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SARS-CoV-2 is an etiological factor in several diseases that the WHO designated covid-19. Covid-19 infection may affect the digestive tract, including the pancreas. The main/most common symptoms of covid-19 include fever (71.6%), cough (68.9%) subjective feeling of shortness of breath (71.2%). The gastrointestinal symptoms include abdominal pain, nausea and vomiting and/or diarrhea. The relationship of covid-19 and pancreas affection is not clearly described. A common finding is hyperlipasemia, eventually hyperamylasemia. Both conditions are usually associated with either no or minimal histomorphological changes, i.e. changes referred to as edematous glandular infiltration. Rarely, a necrotic form was reported. Nevertheless, the mortality of patients with acute pancreatitis who were covid-19 positive was higher than in covid-19 negative individuals. The available data indicate there is a link between covid-19 infection and the pancreas presenting as an acute disorder of the gland. SARS-CoV-2 impairment of both exocrine and endocrine function of the pancreas is multifactorial. It is debatable whether the involvement of the gland is directly related to the presence of the virus or whether it is an epiphenomenon. Angiotensin-converting enzyme 2 (ACE-2) receptors, inflammatory changes (especially in pancreatic beta cells), together with high IL-18 levels, virus-induced lipotoxicity and immunological dysregulation play an important role in the induction of pancreatic damage. During the covid-19 pandemic, pancreatopathies represent a very lively topic and are being studied intensively. Keywords SARS-CoV-2, COVID-19, chronic pancreatitis, pancreas, endoscopy

Crohn’s disease and ulcerative colitis are both chronic inflammatory bowel diseases (IBD). This article summarizes current best practice in treating pregnant patients with IBD, ranging from conservative therapy to endoscopy and imaging methods, including a description of surgical therapy indications. Female patients with IBD should ideally plan their pregnancies for when their disease is in remission. Patients in remission may also have complications during pregnancy, however the risk of complications is lower than in patients with active disease. Any chronic medications they were on before becoming pregnant (with the exception of teratogenic methotrexate) should remain unchanged. According to the current literature, pregnancy does not itself complicate the course of IBD. In cases of a severe relapse or an occurrence of complications in these patients, careful multidisciplinary cooperation is required, especially between the gastroenterologist, surgeon, radiologist, and gynaecologist. Surgical treatment is required only in cases of acute complications of IBD (such as acute severe colitis resistant to medical therapy, perianal abscess, and complications of IBD in the sense of such acute abdomen events as perforations, ileus due to a stenosis, or massive haemorrhage).

Pneumoperitoneum is a condition that refers to the presence of free air (gas) in the abdominal cavity. Differential diagnosis of the causes of pneumoperitoneum varies widely and represents varying degrees of severity. In the patients who have not recently underwent laparotomy or laparoscopy, the finding of pneumoperitoneum is usually a sign of gastrointestinal perforation that requires immediate surgical approach due to the risk of peritonitis with subsequent life-threatening sepsis. However, not all causes of pneumoperitoneum require surgery. In our case report, we present a rare case of clinically asymptomatic pneumoperitoneum that developed in a 66-year-old patient after CT colonography. In this diagnostic method, we inflate colon with carbon dioxide (CO2 ); therefore this kind of pneumoperitoneum can de facto be called capnoperitoneum. In this patient, free air (gas) in the abdominal cavity manifested itself in the so-called benign pneumoperitoneum, which is defined as asymptomatic free air in the abdominal cavity and pneumoperitoneum without peritonitis. Despite the fact that CT colonography is considered a method with a very low incidence of complications, it is necessary to take into account the presence of risk factors in its indication and to contraindicate to avoid the number of postoperative complications. The fundamental message of our case report is that extensive pneumoperitoneum after proven CT colonography can be asymptomatic and can be treated conservatively (if clinical and laboratory results are favorable).

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.

