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Gastric cancer:Prevention,screening and early diagnosis

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

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Era of Barrett’s surveillance: Does equipment matter?

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World Journal of gastroenterology 2010年第37期16卷 4640-4645页

作者： Jayan Mannath Krish Ragunath Nottingham digestive diseases centre and NIHR Biomedical Research Unit Nottingham University Hospitals NHS Trust

Barrett’s esophagus is a consequence of long standing gastro-esophageal reflux disease and predisposes to the development of esophageal adenocarcinoma. Regular surveillance endoscopies can detect curable early neoplasia in asymptomatic patients, which in turn could improve the prognosis compared to symptomatic cancer. Early neoplastic lesions, which are amenable for local therapy, could be treated endoscopically, avoiding a major surgery. However, in the absence of obvious mucosal lesions, random four quadrant biopsies are done, which is associated with significant sampling error. Newer imaging modalities, such as autofluorescence endoscopy, are helpful in detecting subtle lesions that could be examined in detail with narrow band imaging to characterize and target biopsies. This has the potential benefit of reducing the number of random biopsies with a better yield of dysplasia. Confocal endomicroscopy provides "optical biopsies" and is a valuable tool in targeting biopsies to improve dysplasia detection; however, this is technically challenging. Fuji intelligent chromoendoscopy and I-Scan are recent additions to the imaging armamentarium that have produced notable early results. While all these additional new imaging techniques are promising, a thorough examination by high resolution white light endoscopy after clearing the mucosa with mucolytics should be the minimum standard to improve dysplasia detection during Barrett’s surveillance.

关键词： Barrett’s esophagus Endoscopy Autofluorescence imaging Narrowband imaging Early diagnosis of cancer

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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

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Emerging blood-based biomarkers for detection of gastric cancer

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World Journal of gastroenterology 2015年第41期21卷 11636-11653页

作者： Zane Kalnina Irēna Meistere Ilze Kikuste Ivars Tolmanis Pawel Zayakin Aija Linē Latvian Biomedical Research and Study centre digestive diseases centre gastro Faculty of Medicine University of Latvia

Early detection and efficient monitoring of tumor dynamics are prerequisites for reducing disease burden and mortality, and for improving the management of patients with gastric cancer(GC). Blood-based biomarker assays for the detection of early-stage GC could be of great relevance both for population-wide or risk groupbased screening programs, while circulating biomarkers that reflect the genetic make-up and dynamics of the tumor would allow monitoring of treatment efficacy, predict recurrences and assess the genetic heterogeneity of the tumor. Recent research to identify blood-based biomarkers of GC has resulted in the identification of a wide variety of cancer-associated molecules, including various proteins, autoantibodies against tumor associated antigens, cell-free DNA fragments, m RNAs and various non-coding RNAs, circulating tumor cells and cancer-derived extracellular vesicles. Each type of these biomarkers provides different information on the disease status, has different advantages and disadvantages, and distinct clinical usefulness. In the current review, we summarize the recent developments in blood-based GC biomarker discovery, discuss the origin of various types of biomarkers and their clinical usefulness and the technological challenges in the development of biomarker assays for clinical use.

关键词： Gastric cancer Biomarker Liquid biopsy Cell-free DNA Cell-free RNA Extracellular vesides Autoantibodies Proteomics

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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

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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

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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

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Overexpression of HMGB1 A-box reduced lipopolysaccharide-induced intestinal inflammation via HMGB1/TLR4 signaling in vitro

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World Journal of gastroenterology 2015年第25期21卷 7764-7776页

作者： Fu-Cai Wang Jing-Xuan Pei Jun Zhu Nan-Jin Zhou Dong-Sheng Liu Hui-Fang Xiong Xiao-Qun Liu Dong-Jia Lin Yong Xie Department of gastroenterology the First Affiliated Hospital of Nanchang University Gastro-enterology Institute of Jiangxi Province Key Laboratory of Digestive Diseases of Jiangxi Province Department of Immunology Medical College of Nanchang University Department of Pathophysiology Medical College of Nanchang University Institute of Immunology and Biological Therapy Jiangxi Academy of Medical Sciences

