Seminar Seminar Medical Faculty Medical Faculty - - Pra Pra gue gue , , October October 20 20 1 1 7 7 GASTROENTEROLOG GASTROENTEROLOG Y Y LABORATORY LABORATORY DIAGNOSTI DIAGNOSTI CS & CASES CS & CASES MUDr.Petr Kocna CSc. http://www.lf1.cuni.cz/~kocna/pkweb1.htm MUDr.Petr Kocna CSc. MUDr.Petr Kocna CSc. http://www.lf1. http://www.lf1. cuni cuni . . cz cz /~ /~ kocna kocna /pkweb1. /pkweb1. htm htm
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GASTROENTEROLOGY LABORATORY …ukb.lf1.cuni.cz/ppt/ge_kasu2017_gb.pdfEXOCRINE PANCREATIC FUNCTION QUANTITATIVE FIT ... Hp infection - Gastric-cancer - Gastritis - Hp infection ...
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Seminar Medical Faculty - Prague, October 2017SeminarSeminar Medical FacultyMedical Faculty -- PraPraguegue, , OctoberOctober 20201177
CCOLOREOLORECCTTAAL L CANCER SCREENINGCANCER SCREENING
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
CCOLOREOLORECCTTAAL L CANCER SCREENINGCANCER SCREENING
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
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GASTRITIS - CARCINOMA SEQUENCESGASTRITGASTRITIS IS -- CCARCINOMARCINOMA SEQUENCESA SEQUENCES
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
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Male - J.N. - IT specialist - born 1978in childhood common childhood diseases,
none of injury, none of hospitalization, parents in healthy, severe disease in the family - who do not know.Now does not have any subjective complainrts.
Male Male -- J.N. J.N. -- ITIT specialisspecialistt -- born born 19719788in childhood common childhood diseasesin childhood common childhood diseases, ,
none of injury, none of hospitalizationnone of injury, none of hospitalization, , parents in healthyparents in healthy, , severe disease in the family severe disease in the family -- who do not knowwho do not know..Now does not have any subjective Now does not have any subjective complainrtscomplainrts..
CASE: 12-01CASECASE:: 1212--0101
Comes to LG laboratories with requirement for Hp test - UBTComes to Comes to LGLG laboratories with requirement for Hp test laboratories with requirement for Hp test -- UBTUBT
On the internet he found - Hp is cancerogen of the 1.classOn theOn the internetinternet he foundhe found -- HpHp isis ccancerogenancerogen of the of the 1.1.classclass
On the internet he found - LG laboratory, non-invasive Hp testOn theOn the internetinternet he foundhe found -- LGLG laboratolaboratoryry, non, non--invainvassivivee Hp Hp testtest
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
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13C-UBT performed on the individual wish (self-paying)Value of 13C DOB – 14.1 ‰, Hp - positive
( Normal values up to DOB 5 ‰ )
1313CC--UBTUBT performed on the individual wish (selfperformed on the individual wish (self--paying)paying)Value of Value of 1313C DOB C DOB –– 14.1 ‰, 14.1 ‰, HpHp -- popossitivitivee
( ( NormNormaal l values up to values up to DOB 5 ‰ )DOB 5 ‰ )
Comes to GE ambulance with requirement foreradication therapy, which the alone cannot pay
Comes toComes to GE ambulance GE ambulance with requirement forwith requirement foreradieradication cation tthheraperapyy, , which the alone cannot paywhich the alone cannot pay
On the internet he found - suitable eradication therapyOn theOn the internetinternet he foundhe found -- suitable esuitable eradiradiccaationtion therapytherapy
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
European Helicobacter Pylori Study GroupCurrent Concepts in the Management of
European Helicobacter PyloriEuropean Helicobacter Pylori StudyStudy GroupGroupCurrent Concepts in theCurrent Concepts in the Management ofManagement of
WHO TO TREAT - STRONGLY RECOMMENDED INDICATIONSWHOWHO TOTO TREATTREAT -- STRONGLY RECOMMENDED INDICATIONSSTRONGLY RECOMMENDED INDICATIONS
DU/GU (active or not, including complicated PUD) 1
MALToma 2
Atrophic gastritis 2
Post-gastric cancer resection 3
Patients - first degree relatives of gastric cancer patients 3
Patients wishes (after full consultation with their physician) 4
DUDU//GUGU ((active oractive or not,not, including complicatedincluding complicated PUD)PUD) 11
MALTomaMALToma 22
AtrophicAtrophic gastritisgastritis 22
PostPost--gastric cancer resectiongastric cancer resection 33
PatientsPatients -- first degree relativesfirst degree relatives ofof gastric cancer patientsgastric cancer patients 33
Patients wishesPatients wishes ((after full consultation with their physicianafter full consultation with their physician)) 44
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
HCl HCl
88
HOW TO PREDICT RESULT of Hp INFECTIONHOWHOW TOTO PREDICT RESULTPREDICT RESULT ofof Hp INFECTIONHp INFECTION
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
99
Suspected - Gastritis - Hp infection - Gastric-cancer Suspected Suspected -- Gastritis Gastritis -- HpHp infecinfectiontion -- GastricGastric--cancer cancer
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
negative Hp,normal PGI/PGII
normal G-17b
negative Hp,normal PGI/PGII
normal G-17b
positive Hp,normal PGI/PGII
normal G-17b
positive Hp,normal PGI/PGII
normal G-17b
Hp +/-,low PGI/PGIIhigh G-17b
Hp +/-,low PGI/PGIIhigh G-17b
positive Hp,low PGI/PGII
low G-17b
positive Hp,low PGI/PGII
low G-17b
No risk of a stomach disease
No risk of No risk of a a sstomachtomach diseasedisease
Increased risk ofgastric or duodenal
ulcer
IncreasedIncreased risk ofrisk ofgastric or duodenalgastric or duodenal
ulcerulcer
Increased risk ofgastric cancer
IncreasedIncreased risk ofrisk ofgastric cancergastric cancer
detection HpPGI/PGII, G-17b
detection HpPGI/PGII, G-17b
H. pylori gastritisH.H. pyloripylori gastritisgastritis Atrophic gastritis Atrophic gastritiAtrophic gastritis s
Rationale in diagnosis and screening of atrophic gastritis with stomach-specific plasma biomarkers. Agréus L, Kuipers EJ, Kupcinskas L, Malfertheiner P, et al.
