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Manometry and its use in patients with a diagnosis of globus faryngeus
Gregová, Daniela ; Bitnar, Petr (advisor) ; Hep, Aleš (referee)
Introduction The main aim of this study is to present a complex review comprising etiological factors, diagnostic options and therapeutic methods related to globus pharyngeus, a persistent or intermittent sensation of a lump or foreign body in the throat. The second purpose is to investigate the reciprocal relationship between motor control with musculoskeletal system and pressure changes in the esophagus, especially in the upper esophageal sphincter. Methods 37 patients participated in the study. 24 of them suffered globus pharyngeus and 13 were patients with GERD but without the symptoms of globus pharyngeus. Because of the complex physiology of esophageal function and the inability of conventional manometry to fully describe this complexity, we found High-Resolution Manometry as a useful device for accomlishing the referred task. Patients were examined in four different postural situations which had to be modified when the attitude wasn't tolerated. The examination was followed by manual physiotherapy and exercises targeted to influence postural alignment. 10 patients with globus pharyngeus who agreed with a control manometry examination were familiarized with the results as a form of biofeedback. Results On the basis of the results of this research, it can be concluded that a high pressure...
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Incidence of multiple sclerosis in patiens with inflammatory bowel diseases (IBD)
Ročková, Petra ; Keil, Radan (advisor) ; Hep, Aleš (referee) ; Zádorová, Zdeňka (referee)
Ročková Summary Inflammatory bowel diseases (IBD) - Crohn's disease (CD) and ulcerative colitis (UC) are associated with various extraintestinal manifestations (EM). These manifestations may involve virtually any organ system. Neurological manifestations are not regarded as very common, but they are probably underdiagnosed. Patients with IBD have higher risk of developing multiple sclerosis (MS) regardless of therapy manner they use. There are quite a lot of publications describing relationship between developing multiple sclerosis and therapy with monoclonal antibody against tumor necrosis alpha (anti TNF-α). However, it remains to be shown whether anti-TNF-alpha itself causes MS or merely acts as a trigger, exacerbating preexisting subclinical CNS damage during chronic anti- TNF-α treatment. Majority of published cases support the second possibility. These results let us to define a hypothesis, that preselection of patients with IBD without any preclinical signs of demyelination before the initiation of anti TNF- a therapy may improve patient safety. The aim of our project was to develop neurological and magnetic resonance (MRI) screening of patients with IBD before anti TNF- α therapy initiation and subseqently exclusion of patients wth high risk of developing MS. The second aim was to follow up on the...
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Inflammatory bowel diseases in pregnancy
Koželuhová, Jana ; Matějovič, Martin (advisor) ; Keil, Radan (referee) ; Hep, Aleš (referee)
Inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis, can affect mainly young people in their reproductive years. IBD therefore has a major impact on patient's family planning decisions. Management of IBD in pregnancy requires a challenging balance between optimal disease control and drug safety. An unanswered question is the impact of the course of childbirth in women with preexisting IBD regarding anal sphincter function and development of anal or fecal incontinence. To this date there aren't any clinically relevant guidelines for managing childbirth in women with IBD. From gastroenterologist's point of view, a clear indication for Caesarean section (CS) is active perianal disease or active IBD with rectal involvement, a relative indication for CS is ileal-pouch-anal anastomosis (IPAA) or ileal-rectal anastomosis in women after colectomy for refractory UC. Studies have shown a lack of knowledge among both patients and physicians regarding reproductive issues in IBD. The main aim of this thesis was first to assess risk of vaginal delivery in development of anal incontince, second to evaluate the safety of biologic therapy during pregnancy in women with inflammatory bowel disease. We present a study researching the morbidity of children born to mothers treated with biological...
