Novinky v gastroenterologii pro internisty

Milan Lukáš

Vnitr Lek 2018, 64(6):585  

The IBD outpatient care in the clinical practice

Luděk Hrdlička

Vnitr Lek 2018, 64(6):654-658 | DOI: 10.36290/vnl.2018.089  

The number of patients with inflammatory bowel disease (Crohn's disease and ulcerative colitis) has increased steadily. Gastroenterology outpatient secondary type centres play very important role in the care for these patients. Their clinical practice was assessed in our study. The data was obtained using a structured questionnaire concerned on 4 major topics (the centre characteristics, diagnosis, therapy and patient's monitoring). Obtained data was compared with both local and international recommendations and showed high professional standards of care.

Current trends in the diagnosis and treatment of gastroesophageal reflux disease

Radek Kroupa, Štefan Konečný, Jiří Dolina

Vnitr Lek 2018, 64(6):588-594 | DOI: 10.36290/vnl.2018.081  

Gastroesophageal reflux disease and its typical symptoms heartburn and regurgitation is one of the most common gastrointestinal disorders. Besides esophageal symptoms awareness of extraesophageal symptoms is increasing. The diagnosis is usually based on history of symptoms and on endoscopically visible esophageal injury in some patients. Normal endoscopic finding and refractory symptoms on standard treatment should evoke further examination. Proton pump inhibitors have been the mainstay of medical therapy. Long term maintenance treatment may raise awareness of side effects and therapeutic alternatives. This review is focused of current available diagnostic...

Therapy for peptic ulcer disease

Milan Lukáš

Vnitr Lek 2018, 64(6):595-599 | DOI: 10.36290/vnl.2018.082  

The modern therapy for peptic ulcer disease and other acid peptic diseases is based on administration of proton pump inhibitors (PPI) which have fully replaced anacids, parasympatholytics and histamine H₂ receptor antagonists. The most effective way is to administer proton pump inhibitors in the morning on an empty stomach in a single daily dose. It is a very safe therapy, despite the fact that a potential adverse effect of long-term PPI treatment on the efficacy of other medications (clopidogrel), on bone metabolism and development of respiratory infections have been discussed recently. PPI also play an essential role in the eradication...

History of celiac disease

Jan Bureš

Vnitr Lek 2018, 64(6):600-601 | DOI: 10.36290/vnl.2018.083  

Intestinal disease with prominent malabsorption resembling celiac disease was already described in India in the 15th century B.C. This review provides a brief history of celiac disease from Aretaeus of Cappadocia (1st century A.D.) to Willem Karel Dicke (mid 20th century).

Celiac disease in 2018

Jan Bureš

Vnitr Lek 2018, 64(6):602-610 | DOI: 10.36290/vnl.2018.084  

Currently more than 50 diseases and disorders are associated with gluten and/or other wheat (cereals) components. Even celiac disease is not just one illness but a group of at least three different related entities. This review provides highlights of celiac disease and its differential diagnosis.

Diagnosis of gastrointestinal motility disorders

Jana Koželuhová, Karel Balihar, Lucie Zdrhová

Vnitr Lek 2018, 64(6):611-620 | DOI: 10.36290/vnl.2018.085  

Gastrointestinal motility and the effects on luminal contents that are brought about by it can be studied in several ways. In clinical practice, manometry remains one of the most important investigational techniques, in particular for oesophageal and anorectal disorders. Radiographic examination of bolus transit through the gastrointestinal tract also continues to be a valuable tool. Scintigraphy still is the standard for assessment of gastric emptying, but ¹³C breath tests are an alternative. Many other techniques are used mainly in the context of scientific research but some of these may become incorporated in the diagnostic armamentarium.

Diverticular disease: diagnosis and treatment

Julius Špičák, Miloš Kučera, Gabriela Suchánková

Vnitr Lek 2018, 64(6):621-634 | DOI: 10.36290/vnl.2018.086  

Diverticular disease is one of the most common gastroenterological diseases. Its morphological basis are diverticula, whose prevalence in adults nears 50 %, with 25% clinical symptomatology and 5% occurrence of complications. It is a disease of older age, however its incidence is also rising in younger individuals, where it takes a more severe course. Its incidence is ascribed to a diet with a relatively low fibre content, however studies do not yield such clear results. Further risk factors include smoking, use of opiates and corticoids, obesity, alcoholism and smoking, hypertension, polycystosis, immunosuppression and use of non-steroid antiflogistics....

Familial adenomatous polyposis: complex patient management

Jiří Cyrany, Jan Bureš, Stanislav Rejchrt, Marcela Kopáčová

Vnitr Lek 2018, 64(6):635-641 | DOI: 10.36290/vnl.2018.087  

Familial adenomatous polyposis (FAP) is a hereditary disease characterized by presence of numerous colorectal adenomas. It often exposes its carrier to absolute risk of colorectal cancer, but also to other extracolonic tumours (especially to duodenal cancer and desmoid). Screening and surveillance of FAP patients leads to reduction of colorectal cancer incidence and mortality. Colonoscopy/lower endoscopy and esophagogastroduodenoscopy (including use of side-viewing endoscope) are the principal examinations. Colectomy is the standard therapeutic procedure, but endoscopic therapy plays relevant role both in upper and lower gastrointestinal tract. Recent...

