Introduction: Bowel dysfunction is common after spinal cord injury (SCI). We aimed to determine the role of the hindgut in the symptom development and motor function (transit) of SCI patients. Methods: A total of 5 patients with chronic complete SCI and 6 healthy volunteers were studied. All of the patients had lesions above Th5. All of the patients complained of constipation. Gut transit, rectal mechano- and electrosensitivity were tested. Results: Slow colonic transit occurred in all patients, transit time was 102 hrs (70–144 hrs) in patients with constipation vs. control: 30 hrs (24–48 hrs) P<0.001. Delay was pancolonic. All SCI patients had an elevated sensory threshold: 110 vs. 70ml for urge, 300 vs. 120ml for pain P<0.001, electrical stimulation: 1.0 mA vs. 0.6 mA for discomfort (P<0.01) respectively. Conclusions: In SCI, subjective constipation correlates closely with slow gut transit. Delay is pancolonic. Sensory testing provides evidence for completeness of lesion, providing evidence for pain transmission through sympathetic pathways.

Background: Slow transit constipation is one of the common causes of chronic constipation. The number of Cajal cells in the muscular layer was decreased in the patients with slow colonic transit. Patients may have motor abnormalities not limited to the colon. The aim of this study was to determine motility abnormalities of the upper gastrointestinal tract in patients with slow-transit constipation.

Background: Fecal incontinence is a common health care problem affecting 1–7% of the population. The aim of this study was to determine the relatonship between anorectal manometry, fecal incontinence severity and findings at endoanal ultrasound.

BACKGROUND AND STUDY AIMS:To measure urinary albumin excretion using immunoturbidimetry (IT) and high-performance liquid chromatography (HPLC) in inflammatory bowel diseases.PATIENTS AND METHODS:A cross-sectional study was carried out on 60 selected patients with Crohn's disease (CD), 57 with ulcerative colitis (UC) and 22 healthy volunteers, as controls. Urinary albumin excretion was measured by IT and HPLC, and albumin-creatinine ratio was calculated. This ratio was compared in patients with active and inactive CD and UC and in healthy volunteers.RESULTS:Patients with CD and UC had higher albumin-creatinine ratio compared to controls using both IT and HPLC (p < 0.05). We measured higher albumin-creatinine ratio in patients with active compared to inactive CD (p < 0.05). Albuminuria did not correlate with disease duration of CD or UC, but patients with more extended CD according to the Montreal classification had higher HPLC-albumin-creatinine ratio. In CD, we found a significant correlation between HPLC-albumin-creatinine ratio and some inflammatory markers i.e. white blood cells (p < 0.05) and erythrocyte sedimentation rate (p < 0.05). In UC, there was no significant correlation between HPLC-albumin-creatinine ratio and the above markers of systemic inflammation or activity of UC. Albumin-creatinine ratio measured by HPLC was higher in both active and inactive CD and UC groups than albumin-creatinine ratio measured by IT. Using a receiver operating characteristics curve analysis, in case of HPLC-albumin-creatinine ratio cut-off values of the activity of CD were 2.46 mg/mmol for men, 5.30 mg/mmol for women.CONCLUSIONS:HPLC-urinary albumin-creatinine ratio is associated with the clinical and laboratory disease activity indices in CD, but not in UC. Using HPLC we found a more sensitive method compared to IT to measure albuminuria that would be a sensitive activity marker in CD.

Secondary aortoenteric fistula is a rare but well-known delayed and life-threatening complication of previous aortic reconstruction which is as difficult to diagnose as it is to treat. A combination of esophagogastroduodenoscopy and computed tomography (CT) or MR may offer the best chance of detecting a fistula, but the most important tool to achieve diagnosis is clinical suspicion in patients who have undergone aortic surgery and present classically with either signs of infection or gastrointestinal hemorrhage.

Several guidelines recommend anorectal manometry in patients with functional anorectal disorders, eg. fecal incontinence and chronic constipation caused by outlet obstruction. We retrospectively reviewed tracings obtained between March 2005 and November 2008. A total of 189 patients (80% women; average age 56 years) were included. The main indications were fecal incontinence (21%) and constipation (79%). Patients suffering from incontinence were older (68±6 vs. 52±8 years) and had lower resting (35±8mmHg vs. 63±5mmHg P≤0.01) and squeeze pressure (54±7mmHg vs. 112±9mmHg P≤0.01) compared to continent patients, the perceptual thresholds were significantly lower in patients with fecal incontinence (urge: 50±4ml), compaired to those with constipation (137±18ml, P≤0.001). However, the sensitivity and specificity of manometric data seems to be low. An abnormal straining pattern suggesting dyssynergic defecation was seen in 51% of constipated patients compared to 85% of patients with fecal incontinence. Because of the low sensitivity and specificity of manometric parameters endoanal ultrasonography, defecography, balloon expulsion test are suggested to be performed in all patients with defecation disorders in order to make accurate diagnosis.

