Lukošienė, Jaunė Ieva

Pratarmė. Mieli studentai, Gastroenterologija yra viena įdomiausių ir greičiausiai besiplėtojančių medicinos sričių. Dėl mokslo ir technologijų pažangos XXI a. gastroenterologija apima vis platesnį kepenų ir virškinamojo kanalo ligų, gydymo metodų spektrą. Tai neabejotinai viena įvairiapusiškiausių specialybių, kur akivaizdi klinikinių įgūdžių, molekulinių ir ultragarsinių tyrimų bei sudėtingų endoskopinių intervencijų sąsaja. Uždegiminės žarnyno ligos, retos virškinamojo kanalo ligos, mikrobiotos ir kepenų transplantacija yra tik nedidelė dalis sričių, kurios yra patikėtos gydytojams gastroenterologams. Šis Lietuvos sveikatos mokslų universiteto Medicinos akademijos Medicinos fakulteto Gastroenterologijos klinikos (toliau - Gastroenterologijos klinika) kolektyvo parengtas vadovėlis yra skirtas studentams, siekiantiems susipažinti su gastroenterologijos pagrindais. Jau beveik 30 metų Gastroenterologijos klinika aktyviai dalyvauja rengiant tarptautines diagnostikos ir gydymo gaires, yra prestižinių tarptautinių mokslo projektų ir konsorciumų dalyvė, o 2020 m. klinika tapo ir asocijuota Europos retų kepenų ligų tinklo nare. Mūsų klinikos mokslinių tyrimų rezultatai yra publikuojami prestižiniuose mokslo leidiniuose: Nature, Lancet, New England Journal of Medicine, Nature Genetics ir kituose. Rengdami šį vadovėlį stengėmės perteikti visą klinikos sukauptą ilgametę pedagoginę ir klinikinę patirtį bei naujausius mokslo pasiekimus. Tikimės, kad šis vadovėlis ne tik suteiks Jums pagrindinių žinių apie gastroenterologiją, bet ir paskatins rinktis šią specialybę rezidentūros studijose. Autorių vardu prof. Juozas Kupčinskas

The etiology of colonic diverticular disease (DD) is considered to be a multifactorial process, involving environmental and dietary factors, structural and functional changes of the colonic wall and enteric nervous system, and genetic predisposition[1]; however, to this day, the exact pathogenesis of this disease is incompletely understood. Compiled data from recent decades have indicated that genetic factors undoubtedly contribute to the development of the disease and to its complications[2]. This chapter provides an overview of the most signifcant fndings in this feld of research. Prior to this time, the role of inherited factors in the development of D Dseemsto have been overlooked. The existing transethnic differences in prevalence ratesand the predominant location of diverticula between Western and Asian populations(Asians are more likely to have acquired pseudodiverticula in the ascending colon, whereas Westerners tend to have acquired pseudodiverticula in the descending and sigmoid colon [3, 4]) were pointing toward the potential role of heritability in D Doccurrence. An attempt to investigate the signifcance of genetics in the development of the disease was made in two European epidemiological twin studies [5, 6].Granlund et al. linked the Swedish Twin Registry to the Swedish Inpatient Registry [5]. With the use of mathematical models, the heritability was estimated to be 40%in a cohort of twins with (2296 people) or without (102,156 people) DD, and the nonshared environmental effects were calculated to account for 60% of the trait variability [5]. A comparable result was evidenced by a Danish twin study. Using the Danish National Registry of Patients linked to the Danish Twin Registry, the heritability of DD was estimated to be 53% in a twin cohort comprising twins with(923 people) and without (29,399 people) DD [6]. [...].

Tikslas: ištirti enterinės nervų sistemos (ENS) remodeliacijos, genetinių, mitybos ir aplinkos veiksnių įtaką divertikuliozės išsivystymui. Uždaviniai: 1) nustatyti su kolageno apykaita siejamų ir jungiamąjį audinį koduojančių genų – COL3A1, COL1A1, ARHGAP15, COLQ ir FAM155A – vieno nukleotido polimorfizmų (VNP) įtaką ligos išsivystymui; 2) ištirti CGRP nervinių skaidulų ir ląstelių kūnų pasiskirstymą ENS rezginiuose bei (3) ultrastruktūrinius pokyčius, sergant divertikulioze; 4) įvertinti sociodemografinių, mitybos ir tuštinimosi įpročių reikšmę ligos išsivystymui. Išvados: COL3A1 (rs1800255), COL1A1 (rs1800012), COLQ (rs7609897) nėra susiję su divertikuliozės išsivystymo rizika. COL3A1 (rs3134646) VNP didina riziką europidų kilmės vyrams. FAM155A (rs67153654) didina divertikulito, o ARHGAP15 (rs4662344) divertikulito ir divertikuliozės riziką. Sergant divertikulioze, CGRP reguliacija pakinta. Ligai progresuojant, lygiųjų raumenų jaudrumas palaipsniui mažėjančiam CGRP kiekiui didėja. Ultrastruktūriniai pakitimai būdingi tik simptominei ligai. Pažeidžiamos visos ENS dalys – nerviniai mazgai ir neuronų kūnai, nervai ir nervinės skaidulos, sumažėja varikozių su neuromediatoriaus pūslelėmis ir sinapsinių kontaktų. Nervinio–raumeninio perdavimo pokyčiai gali būti viena pagrindinių ligos etiologijos priežasčių. Išorinių veiksnių poveikio analizė atskleidė, jog ligos rizika yra susijusi su vyresniu amžiumi, didesniu KMI, tuštinimosi dažniu ir nepilno išsituštinimo pojūčiu.

