MF Gastroenterologijos klinika (04.19)

ĮVADAS. Cistinė fibrozė (CF) - tai genetinė liga, kurią sukelia cistinės fibrozės transmembraninio laidumo reguliatoriaus (angl. cysticfibrosis transmembrane conductance regulator, CFTR) baltymo funkcijos sutrikimas. Šis sutrikimas lemia įvairių egzokrininių liaukų sekrecijos pokyčius, sukelia lėtinį kvėpavimo takų uždegimą, pasikartojančias infekcijas, virškinimo sistemos, kepenų ir kitų organų pažeidimus. Ilgus metus CF laikyta tik vaikų liga, nes sergantieji nesulaukdavo suaugusiųjų amžiaus. Pastaraisiais metais daugėja suaugusių CF sergančių asmenų, o tai siejama tiek su geresne ligos diagnostika, tiek su pažangesne ligos priežiūra. Manoma, kad išgyvenamumas ir toliau ilgės dėl gerėjančių gydymo galimybių, ypač į klinikinę praktiką įdiegus CFTR moduliatorius. Dėl pažangos diagnostikoje, įskaitant visuotinę naujagimių patikrą ir molekulinės genetikos tyrimus, CF galima nustatyti ankstyvame amžiuje, dar iki klinikinių simptomų pasireiškimo. Tai leidžia pradėti intervencijas ir gydymą kuo anksčiau, taip sumažinant komplikacijų riziką ir pagerinant gyvenimo kokybę. Šių nacionalinių rekomendacijų paskirtis - apibrėžti CF diagnostikos algoritmus, tinkamiausius gydymo metodus, pritaikytus mūsų šalies sveikatos priežiūros sistemai, infekcijų kontrolės, komplikacijų prevencijos ir pacientų ilgalaikės stebėsenos standartus. Rengiant rekomendacijas remtasi naujausiomis Europos cistinės fibrozės draugijos (angl. European Cystic Fibrosis Society, ECFS), Jungtinių Amerikos Valstijų (JAV) Cistinės fibrozės fondo (angl. Cystic Fibrosis Foundation, CFF), Jungtinės Karalystės Cistinės fibrozės paramos fondo (angl. Cystic Fibrosis Trust) gairėmis, nacionalinės bei tarptautinės praktikos duomenimis, taip pat epidemiologine situacija mūsų šalyje.

Alzheimer's disease (AD) and type 2 diabetes mellitus (T2DM) share metabolic and inflammatory mechanisms, potentially mediated by the gut microbiota, yet the neurobiological impact of comorbid AD+T2DM microbiota from elderly donors remains unexplored. Fecal microbiota from healthy, AD, T2DM, and AD+T2DM postmenopausal female donors (aged 56-89 years) was transplanted into antibiotic-treated male mice. Behavioral testing, blood profiling, hippocampal neurotrophic gene expression, and 16S rRNA sequencing with taxonomic, functional, and metabolic analyses were performed. Human AD+T2DM microbiota displayed the greatest dysbiosis, characterized by enrichment of pro-inflammatory taxa, depletion of butyrate-producing genera, and loss of neuroprotective metabolic pathways. FMT induced robust engraftment, with AD+T2DM recipients diverging most from controls (PERMANOVA R2 = 0.209, p = 0.001) and healthy recipients (PERMANOVA R2 = 0.111, p = 0.002). Donor age contributed significantly to recipient microbiota variation (R2 = 0.028, p = 0.006), suggesting transmission of aging-associated microbial signatures. Hippocampal neurotrophic gene expression was most suppressed in AD+T2DM recipients (adjusted p value < 0.05) and negatively correlated with disease- and aging-associated taxa and microbial functions (|r| > 0.4, FDR p < 0.05). AD recipients showed reduced olfactory discrimination and increased daytime locomotor activity. Metabolic network analysis revealed depletion of flavonoid, isoflavonoid, and lignan biosynthesis pathways in disease recipients. These findings suggest that microbiota from elderly donors with comorbid AD+T2DM may induce gut-brain axis alterations, linking aging, metabolic dysfunction, and neurodegeneration through convergent taxonomic, functional, and neurotrophic changes. We underscore the potential role of age-associated gut microbial signatures in modulating neurobiological outcomes.

