AIMS The EUS is a minimally invasive method, with a most specificness and sensitivity in verification of concrements in choledochus. The aim of this study is to compare the findings of conventional ultrasound with radial EUS in diagnosis of choledocholithiasis. PTS AND METHODS: 2o pts were included in the study, 13 females. All pts were under susceptibility of concrement presence in choledoch. From 32 examinees in 13 by the none methods was confirmed that they have the obstruction of this ethiolology. The rest 19 examinees underwent endoscopy by an experienced endosonographyst, completely independent of eventual findings by conventional US. Comparative method was done by an ultrasonographer, also uninformed of earlier procedures. RESULTS 5/20 pts (25%), were excluded from the study. 5/15 pts (33%) were females. Nine (60%) pts (2 males) examined by EUS, showed a presence of concrements in a choledoch, its size varying from 1 x 1 mm to 16 x 6 mm. US provided a very similar results, with minimal differences in the size of concrements (t = 1,706; p < 0.10). In 3 pts the EUS determined a presence of concrements in choledoch, with sizes varying from 1.5 mm to 4 mm, whilst US showed a susceptible changes with recommendation for further analysis. The EUS findings in 3 patients verified a small concrements in choledoch, while standard US did not show presence of these concrements. It is necessary to underline that last three patients underwent cholechistecthomy. CONCLUSION The radial EUS is a preferred method with excellent performance in verification of choledocholithiasis.

Malnutrition is state of organism with import of energy and other nutritional factors lower then consumption, leading in certain period, to deviation from normal, or changes in some functions. Patients with gastrointestinal diseases are prone to malnutrition states because of basic functions in absorption of nutritional substances. Most common causes are inflammatory bowel diseases (ulcerative colitis and Crohns disease especially), different digestive fistulas (proximal parts), chronic pancreatitis, chronic liver diseases and malignant tumors of digestive tube.

Endoscopic Ultrasonography, or EUS, has joined medical techniques of endoscopy with high frequency ultrasound technique, known as ultrasound. This removable achievement allows physician for microscopic tissue examination, not only in digestive system, but also in its surroundings by highly frequent technique. Endoscopic ultrasonography detects all kinds and nature of possible abnormalities, including and information, which are necessary for proper diagnosis and optimal treatment. In experience hands, EUS can detect abnormalities, which are undetectable during any other techniques of examination. EUS is applied from inside the body, near or even touching the examined surface, so the precise, highly frequent energy of showing the images can be used. The sonography, MRI, CT techniques must show the inner organs through outside surface of body, loosing the resolution during process. The superior resolution of EUS shows 5 layers of digestive tract, almost equally good as by microscope; none of other techniques allows showing of intestinal wall equally good as this one. By EUS liquid has been proved with 90% of precision in diagnosis of operative degrees of pancreas tumours. CT in this case has shows only 50% of precision. Highly skilled surgeons are aware of application of these diagnostics techniques in preoperative cases so the surgical removement of tumours is going to be more effective. The precision of EUS findings are of critical importance for the utilisation of maximum of new treatment having in mind that abnormalities could be diagnosed and characterised without operative intervention. To be able to focus on specific anatomic surfaces, there is need of great knowledge, skillfulness and practice during the manipulation with EUS instrument. The years of experience are needed to be able to achieve high standard of expertise. The accuracy of results varies, depending on physician's diagnostic experience, sub-optimal results are not going to be a good guide during treatment planning. Endosonographist must be in position to document at least 80% of accuracy in diagnosis and determination of disease stage in order to achieve 30-60% changes in plans treatment.

BACKGROUND The pathogenic role of Helicobacter pylori (H. pylori) infection in the setting of NSAID use is still controversial. Aim of the study is to prove increased incidence of gastric mucosa damage in H. pylori positive NSAID users compared to H. pylori negative patients. METHODS Patients with dyspeptic symptoms (n = 160, average age 62.13 +/- 6.24, ranged from 51 to 77 years) were divided in two groups: 80 patients (45 male, 35 female) with positive history of using NSAID and same group with negative history for NSAID. All patients underwent endoscopy, examined to H. pylori presence by rapid unease test. Patients with ulcer or erosions (> 5) were evaluated and grade of gastric mucosa damage were done according to Forrest classification of gastrointestinal bleeding. RESULTS In first group 69/80 of examined patients were H. pylori positive, in second group 56/80 were H. pylori positive (X2 = 5.266; p = 0.022). In gastric mucosa bleeding, caused with NSAIDs, H. pylori was not diagnosed more often compared to other group (p > 0.05). CONCLUSION Patients with NSAID induced gastric injury were significantly greater incidence of H. pylori infection compared to patients without history of NSAIDs abuse. H. pylori was not significantly present in complication of ulcer disease (bleeding) caused by NSAID.