Pancreatic ductal adenocarcinoma (PDAC) is now the 11th most common cancer and in 2018 there were 458,918 new cases worldwide. In the Czech Republic, a total of 2,173 patients were diagnosed in 2015, ranking the second in incidence worldwide. In contrast to other malignancies, recent research has not brought any major breakthrough in the treatment of PDAC and hence the prognosis remains very serious. Radical resection is the only curative approach, but after the initiation of the standard pathological evaluation of the resected tissue, according to the Leeds protocol, 80% of the resections are R1 (resections with microscopically positive margins). The results of studies in patients with borderline resectable or locally advanced PDAC prefer neoadjuvant chemotherapy or chemoradiotherapy. This approach leads to a higher number of radical R0 resections and better survival. For neoadjuvant treatment in patients with primarily resectable PDAC, most results come from retrospective analysis or phase II trials. However, recently, data from three randomized clinical trials with neoadjuvant therapy for resectable PDAC were presented. These results support the use of chemotherapy or chemoradiotherapy prior to surgery. In the trials published to date, there are differences in chemotherapeutic regimens, cytostatic doses, and the definition of resectability. Thus, up-front resection with adjuvant chemotherapy is still the standard of care and a well-designed randomized trial using neoadjuvant therapy is now necessary.

Prezentujeme kazuistiku pacienta se somatickou retardaci a abnormalnim vzhledem vlasů, který trpěl opakovanými epizodami vodnateho hlenoviteho průjmu, postihem jaternich funkci a neprospivanim. U pacienta byly pozorovany těžke průběhy infekci vcetně hepatitidy neznameho původu komplikovane selhanim jater ve 4 měsicich, bronchopneumonie ve 4 letech a septickeho soku ve věku 8 let. Ezofagogastroduodenoskopie a koloskopie byly provedeny ve 4 letech, k vylouceni zanětliveho onemocněni střev (IBD). Histologicky vsak byly patrne pouze znamky nespecificke kolitidy. Imunologicke vysetřeni odhalilo snižený pocet naivnich CD4+ lymfocytů a sniženou T-lymfoproliferativni odpověď na mitogeny. K vysetřeni vzorku DNA pacienta bylo použito masivni paralelni sekvenovani (nazývane take sekvenovani nove generace, next generation sequencing – NGS) zaměřene na panel genů souvisejicich s primarnimi imunodeficiencemi. NGS analýza odhalila dvě heterozygotni varianty v genu TTC37. Nonsense varianta p.Arg1201* a missense varianta p.Leu1505Ser v exonu 34, resp. 42, byly vyhodnoceny jako patogenni na zakladě predikce in silico a jejich vzacneho výskytu v obecne populaci. Vzhledem k tomu, že obě mutace již byly popsany u pacientů s trichohepatoenterickým syndromem (THES) a klinicke znamky u naseho pacienta byly v souladu s touto diagnozou, považujeme nase zjistěni za přicinne. THES je v dětstvi casto život ohrožujicim onemocněnim, zejmena u pacientů, u kterých se rozvine onemocněni jater nebo trpi zavažným průběhem infekcnich onemocněni. THES může mit podobný klinický obraz jako zanětlive onemocněni střev s velmi casným zacatkem (very early-onset inflammatory bowel disease – VEO-IBD) a je casto do teto skupiny přiřazovan. IBD jsou obecně považovana za polygenni onemocněni, nicmeně u některých děti s VEO-IBD je znamo, že jejich onemocněni ma monogenni etiologii, tak jako je tomu u THES. Cilený NGS je ucinným nastrojem pro jednoznacne stanoveni diagnozy u pacientů s VEO-IBD.

