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Gastrointestinal organs are involved in the course of von Hippel Lindau disease. Typically pancreas in von Hippel Lindau syndrome is a site of cystic and solid tumors. Differential diagnosis of pancreatic lesions includes benign lesions (cysts, serous cystic adenomas), potentially malignant (neuroendocrine) and malignant tumors(metastases).In this work we present a patient with VHL syndrome with pancreatic cysts and neuroendocrine tumor.

Pancreatic cancer remains one of the deadliest solid tumors in humans and an unsolved problem of today's medicine. Experimental studies reveal that the heterogeneous and complex pancreatic cancer microenvironment is responsible, not only for cancer growth, spread, development of metastases, but also for cancer recurrence and chemotherapy resistance. Chemotherapy affecting the cancer stroma is still under clinical and experimental research and remains hope for cure of pancreatic cancer. We present the cancer microenvironment characteristics and summary of experimental studies with use of agents affecting pancreatic cancer stroma.

Three cases of young females with pancreatic solid pseudopapillary tumor (SPT) were reported. They were referred to Department of Gastroenterology, because of the ultrasonographical finding of the pancreatic tale tumor. In all presented cases, proper diagnosis was made preoperatively. The patients underwent surgical treatment, and remain symptoms-free with no features of recurrence of the disease (follow-up from 6 to 36 months).

The most common tumor of the pancreas is cancer, which constitutes 85% of all pancreatic neoplasms. Cystic pancreatic tumors comprise 10% of malignancies. No more than 5% of pancreatic tumors are rare solid tumors as: neuroendocrine tumors, gastrointestinal stromal tumors, solid pseudopapillary tumors, pecomas, lymphomas, granulocytic sarcomas, schwannomas, lipomas, liposarcomas and metastases to pancreas. Nowadays, these tumors are diagnosed more commonly due to the developement and accessibility of the diagnostic imaging techniques. Moreover, the treatment and management of rare solid pancreatic tumors often differs from the management in pancreatic cancer what makes the differential diagnosis difficult and responsible challenge. The main purpose of this article is to present an actual data of epidemiology, clinical presentation, management and treatment of rare solid pancreatic tumors according to recent literature and self experience.

Endoscopic biliary drainage (EBD) performed via retrograde cholangiopancreatography (ERCP) is a widely accepted method of treatment of obstructive jaundice. However, in some patients (around 15% of cases) due to various reasons proper cannulation of the biliary tract cannot be achieved, and these individuals are most commonly qualified for transcutaneous drainage or surgical intervention. Unfortunately, both of these procedures are accompanied with high rate of complications. In this paper we report a case of a patient suffering from non-operative, rarely occurring tumor of the papilla of Vater (rhabdomyosarcoma), who was treated with novel endoscopic procedure for obstructive jaundice. This patient presented indications for biliary drainage, however, the endoscopic intervention using classical retrograde access was technically impossible. Endoscopic ultrasonography-guided needle puncture was performed to visualize from the duodenal bulb the bile duct, that was amputated in its distal parts by the tumor mass. A guidewire was inserted through the needle, dilated, prosthesis was successfully inserted and normal gall flow was achieved. Authors have not observed any complications after this intervention. To our best knowledge, we are the first who performed such endoscopic procedure in Poland.

Ectopic pancreas is the most common type of ectopic tissue in gastrointestinal tract. It is typically asymptomatic, presenting as a small submucosal lesion in prepyloric region of stomach. The diagnosis is usually incidental, during gastroscopy. The patient with symptomatic heterotropic pancreas, mimicking gastric malignancy was described.

Unlabelled: Despite some advances in the oncological managament, pancreatic cancer remains a clinical problem and has remained leading cause of cancer deaths. The association between Helicobacter pylori (H. pylori) infection and pancreatic was suggested, but the issue remains of contentious. The aim of the study was to determine the relationship between H. pylori infection and pancreatic cancer development on a sample of Polish population., Material and Methods: 139 patients with pancreatic cancer and 177 controls were included in the study. Seropositivity for H. pylori, including CagA protein were assessed by the enzyme-linked immunosorbent assay and Western blot, respectively. The frequency of H. pylori in pancreatic cancer patients and controls were compared adjusted for age, sex, cigarette smoking and a family history of cancer in the logistic regresion model., Results: No significant differences between pancreatic cancer patients and controls were seen according to H. pylori seropositivity (87.1 vs 82.5%; OR = 1.27; CI95%: 0.64-2.61; p = 0.514) and CagA seropositivity (83.5 vs 84.9%; OR = 0.90; CI95%: 0.46-1.73; p = 0.744)., Conclusions: The study didn't support previous observations of H. pylori infection as a plausible pathogenic risk factor for pancreatic cancer development. The high prevalence of infection in the control group may explain why the earlier reports of a positive association between H. pylori infection and pancreatic cancer could not be confirmed in the study.

