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Gastric cancer:Prevention,screening and early diagnosis

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World Journal of gastroenterology 2014年第38期20卷 13842-13862页

作者： Victor Pasechnikov Sergej Chukov Evgeny Fedorov Ilze Kikuste Marcis Leja Stavropol State Medical University Moscow State Medical University Faculty of Medicine University of Latvia digestive diseases centre gastro Department of Research Riga East University Hospital

Gastric cancer continues to be an important healthcare problem from a global perspective. Most of the cases in the Western world are diagnosed at late stages when the treatment is largely ineffective. Helicobacter pylori(H. pylori) infection is a well-established carcinogen for gastric cancer. While lifestyle factors are important,the efficacy of interventions in their modification,as in the use of antioxidant supplements,is unconvincing. No organized screening programs can be found outside Asia(Japan and South Korea). Although several screening approaches have been proposed,including indirect atrophy detection by measuring pepsinogen in the circulation,none of them have so far been implemented,and more study data is required to justify any implementation. Mass eradication of H. pylori in high-risk areas tends to be cost-effective,but its adverse effects and resistance remain a concern. Searches for new screening biomarkers,including microRNA and cancer-autoantibody panels,as well as detection of volatile organic compounds in the breath,are in progress. Endoscopy with a proper biopsy follow-up remains the standard for early detection of cancer and related premalignant lesions. At the same time,new advanced high-resolution endoscopic technologies are showing promising results with respect to diagnosing mucosal lesions visually and targeting each biopsy. New histological risk stratifications(classifications),including OLGA and OLGIM,have recently been developed. This review addresses the current means for gastric cancer primary and secondary prevention,the available and emerging methods for screening,and new developments in endoscopic detection of early lesions of the stomach.

关键词： Gastric cancer Helicobacter pylori

Inflammatory bowel disease and cancer: The role of inflammation, immunosuppression, and cancer treatment

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World Journal of gastroenterology 2016年第20期22卷 4794-4801页

作者： Jordan E Axelrad Simon Lichtiger Vijay Yajnik Department of Medicine Division of Digestive and Liver Diseases Columbia University Medical Center Department of Medicine Division of Gastro-enterology The Massachusetts General Hospital

In patients with inflammatory bowel disease(IBD), chronic inflammation is a major risk factor for the development of gastrointestinal malignancies. The pathogenesis of colitis-associated cancer is distinct from sporadic colorectal carcinoma and the critical molecular mechanisms underlying this process have yet to be elucidated. Patients with IBD have also been shown to be at increased risk of developing extra-intestinal malignancies. Medical therapies that diminish the mucosal inflammatory response represent the foundation of treatment in IBD, and recent evidence supports their introduction earlier in the disease course. However, therapies that alter the immune system, often used for long durations, may also promote carcinogenesis. As the population of patients with IBD grows older, with longer duration of chronic inflammation and longer exposure to immunosuppression, there is an increasing risk of cancer development. Many of these patients will require cancer treatment, including chemotherapy, radiation, hormonal therapy, and surgery. Many patients will require further treatment for their IBD. This review seeks to explore the characteristics and risks of cancer in patients with IBD, and to evaluate the limited data on patients with IBD and cancer, including management of IBD after a diagnosis of cancer, the effects of cancer treatment on IBD, and the effect of IBD and medications for IBD on cancer outcomes.

关键词： Inflammatory bowel disease Cancer Antitumor necrosis factor Immunosuppression Chemotherapy Radiation

Role of pre-existing incomplete intestinal metaplasia in gastric adenocarcinoma:A retrospective case series analysis

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World Journal of Clinical Cases 2023年第12期11卷 2708-2715页

作者： Inga Bogdanova Inese Polaka Ilona Aleksandraviča Zane Dzērve Linda Anarkulova Vita Novika Ivars Tolmanis Marcis Leja Department of Pathology Academic Histology LaboratoryRiga LV1073Latvia Institute of Clinical and Preventive Medicine University of LatviaRiga LV1079Latvia Department of Research Riga East University HospitalRiga LV1079Latvia Department of Endoscopy Digestive Diseases Centre GASTRORiga LV1079Latvia Department of gastroenterology Digestive Diseases Centre GASTRORiga LV1079Latvia