Scand J Gastroenterol. 2012; 47(2):136-147
Rationale in diagnosis andRationale in diagnosis and screening ofscreening of atrophicatrophic gastritisgastritis with stomachwith stomach--specific specific plasmaplasma biomarkersbiomarkers.. AgréusAgréus L,L, KuipersKuipers EJ,EJ, KupcinskasKupcinskas L,L, MalfertheinerMalfertheiner P,P, et alet al..
Hp INFECTION DIAGNOSTIC METHODS Hp INFECHp INFECTION TION DIAGNOSTIDIAGNOSTICC METHODS METHODS
non-invasive test, gold standard,specificity and sensitivity 95% - 13C UBT, breath test with 13C-urea
non-invasive test, if 13C-UBT not available, Hp antigen in stool
rapid urease test (CLO test) - if the gastroscopy clinically indicated, required bioptic samples from at least three different gastro-duodenal positions
IgA-IgG antibodies determination in serum does not have primary diagnostic importance, as positivity to Hp-antibodiesin subjects > 60 years could be 85%
non-invasive test, gold standard,specificity and sensitivity 95% - 13C UBT, breath test with 13C-urea
non-invasive test, if 13C-UBT not available, Hp antigen in stool
rapid urease test (CLO test) - if the gastroscopy clinically indicated, required bioptic samples from at least three different gastro-duodenal positions
IgA-IgG antibodies determination in serum does not have primary diagnostic importance, as positivity to Hp-antibodiesin subjects > 60 years could be 85%
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
1111
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
Statement 9: The available data consistently recognise pepsinogen (Pg)serology as the most useful non-invasive test to explore the gastric
mucosa status (non-atrophic vs atrophic). The PgI/PgII ratio can never be assumed as a biomarker of gastric neoplasia.
Level of evidence: 2a Grade of recommendation: A
StatementStatement 9:9: The availableThe available datadata consistently recogniseconsistently recognise pepsinogenpepsinogen ((PgPg))serologyserology asas thethe mostmost useful nonuseful non--invasiveinvasive test totest to explore the gastric explore the gastric
mucosamucosa statusstatus ((nonnon--atrophic vs atrophicatrophic vs atrophic).). The PgIThe PgI//PgII ratio can never be PgII ratio can never be assumedassumed as aas a biomarkerbiomarker ofof gastric neoplasiagastric neoplasia..
LevelLevel of evidence: 2a Grade ofof evidence: 2a Grade of recommendationrecommendation: A: A
Statement 1: UBT is the most investigated and best recommended non-invasive test in the context of a ‘test-and-treat strategy’. Monoclonal SAT can
also be used. Serological tests can be used only after validation. Rapid (‘office’) serology tests using whole blood should be avoided in this regard.
Level of evidence: 2a Grade of recommendation: B
StatementStatement 1:1: UBT is theUBT is the mostmost investigated and best recommendedinvestigated and best recommended nonnon--invasiveinvasive testtest in the contextin the context of a ‘testof a ‘test--andand--treat strategy’treat strategy’.. Monoclonal SAT can Monoclonal SAT can
also bealso be usedused.. Serological tests can be used only after validationSerological tests can be used only after validation. Rapid . Rapid (‘(‘office’office’)) serologyserology tests using whole blood should be avoided in this regardtests using whole blood should be avoided in this regard..
LevelLevel of evidence: 2a Grade ofof evidence: 2a Grade of recommendationrecommendation: B: B
Management of Helicobacter pylori infection - ConsensusManagement ofManagement of Helicobacter pylori infectionHelicobacter pylori infection -- ConsensusConsensus
Management of Helicobacter pylori infection-the Maastricht V/FlorenceConsensus Report.
Malfertheiner P. et all. - The European Helicobacter Study Group (EHSG).Gut. 2017 Jan; 66 (1): 6-30
MalfertheinerMalfertheiner P.P. et allet all. . -- The European HelicobacterThe European Helicobacter StudyStudy GroupGroup ((EHSGEHSG))..GutGut. 2017 Jan;. 2017 Jan; 6666 (1):(1): 66--3030
TrTreeaat fort for Hp infectionHp infection
1122
Elitza S Theel - Helicobacter pylori Infection: Test Utilization Strategies for Diagnosis. MayoMedicalLab. Communiq. 2013, 38/6
ElitzaElitza S S TheelTheel -- Helicobacter pylori Infection: Helicobacter pylori Infection: Test Utilization Strategies for Diagnosis. Test Utilization Strategies for Diagnosis. MayoMedicalLabMayoMedicalLab. C. Communiqommuniq. . 2013, 382013, 38//6 6
POPOSSITIVITIVEE
Evaluate for other causesEvaluate for other causesof dyspepsiaof dyspepsia
EndosEndosccopopyybiopsbiopsyy ++ RUTRUT
ChildrenChildren Adults < 55 yearsAdults < 55 years
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
1133
Telaranta-Keerie A, Kara R, Paloheimo L, Härkönen M, Sipponen P.Prevalence of undiagnosed advanced atrophic corpus gastritis in Finland:
an observational study among 4,256 volunteers without specific complaints.
Scand J Gastroenterol. 2010 Sep;45(9):1036-41.
TelarantaTelaranta--KeerieKeerie A,A, KaraKara R,R, PaloheimoPaloheimo L,L, HärkönenHärkönen M,M, SipponenSipponen P.P.Prevalence ofPrevalence of undiagnosed advanced atrophicundiagnosed advanced atrophic corpus gastritiscorpus gastritis in Finlandin Finland::
an observationalan observational studystudy amongamong 4,2564,256 volunteers without volunteers without specific complaintsspecific complaints..
