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Imunoglubulin G4 asociovane nemoci tvoři skupinu chorob, ktere charakterizuje vysoka hladina imunoglobulinu G4 (IgG4) v krevnim seru, zvýsený obsah lymfocytů a plasmatických buněk s IgG4 v parenchymu některých organů a storiformni fibroza. Nejcastěji postiženým organem je pankreas. Hovořime o autoimunitni formě pankreatitidy, ktera se rozlisuje na dva typy. 1. typ s vysokým obsahem IgG4 v pankreatickem parenchymu je významně castějsi než 2. typ a ma zasadni odlisnost, i pokud jde o přitomnost extrapankreatických postiženi. V obecne rovině plati, že chronický zanět patři mezi rizikove faktory vzniku karcinomu. Chronicka pankreatitida je tak akceptovaným rizikovým faktorem vzniku pankreatickeho karcinomu. Je otazkou, zda toto plati i o autoimunitni pankreatitidě (AIP), ktera ma některe mediatory zanětu shodne s pankreatitidou sporadickou, a jakou roli hraje přitomnost imunoglobulinu G4. Naprosta větsina praci s touto tematikou jsou kazuisticka sděleni, přesto vsak, a to i na zakladě vlastnich zkusenosti, si dovolujeme tvrdit, že existuje vztah mezi autoimunitni formou pankreatitidy a pankreatickým karcinomem, který se objevuje obvykle v prvnich dvou letech od stanoveni diagnozy AIP. Významný je rovněž fakt, že u skupiny osob s AIP, ktera je klinickou manifestaci IgG4 asociovaných onemocněni, byl nalezen dokonce vyssi výskyt nadorových onemocněni extrapankreatických, než tomu bylo v pankreatu samotnem. Diferencialni diagnostika AIP od karcinomu pankreatu může být někdy problematicka, protože tato onemocněni se mohou projevovat obě jako fokalni pankreaticke leze. IgG4 je považovan za užitecný pro diagnostiku AIP, avsak hladiny IgG4 mohou být mirně zvýsene i v připadě adenokarcinomu pankreatu. Hladiny IgG4 přesahujici dvojnasobek horni hranice jsou u pacientů s adenokarcinomem pankreatu vzacne. Byly vsak zdokumentovany připady soucasneho projevu karcinomu pankreatu a AIP, a proto ani tato možnost by neměla být opomijena. AIP patři mezi stav, jenž vyžaduje pravidelnou dispenzarizaci, a to i z pohledu možne kancerogeneze.

Background Metabolic syndrome is a serious societal problem worldwide. In the Czech Republic more than 30% of the adult population are sufferers. The role of recurrent acute pancreatitis in the induction of chronic pancreatitis, following the socalled „mechanistic definition“ of chronic pancreatitis, has been unequivocally confirmed. However, there are a number of factors that may contribute to the development of chronic pancreatitis. The first aim of the study was to determine whether the metabolic syndrome may affect the development of chronic pancreatitis. The second question we asked ourselves was whether even one acute attack of pancreatitis could be an inductive factor in chronic pancreatitis. Methods Based on data obtained retrospectively from a total of 264 people diagnosed with chronic pancreatitis in 4 centers, a total of 59 people (22.3%) diagnosed within 36 months of a first attack of acute pancreatitis was obtained. Etiologies of either genetically induced pancreatitis or autoimmune pancreatitis were excluded. Diagnostics to identify the presence of metabolic syndrome were run on the 59 persons so obtained using the criteria from the socalled „harmonized“ definition of 2009 (obesity, arterial hypertension, hypertriglyceridemia, type 2 diabetes mellitus and a decreased level of HDL cholesterol). Results Comparing the findings of the individual components of metabolic syndrome in persons with chronic pancreatitis after a 1st attack of acute pancreatitis with the metabolic syndrome and in persons with chronic pancreatitis after the 1st attack of acute pancreatitis but without metabolic syndrome, a statistically significant difference in obesity was found (82.5% vs. 28.5%), hypertriglyceridemia (82.3% vs 17.8%) and arterial hypertension (70.5% vs 21.4%). The interval during which chronic pancreatitis occurred after acute pancreatitis averaged 12 months (10-14 months) in subjects with metabolic syndrome, whereas in the group without metabolic syndrome the interval was longer, 20 months (16-29 months). Conclusion Our results show that even one attack of acute pancreatitis (regardless of etiology) can be an inductive factor in chronic pancreatitis. The presence of metabolic syndrome can accelerate the development of chronic pancreatitis after one has had acute pancreatitis.

