Background/Objectives: Colorectal cancer (CRC) is a major global health concern, with rising incidence across age groups. Early detection via colonoscopy and identification of precancerous polyps are crucial for prevention and improved outcomes. The objectives were to evaluate the epidemiology, anatomical distribution, morphology, and histopathology of CRC, and its association with synchronous colorectal polyps. Methods: In 2023, a retrospective study was conducted on 1973 patients undergoing colonoscopy due to symptoms like blood in the stool, changes in bowel habits, abdominal pain, weight loss, anemia, or as CRC follow-up. Complete colonoscopies were performed, and suspicious lesions were biopsied or resected for histological evaluation. Statistical analysis was performed using SPSS 11.0. Results: CRC was diagnosed in 78 patients (3.95%), with a male predominance (70.51%, p < 0.05) and a mean age of 65.1 ± 8.9 years. The most affected age group was 61–70 years (43.58%). Tumors were most commonly located in the rectum (32.05%) and sigmoid colon (26.92%). Polypoid morphology was observed in 67.95% of cases. Adenocarcinoma was the predominant histological type (93.59%), followed by mucinous adenocarcinoma (6.41%), with significant differences between right and left colon (p < 0.001). Synchronous polyps were detected in 47.43% of CRC cases, primarily adenomas (60.22%). In 37.84%, the tumor and polyp were in the same colon segment. Men had a higher rate of synchronous polyps than women (p < 0.05). Conclusions: CRC is more common in older males and typically affects the rectosigmoid region. Adenocarcinoma is the leading type. Nearly half of patients had synchronous adenomas, highlighting the importance of full colonoscopy for early CRC detection and prevention.

Background and Objectives: Metabolic syndrome (MetS) is characterized by a cluster of metabolic abnormalities, including abdominal obesity, hyperglycemia, insulin resistance, dyslipidemia, and hypertension. Growing evidence suggests that these components may contribute to the development of gastrointestinal (GI) malignancies. This review aims to explore the association between MetS and GI cancers, including esophageal, gastric, pancreatic, and colorectal cancers. Materials and Methods: A narrative literature review was conducted using PubMed, incorporating 22 sources published between 1991 and 2024. Search terms included “gastrointestinal malignant tumors”, “metabolic syndrome”, “diabetes mellitus”, and “obesity.” Priority was given to large-scale studies from Europe, America, and Asia. Case reports, commentaries, and conference abstracts were excluded. Results: By analyzing the available literature data, this study determined that hyperinsulinemia (IGF-1 pathway), hyperglycemia, and obesity (>102 cm in men and >88 cm in women) are highly associated with the development of esophageal cancer (primarily with Barret’s long and short segment as precancerosis), gastric cancer (through reactive oxygen species), and both pancreatic (1,5–2,4 higher risk) and colorectal cancer (30% higher risk). Patients with a high BMI (> 40 kg/m2) show a 20%- or 1,18-times greater risk of developing colorectal cancer and a 1,72-times higher risk of developing pancreatic cancer. There is not enough evidence on the specific influence of hypertriglyceridemia, low HDL cholesterol, and high blood pressure on the development of gastrointestinal malignancy. However, those three conditions have shown a low to moderate association (from 6% to 12%) with the development of colorectal cancer. Conclusions: Metabolic syndrome (MetS) is increasingly being recognized as a significant risk factor for the development and progression of gastrointestinal cancers. Key components such as obesity, hyperglycemia, insulin resistance, and type 2 diabetes mellitus appear to contribute to carcinogenesis through mechanisms involving chronic inflammation, oxidative stress, and immune dysregulation. Further research is needed to clarify the biological pathways linking MetS to gastrointestinal malignancies and to inform effective prevention strategies.