Background Identifying the underlying cause of acute pancreatitis is fundamental for prevention of recurrence. However, no standardised algorithm for determining its aetiology exists.

Background & aims: Evidence on optimal bismuth and antibiotic dosing is limited. We aimed to analyse the effectiveness of bismuth-containing quadruple regimens according to drug dosage.

Bariatric surgery remains the most effective intervention for severe obesity. However, long-term weight regain remains a significant clinical challenge. Although substantial excess weight loss is achieved during the first postoperative year, up to 20–30% of patients experience insufficient response, and nearly 60% fail to maintain at least 30% of weight loss in the long term. Identification of modifiable lifestyle determinants is crucial to optimize clinical outcomes and prevent weight regain. A structured review of recent international literature was performed to evaluate modifiable factors associated with longterm weight maintenance. Adequate protein intake (≥60 g/day or up to 1.5 g/kg ideal body weight/day) is crucial to preserve lean body mass and prevent sarcopenia during rapid weight loss. Sufficient micronutrient supplementation is necessary to reduce the risk of iron deficiency anemia, vitamin B12 deficiency, and decreased bone mineral density. Regular physical activity, combining moderate-intensity aerobic exercise and resistance training, improves insulin sensitivity, resting metabolic rate, and body composition, contributing to lomg-term weight stabilization. In contrast, sedentary behavior is independently associated with weight regain. Sleep duration and stress regulation are additional determinants. Sleep shorter than 6 hours per night disrupts leptin and ghrelin balance, increasing appetite (hyperphagia) and energy intake. Chronic stress activates the hypothalamic–pituitary–adrenal axis, elevating cortisol levels and promoting visceral fat accumulation. Evidence suggests that surgery alone does not ensure durable metabolic success. Long-term outcomes depend on sustained behavioral modification, adherence to dietary recommendations, regular exercise, and psychological support. Neuroendocrine mechanisms further highlight the importance of sleep hygiene and stress management in preventing weight regain. Long-term success of bariatric surgery depends on sustained lifestyle modification. Adequate nutrition, structured physical activity, sleep hygiene and stress management are key determinants of weight maintenance. Multidisciplinary long-term follow-up strategies into postoperative care is essential to optimize clinical outcomes and prevent weight regain.

Saccharomyces boulardii CNCM I-745 (Sb) is one of the most widely used probiotics in clinical practice. The aim of this study was to assess the impact of adding Sb to Helicobacter pylori eradication therapy on treatment outcomes (effectiveness and safety) in routine European gastroenterology clinical practice.

Background/Objectives: Helicobacter pylori (H. pylori) infection remains common globally, yet data on its prevalence and correlates among dental students in Eastern Europe are limited. Dental students may face potential occupational exposure through contact with saliva and aerosols during their clinical training. This study aimed to measure the seroprevalence of H. pylori among Lithuanian dental students and evaluate its associations with academic year, self-perceived oral health and hygiene factors, and gastrointestinal symptoms. Methods: An observational–analytical cross-sectional study was conducted in 2025 among 202 dental students from lower (I–II) and higher (IV–V) academic years at the Lithuanian University of Health Sciences. Participants underwent serological testing for H. pylori IgG antibodies using capillary blood and completed a structured questionnaire on sociodemographic factors, oral health behaviors, clinical exposure, and gastrointestinal symptoms assessed by the Gastrointestinal Symptoms Rating Scale (GSRS). Descriptive and bivariate statistical analyses were performed to assess associations. Results: Overall H. pylori seroprevalence was 12.4% and did not differ significantly in different academic years. Seropositivity was significantly associated with longer toothbrushing duration and a family history of stomach ulcer. No significant associations were found with the number of patients treated, the use of personal protective equipment, or most oral hygiene indicators. Higher-year students reported greater overall gastrointestinal symptom scores than lower-year students; however, GSRS scores did not differ between H. pylori-seropositive and -seronegative participants. Conclusions: H. pylori seroprevalence in this student population was relatively low, and no association was found with clinical exposure or gastrointestinal symptom severity. Household-related factors may be more relevant to transmission than occupational exposure in dental training. Further longitudinal studies are needed to clarify risk factors and transmission pathways.