Irritable bowel syndrome (IBS) is one of the most common disorders of gastrointestinal tract, affecting significant number of western population. The characteristic features are chronic and(or) recurrent abdominal pain and discomfort associated with changes in the bowel habit with or without bloating. According to Rome Criteria III there is an improved focus on the intestinal transit time which allows for better diagnosis and characterization of patients either with diarrhea, constipation predominant or mixed type IBS. Patients with IBS also frequently manifest various symptoms related to central nervous system (CNS) as depression or personality disorders. In this review we present current knowledge concerning etiopathogenesis of IBS with emphasis on the role of microbiota and describe promissing profilatic and treatment modalities with anti-biotics and probiotics capable to modulate microbiota and gut-brain axis. Most recent studies concerning clinical efficacy of antibiotic rifaximin and probiotic strain Lactobacillus plantarum 299v in symptom prevention (reduction) of this common gastrointestinal disorder are briefly described.

Wilson's disease is caused by a P-type ATP-ase gene mutations with reduced biliary copper excretion and accumulation copper in the liver and other tissues. Clinical symptoms can be heterogeneous but in many cases on the first stage the only abnormalities is elevation of aminotransferase activity. In some cases the first fatal symptom of disease is acute liver failure, therefore early diagnosis and treatment is essential. We present an actual recommendations for diagnosis and treatment of patients with Wilson's disease.

Thrombophilia in adults is one of main causes of portal vein thrombosis. Esophageal and gastric varices, ascites and hypersplenism are well known complications of portal hypertension. There are controversial issues on the management, especially anticoagulant therapy and surgical treatment of these patients. We present a 42-years old woman with a history of three acute coronary episodes suffering from recurrent variceal bleeding due to portal and splenic vein thrombosis in the course of myeloproliferative disorder and protein C deficiency. It was 10 months delay of diagnosis. She was successfully treated with medical and surgical treatment (esophageal stapler transection, cardial devascularization, and splenectomy). In the paper we discuss complexity of diagnosis and surgical treatment.

Upper gastrointestinal endoscopy plays a major role in the diagnostic and treatment of the complications of portal hypertension in patients with liver cirrhosis. Endosonography (EUS), which combines routine endoscopy and ultrasound examination has been so far infrequently used in these cohort of patients despite the fact that it offers much more detailed analysis of several features of portal hypertension, not detected with routine endoscopy. These include detection of so called "deep varices", assessment of the thickness of gastric wall, differentiation between thickened folds and varices or detection of subclinical amounts of ascitic fluid. In this paper we systematically review the current and potential future applications of EUS in the diagnostic and treatment of patients with liver cirrhosis.

This paper presents a case report of a 61 year-old man who had diagnosed in colonoscopy rectal cancer of early stage. In endosonography (EUS) intramucosal lesion without enlargement of regional lymph nodes was demonstrated. The patient was qualified for endoscopic therapy by submucosal dissection (ESD). The treatment was performed without any complications. The histological findings confirmed an early stage of rectal cancer--This, according to TNM classification.

Unlabelled: Mutation of the p53 gene belongs to the most common genetic alteration in human cancer. Prognostic significance of serum anti-p53 antibodies in patients with gastric cancer is still a matter of controversy. The aim of the study was to estimate the presence of anti-p53 antibodies in serum of gastric cancer patients and relationship between anti-p53 antibodies and chosen clinical and pathomorphological data age, sex, localization of cancer, histology, stage of disease, metastases to lymph nodes and the time of survival., Material and Method: Serum samples from 71 patients with gastric cancer were analyzed by specific enzyme-linked immunosorbent assay (ELISA) to determine the presence of serum anti-p53 antibodies. The results were statistically compared with clinical and pathological features and postoperative survival., Results: Anti-p53 antibodies were detected in 16 (23%) gastric cancer patients. The presence of p53 antibodies was connected with intestinal tumor type (p < 0.05) and older age (p = 0.0035). There were no association between anti-p53 antibodies, stage and the time of survival., Conclusion: These results suggest that in gastric cancer patients serum anti-p53 antibodies detected by ELISA are not predictor of prognosis.