BACKGROUND Risk stratification for patients with gastric precancerous lesions for endoscopic surveillance remains *** To analysis of patients having developed gastric adenocarcinoma during the period of *** We conducted a retrospective study on patients having undergone upper endoscopy prior to the development of gastric adenocarcinoma. The presence and stage of precancerous lesions as well as subtype of intestinal metaplasia at the baseline endoscopy got evaluated. Literature mini-review was *** Out of 1681 subjects in the Biobank, gastric adenocarcinoma was detected in five cases in whom previous endoscopy data with biopsies either from the corpus or antral part were available. All of the patients had incomplete intestinal metaplasia during the baseline endoscopy;all three subjects in whom intestinal metaplasia subtyping was performed according to Filipe et al, had Type Ⅲ intestinal metaplasia. Two of the five cases had low Operative Link on Gastritis Assessment(OLGA) and Operative Link on Gastritis Intestinal Metaplasia Assessment(OLGIM) stages(Ⅰ-Ⅱ) at the *** The presence of incomplete intestinal metaplasia, in particular, that of Type Ⅲ is a better predictor for gastric adenocarcinoma development than OLGA/OLGIM staging system. Subtyping of intestinal metaplasia have an important role in the risk stratification for surveillance decisions.

关键词： Minireview Gastric adenocarcinoma Precancerous lesions Retrospective study Subtypes of intestinal metaplasia OLGA/OLGIM staging

Hepatitis D infection:from initial discovery to current investigational therapies

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gastroenterology Report 2019年第4期7卷 231-245,I0001页

作者： Ben L.Da Theo Heller Christopher Koh digestive diseases Branch National Institute of Diabetes&Digestive&Kidney DiseasesNational Institutes of HealthBethesdaMDUSA Liver diseases Branch National Institute of Diabetes&Digestive&Kidney DiseasesNational Institutes of HealthBethesdaMDUSA

Hepatitis D is the most severe form of viral hepatitis associated with a more rapid progression to cirrhosis and an increased risk of hepatocellular carcinoma and mortality compared with hepatitis B *** once thought of as a disappearing disease,hepatitis D is now becoming recognized as a serious worldwide issue due to improvement in diagnostic testing and immigration from endemic *** these concerns,there is currently only one accepted medical therapy(pegylated-interferon-a)for the treatment of hepatitis D with less than desirable efficacy and significant side *** to these reasons,many patients never undergo ***,increasing knowledge about the virus and its life cycle has led to the clinical development of multiple promising new therapies that hope to alter the natural history of this disease and improve patient *** this article,we will review the literature from discovery to the current investigational therapies.

关键词： Hepatitis D hepatitis B epidemiology natural history outcome treatment novel therapies

Characteristics of Clostridium difficile infection in patients hospitalized with myelodysplastic syndrome or acute myelogenous leukemia

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World Journal of Clinical Oncology 2017年第5期8卷 398-404页

作者： Kamini Shah Bryan F Curtin Christopher Chu Daniel Hwang Mark H Flasar Erik von Rosenvinge Division of Infectious diseases Department of MedicineUniversity of Maryland School of Medicine digestive diseases Branch National Institute of Diabetes and Digestive and Kidney Diseases Department of Medicine University of Maryland School of Medicine Division of gastro-enterology and Hepatology Department of MedicineUniversity of Maryland School of Medicine and VA Maryland Health Care System

