INTRODUCTION AND OBJECTIVE Many illnesses are related to the loss of appetite or the inability to intake food in a regular fashion. The consequence of long-term or even short-term non-intake of food leads to damaging of organ functions and tissue. Tissue consumption, which is speeded up through metabolic effects of inflammatory mediators, is a characteristic which is identified as clinical malnutrition. The objective of this paper is to offer leading guidelines for uncovering the risk of malnourishment, whilst suggesting several standards which are practical for general use with patients and health workers. METHODOLOGY AND TEST SUBJECTS: This, systematically planned, descriptive, biannual (2006-2007) prospective clinical research, included in total 2.200 hospitalised patients at Clinical Centre University of Sarajevo. Test subjects were hospitalised patients with precisely determined diagnosis, for the purpose of evaluating test subjects' nutritional status and the prevalence of hospital malnourishment. RESULTS According to MUST test, total of 58% of test subjects were malnourished. The test relied more on the subjective evaluation of the patient and was not proved as acceptable for general screening. According to NRS 2002 test, total of 52.04% of test subjects from other clinics were malnourished. Test was suitable because the "yes" and "no" answers were acceptable for the patient and the final screening was simple. According to MNA test, total of 55.3% from all test subjects were malnourished, but the test was not suitable because the answers were more subjective and as such, unacceptable for both patients and doctors. CONCLUSION More than 55% of test subjects were in the clinical malnourishment, which was proved with all three tests. The highest risk of malnutrition among patients with internal illnesses is carried by oncology patients. BMI must be routinely conducted on first examination. NRS 2002 test is suitable and acceptable for the patient.

Patients with verified early stage of the esophageal carcinoma are presented with a very good prognosis, however all over the world patients present themselves with advanced stages thus minoring the chances for survival. Data obtained form the USA programmes are presenting information about 5 year survival period in 14% of the cases. On the other hand, prospective multi centric European study refers to the same period in 10%. UK studies are presenting age-standardized relative rate of survival at 25% for the first 2 years and corresponding 4,8%-6,3% for the 5 year period. Prognoses are deteriorating with the progression of the primary tumor, thus patients in stage IV are facing 5 year survival period in less than 5 % of the cases. 5 year survival period for patients, who underwent surgery in N0 stage, is 40%-60% comparing to 5%-17% for those in confirmed N1 stage. Patients who undergo surgery in confirmed T3N1 stage are faced with 5 year survival period in 8%-10% of the cases, emphasizing the fact that these tumors are operable, but rarely curable by surgery itself. Neo adjuvant therapy use is increasing for the patients in stages IIB and IIC (local progression of the tumor), aiming to decrease the size of the primary cancer prior to surgery thus increasing the rate of long term survival. Our experiences brought out in this study correlate with the foreign results thus aging stressing the fact that the exact staging of the tumor is the basics for the treatment as well as the right choice of the patients for surgery treatment, and those who need neo adjuvant therapy.

Portal hypertenisive gastropathy (PHG) and GAVE syndrome are recently discovered entities who can be associated with bloodloss from gastrointestinal tract at patients with or without liver cirrhosis. PHG will be developed at 65% of patients with portal hypertension caused by liver cirrhosis but it could be developed at portal hypertension which is not caused by the liver cirrhosis. PHG is often assosiated with portal hypertension patients and presence of esofageal and /or gastric varices. Mechanism of pathogenesis PHG is still not completely cleared up, but regulation of gastric nitric oxide level, postaglandins, tumor necrosis factor (TNF) and epidermal growth factor production could be important factors in development of portal hypertensive gastropathy. Mechanisms who participate in originating of Gastric Antral Vascular Ectasia (GAVE) are also not completly clear. Classic characteristics of this syndrome are red, often haemorrhagic lesions most often located in stomach antrum, and who could result in blood loss. More than 70% of patients with GAVE syndrome have no cirrhosis or portal hypertension. But when liver cirrhosis is present, it is very difficult to make difference between GAVE and PHG. This review will be focused on incidence, clinical importance, etiology, pathofisiology and treatment of PHG, and how to differentiate between GAVE syndrom and PHG in a case that there exists.

