Oncological screening in gastroenterology and hepatology

Jan Křivinka, Přemysl Falt, Barbora Pipek, Ondřej Urban

Vnitr Lek 2026, 72(4):8 | DOI: 10.36290/vnl.2026.044  

Gastrointestinal cancers are among the leading causes of death in the Czech Republic. Screening programs focused on the detection of precancerous lesions and early-stage disease play a crucial role in secondary prevention, as they have been proven to reduce mortality and improve overall survival rates. In this review article, we summarize current epidemiological data, etiopathogenesis and screening diagnostic methods for patients with Barrett's esophagus, colorectal cancer (including patients with inflammatory bowel disease), hepatocellular carcinoma in patients with liver cirrhosis and individuals at risk of developing pancreatic cancer.

Hlavní téma – současné trendy v gastroenterologii

MUDr. Denisa Kyselová, Ph.D.

Vnitr Lek 2026, 72(4):203  

Inflammatory bowel diseases - current situation in the Czech Republic and future perspectives

Václav Štěpánek, Martin Bortlík

Vnitr Lek 2026, 72(4):215-223 | DOI: 10.36290/vnl.2026.045  

Crohn's disease and ulcerative colitis belong to chronic inflammatory conditions (IBD) with increasing prevalence. In the Czech Republic, the current prevalence reaches 1%. Both conditions require long-term medical therapy that consists of conventional and advanced drugs (biologics and small molecules). Advanced therapy is more effective and safer compared to conventional drugs and should be preferred in patients with moderate to severe disease. In the Czech Republic, IBD patients with advanced drugs are enrolled into the registry called CREdIT. The proportion of such patients is, however, low compared to most developerd countries in the Europe. On...

Acute pancreatitis: a practical update through the eyes of young gastroenterologists

Martin Kyselý, Štěpán Šembera

Vnitr Lek 2026, 72(4):224-230 | DOI: 10.36290/vnl.2026.046  

Background: Acute pancreatitis (AP) is one of the most frequent gastrointestinal diseases with a steadily increasing incidence. Despite declining mortality, clinical practice remains burdened by outdated management strategies not aligned with current evidence. Aim: To provide a practical and up-to-date overview of the diagnosis, classification and management of acute pancreatitis for internal medicine physicians, highlighting recent paradigm shifts in clinical practice. Methods: This narrative review is based on current international guidelines (2025) and recommendations of professional societies. It summarizes contemporary evidence on etiology, diagnostic...

MASLD and its lean phenotype

Kateřina Janstová, Denisa Kyselová, Pavel Trunečka

Vnitr Lek 2026, 72(4):232-239 | DOI: 10.36290/vnl.2026.047  

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease, with a global prevalence of 30-40%. Although it is typically associated with obesity and metabolic syndrome, a significant and often overlooked group of patients consists of individuals with normal body weight, referred to as the lean phenotype of MASLD. These individuals account for approximately 5-20% of MASLD patients, and their disease is often diagnosed only at advanced stages. The pathogenesis is complex and involves combination of genetic predisposition, visceral adiposity, insulin resistance, and sarcopenia. Despite having a normal body...

Mineral and bone disorder in chronic kidney disease (CKD-MBD): a practical perspective for the internist

Kateřina Oulehle, Jan Vachek, Oskar Zakiyanov, Martin Jedlička, Richard Pikner, Vladimír Tesař

Vnitr Lek 2026, 72(4):240-246 | DOI: 10.36290/vnl.2026.048  

disorders of mineral and bone metabolism in chronic kidney disease (CKD-MBD) represent a complex systemic syndrome involving dysregulation of calcium, phosphorus, parathyroid hormone (PTH), vitamin D, and fibroblast growth factor 23 (FGF23) metabolism, disturbances of bone remodeling and mineralization, and extraskeletal-particularly vascular and valvular-calcifications. Understanding of this issue has undergone a fundamental transformation: from an isolated perception of secondary hyperparathyroidism, through the concept of renal osteodystrophy, to the current integrated view that also includes osteoporosis, cardiovascular risk, and the overall clinical...