Background: Sepsis is a leading cause of mortality in intensive care units, with liver dysfunction representing a critical determinant of poor outcome, mainly associated with excessive inflammation and oxidative stress. Lycopene, a carotenoid with potent antioxidant and anti-inflammatory properties, has been proposed as a potential therapeutic agent. This study investigated whether lycopene supplementation mitigates lipopolysaccharide-induced oxidative and inflammatory liver injury in rats. Methods: Male Wistar rats, divided into four groups, were exposed to either lipopolysaccharide or a combination of lipopolysaccharide (10 mg/kg) and lycopene (6 mg/kg). In order to assess liver damage induced by lipopolysaccharide, hepatocellular injury markers, oxidative stress indices, nitric oxide metabolism, glutathione redox status, apoptotic enzyme activity, and inflammatory mediators were assessed in serum and liver tissue. Results: Lipopolysaccharide induced marked hepatocellular damage, characterized by elevated serum liver-cell damage parameters, and liver tissue xanthine oxidase, myeloperoxidase, thiobrabituric reactive substances, protein carbonyl content, deoxyribonuclease I/II activity, nuclear factor kappa B, tumor necrosis factor-α, and interleukin-6, alongside depletion of reduced glutathione and reduced glutathione reductase and glutathione peroxidase activities. Lyc pretreatment significantly attenuated liver enzyme leakage, oxidative damage, and cytokine release while restoring reduced glutathione and glutathione reductase activity. In contrast, lycopene had limited effects on glutathione peroxidase activity, nitric oxide/inducible nitric oxide synthase signaling, and nuclear factor erythroid 2-related factor 2 expression. Conclusions: These findings demonstrate that lycopene confers partial hepatoprotection in endotoxemic rats, primarily through suppression of oxidative damage and nuclear factor kappa B-mediated inflammation. Further studies are needed to clarify tissue-specific mechanisms and optimize dosing strategies in order to increase the efficacy of this carotenoid.

Galectins represent a family of widely expressed lectins that have the ability to bind β-galactoside in modulating “cell-to-cell” and “cell-to-matrix” interactions in all organisms. These proteins are expressed in many inflammatory cells, such as macrophages, and depending on the inflammatory environment, they promote pro-inflammatory or anti-inflammatory responses. Galectin-3 (Gal-3) is predominantly located in the cytoplasm, but, as noted, it has also been detected in the nucleus, on the cell surface and in the extracellular environment, which indicates the multifunctionality of this molecule. It has been shown in many studies that Gal-3 is involved in immune regulation, fibrosis, and tissue remodeling, making it an important player in disorders such as inflammatory bowel disease (IBD), non-alcoholic steatohepatitis (NASH), and liver fibrosis. In IBD, this protein is associated with activation of the NLRP3 inflammasome, contributing to chronic intestinal inflammation. Also, in primary biliary cholangitis and autoimmune hepatitis, Gal-3 potentiate development of fibrosis through fibroblast-to-myofibroblast transition and extracellular matrix deposition, while in liver fibrosis, it is upregulated in hepatic stellate cells and macrophages, promoting fibrosis and inflammation. Studies show that Gal-3 inhibition reduces fibrosis and inflammation, making it a promising therapeutic target.

BACKGROUND Primary pancreatic lymphoma (PPL) is a rare tumor that mimics pancreatic adenocarcinoma, leading to diagnostic and therapeutic challenges. PPL accounts for 0.2% of all pancreatic tumors and is typically treated with chemotherapy. However, the long-term survival rates for PPL with chemotherapy and radiotherapy alone are unsatisfactory. Due to the improvements in pancreatic surgery, there is a need to reevaluate the treatment strategies for PPL. CASE SUMMARY A 62-year-old male presented to our clinic. A biopsy was unsuccessful, and the imaging was suggestive of pancreatic adenocarcinoma. Therefore, subtotal splenopancreatectomy was performed and histopathology was performed. He was then diagnosed with primary pancreatic diffuse large B-cell lymphoma. He received adjuvant chemotherapy and radiotherapy. Currently, the patient is alive with no evidence of disease 36 months after surgery. CONCLUSION The potential role of surgery in the treatment of PPL should be emphasized and added in the management protocol of early stage lymphoma.