Background: Eosinophilic esophagitis (EoE) is a chronic, progressive inflammatory disease of the esophagus characterized by local eosinophilic infiltration accompanied by symptoms of esophageal dysfunction. The aim of this study was to characterize features of EoE dia gnosed regionally and to describe local strategies for its treatment. Methods: The observational survey retrospectively analyzed a data set of child patients with histologically proven EoE from five pediatric endoscopy centers. This analysis focused on describing their general situation (age, gender, symptoms) and also aimed to investigate any possible linkage between age and symptoms or length of dia gnosis period. Demographic features; clinical symptoms; laboratory, endoscopic, and histopathological findings; and chosen treatment of patients were recorded and analyzed. Results: From January 2010 to September 2020, 33 new cases of EoE were reported. Strong association of EoE with male sex is consistent with the results from formerly published studies (81.8%). The median age of symptom onset was 7 years, while the median age for dia gnosis was almost 13 years. The most common symptoms were reflux symptoms in general (39.4%), followed by vomiting (36.4%), and dysphagia (33.3%). Examination for sensitization to food allergens was performed on 23 (69.7%) patients with dia gnosed EoE. Out of these, 17 (51.5% of all cases) were found to be sensitive to some allergens. Most of this subgroup (and 48.5% of all cases) were examined by specific IgE testing, and just 2 (6.1% of all cases) patients were tested only by skin prick tests. Another allergic comorbidity was present in 75.8% of patients, and the most common of these were bronchial asthma and allergic rhinoconjunctivitis (45.5% and 42.2%, respectively). More than two-thirds of patients (69.7%) had abnormal macroscopic findings during dia gnostic endoscopy, and the most common were longitudinal furrows and white exudates. The most common initial modality of treatment was to use proton-pump inhibitors (PPI; 93.9%), followed by food elimination (75.8%) and then by corticosteroid administration (63.6%). The vast majority of patients treated with corticosteroids received a topical preparation (90.9%). Conclusion: This is the first retrospective study on pediatric patients with EoE in the Czech Republic. We found similar features of EoE as reported in formerly published works elsewhere. Collecting long-term prospective observational data in a national EoE register of patients in the Czech Republic would significantly improve our knowledge of this disease.

An acute abdomen is an urgent condition requiring rapid diagnosis and treatment. Nowadays, with the new developments and progression in ultrasonography (US) and computed tomography (CT), these methods have become a far better alternative to plain abdominal radiography. US is now an available and proven method used to provide a “final” diagnosis in various conditions. The frequency for CT examination for the diagnosis of acute abdomen has increased. A disadvantage of using CT examination includes high doses of radiation for the patient. Fortunately, this disadvantage is outweighed by the multitude of advantages. The advantages include high sensitivity and specificity in the detection of causes in urgent conditions. The CT protocol of examination is primarily lead by the radiologist.

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: Krvaceni do horniho gastrointestinalniho traktu (GIT) patři mezi život ohrožujici stavy, ktere vyžaduji aktivni přistup a dynamický management akutni pece. Gastroskopie představuje zasadni diagnostický a terapeutický krok. Bohužel mnoho mensich nemocnic nema možnost provest gastroskopii mimo pracovni dobu. Glasgow-Blatchford skore (GBS) představuje nastroj umožňujici odhad vývoje stavu pacienta s krvacenim do horniho GIT. Evropska guidelines doporucuji ambulantni řeseni pacientů s GBS rovno 0 nebo 1. Cilem nasi studie bylo posoudit použitelnost GBS na ceske populaci a zhodnotit bezpecnost vyssi hranice GBS pro řeseni pacientů v ambulantnim režimu. Metody: Retrospektivni sběr dat pacientů, kteři byli hospitalizovani a endoskopovani v Nemocnici Boskovice pro symptomy krvaceni z horniho GIT od řijna 2018 do prosince 2019. Výsledky: Data hodnotici celkový průběh onemocněni naznacuji, že optimalni GBS pro stanoveni pacienta s nizkým rizikem je 3, ale s přihlednutim k endoskopickým nalezům lze za bezpecne pro ambulantni lecbu považovat GBS 2. GBS 10 pak předpovida zavažný celkový průběh nemoci a zavažne endoskopicke nalezy. Zavěr: Dle nasich dat lze zvýsit hodnotu GBS na 2 pro ambulantni řeseni pacientů, což by mohlo snižit delku hospitalizace a tlak na urgentni endoskopie. Tyto zavěry je nutne ověřit dalsim výzkumem – idealně multicentrickou prospektivni studii s velkým množstvim analyzovaných pacientů.

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.

