4 th Central European Gastroenterology Meeting Visegrád , Hungary June 29 – July 2 , 2006 The history of Central European Gastroenterology

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Author	Biro, A. Beatrix Scherzer, Thomas Matthias Folhoffer, Anikó Horváth, Andrea Osztovits, János Lakatos, Peter L. Karádi, István Füst, György Ferenci, Peter Szalay, Ferenc A. De
Copyright Year	2006
Abstract	Abstracts were not subjected to English edition in the Editorial Office of the Journal.s were not subjected to English edition in the Editorial Office of the Journal. RELEVANCE OF COLOR DOPPLER ULTRASONOGRAPHY IN ASSESSMENT OF PANCREATIC CARCINOMA VASCULAR INVASION Tamara Alempijevic, Nada Kovacevic, Dragan Tomic, Srdjan Djuranovic, Miodrag Krstic Clinic for Gastroenterology and hepatology, Institute for digestive diseases, Clinical Center of Serbia, Belgrade, Serbia and Montenegro Introduction and aim: It is highly appreciated to provide accurate data on vascular invasion of pancreatic carcinoma relaying as much as possible on non-invasive diagnostic procedures. Color Doppler ultrasonography has been proofed as an efficient method for clinical staging of pancreatic carcinoma necessary for therapeutic decisions. The aim of this study is to provide an analysis of sensitivity and specificity for Color Doppler ultrasonography in patients suffering from pancreatic carcinoma. Methods: We perform Color Doppler ultrasonography examination of 43 pancreatic carcinoma patients prior to surgery. The findings of ultrasonography on neoplasm vascular invasion are correlated to findings obtained during subsequent surgical procedures. Estimation of neoplastic invasion of certain blood vessels including portal vein, celiac trunk, and superior mesenteric artery and vein is critical for decision regarding surgical treatment. Patients having metastases of pancreatic carcinoma were excluded from the study. Results: Comparing Color Doppler and surgical findings we estimate sensitivity for detection of neoplastic vascular invasion ranging from 79-83%, whereas specificity range is from 83-93%. Conclusion: Comparing the findings of Color Doppler ultrasonography to those obtained during the surgery we determine that Color Doppler ultrasonography is providing sufficiently sensitive and specific information that are of value for evaluation of vascular invasion in pancreatic carcinoma patients. Regarding the facts that Color Doppler ultrasonography is a non-invasive, radiation free, and less cost diagnostic method, taking into consideration presented results and published outcomes of similar studies, we are strongly advocating for Color Doppler ultrasonography use in initial presurgical evaluation of pancreatic carcinoma patients. COELIAC DISEASE DURING PREGNANCY AND PUERPERIUM. Bajor J., Beró T. Baranya County Hospital Department of Internal Medicine and Gastroenterology, Pécs, Hungary Coeliac disease is a genetically determined disorder, which can manifest in any age. Manifestation of latent disease is common in young women during pregnancy and after childbirth. Three cases are presented in our lecture. In our first case severe diarrhoea developed in a young female following both her childbirths. The gluten sensitive enteropathy was not diagnosed at her first observation despite detailed examinations. Following her first pregnacy she remained symptomless for several years on a normal diet. After the birth of her second child her symptoms flared up. Serological and histological findings confirmed the diagnosis. In our second patient the symptoms manifested at the 3th month of her pregnancy. She was admitted to obstetrical ward 4 month later, with severe complains including watery diarrhoea and serious malabsorption. Coeliac disease was diagnosed on the base of symptoms and serological markers. Gluten free diet and supportive therapy was started. Because of her critical condition the pregnancy had to be terminated by caesarean section. In the third case the mild symptoms (bloating, weakness, diarrhoea) began during puerperium, 3 month after childbirth. Gastroenterological examinations revealed the diagnosis. Conclusion: The latent coeliac disease is tipically manifested in pregnancy and puerperium in young women. The hormonal and immunological changes in the perinatal period may lead to the activation of the illness. RESULTS OF OUR COELIAC HEALTH SURVEY T. Beró, J. Bajor, Sz. Gódi, B. Anga Baranya County Hospital Department of Internal Medicine and Gastroenterology, Pathology, Pécs, Hungary In the past two years 320 patients were examined in our outpatient clinic because of coeliac disease. In most cases, the possibility of gluten sensitive enteropathy was based on clinical symptoms, in others on associated illnesses. In some symptomless relatives, screening examinations revealed this diagnosis. Serologic tests were performed in an accredited immunological institute. Duodenal biopsy was done in 85 cases. Results: From 320 examined patients coeliac disease was verified by serology in 29 cases. Histology in 23 of seropositive patients showed subtotal-total villous atrophy. 