Introduction/Aim. Anemia is a common extraintestinal manifestation of inflammatory bowel diseases (IBDs). Recognizing and treating anemia in patients with IBD is vital for improving the quality of life and reducing complications. The aim of this study was to assess the effectiveness and safety of the liposomal iron formulation in the treatment of anemia in patients with Crohn's disease and ulcerative colitis. Method. Among 447 patients in the state of clinical remission of ucerative colitis and Crohn's disease treated with biological therapy, there were 37 patients with confirmed sideropenic anemia (Hb 10 g/dl-12 g/l, ferritin less than 100) who received a liposomal iron pyrophosphate preparation at the dose of 30 mg daily for one month. Parameters such as hemoglobin level, hematocrit, ferritin, and mean corpuscular volume (MCV) were monitored, along with anemia symptoms, and correlated with the onset of therapy; quality of life was also assessed. Statistical analysis was performed using the SPSS program. Results. The application of liposomal iron over one month resulted in a statistically significant increase in hemoglobin levels, averaging 3 g/dL (p = 0.021). A significant increase in hemoglobin was observed in patients in endoscopic remission, almost 10 g/dL (p = 0.008). Additionally, there was an average increase in ferritin levels by almost 2 ng/mL (p = 0.514) and hematocrit by 0.006% (p = 0.126), although these increases did not reach statistical significance. Analyzing the results based on the type of IBD, greater efficacy was observed in patients with ulcerative colitis, showing a significant increase in hemoglobin of 8 g/dL (p = 0.012) compared to patients with Crohn's disease. Two patients reported abdominal discomfort and diarrhea (5.4%) as adverse effects. Conclusion. Our results suggest that 8.3% of IBD patients in clinical remission have anemia and liposomal iron is an effective and safe option for treating anemia in patients. Further research is needed to evaluate the long-term effectiveness and safety of liposomal iron in this patient population.

Introduction. Systemic lupus erythematosus (SLE) represents a multisystemic disease characterized by antibody production, complement activation, and immune complexes deposition. Certain types of malignancies occur more often, and conversely, some of them occur less often in SLE patients. Mucosal melanoma of the anorectal region represents a rare form of melanoma occurring in 1.5% of all melanoma patients, predominantly female. The introduction of novel agents dramatically changed the outcome in melanoma patients and introduced different adverse events, diverse contraindications, and drug interactions.Immune checkpoint inhibitors have a role in the maintenance of immunologic homeostasis. Patients with underlying autoimmune diseases were often excluded from clinical trials, for fear of possible autoimmune disease exacerbation or high-grade immune-related adverse events. Due to that, data regarding this subgroup of patients is limited, with no clear recommendations. Given the fact that prevalence among the general population is high (5 -10%), autoimmune diseases represent common comorbidity in cancer patients. Having that in mind, it is of utmost importance to personalize the approach and individualize the SLE treatment and enable the use of PD-1 antibody in the safest and most useful way while keeping the SLE in control.Case report. Herein we present a 79-year-old with primary mucosal melanoma of the anorectal region, with lung metastasis and preexisting SLE in remission. Hydroxychloroquine was the only treatment for SLE. Nivolumab treatment was initiated in the standard dosing schedule. After the first and second follow-up, no further progression of melanoma was detected, with no SLE exacerbation and immune-related adverse events.Conclusion. PD-1 treatment in a patient with an underlying autoimmune disease represents a viable choice with a necessity for a multidisciplinary approach and close monitoring.

Caroli's disease is a rare disease characterized by dilatation of large intrahepatic bile ducts.It occurs in the classic form presented by repeated episodes of cholangitis (Caroli's disease), as well as in the form of syndrome with the development of fibrosis and cirrhosis of the liver (Caroli's syndrome).The disease can occur throughout entire life, but mostly before the age of 30.The incidence of this disease is estimated at about 1 in 1,000,000 cases for Caroli's disease and 1 in 100,000 for Caroli's syndrome.The main symptoms are: fever, jaundice, itchy skin, pain under the right costal arch, nausea and vomiting.Possible complications are the development of liver fibrosis and cirrhosis and cholangiocellular carcinoma.Diagnosis is made by clinical and ultrasound examination, computed tomography, more often by magnetic resonance cholangiopancreatography and liver biopsy.We present a clinical case of an elderly patient who has been suffering from Caroli's disease for a few years now.Diagnostic challenges and applied therapy are presented.

