In addition to the obviously benign and malign common bile duct (CBD) strictures there is a so called indeterminate CBD strictures group, that covers those which cannot be definitely diagnosed with conventional ERCP sampling methods (brushing, intraductal biopsy). In these cases intraductal cholangioscopy is more suitable for a more accurate diagnosis. As a special endoscopic method a device is directly inserted into the CBD allowing direct visualisation. This allows targeted biopsies resulting greater diagnostic accuracy. One form of the procedure is to introduce a cholangioscope into the bile duct via the accessory channel of the duodenoscop, the other possibility is introducing an ultraslim endoscope through the mouth. Previous sphincterotomy is required in both cases, and the use of a guide wire is also recommended. Since 1 July 2017 we have performed 14 cholangioscopies in our department. 5 of the 14 examined cases were diagnosed as indeterminate stricture. We present the medical history of 31 year old young patient in our case report.

This review summarizes the update investigation and modern approach to assessing findings in patients with GERD. Over more than a decade since the Porto Consensus, a number of changes have taken place in the diagnostic work up of GERD, which are published now in the Lyon Consensus. The Lyon Consensus defines parameters on oesophageal testing that conclusively establish the presence of GERD and characteristics that rule out GERD. Clinical history and response to antisecretory therapy are insufficient to make a clear diagnosis of GERD, but are indispensible to determine the need for further investigation. Conclusive diagnosis can be made in cases where LA-C, LA-D oesophagitis or complicated GERD has been demonstrated at endoscopy. A normal endoscopic finding with histology does not exclude GERD. In patient with PPI refractory GERD pH and impedance monitoring plays a central role. In most cases, the study should be performed at least one week after the PPI treatment is discontinued, and if the acid exposure time (AET) in the distal oesophagus is >6%, GERD is established, or it can paracticaly be excluded if the AET<4% and the number of reflux episodes is <40. The reflux-symptom relationship on pH and impedance monitorig is indicated by the symptom index (SI) and the symptom association probability (SAP). In cases with normal AET (50%, SAP>95%). In patients with borderline pH-impedance monitoring values (AET 4-6%, the number of reflux episodes 40-80), or in other inconclusive cases the impaired cardia or oesophagus body function detected by high resolution manometry (HRM) can be of value to make further therapeutic decisions. Concerning the future GERD management the Lyon Consensus report proposes an individual patient phenotype-based strategy.

Ulcerative colitis is an immune-mediated bowel disease of unknown etiology, which requires long-term treatment and follow-up. The disease is characterized by relapses, and clinical and endoscopic indices can be of great tool in monitoring it, allowing easier comparability, objective, clear documentation and therapeutic decisions. Many clinical and endoscopic score systems have been developed, but only a fraction of them are validated, however, simplicity of use has a priority in practice.

Hepatitis C viral (HCV) infection became curable by Today. Eradication of the virus is beneficial and essential from both individual as well as from social aspects. Treatment depends on availability and reimbursement of approved drugs in Hungary, and is based on a national consensus guideline, updated six-monthly. If no contraindication, demonstration of viral replication qualifies as indication of therapy. IFN-free treatments are recommended and available for most of diagnosed patients. Pegylated IFN (PegIFN) plus ribavirin (RBV) therapy is restricted to exceptional situations only. Sequence of treatment initiation is determined by stage of fibrosis and by other – including epidemiological – factors, according to a priority scoring system.