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The National Research Programme On Main Diseases Threatening The Life Expectancy and Life Quality of The Latvian Population: Scientific papers

Volume 63 (2009): Edizione 3 (June 2009)

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Dettagli della rivista
Formato
Rivista
eISSN
2255-890X
Pubblicato per la prima volta
14 Sep 2008
Periodo di pubblicazione
6 volte all'anno
Lingue
Inglese

Cerca

Volume 74 (2020): Edizione 2 (April 2020)

Dettagli della rivista
Formato
Rivista
eISSN
2255-890X
Pubblicato per la prima volta
14 Sep 2008
Periodo di pubblicazione
6 volte all'anno
Lingue
Inglese

Cerca

18 Articoli
access type Accesso libero

The Effect of 5-Aminosalicylic Acid on Intestinal Microbiota

Pubblicato online: 11 May 2020
Pagine: 53 - 57

Astratto

Abstract

The article discusses the possible relationships between intestinal microbiota and the therapeutic efficacy of 5-aminosalicylic acid (5-ASA) in inflammatory bowel diseases. Intestinal microbiota may be involved in 5-ASA enzymatic biotransformation, but the metabolism of drugs by the intestinal microbiota has been studied in less detail, and little is known about the relationships between anti-inflammatory efficacy of 5-ASA with bacterial viability, quantity and activity. It remains unclear whether 5-ASA affects the microbiota depending on the different segments of gastrointestinal tract. Drugs and diet can both improve and worsen the composition of the intestinal microbiota. However, it is not known whether drugs affect the intestinal microbiota regardless of diet. Further research is needed to answer these questions.

Parole chiave

  • 5-ASA
  • inflammatory bowel diseases
  • microbiota
  • inflammation
access type Accesso libero

Microbial Community of Kefir and its Impact on the Gastrointestinal Microbiome in Health and Disease

Pubblicato online: 11 May 2020
Pagine: 58 - 64

Astratto

Abstract

Kefir is a fermented dairy product, created by fermentation of milk by bacteria and yeasts. Kefir is the most common traditional non-sweetened fermented dairy beverage in the Baltic countries. Whole kefir and specific fractions and individual organisms isolated from kefir provide a multitude of health benefits, including regulation of composition of the gut microbiome. This review aims to summarise the available data about influence of kefir consumption on the gut microbiome in healthy individuals and to highlight the effects that kefir consumption as well as separated fractions of kefir can have in disease states via modulation of the host microbiome.

Parole chiave

  • kefir
  • lactobacillus
  • microbiome
  • probiotics
  • dysbiosis
access type Accesso libero

Perspective: Physiological Benefits of Short-Chain Fatty Acids from Cereal Grain Fibre Fermentation and Metabolic Syndrome

Pubblicato online: 11 May 2020
Pagine: 65 - 67

Astratto

Abstract

Currently, intervention studies in humans have demonstrated that dietary fibre and whole grain consumption increase gut bacterial diversity. However, low-fibre intake drives depletion of the human gastrointestinal microbiota and indirectly stimulates metabolic abnormalities linked to metabolic syndrome insulin-resistance and abdominal obesity. The aim of the current paper was to summarise current evidence for the effect of consumption of cereal fibres on gut microbiota composition and their metabolites. By increasing the daily consumption of cereal fibre, the gut micro-biota diversity should have positive impact on the host’s health.

Parole chiave

  • dietary fibre
  • cereal fibre
  • gut microbiota
  • prebiotic
  • postbiotic
access type Accesso libero

Stem Cell Therapy for Perianal Crohn’s Disease

Pubblicato online: 11 May 2020
Pagine: 68 - 74

Astratto

Abstract

The goal of the study was to compare the effect of combination therapy (local and systemic administration) with bone marrow mesenchymal stromal cells (MSC), anticytokine therapy with infliximab (IFX), and antibiotic (AB)/immunosuppressive (IS) therapy on the frequency of healing of simple perianal fistulas in Crohn’s disease. Three patient groups were used in our study. The 1st group of patients (age 19 to 58 years, mean 29 years, n = 12) received MSCs culture systemically and locally. The 2nd group of patients with CD (age 20 to 68 years, mean age 36 years, n = 10) received anticytokine therapy with infliximab (IFX). The 3rd group of patients with CD (age 20 to 62 years, mean age 28 years, n = 14) received antibiotics (AB) and immunosuppressors (IS). Treatment effect was assessed by the index of perianal activity of Crohn’s disease (PCDAI) and the frequency of relapses. After 12 weeks, in the 1st group, healing of simple fistulas was noted in 8/12 patients (66.6%), in the 2nd group in 6/10 (60.0%) and in the 3rd group in 1/14 patients (7.1%). After six months, in the 1st group of patients healing of simple fistulas occurred in 8/12 (66.6%), in the 2nd group in 6/10 (60.0%) and in the 3rd group in 1/14 patients (7.1%). After 12 months, in the 1st group, healing of simple fistulas was observed in 7/12 (58.3%), in the 2nd group in 6/10 (60.0%) and in the 3rd group in 2/14 patients (14.3%). After 24 months, among the patients of the 1st group, fistula closure was observed in 5/12 patients (41.6%), in the 2nd group in 4/10 (40.0%) and in the 3rd group in 0/14 patients (0.0%). Combined cellular and anticytokine therapy of CD with perianal lesions significantly contributes to more frequent and prolonged closure of simple fistulas, as compared to antibiotics/immunosuppressors, and to a decrease in the frequency of recurrence of the disease.

Parole chiave

  • inflammatory bowel diseases
  • infliximab
  • fistula form
  • mesenchymal stromal cells
  • cell treatment
access type Accesso libero

Repeatability of Magnetic Resonance Measurements Used for Estimating Crohn’s Disease Activity

Pubblicato online: 11 May 2020
Pagine: 75 - 82

Astratto

Abstract

The MR activity indices used for quantification and follow-up of Crohn’s disease are composed of a number of subjectively determinable components with equivocal repeatability. The purpose of this article was to assess the repeatability of measurements used for quantitative estimation of Crohn’s disease activity in the terminal ileum. In five adults (23–57 y.o.) and 12 children (10–17 y.o.) with active terminal ileitis, the inflamed bowel was divided into 3 cm segments (n = 32 in adults, n = 46 in children), and measurements for the calculation of MaRIA and Clermont scores were performed. Parameters included apparent diffusion coefficients (ADC) for diffusion-weighted imaging (DWI) sequences with selective and non-selective fat suppression, wall signal enhancement before (WSI-preGd) and after (WSI-preGd) gadolinium enhancement, bowel thickness, and presence of ulcers. The measurements were standardised (accurate site-to-site comparison, exact ROI size, where applicable) and repeated by the same researcher after two months. Intra-observer agreement for ADC, WSI-preGd and WSI-postGd, bowel thickness was assessed with a paired t-test, and the significant difference in presence/absence of ulcers was assessed by the Pearson 2 test. Absolute difference was not found between the 1st and 2nd measurements of ADC, WSI-preGd, WSI-postGd and wall thickness. There was systematic difference in the presence of bowel ulcers. In standardised conditions the repeatability of ADC, WSI-preGd and WSI-postGd is high. Efforts must be made to precisely define the size and appearance of ulcers that may be included in the index calculation.