Background: Hyperreactive lower esophageal sphincter is a rare motility disorder of the LES. Nissen fundoplication was shown to be effective in the treatment of patients with GERD induced hypertensive LES. Aim of this study was to determine the efficacy of PPI therapy in patients with hypertensive LES.

A 66 years old female, with a history of surgical removal of thymus carcinoma, presented with progressive dysphagy and severe vomiting. Endoscopy revealed dilated tubular oesophagus, retention oesophagitis, mycosis and cardiac stenosis, manometry proved achalasia. After two times pneumatic dilatation dysphagy resolved, but gastric distension and noisea occured caused by gastric retention with delayed gastric emptying. In the background of the symptoms gastroparesis was suggested, therefore pyloric botulinus toxin injections were performed. Afterwards gastric emptying improved. The case was complicated by normochromic, normocytic anemia, crista biopsy and flowcytometry revealed pure red cell anaemia.

The physiologic importance of afferent sensory pathways in the esophageal motor functions has been recently recognised. Capsaicin-sensitive sensory afferents were shown to play a role in the maintenance of mucosal integrity of the GI tract, and regulation of human esophageal motility. The aim of this study was to investigate the effect of topical application of capsaicin-containing red pepper sauce (Tabasco, 25%v/v, pH: 5.7) suspension on the phasic activity and clearance of the human esophagus in healthy volunteers. Methods: Simultaneous stacionary manometry and esophageal impedance measurement were performed in 10 healthy volunteers. Esophageal motility (peristalsis, clearance, lower esophageal sphincter (LES) tone) was measured before and after acute topical application of capsaicin. Results: Capsaicin containing red pepper sauce increases the motility response (LES tone, contraction amplitude, propagation velocity) of the human esophagus in healthy volunteers. However the clearance of the esophagus was found to be inhibited at the suprasphincteric region of the esophagus. Conclusion: Phasic contractility is increased, however the esophageal clearance was not affected by topical capsaicin. The increased tone of LES is most likely involved in the inhibited clearance of the esophagus after capsaicin application.

Familial autoinflammatory syndromes, including familial Mediterranean fever, are recently recognized group of disorders characterized by seemingly unprovoked inflammation but lacking high-titer autoantibodies. Genetic and clinical tools are improving the ability of the clinician to better approach patients with periodic fever and inflammation. The pathogeneses of many of these diseases are now understood to involve different aspects of a common pathway, largely affecting inflammatory cascades related to IL-1 or tumor necrosis factor-alpha (TNF-alpha). Here we report two cases, where patients were presented with periodic abdominal pain, fever, signs of polyserositis and arthritis. IBD, malignancy, porphyria, systemic autoimmune diseases, infection and lead intoxication were excluded. Both patients formerly underwent cholecystectomy and appendectomy during an acute phase without any effect on recurrent complaints. Erythrocyte sedimentation rate, serum CRP and TNF-alpha levels were found to be increased during acute phase. We have found familiality in one case where the patient's daughter developed the same symptoms. MEFV (Mediterranean fever) gene mutation was found to be positive in 70–80% of the cases, however, our patients presented were negative for the syndrome. We propose an algorithm for the evaluation of a patient with periodic fever, taking into account the patient's age, ethnicity, symptoms and signs, and results of laboratory and genetic testing.

Aims: The aim of this study were 1. to determine the role of anal vector manometry in the assessment of anal sphincter injury, 2. to establish the most suitable method of anal vector volume analysis for identifying significant anal sphincter (EAS) injury in patients with fecal incontinence. Methods: A total of 15 consecutive women with a history of instrumental or traumatic vaginal delivery were recruited. Anal ultrasonography and anal vector manometry were performed. Receiver-operator characteristic curves were used to determine the usefulness of anal manometry and anal vector volume analysis in the identification of significant EAS disruption (full thickness, more than one quadrant involved) detected by ultrasonography. Results: 3 women had significant EAS disruption identified by anal ultrasonography. Anal vector manometry provided complementary functional information. Anal vector symmetry index (VSI), determined by analysis of mean maximum squeeze pressure, yielded 100% sensitivity for significant EAS disruption, with a positive predictive value of 65%. Conclusion: Anal vector manometry correlates with endoanal ultrasonography. Anal vector symmetry correlates well with anal sphincter disruption identified by intracavitary ultrasonography.