ATROPHIC GASTRITIS SCREENING – PEPSINOGEN I/II RATIOATROATROPHPHIC GASTRITIC GASTRITIS SCREENING IS SCREENING –– PEPSINOGEN PEPSINOGEN I/I/II RATIOII RATIO
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
CCOLOREOLORECCTTAAL L CANCER SCREENINGCANCER SCREENING
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS INAL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
1155
Woman - L.J. - born 1972in childhood anemic, asthenic, often in sanatoria,
mother and sister followed for thyreopathyastheny, height 171 cm, weight 52 kg
menarche at 15 years, married,at the time of diagnosis (2005) after 1 spont. abortion 1994
WomanWoman -- L.J. L.J. -- born born 19721972in childhoodin childhood anemicanemic,, asthenicasthenic, , often in sanatoria,often in sanatoria,
mother and sister followed for mother and sister followed for thyreopatthyreopathyhyasthenasthenyy, , heightheight 171 cm, 171 cm, weightweight 52 kg52 kg
menarchmenarchee atat 15 15 yearsyears, , married,married,at the time of diagnosisat the time of diagnosis (2005) (2005) afterafter 11 spontspont. . abortionabortion 19941994
CASE: 12-02CASECASE:: 1212--0202
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS INAL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
1166
2005 admitted to gastroenterology clinic
with requiremed of colonoscopy for hypochrome anemia
Colonoscopy - normal findings
Histology of bioptical samples - normal findings
2005 2005 admitted to admitted to gastroenterologgastroenterology cy clinilinicc
withwith requiremedrequiremed ofof colonoscopycolonoscopy for for hypochypochhromromee anemianemiaa
CColoolononossccopopyy -- normnormaal l findingsfindings
Histology ofHistology of biopticalbioptical samplessamples -- normnormaal l findingsfindings
CASE: 12-02CASECASE:: 1212--0202
Routine laboratory test indicatedRoutine laboratory test indicatedRoutine laboratory test indicated
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS INAL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS INAL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
1188
coeliac screening markers - 11/4/05:
IgA anti-transglutaminase 132 U/ml
IgA anti-gliadin 30 U/ml
IgG anti-gliadin 132 U/ml
IgA anti-endomysium - positive
ccooeliaeliac screening markers c screening markers -- 11/4/05:11/4/05:
IgA antiIgA anti--transglutamintransglutaminasease 132 U/ml132 U/ml
IgA antiIgA anti--gliadingliadin 3030 U/mlU/ml
IgG antiIgG anti--gliadingliadin 132 132 U/mlU/ml
IgA antiIgA anti--endomysiumendomysium -- popossitivitivee
Histology Histology -- small bowel biopsy:small bowel biopsy:active active ccooeliaeliacc,, subtotsubtotaall atroatrophyphy, , decreased decreased lalaccttasease,, IELIEL 50/10050/100
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS INAL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
Definitive diagnosis of CDDefinitive diagnosis of CD
Gluten free dietGluten free diet
HLA HLA typitypingng,,bbiopsiopsy rey re--evaluationevaluation
Briani C, Samaroo D, Alaedini A. Celiac disease: from gluten to autoimmunity.Autoimmun Rev. 2008 Sep;7(8):644-650.
BrianiBriani C, C, SamarooSamaroo D, D, AlaediniAlaedini A. Celiac disease: from gluten to autoimmunity.A. Celiac disease: from gluten to autoimmunity.AutoimmunAutoimmun Rev. 2008 Sep;7(8):644Rev. 2008 Sep;7(8):644--650.650.
Definitive diagnosis of CDDefinitive diagnosis of CD
Normal dietNormal dietFurther serology testingFurther serology testing
IgA EmAIgA EmA
EmA positiveEmAEmA positivepositive
2222
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
European Society for Pediatric Gastroenterology,Hepatology, and Nutrition Guidelines for the Diagnosis ofCoeliac Disease. Husby S. at al. JPGN 2012; 54: 136–160
EuropeanEuropean Society forSociety for Pediatric GastroenterologyPediatric Gastroenterology,,HepatologyHepatology,, and Nutrition Guidelinesand Nutrition Guidelines forfor the Diagnosisthe Diagnosis ofofCoeliac DiseaseCoeliac Disease.. HusbyHusby S.S. at alat al.. JPGNJPGN 2012; 54: 1362012; 54: 136––160160
2323
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
INTESTINAL BIOPSY IN THE COELIAC DISEASE DIAGNOSTICSINTESTINAL BIOPSY IN THE INTESTINAL BIOPSY IN THE COELIACCOELIAC DISEASE DIAGNOSTICSDISEASE DIAGNOSTICS
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
Normal duodenalmusoca
NormNormaal l duodenalduodenalmusocamusoca
Mosaic pattern of duodenal mucosaMoMossaiaic pattern of c pattern of duodenal duodenal mucosamucosa
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
TREATED TREATED CCOOELIAELIAC C ??OTHER OTHER AUTOIAUTOIMMMUNITMUNITYY ??
2277
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
INCREASE OF IgA atTG SPECIFICITYINCREASEINCREASE OFOF IgA atTGIgA atTG SPECIFICITYSPECIFICITY
INCREASE OF IgA atTG SPECIFICITYCOELIAC DETECTION WITH IgA DEFFICIENCYCOELIAC DETECTION IN CHILDRENS < 2 YR
INCREASE INCREASE OFOF IgA atTGIgA atTG SPECIFICITYSPECIFICITYCOELIACCOELIAC DETECTION WITHDETECTION WITH IgAIgA DEFDEFFICIENCYFICIENCYCOELIACCOELIAC DETECTIONDETECTION IN IN CHILDRENSCHILDRENS < 2 YR< 2 YR
COELIAC DETECTIONIN CHILDRENS < 2 YRCOELIACCOELIAC DETECTIONDETECTIONIN IN CHILDRENSCHILDRENS < 2 YR< 2 YR
IgA atTGIgA atTGIgA atTG IgA atTGIgA atTGIgA atTG
+ IgA EmA++ IgA EmAIgA EmA
+ IgG atTG++ IgG atTGIgG atTG
+ IgA AGA++ IgAIgA AGAAGA
+ IgG DGP++ IgGIgG DGPDGP
+ IgA++ IgAIgA
Volta U., Fabbri A., Parisi C. et al. Old and new serological tests for celiac disease screening. Expert Rev. Gastroenterol. Hepatol. 2010, 4(1)
Volta U.,Volta U., FabbriFabbri A., Parisi C.A., Parisi C. et alet al. . Old and new serological testsOld and new serological tests forfor celiac celiac diseasedisease screeningscreening. . ExpertExpert RevRev.. GastroenterolGastroenterol.. HepatolHepatol. 2010, 4(1). 2010, 4(1)
Wolf J, Petroff D, et al.: Validation of Antibody-Based Strategies for Diagnosis of Pediatric Celiac Disease Without Biopsy. Gastroenterology. 2017;153: 410-419Wolf J, Wolf J, PetroffPetroff D, et al.: Validation of AntibodyD, et al.: Validation of Antibody--Based Strategies for Diagnosis Based Strategies for Diagnosis
of Pediatric Celiac Disease Without Biopsy.of Pediatric Celiac Disease Without Biopsy. GastroenterologyGastroenterology. 2017;153: 410. 2017;153: 410--419419
IgAIgA--atTGatTG
IgGIgG--DGPDGP
cutcut--offoff x1x1cutcut--offoff x10x10
2828
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
2929
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
AT-1001 ALBA THERAPEUTICSATAT--1001 ALBA1001 ALBA THERAPEUTICSTHERAPEUTICSxx
NEXVAX2 - IMMUSAN T INC.NEXVAX2 NEXVAX2 -- IMMUSANIMMUSAN TT INCINC..
