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Maciej Swiatkowski

Publications and source records attributed to Maciej Swiatkowski.

At least 19 recordsLinked to original sources
PubMed2006

[Gastroesophageal reflux disease and coronary heart disease--coexistence or interrelationship?].

There is the normal coronary artery appearance in 20-30% of coronarographies, made in patients with chest pain and/or positive noninvasive cardiological tests. The simple explanation of this fact is the presence of diseases which may affect coronary perfusion via mechanism independent to the diameter of main coronary arteries. One of them is gastroesophageal reflux disease (GERD). The presence of GERD symptoms in general population concerns about 30-40% of individuals, while non-physiological reflux is stated in 50-65-85% of patients with coronary heart disease (CHD). That means, that GERD is twice more frequent in patients with CHD than in general population. One explanation of the increased frequency of gastroesophageal reflux appearance in patients with CHD is the adverse effect of drugs used in treatment of cardiological diseases. Morover, one of potential mechanisms explaining the influence of esophagal disturbance on the appearance of coronary hipoperfusion may be their common neurological control of the functions. There are three aspects of it: vagal reflexes (esophageal-cardiac reflex), the disturbances of autonomic nervous system balance and changes in visceral pain perception threshold. Visceral reflex can combine GERD and CHD with mechanism of vicious circle: acid gastroesophageal reflux via vagal reflex may cause coronary hipoperfusion, and the products of anaerobic metabolism of cardiomyocytes may cause relaxation of lower esophagus sphincter, facilitating reflux. Additional mechanism connecting GERD and CHD is inflammation caused by Helicobacter pylori infection. The relationship between digestive tract pathology and evolution, as well as progression and complications of atherosclerosis together with similarity of clinical presentation imply the necessity of precise diagnosis of chest pain causes and caution in interpretation of laboratory examination results.

Comorbidity↗
PubMed2006

[Insulin secretion at the diagnosis of gestational diabetes is lower in multiparas than in primiparas].

UNLABELLED: Gestational diabetes mellitus (GDM) has heterogeneous ethiopathogenesis, pathophysiology and clinical features. OBJECTIVES: The aim of the study was to evaluate some of anthropometric parameters, clinical features and indices of insulin resistance and beta cell function in GDM women in first pregnancy and in GDM women in third and following pregnancies. MATERIAL AND METHODS: 877 GDM women, aged 18-48 years were studied. Both groups were compared according to age, BMI before pregnancy, week of GDM diagnosis, weight gain during pregnancy, fasting blood glucose, fasting serum insulin level, HbA1c, insulin resistance and beta-cell function indices. All parameters except BMI were evaluated at GDM diagnosis. RESULTS: Multiparas were older, with higher BMI and lower beta-cell function indices. CONCLUSION: At the moment of GDM diagnosis, insulin secretion evaluated by HOMA indices are lower in multiparas in comparison to primaparas.

Adult↗
PubMed2006

Differences in esophageal corpus motility in patients with pathological and non-pathological gastroesophageal reflux.

BACKGROUND: First- and second-order esophageal contractions are important factors responsible for esophageal clearance of refluxed gastric content. The aim of this study was to estimate the influence of acid reflux on second-order esophageal peristalsis. MATERIAL/METHODS: Simultaneous 24-h esophageal pH-metry and 24-h motility monitoring was performed in 213 patients with non-cardiac chest pain. Pathological gastroesophageal acid reflux (pGER) was defined as pH <4 for more than 4.5% of the total monitoring time. RESULTS: The group of pGER patients (n=65, 31%) had a lower percentage of complete and effective peristalsis, a higher percentage of incomplete peristalsis, and a lower mean contraction amplitude than the group of patients with normal esophageal acid exposure (nGER). Analysis of motility parameters in three periods, i.e. during acid reflux and 2 min before and 10 min after episodes (second-order peristalsis), showed that the pGER group had a lower percentage of effective peristalsis (20.6 +/- 13.3 vs. 29.6 +/- 16.2%, p = 0.002) and a higher percentage of ineffective peristalsis both during and after acid reflux, a lower mean contraction amplitude (56.5 +/- 30.3 vs. 70.0 +/- 32.8 mmHg, p=0.025), and a lower contraction frequency during acid reflux (1.6 +/- 0.7 vs. 2.6 +/- 3.1/min, p=0.001) and 10 min after (1.9 +/- 1.9 vs. 20.6 +/- 30.2/min, p=0.002), which indicated a lack of esophageal peristalsis acceleration after acid reflux in the pGER group. CONCLUSIONS: (1) pGER patients had ineffective esophageal peristalsis more frequently than nGER patients. (2) Impaired second-order peristalsis in pGER patients may be an important factor determining prolonged exposure of the esophageal mucosa to gastric content in addition to lower esophageal sphincter function.