Gastric cancer is the fourth most common cancer in the world with over a million new cases per year, and over 750,000 deaths caused by it.The highest incidence is recorded in Japan and China, Eastern Europe and South America, and the lowest is in Africa.The disease is 2 to 3 times more common within male population and people over 60 years of age, but this boundary shifts towards younger age.Five-year survival rate in European countries is 10 to 30%.This is a multifactorial disease and the most important risk factors are: Helicobacter pylori infection, smoking cigarettes, alcohol consumption, male gender, older age, reduced intake of vegetables and fruits, genetic predisposition, diabetes mellitus, etc.A prospective study was conducted on a selected population of 43 patients diagnosed with the two most common types of stomach cancer: adenocarcinoma and signet ring cell type cancer.Out of the total number of examinees, there were 32 male and 11 female patients, the average age of 68.83±9.26.Among all patients, 39.5% were smokers, 20.9% were alcohol consumers, 62.8% had Helicobacter pylori infection and 16.3% patients had diabetes mellitus.Analysis of the relationship between sex, age, smoking, alcohol intake and diabetes mellitus with the type of cancer did not show statistical significance.The frequency of Helicobacter pylori was statistically significantly different in relation to the type of cancer (p=0.007).In our study, there was no statistically significant difference between the male gender, the younger population, smokers, chronic alcohol consumers, and patients with diabetes mellitus and a certain type of cancer.Helicobacter pylori infection was found to be a key factor in the development of both types of gastric cancer.This research included a smaller sample of patients and it is necessary to examine a larger number of subjects in the future.

Background: Isolated splenic metastases from endometrial cancer, which is a relatively common malignancy, are extremely rare findings; to date, only 14 cases have been reported in the literature. Case Summary: We report a patient with isolated splenic metastases of endometrial cancer 3 years after radical surgery of the primary tumor. The patient was successfully treated by splenectomy and six cycles of paclitaxel. Fifty months after splenectomy, she was alive and well, and with no evidence of disease. Conclusion: Isolated spleen metastasis of endometrial cancer is very rare. Radical surgery and adjuvant therapy may offer excellent long-term survival.

The inferior vena cava (IVC) collects blood from the abdomen and lower extremities, climbs the retroperitoneum and enters into the right atrium of the heart.Obstruction of IVC can be caused by venous thrombosis, a neoplasm that exerts external pressure on a vein or infiltrates the vein and by pregnancy.Obstruction of the IVC causes edema of the lower extremities, dilatation of the veins of the lower part of the abdomen which serve as collaterals.In the diagnosis of these disorders, it is necessary to perform detailed laboratory tests, ultrasound of the abdomen, computerized tomography, and finally cavography.In this way, the etiology of the obstruction is determined, the place and degree of obstruction, collateral circulation is detected and eventual surgical reconstruction is planned.

Congenital esophageal stenosis (CES) is a type of esophageal stenosis, and three histological subtypes (tracheobronchial remnants, fibromuscular thickening or fibromuscular stenosis, and membranous webbing or esophageal membrane) are described. Symptoms of CES usually appears with the introduction of the semisolid alimentation. Dysphagia is the most common symptom, but esophageal food impaction, respiratory distress or failure to thrive can be clinical manifestations of CES. Wide spectrum of differential diagnoses leads to delayed definitive diagnosis and appropriate treatment. Depends on hystological subtype of CES, some treatment procedures (dilation or segmental esophageal resection) are recommended, but individually approach is still important in terms of frequency and type of dilation procedures or type of the surgical treatment. Dysphagia can persist after the treatment and a long follow-up period is recommended. In 33% of patients with CES, a different malformations in the digestive system, but also in the other systems, are described.

