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Colorectal cancer population screening programs worldwide in 2016: An update

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World Journal of Gastroenterology 2017年第20期23卷 3632-3642页

作者： Mercedes Navarro Andrea Nicolas angel Ferrandez angel lanas Service of Digestive Diseases University Clinic Hospital Lozano Blesa University of Zaragoza Aragón Health Research Institute (IIS Aragón) CIBERehd

Colorectal cancer(CRC)is the third most commonly diagnosed cancer in the *** incidence and mortality show wide geographical *** is recommended to reduce both incidence and ***,there are significant differences among studies in implementation strategies and *** review aimed to present the results and strategies of different screening programs *** reviewed the literature on national and international screening programs published in Pub Med,on web pages,and in clinical *** Screening programs are currently underway in most European countries,Canada,specific regions in North and South America,Asia,and *** most extensive screening strategies were based on fecal occult blood testing,and more recently,the fecal immunochemical test(FIT).Participation in screening has varied greatly among different *** Netherlands showed the highest participation rate(68.2%)and some areas of Canada showed the lowest(16%).Participation rates were highest among women and in programs that used the FIT *** exhibited the greatest number of positive *** FIT test has been the most widely used screening program *** advent of this test has increased participation rates and the detection of positive results.

关键词： Colorectal cancer Colorectal cancer screening Fecal occult blood test Fecal immunochemical test Colonoscopy

Interaction between Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs and/or low-dose aspirin use: Old question new insights

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World Journal of Gastroenterology 2014年第28期20卷 9439-9450页

作者： Carlos Sostres Carla Jerusalen Gargallo angel lanas Service Department of Digestive Diseases University Hospital Lozano Blesa Digestive Diseases Department Aragon Health Sciences Institute CIBERehd University of Zaragoza (Zaragoza)

Previous reports clearly demonstrated that Helicobacter pylori(***)infection,nonsteroidal anti-inflammatory drugs(NSAID)or low dose aspirin(ASA)use significantly and independently increased the risk for the development of peptic ulcer ***,the presence of *** infection associated with low dose ASA and/or NSAID use in the same patient is becoming more frequent and therefore the potential interaction between these factors and the consequences of it has important *** NSAID intake in the presence of *** infection may further increase the risk of peptic ulcer carried by the presence of only one risk factor is still a matter of *** on the interaction between the two risk factors yielded conflicting data and no consensus has been reached in the last *** addition,the interaction between *** infection and low-dose ASA remains even more *** real clinical practice,we can find different clinical scenarios involving these three factors associated with the presence of different gastrointestinal and cardiovascular risk *** huge variety of possible combinations greatly hinder the decision making process of physicians.

关键词： Nonsteroidal anti-inflammatory drugs Low dose aspirin Helicobacter pylori infection Helicobacter pylori eradication Peptic ulcer disease

Role of gastrin-peptides in Barrett's and colorectal carcinogenesis

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World Journal of Gastroenterology 2012年第45期18卷 6560-6570页

作者： Eduardo Chueca angel lanas Elena Piazuelo IIS Aragon Aragon Institute of Health Sciences50009 ZaragozaSpain Networked Biomedical Research Center Hepatic and Digestive Diseases(CIBERehd) C/Corcega 180 bajos dcha08036 BarcelonaSpain Department of Medicine Psychiatry and DermatologyMedical University of ZaragozaC/Domingo Miral50009 ZaragozaSpain Service of Gastroenterology Hospital Clinico UniversitarioAvda.San Juan Bosco 1550009 ZaragozaSpain