THE FUTURE OF COELIAC DISEASE THERAPYTHE FUTURE OF THE FUTURE OF CCOOELIAELIAC DISEASEC DISEASE THTHERAERAPYPY
Gottlieb K., Dawson J., Hussain F., et al. Development of drugs for celiac disease:review of endpoints for Phase 2 and 3 trials. Gastroenterology Report, 2015, 1–12
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
3311
QQ Q Q PP YY PP QQ PP QQ
CARICAINCARICAIN((Carica PapayaCarica Papaya..))
Cornell HJ, Stelmasiak T. The Significance of Key Amino Acid Sequences in the Digestibility and Toxicity of Gliadin Peptides in Celiac Disease.
International Journal of Celiac Disease, 2016, Vol. 4, No. 4, 113-120
Cornell Cornell HJHJ, , StelmasiakStelmasiak T.T. The Significance of Key Amino Acid Sequences in the The Significance of Key Amino Acid Sequences in the Digestibility and Toxicity of Digestibility and Toxicity of GliadinGliadin Peptides in Celiac Disease. Peptides in Celiac Disease.
International Journal of Celiac Disease, 2016, Vol. 4, No. 4, 11International Journal of Celiac Disease, 2016, Vol. 4, No. 4, 1133--120120
GLIADIN DETOXIFICATION BY CARICAINGLIADINGLIADIN DETOXIFIDETOXIFICATION CATION BY BY CARICAINCARICAIN
GLUTEGUARD - CARICA PAPAYA EXTRACT, CONTAINS HYDROLYTIC ENZYMES CARICAIN AND OTHER
PROLYL-ENDOPEPTIDASES, NO CELIAC THERAPY, IT’S ONLY FOOD SUPPLEMENTS
PRICE IN AUSTRALIA - 60 TABLETS, 44 AUD
GLUTEGUARDGLUTEGUARD -- CARICACARICA PAPAYA EXTRACT, PAPAYA EXTRACT, CONTAINS HYDROLYTIC ENZYMESCONTAINS HYDROLYTIC ENZYMES CARICAINCARICAIN AND OTHERAND OTHER
PROLYLPROLYL--ENDOPEPTIDASESENDOPEPTIDASES, , NO CELIAC THERAPY, IT’S ONLY FOOD SUPPLEMENTS NO CELIAC THERAPY, IT’S ONLY FOOD SUPPLEMENTS
PRICE IN AUSTRALIA PRICE IN AUSTRALIA -- 60 TABLETS, 4460 TABLETS, 44 AUD AUD
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
FOOD SUPPLEMENTS CONTAINING GLUTEN DEGRADING ENZYMES, DECLARED BY THE MANUFACTURER AS INTENDED
FOR PERSONS WITH GLUTEN INTOLERANCE
FOOD SUPPLEMENTS CONTAINING GLUTEN DEGRADING FOOD SUPPLEMENTS CONTAINING GLUTEN DEGRADING ENZYMES, DECLARED BY THE MANUFACTURER AS INTENDED ENZYMES, DECLARED BY THE MANUFACTURER AS INTENDED
FOR PERSONS WITH GLUTEN INTOLERANCEFOR PERSONS WITH GLUTEN INTOLERANCE
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
day amount - mg gliadin/80kg weightday amount day amount -- mgmg gliadingliadin//880kg 0kg weightweight
Gabrovská D., Kocna P., et al.: Monitoring of Daily Gliadin Intake in Patients on Gluten-free Diets. Prague Medical Report 2011, 112 (1): 5 – 17
GabrovskáGabrovská D., Kocna P., et al.: D., Kocna P., et al.: Monitoring of Daily Monitoring of Daily GliadinGliadin Intake in Patients Intake in Patients on Glutenon Gluten--free Diets. free Diets. Prague Medical Report 2011, 112 (1): 5 Prague Medical Report 2011, 112 (1): 5 –– 1717
Therapy errorFood with
high gliadin level
Therapy errorTherapy errorFood with Food with
highhigh gliadingliadin levellevel
boy 4,5 years, 25 kgboy, 7 years, 20 kggirl, 10 years, 35 kggirl, 7.5 years, 16 kgboy, 12 yaers, 37 kgstudent DM, 16 years, 44 kgstudent, 21 years, 58 kgpregnant mother
29 years, 65 kgwoman, 32 years, 55 kgwoman, 45 years, 58 kgwoman, 42 years, 58 kgboy, 10 years, 24 kggirl, 4 years, 14 kgwoman, 32 years, 92 kg
since 11/2005 complete gluten-free diet2008 gave birth to a healthy daughter, who has not coeliac,
follows the diet - is on remision
sincesince 11/2005 11/2005 completecomplete glutengluten--freefree dietdiet2008 2008 gave birth to agave birth to a healthy daughterhealthy daughter, , who has not who has not coeliaccoeliac,,
follows the diet follows the diet -- is on is on remisionremision
coeliac specific antibodies - 24/4/06:
IgA anti-transglutaminase 2 U/ml
IgA anti-gliadin 7 U/ml
IgG anti-gliadin 29 U/ml
IgA anti-endomysium - negative
coeliaccoeliac specific antibodies specific antibodies -- 24/4/06:24/4/06:
IgA antiIgA anti--transglutamintransglutaminasease 2 U/ml2 U/ml
IgA antiIgA anti--gliadingliadin 7 U/ml7 U/ml
IgG antiIgG anti--gliadingliadin 29 U/ml29 U/ml
IgA antiIgA anti--endomysiumendomysium -- negativnegativee
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
anti-tTG (IgA) + celkové IgAantianti--tTGtTG ((IgAIgA) + celkové) + celkové IgAIgA
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
H2/CH4 and 13C - BREATH TESTSHH22/CH/CH44 and and 1313C C -- BREATH TESTSBREATH TESTS
3737
SMALL BOWEL ABSORPTION - FUNCTION TESTSSMALL BOWEL ABSORPTION - FUNCTION TESTS
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
Regression of lactose malabsorption in coeliac patients after receiving a gluten-free diet.