Parole chiave

  • Terminal ileitis
  • magnetic resonance enterography
  • Clermont score
  • MaRIA
  • activity indices
  • intra-observer agreement
access type Accesso libero

2L of Polyethylene Glycol as the Main Small Bowel Cleansing Regimen Component Prior to Video Capsule Endoscopy: Interim Analysis

Pubblicato online: 11 May 2020
Pagine: 83 - 87

Astratto

Abstract

Capsule Enteroscopy (CE) is a fundamentally new method in diagnostic endoscopy. However, there are several factors influencing the quality of this procedure, including impermeable fluids, food remains etc. The aim of the study was to assess one of the most popular currently used bowel preparation methods and evaluate possible effects of various factors. 136 CE examinations were analysed. Each patient was prepared using 2 litres of polyethylene glycol (PEG) one day prior to examination. There was a special form filled in for each patient, which included relevant parameters (anamnesis, CE data etc.). Of 136 CE cases, 84 (61.8%) were female patients and 52 (38.2%) were male. The small bowel (SB) transit time in 112 patients varied from 39 to 502 minutes, but in 24 cases the capsule did not reach caecum. The degree of bowel cleanliness was as follows: very good — 30 (22.1%) patients, satisfactory — 97 (71.3%), and poor — 9 (6.6%). A positive correlation was observed between the degree of SB cleanliness and the SB transit time (p = 0.015). A longer SB transits time was associated with poor SB cleanliness. The results obtained in this study showed that the quality of SB cleanliness is affected by SB transit time. A relatively large percentage of cases rated as satisfactory bowel cleanliness and comparatively small percentage of bowel cleanliness cases rated as “very good” were observed when 2 litres of PEG were used prior to CE, indicating an important issues in preparation of the bowel prior to CE.

Parole chiave

  • capsule endoscopy
  • transit time
  • bowel cleanliness
  • bowel preparation
access type Accesso libero

Iron Absorption Disturbances in Patients with Enteropathy: Interim Analysis of a Single Centre Study

Pubblicato online: 11 May 2020
Pagine: 88 - 93

Astratto

Abstract

There are about 2 billion people in the world who suffer from anaemia, mostly iron deficiency anaemia (IDA), by WHO data. Iron deficiency without anaemia is three times more common than IDA. In such patients, the condition of the small intestine should be evaluated, and malabsorption excluded. The aim of the study was to evaluate potential correlation between different types of enteropathy and iron absorption disturbances. The study was performed at the Latvian Maritime Medical Center “Gastroklinika” between the years 2014 and 2018. Iron absorption tests with 50 mg of oral iron gluconate were performed for each patient. Patients had filled in a FACIT questionnaire and had underwent video capsule endoscopy (VCE). A total of 48 patients were enrolled for analysis — 41 (85.4%) female and 7 (14.6%) male. Enteropathy was diagnosed in 35 cases: erosive — 17, erythematous — 12 and congestive — 6. By the time of VCE, 24 patients were suffering from anaemia. A total of 33 (68.7%) patients had problems with iron absorption, of whom 8 had no signs of enteropathy and 25 were diagnosed with enteropathy during VCE. IDA did not show a statistically significant correlation with enteropathy. However, the obtained results suggest that this should be studied further in association with small intestine malabsorption, to determine the precise role of enteropathy in IDA patients.

Parole chiave

  • anaemia
  • oral iron absorption test
  • video capsule endoscopy
  • enteropathy
access type Accesso libero

The Level of Cytokeratin 18 in Patients with HIV and Viral Hepatitis C Co-Infection in Latvia

Pubblicato online: 11 May 2020
Pagine: 94 - 99

Astratto

Abstract

Cytokeratin 18 (CK18) is a specific marker of hepatocellular apoptosis, which is a useful noninvasive indicator of liver fibrosis in the HIV/HCV group. However, data on the CK18 level in serum are limited for this group. This study demonstrated CK18 levels in serum in HIV/HCV co-infected and HIV mono-infected patients; investigated the association of CK18 levels with other non-invasive markers of liver fibrosis; and presents CK18 dynamics in a four-month-long period. The sample included 273 patients with HIV infection (128 of them were with HIV/HCV co-infection) aged from 23 to 65 (35% females). Levels of hyaluronic acid, CK18, ALT, and AST were determined in serum, and the FIB4 index was calculated. All markers had higher levels in the HIV/HCV group than in the HIV mono-infection group. The HIV/HCV group demonstrated coherent correlations among the markers and their associations with the level of CK18 than the HIV mono-infection group. During the four-month-long period, the CK18 level in serum showed no significant changes.

Parole chiave

  • liver fibrosis
  • non-invasive test
  • hepatocyte apoptosis
  • CK18
  • HIV/HCV
access type Accesso libero

Culture Based Evaluation of Microbiota in Children with Acute Appendicitis

Pubblicato online: 11 May 2020
Pagine: 100 - 105

Astratto

Abstract

Treatment strategies for acute uncomplicated appendicitis have evolved and now conservative antibacterial treatment is recommended over surgical treatment, especially for paediatric patients. The aim of this study was to evaluate microbiota in paediatric patients with acute uncomplicated and complicated appendicitis, and antibacterial susceptibility of the causative microorganisms. Bacteriological identification was conducted using the VITEK2 analyser. Antibacterial susceptibility tests were performed and the results were evaluated in accordance with the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) “Clinical breakpoints and dosing of antibiotics” (Version 7.0, January 2019). Serodiagnosis of Yersinia enterocolitica was performed using indirect haemagglutination. The results revealed differences in microbiota in cases of acute complicated and acute uncomplicated appendicitis. Pseudomonas aeruginosa was identified more frequently in cases of acute complicated appendicitis. Mixed culture was prevalent in cases of both acute complicated and acute uncomplicated appendicitis. Very few positive extended spectrum beta-lactamase (ESBL) Escherichia coli cultures were identified. Most of strains of Pseudomonas aeruginosa were resistant to amoxicillin with clavulanic acid, ertapenem, ampicillin and cefotaxime. Some of E. coli isolates were resistant to ampicillin and to amoxicillin with clavulanic acid.