Cilem teto retrospektivni studie je zhodnotit nase zkusenosti s diagnostickou a terapeutickou endoskopickou retrogradni cholangiopankreatikografii (ERCP) u pacientů po choledochoduodenoanastomoze. Metoda: Studium souboru trvalo 20 let (listopad roku 1994 až prosinec roku 2014). V praci byli retrospektivně hodnoceni 3 pacienti po choledochoduodenoanastomoze, kteři měli projevy biliarni obstrukce. K provedeni ERCP byl ve vsech připadech použit standardni terapeutický videolateroskop. Pacienti a výsledky: U těchto 3 pacientů se stavem po choledochoduodenoanastomoze jsme při ERCP dosahli 100% kanylacni uspěsnosti – 3 pacienti ze 3. Jednalo se tedy o 100% uspěsnost diagnosticke ERCP. U vsech těchto pacientů byla při ERCP nalezena jednak stenoza přirozeneho usti Vaterovy papily, dale stenoza choledochoduodenoanastomozy, a dale pak jestě suprastenoticka distalni choledocholitiaza. U vsech pacientů s výse popsaným patologickým nalezem na ERCP byla bezprostředně po diagnosticke ERCP zahajena endoskopicka lecba, ktera se sestavala jednak ze standardni endoskopicke papilotomie stenoticke Vaterovy papily, dale balonkove dilatace stenozy choledochoduodenoanastomozy, a nakonec endoskopicke extrakce suprastenoticke distalni choledocholitiazy. Celkem byla terapeuticka ERCP kompletně uspěsna u vsech 3 pacientů ze 3 (100%), u kterých byla původně endoskopicka lecba zahajena. V nasem souboru 3 pacientů se nevyskytly žadne komplikace. Zavěr: Při ERCP u pacientů po choledochoduodenoanastomoze jsme dosahli u vsech těchto 3 nasich nemocných 100% uspěsnosti diagnosticke i terapeuticke ERCP

Celiac disease is an immune mediated entheropathy triggered by gluten in genetically predisposed individuals. Patients with celiac disease are at a higher risk of gastrointestinal malignancies. Diagnosis at an advance stage is one of the factors of an unfavorable prognosis of these complications. Our patient is a woman who was diagnosed with celiac disease at 53 years of age. After two years on a gluten-free diet she developed sideropenic anemia. No source of bleeding was found on the esophagogastroduodenoscopy or colonoscopy. Video capsule endoscopy revealed exulcerated bleeding stenosis in the jejunum, in front of which the capsule lodged. There were no signs of infiltration on simultaneous CT enterography. The patient was operated on and the infiltration of the jejunum was resected. The specimen was evaluated by a histopathologist as a moderately differentiated adenocarcinoma. Due to the risk factors, the patient received adjuvant chemotherapy. The knowledge of the malignant complications of celiac disease, their risk factors and the possibilities of modern enteroscopic methods could help in the early diagnosis and improvement of the prognosis of these diseases. Due to a lack of data and an absence of guidelines, treatment of a small bowel adenocarcinoma is based on an expert agreement and guidelines for colon cancer. Surgical treatment is the only potentially curative option. For stage II with risk factors and stage III adjuvant chemotherapy should be considered.