6,5 years was the average elapsed time from the beginning of the symptoms till the established diagnosis. Most common symptoms were diarrhea, abdominal pain, bloating, weight loss, weakness, anemia, vomiting, rashes, articular pain, depression, loss of hair. Conclusion: Nowadays coeliac spure is still rarely diagnosed because of the wide spectrum of symptoms. In some cases it takes years or decades until coeliac disease is recognized. If the diet is started late, the complications are often irreversible. Collaboration of other specialties, more widespread use of serologic tests, and screening in risk groups could result in an earlier diagnosis. COLONIC STENOSIS AND PROTEIN-LOOSING ENTEROPATHY SECONDARY TO NON-STEROID ANTI-INFLAMMATORY AGENTS AS A CAUSE OF ALTERNATING CONSTIPATION AND DIARRHEA: A CASE REPORT Bojic D, Jojic Nj, Bojic B, Protic-Nedeljkovic M, Svorcan P, Gligorijevic V, Sreckovic S. Zvezdara University Clinical Center, Belgrade, Serbia and Montenegro Apart from mucosal injury of upper gastrointestinal (GI) tract, distal small bowel and mostly right colon are additional organs of the GI tract exposed to deletirous efects of non-steroidal antiinflammatory drugs (NSAID). Mucosal inflammation and ulcerations, as well as colonic stenosis characterized by diaphragm-like strictures have been reported to be associated with long-term NSAID use. Most patients present with anemia, obstructive symptoms, diarrhea, or weight loss. Histologic biopsy specimens are characterised with prominent submucosal fibrosis and superficial mucosal ulcerations. NSAID cessation, along with steroid therapy, endoscopic dilation, and ultimately surgical resection, are possible treatments. We report a case of 35-year-old female on chronic (> 8 years) self-induced NSAID abuse (Naproxen tablets, tid) due to undefined lumbar spine pain, who presented with abdominal pain, alternating constipation and diarrhea, sideropenic anemia, significant hypoalbuminemia and weight loss, but no signs of subacute intestinal obstruction. She had moderately elevated ESR and normal CRP level. Fecal alpha-1antitrypsine clearance were 1100ml/24h (normal value< 60ml/24h) almost 20-folds increased, confirming protein-loosing enteropathy (PLE). Colonoscopy revealed right colon ulcerations and NSAID-induced diaphragm-like stricture located in right colonic flexure that was almost inpatient to endoscope. Histology excluded malignancy and Crohn's disease. The patient was advised to stop NSAID and started 2 months prednisone course, which did not results in endoscopic and clinical resolution of symptoms since the patient continued NSAID intake after discharge from the hospital. We conclude that this uniqe symptom combination (not caused by colonic malignancy or irritable bowel syndrome) of alternating constipation and diarrhea in one patient was caused by NSAID-induced diaphragm-like stricture itself (responsible for constipation) and NSAID induced PLE (responsible for diarrhea). Clinicians must be aware of this possibility when dealing with patient on long-term NSAID therapy. POUCHE SURGERY OFFERS A GOOD QUALITY OF LIFE DESPITE ONGOING PROBLEMS Martin Bortlík, Dana Ďuricová, Robert Donoval, Milan Lukáš Gastroenterology Center, IVth Medical Department, General Faculty Hospital and 1st School of Medicine, Charles University, Prague, Czech Republic Restorative proctocolectomy with ileal pouche-anal anastomosis (IPAA) is currently thought to be the best option for patients with intractable ulcerative colitis (UC). Despite removing entire inflammed large bowel, several symptoms usually persist in most patients with IPAA. To assess a functional status and quality of life we performed a retrospective analysis in 20 patients with UC and IPAA. Thirteen patients had corticodependent and 7 corticoresistant disease, most operations were 3-step procedures. Fourty percent of our patients experienced at least one course of pouchitis. As far as the functionality of the ileal pouche-anal anastomosis, the mean number of soft stools was 6 during the day and 2 at the night with rare incontinency but frequent difficulty to differentiate between the stool and gas when urgency occurs. Most patients had to modify their activities according to the intensity of bowel problems, more than one third use regularly the antidiarrheals. For assessment of quality of life we used the Cleveland Global Quality of Life (CGQL) questionaire that has previously been developed and validated in patients with UC undergoing restorative proctocolectomy. Here, patients rated each of three items (current quality of life, current quality of health, and current energy level) on a scale of 0-10 with 0 being the worst and 10 the best. The sum of these scores divided by 30 gives then the final score (range 0-1). In our patients we found the mean CGQL score to be 0.73 which is a result similar to what has been described by others. It is also higher than CGQL score described in UC patients with intractable UC pre-operatively. ANTI-CHOLESTEROL ANTIBODY (ACHA) LEVELS IN CHRONIC HEPATITIS C. HIGH TITERS IN PATIENTS WITH GENOTYPE 3 AND 4, BUT NOT IN GENOTYPE 1B Timea Csak, Adrienn Bíró, Thomas Matthias Scherzer, Aniko Folhoffer, Andrea Horvath, Janos Osztovits, Peter Laszlo Laka
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