Adult↗
PubMed2006

[Insulin resistance in pregnant type 1 diabetic female. Case report].

Insulin resistance may coexist with diabetes type 1 and make treatment of diabetes difficult. Case of 24-year-old type 1 diabetic female with insulin resistance features prior to pregnancy is reported. Exacerbating of insulin resistance during pregnancy was manifested by difficulties to overcome excessive weight gain and necessity to initiate treatment with high doses of insulin. The treatment was based on diet with progressive caloric restriction to 800 kcal/day in 35 week of pregnancy. That diet was continued till the delivery in 37 week. The fast acting analog insulin (Humalog) and long acting insulin (Humulin U) were used in treatment of diabetes. Treatment with low calorie diet did not cause negative effects on diabetic female metabolism and on the neonate state.

Adult↗
PubMed2005

[Gastroesophageal acid reflux as a causative factor of paroxysmal atrial fibrillation].

We present a case of a patient with very frequent episodes of paroxysmal atrial fibrillation (AF) who, besides hypertension and well-controlled post-amiodarone thyreotoxicosis, had no other potential causes of AF. Because of symptoms of gastroesophageal acid reflux, the patient was treated with omeprazole which significantly reduced the frequency of AF episodes. Next, the patient underwent anti-reflux surgery and has now only sporadic recurrences of AF. Our observations suggest that gastroesophageal acid reflux may be a triggering factor of AF.

Atrial Fibrillation↗
PubMed2005

[Outcome of non-pharmacologic treatment in a gestational diabetic woman with high insulin resistance HOMA-IR index and allergy to human insulin. Case report].

Gestational diabetes is a syndrome of significant pathophysiological and clinical heterogeneity. This type of diabetes mellitus can be treated with diet, exercise and insulin in cases of unsatisfactory results of nonpharmacologic treatment. It has been reported the case of a 28-year -old female with gestational diabetes treated with high doses of insulin (128 U/per day) on four injections regimens. During the therapy allergic type III reactions to human insulin preparations (Ultratard HM, Actrapid HM Humulin U, Humulin R, Humalog) has been occurred at the injection site. The insulin was omitted. We applied diet modification and 15-30 minutes walking before meals till the afternoon with god metabolic control. High insulin resistance index HOMA-IR, type 2 diabetes history in both parents god metabolic control of nonpharmacologic treatment, and impaired glucose tolerance after post-partum may suggest, the early stage of diabetes type 2 in presented case.

Adult↗
PubMed2005

[The relationship between oesophageal and gastric pH during 24-hours pH-metry in patients diagnosed with atypical chest pain].