Parole chiave

  • Pseudomonas aeruginosa
  • Escherichia coli
access type Accesso libero

Pathogenic Escherichia coli Among Asymptomatic Children and Associated Factors

Pubblicato online: 11 May 2020
Pagine: 106 - 110

Astratto

Abstract

Although Escherichia coli is a part of the commensal flora of the gastrointestinal tract, pathogenic types of E. coli can cause diarrhea, especially in children. Pathogenic types are found also in healthy individuals, but prevalence of pathogenic E. coli among asymptomatic children varies and has not been studied in Latvia. The aim of the study was to determine prevalence of pathogenic E. coli among asymptomatic children and identify factors associated with presence of bacterium. Children (aged 0.5–8 years) without acute gastrointestinal symptoms were included in a cross-sectional study. Parents were asked to answer a questionnaire (demographic data, parental education, type of delivery, breastfeeding, antibacterial therapy, and allergic diseases) and bring a faecal sample of their child. The prevalence of pathogenic E. coli was detected by polymerase chain reaction and analysed in respect to risk factors. Statistical analyses included Chi-Square test, one-way ANOVA, and logistic regression. The patient sample group contained 245 children, mean age 4.5 SD ± 2.1; 46.5% (114/245) had allergies. In total, 16% (39/245) of isolates were positive for pathogenic E. coli. Prevalence of pathogenic types of E. coli was significantly higher among children without allergy compared to children with allergy: 21% (27/131) vs. 11% (12/114), p = 0.03. Prevalence did not differ significantly in respect to other studied factors. In logistic regression analysis pathogenic E. coli positivity was inversely associated with presence of allergy (OR = 0.45, CI: 0.21–0.94, p = 0.03). Asymptomatic carriage of pathogenic E. coli was identified in our paediatric patient sample and was inversely associated with an allergic disease. Microbiota changes related to pathogenic E. coli, as well as duration of carriage of bacterium, should be studied further.

Parole chiave

  • Commensal flora
  • enteropathogenic E. coli
  • children
  • asymptomatic
  • allergy
access type Accesso libero

Inflammatory Cells in Gastric Cancer: Promoting the Tumour or Protecting the Host?

Pubblicato online: 11 May 2020
Pagine: 111 - 117

Astratto

Abstract

The study represents a comprehensive retrospective morphological profiling of gastric carcinoma in order to reveal associations between certain tumour-infiltrating inflammatory cells and clinical and/or pathological parameters. Patients’ age and gender, the extent of local tumour spread (pT), presence of metastases in regional lymph nodes (pN), tumour grade (G) as well as type according to World Health Organisation (WHO) and Lauren classifications were assessed in 211 consecutive surgically resected gastric carcinomas. Tumour-infiltrating inflammatory cells including eosinophils, neutrophils and lymphocytes were counted within the cancer stroma in five randomly selected high-power fields representative of the tumour. Descriptive statistics, Mann–Whitney and Kruskal–Wallis tests were applied; p < 0.05 was considered significant. Higher number of stromal eosinophils was associated with absence of metastases in regional lymph nodes (pN0) and histological structure of adenocarcinoma by WHO classification (p = 0.005 and p = 0.002, respectively). Higher count of stromal neutrophils showed significant associations with younger age (less than 65 years), and intestinal type by Lauren classification (p = 0.029 and p = 0.007, respectively). The density of stromal lymphocytes lacked any statistically significant association with the evaluated clinical or morphological parameters. In conclusion, the current study highlights the links between certain innate immune system cells and morphological features of gastric carcinoma.

Parole chiave

  • stomach cancer
  • inflammatory infiltrate
  • tumour-infiltrating neutrophils
  • tumourinfiltrating eosinophils
access type Accesso libero

Establishing Cut-Offs for Non-Invasive Liver Tests to Detect Cirrhosis at a High Sensitivity

Pubblicato online: 11 May 2020
Pagine: 118 - 124

Astratto

Abstract

Liver cirrhosis is the end stage of chronic liver diseases. The current gold standard for diagnosing this condition, liver biopsy, has too many drawbacks, and research for better alternatives is ongoing. One major diagnostic arsenal includes various serological composition scores or so-called formulas. They are constantly being validated for development of new formulas. In our retrospective study of 215 patients case files who had confirmed cirrhosis of various etiologies, we examined the sensitivity and set new cut-offs for five of the most well-documented formulas. Data was obtained from the Rīga East University Hospital from 2012 to 2017 and analysed using SPSS V.22.00. In our study we found that FIB-4 at cut-off > 1.45 had over 95% sensitivity for excluding advanced fibrosis regardless of cirrhosis etiology. None of evaluated formulas had high sensitivity for detecting cirrhosis of alcohol etiology. For the viral hepatitis C genesis group, the best choice was deRitis index with almost 90% sensitivity. FIB-4 at cut-off > 2.75 was the best choice for the combined alcohol and viral hepatitis C group; BONACINI at score 8+ and FIB-4 at > 3.25 were the most sensitive in the main group containing all patients irrespective of cirrhosis etiology.

Parole chiave

  • diagnosing liver cirrhosis
  • serological markers
  • liver biopsy alternatives
  • FIB-4 and deRitis
access type Accesso libero

Palliative Endoscopic Esophageal Stenting for Malignant Esophageal Tumour Complications: A Clinical Case and Single Centre Experience in Latvia

Pubblicato online: 11 May 2020
Pagine: 125 - 130

Astratto

Abstract

Esophageal stenting is used in patients with malignant esophageal tumours to reduce dysphagia and inanition. The objective of this study was to analyse the main reasons for esophageal stenting in Rīga East Clinical University Hospital (RECUH) and their association with dysphagia and mortality. A cross-sectional study of all patients hospitalised in RECUH who received esophageal self-expanding metal stents (SEMS) from October 2013 to December 2015 was performed. A total of 29 patients, 24 (82.8%) male and 5 (17.2%) female, with mean age 63.7 ± 11.3 years, underwent the procedure. The most common indications for stenting were tumour-related stenosis (52.9%) and fistulae (17.6%). Mean time from establishing the diagnosis of esophageal cancer to stent placement was 338.6 days. Median survival after stenting was 4.8 months. A complex case of a patient requiring placement of three palliative stents illustrates the challenges of esophageal cancer care. Esophageal stent placement is an effective palliative method for treating tumour-related symptoms but carries risks of stent complications and fistula development over time. SEMS are being successfully used in cancer patient treatment in Latvia.

