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Anti-tumor necrosis factor α therapy associates to type 17 helper T lymphocytes immunological shift and significant microbial changes in dextran sodium sulphate colitis

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World Journal of Gastroenterology 2019年第12期25卷 1465-1477页

作者： Valentina Petito Cristina Graziani Loris R Lopetuso Marco Fossati Alessandra Battaglia Vincenzo Arena Domenico Scannone Gianluca Quaranta Andrea Quagliariello Federica Del Chierico Lorenza Putignani Luca Masucci Maurizio Sanguinetti Alessandro Sgambato Antonio Gasbarrini Franco Scaldaferri Istituto di Patologia Speciale Medica Università Cattolica del Sacro Cuore UOC di Medicina Interna e gastroenterologia Area di Gastroenterologia e Oncologia Medica Dipartimento di Scienze Gastroenterologiche Endocrino-Metaboliche e Nefro-Urologiche Fondazione Policlinico Universitario "A. Gemelli" IRCCS Dipartimento delle Scienze della Salute della Donna e del Bambino Fondazione Policlinico Universitario "A. Gemelli" IRCCS Istituto di Clinica Ostetrica e Ginecologica Università Cattolica del Sacro Cuore U.O.S.A. Gineco-Patologia e Patologia Mammaria Fondazione Policlinico Universitario "A. Gemelli" IRCCS Istituto di Anatomia Patologica Università Cattolica del Sacro Cuore Dipartimento di Anatomia Patologica e Istologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS Dipartimento di Microbiologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS Istituto di Microbiologia Università Cattolica del Sacro Cuore Unità di Microbioma Umano Ospedale Pediatrico Bambino Gesù IRCCS Unità di Parassitologia Ospedale Pediatrico Bambino Gesù IRCCS Istituto di Patologia Generale Università Cattolica del Sacro Cuore

BACKGROUND Anti-tumor necrosis factor α(TNFα) represents the best therapeutic option to induce mucosal healing and clinical remission in patients with moderate-severe ulcerative colitis. On the other side gut microbiota plays a crucial role in pathogenesis of ulcerative colitis but few information exists on how microbiota changes following anti-TNFα therapy and on microbiota role in mucosal healing.AIM To elucidate whether gut microbiota and immune system changes appear following anti TNFα therapy during dextran sulfate sodium(DSS) colitis.METHODS Eighty C57 BL/6 mice were divided into four groups: "No DSS", "No DSS + antiTNFα", "DSS" and "DSS + anti-TNFα". "DSS" and "DSS + anti-TNFα" were treated for 5 d with 3% DSS. At day 3, mice whithin "No DSS+anti-TNFα" and"DSS+anti-TNFα" group received 5 mg/kg of an anti-TNFα agent. Forty mice were sacrificed at day 5, forty at day 12, after one week of recovery post DSS. The severity of colitis was assessed by a clinical score(Disease Activity Index), colon length and histology. Bacteria such as Bacteroides, Clostridiaceae, Enterococcaceae and Fecalibacterium prausnitzii(F. prausnitzii) were evaluated by quantitative PCR.Type 1 helper T lymphocytes(Th1), type 17 helper T lymphocytes(Th17) and CD4+ regulatory T lymphocytes(Treg) distributions in the mesenteric lymph node(MLN) were studied by flow cytometry.RESULTS Bacteria associated with a healthy state(i.e., such as Bacteroides, Clostridiaceae and F. prausnitzii) decreased during colitis and increased in course of anti-TNFαtreatment. Conversely, microorganisms belonging to Enterococcaceae genera,which are linked to inflammatory processes, showed an opposite trend.Furthermore, in colitic mice treated with anti-TNFα microbial changes were associated with an initial increase(day 5 of the colitis) in Treg cells and a consequent decrease(day 12 post DSS) in Th1 and Th17 frequency cells. Healthy mice treated with anti-TNFα showed the same histological, microbial and immune features of untreated colitic mice. "No DSS + anti-TNF

关键词： Gut microbiota Dextran sodium sulphate colitis Immune system T cells Mesenchymal lymphnode Tumor necrosis factor α

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Use of non-selective beta blockers in cirrhosis:The evidence we need before closing(or not) the window

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World Journal of Gastroenterology 2015年第8期21卷 2265-2268页