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Incidence of multiple sclerosis in patiens with inflammatory bowel diseases (IBD)
Ročková, Petra ; Keil, Radan (advisor) ; Hep, Aleš (referee) ; Zádorová, Zdeňka (referee)
Ročková Summary Inflammatory bowel diseases (IBD) - Crohn's disease (CD) and ulcerative colitis (UC) are associated with various extraintestinal manifestations (EM). These manifestations may involve virtually any organ system. Neurological manifestations are not regarded as very common, but they are probably underdiagnosed. Patients with IBD have higher risk of developing multiple sclerosis (MS) regardless of therapy manner they use. There are quite a lot of publications describing relationship between developing multiple sclerosis and therapy with monoclonal antibody against tumor necrosis alpha (anti TNF-α). However, it remains to be shown whether anti-TNF-alpha itself causes MS or merely acts as a trigger, exacerbating preexisting subclinical CNS damage during chronic anti- TNF-α treatment. Majority of published cases support the second possibility. These results let us to define a hypothesis, that preselection of patients with IBD without any preclinical signs of demyelination before the initiation of anti TNF- a therapy may improve patient safety. The aim of our project was to develop neurological and magnetic resonance (MRI) screening of patients with IBD before anti TNF- α therapy initiation and subseqently exclusion of patients wth high risk of developing MS. The second aim was to follow up on the...
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Inflammatory bowel diseases in pregnancy
Koželuhová, Jana ; Matějovič, Martin (advisor) ; Keil, Radan (referee) ; Hep, Aleš (referee)
Inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis, can affect mainly young people in their reproductive years. IBD therefore has a major impact on patient's family planning decisions. Management of IBD in pregnancy requires a challenging balance between optimal disease control and drug safety. An unanswered question is the impact of the course of childbirth in women with preexisting IBD regarding anal sphincter function and development of anal or fecal incontinence. To this date there aren't any clinically relevant guidelines for managing childbirth in women with IBD. From gastroenterologist's point of view, a clear indication for Caesarean section (CS) is active perianal disease or active IBD with rectal involvement, a relative indication for CS is ileal-pouch-anal anastomosis (IPAA) or ileal-rectal anastomosis in women after colectomy for refractory UC. Studies have shown a lack of knowledge among both patients and physicians regarding reproductive issues in IBD. The main aim of this thesis was first to assess risk of vaginal delivery in development of anal incontince, second to evaluate the safety of biologic therapy during pregnancy in women with inflammatory bowel disease. We present a study researching the morbidity of children born to mothers treated with biological...
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Manometry and its use in patients with a diagnosis of globus faryngeus
Gregová, Daniela ; Bitnar, Petr (advisor) ; Hep, Aleš (referee)
Introduction The main aim of this study is to present a complex review comprising etiological factors, diagnostic options and therapeutic methods related to globus pharyngeus, a persistent or intermittent sensation of a lump or foreign body in the throat. The second purpose is to investigate the reciprocal relationship between motor control with musculoskeletal system and pressure changes in the esophagus, especially in the upper esophageal sphincter. Methods 37 patients participated in the study. 24 of them suffered globus pharyngeus and 13 were patients with GERD but without the symptoms of globus pharyngeus. Because of the complex physiology of esophageal function and the inability of conventional manometry to fully describe this complexity, we found High-Resolution Manometry as a useful device for accomlishing the referred task. Patients were examined in four different postural situations which had to be modified when the attitude wasn't tolerated. The examination was followed by manual physiotherapy and exercises targeted to influence postural alignment. 10 patients with globus pharyngeus who agreed with a control manometry examination were familiarized with the results as a form of biofeedback. Results On the basis of the results of this research, it can be concluded that a high pressure...
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Treatment of anal incontinence with PC biofeedback therapy
Keilová, Marie ; Bitnar, Petr (advisor) ; Hep, Aleš (referee)
Bibliographic identification KEILOVÁ, Marie. Treatment of anal incontinence with PC biofeedback therapy. Prague: Charles University, 2nd Faculty of Medicine, Department of rehabilitation and sport medicine, 2013, 87 p. Supervisor Mgr. Petr Bitnar Abstract The presented thesis deals with issues of anal incontinence. The first theoretical part of the study gives an overview of the current knowledge on anal incontinence - it reviews its prevalence, etiology and possibilities of examination and therapy. The second practical part uses high-resolution anorectal manometry to evaluate function of anal sphincters before and after biofeedback therapy. The study was performed on a sample of 10 patients with weakened anal sphincters and with symptoms of incontinence. These patients underwent 4,5 months of therapy which consisted of PC biofeedback and physiotherapy of pelvic floor. The patients were subjected to manometric examination before and after the therapy. Significant effect (p<0.05) of the therapy was detected on two variables: pressure during maximum squeeze and pressure during caugh. Additionally, the therapy was evaluated by standardized questionaire Fecal Incontinence Quality of Life Scale (FIQL). The questionaire was given to the patients before and after the therapy. Significant effect of the therapy was...