Scand J Gastroenterol. 2008;43(2):174-177
Regression of lactoseRegression of lactose malabsorptionmalabsorption inin coeliaccoeliac patients patients after receiving a glutenafter receiving a gluten--free diet.free diet.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
HISTOCHEMICAL DETECTIONOF LACTASE ACTIVITY IN THEENTEROCYTE BRUSH BORDERIMMUNOHISTOCHEMICAL TEST
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
H2 /CH4 /CO2 - TEST AKTÓZOVÉ INTOLERANCE HH22 /CH/CH44 /C/COO22 -- TEST TEST AKTAKTÓZOVÉÓZOVÉ INTOLERANCE INTOLERANCE
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
CCOLOREOLORECCTTAAL L CANCER SCREENINGCANCER SCREENING
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
4444
Male - A.A. - born 1938history of gallbladder problems - (cholecystolithiasis)
hypertension treatment on Ca blockers, obesityDietary error - goulash, beer
Abdominal pain around the navel broadening in the back, vomitingS-amylase 20,2, C-reactive protein 1.day 5 g/l, calcium 1,85 mmol/l
hypertension treatment on Ca blockers, obesityhypertension treatment on Ca blockers, obesityDietary error Dietary error -- goulash, beergoulash, beer
Abdominal pain around the navel broadening in the back, vomitingAbdominal pain around the navel broadening in the back, vomitingSS--amylase amylase 20,220,2, C, C--reactive protein 1.day 5 g/l, calcium 1,85 reactive protein 1.day 5 g/l, calcium 1,85 mmolmmol/l/l
Admitted to Admitted to surgarysurgary clinic clinic –– emmergencyemmergency unitunitliquid saturation liquid saturation –– 5000 ml/24 hrs5000 ml/24 hrs
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
4545
5.day - CT abdomenSevere acute necrotizing pancreatitis (more than 60%)
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
1-2 day dehydratation 7 day metabolic alkalosis11--2 day 2 day dehydratation dehydratation 7 day metabolic7 day metabolic alalkkalalosisosis
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
4747
45.day transfer to metabolic unit of 2nd. medical clinicintroduced naso-jejunal probe, pulled the drain, gradually increased
enteral nutrition to 2200 ml per day (2200 kcal, 85 g protein)Drugs: proton pump inhibitors (omeprazole 2x20 mg),
substituted pancreatic enzymes (Creon 25000j 3 x 1 cps),liquid free, probiotics. Conducted training for home
enteral nutrition and released to home care
45.d45.day transferay transfer toto metabolicmetabolic unit of 2nd. medical cunit of 2nd. medical cliniliniccintroduced introduced nasonaso--jejunaljejunal probeprobe, , pulled the pulled the drdraiain, n, gradually increased gradually increased
enteralenteral nutritionnutrition to 2200 ml perto 2200 ml per dayday (2200(2200 kcalkcal, 85 g protein), 85 g protein)DrugsDrugs: proton pump: proton pump inhibitorsinhibitors ((omeprazoleomeprazole 2x20 mg),2x20 mg),
substituted pancreatic enzymessubstituted pancreatic enzymes ((CreonCreon 25000j 3 x 1 25000j 3 x 1 cpscps)),,liquid liquid freefree, , probioticsprobiotics.. Conducted trainingConducted training forfor homehome
enteral nutrition and releasedenteral nutrition and released toto homehome carecare
The ICU 52 days, 55 days in the hospital, then home enteralnutrition 93 days, gradual transfer to oral intake.
The ICUThe ICU 5252 daysdays, 55, 55 days in the hospitaldays in the hospital,, then home enteralthen home enteralnutritionnutrition 9393 daysdays,, gradualgradual transfer to oraltransfer to oral intakeintake..
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
CASE: 12-03CASECASE:: 1212--0303
4488
After 1,5 year executed exocrine pancreatic secretion tests :
Pancreatic enzyme substitution discontinued,at this time gall diet without pancreatic substitution.
PPananccreaticreatic enzymeenzyme substitusubstitution tion discontinueddiscontinued,,at this time gallat this time gall dietdiet without pancreatic substitutionwithout pancreatic substitution..
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
LABORATORNÍ DIAGNOSTIKA V GASTROENTEROLOGII Kocna P.LABORATORNÍ DIAGNOSTIKA V GASTROENTEROLOGII KLABORATORNÍ DIAGNOSTIKA V GASTROENTEROLOGII Kocna P.ocna P.
Should a pancreatic function test be performed at the time of diagnosis?Statement 3-8. Every patient with a new diagnosis of CP should be screened for PEI. (Grade 1A, strong agreement)
ShouldShould aa pancreatic functionpancreatic function testtest be performed at the timebe performed at the time ofof diagnosisdiagnosis??StatementStatement 33--88.. Every patient withEvery patient with aa new diagnosisnew diagnosis ofof CP CP should be screenedshould be screened forfor PEIPEI. (Grade 1A,. (Grade 1A, strong agreementstrong agreement))
Which test is clinically indicated for diagnosing exocrine pancreatic insufficiency (PEI) ?
Statement 3-6. In a clinical setting, a non-invasive pancreatic function test (PFT) should be performed. The FE-1 test is feasible and widely available and
is therefore most frequently used in this setting, while the 13C mixed triglyceridebreath test (13C-MTG-BT) offers an alternative. The s-MRCP test may also be
used as an indicator of PEI but provides only semiquantitative data. (Grade 1B, agreement)
WhichWhich testtest is clinically indicated is clinically indicated forfor diagnosing exocrine pancreatic insufficiencydiagnosing exocrine pancreatic insufficiency ((PEIPEI) ?) ?
StatementStatement 33--66.. InIn aa clinical settingclinical setting,, aa nonnon--invasive pancreatic functioninvasive pancreatic function test test ((PFTPFT)) should be performedshould be performed.. TheThe FEFE--1 test1 test is feasible and widely available and is feasible and widely available and
is thereforeis therefore mostmost frequently used in this settingfrequently used in this setting,, while thewhile the 13C13C mixed triglyceridemixed triglyceridebreathbreath test (13Ctest (13C--MTGMTG--BTBT)) offers an alternativeoffers an alternative.. TheThe ss--MRCPMRCP testtest may also be may also be
usedused asas an indicatoran indicator ofof PEI but provides only semiquantitativePEI but provides only semiquantitative data. data. (Grade 1B,(Grade 1B, agreementagreement))
Chronic pancreatitis - evidence based guidelinesChronic pancreatitisChronic pancreatitis -- evidenceevidence based guidelinesbased guidelines
Löhr M. - HaPanEU/UEG Working Group, UEG Journal, 2017, Vol. 5(2) 153–199United European Gastroenterology evidence based guidelines for the diagnosis
and therapy of chronic pancreatitis (HaPanEU)
LöhrLöhr M. M. -- HaPanEUHaPanEU//UEGUEG Working GroupWorking Group, , UEGUEG Journal, 2017, Vol. 5(2) 153Journal, 2017, Vol. 5(2) 153––199199United European United European GastroenterologyGastroenterology evidence based guidelines for the diagnosis evidence based guidelines for the diagnosis
and therapyand therapy of chronic of chronic pancreatitispancreatitis ((HaPanEUHaPanEU))
Is a pancreatic function test required for the diagnosis of CP?Statement 3-7. A function test is required for the diagnosis of CP.