作者： Vincenzo La Mura Giulia Tosetti Massimo Primignani Francesco Salerno U.O. Medicina Interna IRCCS-San Donato Dipartimento di Scienze Biomediche per la Salute Università degli studi di Milano U.O. gastroenterologia-1 IRCCS-Ca’ Granda Ospedale Maggiore Policlinico

Non selective beta blockers(NSBBs)are used in primary and secondary prophylaxis of portal hypertensionrelated bleeding in patients with cirrhosis.The efficacy of NSBBs treatment is predicted by hemodynamic response in term of reduction of the hepatic venouspressure gradient(HVPG)below 12 mm Hg or at least20%of the basal value.Nevertheless a relevant number of patients who do not achieve this HVPG reduction during NSBBs therapy do not bleed during follow up;this evidence suggests an additional non-hemodynamic advantage of NSBBs treatment to modify the natural history of cirrhosis.Recent studies have questioned the efficacy and safety of NSBBs in patients with advanced stage of liver disease characterized by refractory ascites and/or spontaneous bacterial peritonitis.These studies have suggested the existence of a defined and limited period to modify the natural history of cirrhosis by NSBBs:the"window hypothesis".According with this hypothesis,patients with cirrhosis benefit from the use of NSBBs from the appearance of varices up to the development of an advanced stage of cirrhosis.Indeed,in patients with refractory ascites and/or spontaneous bacterial peritonitis the hemodynamic effects of NSBBs may expose to a high risk of further complications such as renal insufficiency and/or death.Methodological concerns and contrasting results counterbalance the evidence produced up to now on this issue and are the main topic of this editorial.

关键词： Bleeding prophylaxis End stage liver disease Non-s

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Management of portopulmonary hypertension:New perspectives

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World Journal of Gastroenterology 2013年第45期19卷 8252-8257页

作者： Luigi Mancuso Francesca Scordato Michela Pieri Eliana Valerio Andrea Mancuso Department of Cardiologia Ospedale Cervello90100 Palermo Italy Cardiologia Clinica Candela 90100 Palermo Italy Epatologia e gastroenterologia Ospedale Niguarda Cà Granda Milano 20162 Milano Italy Medicina Interna 1 ARNAS Civico 90100 Palermo Italy

Portopulmonary hypertension(PPHTN)is a known complication of cirrhosis.Moderate-to-severe PPHTN implies an extremely poor prognosis.It occurs in 5%-10%of patients referred for liver transplantation(LT),and probably with an higher incidence in patients with large portosystemic shunts.Patients with moderate-tosevere pulmonary hypertension have been previously excluded from LT because of the extremely high surgical risk and since the post-transplant outcome reported was poor.Recently,new perspectives in the management of patients with portopulmonary hypertension are emerging.In fact,some pulmonary vasoactive drugs have become routine in the treatment of patients with idiopathic pulmonary hypertension.These drugs,particularly epoprostenol,have been recently introduced in the treatment of patients with PPHTN,and have been shown to be effective in reducing pulmonary artery pressure as well as pulmonary vascular resistances.Furthermore,recent studies seem to demonstrate that treatment with pulmonary vasoactive drugs could allow liver transplantation with acceptable surgical risks and excellent survival.Although there are not large series nor prospective studies addressing this topic,the clinical scenario of patients with PPHTN seems to be positively changing.

关键词： Portopulmonary hypertension Cirrhosis Liver transplantation Management Epoprostenol

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Naïve hepatitis B e antigen-negative chronic hepatitis B patients are at risk of carotid atherosclerosis:A prospective study

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World Journal of Gastroenterology 2021年第30期27卷 5112-5125页

作者： Mar Riveiro-Barciela Cristina Marcos-Fosch Fernando Martinez-Valle Fabrizio Bronte Olimpia Orozco Isidro Sanz-Pérez Daniele Torres Maria-Teresa Salcedo Salvatore Petta Rafael Esteban Antonio Craxi Maria Buti Department of Medicine of the UAB Hospital Universitari Vall d’HebronBarcelona 08035Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Instituto de Salud Carlos IIIMadrid 28029Spain Systemic Autoimmune Diseases Unit Internal Medicine DepartmentHospital Universitari Vall d'HebronBarcelona 08035Spain Sezione di gastroenterologia Di.Bi.M.I.SUniversity of PalermoPalermo 90133Italy Pathology Department Hospital Universitari Vall d'HebronBarcelona 08035Spain