Refluxni choroba jicnu (gastroesophageal reflux disease - GERD) je multifaktorialni onemocněni, na kterem se mimo jine podili i geneticka predispozice jedince. Při diagnostice GERD a jejich komplikaci, jako je Barrettův jicen (Barrett's esophagus - BE) a adenokarcinom jicnu (esophageal adenocarcinoma - EAC), jsou standardně využivany endoskopicke metody a histologicke vysetřeni. Pro screening BE u osob se zvýseným rizikem vzniku tohoto onemocněni i při sledovani rozvoje dysplazie BE by vzorky jicnove sliznice mohly být odebrany pomoci novodobých neendoskopických postupů, kterými lze minimalizovat invazivnost zakroku a zlepsit compliance a adherenci pacientů k lecbě. Neendoskopicky odebraný vzorek sliznice jicnu je možne stejně jako vzorek ziskaný endoskopickou biopsii analyzovat jak imunohistochemickým vysetřenim, tak provest molekularně biologickou analýzu na specificke biomarkery. Markery jako caudal type homeobox 2 (CDX2) a protein p53 již nasly sve uplatněni v diagnostice GERD, a proto se výzkum v poslednich letech zaměřuje na identifikaci dalsich biomarkerů, pomoci kterých by bylo možne spolehlivě predikovat vznik a rozvoj BE nebo EAC. Tento přehledový clanek shrnuje informace o modernich neendoskopických metodach odběru vzorků sliznice jicnu a o biomarkerech, ktere byly v souvislosti s predikci a diagnostikou BE a EAC studovany v neendoskopicky odebrane tkani a maji potencial pro využiti v klinicke praxi.

Uvod: Konfokalni laserova endomikroskopie využivajici sondy (probe-based confocal laser endomicroscopy - pCLE) je nova diagnosticka metoda urcena pro endoskopii, ktera umožňuje mikroskopicke vysetřeni na buněcne urovni v realnem case. Endoskopicka diagnostika casných neoplastických lezi distalniho jicnu neni snadna a casto tyto leze mohou být přehlednuty. Cilem pilotni studie bylo ziskat charakteristicke pCLE obrazy u onemocněni jicnu pro dalsi studie a vyhodnotit možnou roli pCLE v diagnostice dysplastickeho Barrettova jicnu (Barrett´s esophagus - BE) a casneho adenokarcinomu jicnu (esophageal adenocarcinoma - EAC). Metody: Nejprve byl vyhledan přehled soucasne literatury s nasledným nastudovanim předchozich publikaci obsahujici pCLE obrazy a jejich klasifikaci u onemocněni jicnu. V druhe fazi byli do teto pilotni studie zařazeni pacienti s onemocněnim jicnu, kteři podstoupili horni endoskopicke vysetřeni s pCLE. Zařazena byla i zdrava kohorta osob. Výsledky: Od ledna roku 2019 do cervence roku 2019 bylo vysetřeno celkem 14 pacientů v ramci teto prospektivni pilotni studie: 3 pacienti s refluxni ezofagitidou, 4 s BE, 3 s EAC a 4 zdrave osoby. Byla provedena endoskopie s pCLE a ziskany charakteristicke pCLE obrazy. Spravna diagnoza byla endoskopistou stanovena pomoci pCLE (real-time) celkem u 11 ze 14 vysetřených pacientů (78,6 %). Zavěr: Bylo možne ziskat typicke pCLE obrazy u onemocněni jicnu během standardni endoskopie s využitim capu. pCLE se zda být novou slibnou metodou k surveillance BE a detekci casných neoplastických lezi. Na druhou stranu je zapotřebi vice dalsich studii a dat na větsim souboru pacientů.

Liver cirrhosis is a chronic liver disease in which the liver tissue and the vascular beds are remodeled leading to impaired hepatic function. Portal hypertension and subsequent esophageal varices are a frequent complication of liver cirrhosis and are a cause of mortality in patients with liver cirrhosis. Pregnancy in women with liver cirrhosis is uncommon, the incidence being about 1 in 5 950 pregnancies. Hepatocellular damage and the associated alteration in the metabolism of the sex hormones is thought to be responsible and leads to anovulation. In spite of all these factors, women with cirrhosis can and do become pregnant. Pregnancy is successful in most of the patients with chronic liver disease, but maternal and fetal complication rates are still high for decompensated liver cirrhosis. Portal hypertension associated with pregnancy is a high-risk situation as both pregnancy and portal hypertension share some of the hemodynamic changes. Risks of variceal bleeding and hepatic decompensation increases many fold during pregnancy. Despite the possible complications mentioned above, the maternal-fetal morbidity and mortality rates have been decreased by the current developments in hepatology, prevention of bleeding from varices with drugs and/or endoscopic variceal ligation, improvement in liver transplantation, and an increased experience in these issues. We present a case of a 31-year-old female patient with liver cirrhosis who successfully managed pregnancy and birth without complications after the insertion of transjugular intrahepatic portosystemic shunt (TIPS). Unfortunately, 2 years after delivery, the patient developed lymphoblastic lymphoma and, despite intensive therapy for this disease, the patient died at the age of 40. We did not find any link between liver cirrhosis and lymphoblastic lymphoma.

