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Article ; Online: Recurrent bleeding in a patient with hepaticojejunostomy caused by Dieulafoy's lesion.

Falt, Premysl / Kunovsky, Lumir

United European gastroenterology journal

2023 Volume 11, Issue 9, Page(s) 904–905

MeSH term(s)	Humans ; Intestines ; Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/surgery
Language	English
Publishing date	2023-07-27
Publishing country	England
Document type	Case Reports
ZDB-ID	2728585-6
ISSN	2050-6414 ; 2050-6406
ISSN (online)	2050-6414
ISSN	2050-6406
DOI	10.1002/ueg2.12440
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Article ; Online: Improved nutritional outcomes and gastrointestinal symptoms in adult cystic fibrosis patients treated with elexacaftor/tezacaftor/ivacaftor.

Stastna, Nela / Kunovsky, Lumir / Svoboda, Michal / Pokojova, Eva / Homola, Lukas / Mala, Miriam / Gracova, Zaneta / Jerabkova, Barbora / Skrickova, Jana / Trna, Jan

Digestive diseases (Basel, Switzerland)

2024

Abstract: Introduction: CFTR modulator therapy improves nutritional status and quality of life. Clinical trials have shown pancreatic insufficiency conversion, mostly in pediatric patients treated with ivacaftor. Studies with elexacaftor/tezacaftor/ivacaftor (ETI) ...

Abstract	Introduction: CFTR modulator therapy improves nutritional status and quality of life. Clinical trials have shown pancreatic insufficiency conversion, mostly in pediatric patients treated with ivacaftor. Studies with elexacaftor/tezacaftor/ivacaftor (ETI) in older patients have not suggested restoration of exocrine pancreas function, but quality data in adults are lacking. Our aim was to show the effect of ETI in adults with CF on nutritional status and digestive function. We hypothesized improvement of nutritional parameters and gastrointestinal symptoms, reduction of pancreatic enzyme replacement therapy, but uncertain improvement in exocrine pancreatic function. Methods: We prospectively enrolled adults with CF treated with ETI from August 2021 to June 2022. We measured anthropometric parameters, laboratory nutritional markers, change of fecal elastase, pancreatic enzymes replacement therapy needs, and gastrointestinal symptoms. Results: In the cohort of 29 patients (mean age 29.1 years), 82.8% suffered exocrine pancreatic insufficiency. After ETI, mean BMI increased by 1.20 kg/m2 (p < 0.001), mean body weight by 3.51 kg (p < 0.001), albumin by 2.81 g/L, and prealbumin by 0.06 (both p < 0.001). Only one patient, initially pancreatic insufficient (4.5%, p < 0.001), developed pancreatic sufficiency, indicated by increased fecal elastase from 45 µg/g to 442.1 µg/g. Mean change in lipase substitution decreased by 1,969 units/kg/day (p < 0.001) and stools frequency by 1.18 per day (p < 0.001). Conclusion: Our data suggest increased nutritional parameters, lower pancreatic substitution requirements, and improved defecation in adult CF patients on ETI. Improvement in exocrine pancreatic function might be mutation-specific and needs further study.
Language	English
Publishing date	2024-04-03
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	632798-9
ISSN	1421-9875 ; 0257-2753
ISSN (online)	1421-9875
ISSN	0257-2753
DOI	10.1159/000538606
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Article: Risk factors of pancreatic cancer and their possible uses in diagnostics.

Lang, Jitka / Kunovský, Lumír / Kala, Zdeněk / Trna, Jan

Neoplasma

2020 Volume 68, Issue 2, Page(s) 227–239

Abstract: Pancreatic cancer (PC) is a form of malignancy of increasing incidence and poor prognosis, with an average of less than 10% of patients surviving 5 years after being diagnosed. The main reason for this unfavorable situation is the long asymptomatic ... ...

