Peutz-Jeghers syndrome:Diagnostic and therapeutic approach

Peutz-Jeghers syndrome(PJS)is an inherited,autosomal dominant disorder distinguished by hamartomatous polyps in the gastrointestinal tract and pigmented mucocutaneous lesions.Prevalence of PJS is estimated from 1 in 8300 to 1 in 280 000 individuals.PJS predisposes sufferers to various malignancies(gastrointestinal,pancreatic,lung,breast,uterine,ovarian and testicular tumors).Bleeding,obstruction and intussusception are common complications in patients with PJS.Double balloon enteroscopy(DBE)allows examination and treatment of the small bowel.Polypectomy using DBE may obviate the need for repeated urgent operations and small bowel resection that leads to short bowel syndrome.Prophylaxis and polypectomy of the entire small bowel is the gold standard in PJS patients.Intraoperative enteroscopy(IOE)was the only possibility for endoscopic treatment of patients with PJS before the DBE era.Both DBE and IOE facilitate exploration and treatment of the small intestine. DBE is less invasive and more convenient for the pa- tient.Both procedures are generally safe and useful. An overall recommendation for PJS patients includes not only gastrointestinal multiple polyp resolution,but also regular lifelong cancer screening(colonoscopy, upper endoscopy,computed tomography,magnetic resonance imaging or ultrasound of the pancreas, chest X-ray,mammography and pelvic examinationwith ultrasound in women,and testicular examination in men).Although the incidence of PJS is low,it is important for clinicians to recognize these disorders to prevent morbidity and mortality in these patients,and to perform presymptomatic testing in the first-degree relatives of PJS patients.

Double balloon enteroscopy and acute pancreatitis

Double balloon enteroscopy(DBE)is a new technique, first published and introduced into clinical practice in 2001 by Yamamoto,the inventor of this outstanding method.DBE allows complete visualization,biopsy and treatment of the small bowel.Nowadays,we have some experience of this method for evaluation of the complica- tion rate.Severe complications are described in 1%-1.7% of patients.Acute pancreatitis is a rare complication of the investigation.The incidence of acute pancreatitis after diagnostic DBE is 0.3%in most studies.More than 50 cases of acute pancreatitis have been described in the literature so far.On the contrary,hyperamylasemia after DBE seems to be a rather common condition.Association with acute pancreatitis is supposed to be possible,but not obligatory.The causal mechanism of post-DBE acute pancreatitis is uncertain,and there are several theories in the literature.The most probable cause seems to be a mechanical straining of the endoscope with over-tube on the pancreas or in the papillary area.

Blood pressure and stature in Helicobacter pylori positive and negative persons

To evaluate vital signs and body indices in Helicobacter pylori(H.pylori)positive and negative persons.A total of 22 centres entered the study.They were spread over the whole country,corresponding well to the geographical distribution of the Czech population.A total of 1818 subjects(aged 5-98 years)took part in the study,randomly selected out of 38147 subjects.H.pylori infection was investigated by means of a 13Curea breath test.Data on height,weight,systolic and diastolic blood pressure and heart rate were collected at the clinics of general practitioners.The overall prevalence of H.pylori infection was 30.4%(402/1321)in adults(≥18 year-old)and 5.2%(26/497)in children and adolescents(≤17 year-old).Once adjusted for age and gender,only a difference in body mass index remained statistically significant with H.pylori positive adults showing an increase of 0.6 kg/m2 in body mass index.Once adjusted for age and gender,we found a difference in height between H.pylori positive and H.pylori negative children and adolescents.On further adjustment for place of residence,this difference became statistically significant,with H.pylori positive children and adolescents being on average 3.5 cm shorter.H.pylori positive adults were significantly older compared to H.pylori negative subjects.Once adjusted for age and gender,H.pylori infection had no impact on body weight,body mass index and vital signs either in adults or children and adolescents.Chronic H.pylori infection appeared to be associated with short stature in children.H.pylori infection did not influence blood pressure,body weight and body mass index either in adults or children and adolescents.

Bacteriocinogeny in experimental pigs treated with indomethacin and Escherichia coli Nissle

AIM:To evaluate bacteriocinogeny in short-term highdose indomethacin administration with or without probiotic Escherichia coli Nissle 1917(EcN) in experimental pigs.METHODS:Twenty-four pigs entered the study:Group A(controls),Group B(probiotics alone),Group C(indomethacin alone) and Group D(probiotics and indomethacin).EcN(3.5 × 1010 bacteria/d for 14 d) and/or indomethacin(15 mg/kg per day for 10 d) were administrated orally.Anal smears before and smears from the small and large intestine were taken from all animals.Bacteriocin production was determined with 6 different indicator strains;all strains were polymerase chain reaction tested for the presence of 29 individual bacteriocinencoding determinants.RESULTS:The general microbiota profile was rather uniform in all animals but there was a broad diversity in coliform bacteria(parallel genotypes A,B1,B2 and D found).In total,637 bacterial strains were tested,mostly Escherichia coli(E.coli).There was a higher incidence of non-E.coli strains among samples taken from the jejunum and ileum compared to that of the colon and rectum indicating predominance of E.coli strains in the large intestine.Bacteriocinogeny was found in 24/77(31%) before and in 155/560(28%) isolated bacteria at the end of the study.Altogether,13 individual bacteriocin types(out of 29 tested) were identified among investigated strains.Incidence of four E.coli genotypes was equally distributed in all groups of E.coli strains,with majority of genotype A(ranging from 81% to 88%).The following types of bacteriocins were most commonly revealed:colicins Ia/Ib(44%),microcin V(18%),colicin E1(16%) and microcin H47(6%).There was a difference in bacteriocinogeny between control group A(52/149,35%) and groups with treatment at the end of the study:B:31/122(25%,P = 0.120);C:43/155(28%,P = 0.222);D:29/134(22%,P = 0.020).There was a significantly lower prevalence of colicin Ib,microcins H47 and V(probiotics group,P < 0.001),colicin E1 and microcin H47(indomethacin group,P < 0.001) and microcins H47 and V(probiotics and indomethacin group,P = 0.025) compared to controls.Escherichia fergusonii(E.fergusonii) was identified in 6 animals(6/11 isolates from the rectum).One strain was non-colicinogenic,while all other strains of E.fergusonii solely produced colicin E1.All animals started and remained methanogenic despite the fact that EcN is a substantial hydrogen producer.There was an increase in breath methane(after the treatment) in 5/6 pigs from the indomethacin group(C).CONCLUSION:EcN did not exert long-term liveability in the porcine intestine.All experimental pigs remained methanogenic.Indomethacin and EcN administered together might produce the worst impact on bacteriocinogeny.