INFLUENCE OF PECTIN AND CHITOSAN ON THE PROPERTIES OF GELS PROTECTING THE OESOPHAGEAL MUCOSA

Among the diseases of the digestive tract, gastro-oesophageal reflux is one of the most troublesome ailments. It is estimated that in highly developed countries, reflux symptoms occur in about 5%-10% of people every day. It has also been found that about 20% of people experience such symptoms once a week. The incidence of this disease increases with age, regardless of gender. The aim of the study was to investigate the physicochemical properties of gels intended for the protection of the oesophageal mucosa. Preparations containing 3.0% pectin showed the lowest pH. These gels can be used in the treatment of advanced alkaline reflux. The addition of chitosan to all tested gels increased their pH and dynamic viscosity. The texture tests showed the effect of pectin concentration on the adhesion work of the tested gels.

TOTAL ANTIOXIDANT ACTIVITY AND INFLAMMATION MARKERS DURING PROGRESSION OF GASTROESOPHAGEAL REFLUX DISEASE IN YOUNG PATIENTS WITH AUTOIMMUNE THYROIDITIS

The aim of this study is to establish the content of inflammation markers (tumour necrosis factor alpha and interleukin 18) and the index of total antioxidant activity in young patients with comorbidity between gastroesophageal reflux disease and autoimmune thyroiditis and to determine their dependence on morpho-histological changes in the oesophageal mucosa. Materials and methods. The study involved 182 students aged 18 to 25 years: 120 patients with comorbidity between gastroesophageal reflux disease and autoimmune thyroiditis, 42 those having an isolated course of autoimmune thyroiditis. The methodology included complex clinical, instrumental, immunological, statistical methods. Results. Determining the activity of proinflammatory cytokines has revealed their statistically significant increase. The level of these cytokines depends on morpho-histological changes in the mucous membrane and reaches the maximum during the erosive process. At the same time, the indicator of total antioxidant activity significantly decreases. In this case, the erosive form of the disease is accompanied by more expressive changes in this indicator. Conclusions. The inflammatory process in the oesophagus is accompanied by the activation of the pro-inflammatory segment of immunity against the background of the suppression of the antioxidant system, which is dependent on morphological changes in the oesophageal mucosa. These changes will contribute to the development of pathological apoptosis and the progression of nosologies.

Oesophageal mucosal tears caused by suboptimal nasogastric tube insertion: a case study

Oesophageal bezoars are one of the many causes of nasogastric tube obstruction; however, they are extremely rare and, therefore, not often considered to be the cause of a blockage. A bezoar is a solid mass of indigestible material that accumulates in the digestive tract. After a blockage is identified, the nasogastric tube is usually removed and another one inserted. However, this can be dangerous and can easily cause tearing of the oesophageal mucosa, bleeding, and other serious complications. In this article, the authors present a case of nasogastric tube obstruction caused by oesophageal bezoars. After the nasogastric tube was replaced, the patient experienced two tears of the oesophageal mucosa. This article highlights the importance of the introduction of a procedure for nurses to follow in cases of nasogastric tube obstruction, bearing in mind the possibility of the presence of oesophageal bezoars. If necessary, a gastroscope should be used to ensure safe insertion of the nasogastric tube and prevent oesophageal mucosal tears.

Long-term follow-up of a patient with eosinophilic oesophagitis

A young man with complaints of dysphagia and heartburn had the diagnosis of eosinophilic oesophagitis verified at the age of 21 based on a typical endoscopic picture (transverse rings, oesophageal stricture) and histological examination (significant eosinophilic infiltration of the oesophageal mucosa). According to his medical history, at the age of 7 the patient was diagnosed with bronchial asthma, atopic dermatitis, food allergy, the manifestation of eosinophilic oesophagitis also occurred in childhood, and at the age of 14 an oesophageal stricture was found. Initial treatment with fluticasone and proton pump inhibitors resulted in achievement of clinical, endoscopic and histological remission. The article presents the dynamic course of eosinophilic oesophagitis over a 4-year period; the patient’s refusal of medication or withdrawal of fluticasone, quitting of the elimination diet was followed by clinical or histological worsening. Marked histological changes in the oesophageal mucosa might have not been accompanied by complaints of dysphagia neither a typical endoscopic picture could be observed. Maintenance therapy with topical steroids should be administered for a long period, and histological remission is an important criterion of its effectiveness. Key words: eosinophilic oesophagitis, fluticasone, topical steroids, proton pump inhibitor, remission

Expressions of melanoma-associated antigen A1 as a prognostic factor in Chinese patients with resectable oesophageal squamous cell carcinoma

OBJECTIVESMelanoma-associated antigen A1 (MAGEA1) is a potential target for immunotherapy and has been associated with poor survival rate in several cancers. However, little is known about the prognostic predictive value of MAGEA1 in oesophageal squamous cell carcinoma (OSCC). This study aims to determine whether the expression of MAGEA1 is an independent predictor of survival in patients with resectable OSCC.METHODSA retrospective analysis was performed on a large cohort of 197 patients with OSCC who underwent radical surgical treatment in the Department of Thoracic Surgery between January 2006 and December 2012. The expression of MAGEA1 in OSCC and matched normal oesophageal mucosa specimens from these patients was detected by immunohistochemistry with tissue microarray technology.RESULTSThe MAGEA1 protein was expressed in the cytoplasm and nucleus of tumour cells. The positive expression rate of MAGEA1 was significantly higher in OSCC tissue than in normal oesophageal mucosa (73.6% vs 5.6%, P < 0.001). MAGEA1 expression had no correlations with sex, age, history of smoking, alcohol consumption, family history of upper gastrointestinal cancer, T stage, lymph node metastasis, grade/location of the tumour or TNM stage (all at P > 0.05). Compared with those with negative MAGEA1 expression, patients with positive MAGEA1 expression were associated with a reduced overall survival rate (5-year survival rate: 53.8% vs 37.2%; P = 0.018). The multivariable analysis revealed that MAGEA1 expression is an independent predictor of prognosis (P = 0.007, hazard ratio 1.85, 95% confidence interval 1.19–2.89).CONCLUSIONSThe expression of MAGEA1 is abundant in Chinese patients with OSCC and is related to a worse clinical outcome. MAGEA1 may be a useful prognostic factor in patients with resectable OSCC.

Rhinitis following intraoperative gastro-oesophageal reflux in a dog

A four-month-old, male dog underwent surgical repair of femoral and pelvic fracture. The dog was premedicated with acepromazine combined with morphine; anaesthesia was induced with propofol to effect and maintained with isoflurane in 100 per cent oxygen. One hour after induction the dog regurgitated and gastric contents emerged through the nares. At the end of the surgery rhinoscopy and oesophagoscopy were performed. The oesophageal mucosa was apparently normal, while posterior and retrograde rhinoscopy revealed diffused hyperaemia and oedema of the nasal cavity and nasopharyngeal mucosa; food particles and moderate amount of mucous exudates were also seen. Copious lavage was performed, and administration of antibiotics, metoclopramide, cimetidine and sucralfate was initiated. Nasal mucosa was re-evaluated four days later. No abnormalities were detected in both nasal cavities and nasopharynx. The development of rhinitis following regurgitation during anaesthesia should be considered as a possible complication.