INTRODUCTION Some substances, for example amoniac, that appear during an infection caused by Helicobacter Pylori (HP), can neutralise acid. It is assumed that a HP infection can attribute to the worsening of GERB disease with antral predominant gastritis and a defensive factor eith corpus-predominant gastrytis or esofagitis. AIMS The aim of this study is to ascertain the role of HP infection in the modification of GORD through a prospective study, that is to see does a HP infection prospectively influence the disease or not, with a special focus on symptomatology with pathohistological findings of the antrum and the corpus of the gaster through a monitoring period of 12 months. MATERIALS AND METHODS 50 patients of the main group were involved in this prospective study with symptoms of GORD, or that eventually had a black stool. A control group of 47 patients was formed that had Gerb positive symptomatology, identical to the first group. During endoscopic act eventual changes in oesophagus in view of GORD, so they have been graduated according to Sawary-Millerov graduation from 1991: via Standard Olympus byoptic tongs byoptic specimens were taken with changes in view of GORD, and corpus and antrum mucosac of gaster and they were put into 2% formalin, so analyses has been done at Institute for pathology in Sarajevo. A special attention has been made to the graduation of gastritis, so Sydney classification has been followed. A modification lasted for four weeks since dg has been made, so two groups were formed, one with eradicated HP and second with HP presence. In the second part of this study both groups were followed without treatment in the period of 12 months, meaning that the natural course of illness has been followed up. RESULTS The results of tests of significant differences between treated and control group after 12 months gr. I Sawary-Miller: normal differences n.s. (t = 0.122); chronic differences n.s. (t = 0.724), reflux esophagitis difference n.s.t = 0.733). Tests of differences between treated and control group of pts according to topographic classification of gastritis for GORD gr. I (X2 = 1.076)-n.s.; za GORD gr. II (X2 = 0.999) non significant. Tests between groups of PTS for treated group (X2 = 1.4) n.s., for control group (X2 = 5.073) significant result for p < 0.05; GORD gr. II for treated group (X2 = 1.051) n.s. The results of tests of significant difference between pathohistological findings of corpus antrum treated and control group within gr. I Sawary-Miller: the difference is not statistically significant t = 0.816. The results of test significant differences of antrum after 12 months between treated and control group: within gr. I X2 = 1.623 difference n.s.; within gr. II t = 0.015 difference n.s. CONCLUSION This study proved that eradication of HP infection acts to GORD course by improvement of endoscopic findings by Sawary-Miller and pathohistological findings on oesophagus, as well as with decrease of activity predominant antral atrophic gastritis in I degree of GORD 12 months after and by decreasing daily acid symptoms. The eradication of HP infection in GORD do not influence on activity of predominant corpus gastritis, as well as on heartburn symptom, weekly acid symptom nor chest pain.

AIM Prospective clinical investigation efficacy of omeprazole was proved in combination with two antibiotics (azithromicine and amoxycillin) in H. pylori eradication. Efficacy of omeprazole was also followed in gastric and duodenal ulcer healing. PATIENTS AND METHODS Patients with dyspepsia and peptic ulcer of stomach and duodenum were examined. Positive H. pylori status was proved by rapid urease test (Pronto dry). During first 7 days patients were treated with omeprazole (Ulzol caps. 2 x 20 mg), amoxycillin 7 days (Amoxil 2 x 1000 mg), and Azithromicin 3 days (Sumamed 1 x 1000 mg). After that period patients received omeprazole (Ulzol caps. 1 x 20 mg) in single morning dose next 21 or 28 days in continuation of antisecretory treatment. Control endoscopy revealed rate of ulcer healing and rate of H. pylori infection with same test at least 28 days after initiation of treatment. RESULTS Complete eradication of H. pylori was in 46/50 (92%) patients (p < 0.001), complete ulcer healing in 48/50 (96%) patients. No patients had complication after omeprazole treatment. Two patients (4%) had worsening of dyspepsia, but without treatment discontinuation. CONCLUSION Triple treatment with omeprazole, azithromicin and amoxycillin achieved high rate of H. pylori eradication, gastric and duodenal ulcer healing. Treatment was well tolerated, with rapid pain and dyspepsia symptoms relief.

Examination of lower part of digestive system by colonoscopy is necessity in occult fecal hemorrhage occurrence, hematochesis, unresolved loss of blood iron and suspicious finding of large bowel X-ray barium study. By therapeutical colonoscopy, haemorrhage from neoplasms and angiodysplastic changes are controlled, foreign bodies are removed as well as routine polipectomics. Balloon dilation of large bowel stenosis, and palliative treatment of unoperable stenoses lead to improvement in quality of life with significant cost-benefit effects. Follow-up of patients on high-risk for colorectal neoplasms increased early diagnosis of neoplasms.

Gastroscopy is medical procedure which allows examination of esophagus, stomach and duodenum by flexible instrument named gastroscope. Procedure could be strictly diagnostical, with evidence of current state and interventional/therapeutical, by attempting of prompt action (haemostasis, mucosal resection of cancer "in situ", polypectomy, dilation of benign and malignant strictures of digestive tube, placing endoprosthesis over strictures) Despite of its invasive nature, endoscopy is daily routine, safe and accurate procedure.

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.

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.

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 praxis 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 physicians 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.

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 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.