prepared answers marked by the respondents. Each of the questions corresponded to a certain time level of complaint persistence. The data obtained from the questionnaires were subject to statistical analysis. The studies were conducted on a group of 10,623 patients. Adequate methods were used in the statistical analysis of data from obtained answers. The significance threshold for each of the studies was p < 0.01, which means that the obtained conclusions are true with the probability of at least 99%. The majority of statistical calculations were performed with the use of STATISTICA 7.0 and Excel software. RESULTS: Improvement of quality of life was found in all the studied aspects: physical (questions 1, 3, 4, 5, 7), functional (question 6), emotional (questions 2, 10) and social (questions 8, 9). No correlation with age or gender was found. The analysis of test correctness was conducted, revealing reliability, validity, sensitivity, appropriateness and practicality of the questionnaire. CONCLUSIONS: 1. The original quality of life questionnaire meets the requirements for the tools evaluating quality of life in gastroesophageal reflux disease. 2. The usefulness of questionnaire was confirmed in a group of 10,623 patients with gastroesophageal reflux disease in the Polish population. 3. The questionnaire equals the international tests, while its advantages are the ease of completion and high level of perception.

Combined esophageal multichannel intraluminal impedance and pH monitoring (MII -pH) in the diagnostics and treatment of gastroesophageal reflux disease and its complications.

The technique of 24-hour esophageal multichannel intraluminal impedance monitoring combined with pH-metry (MII-pH) is currently considered to be the golden standard in the diagnostics of gastroesophageal reflux disease (GERD). The technique allows for differentiation of gas and liquid reflux as well as detection of non-acid reflux, which cannot be detected with other techniques that are based only on measuring the pH of gastric contents.THE AIM OF THE STUDY was to assess the usefulness of MII-pH in the diagnostics and treatment of GERD and its complications. MATERIAL AND METHODS. A group of 213 patients referred to II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Ukladu Pokarmowego Uniwersytetu Medycznego w Lublinie [the Second Faculty and Clinic of General and Gastrointestinal Surgery and Gastrointestinal Oncology at Medical University of Lublin] due to persistent symptoms of GERD and 21 volunteers without any clinical evidence of GERD underwent esophageal monitoring via MII-pH. The results were correlated with those of upper gastrointestinal tract endoscopy. The data gathered during MII-pH and endoscopy as well as information from questionnaires were entered into an MS Excel spreadsheet and subsequently analyzed with STATISTICA PL software. RESULTS AND CONCLUSIONS. MII-pH proved to be considerably more useful than conventional pHmetry in recording acid reflux. The sensitivity of pH-metry based on the MII-pH technique was established at 74%. GERD-induced changes in the esophageal mucosa result in decreased impedance baseline. The presence and severity of inflammatory esophageal lesions was proven to be associated with acid reflux episodes and proximal reflux episodes. No direct relationship between the grade of GERD and the occurrence of non-acid reflux episodes was confirmed. Non-acid reflux episodes were shown to predispose to non-erosive reflux disease (NERD). The results of this study confirm that MIIpH is an essential technique in the diagnostics, as well as in assessment of the course of treatment and the severity of GERD.

Evaluation of endostatin and EGF serum levels in patients with gastric cancer.

THE AIM OF THE STUDY was to assess angiogenesis markers - endostatin and endothelial growth factor (EGF) as markers of detection of gastric carcinoma. MATERIAL AND METHODS. The study involved 20 patients with colorectal cancer (10 women, 10 men) aged 35 - 75 years, mean age = 55 years ± 11.2 who referred to the 2nd Department of General Surgery, Medical University in Lublin between June 2008 and June 2009. The control group comprised 10 volunteers (6 women, 4 men) who underwent upper gastrointestinal (GI) endoscopy due to the reflux disease and in whom gastric cancer was not diagnosed. RESULTS. The mean endostatin concentration in controls was 5.21 ng/mL ± 1.37. Mean concentrations in patients with gastric cancer were higher than those in controls - 5.91 ng/mL ± 1.5. The difference was not statistically significant (p= 0.714). The EGF concentration in the control group was 28.19 pg/mL ± 12.94. EGF concentrations in patients with gastric cancer were higher compared to the control group - 28.8 pg/mL ± 12.63. The difference was not statistically significant (p= 0.85). The mean concentration of endostatin before the operation was 5.91 ng/mL ± 1.5 and after surgery was 5.33 ng/mL ± 2.01, the difference was not statistically significant. CONCLUSIONS. Blood endostatin and EGF quantitative determinations probably is not useful for detection of gastric carcinoma and effectiveness of treatment.