BACKGROUND There is an increased risk of atherosclerosis in patients with chronic hepatitis C or human immunodeficiency virus,but there is scarce data on hepatitis B virus infection.The hypothesis of this study is that hepatitis B virus infection increases the risk of carotid plaques and subclinical atherosclerosis in naïve hepatitis B e antigen(HBeAg)negative subjects.AIM To assess the rate of carotid plaques and subclinical atherosclerosis in naïve HBeAg negative subjects in comparison with a cohort of healthy controls.METHODS Prospective case-control collaborative study conducted in two tertiary hospitals.Four hundred and two subjects prospectively recruited at the outpatient clinic were included from May 2016 to April 2017:201 naïve HBeAg-negative hepatitis B virus-infected[49 chronic hepatitis B(CHB)and 152 inactive carriers(ICs)]and 201 healthy controls.Anthropomorphic and metabolic measures,liver stiffness and carotid Doppler ultrasound were performed.Subclinical atherosclerosis was established on an intima-media thickness increase of≥1.2 mm and/or the presence of carotid plaques.Normally distributed quantitative variables were compared with the Student t test and those with a non-normal distribution with the Mann-Whitney U test.Categorical variables were compared between groups using theχ2 or Fisher exact test.RESULTS Carotid plaques were found more often in CHB(32.7%)than ICs(17.1%)or controls(18.4%)(P=0.048).Subclinical atherosclerosis was also increased in CHB(40.8%)vsICs(19.1%)or controls(19.4%)(P=0.003).No differences in the risk of atherosclerosis were observed between controls and ICs.The factors independently associated with the presence of carotid plaques were age[odds ratio(OR)1.43,P23,P28).In the subset of young subjects(2.5%vs 1.1%,P=0.027)and subclinical atherosclerosis(12.5%vs 2.2%,P=0.058)were more frequent among CHB than ICs.CONCLUSIO

关键词： Hepatitis B virus Carotid plaques Subclinical atherosclerosis Cardiovascular risk Endothelial dysfunction Intima-media thickness

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Therapeutic and clinical aspects of portal vein thrombosis in patients with cirrhosis

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World Journal of Hepatology 2015年第29期7卷 2906-2912页

作者： Massimo Primignani Giulia Tosetti Vincenzo La Mura U.O. gastroenterologia ed Epatologia IRCCS-Ca’ GrandaOspedale Maggiore Policlinico U.O. Medicina Interna IRCCS-San DonatoDipartimento di Scienze Biomediche per la SaluteUniversità degli studi di Milano

Portal vein thrombosis(PVT) is a frequent complication in cirrhosis, particularly in advanced stages of the disease. As for general venous thromboembolism, risk factors for PVT are slow blood flow, vessel wall damage and hypercoagulability, all features of advanced cirrhosis. Actually, the old dogma of a hemorrhagic tendency in cirrhosis has been challenged by new laboratory tools and the clinical evidence that venous thrombosis also occurs in cirrhosis. The impaired hepatic synthesis of both pro- and anticoagulants leads to a rebalanced hemostasis, more liable to be tipped towards thrombosis or even bleeding. Conventional anticoagulant drugs(low molecular weight heparin or vitamin K antagonists) may be used in cirrhosis patients with PVT, particularly in those eligible for liver transplantation, to prevent thrombosis progression thus permitting/facilitating liver transplant. However, several doubts exist on the level of anticoagulation achieved as estimated by coagulation tests, on the efficacy of treatment monitoring and on the correct timing for discontinuation in non-transplant candidates, while in transplant candidates there is expert consensus on continuing anticoagulation until transplantation. The recent introduction of direct acting oral anticoagulant drugs(DOACs) in other clinical settings generates much interest on their possible application in patients with cirrhosis and PVT. However, DOACs were not evaluated yet in patients with liver disease and cannot be recommended for the present time.

关键词： Portal vein thrombosis Coagulopathy Hypercoagulopathy Direct acting oral anticoagulantdrugs Cirrhosis

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Metabolic-associated fatty liver disease is associated with low muscle mass and strength in patients with chronic hepatitis B

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World Journal of Hepatology 2022年第8期14卷 1652-1666页