Introduction Gastroesophageal reflux disease (GERD) is among the most common gastrointestinal disorders. Risk factors associated with GERD can be categorised into non-modifiable (e.g. age, sex, ethnicity) and modifiable (e.g. body weight, lifestyle and dietary habits) [1]. Lifestyle and dietary changes are commonly recommended as a first line treatment, therefore, patients’ understanding of forementioned modifiable risk factors is of particular importance [2]. Aim To evaluate GERD patients’ knowledge about the modifiable risk factors of this disease. Methods The study was conducted between 1st of December 2021 and 10th of March 2022 at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics. It included adult patients with GERD who completed an original questionnaire on our considered modifiable risk factors for GERD, including nutrition and lifestyle aspects. Statistical analysis was performed using MS Excel and SPSS programmes. Chi-square and Wilcoxon signed-rank tests were used to compare answers between respondents. Statistically significant findings were assumed with p<0.05. Results The study included 70 patients: 46 (65.7%) women and 24 (34.3%) men, mean age of respondents was 45.64 (SD=13.83) years. The majority of participants had higher education (64.3%). However, there was no significant dependence between educational status and patientsʻ knowledge. 7 out of 10 recommended and 12 out of 17 non-recommended products were statistically significantly known in patients with GERD (p<0.05). […].

Background & Aims: Colonic diverticulosis (CD) is among the most common conditions of the large bowel. Several factors have been associated with an increased risk of CD and its complications, including advanced age, obesity, physical inactivity, and a low-fiber diet. Available data is conflicting and a comprehensive analysis of different bowel, dietary and environmental habits linked with CD is lacking. We aimed to investigate the relationship between potential risk factors and CD prevalence using full data from a colonoscopy-based cross-sectional study in Europe. Methods: The study was conducted at three tertiary referral centers in Germany and Lithuania. It included consecutive adult patients referred for routine colonoscopy who completed a detailed questionnaire on our considered multiple risk factors for diverticulosis and diverticulitis, including dietary and environmental factors, and bowel habits. Results: The study included 1,333 patients, 696 women and 635 men. Colonic diverticulosis was diagnosed in 858 (64%) of patients. Multivariate analysis revealed that age (OR: 1.08, 95%CI: 1.06–1.10, p<0.001) and obesity (OR: 1.05, 95%CI: 1.02–1.09, p=0.004) were associated with CD. We also revealed new risk factors for CD: increased frequency of bowel movements (OR: 0.10, 95%CI: 0.03-0.33, p<0.001) and feeling of incomplete bowel emptying (OR: 2.05, 95%CI: 1.47–2.87, p<0.001). Older participants had reduced odds (OR: 0.921, 95 CI: 0.89–0.95, p<0.05) of diverticulitis compared to younger subjects. Feeling of incomplete bowel emptying after defecation was associated with increased odds (OR: 2.769, 95% CI 1.35–5.7, p<0.006) for diverticulitis. Moreover, participants with a higher educational status had increased odds (OR: 2.453, 95%CI: 1.31–4.59, p=0.005) for diverticulitis compared to the lower education group. [...]

Introduction: Colonic diverticulitis is one of the most common complications of symptomatic diverticular disease frequently seen in the outpatient and inpatient settings [1]. The prevalence of diverticulitis has increased dramatically over the past several decades. It is estimated that 1-4% of patients with colonic diverticulosis will develop diverticulitis [2]. Despite the ever-growing burden on National Health Care systems worldwide [3], its pathophysiology remains poorly understood. During the last decade, a number of different risk factors have been associated with symptomatic diverticular disease including obesity, physical inactivity, and a low-fiber diet [4-8]. However, risk factors for diverticula development are likely different from those for inflammation and high-powered comprehensive analysis of different dietary and environmental factors linked with diverticulitis is lacking [9]. Therefore, the aim of our study was to investigate the association between potential risk factors and the prevalence of diverticulitis using inclusive data from a large multicenter colonoscopy-based study. Aims & Methods: The research was conducted at three tertiary referral centers in Germany and Lithuania. Our study included consecutive adult patients referred for routine colonoscopy who completed a detailed questionnaire on diet, bowel habits, and various lifestyle aspects. We considered multiple risk factors for diverticulitis including diet (portion size, amount of meals per day, amount of fluids, amount of fish and red meat per week ,etc.), frequency of bowel movements, various symptoms of constipation, tobacco use, alcohol use, nonsteroidal anti-inflammatory drug (NSAID) use, education, obesity, age, and gender. The link between risk factors and colonic diverticulitis was assessed using logistic regression and standard hypothesis testing methods where pertinent. Results: The study included 858 patients with colonic [...].