Gastrin is the main hormone responsible for the stimulation of gastric acid secretion;in addition,gastrin and its derivatives exert proliferative and antiapoptotic effects on several cell *** synthesis and secretion are increased in certain situations,for example,when proton pump inhibitors are *** impact of sustained hypergastrinemia is currently being *** vitro experiments and animal models have shown that prolonged hypergastrinemia may be related with higher cancer rates;although,this relationship is less clear in human *** gastrin levels have been shown to cause hyperplasia of several cell types;yet,the risk for developing cancer seems to be the same in normo-and hypergastrinemic *** tumors also produce their own gastrin,which can act in an autocrine manner promoting tumor *** cancers are extremely dependent on gastrin to *** research focused only on the effects of amidated gastrins,but there has been an interest in intermediates of gastrin in the last few *** intermediates aren't biologically inactive;in fact,they may exert greater effects on proliferation and apoptosis than the completely processed *** certain gastrin overproduction states,they are the most abundant gastrin peptides *** purpose of this review is to examine the gastrin biosynthesis process and to summarize the results from different studies evaluating the production,levels,and effects of the main forms of gastrin in different overexpression states and their possible relationship with Barrett's and colorectal carcinogenesis.

关键词： Gastrin Progastrin Glycine-extended gas-trins C-terminal flanking peptide Hypergastrinemia,Proton pump inhibitors Colorectal cancer Esophagealadenocarcinoma Barrett's esophagus

Education-based approach to addressing non-evidence-based practice in preventing NSAID-associated gastrointestinal complications

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World Journal of Gastroenterology 2009年第47期15卷 5953-5959页

作者： angel lanas Juan V Esplugues Javier Zapardiel Eduardo Sobreviela Service of Digestive Diseases University Hospital University of ZaragozaInstituto Aragonés de Ciencias de la Salud(IACS)Centros de Investigación en Red de Enfermedades Hepáticas y Digestivas(CIBERehd)C/San Juan Bosco 15 50009 ZaragozaSpain Department of Pharmacology University of ValenciaCIBERehdAv.Vicent Andrés Estellés s/n46100 BurjassotValenciaSpain Department of Medical AstraZeneca Farmacéutica SpainParque NorteEdificio RobleC/Serrano Galvache 5628033 MadridSpain MediClin-Quintiles c/Sardenya no 541-54308024 BarcelonaSpain

AIM:To evaluate an evidence-based educational program for improving strategies for prevention of non-steroidal anti-inflammatory drug(NSAID)-associated gastrointestinal(GI)complications. METHODS:Four hundred and fifty-six specialists replied to a questionnaire that covered issues related to NSAID-induced adverse *** also collected data from their last five consecutive patients before and after they had attended an evidence-based seminar on GI prevention strategies. RESULTS:Four hundred and forty-one of 456 specialists(96.7%)participated in the survey,and 382(83.7%)in the education-based study that recorded data from 3728 *** specialists overestimated the risk of GI complications with NSAIDs,underestimated the GI safety profile of coxibs,but were aware of the risk factors and of the current prevention *** pump inhibitors were co-prescribed with NSAIDs in>80% of patients with and without risk *** educational program had little impact on prescribing ***:Specialists are informed of advances in NSAID-associated adverse effects and have high rates of GI-prevention *** educational program did not alter these rates.

关键词： Nonsteroidal anti-inflammatory agents Education Gastrointestinal diseases Adverse effects Cyclooxygenase 2 inhibitors Proton pump inhibitors

Endoscopic Staging and Treatment of Early Gastric Cancer

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Journal of Cancer Therapy 2013年第1期4卷 92-98页

作者： angel Ferrández Sonia Mostacero angel lanas Fundación Hospital de Calahorra La Rioja Spain Service of Digestive Diseases Hospital Clínico Lozano Blesa Zaragoza Spain&The Centro de Investigación Biomédica en Red Barcelona Spain Service of Digestive Diseases Hospital Clínico Lozano Blesa Zaragoza Spain&The Centro de Investigación Biomédica en Red Barcelona Spain&Universidad de Zaragoza Zaragoza Spain.

Gastric cancer is the most common cancer worldwide and it is often diagnosed in an advanced stage. In countries where screening endoscopy is performed widely, early detection is possible. In fact, early gastric cancer incidence is increasing during the last years worldwide and screening could be a major factor in such increase. In the past, the standard treatment of gastric cancer was surgical resection;however, the endoscopic treatment has increased due to advances in the instruments available and clinician experience. In fact, endoscopic resection has become one of the greatest advances in EGC treatment. It is the standard treatment in most of the cases because early gastric cancer is associated with a low rate of lymph node metastasis and a high survival rate. Endoscopic Mucosal Resection and more recently Endoscopic Submucosal Dissection are the two main developed procedures. Endoscopic Submucosal Dissection achieves a higher rate of en-bloc resection, complete resection, curative resection and lower local recurrence compared with Endoscopic Mucosal Resection group. The disadvantages associated with Endoscopic Submucosal Dissection, such as higher perforation rates and longer procedure time, will probably improve as the endoscopists experience increases and new endoscopic tools are developed. The aim of this paper is to review the management of EGC with a special focus on endoscopic detection, staging, therapy, surveillance, and prevention.