(Grade 2B, strong agreement)
IsIs aa pancreatic functionpancreatic function testtest requiredrequired forfor the diagnosisthe diagnosis ofof CPCP??StatementStatement 33--77.. AA functionfunction testtest is requiredis required forfor the diagnosisthe diagnosis ofof CPCP..
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
STANDARDSTANDARD METMETHHODOD FORFOREXOEXOCCRINRINEE PANPANCCREATREATIC FUNCTIONIC FUNCTION
S-CCK TESTSS--CCKCCK TESTTEST
FAT 72 hr.FATFAT 72 72 hrhr..
5151
Erchinger F, Engjom T, Gudbrandsen OA et al.:Automated spectrophotometric bicarbonate analysis in duodenal juice compared
to the back titration method. Pancreatology. 2016; 16(2): 231-237
ErchingerErchinger F,F, EngjomEngjom T,T, Gudbrandsen OA et alGudbrandsen OA et al.:.:Automated spectrophotometric bicarbonate analysis in duodenal juAutomated spectrophotometric bicarbonate analysis in duodenal juice compared ice compared
toto the back titration methodthe back titration method.. PancreatologyPancreatology. 2016; 16(2): 231. 2016; 16(2): 231--237237
SHORT ENDOSCOPIC SECRETIN TESTSHORT ENDOSCOPIC SECRETIN TEST
DUODENDUODENAAL L JUICEJUICEAUTOMATIAUTOMATIED METHODSED METHODS
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
EXOCRINE PANCREATIC FUNCTION TESTSEXOEXOCCRINRINEE PANPANCCRREEATATIC FUNCTION TESTSIC FUNCTION TESTS
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
5353
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
40 - 120 kIU LIPASE
THERAPY OK
THERAPY OK
COMBINATION WITH PPI
THERAPY OK
MALABSORPTIONSYNDROME
OTHER SOURCES
FAILED THERAPY
PABA, PLT, 13C-MTG TESTWITH SUBSTITUTION
FAILED THERAPY
SUBSTITUTION THERAPY
PANCREAS RESECTION
40 - 120 kIU LIPASE
THERAPY OK
THERAPY OK
COMBINATION WITH PPI
THERAPY OK
MALABSORPTIONSYNDROME
OTHER SOURCES
FAILED THERAPY
PABA, PLT, 13C-MTG TESTWITH SUBSTITUTION
FAILED THERAPY
SUBSTITUTION THERAPY
PANCREAS RESECTION Kahl S, Malfertheiner P.Exocrine and endocrine pancreatic
insufficiency after pancreatic surgery.Best Pract Res Clin Gastroenterol.
2004 Oct;18(5):947-55.
KahlKahl S,S, MalfertheinerMalfertheiner P.P.Exocrine and endocrine pancreatic Exocrine and endocrine pancreatic
insufficiency after pancreatic surgeryinsufficiency after pancreatic surgery..Best Pract Res Clin GastroenterolBest Pract Res Clin Gastroenterol. .
Amarri S. et al.: Archives of Disease in Childhood 1997; 76: 349–351
13Carbon13Carbon mixed triglyceride breathmixed triglyceride breath testtestand pancreaticand pancreatic enzymeenzyme supplementation in cystic fibrosissupplementation in cystic fibrosis
AmarriAmarri S.S. et alet al.:.: ArchivesArchives ofof Disease in ChildhoodDisease in Childhood 1997; 76: 3491997; 76: 349––351351
CF without enzyme therapy2400 IU lipase/kg/food4800 IU lipase/kg/food
CF without enzyme therapyCF without enzyme therapy2400 2400 IUIU lipaselipase/kg//kg/foodfood448800 00 IUIU lipaselipase/kg//kg/foodfood
cPDR 13CcPDRcPDR 1313CC
5454
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
13C-MTG - BREATH TEST WITH MIXED TRIGLYCERIDE13C-MTG - BREATH TEST WITH MIXED TRIGLYCERIDE
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
13C-MTG - BREATH TEST & FECAL ELASTASE13C-MTG - BREATH TEST & FECAL ELASTASE
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
13C-MTG - BREATH TEST & FECAL ELASTASE13C-MTG - BREATH TEST & FECAL ELASTASE
CCOLOREOLORECCTTAAL L CANCER SCREENINGCANCER SCREENING
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
5588
Colorectal carcinoma is the most common tumor of the GE tractIn the Czech Republic (2010) was diagnosed 8136 subjects with CRC,
on CRC died 3934 patients, more than 50% of the mortality is due to the high proportion of patients diagnosed in advanced stages III and IV
Screening over 50 years - the target population in the Czech Republic includes 3,782,524 subjects
FOBT/TOKS screening test was carried out in 2010 only in 521 429persons, ie. 13.7%
FOBT/TOKS + indicated colonoscopy in 2010 found only 829 CRC of 8136 diagnosed CRC, which is only 10.1%
Colorectal carcinoma is the most common tumor of the GE tractColorectal carcinoma is the most common tumor of the GE tractIn the Czech Republic (2010) was diagnosed 8136 subjects with In the Czech Republic (2010) was diagnosed 8136 subjects with CRCCRC, ,
on on CRCCRC died 3934 patients, died 3934 patients, more than 50%more than 50% of the mortality is of the mortality is due to the high proportion of patients diagnosed in due to the high proportion of patients diagnosed in advanced advanced stages III and IVstages III and IV
ScreeningScreening overover 5050 yearsyears -- the target population in the Czech Republic the target population in the Czech Republic includesincludes 3,782,524 3,782,524 subjectssubjects
FOBTFOBT//TOKS TOKS screening testscreening test was was carried outcarried out inin 20102010 only only in 521 429in 521 429personspersons,, ieie. . 1313..77% %
FOBTFOBT//TOKSTOKS + indicated + indicated colonoscopycolonoscopy in 2010in 2010 found onlyfound only 882929 CRCCRC of of 88113636 diagnosed diagnosed CRCCRC,, which is only which is only 1010..11% %
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
prevention in the Czech Republic: time trends in performance indicators and current situation after 10 years of screening
European Journal of Cancer Prevention 2014, 23:18–26
SuchanekSuchanek S., S., MajekMajek O., O., VojtechovaVojtechova G., G., MinarikovaMinarikova P., P., RotnaglovaRotnaglova B., Seifert B., Seifert B., B., MinarikMinarik M., M., KozenyKozeny P., P., DusekDusek L., L., ZavoralZavoral M.: Colorectal cancer M.: Colorectal cancer
prevention in the Czech Republic: time trends in performance indprevention in the Czech Republic: time trends in performance indicators icators and current situation after 10 years of screeningand current situation after 10 years of screening
European Journal of Cancer Prevention 2014, 23:18European Journal of Cancer Prevention 2014, 23:18––2626
5959
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
Proteomics of colorectal cancer: overview of discovery studies and identification ofcommonly identified cancer-associated proteins and candidate CRC serum markers.
