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Peutz-Jeghers syndrome:Diagnostic and therapeutic approach

World Journal of Gastroenterology 2009年第43期15卷 5397-5408页

作者： Marcela Kopacova Ilja Tacheci stanislav rejchrt Jan Bures 2nd Department of Medicine Charles University in PrahaFaculty of Medicine at Hradec KrálovéUniversity Teaching HospitalSokolská581Hradec Králové500 05 Czech Republic

Peutz-Jeghers syndrome （P3S） is an inherited, autosomal dominant disorder distinguished by hamartomatous polyps in the gastrointestinal tract and pigmented mucocutaneous lesions. Prevalence of PJS is estimated from 1 in 8300 to 1 in 280000 individuals. PJS predisposes sufferers to various malignancies （gastrointestinal, pancreatic, lung, breast, uterine, ovarian and testicular tumors）. Bleeding, obstruction and intussusception are common complications in patients with P3S. Double balloon enteroscopy （DBE） allows examination and treatment of the small bowel. Polypectomy using DBE may obviate the need for repeated urgent operations and small bowel resection that leads to short bowel syndrome. Prophylaxis and polypectomy of the entire small bowel is the gold standard in PJS patients. Intraoperative enteroscopy （IOE） was the only possibility for endoscopic treatment of patients with PJS before the DBE era. Both DBE and IOE facilitate exploration and treatment of the small intestine. DBE is less invasive and more convenient for the patient. Both procedures are generally safe and useful. An overall recommendation for PJS patients includes not only gastrointestinal multiple polyp resolution, but also regular lifelong cancer screening （colonoscopy, upper endoscopy, computed tomography, magnetic resonance imaging or ultrasound of the pancreas, chest X-ray, mammography and pelvic examination with ultrasound in women, and testicular examination in men）. Although the incidence of PJS is low, it is important for clinicians to recognize these disorders to prevent morbidity and mortality in these patients, and to perform presymptomatic testing in the first-degree relatives of PJS patients.

关键词： Gastrointestinal endoscopy Intraoperative period Peutz-Jeghers syndrome Hamartoma

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Buried bumper syndrome:A complication of percutaneousendoscopic gastrostomy

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World Journal of Gastroenterology 2016年第2期22卷 618-627页

作者： Jiri Cyrany stanislav rejchrt Marcela Kopacova Jan Bures nd Department of Internal Medicine-Gastroenterology University Hospital Hradec Kralove50005 Hradec KraloveCzech Republic Faculty of Medicine in Hradec Kralove Charles University in Prague50005 Hradec KraloveCzech Republic

Percutaneous endoscopic gastrostomy(PEG) is a widely used method of nutrition delivery for patients with longterm insufficiency of oral intake. The PEG complication rate varies from 0.4% to 22.5% of cases, with minor complications being three times more frequent. Buried bumper syndrome(BBS) is a severe complication of this method, in which the internal fixation device migrates alongside the tract of the stoma outside the stomach. Excessive compression of tissue between the external and internal fixation device of the gastrostomy tube is considered the main etiological factor leading to BBS. Incidence of BBS is estimated at around 1%(0.3%-2.4%). Inability to insert, loss of patency and leakage around the PEG tube are considered to be a typical symptomatic triad. Gastroscopy is indicated in all cases in which BBS is suspected. The depth of disc migration in relation to the lamina muscularis propria of the stomach is critical for further therapy and can be estimated by endoscopic or transabdominal ultrasound. BBS can be complicated by gastrointestinal bleeding, perforation, peritonitis, intra-abdominal and abdominal wall abscesses, or phlegmon, and these complications can lead to fatal outcomes. The most important preventive measure is adequate positioning of the external bolster. A conservative approach should be applied only in patients with high operative risk and dismal prognosis. Choice of the method of release is based on the type of the PEG set and depth of disc migration. A disc retained inside the stomach and completely covered by the overgrowing tissue can be released using some type of endoscopic dissection technique(needle knife, argon plasma coagulation, or papillotome through the cannula). Proper patient selection and dissection of the overgrowing tissue are the major determinants for successful endoscopic therapy. A disc localized out of the stomach(lamina muscularis propria) should be treated by a surgeon.

关键词： Buried bumper syndrome Percutaneous endoscopic gastrostomy Endoscopy Complication Enteral nutrition

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Blood pressure and stature in Helicobacter pylori positive and negative persons

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World Journal of Gastroenterology 2014年第19期20卷 5625-5631页

作者： Marcela Kopacova Ilona Koupil Bohumil Seifert Miluska Skodova Fendrichova Jana Spirkova Viktor Vorisek stanislav rejchrt Tomas Douda Ilja Tacheci Jan Bures 2~(nd)Department of Internal Medicine-Gastroenterology Charles University in PrahaFaculty of Medicine at Hradec KraloveUniversity Teaching Hospital50005 Hradec KraloveCzech Republic Centre for Health Equity Studies Stockholm UniversityKarolinska Institute17177 StockholmSweden Institute of General Practice First Faculty of MedicineCharles University12002 PrahaCzech Republic Institute of Clinical Biochemistry and Diagnostics Charles University in PrahaFaculty of Medicine at Hradec KraloveUniversity Teaching Hospital50005 Hradec KraloveCzech Republic