关键词： Early Gastric Cancer Endoscopic Mucosa Resection Endoscopic Submucosal Dissection Endoscopic

Aspirin, cyclooxygenase inhibition and colorectal cancer

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2014年第1期5卷 40-49页

作者： Carlos Sostres Carla Jerusalen Gargallo angel lanas Department of Digestive Diseases University Hospital Lozano Blesa Aragon Health Sciences Institute Centro de Investigación Biológica en Red de Enfermedades Hepáticasy Digestivas Department of Gastroenterology University of Zaragoza

Colorectal cancer(CRC)is the third most common type of cancer *** measures are far from adequate and not widely available in resourcepoor *** prevention strategies therefore remain necessary to reduce the risk of developing *** evidence from epidemiological studies,randomized clinical trials and basic science supports the effectiveness of aspirin,as well as other non-steroidal anti-inflammatory drugs,for chemoprevention of several types of cancer,including *** includes the prevention of adenoma recurrence and reduction of CRC incidence and *** detectable benefit of daily low-dose aspirin(at least 75 mg),as used to prevent cardiovascular disease events,strongly suggests that its antiplatelet action is central to explaining its antitumor *** low-dose aspirin achieves complete and persistent inhibition of cyclooxygenase(COX)-1 in platelets(in pre-systemic circulation)while causing alimited and rapidly reversible inhibitory effect on COX-2and/or COX-1 expressed in nucleated *** has a short half-life in human circulation(about 20 minutes);nucleated cells have the ability to resynthesize acetylated COX isozymes within a few hours,while platelets do ***-independent mechanisms of aspirin have been suggested to explain its chemopreventive effects but this concept remains to be demonstrated in vivo at clinical doses.

关键词： Aspirin Colorectal cancer Cyclooxygenase inhibition Mechanisms Risk Benefits

Superoxide dismutase prevents development of adenocarcinoma in a rat model of Barrett's esophagus

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World Journal of Gastroenterology 2005年第47期11卷 7436-7443页

作者： Elena Piazuelo Carmelo Cebrián Alfredo Escartín Pilar Jiménez Fernando Soteras Javier Ortego angel lanas Instituto Aragonés de Ciencias de la Salud Unidad Mixta de InvestigaciónC/Domingo Miral s/n 50009 ZaragozaSpain Service of Pathology Hospital Clínico Universitario "Lozano Blesa"Avenida San Juan Bosco15 50009 ZaragozaSpain Unidad Mixta de Investigatión University of ZaragozaDomingo Miral s/n 50009 ZaragozaSpain Unidad Mixta de Investigación University of ZaragozaDomingo Miral s/n 50009 ZaragozaSpain Service of Gastroenterology Hospital Clínico Universitario "Lozano Blesa"Avenida San Juan Bosco15 50009 ZaragozaSpain