Parole chiave

  • palliative care
  • gastrointestinal cancer
  • dysphagia
  • tracheoesophageal fistula
access type Accesso libero

Liver Abscesses — Seven-Year Experience of a Single Tertiary Care Hospital

Pubblicato online: 11 May 2020
Pagine: 131 - 137

Astratto

Abstract

We reviewed medical records of cases of liver abscesses (LA) registered in Rīga East University Hospital clinical centre “Gaiïezers” from January 2012 to October 2018 to assess sociodemo-graphic factors, clinical, laboratory, microbiological and radiological findings, as well as therapeutic modalities and their efficacy associated with LA. A total of 95, including five recurrent, cases were included in this study. No statistically significant differences in gender distribution were found. Mean patient’s age was 64.5 ± 15.9. The most common documented risk factors for the development of LA were underlying biliary tract abnormalities (37.9% of cases), and diabetes mellitus (12.7%), while in 21.1% of cases, LA were defined as cryptogenic. Most patients presented with fever (70.5%); right upper abdominal pain was reported in 61.1%, while vomiting and / or nausea — in 25.3% of cases. The most common isolates identified from LA were Klebsiella pneumonia (40.3% of cases), mainly in monomicrobial LA, and Escherichia coli (22.6% of cases), predominantly in polymicrobial LA. Ceftriaxone and metronidazole intravenous formulations were used in 35.5% cases as the principal antimicrobial combination at hospital. Median overall expected duration of antimicrobial treatment was 15 days. LA drainage was performed in 87.4% of cases for the median duration of seven days. In 86.3% of cases both approaches were combined.

Parole chiave

  • liver abscess
  • clinical patterns
  • treatment
access type Accesso libero

Incidence and Prevalence of Crohn’s Disease and Ulerative Colitis (2013–2017) Based on the Latvian Nationwide Medicines Reimbursement Database

Pubblicato online: 11 May 2020
Pagine: 138 - 143

Astratto

Abstract

Inflammatory bowel disease (IBD) is a chronic, relapsing–remitting, inflammatory condition of the gastrointestinal tract which consists of Crohn’s disease (CD), ulcerative colitis (UC) and undifferentiated IBD. Epidemiology of IBD is changing worldwide, but a significant gap remains in the description of the IBD population in Latvia. The aim of the study was to determine the incidence and prevalence rates of IBD in Latvia in the period between 2013 and 2017. Retrospective analysis of reimbursed medicines claims for IBD diagnoses from the Latvian National Health Service database (NHS) was conducted for the period of 2012 to 2017. From CD patients, 53.7% were female and the area of residency strongly favoured urban areas vs rural districts of Latvia, 59.1% vs 40.9%, respectively. A similar demographic pattern was observed in UC patients, where 56.2% were female and 55.1% of the total UC population lived in urban areas. The overall age- and sex-adjusted incidence rates for CD and UC were 16.45 (CI95% [14.68, 18.21]) and 70.53 (CI95% [66.88, 74.19]) per 100 000 population, respectively, for the entire 2013–2017 period. The prevalence of CD and UC in 2012 was 12.4 and 54.8 cases per 100 000 persons, respectively, compared to 15.5 and 79.5 cases per 100 000 persons in CD and UC in 2017, resulting in a 25% increase in prevalence of CD and 41% increase in UC over the 5-year period. For the first time temporal trends in IBD incidence and prevalence as well as differences across age groups and gender over a five-year period are reported for Latvia.

Parole chiave

  • Crohn’s disease
  • epidemiology
  • National Health Services and Central Statistics Bureau databases
  • incidence
  • prevalence
access type Accesso libero

T-Cell Lymphoma Misdiagnosed as Crohn’s Disease: Case Report

Pubblicato online: 11 May 2020
Pagine: 144 - 149

Astratto

Abstract

For many years, there has been a concern that inflammatory bowel disease carries an increased lymphoma risk. At the same time, patients with intestinal lymphomas are occasionally misdiag-nosed as having Crohn’s disease. We report a case of T-cell lymphoma of the bowel misdiag-nosed as Crohn’s disease, which illustrates the diagnostic challenges posed by peripheral extranodal lymphomas. A 68-year old female presented with clinical symptoms (diarrhoea, abdominal pain, poor appetite and significant weight loss), and colonoscopic and initial histological findings that were similar to inflammatory bowel disease. She was diagnosed with Crohn’s disease and received treatment with sulfasalazine with subsequent improvement of symptoms. Eight months after the initial diagnosis the patient experienced sudden abdominal pain. Laparotomy revealed necrosis in the small and large intestine and ileostomy was performed. On day 10 of a complicated postoperative period the patient died. Post-mortem histopathological examination of small and large intestine revealed highly malignant peripheral T-cell lymphoma, not otherwise specified. Differentiation of intestinal T-cell lymphoma from Crohn’s disease continues to be a challenge, because clinical, colonoscopic, radiological and histopathological findings can mimic Crohn’s disease. Careful multi-disciplinary assessment and knowledge of this rare disorder is crucial for timely diagnosis.

Parole chiave

  • T-cell lymphoma
  • PTCL-NOS
  • Crohn’s disease
  • inflammatory bowel diseases
access type Accesso libero

Association of Dunbar, May-Thurner and Nutcracker Compression Syndromes in One Patient

Pubblicato online: 11 May 2020
Pagine: 150 - 155

Astratto

Abstract

We report a case of Dunbar syndrome, May–Thurner syndrome and Nutcracker syndrome diagnosed in one patient with clinical presentation and imaging findings on Doppler ultrasonography. Dunbar syndrome or truncus coeliacus compression syndrome is an under-diagnosed vascular compression syndrome with a lot of controversy around it because of insufficient differentiation from celiac artery stenosis. May–Thurner syndrome or iliac vein compression syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression by the right common iliac artery as it crosses the iliac vein anteriorly. In Nutcracker syndrome due to compression the outflow from the left renal vein into the inferior vena cava is obstructed. The combination of all these syndromes in one patient was not described before.