Chronic pancreatitis is one of the diseases whose incidence is slightly increasing long-term. Apparently this is related to our current dietary habits and to the way of life in industrialized societies in general. In recent years, chronic pancreatitis has experienced greater diagnostic accuracy and reliability, although we are still unable to diagnose the early stages of the disease. In diagnostics, sophisticated imaging methods are in the forefront, and less frequent is the use of tests that assess the exocrine function of the gland. Non-invasive therapeutic approaches include dietary measures, including an absolute ban on alcohol. Drug therapy consists of the application of drugs containing pancreatic digestive enzymes and the treatment of pancreatic pain. The administration of capsules containing microparticles containing pancreatic enzymes, protected against inactivation of enzymes in an acidic gastric environment, is effective. In the treatment of pancreatic pain, we use a range of analgesic drugs, but abstinence from alcohol itself leads to a decrease in the frequency of pancreatic pain. Surgical therapy is very effective. Among other treatment methods include also endoscopic therapy. From the point of view of diagnosis and therapy, chronic pancreatitis is one of the conditions requiring a multidisciplinary approach. In this review article, we discuss the possibilities of diagnosis and treatment of chronic pancreatitis according to the current recommendations of UEG (United European Gastroenterology).

Immunoglobulin G4-related diseases (IgG4-RD) are a group of diseases characterized by high serum levels of immunoglobulin G4 (IgG4), increased lymphocyte and plasma cell with IgG4 positivity in the parenchyma of some organs, and storiform fibrosis. The most frequently affected organ is the pancreas. This is an autoimmune form of pancreatitis, which can be divided into two types: Type 1, which is significantly more common than Type 2, is high in IgG4 in the pancreatic parenchyma and shows a fundamental difference in the noted presence of extrapancreatic disorders. In general, chronic inflammation is a risk factor in the development of carcinomas. Chronic pancreatitis is an accepted risk factor for the development of pancreatic cancer. The question is whether this also applies to autoimmune pancreatitis (AIP), which has some mediators of inflammation in common with sporadic pancreatitis, and what role the presence of IgG4 plays. The vast majority of the work on this topic consists of case reports, yet, even based on our own experience, we would like to say that there is a relationship between the autoimmune form of pancreatitis and pancreatic cancer, which usually occurs in the first two years after diagnosis of AIP. Also significant is the fact that the group of people with AIP, who is a clinical manifestation of IgG4-RD, was found to have an even higher incidence of extrapancreatic cancer than in the pancreas itself. Differentiating AIP from pancreatic cancer can sometimes be problematic since these diseases can both present as focal pancreatic lesions. IgG4 has been considered useful for AIP diagnosis, however, IgG4 levels can be slightly elevated, as in the case with pancreatic adenocarcinoma. IgG4 levels of over twice the upper limit are rare among patients with pancreatic adenocarcinoma. However, cases of simultaneous presentation of pancreatic cancer and AIP have been documented and should not be neglected. AIP is a condition where regular followup is mandatory, including from the perspective of possible cancerogenesis.

Resekce žaludku podle Billrotha I (B I) se provadi velice zřidka. Cilem teto retrospektivni studie je zhodnotit nase zkusenosti s diagnostickou a terapeutickou endoskopickou retrogradni cholangiopankreatikografii (ERCP) u pacientů po resekci žaludku podle Billrotha I. U pacientů se stavem po resekci žaludku podle B I trvalo studium souboru 20 let (listopad roku 1994 - prosinec roku 2014). V praci byli retrospektivně hodnoceni 3 pacienti po resekci žaludku podle B I, kteři měli projevy biliarni obstrukce. K provedeni ERCP byl ve vsech připadech použit standardni (tedy jako za normalni anatomicke situace) terapeutický videolateroskop Olympus. Kanylacniho uspěchu při diagnosticke ERCP bylo dosaženo u 3 pacientů ze 3 - tedy jednalo se o 100% uspěsnost diagnosticke ERC. U vsech těchto 3 pacientů byla při ERCP nalezena CDL. Dale pak u vsech těchto 3 pacientů s patologickým nalezem CDL na ERCP byla bezprostředně po diagnosticke ERCP realizovana endoskopicka lecba, jejimž uvodnim krokem byla vždy standardnim způsobem (tedy jako u normalni anatomie) provedena suficientni endoskopicka papilotomie (EPT). Nasledně byla provedena endoskopicka extrakce veskere CDL z hepatocholedochu do duodena. Celkem byla tedy terapeuticka ERCP kompletně uspěsna u vsech 3 pacientů ze 3 (100 % ze 3), u kterých byla původně endoskopicka lecba zahajena. V nasem souboru 3 pacientů se nevyskytly žadne komplikace. Při ERCP u pacientů po resekci žaludku podle B I jsme měli u vsech těchto nasich nemocných (3 pacienti s CDL) 100% uspěsnost diagnosticke i terapeuticke ERCP.