Expert systems are the software systems developed by the application of the various intelligence, which could successfully compete to peoples-experts, and have the consultant function with the characteristics of the explanations and the advices in some specific domain. These are, in essence, the intelligent information systems, which consists several thousands of the rules from the definite problem field and which are capable to explain their decisions. The knowledge systems are lesser software systems, also developed by means of the technique of the artificial intelligence which are usually less successful in some field of knowledge of the experts. In the paper are presented the basic characteristics three most often applied expert systems in gastroenterology: Quick Medical Reference (QMR), HEPAT, ILIAD.

Gastroesophageal reflux disease (GORD) represents an illness which reflects a syndrome caused by returning of acid gastric, alkaline pancreatic and bowels content into the oesophagus, which is in the stomach, because of the protective mechanisms of oesophageal loss. The aim of this study was that this prospective study should explain the role of Helicobacter pylori infection in modification of GORD, respectively whether the Helicobacter pylori infection acts protectively or by deterioration of the disease. According to the settled rules, the inquiry was performed as well as the selection of 97 candidates to undergo research in this study. Helicobacter pylori infection has been proved by immunoassay in all pts in the beginning of this study. Endoscopy has been performed in all pts, the degree of gastroesophageal reflux disease by Sawary-Miller was done. The main group consisted of 50 candidates in whom the eradication of Helicobacter pylori infection was done with triple therapy, pantoprazol + amoxycilin + klaritromicin, which was proven by an immunoassay test. Two groups of pts were formed: the main one with eradicated Helicobacter infection, and a controlled one with a Helicobacter positive infection, which was subject to modification of life style. During 12 months, this study consisted of endoscopic evaluations and monthly evaluation of pts daily difficulties. The eradication of Helicobacter pylori infection acts on the improvement of gastroesophageal disease course by improvement of endoscopic findings by Sawary-Miller, and by decreasing daily acid symptoms. The eradication of Helicobacter pylori infection in gastroesophageal reflux disease does it act at the symptoms such as heartburn, weekly acid symptoms and chest pain.

Level and dynamics activity of circulating immune complexes (CiC) and persistence CiC in the sera in the acute and prolonged HAV-infection was examined. In the same time we explored the relation of level and dynamics CiC compared with level, dynamics and persistence length ALT and IgM anti-HAV in sera, longitude excretion HAV Ag in stool and intensity patohistological damage in liver. Research have been undertaken in the prospected study on two groups with 90 patients in total: 60 patients with prolonged form of the hepatitis A, and 30 patients with HAV-infection with normal development. CiC was prescribe with fotometer in sediment of poliethilenglicol, and IgM anti HAV with ELISA technique. Ag-HAV in stool was prescribe with methodImmuno/electro/osmophoresis. Results of examination showed that high level values of CiC had present in all patients with HAV-infection, bat yet middle values of CiC had significantly higher in prolonged forms (p < 0.01). In a case of patients with PTHA CiC persistence almost three times longer than in HAV infection with normal development. The highest value of CiC have been found from one to two weeks after e peak ALT in HAV and in PTHA 4-6 weeks later. Persistence of elevated values CiC responded to the middle length persistence of Igm anti HAV-in the sera.

Gastrointestinal endoscopy was born almost 40 years ago as diagnostic modality, but in last two decades with gradually developing of therapeutic possibilities gastroenterologists have taken an increasing role in the iinterventional treatment of many upper gastrointestinal problems. Modalities of treatment for esophageal stenoses were explained. Endoscopists should be aware that all of these methods has their limitations and they must be able to balance technological enthusiasm with full consideration of the patients qualities of life. All of this treatments are palliative, risky and only partially effective at best. They often need to be repeated. Even achieving a large lumen will not restore normal swallowing. The goal must be to restore "adequate but not perfect" swallowing, at lowest risk, cost and inconvenience to the patient.

