Esetismertetés / Case report
A rare congenital anomaly of the biliary system – Duplicated common bile duct of type Va – Case report
Duplication of the extrahepatic bile duct is an extremely rare congenital malformation of the biliary system in which two common bile duct exist, that is characterized by the presence of a septum within the common bile duct or the presence of the accessory common bile duct separately. According to the latest classification (Choi’s classification, 2007), there are five types of double common bile ducts. In this case report we present a case of a 62-year-old woman, at whom we recognized a rare case of type Va duplicated common bile duct with cholelithiasis and choledocholithiasis.
Összefoglaló közlemény / Review
Microbiome-associated inflammation and migraine: a new link in the brain-gut axis?
The gut-brain axis, which represents an important functional relationship between the digestive tract and the central nervous system, is grossly influenced by the gut microbiota. The Human Microbiome Project has resulted in a significant breakthrough and brought new perspectives into the etiopathological research on migraine headache which takes a central part in contemporary neuroscience and clinical pharmacology. Present review addresses the most recent results of migraine research with a focus on the long-lasting effects of environmental factors, especially metabolic and inflammatory changes. Our goal is to highlight key ideas for patient care in symptom discovery and root cause analysis in order to identify valuable lifestyle modifications. By influencing causative environmental factors, the latter can successfully supplement targeted pharmacotherapy and may help migraine prevention. The significance of a cause-oriented therapeutic approach with lifestyle interventions can hardly be overestimated due to the large prevalence of migraine headache in the Western World, and to the long-term adverse effects of current, merely symptomatic, analgesic treatments.
Összefoglaló közlemény / Review
COVID-19 and the liver
SARS-CoV-2 coronavirus, identified in 2019, is primarily causing respiratory tract COVID-19 diseases, in a good number of cases with severe or even fatal consequences. By now, COVID-19 related non-respiratory organ involvement with different severity has been proven. On the other hand, certain symptoms/diseases might persist for a prolonged period of time after the primary infection (post-acute COVID syndrome). Relationship between SARS-CoV-2 virus and the liver, including interactions of COVID-19 disease with pre-existing liver disease, consequences of COVID-19 and its therapy on the liver and vice versa, as well as hepatology aspects of vaccination are reviewed in this paper. Immunological, inflammatory and thrombotic processes, activation of immune system, and particularly the cytokine storm may cause liver injury during COVID-19, which – on the other hand – may worsen COVID-19 disease and its outcome. SARS-CoV-2 virus can directly bind to ACE2 receptors on cholangiocytes, however its direct hepato-pathogenicity is not confirmed. Half of COVID-19 patients develop laboratory abnormalities suggesting liver involvement. Factors associated with liver injury include severity of COVID-19 disease, type and severity of pre-existing liver disease, alcohol in etiology, and advanced age. Drug-induced liver injury is also to be considered in patients treated for COVID-19, and a thorough observation for side-effects is recommended.
Eredeti közlemény / Original publication
The national position of the training in endoscopic retrograde cholangiopancreatography in the light of the educational guidelines of the European Society of Gastrointestinal Endoscopy
Introduction: Appropriate theoretical and practical training is essential for performing high-quality endoscopic retrograde cholangiopancreatography (ERCP). The Endoscopy Section of the Hungarian Society of Gastroenterology aimed to organize this training, but assessing the current situation in Hungary is mandatory. Methods: We analyzed the data provided by the National Health Insurance Company. We surveyed the number of ERCP centers, their geographical location, and the number of all ERCPs, the number of ERCPs per endoscopist, and the number of ERCPs repeated within 30 days or referred to another center. Results: Forty-four institutes perform ERCPs (36% of all endoscopic centers), with an average of 231 ERCPs per center yearly. Only 16 sites (36%) perform examinations above the average number, which is 76% of all examinations annually. Thirty institutes perform at least 2 ERCPs/week, and they have performed 90% of all ERCPs in the last 3 years, with 72 physicians (typically 1-3 physicians/institute). Only one endoscopist performs ERCP in 13 sites (31%). The number of ERCPs/doctor does not reach 52/year in 13 institutes, of which at 5 places (38%) only 1 doctor examines. In 11 sites the rate of repeated ERCPs within 30 days, and in 4 the rate of failed ERCPs transferred to elsewhere exceeded 10%. In the latter institutes, the ERCP/doctor rate did not reach the desired 52/year. In 8 centers a larger number of second ERCPs are performed after a failure in another institution. Discussion: This is the first survey of ERCP performance in Hungary. Based on our survey, insufficiencies, where improvement to achieve indicators that are desirable and internationally accepted is needed, are identified.