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Gastric cancer development after the successful eradication of Helicobacter pylori

World Journal of Gastrointestinal Oncology 2016年第3期8卷 271-281页

作者： Kaname Uno Katsunori Iijima Tooru Shimosegawa division of gastroenterology Tohoku University Hospital

Gastric cancer(GC) develops as a result of inflammationassociated carcinogenesis due to Helicobacter pylori(H. pylori) infection and subsequent defects in genetic/epigenetic events. Although the indication for eradication therapy has become widespread, clinical studies have revealed its limited effects in decreasing the incidence of GC. Moreover, research on biopsy specimens obtained by conventional endoscopy has demonstrated the feasibility of the restoration of some genetic/epigenetic alterations in the gastric mucosa. Practically, the number of sporadic cases of primary/metachronous GC that emerge after successful eradication has increased, while on-going guidelines recommend eradication therapy for patients with chronic gastritis and those with background mucosa after endoscopic resection for GC. Accordingly, regular surveillance of numerous individuals who have received eradication therapy is recommended despite the lack of biomarkers. Recently, the focus has been on functional reversibility after successful eradication as another cue to elucidate the mechanisms of restoration as well as those of carcinogenesis in the gastric mucosa after H. pylori eradication. We demonstrated that Congo-red chromoendoscopy enabled the identification of the multifocal distribution of functionally irreversible mucosa compared with that of restored mucosa after successful eradication in individuals at extremely high risk for GC. Further research that uses functional imaging may provide new insights into the mechanisms of regeneration and carcinogenesis in the gastric mucosa post-eradication and may allow for the development of useful biomarkers.

关键词： Helicobacter pylori eradication Gastric cancer Congo-red chromoendoscopy Biomarker

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Neuroanatomy of lower gastrointestinal pain disorders

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World Journal of gastroenterology 2014年第4期20卷 1005-1020页

作者： Wim Vermeulen Joris G De Man Paul A Pelckmans Benedicte Y De Winter Laboratory of Experimental Medicine and Pediatrics Division of Gastroenterology Faculty of Medicine and Health Sciences University of Antwerp division of gastroenterology and Hepatology Antwerp University Hospital

Chronic abdominal pain accompanying intestinal inflammation emerges from the hyperresponsiveness of neuronal,immune and endocrine signaling pathways within the intestines,the peripheral and the central nervous *** this article we review how the sensory nerve information from the healthy and the hypersensitive bowel is encoded and conveyed to the *** gut milieu is continuously monitored by intrinsic enteric afferents,and an extrinsic nervous network comprising vagal,pelvic and splanchnic *** extrinsic afferents convey gut stimuli to second order neurons within the superficial spinal cord *** neurons cross the white commissure and ascend in the anterolateral quadrant and in the ipsilateral dorsal column of the dorsal horn to higher brain centers,mostly subserving regulatory *** the supraspinal regions and the brainstem,pathways descend to modulate the sensory *** of this multiple level control,only a small proportion of gut signals actually reaches the level of consciousness to induce sensation or *** inflammatory bowel disease(IBD)and irritable bowel syndrome(IBS)patients,however,long-term neuroplastic changes have occurred in the brain-gut axis which results in chronic abdominal *** sensitization may be driven on the one hand by peripheral mechanisms within the intestinal wall which encompasses an interplay between immunocytes,enterochromaffin cells,resident macrophages,neurons and smooth *** the other hand,neuronal synaptic changes along with increased neurotransmitter release in the spinal cord and brain leads to a state of central *** life factors such as but not limited to inflammation and stress contribute to *** together,the degree to which each of these mechanisms contribute to hypersensitivity in IBD and IBS might be diseaseand even *** of sensitization throughout animal and human studies may significantly improve our understanding of sensit

关键词： Afferent nerves Chronic pain Inflammatory bowel disease Irritable bowel syndrome Sensitisation Sensory nerves Visceral hypersensitivity

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Liver injury after aluminum potassium sulfate and tannic acid treatment of hemorrhoids

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World Journal of gastroenterology 2017年第27期23卷 5034-5040页