Abstract	Pancreatic cancer (PC) is a form of malignancy of increasing incidence and poor prognosis, with an average of less than 10% of patients surviving 5 years after being diagnosed. The main reason for this unfavorable situation is the long asymptomatic course of the disease, and the absence of a simple screening method, typically leading to the late discovery of the disease. The development of the malignancy from the initial carcinogenesis into invasive pancreatic carcinoma takes approximately 10 years. However, the progression of pancreatic cancer from early into advanced stages can be, according to the latest studies, incredibly fast, just a few months. Early stages of pancreatic malignancy can be detected only by expensive, and sometimes invasive, diagnostic methods (CT, MRI, or EUS). Due to the current absence of a reliable non-invasive screening method, it is necessary to define a group of patients who have the highest risk of PC development, five to ten times higher risk compared to the regular population at a minimum. Risk factors combine in their effect; therefore, relative risks of PC development need to be summarized to obtain a total relative risk for each person. The main and non-influenceable risk factor in the development of PC is the increasing age. The other non-influenceable risk factor of PC is a genetic predisposition - family incidence of the disease can be detected in 4-16% of patients. Some specific genes and mutations, which can play a role in PC development have already been identified (for example mutation of the PRSS-1 gene). Among the influenceable risk factors of PC is primarily smoking; obesity can play a part in PC development as well. A higher risk of PC is observed in patients with chronic pancreatitis. Nowadays, the relationship between PC and diabetes mellitus (DM) is hotly discussed. In the case of long-standing DM, the risk of pancreatic cancer is two times higher compared to the healthy population. However, new-onset DM can be the first sign of still asymptomatic PC. These patients, with paraneoplastic DM caused by pancreatic cancer cells, represent approximately 1% of recently diagnosed patients. However, this group of patients is still too large for screening. Because of that, it is necessary to find specific criteria to distinguish classic DM from the paraneoplastic form. The application of these criteria can help with the better stratification of risk in patients with new-onset diabetes and hence, it can help to discover PC in its early stages.
MeSH term(s)	Genetic Predisposition to Disease ; Humans ; Pancreatic Neoplasms/diagnosis ; Pancreatic Neoplasms/epidemiology ; Pancreatic Neoplasms/etiology ; Risk Factors ; Smoking ; Pancreatic Neoplasms
Language	English
Publishing date	2020-12-23
Publishing country	Slovakia
Document type	Journal Article
ZDB-ID	415445-9
ISSN	0028-2685
ISSN	0028-2685
DOI	10.4149/neo_2020_200706N699
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Article ; Online: Autoimmune pancreatitis - An ongoing challenge.

Blaho, Martin / Dítě, Petr / Kunovský, Lumír / Kianička, Bohuslav

Advances in medical sciences

2020 Volume 65, Issue 2, Page(s) 403–408

Abstract: Autoimmune pancreatitis is a rare form of chronic pancreatitis. The first descriptions of the disease date back to the 1990s. Etiology is multifactorial, with the use of genetic, environmental and complex immunological mechanisms. It is classified into ... ...

Abstract	Autoimmune pancreatitis is a rare form of chronic pancreatitis. The first descriptions of the disease date back to the 1990s. Etiology is multifactorial, with the use of genetic, environmental and complex immunological mechanisms. It is classified into two subtypes. Type 1 is part of a group of diseases called IgG4-related disease. Clinically is autoimmune pancreatitis manifested by icterus and abdominal discomfort. It can rarely present as acute pancreatitis. There is also a completely asymptomatic form of the disease. The diagnosis is based on abnormalities in histology, imaging methods, serology, the involvement of other organs in relation to IgG4-related disease, and a significant positive response to corticosteroid therapy. Differential diagnosis between the focal form of autoimmune pancreatitis and pancreatic cancer can be complicated, with endosonography playing an important role. In the treatment, we use corticosteroids and other immunosuppressants including biological therapy. Patients with the asymptomatic disease should also be treated to prevent late complications and exocrine and endocrine insufficiency. In addition to drug treatment, endoscopic and/or surgical treatment may be necessary. Even after recovery, the disease can relapse. The relationship between autoimmune pancreatitis and malignancies has not been clearly confirmed. The goal of this review is to provide a comprehensive look at autoimmune pancreatitis and translate latest scientific knowledge into clinical practice.
MeSH term(s)	Acute Disease ; Animals ; Autoimmune Diseases/genetics ; Autoimmune Diseases/immunology ; Autoimmune Pancreatitis/genetics ; Autoimmune Pancreatitis/immunology ; Humans ; Pancreatic Neoplasms/genetics ; Pancreatic Neoplasms/immunology ; Pancreatitis, Chronic/genetics ; Pancreatitis, Chronic/immunology
Language	English
Publishing date	2020-08-14
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2273668-2
ISSN	1898-4002 ; 1896-1126
ISSN (online)	1898-4002
ISSN	1896-1126
DOI	10.1016/j.advms.2020.07.002
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Article: Skin manifestations of pancreatic diseases.