UNLABELLED: Gastric secretion is the only source of hydrochloric acid influencing oesophageal and extraesophageal symptoms in patients with gastroesophageal reflux disease (GERD). The aim of this study was to determine the relationships between gastric and oesophageal pH estimated by 24-hours pH-metry. PATIENTS AND METHODS: We studied 93 men suffering from atypical chest pain. In all endoscopy with mucosa biopsy and simultaneous gastric and oesophageal 24-hours pH-metry using two-channel antimony probe with 15 cm distance of measurement ducts were performed. RESULTS: Among studied patients 24 (26%) had pathological gastroesophageal acid reflux in pH-metry (above 4.5% of monitoring time with oesophageal pH<4). This patients group had higher percentage of monitoring time with gastric pH<4. but only with borderline statistical significance. We did not not find significant differences in values of gastric and oesophageal pH-metry parameters between patients group divided in relation to presence of endoscopic and histologic features of oesophagitis. We found only some significant, but weak correlations between gastric and oesophageal pH. CONCLUSION: Only weak relationship occurring between gastric and oesophageal pH suggests more important role of some other factors in pathogenesis of gastroesophageal reflux and oesophageal mucosa injury.

Adult↗
PubMed2005

[Insulin Lispro as an alternative for insulin Humulin U in the treatment of an obese gestational diabetic woman with allergy to Humulin U. Case report].

It has been reported the case of 32-year-old obese gestational diabetic woman, treated with Humulin U and Humalog from 28 week of gestation. Seventeen days after initiation of insulin Humulin U the woman developed allergic type I cutaneous changes. During the few minutes following injection of Humulin U, the local wheal-flare reactions accompanied by itching has been occurred. These symptoms have been disappeared after a few hours. Insulin Humulin U was discontinued (18 j). Glycemia were monitored every 1-2 hours between 8 pm-6 am. Glycemia were in normal range between 8 pm. till 5 am. We have observed increase of glycemia to 6.34 mmol/l between 5 am.-6 am. The therapy was converted to Humalog injected at 5 30 am with glycemic control one hour later. The glycemic control was very good till next dose of Humalog before breakfast. The doses of Humalog were systematically increased at 5.30 am depend on glycemia at 6.30 with highest doses in 37 week of pregnancy (30 j with 180 j a day). The good glycemic control was maintained till delivery (38 week of pregnancy). That method of therapy was good tolerated and was not strenuous in spite of necessity of early awakening. We suggest that in obese gestational diabetics ultra-short insulin preparation, analog of short acting human insulin (Humalog), injected at 5.30 am might be considered as a therapeutic alteration for long acting insulin injected at evening. This observation may be interesting especially in situations in which long acting insulin injected at evening must be discontinued.

Adult↗
PubMed2005

[The effect of hypolipemic therapy with diet and simvastatin on the course of angina pectoris and the results of exercise stress test in patients with coronary artery disease].

UNLABELLED: Statins are the multi-directorial acting drugs in atherosclerosis prevention, which decrease the overall and cardiovascular mortality. The aim of this study was to estimate the effect of six-month long hypolipemic therapy with diet and 20 mg of simvastatin on clinical intensity of angina pectoris and the course of exercise stress test. PATIENTS AND METHODS: We studied 44 patients with typical anginal chest pain. In all blood sampling and treadmill stress test were made, and next in all hypolipemic diet and simvastatin 20 mg were recommended. After four weeks and six months of treatment clinical assessment and exercise test were made. RESULTS: After four weeks and six month long observation period the decrease of total and LDL cholesterol, triglycerides and fibrinogen were found. Moreover, we have observed the improvement in frequency of anginal symptoms, their intensity in CCS classification and number of nitroglycerin tablets taken per week. The course of exercise test was also ameliorated: the percentage of patients, in whom stress test was finished because of chest pain was decreased, time of chest pain duration after exercise cessation was shorter, the percentage of patients with significant ST interval depression diminished, maximal ST interval depression as well as the time of significant ST interval depression duration also decreased. Although improvement in values of mentioned parameters, after six months long therapy with simvastatin the percentage of patients with Duke's treadmill score value showing intermediate cardiovascular risk (between -10 and +4) increased. In conclusion, therapy with hypolipemic diet and simvastatin already after four weeks decreased plasma lipids and fibrinogen levels and improved the course of angina pectoris and exercise stress test, what suggested its effectiveness not only as the treatment improving atherosclerosis risk factors, but also with prompt and clinical important effect ameliorating the handicapped coronary reserve.