Gastroenterologija yra viena įdomiausių ir greičiausiai besiplėtojančių medicinos sričių. Dėl mokslo ir technologijų pažangos XXI a. gastroenterologija apima vis platesnį kepenų ir virškinamojo kanalo ligų bei gydymo metodų spektrą. Tai neabejotina yra viena įvairiapusiškiausių specialybių, kurioje susisieja klinikiniai įgūdžiai, molekuliniai ir ultragarsiniai tyrimai bei sudėtingos endoskopinės intervencijos. Uždegiminės žarnyno ligos, retos virškinamojo kanalo ligos, mikrobiotos ir kepenų transplantacija yra tik nedidelė dalis sričių, kurios yra patikėtos gydytojams gastroenterologams. Šis Lietuvos sveikatos mokslų universiteto Medicinos akademijos Medicinos fakulteto Gastroenterologijos klinikos kolektyvo parengtas vadovėlis yra skirtas studentams, siekiantiems susipažinti su gastroenterologijos pagrindais. Jau beveik 30 metų Gastroenterologijos klinika aktyviai dalyvauja rengiant tarptautines diagnostikos ir gydymo gaires, yra prestižinių tarptautinių mokslinių projektų ir konsorciumų dalyvė, o 2020 m. tapo asocijuota Europos retų kepenų ligų tinklo nare. Mūsų klinikos mokslinių tyrimų rezultatai yra publikuoti prestižiniuose mokslo leidiniuose: Nature, Lancet, New England Journal of Medicine, Nature Genetics ir kituose. Rengdami šį vadovėlį stengėmes perteikti visą klinikos sukauptą ilgametę pedagoginę ir klinikinę patirtį bei naujausius mokslinius pasiekimus. Šis vadovėlis ne tik suteiks Jums pagrindinių žinių apie gastroenterologiją, bet ir paskatins rinktis šią specialybę rezidentūros studijose.

BACKGROUND: In spite of numerous advances in understanding diverticular disease, its pathogenesis remains one of the main problems to be solved. We aimed to investigate the ultrastructural changes of the enteric nervous system in unaffected individuals, in asymptomatic patients with diverticulosis and in patients with diverticular disease. METHODS: Transmission electron microscopy was used to analyse samples of the myenteric, outer submucosal and inner submucosal plexuses from patients without diverticula (n=9), asymptomatic patients with diverticulosis (n=7) and in patients with complicated diverticular disease (n=9). We described the structure of ganglia, interstitial cells of Cajal and enteric nerves, as well as their relationship with each other. The distribution and size of nerve processes were analysed quantitatively. RESULTS: In complicated diverticular disease, neurons exhibited larger lipofuscin-like inclusions, their membranous organelles had larger cisterns and the nucleus showed deeper indentations. Nerve remodeling occurred in every plexus, characterised by an increased percentage of swollen and fine neurites. Interstitial cells of Cajal had looser contacts with the surrounding cells and showed cytoplasmic depletion and proliferation of the rough endoplasmic reticulum. In asymptomatic patients with diverticulosis, alterations of enteric nerves and ICC were less pronounced. CONCLUSIONS: In conclusion, the present findings suggest that most ultrastructural changes of the enteric nervous system occur in complicated diverticular disease. The changes are compatible with damage to the enteric nervous system and reactive remodeling of enteric ganglia, nerves and interstitial cells of Cajal. Disrupted architecture of enteric plexuses might explain clinical and pathophysiological changes associated with diverticular disease.

Colonic diverticulosis is a very common condition. Many patients develop diverticulitis or other complications of diverticular disease. Recent genome-wide association studies (GWAS) consistently identified three major genetic susceptibility factors for both conditions, but did not discriminate diverticulititis and diverticulosis in particular due the limitations of registry-based approaches. Here, we aimed to confirm the role of the identified variants for diverticulosis and diverticulitis, respectively, within a well-phenotyped cohort of patients who underwent colonoscopy. Risk variants rs4662344 in Rho GTPase-activating protein 15 (ARHGAP15), rs7609897 in collagen-like tail subunit of asymmetric acetylcholinesterase (COLQ) and rs67153654 in family with sequence similarity 155 A (FAM155A) were genotyped in 1,332 patients. Diverticulosis was assessed by colonoscopy, and diverticulitis by imaging, clinical symptoms and inflammatory markers.[...].