作者： Kenichi Yoshikawa Reimi Kawashima Yuki Hirose Keiko Shibata Takafumi Akasu Noriko Hagiwara Takeharu Yokota Nami Imai Akira Iwaku Go Kobayashi Hirohiko Kobayashi Akiyoshi Kinoshita Nao Fushiya Hiroyuki Kijima Kazuhiko Koike Masayuki Saruta division of gastroenterology and Hepatology Internal Medicinethe Jikei University Daisan Hospital division of gastroenterology and Hepatology Internal Medicinethe Jikei University School of Medicine

We are reporting a rare case of acute liver injury that developed after an internal hemorrhoid treatment with the aluminum potassium sulfate and tannic acid(ALTA) regimen. A 41-year-old man developed a fever and liver injury after undergoing internal hemorrhoid treatment with a submucosal injection of ALTA with lidocaine. The acute liver injury was classified clinically as hepatocellular and pathologically as cholestastic. We could not classify the mechanism of injury. High eosinophil and immunoglobulin E levels characterized the injury,and a drug lymphocyte stimulation test was negative on postoperative day 25. Fluid replacement for two weeks after hospitalization improved the liver injury. ALTA therapy involves injecting chemicals into the submucosa,from the rectum to the anus,and this is the first description of a case that developed a severe liver disorder after this treatment; hence,an analysis of future cases as they accumulate is desirable.

关键词： Aluminum potassium sulfate and tannic acid injection Aluminum potassium sulfate and tannic acid therapy Rectal submucosal injection Drug-induced lymphocyte stimulation test Drug-induced liver injury

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Feasibility of full-spectrum endoscopy:Korea's first full-spectrum endoscopy colonoscopic trial

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World Journal of gastroenterology 2016年第8期22卷 2621-2629页

作者： Jeong-Yeop Song Youn Hee Cho Mi A Kim Jeong-Ae Kim Chun Tek Lee Moon Sung Lee division of gastroenterology Department of Internal Medicine LCT Hospital division of gastroenterology Department of Internal Medicine Soon Chun Hyang University Bucheon Hospital

AIM: To evaluate the full-spectrum endoscopy(FUSE) colonoscopy system as the first report on the utility thereof in a Korean ***: We explored the efficacy of the FUSE colonoscopy in a retrospective, single-center feasibility study performed between February 1 and July 20, 2015. A total of 262 subjects(age range: 22-80) underwent the FUSE colonoscopy for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. The cecal intubation success rate, the polyp detection rate(PDR), the adenoma detection rate(ADR), and the diverticulum detection rate(DDR), were calculated. Also, the success rates of therapeutic interventions were evaluated with biopsy ***: All patients completed the study and the success rates of cecal and terminal ileal intubation were 100% with the FUSE colonoscope; we found 313 polyps in 142 patients and 173 adenomas in 95. The overall PDR, ADR and DDR were 54.2%, 36.3%, and 25.2%, respectively, and were higher in males, and increased with age. The endoscopists and nurses involved considered that the full-spectrum colonoscope improved navigation and orientation within the *** colonoscopy was aborted because of colonoscope ***: The FUSE colonoscopy yielded a higher PDR, ADR, DDR than did traditional colonoscopy, without therapeutic failure or complications, showing feasible, effective, and safe in this first Korean trial.

关键词： Colonoscopy Colonoscopes Feasibility studies Colonic polyps

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Endoscopic hemoclip treatment for bleeding peptic ulcer

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World Journal of gastroenterology 2000年第1期6卷 53-56页

作者： Lai YC Yang SS Wu CH Chen TK division of gastroenterology Cathay General HospitalTaipei division of gastroenterology Cathay General HospitalTaipei Medical FacultyChina Medical CollegeTaichungTaiwanChina

AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding *** Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospective studyfor endoscopic hemoclip *** used anewly developed rotatable clip-device for theapplication of hemoclip(MD850)to *** was repeated if there wasany sign or suspicion of rebleeding,and re-clipping was performed if necessary *** Initial hemostatic rate by clippingwas 95%,and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%,96%,and93% in the Fla and Flb subgroups,and totalcases,*** patients with shock onadmission,hemoclipping achieved ultimatehemostasis of 71% and 83% in F1a and F1bsubgroups,*** reached100% in patients without shock regardless ofhemorrhagic activity being F1a or *** number of clips used per case was 3.0(range 2-5).Spurting bleeders required moreclips on average than did oozing bleeders(3.4versus 2.8).We observed no obviouscomplications,no tissue injury,or impairmentof ulcer healing related to *** Endoscopic hemoclip placementis an effective and safe *** theimprovement of the clip and application device,the procedure has become easier and much *** hemoclipping deservesfurther study in the treatment of bleeding pepticulcers.

关键词： Subject headings endoscopic hemoclipping gastrointestinal hemorrhage/therapy peptic ulcer hemostasis

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Key quality indicators in colonoscopy

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gastroenterology Report 2023年第1期11卷 49-59页

作者： Douglas K.Rex division of gastroenterology/Hepatology Indiana University School of MedicineIndianapolisINUSA

Many quality indicators have been proposed for colonoscopy,but most colonoscopists and endoscopy groups focus on measuring the adenoma detection rate and the cecal intubation *** of proper screening and surveillance intervals is another accepted key indicator but it is seldom evaluated in clinical *** preparation efficacy and polyp resection skills are areas that are emerging as potential key or priority *** review summarizes and provides an update on key performance indicators for colonoscopy quality.

关键词： colonoscopy quality adenoma detection rate polypectomy post-polypectomy surveillance

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Lynch syndrome and Lynch syndrome mimics: The growing complex landscape of hereditary colon cancer

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World Journal of gastroenterology 2015年第31期21卷 9253-9261页

作者： John M Carethers Elena M Stoffel division of gastroenterology Department of Internal MedicineUniversity of Michigan

Hereditary non-polyposis colorectal cancer(HNPCC) was previously synonymous with Lynch syndrome; however,identification of the role of germline mutations in the DNA mismatch repair(MMR) genes has made it possible to differentiate Lynch syndrome from other conditions associated with familial colorectal cancer(CRC). Broadly,HNPCC may be dichotomized into conditions that demonstrate defective DNA MMR and microsatellite instability(MSI) vs those conditions that demonstrate intact DNA MMR. Conditions characterized by MMR deficient CRCs include Lynch syndrome(germline MMR mutation),Lynch-like syndrome(biallelic somatic MMR mutations),constitutional MMR deficiency syndrome(biallelic germline MMR mutations),and sporadic MSI CRC(somatic biallelic methylation of MLH1). HNPCC conditions with intact DNA MMR associated with familial CRC include polymerase proofreading associated polyposis and familial colorectal cancer type X. Although next generation sequencing technologies have elucidated the genetic cause for some HNPCC conditions,others remain genetically undefined. Differentiating between Lynch syndrome and the other HNPCC disorders has profound implications for cancer risk assessment and surveillance of affected patients and their at-risk relatives. Clinical suspicion coupled with molecular tumor analysis and testing for germline mutations can help differentiate the clinical mimicry within HNPCC and facilitate diagnosis and management.

关键词： Hereditary non-polyposis colorectal cancer Lynch s

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Gastric cancer in Africa:Current management and outcomes

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World Journal of gastroenterology 2014年第14期20卷 3875-3879页

作者： Akwi W Asombang Rubayat Rahman Jamal A Ibdah division of gastroenterology and Hepatology University of MissouriColumbia