FECAL OCCULT BLOOD TEST- FOBT/TOKS (in Czech)FECALFECAL OCCULT BLOOD TESTOCCULT BLOOD TEST-- FOBTFOBT//TOKS TOKS (in Czech)(in Czech)
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
6161
0
20
40
60
80
100
g-FOBT i-FOBT qi-FOBT0
20
40
60
80
100
g-FOBT i-FOBT qi-FOBTHaemoccultHaemoccult
28,728,7%% 56,856,8%% 83,483,4%%
FIT REPLACED FIT REPLACED gg--FOBT FOBT WITH SENSITIVITY < WITH SENSITIVITY < 30% 30% SINCE JANUARY 2013SINCE JANUARY 2013
Rozhodnutí Komise pro screening KRK MZ ČR ze dne 2.července 2012RozhodnutRozhodnutí Komise pro screening KRK MZ ČRí Komise pro screening KRK MZ ČR ze dne 2.července 2012ze dne 2.července 2012
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
FECAL OCCULT BLOOD TEST- FOBT/TOKS (in Czech)FECALFECAL OCCULT BLOOD TESTOCCULT BLOOD TEST-- FOBTFOBT//TOKS TOKS (in Czech)(in Czech)
sensitivitysensitivitysensitivity
specificityspecificityspecificity
6262 WIDE OFFER WIDE OFFER FFIIT RAPIDT RAPID TESTS IN THE CZECH REPUBLICTESTS IN THE CZECH REPUBLIC
QUALITATIVE FIT METHODS, RAPID TESTSQUALIQUALITATIVTATIVE FIT METHODSE FIT METHODS, RAPID TEST, RAPID TESTSS
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
6363
CRC EPIDEMIOLOGICAL ANALYSIS IN THE CZECH REPUBLICCRC EPIDEMIOLOGICAL ANALYSIS IN THE CZECH REPUBLICCRC EPIDEMIOLOGICAL ANALYSIS IN THE CZECH REPUBLIC
FIT PositivityFIT FIT PoPossitivititivityy
FIT POSITIVITY IN INDIVIDUAL REGIONSMAY BE SIGNIFICANTLY INFLUENCED BY FIT METHODS
FITFIT POSITIVITYPOSITIVITY IN INDIVIDUAL REGIONSIN INDIVIDUAL REGIONSMAY BE SIGNIFICANTLY INFLUENCED BY FIT METHODSMAY BE SIGNIFICANTLY INFLUENCED BY FIT METHODS
KT: 5,2
JH: 8,7
ZR: 8,8
KV: 5,9
ZN: 6,8
BR: 8,2PB: 7,5
CB: 6,8
CK: 4,0
TR: 8,6PT: 9,2
OL: 6,4
JI: 6,8
TA: 6,1
TC: 9,2
SY: 6,9
PS: 6,8
SU: 5,9BN: 11,6
PE: 6,8PI: 6,5
HB: 6,0
FM: 7,5
UO: 8,2
BV: 7,2
LT: 7,1
CL: 9,5
TU: 9,8
VS: 6,2
LN: 8,5
PJ: 6,3OP: 6,5
ZL: 5,1
ST: 8,6
HO: 6,4
MB: 6,6
CR: 6,7
RK: 8,0
UH: 6,7
NJ: 6,3
BK: 6,2
DO: 13,3
CV: 5,2
KH: 9,3
JC: 6,8
RA: 8,6
PA: 5,9
PR: 6,5
HK: 8,0NB: 6,0
KO: 7,6JE: 4,9
SM: 6,9
BE: 8,6
BO: 6,9
LI: 6,1
CH: 7,7
VY: 8,5
DC: 7,0
NA: 7,8
PV: 6,9
KM: 6,6
SO: 4,6
KD: 6,5
ME: 7,8
PZ: 7,6
PH: 8,9AX: 9,2
RO: 11,4
TP: 5,5MO: 6,4 JN: 9,7UL: 7,0
KA: 4,6
BM: 7,6
OT: 5,9
PM: 7,2
< 5,05,0 – 6,56,5 – 8,08,0 – 9,5> 9,5
< 5,05,0 – 6,56,5 – 8,08,0 – 9,5> 9,5
General positivity (2016) : ‐ 7.2 %Range in regions : 4.0 ‐ 13.3 %
Májek O., Suchánek Š. Quality-assured immunochemical testing –proposal for a pilot project in the Czech Republic
European Digestive Cancer Days, Prague - 26. September 2017
MMáájekjek O., SuchO., Suchánek ánek Š. Š. QualityQuality--assured immunochemical testing assured immunochemical testing ––proposal for a pilot project in the Czech Republicproposal for a pilot project in the Czech Republic
EuropeanEuropean DigestiveDigestive CancerCancer Days, Prague Days, Prague -- 26. September 201726. September 2017
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
6464
Haug U., Becker N. Dtsch med Wochenschr 2016; 141(10): 729-731Immunochemical fecal occult blood tests for colorectal cancer screening:
Point-of-care tests are not tenable for a quality-assured program
HaugHaug U., Becker N. U., Becker N. DtschDtsch med med WochenschrWochenschr 2016; 141(10): 7292016; 141(10): 729--731731Immunochemical fecal occult blood tests for colorectal cancer scImmunochemical fecal occult blood tests for colorectal cancer screening: reening:
PointPoint--ofof--care tests are not tenable for a qualitycare tests are not tenable for a quality--assured programassured program
German study - Dtsch Med Wochenschr - 05/2016German studyGerman study -- Dtsch Dtsch MMed Wochenschred Wochenschr -- 05/05/20162016
ThereThere areare different FITsdifferent FITs onon the marketthe market, , namely qualitative FITsnamely qualitative FITs (point(point--ofof--carecare teststests)) and quantitative FITsand quantitative FITs. .
