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Colorectal cancer screening from 45 years of age: Thesis, antithesis and synthesis

World Journal of Gastroenterology 2019年第21期25卷 2565-2580页

作者： Alessandro Mannucci Raffaella Alessia Zuppardo Riccardo Rosati Milena Di Leo José Perea giulia martina cavestro Gastroenterology and Gastrointestinal Endoscopy Unit Division of Experimental OncologyVita-Salute San Raffaele UniversityIRCCS San Raffaele Scientific InstituteMilan 20132Italy Department of Surgery Vita-Salute San Raffaele UniversityIRCCS San Raffaele Scientific InstituteMilan 20132Italy Digestive Endoscopy Unit Division of GastroenterologyHumanitas Research HospitalDepartment of Biomedical ScienceHumanitas UniversityMilan 20090Italy Surgery Department “Fundación Jiménez Díaz” University HospitalMadrid 28040Spain Health Research Institute-Fundación Jiménez Díaz University Hospital Madrid 28040Spain

Colorectal cancer incidence and mortality in patients younger than 50 years are increasing, but screening before the age of 50 is not offered in Europe. Advancedstage diagnosis and mortality from colorectal cancer before 50 years of age are increasing. This is not a detection-bias effect;it is a real issue affecting the entire population. Three independent computational models indicate that screening from 45 years of age would yield a better balance of benefits and risks than the current start at 50 years of age. Experimental data support these predictions in a sex- and race-independent manner. Earlier screening is seemingly affordable, with minimal impediments to providing younger adults with colonoscopy. Indeed, the American Cancer Society has already started to recommend screening from 45 years of age in the United States. Implementing early screening is a societal and public health problem. The three independent computational models that suggested earlier screening were criticized for assuming perfect compliance. Guidelines and recommendations should be derived from well-collected and reproducible data, and not from mathematical predictions. In the era of personalized medicine, screening decisions might not be based solely on age, and sophisticated prediction software may better guide screening. Moreover, early screening might divert resources away from older individuals with greater biological risks. Finally, it is still unknown whether early colorectal cancer is part of a continuum of disease or a biologically distinct disease and, as such, it might not benefit from screening at all. The increase in early-onset colorectal cancer incidence and mortality demonstrates an obligation to take actions. Earlier screening would save lives, and starting at the age of 45 years may be a robust screening option.

关键词： Colonoscopy Guidelines Pros and cons Early onset Early-onset colorectal cancer

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Effects of chronic therapy with non-steroideal antinflammatory drugs on gastric permeability of sucrose: A study on 71 patients with rheumatoid arthritis

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World Journal of Gastroenterology 2006年第31期12卷 5017-5020页

作者： Marta Maino Nicola Mantovani Roberta Merli giulia martina cavestro Gioacchino Leandro Lucas Giovanni Cavallaro Vincenzo Corrente Veronica Iori Alberto Pilotto Angelo Franzè Francesco Di Mario Chair of GastroenterologyDepartment of Clinical Science University of ParmaItaly Gastroenterological UnitAzienda Ospedaliera "C.Poma" MantovaItaly IRCCS Castellana Grotte (BA)Italy Gastroenterological UnitAzienda Ospedaliera ParmaItaly IRCCS San Giovanni Rotondo (FG)Italy

AIM: To evaluate the gastric permeability after both acute and chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) and to assess the clinical usefulness of sucrose test in detecting and following NSAIDs- induced gastric damage mainly in asymptomatic patients and the efficacy of a single pantoprazole dose in chronic users. METHODS: Seventy-one consecutive patients on chronic therapy with NSAIDs were enrolled in the study and divided into groups A and B (group A receiving 40 mg pantoprazole daily, group B only receiving NSAIDs). Sucrose test was performed at baseline and after 2, 4 and 12 wk, respectively. The symptoms in the upper gastrointestinal tract were recorded. RESULTS: The patients treated with pantoprazole had sucrose excretion under the limit during the entire follow-up period. The patients without gastroprotection had sucrose excretion above the limit after 2 wk, with an increasing trend in the following weeks (P = 0.000). A number of patients in this group revealed a significantly altered gastric permeability although they were asymptomatic during the follow-up period. CONCLUSION: Sucrose test can be proposed as a valid tool for the clinical evaluation of NSAIDs- induced gastric damage in both acute and chronic therapy. This tecnique helps to identify patients with clinically silent gastric damages. Pantoprazole (40 mg daily) is effective and well tolerated in chronic NSAID users.