We aimed to evaluate whether two methionine-related compounds, S-adenosylmethionine (SAM), and selenomethionine (SM), could lessen liver damage induced by regurgitated bile in a model of rat bile duct ligation (BDL). Hepatoprotective potentials of S-adenosylmethionine and selenomethionine were estimated based on the changes of serum liver damage parameters (aminotransferases, alkaline phosphatase, gamma-glutamyltranspeptidase and lactate dehydrogenase activity, and bilirubin concentration), tissue oxidative [xanthine oxidase (XO) and catalase activity, thiobarbituric acid reactive substances (TBARS) levels] and inflammatory [tumor necrosis factor-alfa (TNF-α) concentration] parameters, and morphological liver tissue alterations that follow cholestasis. The treatment regimens proved themselves able to prevent significant liver damage induced by cholestasis. Both SAM and SM decreased XO activity and TBARS levels and increased catalase activity, while only SM significantly reduced TNF-α concentration. Morphological changes related to bile-induced liver damage were also found to be partially diminished by SAM and SM. In view of the mechanisms of action of the two tested methionine-derived compounds, one might say that SM predominantly acted as an antioxidant, while SAM exerted its activity by potentially modulating different gene expression and protein structures. It is also worth mentioning that this is the first study (to the best of our knowledge) that dealt with the effects of SM on BDL-induced liver injury in rats and of the findings that speak favorably of this powerful antioxidant.

Colorectal cancer (CRC) is the third most commonly diagnosed carcinoma and the fourth leading cause of carcinoma deaths worldwide. Most cases of CRC occur in people aged over 50 years, often coexisting with other chronic diseases including obesity, type 2 diabetes mellitus, and cardiovascular disease. Diabetes mellitus (DM) and cancer frequently coexist. DM is associated with an increased risk for pancreatic, gastric, liver, colorectal, breast, urinary tract, and female reproductive cancers. It is hypothesized that possible biologic links between diabetes and cancer risk could be related to hormonal (insulin resistance), inflammatory, or metabolic (hyperglycemia) characteristics of DM, as well as with some antidiabetic medications. This review summarizes the current published literature regarding the association of CRC with diabetes since there is growing evidence from recent studies that this association is not random.

Introduction/Objective. The most important complication of gastroesophageal reflux disease (GERD) is Barrett?s esophagus (B?) and the development of esophageal adenocarcinoma. Prevalence of BE is 5?15% in patients with GERD symptoms. The aim of the study was to investigate the prevalence and risk factors for BE in patients with chronic reflux symptoms. A prospective study was conducted in the Clinic of Gastroenterology, Nis Clinical Center. Methods. We included 676 patients with chronic reflux symptoms, who underwent esophagogastroduodenoscopy. The biopsy specimens were obtained in a four-quadrant fashion at intervals of 2 cm from the circumferential endoscopic Barrett?s epithelium in the distal esophagus. BE was diagnosed by pathological examination. Results. Out of the total number patients with GERD, 92 were diagnosed with columnar-lined esophagus (CLE), the prevalence being 13.6%. Histological examination of biopsy from 92 patients with CLE revealed specialized intestinal metaplasia in 15 patients, with the prevalence of 2.22%. Compared to patients without BE, patients with BE were older and more commonly male. Univariable analyses showed that hiatal hernia and Helicobacter pylori infection were two significant risk factors for the onset of esophagitis. The age and the presence of reflux symptoms were associated with the presence of BE. Older age could be considered a significant risk factor for the development of BE and GERD. Conclusion. Prevalence of biopsy-proven BE and CLE in Serbia was 2.22% and 13.6%, respectively, in patients with GERD symptoms.

* Accepted papers are articles in press that have gone through due peer review process and have been accepted for publication by the Editorial Board of the Serbian Archives of Medicine. They have not yet been copy edited and/or formatted in the publication house style, and the text may be changed before the final publication. Although accepted papers do not yet have all the accompanying bibliographic details available, they can already be cited using the year of online publication and the DOI, as follows: the author’s last name and initial of the first name, article title, journal title, online first publication month and year, and the DOI; e.g.: Petrović P, Jovanović J. The title of the article. Srp Arh Celok Lek. Online First, February 2017. When the final article is assigned to volumes/issues of the journal, the Article in Press version will be removed and the final version will appear in the associated published volumes/issues of the journal. The date the article was made available online first will be carried over.