Herpeticka ezofagitida je onemocněni dia­gnostikovane zejmena u imunokompromitovaných pacientů. U imunokompetentnich jedinců se jedna o vzacne onemocněni, na ktere je ale třeba pomýslet při akutně vznikle triadě potiži – odynofagie, bolesti na hrudi a horecka nejasneho původu. Nejcastějsim původcem je herpes simplex virus typu 1 (HSV1). Ve větsině připadů vznika onemocněni reaktivaci latentni infekce HSV1, vzacněji při primoinfekci. Zakladem dia­gnostiky je endoskopicke vysetřeni jicnu s provedenim bio­psie a přimým průkazem přitomnosti viru v bio­ptickem vzorku. U imunokompromitovaných pacientů je vždy indikovana lecba acyklovirem, který je v teto indikaci virostatikem prvni volby. U imunokompetentnich pacientů se jedna o tzv. self-limiting onemocněni, kdy v naproste větsině připadů postacuje symptomaticka lecba. Kazuistika popisuje imunokompetentniho pacienta s nahle vzniklou typickou triadou potiži způsobených herpetickou ezofagitidou. Dia­gnoza byla potvrzena průkazem přitomnosti virove DNA metodou PCR ze vzorku odebraneho při endoskopickem vysetřeni. Vzhledem k těžsimu průběhu onemocněni byl pacient přelecen acyklovirem a doslo k rychle upravě celkoveho stavu i lokalniho endoskopickeho nalezu. Herpeticka ezofagitida je onemocněni dia­gnostikovane zejmena u imunokompromitovaných pacientů. U imunokompetentnich jedinců se jedna o vzacne onemocněni, na ktere je ale třeba pomýslet při akutně vznikle triadě potiži – odynofagie, bolesti na hrudi a horecka nejasneho původu. Nejcastějsim původcem je herpes simplex virus typu 1 (HSV1). Ve větsině připadů vznika onemocněni reaktivaci latentni infekce HSV1, vzacněji při primoinfekci. Zakladem dia­gnostiky je endoskopicke vysetřeni jicnu s provedenim bio­psie a přimým průkazem přitomnosti viru v bio­ptickem vzorku. U imunokompromitovaných pacientů je vždy indikovana lecba acyklovirem, který je v teto indikaci virostatikem prvni volby. U imunokompetentnich pacientů se jedna o tzv. self-limiting onemocněni, kdy v naproste větsině připadů postacuje symptomaticka lecba. Kazuistika popisuje imunokompetentniho pacienta s nahle vzniklou typickou triadou potiži způsobených herpetickou ezofagitidou. Dia­gnoza byla potvrzena průkazem přitomnosti virove DNA metodou PCR ze vzorku odebraneho při endoskopickem vysetřeni. Vzhledem k těžsimu průběhu onemocněni byl pacient přelecen acyklovirem a doslo k rychle upravě celkoveho stavu i lokalniho endoskopickeho nalezu.

Exocrine pancreatic insufficiency (EPI), an important cause of maldigestion and malnutrition, results from primary pancreatic disease or is secondary to impaired exocrine pancreatic function. Although chronic pancreatitis is the most common cause of EPI, several additional causes exist. These include pancreatic tumors, pancreatic resection procedures, and cystic fibrosis. Other diseases and conditions, such as diabetes mellitus, celiac disease, inflammatory bowel disease, and advanced patient age, have also been shown to be associated with EPI, but the exact etiology of EPI has not been clearly elucidated in these cases. The causes of EPI can be divided into loss of pancreatic parenchyma, inhibition or inactivation of pancreatic secretion, and postcibal pancreatic asynchrony. Pancreatic enzyme replacement therapy (PERT) is indicated for the conditions described above presenting with clinically clear steatorrhea, weight loss, or symptoms related to maldigestion and malabsorption. This review summarizes the current literature concerning those etiologies of EPI less common than chronic pancreatitis, the pathophysiology of the mechanisms of EPI associated with each diagnosis, and treatment recommendations.