Adult↗
PubMed2004

Improvement in clinical course and laryngeal appearance in selected patients with chronic laryngitis after eight weeks of therapy with rabeprazole.

BACKGROUND: One well-known extraesophageal manifestation of gastroesophageal reflux disease (GERD) is chronic laryngitis. The aim of this study was to estimate the efficiency of eight weeks of treatment with the PPI rabeprazole in a selected group of patients with chronic idiopathic laryngitis without typical GERD symptoms. MATERIAL/METHODS: Seventeen patients (nine men and eight women) aged 35-72 years, with long histories (0.5 to 6 years) of chronic idiopathic laryngitis were included in the study. Larynx appearance was estimated by laryngostroboscopy. This examination, as well as interview and physical examination were performed in all patients at the start of the study and after 8 weeks of treatment with 20 mg rabeprazole taken orally twice a day. RESULTS: There was remarkably good therapeutic outcome, clinical symptoms such as hoarseness and pharyngeal pain resolved, respectively, in 68.7 and 78.5% of patients and laryngeal signs in 50-80%, except for weak tension of the vocal cords which was observed in 12 patients at the start and end of the study. CONCLUSIONS: Treatment with a proton pump inhibitor can be considered as a first-line diagnostic and therapeutic method in patients with idiopathic chronic laryngitis. Weak tension of vocal cords was often seen in these patients and persisted after the 8-week-long treatment.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2004

Suppression of gastric acid production may improve the course of angina pectoris and the results of treadmill stress test in patients with coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) and gastro-esophageal reflux disease (GERD) often coexist in the same patients. The aim of this study was to estimate the effects of gastric acid output suppression with rabeprazole on course of angina pectoris and results of the treadmill stress test in patients with CAD. MATERIAL/METHODS: We studied 34 patients with stable angina pectoris. In all subjects a medical history, a physical examination, and a stress test were performed at the beginning of the study and after two weeks of add-on rabeprazole therapy (20 mg b.i.d.). RESULTS: Rabeprazole therapy significantly improved the outcome of the stress test in 27 patients (79%), prolonging mean stress exercise time (449+/-147 vs. 489+/-156s, p=0.027) and exercise time, leading to a maximum ST interval depression (360+/-167 vs. 467+/-148s, p=0.001), and also decreasing ST interval depression delta (1.9+/-1.1 vs. 1.5+/-0.9; p=0.013). CONCLUSIONS: In 79% of our study subjects, rabeprazole improved stress test results in CAD patients, which implies that at least some of their symptoms were related to GERD. A proton pump inhibitor exerted a favorable effect on the frequency of angina-like chest pain and the results of the treadmill stress test.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2004

Autonomic nervous function in Helicobacter pylori-infected patients with atypical chest pain studied by analysis of heart rate variability.

OBJECTIVES: Cardiovascular autonomic nervous system (ANS) activity estimated by analysis of heart rate variability (HRV) was compared in Helicobacter pylori-positive and H. pylori-negative male patients suffering from atypical chest pain to verify the hypothesis that autonomic neural system might be the way linking chronic H. pylori infection with gastrointestinal tract disorders. METHODS: We have analysed data obtained from 101 male patients examined in our clinic due to atypical chest pain, without evidence of serious cardiovascular, respiratory and digestive tract or metabolic diseases. In each patient, besides interview and physical examination, were performed: gastroscopy with mucosa biopsy (for urease test and histology), oesophageal pH-metry and manometry, ultrasound abdomen examination, chest X-ray, exercise test on running track, 24-h ECG Holter monitoring with time-domain and frequency-domain HRV analysis, and echocardiography. RESULTS: In comparison with H. pylori-negative, in all H. pylori-infected patients (n = 63) a significantly greater low frequency power, an index of sympathetic activity, and higher values of vagal tone parameters [pNN50, percentage of differences between RR intervals that are greater than 50 ms; high-frequency power in HRV analysis (HF)] were observed. The relationship between H. pylori infection and the HF value was confirmed in multi-factorial analysis. The aforementioned ANS activity differences were accompanied by: significantly fewer gastro-oesophageal acid reflux episodes, lower gastric acidity and more effective and complete oesophageal peristalsis in H. pylori-positive patients. CONCLUSIONS: H. pylori infection may affect ANS activity and via this way also contribute to gastro-oesophageal and cardiovascular pathology.