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Quality of life of Crohn's disease patients
Gabalec, Libor ; Bureš, Jan (advisor) ; Dítě, Petr (referee) ; Hep, Aleš (referee)
Introduction The assessment of the quality of life in chronic diseases has become greatly extended over the past few decades. The main uses for Quality of life measures in clinical practice are identifying and prioritizing problems, facilitating communication, screening for hidden problems, monitoring changes or responses to treatment Objective The objective was to assess the quality of life of Crohn's disease patients from 2 Czech centres by means of Czech versions of the general WHOQOL-BREF (World Health Organization Quality of Life - shortened version) and specific quality of life questionnaire IBDQ (Inflammatory Bowel Disease Questionnaire), to compare the quality of life of patients with an active disease and in remission, and to compare the quality of life with the common Czech population. Methods and results 103 patients with Crohn's disease underwent a survey performed by means of 2 Czech versions of the quality of life questionnaires. The disease activity was assessed by means of the activity index CDAI (Crohn's disease activity index). The set consisted of 53 men and 50 women; the average age of patients was 42 years. An increased activity was found in 45 patients; 58 patients were in remission. The average CDAI score was 232.0 (SD=58.0) and the score in remission was 78.3 (SD=40.4). By...
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The use of physiological and pathophysiological pressure ratios in the area of the biliary ductal system and pancreas for diagnosis and treatment by endoscopic retrograde cholangiopancreatography
Keil, Radan ; Kvapil, Milan (advisor) ; Frič, Přemysl (referee) ; Hep, Aleš (referee) ; Mareš, Jan (referee)
:.In our work we wanted to confirm our clinical experience with therapy of biliary and pancreatic duct injuries from the endoscopic retrograde cholangiopancreatography (ERCP) which was done in 267. Children and infants with a variety of biliary tract disorders and traumatic injuries in the area of biliary and pancreatic duct.. Pressure of the bile plays the key role in the therapy of biliary tract injuries Therefore we have measured the pressure in biliary tract and duodenum before and after the sphincterotomy of Oddi sphincter. Thea aim of our study was to confirm the insertion of drainage into the biliary and pancreatic duct in children with injury in this area. Our results showed significant differences between biliary duct pressure and duodenal pressure in the patients before and after sphincterotomy of Oddi sphincter. This results on theoretical basis confirmed, that it is necessary in children after traumatic rupture of biliary duct to provide ERCP and insert a biliary drainage after sphincterotomy. With this procedure the biliary tract injury is healed ad integrum without surgical liver resection. To provide only papilosphincterotomy without biliary drainage is not sufficient. This new miniinvasive procedure plays a fundamental role in the therapy of blunt abdominal injuries in a children and infants...
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Management of Helicobacter pylori infection and dyspepsia in primary care
Seifert, Bohumil ; Bencko, Vladimír (advisor) ; Holčík, Jan (referee) ; Hep, Aleš (referee)
This thesis is devoted to dyspepsia and Helicobacter pylori infection, both significant issues for primary care. Various epidemiological and clinical studies from primary care are described. Current scientific opinions on dyspepsia and Helicobacter pylori infection important for optimal primary care management are presented. The critical interest of the author is in the severity of complaints and assessment of the individual risk of organic disease in patients presenting dyspepsia in primary care. In another study the author contributes to understanding and mutual cooperation between gastroenterologists and primary care physicians. The thesis concludes with practical guidelines, created as a result of interdisciplinary cooperation..
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