关键词：胃疾病渗透性蔗糖药物治疗

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Outcome of endotherapy for pancreas divisum in patients with acute recurrent pancreatitis

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World Journal of Gastroenterology 2014年第46期20卷 17468-17475页

作者： Alberto Mariani Milena Di Leo Maria Chiara Petrone Paolo Giorgio Arcidiacono Antonella Giussani Raffaella Alessia Zuppardo giulia martina cavestro Pier Alberto Testoni Gastroenterology and Gastrointestinal Endoscopy Unit Division of Experimental OncologyIRCCS San Raffaele Scientific Institute - Vita Salute San Raffaele University20132 MilanItaly

AIM:To assess the rate of relapses of acute pancreatitis(AP),recurrent AP(RAP)and the evolution of endosonographic signs of chronic pancreatitis(CP)in patients with pancreas divisum(PDiv)and ***:Over a five-year period,patients with PDiv and RAP prospectively enrolled were divided into two groups:(1)those with relapses of AP in the year before enrollment were assigned to have endoscopic therapy(recent RAP group);and(2)those free of recurrences were conservatively managed,unless they relapsed during follow-up(previous RAP group).All patients in both groups entered a follow-up protocol that includedclinical and biochemical evaluation,pancreatic endoscopic ultrasonography(EUS)every year and after every recurrence of AP,at the same time as endoscopic retrograde cholangiopancreatography(ERCP).RESULTS:Twenty-two were treated by ERCP and 14were conservatively managed during a mean follow-up of 4.5±1.2 *** the recent RAP group in whom dorsal duct drainage was achieved,AP still recurred in11(57.9%)after the first ERCP,in 6 after the second ERCP(31.6%)and in 5 after the third ERCP(26.3%).Overall,endotherapy was successful 73.7%.There were no cases of recurrences in the previous RAP *** signs of CP developed in 57.9%of treated and 64.3%of untreated *** signs of CP occurred in 42.8%of patients whose ERCPs were successful and in all those in whom it was unsuccessful(P=0.04).There were no significant differences in the rate of AP recurrences after endotherapy and in the prevalence of EUS signs suggesting CP when comparing patients with dilated and non-dilated dorsal pancreatic ducts within each ***:Patients with PDiv and recent episodes of AP can benefit from endoscopic *** endotherapy may reduce the risk of developing EUS signs of CP at a rate similar to that seen in patients of previous RAP group,managed ***,in a subset of patients,endotherapy,although successful,did not prevent the evolution of endosonog

关键词： Endoscopic retrograde cholangiopancreatography Mag

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Does Helicobacter pylori infection eradication modify peptic ulcer prevalence? A 10 years' endoscopical survey

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World Journal of Gastroenterology 2006年第15期12卷 2398-2401页

作者： Giorgio Nervi Stefania Liatopoulou Lucas Giovanni Cavallaro Alessandro Gnocchi Nadia Dal Bò Massimo Rugge Veronica Iori giulia martina cavestro Marta Maino Giancarlo Colla Angelo Franzè Francesco Di Mario Gastroenterology Unit Parma Italy Department of Clinical Sciences Chair of Gastroenterology ParmaItaly Gastroenterology Unit Treviso Italy Institute of Pathology University of Padova Italy

瞄准：为了在病人比较消化性溃疡流行，在根除治疗的进步散开以后在 pre-Helicobacter 时代和十年在二所意大利的医院里为上面的胃肠的内视镜检查法参考了。方法：我们检查了连续地在 1992 和 2002 期间在 1986-1987 和 1995-1996 期间... 详细信息

瞄准：为了在病人比较消化性溃疡流行，在根除治疗的进步散开以后在 pre-Helicobacter 时代和十年在二所意大利的医院里为上面的胃肠的内视镜检查法参考了。方法：我们检查了连续地在 1992 和 2002 期间在 1986-1987 和 1995-1996 期间在 Padova 的肠胃病学单位，并且在 Parma 的肠胃病学单位执行的所有内视镜的考试。迟平方测试被用于统计分析。结果：从两个的数据内视镜的中心在溃疡的流行显示出统计上重要的减少：从 12.7% ～ 6.3%(P<0.001 ) 在 Padova 并且从 15.6% ～ 12%(P<0.001 ) 在 Parma。减少两个都是重要的为十二指肠(从 8.8% ～ 4.8% ， P<0.001 ) 并且胃溃疡(3.9% ～ 1.5% ， P<0.001 ) 在 Padova，并且仅仅为在 Parma 的十二指肠溃疡(9.2% ～ 6.1% ， P<0.001；胃溃疡：6.3% ～ 5.8% ， NS ) 。结论：在征兆的病人的根除在消化性溃疡流行导致了重要减小的广泛的 Helicobacter pylori (H pylori ) 的十年。这减小在 Padova 是特别地明显的，在为在一般 practioners 之中的 H pylori 根除的致敏的一个工程在 1990 和 1992 之间被执行的地方。假如我们的假设应该是真的， H pylori 根除可能在未来导致是的消化性溃疡一稀罕内视镜的发现。

关键词：幽门螺杆菌细菌感染胃溃疡流行病学

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