BACKGROUND Relationships between Helicobacter pylori infection, inflammatory changes in antral region of gastric mucosa, and duodenal ulcer is well known and documented in a large number of studies. This trial is designed to examine effect of one week regimen of Pantoprazole, Amoxycillinum and Metronidazol to eradication of H. pylori, duodenal ulcer healing and histological changes on gastric mucosa. PATIENTS AND METHODS 30 patients with active duodenal ulcer, H. pylori-positive, 16 male, with average age 47.12 +/- 13.13 yrs (AVG +/- STD) and 14 female patients with average age 44.47 +/- 12.29 yrs were included in trial. Biopsy of gastric antral region were performed in each patient. Patients were given Pantoprazole 40 mg bid, Amoxycillinum 1000 mg bid, Metronidazolum 500 mg bid for 7 days. After 7 days of treatment, control endoscopy was performed with repeated rapid ureasa test for H. pylori and antral biopsy and with verification of duodenal ulcer healing. Patients were followed up for 24.3 +/- 9.7 weeks for occasion of subjective symptoms. RESULTS 96.67% patients were presented with eradicated H. pylori, complete ulcer healing was found in 83.34% patients after one week regimen (13.33% patients with ulcer reduced on one third of previous described), 73.33% of patients were presented with histologically feature of chronic gastritis turned from active to stationary phase. CONCLUSION One week regiment with Pantoprazole, Amoxycilline and Metronidazole is effective, and beside a high rate ulcer healing and eradication of H. pylori it provides an improvement of histological feature of antral gastritis.

BACKGROUND This research study has tried to establish efficiency of omeprazole, in combination with two antibiotics (metronidazol and amoxicilin), with the aim to eradicate Helicobacter pylori (H. pylori). Efficiency of omeprazole in healing duodenal ulcer has also been observed. PATIENTS AND METHODS Patients suffering from dyspeptic problems and duodenal ulcer but positive H. pylori status (proved with CLO test) have been examined. Patients have been treated during the first seven days with triple therapy (omeprazol 2 x 20 mg, metronidazol 2 x 500 mg and amoksicilin 2 x 1000 mg). Subsequently, the patients were ordered omeprazole 20 mg in the one single morning dose in period of 21 days. Control endoscopy with the view of establishing the rate of healing ulcer and eradicating H. pylori was made four weeks after the beginning of the therapy. RESULTS Complete eradication of H. pylori was found with 35/43 (81.4%) patients, and alleviation of ulcer was achieved with 40/43 (93.1%) patients. Not a single patient had any complication after the beginning of treatment with omeprazole. Five patients (11.6%) had increased dyspeptic problems but interruption of the therapy was not required. CONCLUSION Triple therapy with omeprazole, metronidazol and amoxicilin brings a high rate of eradication H. pylori and healing duodenal ulcer. Therapy is being well tolerated, the pain and dyspeptic problems are being quickly removed.

We examined appearance, localisation and complications of ulcer diseases of stomach and duodenum and concomitant pathological states revealed during esophagogastroduodenoscopy (EGD) among patients in internal hospital and outpatients unit during the war year 1992/1993 in besieged Sarajevo. We could examined only populations from 4 communities out of 26 which belong to this Clinical Center. Several conditions influenced on the number of examined patients: the lack of electricity, intensity of bombardment and at the beginning on the war internal hospital capacity were occupied with not heavily injured patients. The results show significant difference in appearance of ulcer diseases, especially of simplex and kissing ulcer of duodenum in comparison with pre war period 1991. The kind and the effect of the therapy remind an open question because of the lack of the drugs and their polymorphism especially among the outpatients. We could made only conclusions from the results obtained in the Hospital. Clear gastrointestinal hemorrhage were treated in Intensive Care Unit. These are preliminary reports, next is going to be modified with better working and living conditions. These results show enormous increase of the number of patients with gastroduodenal pathology.

The frequency of pyrosis and its correlation with hyperregeneratory oesophagopaty in patients with duodenal and gastric ulcer and normal oesophago-gastric junction has been investigated. The normal oesophago-gastric junction has been evaluated by endoscopy. The frequency of pyrosis was significant in the group of patients with duodenal ulcer, and the hyperregeneratory oesophagopaty has been more frequent in this group.