Adult↗
PubMed2004

The effect of eight weeks of rabeprazole therapy on nitric oxide plasma level and esophageal pH and motility and motility nitric oxide plasma level in patients with erosive esophagitis.

BACKGROUND: Esophageal clearance, an important pathogenetic factor in gastroesophageal reflux disease, depends mainly on motility. Motility disturbances can be secondary to gastric output reflux. Nitric oxide influences esophageal motility. The aim of this study was to determine the effect of eight weeks of gastric acid secretion suppression with rabeprazole (20 mg/day) on esophageal motility. MATERIAL/METHODS: 20 patients with erosive esophagitis were studied. At study start and two weeks after the end of therapy, we recorded the results of interview, endoscopy, gastric and esophageal mucosa biopsy, 24-h esophageal pH-metry and manometry, and NO metabolites plasma concentration, determined spectrophotometrically (OXIS). RESULTS: All patients reported improvement and remained free of symptoms two weeks later. In 60% of cases, improvement of esophageal mucosa appearance was observed in endoscopic and histological examination. In follow-up we found a significantly smaller number of acid gastrooesophageal refluxes (p<0.05), reduced DeMeester score for pH range >7 (p<0.05), and greater % of time within the esophageal pH range 6-7 (p<0.05). Other esophageal pH-metry and 24-h manometry parameters did not change significantly. NO metabolites plasma concentration increased significantly (p=0.039). CONCLUSIONS: Clinical improvement after eight weeks of therapy with rabeprazole was connected with endoscopic changes only in 60% of our patients. Rabeprazole therapy did not influence esophageal motility, despite increased plasma levels of NO metabolites. Patients with erosive esophagitis need maintenance therapy, since as soon as two weeks after the end of treatment the % of monitoring time with esophageal pH<4 was similar to study start.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2004

Parameters of the functional and morphological status of the upper digestive tract in alcohol-dependent male patients with depression and alexithymia in the context of autonomic nervous system activity and nitric oxide plasma level.

BACKGROUND: Psychosomatic factors play an important role in the pathogenesis of many diseases. The aim of this study was to compare the results of upper digestive tract examinations in alcoholics with depression and/or alexithymia diagnosed with atypical chest pain. MATERIAL/METHODS: In 52 alcohol dependent male patients with atypical chest pain we performed gastroduodenoscopy, esophageal and gastric pH-metry, 24-h esophageal manometry, treadmill stress test, Holter monitoring, and blood sampling. Depression was diagnosed using the Beck Depression Inventory (BDI), and alexithymia according to the Toronto Alexithymia Scale (TAS). RESULTS: Depression and/or alexithymia were diagnosed in 37 patients (71%). Depressive and alexithymic patients, in comparison to subjects with lower BDI and TAS scores, had less intensive Helicobacter pylori antral colonization, higher values of gastro-esophageal acid reflux parameters in 24h pH-metry, higher mean amplitude of contraction, longer mean contraction duration, higher percentage of hypertensive contractions, and a greater percentage of effective peristalsis, in spite of a similar percentage of peristaltic and simultaneous contractions. The patient groups did not differ in relation to gastric pH-metry parameters or factors potentially connecting mental status and esophageal function regulation, such as plasma nitric oxide metabolite concentration and heart rate variability (HRV), which correlate with autonomic nervous system activity. CONCLUSIONS: In alcoholic patients with depression and alexithymia there is a tendency to greater functional disturbances in the upper digestive tract. The observed differences between groups were not related to changes in ANS activity and nitric oxide metabolism.

Adult↗