作者： Cecy Maria de Lima Santos Matheus Duarte Brito Pedro Alves Soares Vaz de Castro Thais Pontello de Vries Nataly Lopes Viana Marta Paula Pereira Coelho Olívio Brito Malheiro Tatiana Bering Maria Cristina Gonzalez Rosangela Teixeira Rodrigo Dias Cambraia Gifone Aguiar Rocha Luciana Diniz Silva Sciences Applied to Adult Health Care Post-Graduate Programme Faculdade de Medicina Universidade Federal de Minas GeraisBelo Horizonte 30130-100Minas GeraisBrazil Outpatient Clinic of Viral Hepatitis Instituto Alfa de GastroenterologiaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo Horizonte 30130-100Minas GeraisBrazil Faculdade de Medicina Universidade Federal de Minas GeraisBelo Horizonte 30130-100Minas GeraisBrazil Department of Locomotor System Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo Horizonte 30130-100Minas GeraisBrazil Department of Food and Nutrition Universidade Federal de Mato GrossoCuiabá78060-900Mato GrossoBrazil Postgraduate Program in Health and Behaviour Catholic University of PelotasPelotas 96015-560Rio Grande do SulBrazil Laboratory of Research in Bacteriology Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo Horizonte 30130-100Minas GeraisBrazil Department of Internal Medicine Universidade Federal de Minas GeraisBelo Horizonte 30130-100Minas GeraisBrazil

BACKGROUND Although the prognostic relevance of sarcopenia has been increasingly recognised in the context of liver disease,there is a paucity of data evaluating body composition in patients with chronic hepatitis B(CHB).Beyond virus-related factors,nutritional and metabolic aspects can be associated with skeletal muscle abnormalities in these patients and should not be disregarded.AIM To evaluate the association between components of sarcopenia and demographic,clinical,lifestyle,nutritional,and biochemical variables in CHB patients.METHODS Dual-energy X-ray absorptiometry(DXA)was used to assess muscle mass by quantifying appendicular lean mass(ALM)adjusted for body mass index(ALMBMI).Muscle function was evaluated by hand grip strength(HGS)and the timed up and go test.Metabolic-associated fatty liver disease(MAFLD)was defined according to the criteria proposed by an international expert panel.A body shape index and the International Physical Activity Questionnaire were used to assess central obesity and physical activity level,respectively.RESULTS This cross-sectional study included 105 CHB outpatients followed at the tertiary care ambulatory centre(mean age,48.5±12.0 years;58.1%males;76.2%without cirrhosis;23.8%with compensated cirrhosis).The DXA-derived fat mass percentage was inversely correlated with the ALMBMI(r=-0.87)and HGS(r=-0.63).In the multivariable analysis,MAFLD,sedentarism and central obesity were positively and independently associated with low ALMBMI.MAFLD and central obesity were independently associated with low HGS.CONCLUSION MAFLD and central obesity were associated with low muscle mass and strength in patients with chronic hepatitis B,independent of the liver disease stage.

关键词： Chronic hepatitis B Appendicular lean mass Muscle strength Metabolic associated fatty liver disease Central obesity Physical performance

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Effects of intragastric balloon placement in metabolic dysfunctionassociated fatty liver disease: A systematic review and metaanalysis

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World Journal of Hepatology 2021年第7期13卷 815-829页

作者： João Remíde Freitas Júnior Igor Braga Ribeiro Diogo Turiani Hourneaux de Moura Vitor Massaro Takamatsu Sagae Gabriel Mayo Vieira de Souza Guilherme Henrique Peixoto de Oliveira Sergio A Sánchez-Luna Thiago Ferreira de Souza Eduardo Turiani Hourneaux de Moura Cláudia Pinto Marques Souza de Oliveira Wanderley Marques Bernardo Eduardo Guimarães Hourneaux de Moura Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP Departamento de GastroenterologiaFaculdade de MedicinaUniversidade de Sao PauloSao PauloSPBR Division of Gastroenterology and Hepatology Department of Internal MedicineBasil I.Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at BirminghamBirminghamAL 35294United States Department of Gastroenterology Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil

BACKGROUND Metabolic dysfunction-associated fatty liver disease corresponds to a clinical entity that affects liver function triggered by the accumulation of fat in the liver and is linked with metabolic dysregulation.AIM To evaluate the effects of the intragastric balloon(IGB)in patients with metabolic dysfunction-associated fatty liver disease through the assessment of liver enzymes,imaging and several metabolic markers.METHODS A comprehensive search was done of multiple electronic databases(MEDLINE,EMBASE,LILACS,Cochrane and Google Scholar)and grey literature from their inception until February 2021.Inclusion criteria involved patients with a body mass index>25 kg/m2 with evidence or previous diagnosis of hepatic steatosis.Outcomes analyzed before and after 6 mo of IGB removal were alanine aminotransferase(IU/L),gamma-glutamyltransferase(IU/L),glycated hemoglobin(%),triglycerides(mg/dL),systolic blood pressure(mmHg),homeostatic model assessment,abdominal circumference(cm),body mass index(kg/m2)and liver volume(cm3).RESULTS Ten retrospective cohort studies evaluating a total of 508 patients were included.After 6 mo of IGB placement,this significantly reduced alanine aminotransferase[mean difference(MD):10.2,95%confidence interval(CI):8.12-12.3],gammaglutamyltransferase(MD:9.41,95%CI:6.94-11.88),glycated hemoglobin(MD:0.17%,95%CI:0.03-0.31),triglycerides(MD:38.58,95%CI:26.65-50.51),systolic pressure(MD:7.27,95%CI:4.79-9.76),homeostatic model assessment(MD:2.23%,95%CI:1.41-3.04),abdominal circumference(MD:12.12,95%CI:9.82-14.41)and body mass index(MD:5.07,95%CI:4.21-5.94).CONCLUSION IGB placement showed significant efficacy in improving alanine aminotransferase and gamma-glutamyltransferase levels in patients with metabolic dysfunctionassociated fatty liver disease as well as improving metabolic markers related to disease progression.

关键词： Intragastric balloon Metabolic dysfunction-associated fatty liver disease Homeostatic model assessment Abdominal circumference Body mass index

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Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy

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World Journal of Gastroenterology 2014年第37期20卷 13382-13401页

作者： Renato Costi Alessandro Gnocchi Francesco Di Mario Leopoldo Sarli Dipartimento di Scienze Chirurgiche Università di ParmaAzienda Ospedaliero-Universitaria di Parma Dipartimento Materno Infantile Unità Operativa di Gastroenterologia ed Endoscopia DigestivaAzienda Ospedaliero-Universitaria di Parma Dipartimento di Medicina Clinica e Sperimentale Università di ParmaAzienda Ospedaliero-Universitaria di Parma

Biliary lithiasis is an endemic condition in both Western and Eastern countries, in some studies affecting 20% of the general population. In up to 20% of cases, gallbladder stones are associated with common bile duct stones(CBDS), which are asymptomatic in up to one half of cases. Despite the wide variety of examinations and techniques available nowadays, two main open issues remain without a clear answer: how to cost-effectively diagnose CBDS and, when they are finally found, how to deal with them. CBDS diagnosis and management has radically changed over the last 30 years, following the dramatic diffusion of imaging, including endoscopic ultrasound(EUS) and magnetic resonance cholangiography(MRC), endoscopy and laparoscopy. Since accuracy, invasiveness, potential therapeutic use and costeffectiveness of imaging techniques used to identifyCBDS increase together in a parallel way, the concept of "risk of carrying CBDS" has become pivotal to identifying the most appropriate management of a specific patient in order to avoid the risk of "under-studying" by poor diagnostic work up or "over-studying" by excessively invasive examinations. The risk of carrying CBDS is deduced by symptoms, liver/pancreas serology and ultrasound. "Low risk" patients do not require further examination before laparoscopic cholecystectomy. Two main "philosophical approaches" face each other for patients with an "intermediate to high risk" of carrying CBDS: on one hand, the "laparoscopy-first" approach, which mainly relies on intraoperative cholangiography for diagnosis and laparoscopic common bile duct exploration for treatment, and, on the other hand, the "endoscopy-first" attitude, variously referring to MRC, EUS and/or endoscopic retrograde cholangiography for diagnosis and endoscopic sphincterotomy for management. Concerning CBDS diagnosis, intraoperative cholangiography, EUS and MRC are reported to have similar results. Regarding management, the recent literature seems to show better short and long term outcome of surgery in terms of re

关键词： Biliary lithiasis Choledocholithiasis Laparoscopy

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Giardia lamblia infection in patients with irritable bowel syndrome and dyspepsia:A prospective study

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World Journal of Gastroenterology 2006年第12期12卷 1941-1944页

作者： Barbara Grazioli Giovanni Matera Costanza Laratta Giuseppina Schipani Giovanni Guarnieri Ester Spiniello Maria Imeneo Andrea Amorosi Alfredo Focà Francesco Luzza Dipartimento di Medicina Sperimentale e Clinica Cattedra di Gastroenterologia Università di Catanzaro 'Magma Graecia' Catanzaro Italy Dipartimento di Scienze Mediche Istituto di Microbiologia Università di Catanzaro 'Magna Graecia' Catanzaro Italy Dipartimento di Medicina Sperimentale e Clinica Cattedra di Anatomia Patologica Universith di Catanzaro 'Magna Graecia' Catanzaro Italy