Gastric cancer is the fourth most common cancer and second most common cause of cancer death worldwide. Globally, gastric cancer poses a significant public health burden - both economically and socially. In 2008, the economic burden from premature cancer deaths and disability was $895 billion and gastric cancer was the second highest cancer responsible for healthy life lost. With the expected increase in cancer deaths and non-communicable diseases, these costs are expected to rise and impact patient care. World Health Organization, estimates a 15% increase in non-communicable disease worldwide, with more than 20% increase occurring in Africa between 2010 and 2020. Mali, West Africa, is ranked 15th highest incidence of gastric cancer worldwide at a rate of 20.3/100000, yet very scarce published data evaluating etiology, prevention or management exist. It is understood that risk factors of gastric cancer are multifactorial and include infectious agents (Helicobacter pylori, Epstein-Barr virus), genetic, dietary, and environmental factors (alcohol, smoking). Interestingly, African patients with gastric cancer are younger, in their 3rd-4th decade, and present at a late stage of the disease. There is sparse data regarding gastric cancer in Africa due to lack of data collection and under-reporting, which impacts incidence and mortality rates. Currently, GLOBOCAN, an International Agency for Research on Cancer resource, is the most comprehensive available resource allowing comparison between nations. In resource limited settings, with already restricted healthcare funding, data is needed to establish programs in Africa that increase gastric cancer awareness, curtail the economic burden, and improve patient management and survival outcomes.

关键词： Gastric cancer Africa Cancer outcomes Cancer survival Cancer management Non-communicable diseases

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Gastric per-oral endoscopic myotomy: Current status and future directions

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World Journal of gastroenterology 2019年第21期25卷 2581-2590页

作者： Alexander Podboy Joo Ha Hwang Linda A Nguyen Patricia Garcia Thomas A Zikos Afrin Kamal George Triadafilopoulos John O Clarke division of gastroenterology and Hepatology Stanford University School of Medicine

Gastroparesis, or symptomatic delayed gastric emptying in the absence of mechanical obstruction, is a challenging and increasingly identified syndrome. Medical options are limited and the only medication approved by the Food and Drug Administration for treatment of gastroparesis is metoclopramide, although other agents are frequently used off label. With this caveat, first-line treatments for gastroparesis include dietary modifications, antiemetics and promotility agents, although these therapies are limited by suboptimal efficacy and significant medication side effects. Treatment of patients that fail first-line treatments represents a significant therapeutic challenge. Recent advances in endoscopic techniques have led to the development of a promising novel endoscopic therapy for gastroparesis via endoscopic pyloromyotomy, also referred to as gastric per-oral endoscopic myotomy or per-oral endoscopic pyloromyotomy. The aim of this article is to review the technical aspects of the per-oral endoscopic myotomy procedure for the treatment of gastroparesis, provide an overview of the currently published literature, and outline potential next directions for the field.

关键词： Gastroparesis Gastric per-oral endoscopic myotomy Per-oral endoscopic pyloromyotomy Myotomy Endoscopic myotomy Peroral endoscopic myotomy Gastric emptying

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Helicobacter pylori-negative,non-steroidal anti-inflammatory drug:Negative idiopathic ulcers in Asia

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World Journal of gastroenterology 2014年第3期20卷 706-713页

作者： Katsunori Iijima Takeshi Kanno Tomoyuki Koike Tooru Shimosegawa division of gastroenterology Tohoku University Graduate School of Medicine

Since the discovery of Helicobacter pylori(***)infection in the stomach,the bacteria infection and non-steroidal anti-inflammatory drugs(NSAIDs)use had been considered to be the 2 main causes of peptic ***,there have been recent reports of an increase in the proportion of peptic ulcers without these known risk factors;these are termed idiopathic peptic *** trend was firstly indicated in 1990s from some reports in North *** Asia,numerous studies reported that idiopathic ulcers accounted for a small percentage of all ulcers in the 1990s,but in the2000s,multiple studies reported that the proportion of idiopathic ulcers had reached 10%-30%,indicating that the incidence of idiopathic ulcers in Asia has also been rising in recent *** a decline in *** infection rates of general population in Asia is seen as the main reason for the increased incidence of idiopathic ulcers,it is also possible that the absolute number of idiopathic ulcer cases has *** age,serious systemic complication,and psychological stress are considered to be the potential risk factors for idiopathic *** of idiopathic ulcers is challenging,at present,because there is no effective preventative measure against recurrence in contrast with cases of ***-positive ulcers and NSAIDs-induced *** it is expected that *** infection rates in Asia will decline further in the future,measures to treat idiopathic ulcers will also likely become more important.

关键词： Helicobacter pylori Non-steroidal anti-inflammatory drugs Idiopathic peptic ulcer

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