To evaluate vital signs and body indices in Helicobacter pylori (H. pylori) positive and negative persons. A total of 22 centres entered the study. They were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1818 subjects (aged 5-98 years) took part in the study, randomly selected out of 38147 subjects. H. pylori infection was investigated by means of a 13C-urea breath test. Data on height, weight, systolic and diastolic blood pressure and heart rate were collected at the clinics of general practitioners. The overall prevalence of H. pylori infection was 30.4% (402/1321) in adults (≥ 18 year-old) and 5.2% (26/497) in children and adolescents (≤ 17 year-old). Once adjusted for age and gender, only a difference in body mass index remained statistically significant with H. pylori positive adults showing an increase of 0.6 kg/m2 in body mass index. Once adjusted for age and gender, we found a difference in height between H. pylori positive and H. pylori negative children and adolescents. On further adjustment for place of residence, this difference became statistically significant, with H. pylori positive children and adolescents being on average 3.5 cm shorter. H. pylori positive adults were significantly older compared to H. pylori negative subjects. Once adjusted for age and gender, H. pylori infection had no impact on body weight, body mass index and vital signs either in adults or children and adolescents. Chronic H. pylori infection appeared to be associated with short stature in children. H. pylori infection did not influence blood pressure, body weight and body mass index either in adults or children and adolescents.

关键词： Epidemiology Helicobacter pylori Czech Republic 13C-urea breath test Blood pressure Heart rate Weight Stature Body mass index

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Double balloon enteroscopy and acute pancreatitis

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World Journal of Gastroenterology 2010年第19期16卷 2331-2340页

作者： Marcela Kopacova Ilja Tacheci stanislav rejchrt Jolana Bartova Jan Bures 2nd Department of Medicine Charles University in PrahaFaculty of Medicine at Hradec KrálovéUniversity Teaching HospitalSokolská581Hradec Králové500 05Czech Republic

Double balloon enteroscopy(DBE)is a new technique, first published and introduced into clinical practice in 2001 by Yamamoto,the inventor of this outstanding *** allows complete visualization,biopsy and treatment of the small ***,we have some experience of this method for evaluation of the complica- tion *** complications are described in 1%-1.7% of *** pancreatitis is a rare complication of the *** incidence of acute pancreatitis after diagnostic DBE is 0.3%in most *** than 50 cases of acute pancreatitis have been described in the literature so *** the contrary,hyperamylasemia after DBE seems to be a rather common *** with acute pancreatitis is supposed to be possible,but not *** causal mechanism of post-DBE acute pancreatitis is uncertain,and there are several theories in the *** most probable cause seems to be a mechanical straining of the endoscope with over-tube on the pancreas or in the papillary area.

关键词： Double balloon endoscopy Gastrointestinal endoscopy Small intestine Hyperamylasemia Acute pancreatitis

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Small intestinal bacterial overgrowth syndrome

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World Journal of Gastroenterology 2010年第24期16卷 2978-2990页

作者： Jan Bures Jiri Cyrany Darina Kohoutova Miroslav Frstl stanislav rejchrt Jaroslav Kvetina Viktor Vorisek Marcela Kopacova 2nd Department of Medicine Charles University in Praha Faculty of Medicine at Hradec Kralove University Teaching Hospital Institute of Clinical Microbiology Charles University in Praha Faculty of Medicine at Hradec Kralove University Teaching Hospital Institute of Experimental Biopharmaceutics Joint Research Centre of Czech Academy of Sciences and PRO.MED.CS Praha a.s. Institute of Clinical Biochemistry and Diagnostics Charles University in Praha Faculty of Medicine at Hradec Kralove University Teaching Hospital

Human intestinal microbiota create a complex polymi-crobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO).SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastro-intestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacte-riostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insuff iciency, immuno-deficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, f istulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Noninvasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be com-plex, addressing all causes, symptoms and complica-tions, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO.

关键词： Bacterial overgrowth Breath test Hydrogen Methane Small intestine

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Significant decrease in prevalence ofHelicobacter pylori in the Czech Republic

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World Journal of Gastroenterology 2012年第32期18卷 4412-4418页

作者： Jan Bure Marcela Kopáová Ilona Koupil Bohumil Seifert Miluka kodová Fendrichová Jana pirková Viktor Voíek stanislav rejchrt TomáDouda Norbert Král Ilja Tachecí Second Department of Medicine Gastroenterology Charles University in PrahaFaculty of Medicine at Hradec KrálovéUniversity Teaching Hospital50005 Hradec KrálovéCzech Republic Centre for Health Equity Studies Karolinska InstituteStockholm University17177 StockholmSweden First Faculty of Medicine Institute of General PracticeCharles University12108 PrahaCzech Republic Institute of Clinical Biochemistry and Diagnostics Charles University in PrahaFaculty of Medicine at Hradec KrálovéUniversity Teaching Hospital50005 Hradec KrálovéCzech Republic