AIM To evaluate factors associated with Clostridium difficile infection (CDI) and outcomes of CDI in the myelodysplastic syndrome(MDS) and acute myeloid leukemia (AML) *** After IRB approval,all MDS/AML patients hospitalized at the University of Maryland Greenebaum Comprehensive Cancer Center between August 2011 and December 2013 were *** charts were reviewed for demographics,clinical information,development of CDI,complications of CDI,and *** with CDI,defined as having a positive stool PCR done for clinical suspicion of CDI,were compared to those without CDI in order to identify predictors of disease.A t-test was used for comparison of continuous variables and chisquare or Fisher's exact tests were used for categorical variables,as *** Two hundred and twenty-three patients (60.1% male,mean age 61.3 years,13% MDS,87% AML) had 594 unique hospitalizations during the study *** patients (15.2%) were diagnosed with *** significantly associated with CDI included lower albumin at time of hospitalization (P < 0.0001),prior diagnosis of CDI (P < 0.0001),receipt of cytarabine-based chemotherapy (P = 0.015),total days of neutropenia (P = 0.014),and total days of hospitalization (P = 0.005).Gender (P = 0.10),age (P = 0.77),proton-pump inhibitor use (P = 0.73),receipt of antibiotics (P = 0.66),and receipt of DNA hypomethylating agent-based chemotherapy (P = 0.92) were not significantly associated with *** CDI is common in the MDS/AML *** significantly associated with CDI in this population include low albumin,prior CDI,use of cytarabine-based chemotherapy,and prolonged *** this study,we have identified a subset of patients in which prophylaxis studies could be targeted.

关键词： Clostridium difficile Acute myeloid leukemia Cytarabine-based chemotherapy Myelodysplastic syndrome Neutropenia

Intestinal autotransplantation

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gastroenterology Report 2017年第4期5卷 258-265,I0001页

作者： Guosheng Wu Xijing Hospital of digestive diseases The Fourth Military Medical UniversityXi’anShaanxiChina

Most abdominal neoplasms involving the root of the superior mesenteric artery and/or celiac artery are difficult to manage with conventional operative techniques because of limited intestinal ischemia times and poor accessibility to the tumor *** vivo surgery followed by intestinal autotransplantation(IATx)is a relatively novel surgical strategy to offer chances for complete resection in such hopeless *** review aims to assess potential surgical indications,operative techniques and clinical outcomes after *** the main indications reported for IATx broadly include pancreatic,mesenteric and retroperitoneal neoplasms closely involving the superior mesenteric *** preliminary results show that radical resection can be effectively achieved in carefully selective *** perioperative morbidity and mortality are relatively high,there are several long-term survivors,particularly after complete resection of benign and low-grade *** tumor recurrence,however,remains a major problem in patients with high-grade tumor,particularly pancreatic ductal *** conclusion,IATx allows patients with selected abdominal neoplasms involving themajormesenteric vessels to be completely ***,this aggressive approach is associated with a considerable operative risk,and should only be performed at experienced *** and adjunctive treatment therapies are required to improve the efficacy of this treatment.

关键词： Intestinal autotransplantation ex vivo surgery pancreatic cancer mesenteric tumors

Clinical features and management of primary sclerosing cholangitis

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World Journal of gastroenterology 2008年第21期14卷 3338-3349页

作者： Marina G Silveira Keith D Lindor Division of gastro-enterology and Hepatology Miles and Shirley Fiterman Center for Digestive DiseasesMayo Clinic and FoundationRochesterMinnesotaUnited States

Primary sclerosing cholangitis is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the bile ducts,resulting in cirrhosis and need for liver transplantation and reduced life *** majority of cases occur in young and middle-aged men,often in association with inflammatory bowel *** etiology of primary sclerosing cholangitis includes immune-mediated components and elements of undefined *** effective medical therapy has been *** multiple complications of primary sclerosing cholangitis include metabolic bone disease,dominant strictures,bacterial cholangitis,and malignancy,particularly cholangiocarcinoma,which is the most lethal complication of primary sclerosing *** transplantation is currently the only life-extending therapeutic alternative for patients with end-stage disease,although recurrence in the allografted liver has been described.A PSC-like variant attracting attention is cholangitis marked by raised levels of the immunoglobulin G4 subclass,prominence of plasma cells within the lesions,and steroid responsiveness.