瞄准：评估兰伯氏贾第虫的流行(G。兰氏鞭毛虫属) 在有急躁的肠症候群(IBS ) 和消化不良并且到的病人的感染证实哪个是最精确的测试在这个背景诊断感染。方法：连续地由于 IBS 或消化不良的症状在 2002 年 1 月和 2003 年 12 月之间第... 详细信息

瞄准：评估兰伯氏贾第虫的流行(G。兰氏鞭毛虫属) 在有急躁的肠症候群(IBS ) 和消化不良并且到的病人的感染证实哪个是最精确的测试在这个背景诊断感染。方法：连续地由于 IBS 或消化不良的症状在 2002 年 1 月和 2003 年 12 月之间第一次出席了门诊病人肠胃病学诊所的 137 个病人被招募。所有病人经历了临床的评估，第一步的 haematology 和化学测试，为乳糜泻的血清学试金， lactose-H (2 ) 呼吸测试，腹的 ultrasonography，和 esophagogastroduodenoscopy。Helicobacter pylori 地位被评估。在有比 45 年旧的 IBS 的症状的病人，结肠镜检查也被执行。在所有病人，十二指肠的活体检视和凳子样品为 G 的 trophozoites 和包囊被检验。由几个方法的兰氏鞭毛虫属。结果：G。兰氏鞭毛虫属在 9 个病人被识别。下列诊断也被做：IBS (100/137， 73%) ，机能性消化不良(62/137， 45%) ，器官的消化不良(33/137， 24%) ，并且乳糖不耐(75/137， 55%) 。一个重要协会在贾第虫病和 H pylori 感染之间被发现(c2=6.632， OR=12.4， CI=1.5-68.1 ) 。没有症状，可靠地允许贾第虫病的识别。当十二指肠的活体检视的组织学的检查显示了低敏感时，在十二指肠的活体检视和凳子样品考试的寄生虫的直接搜索在所有情况中给了一致结果(例如， 22.2%) 。结论：在这个连续系列， G 的诊断。兰氏鞭毛虫属感染与 IBS 和消化不良说明了 6.5% 病人。如果凳子样品检查被执行，为贾第虫病的诊断的十二指肠的活体检视可能是不必要的。

关键词：贾第鞭毛虫病炎症消化不良幽门螺杆菌

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Ecological study of gastric cancer in Brazil:Geographic and time trend analysis

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World Journal of Gastroenterology 2014年第17期20卷 5036-5044页

作者： César Augusto Amorim Jéssica Pronestino Moreira Luisa Rial Antonio José Carneiro Homero Soares Foga?a Celeste Elia Ronir Raggio Luiz Heitor Siffert Pereira de Souza Servi?o de gastroenterologia Departamento de Clínica MédicaHospital UniversitárioUniversidade Federal do Rio de JaneiroRio de JaneiroRJ 21941-913Brazil Instituto de Epidemiologia e Saúde Coletiva Universidade Federal do Rio de JaneiroRio de JaneiroRJ 21941-913Brazil

AIM:To investigate the geographic distributions and time trends of gastric cancer(GC)incidence and mortality in Brazil.METHODS:An ecological study of the DATASUS registry was conducted by identifying hospitalizations for GC between January 2005 and December 2010.The data included information on the gender,age,and town of residence at the time of hospital admission and death.RESULTS:The GC rates,adjusted according to available hospital beds,decreased from 13.8 per 100000in 2005 to 12.7 per 100000 in 2010.The GC rates decreased more among the younger age groups,in which the male-to-female difference also decreased in comparison to the older age groups.Although the lethality rates tended to increase with age,young patients were proportionally more affected.The spatial GC distribution showed that the rates were higher in the south and southeast.However,while the rates decreased in the central-west and south,they increased in the northern regions.A geographic analysis showed higher rates of GC in more urbanized areas,with a coast-toinland gradient.Geographically,GC lethality overlapped greatly with the hospital admission rates.CONCLUSION:The results of this study support the hypothesis of a critical role for environmental factors in GC pathogenesis.The declining rates in young patients,particularly males,suggest a relatively recent decrease in the exposure to risk factors associated with GC.The spatial distribution of GC indicates an ongoing dynamic change within the Brazilian environment.

关键词： Gastric cancer Ecological study Hospitalization Le

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