Pancreatic ductal adenocarcinoma (PDAC) is increasing in incidence and is still associated with a high rate of mortality. Only a minority of patients are diagnosed in the early stage. Radical surgery is the only potential curative procedure. However, radicality is reached in 20% of patients operated on. Despite the multidisciplinary approach in resectable tumors, early tumor recurrences are common. Options on how to select optimal candidates for resection remain limited. Nevertheless, accumulating evidence shows an important role of circulating non-coding plasma and serum microRNAs (miRNAs), which physiologically regulate the function of a target protein. miRNAs also play a crucial role in carcinogenesis. In PDAC patients, the expression levels of certain miRNAs vary and may modulate the function of oncogenes or tumor suppressor genes. As they can be detected in a patient’s blood, they have the potential to become promising non-invasive diagnostic and prognostic biomarkers. Moreover, they may also serve as markers of chemoresistance. Thus, miRNAs could be useful for early and accurate diagnosis, prognostic stratification, and individual treatment planning. In this review, we summarize the latest findings on miRNAs in PDAC patients, focusing on their potential use in the early stage of the disease.

Cystic fibrosis (CF) is a genetic disease affecting many organs including the gastrointestinal tract. While the pulmonary damage is the most life threatening, the pancreas is one of the first and most affected organs by CF. Mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene results in a reduced volume of pancreatic juice and hyperconcentration of macromolecules leading to precipitation in the duct lumina, causing obstruction and damage. The clinical presentation of individual cases depends on a combination of different CFTR mutations, potential presence of modifier genes mutations, and environmental factors. The CFTR mutations are historically divided into 5 classes - severe mutations (classes I-III) and mild mutations (classes IV-V). The CFTR functional status depends on the combined effects of both CFTR allels and the severity of the phenotype depends on the milder mutation. The majority of CF patients exhibit exocrine pancreatic insufficiency in early childhood because functional acinar tissue has been lost in utero or soon after birth. These patients rarely suffer from pancreatic complications such as recurrent acute pancreatitis and/or chronic pancreatitis which, on contrary, can occur in the minority of patients who possess residual pancreatic exocrine function. CFTR mutations are found more frequently in idiopathic and alcoholic chronic pancreatitis but the data is conflicting. A combination with SPINK-1 mutations can be found in idiopathic chronic pancreatitis group, as well as presence of environmental factors. Malnutrition is directly related to worse prognosis of CF patients and delivery of active digestive enzymes is a cornerstone of the treatment with acid supression and vitamins supplementation playing an important additional role.

Echinococcosis is a rare parasitic infection in Central Europe. The most commonly affected organ is liver. There are two types, cystic and alveolar echinococcosis with different type of treatment management. A radical liver resection remains the method of choice in the management of alveolar echinococcosis. We report a case of a 40-year-old woman with an echinococcal alveolar liver lesion successfully treated with a laparoscopic resection of the 5th liver segment. Laparoscopic technique, with all its benefits over the open surgery, provides a save and efficient treatment of selected types of echinococcal cysts located in the liver. It is a mini-invasive surgical approach which enables lower postoperative discomfort, quicker recovery and better cosmetic outcome.

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).

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.

Pancreatic cancer (PC) is a form of malignancy of increasing incidence and poor prognosis, with an average of less than 10% of patients surviving 5 years after being diagnosed. The main reason for this unfavorable situation is the long asymptomatic course of the disease, and the absence of a simple screening method, typically leading to the late discovery of the disease. The development of the malignancy from the initial carcinogenesis into invasive pancreatic carcinoma takes approximately 10 years. However, the progression of pancreatic cancer from early into advanced stages can be, according to the latest studies, incredibly fast, just a few months. Early stages of pancreatic malignancy can be detected only by expensive, and sometimes invasive, diagnostic methods (CT, MR/MRCP, or EUS). Due to the current absence of a reliable non-invasive screening method, it is necessary to define a group of patients who have the highest risk of PC development, five to ten times higher risk compared to the regular population at a minimum. Risk factors combine in their effect; therefore, relative risks of PC development need to be summarized to obtain a total relative risk for each person. The main and non-influenceable risk factor in the development of PC is the increasing age. The other non-influenceable risk factor of PC is a genetic predisposition - family incidence of the disease can be detected in 4-16% of patients. Some specific genes and mutations which can play a role in PC development have already been identified (for example mutation of the PRSS-1 gene). Among the influenceable risk factors of PC is primarily smoking; obesity can play a part in PC development as well. A higher risk of PC is observed in patients with chronic pancreatitis. Nowadays, the relationship between PC and diabetes mellitus (DM) is hotly discussed. In the case of long-standing DM, the risk of pancreatic cancer is two times higher compared to the healthy population. However, new-onset DM can be the first sign of still asymptomatic PC. These patients, with paraneoplastic DM caused by pancreatic cancer cells, represent approximately 1% of recently diagnosed patients. However, this group of patients is still too large for screening. Because of that, it is necessary to find specific criteria to distinguish classic DM from the paraneoplastic form. The application of these criteria can help with the better stratification of risk in patients with new-onset diabetes and hence, it can help to discover PC in its early stages.