Aims: Biofeedback was shown to be effective in the treatment of patients with fecal incontinence. The exact mechanism of action has not been proven yet. We postulated that the response may be associated with changes in the functional extrinsic autonomic nerves. The aim of this study was to investigate the role of autonomic nervous system in the response to biofeedback therapy. Patients and methods: 7 consecutive patients (7 females, median age: 54yrs) were enrolled in the biofeedback treatment program. Colonoscopy and endoanal ultrasonography were performed to exclude structural damage. Anorectal manometry was performed to detect the perception tresholds and measure sphincter function. Functinal abnormalities were excluded by defecography. Patients with perception abnormality were excluded by anorectal manometry before the study. The severity of incontinence was determinated by the Cleveland Score System. Before and after biofeedback therapy RR interval on the electrocardiogram was measured in resting, after deep breathing, during Valsava maneuver and standing. Results: RR interval did not change significantly after biofeedback therapy during resting (837.1±32,8 vs.720.0±43.8ms, NS), after deep breathing (768.6±39.5 vs. 676.0±48.3ms, NS) and during Valsava manoeuvre (651.4±41.8 vs. 668.0±34.4ms, NS), however in standing situation RR interval decreased significantly (728.6±36.5 vs. 644.0±44.0; p<0.05). Conclusion: The extrinsic autonomic nerve system was not significantly affected by biofeedback treatment.

Aims: The diagnosis of inflammatory bowel disease (IBD) is supported by clinical findings and complementary tests. The presence of specific serological markers could be helpful in the characterization of this condition. Serological markers for IBD, including anti-neutrophil cytoplasmic antibody (ANCA) and anti-Saccharomyces cerevisiae antibody (ASCA), have a high specificity and positive predictive value in diagnosing IBD. However, neither indication nor use in clinical practice have been clearly established. Aim: To assess the prevalence of ANCA and ASCA in a group of patients with ulcerative colitis (UC) and its association with clinical features. Material and methods: 50 patients with UC in remission (age range 16–72 years, 33 males) were studied. In a venous blood sample ANCA was measured by indirect immunofluorescence and ASCA by enzyme immune assays for IgG and IgA. Results: 44% of patients were positive for ANCA, 9% for ASCA and 6% for both markers. There was a significant correlation between the presence of ANCA and duration of the UC and the number of crises (>5 crises 72.5). The proportion of colectomized patients with positive ANCA was higher (57.1%). Conclusions: The prevalence of ANCA in the studied population is similar to the published data. The presence of ANCA was significantly higher in UC patients with shorter evolution, higher number of crises and in those with a history of colectomy. There was a low prevalence of ASCA positive patients.

Background: Gastroparesis is a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. Lesion of vagal nerve occurs in 4–40% of patients undergoing laparoscopic fundoplication and after mediastinal surgery. Botulinum toxin is a potent inhibitor of neuromuscular transmission and has been used to treat achalasia.

Background: The morbidity and mortality of colorectal cancer (CRC) are unfavorable in Hungary. Not only the poor survival but also the health care expenses of an advanced stage tumor make the importance of early diagnosis.

Background: Various disease-specific serum-antibodies were described in patients with inflammatory bowel disease (IBD) that can predict the development of IBD. Serologic markers predicting the natural course of the disease could be helpful in either the decision of choice of different immunsuppressive treatments or in the follow-up of the patients.

The aim of this study was to determine the efficacy of biofeedback therapy in patients with passive anal incontinence.

Background: Increased intraabdominal pressure, shortened length of lower esophageal sphincter (LES), transitory LES relaxation, and the increased incidence of hiatus hernia are well established in patients with morbid obesity. The aims of our study were 1. to determine the incidence of erosive reflux disease (ERD) in these patients, 2. to quantify the healing rate of obese GERD patients, and 3. to determine the incidence of esophageal motility disorders in different BMI (normal, overweight, obese, morbid obese) groups.

Background: Slow transit constipation (STC) is a disorder of intestinal motility of unknown etiology. Myogenic or neural mechanisms have been implicated in its pathophysiology. Morphological changes seen in intestinal myopathies include fibrosis, hypertrophy or atrophy of muscle fibers, vacuolation of myocytes, and alteration in the immunohistochemical staining patterns of myocyte contractile proteins, abnormal muscle layering, and presence of intracellular inclusion bodies.

Aims: By stimulating the capsaicin-sensitive nerves with capsaicin, SP and CGRP are released from these nerve endings. We were proved that these fibers and mechanism take place in the development of gastrointestinal mucosal damage/prevention (Mózsik, Abdel-Salam, Szolcsányi: Capsaicin-Sensitive Afferent Nerves in Gastric Mucosal Damage and Protection. Akadémiai Kiadó, Bp. 1997).