Parole chiave

  • Dunbar syndrome
  • May–Thurner syndrome
  • Nutcracker syndrome
access type Accesso libero

IX Latvian Gastroenterology Congress

Pubblicato online: 11 May 2020
Pagine: 156 - 158

Astratto

18 Articoli
access type Accesso libero

The Effect of 5-Aminosalicylic Acid on Intestinal Microbiota

Pubblicato online: 11 May 2020
Pagine: 53 - 57

Astratto

Abstract

The article discusses the possible relationships between intestinal microbiota and the therapeutic efficacy of 5-aminosalicylic acid (5-ASA) in inflammatory bowel diseases. Intestinal microbiota may be involved in 5-ASA enzymatic biotransformation, but the metabolism of drugs by the intestinal microbiota has been studied in less detail, and little is known about the relationships between anti-inflammatory efficacy of 5-ASA with bacterial viability, quantity and activity. It remains unclear whether 5-ASA affects the microbiota depending on the different segments of gastrointestinal tract. Drugs and diet can both improve and worsen the composition of the intestinal microbiota. However, it is not known whether drugs affect the intestinal microbiota regardless of diet. Further research is needed to answer these questions.

Parole chiave

  • 5-ASA
  • inflammatory bowel diseases
  • microbiota
  • inflammation
access type Accesso libero

Microbial Community of Kefir and its Impact on the Gastrointestinal Microbiome in Health and Disease

Pubblicato online: 11 May 2020
Pagine: 58 - 64

Astratto

Abstract

Kefir is a fermented dairy product, created by fermentation of milk by bacteria and yeasts. Kefir is the most common traditional non-sweetened fermented dairy beverage in the Baltic countries. Whole kefir and specific fractions and individual organisms isolated from kefir provide a multitude of health benefits, including regulation of composition of the gut microbiome. This review aims to summarise the available data about influence of kefir consumption on the gut microbiome in healthy individuals and to highlight the effects that kefir consumption as well as separated fractions of kefir can have in disease states via modulation of the host microbiome.

Parole chiave

  • kefir
  • lactobacillus
  • microbiome
  • probiotics
  • dysbiosis
access type Accesso libero

Perspective: Physiological Benefits of Short-Chain Fatty Acids from Cereal Grain Fibre Fermentation and Metabolic Syndrome

Pubblicato online: 11 May 2020
Pagine: 65 - 67

Astratto

Abstract

Currently, intervention studies in humans have demonstrated that dietary fibre and whole grain consumption increase gut bacterial diversity. However, low-fibre intake drives depletion of the human gastrointestinal microbiota and indirectly stimulates metabolic abnormalities linked to metabolic syndrome insulin-resistance and abdominal obesity. The aim of the current paper was to summarise current evidence for the effect of consumption of cereal fibres on gut microbiota composition and their metabolites. By increasing the daily consumption of cereal fibre, the gut micro-biota diversity should have positive impact on the host’s health.

Parole chiave

  • dietary fibre
  • cereal fibre
  • gut microbiota
  • prebiotic
  • postbiotic
access type Accesso libero

Stem Cell Therapy for Perianal Crohn’s Disease

Pubblicato online: 11 May 2020
Pagine: 68 - 74

Astratto

Abstract

The goal of the study was to compare the effect of combination therapy (local and systemic administration) with bone marrow mesenchymal stromal cells (MSC), anticytokine therapy with infliximab (IFX), and antibiotic (AB)/immunosuppressive (IS) therapy on the frequency of healing of simple perianal fistulas in Crohn’s disease. Three patient groups were used in our study. The 1st group of patients (age 19 to 58 years, mean 29 years, n = 12) received MSCs culture systemically and locally. The 2nd group of patients with CD (age 20 to 68 years, mean age 36 years, n = 10) received anticytokine therapy with infliximab (IFX). The 3rd group of patients with CD (age 20 to 62 years, mean age 28 years, n = 14) received antibiotics (AB) and immunosuppressors (IS). Treatment effect was assessed by the index of perianal activity of Crohn’s disease (PCDAI) and the frequency of relapses. After 12 weeks, in the 1st group, healing of simple fistulas was noted in 8/12 patients (66.6%), in the 2nd group in 6/10 (60.0%) and in the 3rd group in 1/14 patients (7.1%). After six months, in the 1st group of patients healing of simple fistulas occurred in 8/12 (66.6%), in the 2nd group in 6/10 (60.0%) and in the 3rd group in 1/14 patients (7.1%). After 12 months, in the 1st group, healing of simple fistulas was observed in 7/12 (58.3%), in the 2nd group in 6/10 (60.0%) and in the 3rd group in 2/14 patients (14.3%). After 24 months, among the patients of the 1st group, fistula closure was observed in 5/12 patients (41.6%), in the 2nd group in 4/10 (40.0%) and in the 3rd group in 0/14 patients (0.0%). Combined cellular and anticytokine therapy of CD with perianal lesions significantly contributes to more frequent and prolonged closure of simple fistulas, as compared to antibiotics/immunosuppressors, and to a decrease in the frequency of recurrence of the disease.

Parole chiave

  • inflammatory bowel diseases
  • infliximab
  • fistula form
  • mesenchymal stromal cells
  • cell treatment
access type Accesso libero

Repeatability of Magnetic Resonance Measurements Used for Estimating Crohn’s Disease Activity

Pubblicato online: 11 May 2020
Pagine: 75 - 82

Astratto

Abstract

The MR activity indices used for quantification and follow-up of Crohn’s disease are composed of a number of subjectively determinable components with equivocal repeatability. The purpose of this article was to assess the repeatability of measurements used for quantitative estimation of Crohn’s disease activity in the terminal ileum. In five adults (23–57 y.o.) and 12 children (10–17 y.o.) with active terminal ileitis, the inflamed bowel was divided into 3 cm segments (n = 32 in adults, n = 46 in children), and measurements for the calculation of MaRIA and Clermont scores were performed. Parameters included apparent diffusion coefficients (ADC) for diffusion-weighted imaging (DWI) sequences with selective and non-selective fat suppression, wall signal enhancement before (WSI-preGd) and after (WSI-preGd) gadolinium enhancement, bowel thickness, and presence of ulcers. The measurements were standardised (accurate site-to-site comparison, exact ROI size, where applicable) and repeated by the same researcher after two months. Intra-observer agreement for ADC, WSI-preGd and WSI-postGd, bowel thickness was assessed with a paired t-test, and the significant difference in presence/absence of ulcers was assessed by the Pearson 2 test. Absolute difference was not found between the 1st and 2nd measurements of ADC, WSI-preGd, WSI-postGd and wall thickness. There was systematic difference in the presence of bowel ulcers. In standardised conditions the repeatability of ADC, WSI-preGd and WSI-postGd is high. Efforts must be made to precisely define the size and appearance of ulcers that may be included in the index calculation.