Aim: The expression of p53 protein was compared in primary gastric carcinomas and coexisting regional and distant metastases. The purpose of the study was to evaluate whether p53 staining in regional lymph-node metastases might improve the value of p53 as a prognostic marker and determine the behaviour of its protein during gastric cancer progression., Material and Methods: 60 gastric cancer patients were included into the study. In all patients the expression of p53 was assessed in primary tumours and in regional lymph-node metastases. Additionally in 12 patients the p53 expression was determinated in distant metastases. The number of all secondary tumours studied was 153. Formalin fixed, paraffin embedded material and three-stage immunohistochemical methods were used., Results: p53 accumulation was detected in 24 (40%) of primary gastric carcinomas. In each patient p53 expression in primary regional and distant metastatic tumours was identical., Conclusions: Our results show that assessment of p53 in lymphnode metastases does not improve prognostic value of p53 in gastric carcinoma and support the view that p53 alterations occur before and maintain during metastatic spread.

Study Aim: The aim of the study was to evaluate the role of Helicobacter pylori CagA(+) infection in gastric cancer., Material and Methods: 475 patients were included into the study (270 gastric cancer patients and 205 control subjects). Helicobacter pylori CagA status was determined by enzyme-linked immunoabsorbent assay (ELISA). The frequency of H. pylori CagA infection in gastric cancer patients and control group was compared. The relationship between presence of anti-H. pylori CagA antibodies and selected clinical and pathomorphological parameters was analysed., Results: Gastric cancer patients and controls had the same prevalence of H. pylori CagA antibodies (54.4 vs 52.5%; p = 0.078). The persons with H. pylori CagA(+) and CagA(-) were at the same risk for developing gastric cancer (OR = 1.08; 95%CI = 0.66-1.49). However subgroup analysis showed that the risk of gastric cancer development in H. pylori CagA(+) depended on age being 2 times higher for young people (15-40 years) (OR = 2.0; 95% CI = 0-4.25) and four times higher for those under the age of 30 years (OR = 4.0; 95%CI = 0-15.9). There was a positive relationship between H. pylori CagA(+) infection and age (p = 0.043). H. pylori CagA(+) infection was independent of sex, family history of cancers, duration of symptoms, ABO blood group, tumour site, stage, histology and p53 accumulation in cancer gastric tissue., Conclusion: Our study shows that H. pylori CagA(+) infection increases the risk for developing gastric cancer in young persons and does not protect the host against cardia cancer. The results suggest also that infection by H. pylori CagA(+) in gastric cancer has no influence on p53 gene mutation development.

Unlabelled: The aim of the study was to evaluate the role of Helicobacter pylori infection in gastric cancer development., Material and Methods: 475 patients were included into the study (270 gastric cancer patients and 205 controls). Helicobacter pylori status was determined by enzyme linked immunoabsorbent assay (ELISA). The frequency of H. pylori infection in gastric cancer patients and the control group was compared. The relationship between the presence of anti-H. pylori antibodies and selected clinical and pathomorphological parameters was analysed., Results: H. pylori infection was statistically more frequent in gastric cancer patients than in controls (94.4% vs. 86.3%, p = 0.0039). Subjects infected with H. pylori were about 2.5-fold more likely to develop gastric cancer than uninfected individuals (OR = 2.69; 95% CI = 0.93-4.45) and the risk depended on age. A positive relationship between H. pylori infection and family history of cancer was found (p = 0.045). H. pylori status was irrespective of patient's age, sex, duration of symptoms, AB0 blood group, tumour site, stage, histology and p53 status in cancer tissue., Conclusion: Our study confirms a positive relationship between H. pylori infection and gastric cancer, however, in contrast to previous reports fails to demonstrate that bacteria protect the host from cardia cancer. Our results suggest also that in gastric cancer H. pylori does not induce p53 mutations.