AIM： To test whether antioxidant treatment could prevent the progression of Barrett＇s esophagus to adenocarcinoma. METHODS： In a rat model of gastroduodenoesophageal reflux by esophagojejunal anastomosis with gastric preservation, groups of 6-10 rats were randomized to receive treatment with superoxide dismutase （SOD） or vehicle and followed up for 4 too. Rat＇s esophagus was assessed by histological analysis, superoxide anion and peroxinitrite generation, SOD levels and DNA oxidative damage. RESULTS： All rats undergoing esophagojejunostomy developed extensive esophageal mucosal ulceration and inflammation by mo 4. The process was associated with a progressive presence of intestinal metaplasia beyond the anastomotic area （9% 1st mo and 50% 4th too）（94% at the anastomotic level） and adenocarcinoma （11% 1^ST mo and 60% 4th too）. These changes were associated with superoxide anion and peroxinitrite mucosal generation, an early and significant increase of DNA oxidative damage and a significant decrease in SOD levels （P〈0.05）. Exogenous administration of SOD decreased mucosal superoxide levels, increased mucosal SOD levels and reduced the risk of developing intestinal metaplasia beyond the anastomotic area （odds ratio = 0.326; 95%CI： 0.108-0.981; P = 0.046）, and esophageal adenocarcinoma （odds ratio = 0.243; 95%CI： 0.073-0.804; P = 0.021）. CONCLUSION： Superoxide dismutase prevents the progression of esophagitis to Barrett＇s esophagus and adenocarcinoma in this rat model of gastrointestinal reflux, supporting a role of antioxidants in the chemoprevention of esophageal adenocarcinoma.

关键词： Barrett's esophagus Esophageal adenocarcinoma Free radicals Oxidative damage Superoxide dismutase

Indomethacin but not a selective cyclooxygenase-2 inhibitor inhibits esophageal adenocarcinogenesis in rats

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World Journal of Gastroenterology 2012年第35期18卷 4866-4874页

作者： Paula Esquivias Antonio Morandeira Alfredo Escartín Carmelo Cebrián Sonia Santander Francisco Esteva María Asunción García-González Javier Ortego angel lanas Elena Piazuelo CIBER Digestive and Hepatic Deseases Service of Surgery University Hospital "Lozano Blesa" Service of Pathology University Hospital "Lozano Blesa" Department of Medicine University of Zaragoza Service of Clinical Biochemistry University Hospital "Lozano Blesa" Aragon Health Science Institute Service of Gastroenterology University Hospital "Lozano Blesa"

AIM： To evaluate the effects of indomethacin [dual cyclooxygenase （COX）-I/COX-2 inhibitor] and 3-（3,4-difluorophenyl）-4-（4-（methylsulfonyl） phenyl）- 2-（5H）-furanone （MF-tricyclic）（COX-2 selective inhibi- tor） in a rat experimental model of Barrett＇s esophagus and esophageal ***： A total of 112 surviving post-surgery rats were randomly divided into three groups： the control group （n = 48）, which did not receive any treatment; the indomethacin group （n = 32）, which were given 2 mg/kg per day of the COX-I/COX-2 inhibitor; and the MF-tricyclic group （n = 32）, which received 10 mg/kg per day of the selective COX-2 inhibitor. Randomly se- lected rats were killed either 8 wk or 16 wk after sur- gery. The timing of the deaths was in accordance with a previous study performed in our group. Only rats that were killed at the times designated by the protocol were included in the study. We then assessed the histology and prostaglandin E2 （PGE2） expression levels in the rat esophagi. An additional group of eight animals that did not undergo esophagojejunostomy were included in order to obtain normal esophageal tissue as a control. RESULTS： Compared to a control group with no treat- ment （vehicle-treated rats）, indomethacin treatment was associated with decreases in ulcerated esophageal mucosa （16% vs 35% and 14% vs 17%, 2 mo and 4 mo after surgery, respectively; P = 0.021）, length of intestinal metaplasia in continuity with anastomosis （2 4- 1.17 mm vs 2.29 ＋ 0.75 mm and 1.25 4- 0.42 mm vs 3.5 4- 1.54 mm, 2 mo and 4 mo after surgery, respec- tively; P = 0.007）, presence of intestinal metaplasia beyond anastomosis （20% vs 71.4% and 0% vs 60%, 2 mo and 4 mo after surgery, respectively; P = 0.009）, severity of dysplasia （0% vs 71.4% and 20% vs 85.7% high-grade dysplasia, 2 mo and 4 mo after surgery, re- spectively; P = 0.002）, and adenocarcinoma incidence （0% vs 57.1% and 0% vs 60%, 2 mo and 4 mo after surgery, respectively; P 〈 0.0001）. Treatment with the select

关键词： Intestinal metaplasia Esophageal adeno-carcinoma Indomethacin MF-tricyclic