Rat bile duct ligation (BDL) represents a useful method that mimics obstructive extrahepatic cholestasis, which is known to be a frequent disorder in humans. Polyamines (putrescine, spermidine, and spermine) are one of the key molecules regulating cell proliferation and differentiation. This work aimed to evaluate the potential beneficial properties of putrescine in rat BDL model by studying several biochemical parameters reflecting liver function and polyamine metabolism. Rats that were subjected to BDL were injected with putrescine (150 mg/kg) for 9 days, while in parallel another group with BDL remained untreated. Two control groups were included as well, sham-opened and putrescine-treated group. The following plasma parameters: ALT, AST, γ-GT, ALP, bilirubin, bile acids, as well as liver malondialdehyde and polyamine concentration and the activity of enzymes involved in polyamine metabolism were studied. After BDL, significant alterations in plasma biochemical parameters occurred, where a 9-day putrescine treatment significantly alleviated liver function deterioration. Putrescine also increased liver polyamines’ concentrations and polyamine and diamine oxidase activities in rats submitted to BDL. Our results demonstrated, for the first time, that putrescine plays an important role in preserving liver tissue function in rats with experimentally induced cholestasis.

Background/Aim. Alcohol is the most common cause of fatty liver. Alcohol metabolism takes place in the liver by alcohol dehydrogenase, to toxic acetaldehyde, with fatty acids accumulation in the liver as a consequence. By daily intake of the amount greater than 80 g/day for men and 20 g for women, there is the risk for developing the alcoholic fatty liver (AFLD). The aim of this study was to determine the profile of atherogenic factors in plasma of patients with AFLD compared to patients with non-alcoholic fatty liver (NAFLD) and determine its diagnostic significance. Methods. The study included 74 patients with AFLD who consumed alcoholic beverages daily in large quantities and over 80 g [for men: 3?4 units (U) of alcohol and for women 2?3 U]; the control group consisted of 70 patients with NAFLD verified with ultrasound. A total holesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and apoliporoteins (ApoA1 and ApoB) were determined and the ratios TC/HDL-C, ApoB/ApoA1 and LDL-C/HDL-C were calculated. Results. The study included two group: 74 AFLD patients (21% of women and 79% of men), mean age 42.65 ? 9.73 years, who consumed alcoholic beverages daily in the amounts of 80 g, or greter, during the average 2.31 ? 0.96 years and 70 patients with NAFLD (37.5% of women and 63.5% of men) with the average 41.3 ? 4.1 years. There was no significant difference in gender distribution and the average age between the examined groups. Higher values of TG ? 9.94 ? 2.94 mmol/L, TC 14.53 ? 2.81 mmol/L, LDL-C 8.57 ? 2.15 mmol/L and ApoB 3.97 ? 0.28 g/L and lower values of HDL-C 0.43 ? 0.11 mmol/L, Apo A1 0.49 ? 0.09 g/L and ApoB/ApoA1 ratio 2.43 ? 1.27 were registered in the AFLD group compared to those registered in the NAFLD group, (TG 8.74 ? 2.54 mmol/L TC 9.87 ? 2.36, LDL-C 6.72 ? 1.98 mmol/L, Apo B 2.38 ? 0.16 g/L, HDL-C 0.78 ? 0.09 mmol/L, Apo A1 0.98 ? 0.04 g/L and ApoB/ApoA1 ratio 7.81?1.42). There were no differences in albumin concentration, international normalized ratio (INR) and values of haemoglobin and haematocrit between the groups. Conclusion. Lipids and the ApoB/ApoA1 ratio, besides markers of hepatocelular damage, can serve as a diagnostic criteria for the presence of AFLD, and as a better indicator of atherogenic risk.