Kunovsky, Lumir / Dite, Petr / Brezinova, Eva / Sedlakova, Libuse / Trna, Jan / Jabandziev, Petr

Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia

2022

Abstract: Although symptoms of pancreatic diseases such as pancreatitis, acute and chronic and, carcinoma of the pancreas are mainly gastrointestinal in nature, the extra-pancreatic symptoms are also important. These include skin symptoms, such as pancreatic ... ...

Abstract	Although symptoms of pancreatic diseases such as pancreatitis, acute and chronic and, carcinoma of the pancreas are mainly gastrointestinal in nature, the extra-pancreatic symptoms are also important. These include skin symptoms, such as pancreatic panniculitis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema, cutaneous signs of hemorrhage, as in persons with severe acute pancreatitis, or the finding of cutaneous metastases of pancreatic carcinoma, which may be a sign of advanced disease. The pancreas is therefore one of those organs for which diagnosis and therapy are often multidisciplinary. In this review article, we summarize current knowledge of the possible skin manifestations of pancreatic disorders.
Language	English
Publishing date	2022-07-22
Publishing country	Czech Republic
Document type	Journal Article
ZDB-ID	17196-7
ISSN	1804-7521 ; 1213-8118 ; 0231-5599 ; 0862-481X
ISSN (online)	1804-7521
ISSN	1213-8118 ; 0231-5599 ; 0862-481X
DOI	10.5507/bp.2022.035
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Article: Current trends in the diagnosis of pancreatic cancer.

Vanek, Petr / Eid, Michal / Psar, Robert / Zoundjiekpon, Vincent / Urban, Ondrej / Kunovský, Lumír

Vnitrni lekarstvi

2022 Volume 68, Issue 6, Page(s) 363–370

Abstract: Pancreatic ductal adenocarcinoma (PDAC) is a dreaded malignancy with a dismal 5-year survival rate despite maximal efforts on optimizing treatment strategies. Currently, early detection is considered to be the most effective way to improve survival as ... ...

Title translation	Současné trendy v diagnostice karcinomu pankreatu.
Abstract	Pancreatic ductal adenocarcinoma (PDAC) is a dreaded malignancy with a dismal 5-year survival rate despite maximal efforts on optimizing treatment strategies. Currently, early detection is considered to be the most effective way to improve survival as radical resection is the only potential cure. PDAC is often divided into four categories based on the extent of disease: resectable, borderline resectable, locally advanced, and metastatic. Unfortunately, the majority of patients are diagnosed with locally advanced or metastatic disease, which renders them ineligible for curative resection. This is mainly due to the lack of or vague symptoms while the disease is still localized, although appropriate utilization and prompt availability of adequate diagnostic tools is also critical given the aggressive nature of the disease. A cost-effective biomarker with high specificity and sensitivity allowing early detection of PDAC without the need for advanced or invasive methods is still not available. This leaves the diagnosis dependent on radiodiagnostic methods or endoscopic ultrasound. Here we summarize the latest epidemiological data, risk factors, clinical manifestation, and current diagnostic trends and implications of PDAC focusing on serum biomarkers and imaging modalities. Additionally, up-to-date management and therapeutic algorithms are outlined.
MeSH term(s)	Humans ; Pancreatic Neoplasms/diagnosis ; Carcinoma, Pancreatic Ductal/diagnosis ; Carcinoma, Pancreatic Ductal/surgery ; Pancreatic Neoplasms
Language	English
Publishing date	2022-10-31
Publishing country	Czech Republic
Document type	Journal Article
ZDB-ID	138213-5
ISSN	1801-7592 ; 0042-773X
ISSN (online)	1801-7592
ISSN	0042-773X
DOI	10.36290/vnl.2022.076
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Article ; Online: Corrigendum to "The combination of endoluminal radiofrequency ablation and metal stent implantation for the treatment of malignant biliary stenosis - Randomized study". [Eur. J. Radiol. 142 (2021) 109830].