Crohn’s disease (CD) and Familial adenomatous polyposis (FAP) are two different diseases which both affect gastrointestinal tract. FAP is an autosomal dominant inherited disease, however the etiology of CD is still unknown but is supposed to be multifactorial (genetics, environment, immune state, microbiom). The therapy of these two diseases differs as well. The ultimate solution for FAP is surgery (colectomy or proctocolectomy). On the other hand, the therapy of CD can be either conservative or surgical. Generally, in cases of bowel resections the alternatives of gastrointestinal tract restoration have to be considered in advance. Furthermore, this decision is even more demanding in patients diagnosed with both diseases (CD and FAP). We present a case of a young female with FAP who was recently diagnosed with active CD in the ileocaecal region. Due to large multiple colon polyps and stenotic terminal ileum she was indicated for surgery (colectomy with terminal ileostomy and terminal ileum resection). Subsequently, the ileorectal anastomosis was constructed in this case. In further text, we also discuss other types of possible bowel restoration solutions (ileal pouch-anal anastomosis and abdominoperineal resection with terminal ileostomy) in such a patient.

Autoimmune pancreatitis is a rare form of chronic pancreatitis. The first descriptions of the disease date back to the 1990s. Etiology is multifactorial, with the use of genetic, environmental and complex immunological mechanisms. It is classified into two subtypes. Type 1 is part of a group of diseases called IgG4-related disease. Clinically is autoimmune pancreatitis manifested by icterus and abdominal discomfort. It can rarely present as acute pancreatitis. There is also a completely asymptomatic form of the disease. The diagnosis is based on abnormalities in histology, imaging methods, serology, the involvement of other organs in relation to IgG4-related disease, and a significant positive response to corticosteroid therapy. Differential diagnosis between the focal form of autoimmune pancreatitis and pancreatic cancer can be complicated, with endosonography playing an important role. In the treatment, we use corticosteroids and other immunosuppressants including biological therapy. Patients with the asymptomatic disease should also be treated to prevent late complications and exocrine and endocrine insufficiency. In addition to drug treatment, endoscopic and/or surgical treatment may be necessary. Even after recovery, the disease can relapse. The relationship between autoimmune pancreatitis and malignancies has not been clearly confirmed. The goal of this review is to provide a comprehensive look at autoimmune pancreatitis and translate latest scientific knowledge into clinical practice.

Ampularni adenokarcinom (AA) je relativně vzacne onemocněni, tvořici meně něž 1 % vsech nadorů gastrointestinalniho traktu, ackoli je to druha nejcastějsi malignita periampularni oblasti (po karcinomu pankreatu). Mezi možnosti lecby ampularnich neoplazii patři endoskopicka resekce, transduodenalni chirurgicka ampulektomie nebo hemipankreatoduodenektomie. V době diagnozy onemocněni je u AA vyssi pravděpodobnost kurabilni chirurgicke resekce než u karcinomu pankreatu (80 vs. 20 %) a rovněž 5lete přeživani je významně delsi. Laparoskopicke resekcni výkony se staly standardem v kolorektalni chirurgii s prokazanými výhodami v casnem pooperacnim průběhu. V tomto clanku prezentujeme kazuistiku 68lete pacientky s AA, u ktere byla provedena laparoskopicka hemipankreatoduodenektomie (LPD). Pojednavame o výhodach a nevýhodach LPD s hepankreatoduodenektomii provaděnou z otevřeneho přistupu, rozebrany jsou lecebne možnosti teto diagnozy (vc. endoskopicke) a přinasime přehled soucastne literatury.