AIM: To investigate the inhibitory effects and mechanism of high mobility group box(HMGB)1 A-box in lipopolysaccharide(LPS)-induced intestinal ***: Overexpression of HMGB1 A-box in human intestinal epithelial cell lines(SW480 cells) was achieved using the plasmid p EGFP-N1. HMGB1 A-box-overexpressing SW480 cells were stimulated with LPS and co-culturing with human monocyte-like cell lines(THP-1 cells) using a Transwell system, compared with another HMGB1 inhibitor ethyl pyruvate(EP). The m RNA and protein levels of HMGB1/toll-like receptor(TLR) 4 signaling pathways [including HMGB1, TLR4, myeloid differentiation factor88(MYD88), Phosphorylated Nuclear Factor κB(p NF-κB) p65] in the stimulated cells were determined by realtime polymerase chain reaction and Western blotting. The levels of the proinflammatory mediators [including HMGB1, interleukin(IL)-1β, IL-6 and tumor necrosis factor(TNF)-α] in the supernatants of the stimulated cells were determined by ***: EP downregulated the m RNA and protein levels of HMGB1, inhibited the TLR4 signaling pathways(TLR4, MYD88 and p NF-κB p65) and reduced the secretion of proinflammatory mediators(HMGB1, IL-1β, IL-6 and TNF-α) in the SW480 and THP-1 cells activated by LPS but not in the unstimulated cells. Activated by LPS, the overexpression of HMGB1 A-box in the SW480 cells also inhibited the HMGB1/TLR4 signaling pathways and reduced the secretion of these proinflammatory mediators in the THP-1 cells but not in the transfected and unstimulated cells. CONCLUSION: HMGB1 A-box, not only EP, can reduce LPS-induced intestinal inflammation through inhibition of the HMGB1/TLR4 signaling pathways.

关键词： High mobility group box 1 Toll-like receptor 4 HMGB1 A-box Ethyl pyruvate Inflammatory bowel disease

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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

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Systematic review: Safety of balloon assisted enteroscopy in Crohn's disease

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World Journal of gastroenterology 2016年第40期22卷 8999-9011页

作者： Ahilan Arulanandan Parambir S Dulai Siddharth Singh William J Sandborn Denise Kalmaz Division of gastro-enterology University of California San Diego

AIM To determine the overall and comparative risk of procedure related perforation of balloon assisted enteroscopy(BAE) in Crohn's disease(CD). METHODS Systematic review(PROSPERO #CRD42015016381) of studies reporting on CD patients undergoing BAE. Seventy-three studies reporting on 1812 patients undergoing 2340 BAEs were included. Primary outcome of interest was the overall and comparative risk of procedure related perforation of diagnostic BAE in CD. Secondary outcomes of interest were risk of procedure related perforation of diagnostic double balloon enteroscopy(DBE), risk of procedure related perforation of therapeutic BAE, efficacy of stricture dilation, and clinical utility of endoscopically assessing small bowel disease *** Per procedure perforation rate of diagnostic BAE in CD was 0.15%(95%CI: 0.05-0.45), which was similar to diagnostic BAE for all indications(0.11%; IRR = 1.41, 95%CI: 0.28-4.50). Per procedure perforation rate of diagnostic DBE in CD was 0.12%(95%CI: 0.03-0.44), which was similar to diagnostic DBE for all indications(0.22%; IRR = 0.54, 95%CI: 0.06-0.24). Per procedure perforation rate of therapeutic BAE in CD was 1.74%(95%CI: 0.85-3.55). Eighty-six percentof therapeutic perforations were secondary to stricture dilation. Dilation was attempted in 207 patients and 30% required surgery during median follow-up of 18 months. When diagnostic BAE assessed small bowel disease activity, changes in medical therapy resulted in endoscopic improvement in 77% of patients. CONCLUSION Diagnostic BAE in CD has a similar rate of perforation as diagnostic BAE for all indications and can be safely performed in assessment of mucosal healing.

关键词： Crohn’s disease Balloon Enteroscopy Safety Perforation Stricture

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