Parole chiave

  • Terminal ileitis
  • magnetic resonance enterography
  • Clermont score
  • MaRIA
  • activity indices
  • intra-observer agreement
access type Accesso libero

2L of Polyethylene Glycol as the Main Small Bowel Cleansing Regimen Component Prior to Video Capsule Endoscopy: Interim Analysis

Pubblicato online: 11 May 2020
Pagine: 83 - 87

Astratto

Abstract

Capsule Enteroscopy (CE) is a fundamentally new method in diagnostic endoscopy. However, there are several factors influencing the quality of this procedure, including impermeable fluids, food remains etc. The aim of the study was to assess one of the most popular currently used bowel preparation methods and evaluate possible effects of various factors. 136 CE examinations were analysed. Each patient was prepared using 2 litres of polyethylene glycol (PEG) one day prior to examination. There was a special form filled in for each patient, which included relevant parameters (anamnesis, CE data etc.). Of 136 CE cases, 84 (61.8%) were female patients and 52 (38.2%) were male. The small bowel (SB) transit time in 112 patients varied from 39 to 502 minutes, but in 24 cases the capsule did not reach caecum. The degree of bowel cleanliness was as follows: very good — 30 (22.1%) patients, satisfactory — 97 (71.3%), and poor — 9 (6.6%). A positive correlation was observed between the degree of SB cleanliness and the SB transit time (p = 0.015). A longer SB transits time was associated with poor SB cleanliness. The results obtained in this study showed that the quality of SB cleanliness is affected by SB transit time. A relatively large percentage of cases rated as satisfactory bowel cleanliness and comparatively small percentage of bowel cleanliness cases rated as “very good” were observed when 2 litres of PEG were used prior to CE, indicating an important issues in preparation of the bowel prior to CE.

Parole chiave

  • capsule endoscopy
  • transit time
  • bowel cleanliness
  • bowel preparation
access type Accesso libero

Iron Absorption Disturbances in Patients with Enteropathy: Interim Analysis of a Single Centre Study

Pubblicato online: 11 May 2020
Pagine: 88 - 93

Astratto

Abstract

There are about 2 billion people in the world who suffer from anaemia, mostly iron deficiency anaemia (IDA), by WHO data. Iron deficiency without anaemia is three times more common than IDA. In such patients, the condition of the small intestine should be evaluated, and malabsorption excluded. The aim of the study was to evaluate potential correlation between different types of enteropathy and iron absorption disturbances. The study was performed at the Latvian Maritime Medical Center “Gastroklinika” between the years 2014 and 2018. Iron absorption tests with 50 mg of oral iron gluconate were performed for each patient. Patients had filled in a FACIT questionnaire and had underwent video capsule endoscopy (VCE). A total of 48 patients were enrolled for analysis — 41 (85.4%) female and 7 (14.6%) male. Enteropathy was diagnosed in 35 cases: erosive — 17, erythematous — 12 and congestive — 6. By the time of VCE, 24 patients were suffering from anaemia. A total of 33 (68.7%) patients had problems with iron absorption, of whom 8 had no signs of enteropathy and 25 were diagnosed with enteropathy during VCE. IDA did not show a statistically significant correlation with enteropathy. However, the obtained results suggest that this should be studied further in association with small intestine malabsorption, to determine the precise role of enteropathy in IDA patients.

Parole chiave

  • anaemia
  • oral iron absorption test
  • video capsule endoscopy
  • enteropathy
access type Accesso libero

The Level of Cytokeratin 18 in Patients with HIV and Viral Hepatitis C Co-Infection in Latvia

Pubblicato online: 11 May 2020
Pagine: 94 - 99

Astratto

Abstract

Cytokeratin 18 (CK18) is a specific marker of hepatocellular apoptosis, which is a useful noninvasive indicator of liver fibrosis in the HIV/HCV group. However, data on the CK18 level in serum are limited for this group. This study demonstrated CK18 levels in serum in HIV/HCV co-infected and HIV mono-infected patients; investigated the association of CK18 levels with other non-invasive markers of liver fibrosis; and presents CK18 dynamics in a four-month-long period. The sample included 273 patients with HIV infection (128 of them were with HIV/HCV co-infection) aged from 23 to 65 (35% females). Levels of hyaluronic acid, CK18, ALT, and AST were determined in serum, and the FIB4 index was calculated. All markers had higher levels in the HIV/HCV group than in the HIV mono-infection group. The HIV/HCV group demonstrated coherent correlations among the markers and their associations with the level of CK18 than the HIV mono-infection group. During the four-month-long period, the CK18 level in serum showed no significant changes.

Parole chiave

  • liver fibrosis
  • non-invasive test
  • hepatocyte apoptosis
  • CK18
  • HIV/HCV
access type Accesso libero

Culture Based Evaluation of Microbiota in Children with Acute Appendicitis

Pubblicato online: 11 May 2020
Pagine: 100 - 105

Astratto

Abstract

Treatment strategies for acute uncomplicated appendicitis have evolved and now conservative antibacterial treatment is recommended over surgical treatment, especially for paediatric patients. The aim of this study was to evaluate microbiota in paediatric patients with acute uncomplicated and complicated appendicitis, and antibacterial susceptibility of the causative microorganisms. Bacteriological identification was conducted using the VITEK2 analyser. Antibacterial susceptibility tests were performed and the results were evaluated in accordance with the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) “Clinical breakpoints and dosing of antibiotics” (Version 7.0, January 2019). Serodiagnosis of Yersinia enterocolitica was performed using indirect haemagglutination. The results revealed differences in microbiota in cases of acute complicated and acute uncomplicated appendicitis. Pseudomonas aeruginosa was identified more frequently in cases of acute complicated appendicitis. Mixed culture was prevalent in cases of both acute complicated and acute uncomplicated appendicitis. Very few positive extended spectrum beta-lactamase (ESBL) Escherichia coli cultures were identified. Most of strains of Pseudomonas aeruginosa were resistant to amoxicillin with clavulanic acid, ertapenem, ampicillin and cefotaxime. Some of E. coli isolates were resistant to ampicillin and to amoxicillin with clavulanic acid.