Andrasina, Tomas / Rohan, Tomas / Panek, Jiri / Kovalcikova, Petra / Kunovsky, Lumir / Ostrizkova, Lenka / Valek, Vlastimil

European journal of radiology

2022 Volume 148, Page(s) 110180

Language	English
Publishing date	2022-02-01
Publishing country	Ireland
Document type	Published Erratum
ZDB-ID	138815-0
ISSN	1872-7727 ; 0720-048X
ISSN (online)	1872-7727
ISSN	0720-048X
DOI	10.1016/j.ejrad.2022.110180
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Article ; Online: Management of pheochromocytomas and paragangliomas: Review of current diagnosis and treatment options.

Eid, Michal / Foukal, Jakub / Sochorová, Dana / Tuček, Štěpán / Starý, Karel / Kala, Zdeněk / Mayer, Jiří / Němeček, Radim / Trna, Jan / Kunovský, Lumír

Cancer medicine

2023 Volume 12, Issue 13, Page(s) 13942–13957

Abstract: Pheochromocytomas (PCCs) are rare neuroendocrine tumors derived from the chromaffin cells of the adrenal medulla. When these tumors have an extra-adrenal location, they are called paragangliomas (PGLs) and arise from sympathetic and parasympathetic ... ...

Abstract	Pheochromocytomas (PCCs) are rare neuroendocrine tumors derived from the chromaffin cells of the adrenal medulla. When these tumors have an extra-adrenal location, they are called paragangliomas (PGLs) and arise from sympathetic and parasympathetic ganglia, particularly of the para-aortic location. Up to 25% of PCCs/PGLs are associated with inherited genetic disorders. The majority of PCCs/PGLs exhibit indolent behavior. However, according to their affiliation to molecular clusters based on underlying genetic aberrations, their tumorigenesis, location, clinical symptomatology, and potential to metastasize are heterogenous. Thus, PCCs/PGLs are often associated with diagnostic difficulties. In recent years, extensive research revealed a broad genetic background and multiple signaling pathways leading to tumor development. Along with this, the diagnostic and therapeutic options were also expanded. In this review, we focus on the current knowledge and recent advancements in the diagnosis and treatment of PCCs/PGLs with respect to the underlying gene alterations while also discussing future perspectives in this field.
MeSH term(s)	Humans ; Pheochromocytoma/diagnosis ; Pheochromocytoma/genetics ; Pheochromocytoma/therapy ; Paraganglioma/diagnosis ; Paraganglioma/genetics ; Paraganglioma/therapy ; Carcinogenesis ; Cell Transformation, Neoplastic ; Adrenal Gland Neoplasms/diagnosis ; Adrenal Gland Neoplasms/genetics ; Adrenal Gland Neoplasms/therapy
Language	English
Publishing date	2023-05-05
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2659751-2
ISSN	2045-7634 ; 2045-7634
ISSN (online)	2045-7634
ISSN	2045-7634
DOI	10.1002/cam4.6010
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Article ; Online: 16S rRNA gene primer choice impacts off-target amplification in human gastrointestinal tract biopsies and microbiome profiling.

Deissová, Tereza / Zapletalová, Martina / Kunovský, Lumír / Kroupa, Radek / Grolich, Tomáš / Kala, Zdeněk / Bořilová Linhartová, Petra / Lochman, Jan

Scientific reports

2023 Volume 13, Issue 1, Page(s) 12577

Abstract: 16S rRNA amplicon sequencing or, more recently, metatranscriptomic analysis are currently the only preferred methods for microbial profiling of samples containing a predominant ratio of human to bacterial DNA. However, due to the off-target amplification ...