Collagenous colitis (CC) is diagnosed histologically and is characterised by a thickened subepithelial collagen band together with inflammatory and epithelial changes. Although routine haematoxylin and eosin (H&E) staining is sufficient for diagnosis in most cases, visual assessment of the collagen band can be challenging in borderline or heterogeneous specimens. Additional stains may be required in diagnostically difficult situations.

Introducción: En la CBP, la HPCS puede presentarse incluso en fases precirróticas debido a un componente presinusoidal. Esto puede limitar la precisión de la rigidez hepática (RH) y los criterios de Baveno VII (BVII) para estimar el riesgo de várices esofágicas (VE). Objetivos: Determinar la utilidad de la medición de la RE para predecir la presencia de VE y varices con necesidad de tratamiento (VNT) en pacientes con CBP. Métodos: Estudio transversal en 12 centros de la ERN-Liver. Se incluyeron pacientes con CBP que tenían al menos uno de los siguientes criterios; RH ? 8 kPa, esplenomegalia, plaquetas ? 150 × 109/L o signos ecográficos de cirrosis y/o hipertensión portal. La RH y la RE se determinaron mediante FibroScan. Se recogieron los resultados de analítica, ecografía (± 6 meses respecto a la RE) y endoscopia digestiva (± 12 meses). Resultados: Se incluyeron 126 pacientes, 110 (87%) mujeres, con una mediana de edad 64 (RIQ 58-71) años, 89% (n = 113) tenían RH ? 8 kPa, 48% (n = 61) plaquetopenia, 49% (n = 62) esplenomegalia y 65% (n = 82) cirrosis. Las medianas de RH y RE fueron 13,6 kPa (RIQ 9,1-21,3) y 36,6 kPa (RIQ 25,2-48,6), respectivamente. El 39% (n = 49) de los pacientes tenían VE, de los cuales 28% (n = 14) eran VNT. La frecuencia de VNT fue significativamente mayor en pacientes con RH > 15 kPa (24%) que en aquellos con RH 8-15 kPa (4%) o < 8 kPa (0%; p = 0,002). Los criterios de BVII para descartar HPCS (RH ?15 kPa y plaquetas ? 150 × 109/L), mostraron una precisión moderada con AUC 0,71, sensibilidad (S) 85%, especificidad (E) 55% y falsos negativos (FN) 15%. BVII para confirmar HPCS (RH > 25 kPa) tuvo una capacidad limitada con AUC 0,53, S 20%, E 87% y FN 80%. El mejor punto de corte de la RH para confirmar VE fue 9,8 kPa (AUC 0,73). La RE fue el parámetro con mejor rendimiento diagnóstico (AUC 0,79, S 78%, E 74%, FN 22%). En pacientes con RH ?15 kPa, la RE superó a la RH y a las plaquetas por separado (AUC 0,78 vs. 0,75 y 0,77, respectivamente). La combinación de RE y plaquetas alcanzó la mayor precisión (AUC 0,81; S 47%; E 95%; FN 53%). Para el cribado de VNT, los criterios BVII (RH ? 20 kPa o plaquetas ?150×109/L) mostraron una capacidad predictiva moderada (AUC 0,68; S 86%; E 51%; FN 14%). Las plaquetas tuvieron mejor rendimiento (AUC 0,77; S 86%; E 56%; FN 14%) que la RH (AUC 0,74; S 43%; E 74%; FN 57%). La RE fue el mejor predictor de VNT (AUC 0,85; S 93%; E 65%; FN 7%) con un punto de corte óptimo de 39 kPa. La combinación de RE y plaquetas mejoró la precisión (AUC 0,86) aunque con un mayor porcentaje de FN (S 79%; E 75%; FN 21%). Conclusiones: La RE mostró una mayor capacidad diagnóstica para predecir VE y VNT en pacientes con CBP, superando a los criterios de Baveno VII y a sus componentes individuales. Además, permitió una identificación más precisa de la HPCS, incluso en pacientes en fases precirróticas.