Parole chiave

  • Pseudomonas aeruginosa
  • Escherichia coli
access type Accesso libero

Pathogenic Escherichia coli Among Asymptomatic Children and Associated Factors

Pubblicato online: 11 May 2020
Pagine: 106 - 110

Astratto

Abstract

Although Escherichia coli is a part of the commensal flora of the gastrointestinal tract, pathogenic types of E. coli can cause diarrhea, especially in children. Pathogenic types are found also in healthy individuals, but prevalence of pathogenic E. coli among asymptomatic children varies and has not been studied in Latvia. The aim of the study was to determine prevalence of pathogenic E. coli among asymptomatic children and identify factors associated with presence of bacterium. Children (aged 0.5–8 years) without acute gastrointestinal symptoms were included in a cross-sectional study. Parents were asked to answer a questionnaire (demographic data, parental education, type of delivery, breastfeeding, antibacterial therapy, and allergic diseases) and bring a faecal sample of their child. The prevalence of pathogenic E. coli was detected by polymerase chain reaction and analysed in respect to risk factors. Statistical analyses included Chi-Square test, one-way ANOVA, and logistic regression. The patient sample group contained 245 children, mean age 4.5 SD ± 2.1; 46.5% (114/245) had allergies. In total, 16% (39/245) of isolates were positive for pathogenic E. coli. Prevalence of pathogenic types of E. coli was significantly higher among children without allergy compared to children with allergy: 21% (27/131) vs. 11% (12/114), p = 0.03. Prevalence did not differ significantly in respect to other studied factors. In logistic regression analysis pathogenic E. coli positivity was inversely associated with presence of allergy (OR = 0.45, CI: 0.21–0.94, p = 0.03). Asymptomatic carriage of pathogenic E. coli was identified in our paediatric patient sample and was inversely associated with an allergic disease. Microbiota changes related to pathogenic E. coli, as well as duration of carriage of bacterium, should be studied further.

Parole chiave

  • Commensal flora
  • enteropathogenic E. coli
  • children
  • asymptomatic
  • allergy
access type Accesso libero

Inflammatory Cells in Gastric Cancer: Promoting the Tumour or Protecting the Host?

Pubblicato online: 11 May 2020
Pagine: 111 - 117

Astratto

Abstract

The study represents a comprehensive retrospective morphological profiling of gastric carcinoma in order to reveal associations between certain tumour-infiltrating inflammatory cells and clinical and/or pathological parameters. Patients’ age and gender, the extent of local tumour spread (pT), presence of metastases in regional lymph nodes (pN), tumour grade (G) as well as type according to World Health Organisation (WHO) and Lauren classifications were assessed in 211 consecutive surgically resected gastric carcinomas. Tumour-infiltrating inflammatory cells including eosinophils, neutrophils and lymphocytes were counted within the cancer stroma in five randomly selected high-power fields representative of the tumour. Descriptive statistics, Mann–Whitney and Kruskal–Wallis tests were applied; p < 0.05 was considered significant. Higher number of stromal eosinophils was associated with absence of metastases in regional lymph nodes (pN0) and histological structure of adenocarcinoma by WHO classification (p = 0.005 and p = 0.002, respectively). Higher count of stromal neutrophils showed significant associations with younger age (less than 65 years), and intestinal type by Lauren classification (p = 0.029 and p = 0.007, respectively). The density of stromal lymphocytes lacked any statistically significant association with the evaluated clinical or morphological parameters. In conclusion, the current study highlights the links between certain innate immune system cells and morphological features of gastric carcinoma.

Parole chiave

  • stomach cancer
  • inflammatory infiltrate
  • tumour-infiltrating neutrophils
  • tumourinfiltrating eosinophils
access type Accesso libero

Establishing Cut-Offs for Non-Invasive Liver Tests to Detect Cirrhosis at a High Sensitivity

Pubblicato online: 11 May 2020
Pagine: 118 - 124

Astratto

Abstract

Liver cirrhosis is the end stage of chronic liver diseases. The current gold standard for diagnosing this condition, liver biopsy, has too many drawbacks, and research for better alternatives is ongoing. One major diagnostic arsenal includes various serological composition scores or so-called formulas. They are constantly being validated for development of new formulas. In our retrospective study of 215 patients case files who had confirmed cirrhosis of various etiologies, we examined the sensitivity and set new cut-offs for five of the most well-documented formulas. Data was obtained from the Rīga East University Hospital from 2012 to 2017 and analysed using SPSS V.22.00. In our study we found that FIB-4 at cut-off > 1.45 had over 95% sensitivity for excluding advanced fibrosis regardless of cirrhosis etiology. None of evaluated formulas had high sensitivity for detecting cirrhosis of alcohol etiology. For the viral hepatitis C genesis group, the best choice was deRitis index with almost 90% sensitivity. FIB-4 at cut-off > 2.75 was the best choice for the combined alcohol and viral hepatitis C group; BONACINI at score 8+ and FIB-4 at > 3.25 were the most sensitive in the main group containing all patients irrespective of cirrhosis etiology.

Parole chiave

  • diagnosing liver cirrhosis
  • serological markers
  • liver biopsy alternatives
  • FIB-4 and deRitis
access type Accesso libero

Palliative Endoscopic Esophageal Stenting for Malignant Esophageal Tumour Complications: A Clinical Case and Single Centre Experience in Latvia

Pubblicato online: 11 May 2020
Pagine: 125 - 130

Astratto

Abstract

Esophageal stenting is used in patients with malignant esophageal tumours to reduce dysphagia and inanition. The objective of this study was to analyse the main reasons for esophageal stenting in Rīga East Clinical University Hospital (RECUH) and their association with dysphagia and mortality. A cross-sectional study of all patients hospitalised in RECUH who received esophageal self-expanding metal stents (SEMS) from October 2013 to December 2015 was performed. A total of 29 patients, 24 (82.8%) male and 5 (17.2%) female, with mean age 63.7 ± 11.3 years, underwent the procedure. The most common indications for stenting were tumour-related stenosis (52.9%) and fistulae (17.6%). Mean time from establishing the diagnosis of esophageal cancer to stent placement was 338.6 days. Median survival after stenting was 4.8 months. A complex case of a patient requiring placement of three palliative stents illustrates the challenges of esophageal cancer care. Esophageal stent placement is an effective palliative method for treating tumour-related symptoms but carries risks of stent complications and fistula development over time. SEMS are being successfully used in cancer patient treatment in Latvia.