European GuidelinesEuropean Guidelines forfor quality assurance in colorectal cancerquality assurance in colorectal cancer screening screening only recommend quantitative FITsonly recommend quantitative FITs
TheThe use ofuse of qualitative FITs isqualitative FITs is not anot a tenable optiontenable option for a for a qualityquality--assuredassured screening programscreening program..
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
QUALITATIVE FIT METHODS, RAPID TESTS - POCTQUALIQUALITATIVTATIVE FIT METHODSE FIT METHODS, RAPID TEST, RAPID TESTS S -- POCTPOCT
AA Quantitative Immunochemical Fecal Occult BloodQuantitative Immunochemical Fecal Occult Blood Test forTest for Colorectal NeoplasiaColorectal Neoplasia
ng Hb/mlng Hbng Hb/ml/ml SYMPTOMATIC SUBJECTS FOR COLONOSCOPYSYMPTOMATIC SUBJECTS FOR CSYMPTOMATIC SUBJECTS FOR COLONOSOLONOSCCOPOPYY
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
Higher Fecal Immunochemical Test Cutoff LevelsTerhaar sive Droste JS et al. Cancer Epidemiol Biomarkers Prev. 2011; 20(2)
Higher Fecal Immunochemical Test Cutoff LevelsHigher Fecal Immunochemical Test Cutoff LevelsTerhaarTerhaar sive Drostesive Droste JS et al. Cancer JS et al. Cancer EpidemiolEpidemiol Biomarkers Biomarkers PrevPrev. 2011; 20(2) . 2011; 20(2)
75
80
85
90
95
50 75 100 125 150 20075
80
85
90
95
50 75 100 125 150 200
sensitivitysensitivitysensitivity
specificityspecificityspecificity
ngng/ml/ml
Optimization of qFIT cut-off, for indication to colonoscopy: Indicate as much as possible, all pathology - with 15% healthy subjects ?
NOT indicate healthy subjects, but decrease sensitivity about 15% ?
Optimization of Optimization of qFITqFIT cutcut--off, for indication to off, for indication to colonoscopycolonoscopy: : Indicate as much as possible, all pathology Indicate as much as possible, all pathology -- with with 15% healthy subjects15% healthy subjects ??
NOT indicate healthy subjects, but NOT indicate healthy subjects, but decrease sensitivity about 15%decrease sensitivity about 15% ??
SAMPLINS SYSTEM - OC SENSOR μSAMPLINS SAMPLINS SYSTSYSTEEM M -- OC SENSOR OC SENSOR μμBIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
colorectal cancercolorectal cancer screeningscreening programmeprogramme
One test used with cutOne test used with cut--off off (75(75 ngng/ml)/ml)Percentage of nonPercentage of non--detected detected CRCCRC 17.6%17.6%
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
3/243/3/2244 10/5310/5310/53
4/144/144/144/244/244/24
1212..5%5%
228.5%8.5%18.1%18.1%
18.8%18.8%
6699
MOLECULAR BIOLOGYDNA CHIPs FOR COLORECTAL CANCER SCREENING
MOLEMOLECCULULAAR BIOLOGR BIOLOGYYDNA DNA CHIPCHIPss FOR CFOR COLOREOLORECCTTAAL L CCAANCERNCER SCREENINGSCREENING
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
cena testu je 600 U$, www.cena testu je 600 U$, www.medscapemedscape..com com
7070
CANCER SCREENING - GASTRIC @ COLORECTUMCANCER SCREENING CANCER SCREENING -- GASTRIC @ CGASTRIC @ COLOREOLORECCTTUMUM
Lee YC, Chiu HM, Chiang TH, et al. BMJ Open 2013;3:e003989.Accuracy of faecal occult blood test and Helicobacter pylori
stool antigen test for detection of upper gastrointestinal lesions.
LeeLee YCYC,, ChiuChiu HM,HM, Chiang THChiang TH,, et alet al.. BMJ OpenBMJ Open 2013;3:e003989.2013;3:e003989.AccuracyAccuracy ofof faecal occult bloodfaecal occult blood testtest and Helicobacter pylori and Helicobacter pylori
stoolstool antigen test forantigen test for detectiondetection ofof upper gastrointestinal lesionsupper gastrointestinal lesions..
HpSA + FIT +( n = 35 )
HpSA HpSA + FIT ++ FIT +( n = 35 )( n = 35 )
HpSA + FIT -( n = 754 )
HpSA HpSA + FIT + FIT --( n = 754 )( n = 754 )
HpSA - FIT +( n = 98 )
HpSA HpSA -- FIT +FIT +( n = 98 )( n = 98 )
HpSA - FIT -( n = 2285 )
HpSA HpSA -- FIT FIT --( n = 2285 )( n = 2285 )
Neoplastic 21 xNeoplasNeoplastictic 21 x21 x
Neoplastic 36 xNeoplasNeoplastictic 36 x36 x
ColonoscopyCColonosolonosccopopyy
GastroscopyGastrosGastrosccopopyy
Neoplastic 16 xNeoplasNeoplastictic 16 x16 x
Neoplastic 6 xNeoplasNeoplastictic 6 x6 x
ColonoscopyCColonosolonosccopopyy
GastroscopyGastrosGastrosccopopyy
Neoplastic 45 xNeoplasNeoplastictic 45 x45 x
Neoplastic 3 xNeoplasNeoplastictic 3 x3 x
ColonoscopyCColonosolonosccopopyy
GastroscopyGastrosGastrosccopopyy
Neoplastic 63 xNeoplasNeoplastictic 63 x63 x
Neoplastic 33 xNeoplasNeoplastictic 33 x33 x
ColonoscopyCColonosolonosccopopyy
GastroscopyGastrosGastrosccopopyy
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.
BIOCHEMICAL DIAGNOSTICS IN GASTROENTEROLOGY Kocna P.BIOCHEMICBIOCHEMICAL DIAGNOSTICS IN AL DIAGNOSTICS IN GASTROENTEROLOGYGASTROENTEROLOGY Kocna P.Kocna P.