AIM:To study possible decrease in prevalence of Helicobacter pylori(***) infection in the Czech Republic within a 10-year ***:A total of 22 centres entered the *** catchment areas of these centres covered cities and towns with more than 20 000 inhabitants,smaller towns(≤ 20 000 inhabitants) with surrounding villages and rural areas,and were spread over the whole country,corresponding well to the geographical distribution of the Czech population.A total of 1 837 subjects(aged 5-98 years) took part in the study,randomly selected out of 38 147 people from the general *** infection was investigated by means of a 13 C-urea breath *** samples in duplicates were analysed using isotope ratio mass *** cut-off point was *** and demographic characteristics were based on data from self-completed ***:The overall prevalence of *** infection was 23.5%(430/1826),and 4.8%(20/420) in children aged 15 or *** was no statistically significant difference in prevalence between males(24.3%;208/857) and females(22.9%,222/969,P = 0.494).*** infection was strongly associated with higher age,among subjects aged 55+ years,prevalence of *** infection was 39.8%(252/633,P < 0.001).The highest prevalence of *** infection was found among persons aged 55-64 years(43.9%,97/221) and 75+ years(37.9%,58/153).Among study subjects aged 15+ years,prevalence of *** infection was significantly increased in those with lowest education(odds risk 3.19,95% CI 1.87-5.47).Compared to never married(14.1%),the prevalence of *** infection was statistically significantly higher among married(35.4%,246/694,P < 0.001),divorced(36.8%,49/133,P < 0.001) and widowed study subjects(40.2%,45/112,P < 0.001),both in minimally and fully adjusted *** was no significant difference in the prevalence of *** infection between married and widowed subjects(35.4%,246/694 vs 40.2%,45/112,P = 0.389).Ther

关键词： Epidemiology Helicobacter pylori Czech Republic 13 C-urea breath test Decline of prevalence

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Bacteriocinogeny in experimental pigs treated with indomethacin and Escherichia coli Nissle

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World Journal of Gastroenterology 2011年第5期17卷 609-617页

作者： Jan Bures David Smajs Jaroslav Kvetina Miroslav Frstl Jan Smarda Darina Kohoutova Martin Kunes Jiri Cyrany Ilja Tacheci stanislav rejchrt Jirina Lesna Viktor Vorisek Marcela Kopacova 2nd Department of Medicine Charles University in PrahaFaculty of Medicine at Hradec KraloveUniversity Teaching Hospital500 05 Hradec KraloveCzech Republic Department of Biology Masaryk UniversityFaculty of Medicine625 00 BrnoCzech Republic Institute of Experimental Biopharmaceutics Joint Research Centre of Czech Academy of Sciences and PRO.MED.CS Praha a.s.500 02 Hradec KraloveCzech Republic Institute of Clinical Microbiology Charles University in PrahaFaculty of Medicine at Hradec KraloveUniversity Teaching Hospital500 05 Hradec KraloveCzech Republic Institute of Clinical Biochemistry and Diagnostics Charles University in PrahaFaculty of Medicine at Hradec KraloveUniversity Teaching Hospital500 05 Hradec KraloveCzech Republic

AIM： To evaluate bacteriocinogeny in short-term highdose indomethacin administration with or without probiotic Escherichia coli Nissle 1917 （EcN） in experimental ***： Twenty-four pigs entered the study： Group A （controls）, Group B （probiotics alone）, Group C （indomethacin alone） and Group D （probiotics and indomethacin）. EcN （3.5 × 10^10 bacteria/d for 14 d） and/or indomethacin （15 mg/kg per day for 10 d） were administrated orally. Anal smears before and smears from the small and large intestine were taken from all animals. Bacteriocin production was determined with 6 different indicator strains; all strains were polymerase chain reaction tested for the presence of 29 individual bacteriocinencoding determinants. RESULTS： The general microbiota profile was rather uniform in all animals but there was a broad diversity in coliform bacteria （parallel genotypes A, B1, B2 and D found）. In total, 637 bacterial strains were tested, mostly Escherichia coli （E. coli. There was a higher incidence of non-E：, coli strains among samples taken from the jejunum and ileum compared to that of the colon and rectum indicating predominance of E. coil strains in the large intestine. Bacteriocinogeny was found in 24/77 （31%） before and in 155/560 （28%） isolated bacteria at the end of the study. Altogether, 13 individual bacteriocin types （out of 29 tested） were identified among investigated strains. Incidence of four E. coli genotypes was equally distributed in all groups of E. coil strains, with majority of genotype A （ranging from 81% to 88%）. The following types of bacteriocins were most commonly revealed： colicins Ia/Ib （44%）, microcin V （18%）, colicin E1 （16%） and microcin H47 （6%）. There was a difference in bacteriocinogeny between control group A （52/149, 35%） and groups with treatment at the end of the study： B： 31/122 （25%, P = 0.120）; C： 43/155 （28%, P = 0.222）; D： 29/134 （22%, P = 0.020）. There was a significantly lower prevalence of colicin Ib, microcins H47 and V （pr

关键词： Bacteriocinogeny Escherichia coli Nissle1917 Experimental pigs Indomethacin

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