Conventional and biological therapy for inflammatory bowel disease

Martin Bortlík

Vnitr Lek 2018, 64(6):642-653 | DOI: 10.36290/vnl.2018.088  

Crohn's disease and ulcerative colitis are chronic digestive conditions incurable by medication or surgery, which affect mainly young populations in economically developed countries. A medical treatment includes conventional preparations: aminosalicylates, corticosteroids, immunosuppressive drugs, antibiotics and exceptionally also probiotics, while in not responding patients or those at higher risk of an adverse course a biological treatment is indicated. The most frequently administered biologics are antibodies directed against the tumour-necrosis factor α, which are highly effective, but the length of their application is limited by a loss...

PSC-IBD: specific phenotype of inflammatory bowel disease associated with primary sclerosing cholangitis

Lukáš Bajer, Pavel Wohl, Pavel Drastich

Vnitr Lek 2018, 64(6):659-664 | DOI: 10.36290/vnl.2018.090  

Primary sclerosing cholangitis (PSC) is a progressive disease of the biliary tree which represents one of the most frequent indications for orthotopic liver transplantation (OLTx) in developed countries. LTx is currently the only curative procedure for PSC. Concomitant inflammatory bowel disease (IBD) is present in approximately 70 % of patients with PSC. Such colitis in PSC has specific clinical and etiological features and is considered as a distinct phenotype of IBD often referred to as "PSC-IBD". The phenotype usually manifests as mild extensive colitis with right-sided predominance. Other morphological features, such as back-wash ileitis and rectal...

Possibilities of therapeutic manipulation of the gut microbiota

Pavel Drastich, Lukáš Bajer, Miloslav Kverka

Vnitr Lek 2018, 64(6):665-671 | DOI: 10.36290/vnl.2018.091  

Human gut microbiota, complex ecosystem of microbes associated with human gut, is essential for the development of the host's immune system and many other physiological functions. Recently, numerous diseases and syndromes were associated with disruption of this ecosystem thus stressing its importance in maintaining the host's health. Growing evidence suggests that by manipulating the gut microbiota, some of these diseases could be treated or even prevented. These manipulations include changes in diet, use of probiotics, prebiotics, antibiotics and fecal microbiota transplantation (FMT). The successes in FMT treatment of recurrent infection of Clostridium...

Prokinetics and their use in gastroenterology

Jiří Dolina, Aleš Hep, Lumír Kunovský, Štefan Konečný

Vnitr Lek 2018, 64(6):673-678 | DOI: 10.36290/vnl.2018.092  

Gastrointestinal motility disorders are reflected in clinical medicine not only in the form of functional disorders but also as primary organic units or secondary manifestations of other diseases and physicochemical effects. Recent sophisticated diagnostic methods and basic research in the field of digestive tract motility have shown significant development. However, causal treatment of prokinetic motility disorders is still marginalized. A number of new effective drugs have been withdrawn from the market due to their significant side effects. The efficacy of others is limited to individual parts of the gastrointestinal tract (GIT), e.g. only the stomach...

Colorectal cancer screening

Štěpán Suchánek, Tomáš Grega, Miroslav Zavoral

Vnitr Lek 2018, 64(6):679-683 | DOI: 10.36290/vnl.2018.093  

In developed countries, colorectal cancer represents one of the most common malignancy. Screening of colorectal cancer, as a tool of secondary prevention, lead to reduction of the incidence and mortality of this disease. It allows to capture not only the precancerous lesions, but also the earlier stages of colorectal cancer, which can be effectively treated. In the Czech Republic the National colorectal cancer screening program was launched in 2000. It is focused to asymptomatic individuals over 50 years old, who have a negative personal and family history of colorectal neoplasia. The basic tools of colorectal cancer screening in the Czech Republic...

Therapeutic digestive endoscopy I

Přemysl Falt, Ondřej Urban

Vnitr Lek 2018, 64(6):684-692 | DOI: 10.36290/vnl.2018.094  

Digestive endoscopy today is able to examine the whole gastrointestinal tract. On the basis of the originally purely diagnostic procedures a range of therapeutic modalities has been developed over years, which in some indications have taken the place of surgical procedures and methods of invasive radiology. Of greatest importance are the methods of endoscopic resection and ablation designed for the treatment of early neoplasms of the digestive tract not accompanied by a significant risk of lymphatic and systemic dissemination. Resection methods include endoscopic polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic...

Therapeutic digestive endoscopy II

Ondřej Urban, Přemysl Falt

Vnitr Lek 2018, 64(6):693-704 | DOI: 10.36290/vnl.2018.095  

Digestive endoscopy today is able to examine the whole gastrointestinal tract. On the basis of the originally purely diagnostic procedures a range of therapeutic modalities was developed over years, which in some indications have taken the place of surgical procedures and methods of invasive radiology. Apart from the methods of endoscopic resection of early neoplasms of the digestive tract, digestive endoscopy plays an important role in diagnosing and treatment of bleeding and stenoses of the gastrointestinal tract. Plastic or self-expansible metal stents are introduced in the treatment of stenoses. Endoscopic retrograde cholangiopancreatography is...