Maligni tumory tenkeho střeva tvoři jen asi 1-2 % ze vsech nadorů gastrointestinalniho traktu. Ackoli neuroendokrinni tumory (NETs) jsou relativně vzacne, tak i přesto představuji druhou nejcastějsi malignitu tenkeho střeva (hned po adenokarcinomu). Klinicky se projevuji bolesti břicha, střevni obstrukci, průjmy, ubytkem na vaze ci krvacenim. Diferencialni diagnostika skryteho gastrointestinalniho krvaceni může být někdy výzvou jak pro metody endoskopicke, tak radiologicke. Prezentujeme připad 80leteho pacienta dosetřovaneho pro těžkou mikrocytarni anemii. Zakladni endoskopicke metody neobjasnily zdroj skryteho krvaceni. Nakonec pomoci kapslove endoskopie (CE) byla diagnostikovana izolovana ulcerace ilea s navalitými okraji. CT enterografie nezachytila žadnou dalsi lezi. Vzhledem k pozitivnim hodnotam chromograninu A, nalezu na endoskopických a zobrazovacich metodach bylo vysloveno podezřeni na NET tenkeho střeva. Během operace bylo zjistěno 7 ložisek NET tenkeho střeva a byla provedena resekce 120 cm ilea. Dle definitivni histologie bylo v preparatu nalezeno celkem 15 ložisek NET grade 1. Kontrolni octreoscan neodhalil žadne dalsi rezidualni ložisko. Představujeme připad pacienta s celkem 15 ložisky NET tenkeho střeva diagnostikovaneho pomoci CE s naslednou uspěsnou resekci ilea.

Introduction Crohns disease (CD) belongs to chronic diseases that highly affect the patient´s quality of life (QoL). The effect of the disease and impairment of QoL in CD patients is already known. The aim was to assess how surgical treatment influences the patients QoL and determine factors that can affect postoperative QoL. Methods and patients We compared the QoL before and after surgery in patients who had undergone a bowel resection at our department due to CD between 2010-2016. The patients filled in a standardized QLQ-CR29 questionnaire to assess QoL in the preoperative period and the postoperative period after a 2-month interval. The control groups were CD patients who had not undergone surgical treatment (bowel resection) and a healthy cohort. In the QoL evaluation, 132 patients with CD who had undergone surgery (bowel resection), 83 patients with CD without an operation and 104 healthy subjects were enrolled. Results 104 of the operated patients experienced a postoperative improvement of the overall QoL (78.8 %), 2 patients did not register any changes in QoL (1.5 %) and 26 patients (19.7 %) experienced a worsening of their postoperative QoL. The results were statistically significant (p Conclusion We detected a significant improvement of the overall QoL after surgical resection in CD patients (measured 2 months after surgery). Gender was identified as the only statistically relevant factor with influence on postoperative QoL.Key words: bowel resection - Crohn´s disease - Czech cohort - inflammatory bowel disease - quality of life - surgical treatment.

Epiduralni absces pateře je raritni onemocněni, ktere se objevuje předevsim u imunokompromitovaných pacientů po operacich nebo urazech pateře a pokud je diagnostikovano přilis pozdě, může vest k těžkemu neurologickemu deficitu nebo dokonce smrti. V literatuře jsou ovsem popsany i připady epiduralniho abscesu pateře u pacientů s fistulujici formou Crohnovy choroby. Představujeme kazuistiku mlade pacientky s Crohnovou chorobou a recidivujicim perianalnim postiženim, ktere bylo komplikovano vznikem epiduralniho abscesu v oblasti hrudni pateře. I diky uzke spolupraci s ortopedy a neurology se podařilo gastroenterologům pacientku uspěsně lecit. Nasledně tak pacientce mohla být navracena biologicka lecba potřebna pro komplikovaný průběh Crohnovy choroby.