关键词： Sclerosing cholangitis Diagnosis Therapy Cholestasis Cholangiocarcinoma Liver transplantation

Nutrient drink test: A promising new tool for irritable bowel syndrome diagnosis

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World Journal of gastroenterology 2019年第7期25卷 837-847页

作者： Fermin Estremera-Arevalo Marta Barcelo Blanca Serrano Enrique Rey Department of gastroenterology Complejo Hospitalario de Navarra Department of gastroenterolgy Hospital Infanta Leonor Department of digestive diseases Hospital Clinico San Carlos Department of digestive diseases Hospital Clinico San Carlos and Complutense University

BACKGROUND Irritable bowel syndrome(IBS) is a highly prevalent condition. It is diagnosed on the basis of chronic symptoms after the clinical and/or investigative exclusion of organic diseases that can cause similar symptoms. There is no reproducible noninvasive test for the diagnosis of IBS, and this raises diagnostic uncertainty among physicians and hinders acceptance of the diagnosis by *** gastrointestinal(GI) syndromes often present with overlapping upper and lower GI tract symptoms, now believed to be generated by visceral hypersensitivity. This study examines the possibility that, in IBS, a nutrient drink test(NDT) provokes GI symptoms that allow a positive differentiation of these patients from healthy *** To evaluate the NDT for the diagnosis of *** This prospective case-control study compared the effect of two different nutrient drinks on GI symptoms in 10 IBS patients(patients) and 10 healthy controls(controls). The 500 kcal high nutrient drink and the low nutrient 250 kcal drink were given in randomized order on separate days. Symptoms were assessed just before and at several time points after drink ingestion. Global dyspepsia and abdominal scores were derived from individual symptom data recorded by two questionnaires designed by our group, the upper and the general GI symptomquestionnaires, respectively. Psycho-social morbidity and quality of life were also formally assessed. The scores of patients and controls were compared using single factor analysis of variance *** At baseline, IBS patients compared to controls had significantly higher levels of GI symptoms such as gastro-esophageal reflux(P = 0.05), abdominal pain(P =0.001), dyspepsia(P = 0.001), diarrhea(P = 0.001), and constipation(P = 0.001) as well as higher psycho-social morbidity and lower quality of life. The very low incidence of GI symptoms reported by control subjects did not differ significantly for the two test drinks. Compared with the low nut

关键词： Irritable bowel syndrome Nutrient drink test Non-invasive Dyspepsia Screening

Fecal microbiota transplantation for Clostridium difficile infection in patients with ileal pouches

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gastroenterology Report 2017年第3期5卷 200-207,I0002页

作者： Nan Lan Jean Ashburn Bo Shen Center for Inflammatory Bowel diseases Digestive Disease InstituteThe Cleveland Clinic FoundationClevelandOHUSA

Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly *** aim of this study was to evaluate the outcome of fecal microbiota transplantation(FMT)in patients with pouch and ***:All consecutive patients that underwent FMT for CDI from 2012 to 2016 were extracted from our IRB-approved,prospectively maintained Registry of Pouch *** primary outcome was negative stool tests for Clostridium difficile after FMT and the secondary outcomes were symptomatic and endoscopic ***:A total of 13 patients were included in this study,with 10 being Caucasian males(76.9%).All patients had underlying ulcerative colitis for J pouch *** a mean of 2.8±0.8 courses of antibiotic treatments was given and failed,22 sessions of FMT were administered with an average of 1.7±1.1 sessions *** the 22 sessions,16 were given via pouchoscopy,4 via esophagogastroduodenoscopy and 2 via *** patients tested negative on *** polymerase chain reaction(PCR)after the initial FMT with a total of 7/12(58.3%)documented patients showed symptomatic improvements and 3/11(27.3%)patients showed endoscopic improvement according to the modified Pouchitis Disease Activity *** the follow-up of 1.2±1.1 years,there were a total of five patients(38.5%)that had recurrence after the successful initial treatment and four of them were successfully treated again with ***:FMT appeared to be effective in eradication of CDI in patients with ileal ***,FMT had a modest impact on endoscopic inflammation and recurrence after FMT and recurrence was common.

关键词： Clostridium difficile fecal microbiota transplantation ileal pouch pouchitis