Abstract	16S rRNA amplicon sequencing or, more recently, metatranscriptomic analysis are currently the only preferred methods for microbial profiling of samples containing a predominant ratio of human to bacterial DNA. However, due to the off-target amplification of human DNA, current protocols are inadequate for bioptic samples. Here we present an efficient, reliable, and affordable method for the bacteriome analysis of clinical samples human DNA content predominates. We determined the microbiota profile in a total of 40 human biopsies of the esophagus, stomach, and duodenum using 16S rRNA amplicon sequencing with the widely used 515F-806R (V4) primers targeting the V4 region, 68F-338R primers and a modified set of 68F-338R (V1-V2M) primers targeting the V1-V2 region. With the V4 primers, on average 70% of amplicon sequence variants (ASV) mapped to the human genome. On the other hand, this off-target amplification was absent when using the V1-V2M primers. Moreover, the V1-V2M primers provided significantly higher taxonomic richness and reproducibility of analysis compared to the V4 primers. We conclude that the V1-V2M 16S rRNA sequencing method is reliable, cost-effective, and applicable for low-bacterial abundant human samples in medical research.
MeSH term(s)	Humans ; RNA, Ribosomal, 16S/genetics ; Genes, rRNA ; Reproducibility of Results ; Sequence Analysis, DNA/methods ; Microbiota/genetics ; Gastrointestinal Tract ; Biopsy ; High-Throughput Nucleotide Sequencing/methods
Chemical Substances	RNA, Ribosomal, 16S
Language	English
Publishing date	2023-08-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-39575-8
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Article ; Online: Celiac Disease: Promising Biomarkers for Follow-Up.

Hrunka, Matěj / Janda, Lubomír / Šťastná, Michaela / Pinkasová, Tereza / Pecl, Jakub / Kunovský, Lumír / Dítě, Petr / Jabandžiev, Petr

Journal of gastrointestinal and liver diseases : JGLD

2023 Volume 32, Issue 4, Page(s) 536–544

Abstract: Celiac disease is a common gastroenterological illness. Current diagnostics of the disease are based on serological markers and histology of duodenal biopsies. Hitherto, a strict gluten-free diet is the only effective treatment and is necessary for good ... ...

Abstract	Celiac disease is a common gastroenterological illness. Current diagnostics of the disease are based on serological markers and histology of duodenal biopsies. Hitherto, a strict gluten-free diet is the only effective treatment and is necessary for good control of the disease. Serological tests in current use have very high specificity and sensitivity for diagnostics, but in follow-up they have some limitations. Their levels do not accurately reflect mucosal healing, and they are unable to detect minimal transgressions in the diet. This problem is significant in patients with IgA deficiency, and there exist no robust follow-up tools for monitoring these patients' adherence to treatment. For their follow-up, we currently use IgG-based tests, and these antibodies persist for a long time even when a patient has stopped consuming gluten. More accurate and specific biomarkers are definitely needed. Adherence to a gluten-free diet is essential not only for intestinal mucosa healing and alleviation of symptoms but also for preventing complications associated with celiac disease. Here, we summarize current evidence regarding noninvasive biomarkers potentially useful for follow-up not only of patients with IgA deficiency but for all patients with celiac disease. We describe several very promising biomarkers with potential to be part of clinical practice in the near future.
MeSH term(s)	Humans ; Celiac Disease ; Follow-Up Studies ; IgA Deficiency ; Glutens ; Diet, Gluten-Free ; Biomarkers ; Immunoglobulin A
Chemical Substances	Glutens (8002-80-0) ; Biomarkers ; Immunoglobulin A
Language	English
Publishing date	2023-12-22
Publishing country	Romania
Document type	Journal Article ; Review
ZDB-ID	2427021-0
ISSN	1842-1121 ; 1841-8724
ISSN (online)	1842-1121
ISSN	1841-8724
DOI	10.15403/jgld-4926
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