Parole chiave

  • palliative care
  • gastrointestinal cancer
  • dysphagia
  • tracheoesophageal fistula
access type Accesso libero

Liver Abscesses — Seven-Year Experience of a Single Tertiary Care Hospital

Pubblicato online: 11 May 2020
Pagine: 131 - 137

Astratto

Abstract

We reviewed medical records of cases of liver abscesses (LA) registered in Rīga East University Hospital clinical centre “Gaiïezers” from January 2012 to October 2018 to assess sociodemo-graphic factors, clinical, laboratory, microbiological and radiological findings, as well as therapeutic modalities and their efficacy associated with LA. A total of 95, including five recurrent, cases were included in this study. No statistically significant differences in gender distribution were found. Mean patient’s age was 64.5 ± 15.9. The most common documented risk factors for the development of LA were underlying biliary tract abnormalities (37.9% of cases), and diabetes mellitus (12.7%), while in 21.1% of cases, LA were defined as cryptogenic. Most patients presented with fever (70.5%); right upper abdominal pain was reported in 61.1%, while vomiting and / or nausea — in 25.3% of cases. The most common isolates identified from LA were Klebsiella pneumonia (40.3% of cases), mainly in monomicrobial LA, and Escherichia coli (22.6% of cases), predominantly in polymicrobial LA. Ceftriaxone and metronidazole intravenous formulations were used in 35.5% cases as the principal antimicrobial combination at hospital. Median overall expected duration of antimicrobial treatment was 15 days. LA drainage was performed in 87.4% of cases for the median duration of seven days. In 86.3% of cases both approaches were combined.

Parole chiave

  • liver abscess
  • clinical patterns
  • treatment
access type Accesso libero

Incidence and Prevalence of Crohn’s Disease and Ulerative Colitis (2013–2017) Based on the Latvian Nationwide Medicines Reimbursement Database

Pubblicato online: 11 May 2020
Pagine: 138 - 143

Astratto

Abstract

Inflammatory bowel disease (IBD) is a chronic, relapsing–remitting, inflammatory condition of the gastrointestinal tract which consists of Crohn’s disease (CD), ulcerative colitis (UC) and undifferentiated IBD. Epidemiology of IBD is changing worldwide, but a significant gap remains in the description of the IBD population in Latvia. The aim of the study was to determine the incidence and prevalence rates of IBD in Latvia in the period between 2013 and 2017. Retrospective analysis of reimbursed medicines claims for IBD diagnoses from the Latvian National Health Service database (NHS) was conducted for the period of 2012 to 2017. From CD patients, 53.7% were female and the area of residency strongly favoured urban areas vs rural districts of Latvia, 59.1% vs 40.9%, respectively. A similar demographic pattern was observed in UC patients, where 56.2% were female and 55.1% of the total UC population lived in urban areas. The overall age- and sex-adjusted incidence rates for CD and UC were 16.45 (CI95% [14.68, 18.21]) and 70.53 (CI95% [66.88, 74.19]) per 100 000 population, respectively, for the entire 2013–2017 period. The prevalence of CD and UC in 2012 was 12.4 and 54.8 cases per 100 000 persons, respectively, compared to 15.5 and 79.5 cases per 100 000 persons in CD and UC in 2017, resulting in a 25% increase in prevalence of CD and 41% increase in UC over the 5-year period. For the first time temporal trends in IBD incidence and prevalence as well as differences across age groups and gender over a five-year period are reported for Latvia.

Parole chiave

  • Crohn’s disease
  • epidemiology
  • National Health Services and Central Statistics Bureau databases
  • incidence
  • prevalence
access type Accesso libero

T-Cell Lymphoma Misdiagnosed as Crohn’s Disease: Case Report

Pubblicato online: 11 May 2020
Pagine: 144 - 149

Astratto

Abstract

For many years, there has been a concern that inflammatory bowel disease carries an increased lymphoma risk. At the same time, patients with intestinal lymphomas are occasionally misdiag-nosed as having Crohn’s disease. We report a case of T-cell lymphoma of the bowel misdiag-nosed as Crohn’s disease, which illustrates the diagnostic challenges posed by peripheral extranodal lymphomas. A 68-year old female presented with clinical symptoms (diarrhoea, abdominal pain, poor appetite and significant weight loss), and colonoscopic and initial histological findings that were similar to inflammatory bowel disease. She was diagnosed with Crohn’s disease and received treatment with sulfasalazine with subsequent improvement of symptoms. Eight months after the initial diagnosis the patient experienced sudden abdominal pain. Laparotomy revealed necrosis in the small and large intestine and ileostomy was performed. On day 10 of a complicated postoperative period the patient died. Post-mortem histopathological examination of small and large intestine revealed highly malignant peripheral T-cell lymphoma, not otherwise specified. Differentiation of intestinal T-cell lymphoma from Crohn’s disease continues to be a challenge, because clinical, colonoscopic, radiological and histopathological findings can mimic Crohn’s disease. Careful multi-disciplinary assessment and knowledge of this rare disorder is crucial for timely diagnosis.

Parole chiave

  • T-cell lymphoma
  • PTCL-NOS
  • Crohn’s disease
  • inflammatory bowel diseases
access type Accesso libero

Association of Dunbar, May-Thurner and Nutcracker Compression Syndromes in One Patient

Pubblicato online: 11 May 2020
Pagine: 150 - 155

Astratto

Abstract

We report a case of Dunbar syndrome, May–Thurner syndrome and Nutcracker syndrome diagnosed in one patient with clinical presentation and imaging findings on Doppler ultrasonography. Dunbar syndrome or truncus coeliacus compression syndrome is an under-diagnosed vascular compression syndrome with a lot of controversy around it because of insufficient differentiation from celiac artery stenosis. May–Thurner syndrome or iliac vein compression syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression by the right common iliac artery as it crosses the iliac vein anteriorly. In Nutcracker syndrome due to compression the outflow from the left renal vein into the inferior vena cava is obstructed. The combination of all these syndromes in one patient was not described before.

Parole chiave

  • Dunbar syndrome
  • May–Thurner syndrome
  • Nutcracker syndrome
access type Accesso libero

IX Latvian Gastroenterology Congress

Pubblicato online: 11 May 2020
Pagine: 156 - 158

Astratto

Pianifica la tua conferenza remota con Sciendo