Gastric antral vascular ectasia (GAVE) and solitary rectal ulcer syndrome (SRUS) are both mentioned in the literature as rare causes of iron deficiency anemia and gastrointestinal (GI) bleeding. GAVE accounts for up to 4 % of upper non-variceal GI bleeding; SRUS is a rare benign disorder that presents with rectal bleeding. We present the case of a 75-year-old patient who was admitted to our facility with anemia. In the same patient, we encountered chronic bleeding from GAVE and SRUS. Both diagnoses were treated endoscopically: GAVE by argon plasma coagulation and a subsequent treatment with proton pump inhibitors and SRUS by adrenaline injection and clipping, consecutively treated with mesalazine enemas. The patient was successfully cured, resulting in a stable level of hemoglobin and no recurrent GI bleeding. We report a unique case of chronic GI bleeding caused by two uncommon diagnoses. The co-occurrence of GAVE and SRUS has not been previously described or published.Key words: anemia - endoscopy - gastric antral vascular ectasia (GAVE) - gastrointestinal bleeding - solitary rectal ulcer syndrome (SRUS).

The autoimmune form of pancreatitis (AIP) is divided into the following two subtypes. The 1st subtype is characterized by the high presence of immunoglobulin G4 in the blood serum and tissue of some organs which are in the close connection to the so called IgG4 associated disorders. The typical diagnostic signs of AIP are the histomorphological changes. This type of AIP is more frequent than the 2nd type with which has however some common histomorphological signs and mainly the positive response to the administered steroids used in the initial treatment. Whilst the 1st type of AIP is typically connected to the disorders of various organs such are the biliary tract, salivary and lacrimal glands, retroperitoneal fibrosis, reins, prostate gland and the next ones, the 2nd type of AIP is significantly connected to the inflammatory bowel disease only. Inflammatory bowel diseases are rarely present in the 1st type of AIP on the contrary. In our case report we mention the first published observations performed in the Czech Republic when the 1st type of AIP is succeeded by the inflammatory bowel disease - Crohn´s disease.

Pancreatic steatosis is the name for a state characterized by an increased accumulation of fat in the pancreas. It is most frequently due to obesity and the metabolic syndrome, other etiological factors may include some congenital syndromes, toxic substances or viral diseases. Diagnostics is based on non-invasive imaging methods. The most accessible is abdominal ultrasound, also endoscopic ultrasound, computed tomography or magnetic resonance imaging can be used. In clinical practice, pancreatic steatosis is in particular significant because of its close association with type 2 diabetes mellitus, non-alcoholic fatty liver disease and cardiovascular diseases. The disorder may aggravate the burden of acute pancreatitis, examined is its relationship to pancreatic cancer. Significant are also surgical reports on complications after pancreatic surgeries on individuals with pancreatic steatosis. Key words: acute pancreatitis - dyslipidemia - fatty pancreas - non-alcoholic fatty pancreas disease - non-alcoholic steatopancreatitis - obesity - pancreatic carcinoma.

Primary malignant tumors of small bowel constitute only about 1-2% of all gastrointestinal neoplasms. Although neuroendocrine tumors (NETs) are relatively rare, they still represent the second most common malignancy of the small bowel (after adenocarcinoma). Clinical manifestations include abdominal pain, bowel obstruction, diarrhea, weight loss and bleeding. The differential diagnosis of obscure gastrointestinal bleeding can sometimes be challenging for endoscopy as well as for radiology methods. We present the case of an 80-year-old man suffering from severe hypochromic anemia. Routine endoscopic methods did not show any appropriate pathology. Finally, a single ulcerative infiltration of the ileum was diagnosed by capsule endoscopy (CE). CT enterography did not reveal any other lesions. In accordance with a positive chromogranin A, endoscopic and radiologic methods, a suspicion of NET was expressed. During the surgery, 7 lesions were found and a resection of 120 cm of ileum was performed. The histology confirmed a diagnosis of NET grade 1, with a total number of 15 NET lesions in the specimen. The following octreotide scan did not show any residual infiltration. We present a patient with 15 NET lesions in the ileum diagnosed by CE and successfully cured by surgical resection of the ileum. Key words: capsule endoscopy - carcinoid syndrome - gastrointestinal carcinoids - neuroendocrine tumor - obscure gastrointestinal bleeding - small bowel - surgery.