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.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive disease caused by a mutation in the TYMP gene encoding thymidine phosphorylase. MNGIE causes gastrointestinal and neurological symptoms in homozygous individuals and is often misdiagnosed as anorexia nervosa, inflammatory bowel disease, or celiac disease. We present the case of a 26-year-old female with MNGIE, who was initially diagnosed with anorexia nervosa and Crohn’s disease. The diagnosis of MNGIE was established by biochemical confirmation of elevated serum and urine thymidine and deoxyuridine levels after multiple examinations and several years of disease progression and ineffective treatment. Subsequent molecular genetic testing demonstrated a homozygous TYMP gene mutation. MNGIE should be considered in patients with unexplained malnutrition, intestinal dysmotility, and atypical neurological symptoms.

Hiatove hernie jsou casto spojovany s lecbou refluxni choroby jicnu. V tomto připadě je u nich zvažovano buď pokracovani zavedene lecby pomoci inhibitorů protonových pump, anebo provedeni antirefluxni operace. U malých hiatových kýl je cetnost výskytu komplikacinizka. S narůstajici velikosti hiatove hernie se ale zvysuje riziko výskytu akutnich komplikaci, ktere mohou pacienta ohrozit na životě. Důležitou soucasti lecby komplikaci hiatových hernii je prevence. Elektivni operacni řeseni hiatových kýl ma velmi dobre funkcni výsledky s nizkým rizikem pooperacnich komplikaci. Proto by měly být planovaně operovany předevsim kýly paraezofagealni nebo objemne smisene hiatove hernie. Nejzavažnějsimi akutnimi komplikacemi jsou volvulus žaludku a rozvoj zavažneho krvaceni. Volvulus žaludku je život ohrožujici stav, který vyžaduje rychlou diagnostiku a lecbu. Symptomy volvulu žaludku nemusi být typicky vyjadřene, což ztěžuje diagnostiku onemocněni. Zakladni soucasti chirurgicke lecby akutnich komplikaci u hiatových hernii je repozice žaludku do dutiny břisni a jeho pexe ke stěně břisni. Při akutni operaci objemne hiatove hernie je významně vyssi riziko nutnosti laparotomie než při operaci elektivni, ktere se větsinou daři dokoncit laparoskopicky. Narůsta riziko peroperacniho poraněni jicnu, sleziny, ale take nechirurgických pooperacnich komplikaci, jako jsou pneumonie, delirium a arytmie. U vybraných pacientů s volvulem žaludku bez jeho perforace může být uspěsne i řeseni endoskopicke. Akutni operacni řeseni si může vyžadat i masivni krvaceni ze žaludku při objemne hiatove hernii, u ktereho je uspěsnost endoskopicke lecby a konzervativniho postupu nizka.

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.

Aims Primary malignant tumors of the 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 endoscopic as well as for radiological methods. The aim of the lecture is to present the diagnostic and therapeutic management of a patient with NET of the small bowel. Methods A literature research (in MEDLINE, PubMed and Google Scholar databases) was done focusing on diagnostics, endoscopic and surgical treatment of neuroendocrine tumor of the small bowel. Results We present a case of an 80-year-old man suffering from severe hypochromic anemia. Routine endoscopic methods did not show any any pathology explaining the severe anemia. 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 radiological 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. Conclusions NETs located in the duodenum up to 1 cm in size can be treated endoscopically and are mostly isolated lesions. On the other hand, surgical treatment is recommended for NETs in the jejunoileum. They have a greater propensity to metastasize and NETs in this localization can even form more lesions. We present a patient with 15 NET lesions in the ileum diagnosed by CE and successfully treated by surgical resection of the ileum.