Primary aldosteronism: A review of the 2025 American-European Endocrine Society Clinical Practice Guidelines

Zdeněk Ramík, Libor Jelínek, Monika Beliančinová, Martin Ráchela, Jiří Vrtal, Josef Dodulík, Tomáš Kvapil, Jan Václavík

Vnitr Lek 2026, 72(4):247-254 | DOI: 10.36290/vnl.2026.049  

Primary aldosteronism represents a common and clinically important cause of secondary hypertension, the diagnosis and management of which have undergone substantial advances in recent years. The updated 2025 Endocrine Society clinical practice guidelines provide a structured framework for screening, laboratory diagnostics, disease confirmation, subtyping, and the selection of targeted therapy. Particular emphasis is placed on the expansion of screening indications, standardization of aldosterone-to-renin ratio interpretation with regard to the analytical method used, clinical stratification of patients according to the probability of lateralized aldosterone...

Type 2 diabetes mellitus + glaucoma = type 4 diabetes mellitus

Štefan Sotak

Vnitr Lek 2026, 72(4):E1-E3 | DOI: 10.36290/vnl.2026.053  

The term "type 4 diabetes mellitus (DM)" is not generally recognized. It occurs more in popular science than in professional science literature. However, it is interesting that this term has two meanings, two different definitions. The first definition of this type of diabetes is that it is a type 2 DM that occurs in patients with glaucoma. Although the relationship between any type of glaucoma and any type of DM has been debated in the past, cumulative epidemiological evidence confirms that the risk of developing glaucoma, specifically primary open-angle glaucoma, is increased in the diabetic population. Other types of glaucoma in diabetes have not...

Vasculitides - a fast diagnostic-therapeutic guide for internists

Jakub Videman, Martina Skácelová, Pavel Horák

Vnitr Lek 2026, 72(4):268-274 | DOI: 10.36290/vnl.2026.052  

Vasculitides represent a broad group of diseases characterized by inflammatory involvement of the vessel wall. Primary vasculitides are categorized according to the caliber of the affected vessels. Symptoms of primary vasculitides are significantly heterogeneous and vasculitides should be included in a broader differential diagnostic consideration of many clinical scenarios. The diagnosis of vasculitides is usually challenging, based on the synthesis of clinical, laboratory, and radiographic findings, evidence of organ damage, and often requiring biopsy verification. A wide range of immunosuppressive agents is used in therapy. Oftentimes, the possibility...

Combined heme and nonheme iron: a detailed perspective on their synergy, biology, and significance based on new in vitro evidence

Jiří Slíva

Vnitr Lek 2026, 72(4):256-260 | DOI: 10.36290/vnl.2026.050  

Combining heme and nonheme iron represents a promising strategy capable of overcoming the limitations of conventional nonheme iron supplements. New in vitro evidence demonstrates that such formulations not only enhance iron absorption but also preserve and stabilise intestinal barrier integrity, supporting improved safety and tolerability. They concomitantly activate both major iron transport pathways, DMT1 and HCP1, while promoting intracellular metabolic handling through ferritin and ferroportin. These synergistic mechanisms explain the significantly higher bioavailability observed with combined formulations compared with traditional soluble iron...

Do you want to be healthier? Try cutting back on highly processed foods

Markéta Sovová, Eliška Sovová

Vnitr Lek 2026, 72(4):E4-E6 | DOI: 10.36290/vnl.2026.054  

In recent decades, there has been a significant increase in the consumption of ultra-processed foods (UPF) worldwide, which in some countries account for almost half of total energy intake. The aim of this review article is to summarize current knowledge on the definition and classification of UPF, the extent of their consumption in Europe and the Czech Republic, possible mechanisms of their effects on human health, and their relationship to health risks. Special attention is paid to the NOVA classification, which is currently the most widely used tool for identifying UPF. Available epidemiological studies and meta-analyses consistently show that higher...

Osilodrostat

Michal Kršek, Marta Šimůnková

Vnitr Lek 2026, 72(4):262-266 | DOI: 10.36290/vnl.2026.051  

Cushing's syndrome (CS) is a disease caused by excessive autonomous production of cortisol and its effects on cells, tissues and organs of the human body. The clinical feature of CS is very complex and directly threatens the lives of its carriers. Morbidity and mortality of patients with active CS is up to four times higher than in the reference population, mainly due to cardiovascular causes, but patients are at risk of a number of other complications. In addition, there is evidence that increased morbidity and mortality persist for many years even after successful treatment. Treatment of CS must be early and comprehensive. In all situations with...