Gastrointestinal motility disorders are reflected in clinical medicine not only in the form of functional disorders but also as primary organic units or secondary manifestations of other diseases and physicochemical effects. Recent sophisticated diagnostic methods and basic research in the field of digestive tract motility have shown significant development. However, causal treatment of prokinetic motility disorders is still marginalized. A number of new effective drugs have been withdrawn from the market due to their significant side effects. The efficacy of others is limited to individual parts of the gastrointestinal tract (GIT), e.g. only the stomach or the intestine. The article presents an overview of prokinetic indications with an effect on selected pathological conditions. In addition to isolated administering of prokinetics, they can also be used in combination with other drugs, for example in the treatment of gastroesophageal reflux disease with proton pump inhibitors. There is currently no "gold standard" prokinetic, which would globally therapeutically and, at the same time, causally affect such a complicated pathophysiological chain of GIT dysmotility. There is ongoing research to develop new drugs with a beneficial effect on the propulsion activity disorder which, while maintaining a prokinetic effect over the full length of the GIT, would not show any adverse or side effects. Patient access in this case needs to be individualized according to the proven type of motility disorder. Key words: gastroesophageal reflux disease - gastrointestinal dysmotility - gastroparesis - intestinal pseudo-obstruction - obstipation.

Crohns disease (CD) belongs to chronic diseases that highly affect the patient´s quality of life (QoL). The effect of the disease and impairment of QoL in CD patients is already known. The aim was to assess how surgical treatment influences the patients QoL and determine factors that can affect postoperative QoL.We compared the QoL before and after surgery in patients who had undergone a bowel resection at our department due to CD between 2010-2016. The patients filled in a standardized QLQ-CR29 questionnaire to assess QoL in the preoperative period and the postoperative period after a 2-month interval. The control groups were CD patients who had not undergone surgical treatment (bowel resection) and a healthy cohort. In the QoL evaluation, 132 patients with CD who had undergone surgery (bowel resection), 83 patients with CD without an operation and 104 healthy subjects were enrolled.104 of the operated patients experienced a postoperative improvement of the overall QoL (78.8 %), 2 patients did not register any changes in QoL (1.5 %) and 26 patients (19.7 %) experienced a worsening of their postoperative QoL. The results were statistically significant (p0.001).We detected a significant improvement of the overall QoL after surgical resection in CD patients (measured 2 months after surgery). Gender was identified as the only statistically relevant factor with influence on postoperative QoL.Key words: bowel resection - Crohn´s disease - Czech cohort - inflammatory bowel disease - quality of life - surgical treatment.

Metabolic syndrome and its components play an important part in the development of not only cardiovascular conditions, but also digestive and pancreaticobiliary system diseases. The aim of our study is to present a comprehensive overview of the diseases where metabolic syndrome is an inducing risk factor, or where it affects the course of the disease.Metabolic syndrome is a significant risk factor of induction of gastroesophageal reflux and its complication, which is Barretts esophagus. Metabolic syndrome was described as the disease closely linked to idiopathic intestinal inflammations, diseases of the biliary tree and pancreas. Acute pancreatitis, both its development in obese individuals and the burden of its course, are in close correlation with metabolic syndrome, similarly as the course of chronic, mainly alcoholic pancreatitis. Study of non-alcoholic steatopancreatitis presents a challenge, most importantly with regard to the function of pancreatic B cells in obese individuals. Non-alcoholic hepatic steatosis and its forms may as much as lead to the stage of cirrhosis of the liver and they pose a risk of hepatocellular carcinoma. Metabolic syndrome was also described in a population study as a risk factor for carcinoma of the colon.Metabolic syndrome and its components present an important risk factor in relation to inducing some benign as well as malignant gastrointestinal and pancreaticobiliary diseases. A systemic approach to influencing the metabolic syndrome and its components is therefore one of the important approaches to influencing the development and course of not only cardiovascular conditions.