Purpose: The diagnosis of pancreatic ductal adenocarcinoma (PDAC) in treatable early stages continues to be challenging. Autoimmune pancreatitis (AIP) can, similarly to PDAC, present as a focal mass and, therefore, an accurate differential diagnosis is of crucial importance. Raised serum immunoglobulin G4 (IgG4) levels, over the twice the normal value, are considered to be one of the significant diagnostic features of type 1 AIP. However, IgG4 can also be increased in patients with PDAC, but levels usually do not exceed twice the normal value. Materials and methods: In the years 2012 - 2018, IgG4 serum levels were examined in 117 patients with histologically confirmed PDAC. Histological resection specimens or bioptic specimens were taken from the pancreatic lesions of patients with both PDAC and an elevated IgG4 level (above 135mg/dL). These were then tested for the presence of IgG4 and plasmocytes in the pancreatic tissue, and changes characteristic for type 1 AIP were also searched for. Results: In 14/117 PDAC patients (11.9 %) the plasmatic IgG4 levels were higher than 135 mg/dL. In 2 patients (1.7 %) the serum IgG4 levels were more than double the normal value, and thus suggestive of AIP according to the guidelines. Of these two patients - one of them met the histological criteria for diagnosis of AIP in the simultaneous presence of PDAC. Conclusions: Differentiating AIP from PDAC can be sometimes problematic since these diseases can both present as focal pancreatic mass/ lesions. IgG4 has been considered useful for AIP diagnosis, however, IgG4 levels can be slightly elevated, as is the case with PDAC. IgG4 levels of over the twice of the upper limit are rare among PDAC patients (1.7% in our study group). However, cases of simultaneous presentation of PDAC and AIP have been documented and should not be neglected. Therefore, targeted biopsy of the pancreas is the method of choice in cases suspected of being a focal form of AIP, and we recommend it over other modalities, such as e.g. response to steroid therapy.

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.

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.

Adenocarcinomas of ampulla of the Vater are relatively uncommon tumors of the gastrointestinal tract. In premalignant lesions endoscopic treatment predominate. According to some authors even early adenocarcinomas (limited to mucosa) can be solved endoscopically. In malignant lesions affecting deeper layers (including submucosa) surgical therapy is the most important. The article summarises the current view for a surgical treatment of ampullary adenocarcinomas and presents results concerning our group of patients.In 2012-2016 a total number of 17 patients underwent resection for a tumor of ampulla of the Vater. Patients underwent standard staging, were presented before a multidisciplinary committee and referred to a surgical treatment. The main measured parameters were the type of surgical procedure, 30-day morbidity and mortality, histopathologic result and subsequent oncologic treatment. The Leeds Pathology Protocol was used to evaluate the specimens after pancreaticoduodenectomy (PD).PD (n = 9) was a more often performed procedure than the transduodenal surgical ampullectomy (TSA) (n = 8). TSA predominated in polymorbid patients. Histological results (n = 17) established adenoma with high-grade dysplasia in 4 patients, the diagnosis of adenocarcinoma was set in 13 patients. Eight patients underwent adjuvant oncologic therapy (2 had adjuvant chemotherapy, 6 had combination of chemoradiotherapy).Premalignant neoplasias of ampulla of the Vater can be mostly solved by endoscopy. If endoscopic resection is not possible surgical therapy is indicated. PD is preferred procedure in the diagnosis of adenocarcinoma. In high-risk and polymorbid patients, with no suspicion for a metastatic lymph nodes, TSA can be considered. Endoscopic ultrasonography is the imaging modality of choice for local staging of ampulla of the Vater and has important role in deciding between endoscopic, local surgical excision (TSA) or radical resection (PD). Our results confirmed rightfulness to perform TSA especially in elderly or polymorbid patients, where in histopathologic specimens evaluation in TSA procedures early T stage and more favorable grading predominated.Key words: adenocarcinoma of the ampulla of Vater - duodenum - endoscopic resection - ampullectomy - pancreaticoduodenectomy - surgery.