ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Endoscopic ultrasound (EUS) plays a vital role in management of upper gastrointestinal disorders, particularly cancer of the esophagus, pancreas, stomach, lung (via transesophageal mediastinal staging), and bile duct. Endoscopic ultrasound has also been valuable in detection of early chronic pancreatitis (CP). In cancer of the esophagus, the primary role of EUS is to determine whether disease is localized (T1–2, N0) and appropriate for surgery, locally advanced (T3–4, N1, M1a) (which may benefit from chemoradiation with or without surgery), or metastatic. Pancreatic and bile duct cancers are more complex given the controversy over portal vein resection. In centers that resect tumors invading the portal venous system, the role of EUS is limited to tissue confirmation or identification of metastases to the liver or distant lymph nodes. In centers that do not resect the portal vein invasion, EUS plays an important role in local staging. In lung cancer, EUS is emerging as an accurate, nonsurgical alternative to staging the mediastinum through EUS fine-needle aspiration. Endoscopic ultrasound has an important role in diagnosing CP because of its high degree of sensitivity. This has also led to controversy over whether EUS can overdiagnose CP. For these reasons, we recommend the use of a high threshold for EUS and that CP be diagnosed in conjunction with other standard tests (endoscopic retrograde cholangiopancreatography, pancreatic function tests).

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The gut flora plays a fundamental role in maintaining normal intestinal function. A disturbance of this flora, or the host response to this flora, has been clearly demonstrated to play a role in the pathogenesis of inflammatory bowel disease (IBD). This has led to attempts to modify the bacterial flora with “live non-pathogenic organisms that confer health benefits by improving the microbial balance,” otherwise known as probiotics. Recent attention has focused on this potential strategy to treat or prevent IBD. The potential therapeutic benefit is enhanced by the natural and apparently safe approach that probiotics offer. Animal models of colitis have provided the proof of principle that probiotics can prevent and treat established intestinal inflammation. Controlled clinical studies have demonstrated the efficacy of probiotics in the maintenance of remission of pouchitis, prophylaxis of pouchitis after the formation of an ileoanal reservoir, maintenance of remission of ulcerative colitis, and treatment of Crohn's disease. However, large controlled trials are needed to definitively establish the place for probiotics in the treatment of IBD and resolve issues such as the dose, duration, frequency of treatment, and use of single or multiple strains. Research is focusing on establishing the mechanism of action, so that treatments with individually tailored properties are developed and innovative approaches are explored.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundEosinophil accumulation and activation are characteristic features of inflammation in allergic diseases and in host defense against parasites.GoalsTo investigate the involvement of eosinophils in inflamed and noninflamed mucosa of patients with inflammatory bowel disease (IBD).StudySpecimens of inflamed colonic mucosa from 15 patients with ulcerative colitis (UC) and inflamed and noninflamed colonic mucosa from 15 patients with Crohn's disease (CD) were submitted to histologic and immunohistochemical studies. Twelve patients with irritable bowel syndrome were studied as controls. Sirius red was used to label eosinophils in tissue. EG1, EG2, and anti–hIL-5 were used as primary antibodies in an indirect alkaline phosphatase-labeled immunostaining protocol. Both positive and negative lamina propria cells were assessed by a quantitative grading system and the results expressed as cell numbers per mm2.ResultsIncreased proportions of eosinophils stained with Sirius red, EG1, EG2, and anti–hIL-5+ cells were found in the colon of patients with UC and in inflamed and noninflamed colon of CD patients as compared with controls. Crohn's disease patients showed increased proportions of EG1+ and EG2+ cells as compared with those with UC. Increased proportions of IL-5+ cells were detected in UC patients as compared with those with CD.ConclusionQuantitative eosinophil alterations and IL-5+ cells may indicate enhanced cellular activation with degranulation, which is implicated in the pathogenesis of IBD. Increase in IL-5+ cells may reflect a predominant local Th2 response in UC as compared with CD.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundShort-segment Barrett's esophagus (SSBE) is defined by the presence of columnar-appearing mucosa in distal esophagus (involving less than 2 to 3 cm), with intestinal metaplasia on biopsy. Its potential to develop dysplasia and cancer may require a surveillance program with better diagnostic tools to detect intestinal metaplasia.GoalsTo investigate the role of imprint cytology as a diagnostic tool either alone or combined with histology in SSBE.StudySeventy-nine patients (46 men, 33 women) with SSBE diagnosed during elective upper gastroscopy were included. Patients with serrated z-line with short tongues of pink mucosa and patients with a circular nonserrated z-line that extended less than 2 cm above the esophagogastric junction were biopsied on four quadrants just distal to z-line. Four slides of imprint preparation (including 1, 2, 3, and 4 touching of each biopsy specimen) was made for cytologic examination. Hematoxylin and eosin and Alcian blue staining for histologic examinations and Alcian Blue for cytologic evaluations were used to find evidence of intestinal metaplasia.ResultsIntestinal metaplasia was detected in 15 (19%), 21 (27%), and 30 (38%) patients by histologic examination with hematoxylin and eosin alone, by Alcian blue alone, and by histologic plus cytologic examination with Alcian blue, respectively. Nine patients with negative histologic but positive cytologic results were positive for intestinal metaplasia when they were reevaluated after further sectioning and staining. Sensitivity of imprint cytology alone was 53%. When imprint cytology was combined with the histologic evaluation, the prevalence of intestinal metaplasia increased from 27% to 38% (p< 0.05).ConclusionImprint cytology might be a complementary diagnostic tool for histology in detecting patients with SSBE.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

GoalsTo determine whether serum vitamin B12levels in non-vitamin B12deficient healthy adults correlate with serological evidence ofH. pyloriinfection.BackgroundAn association betweenH. pyloriinfection and vitamin B12deficiency has been recently reported.Study133 adults, presenting to a community based primary care clinic who met the following exclusion criteria; history ofH. pylorieradication or antacid use, liver disease, inflammatory bowel disease, previous gastrointestinal surgery, a vegetarian diet or multivitamin supplementation were studied. Blood was drawn for a complete blood count, serum vitamin B12, gastrin, folic acid andH. pyloriIgG antibodies. Subjects with vitamin B12≤ 145 ng/mL (deficient range) were excluded.ResultsOf 133 subjects 96 (72.2%) were seropositive forH. pyloriIgG antibodies (HP+). Age of HP(+) subjects did not differ from that of seronegative subjects (HP−); 52.8 ± 1.6 mean ± SE versus 49.2 ± 2.9 (p= NS). Prevalence of HP seropositivity was significantly higher among subjects with borderline (>145–180 pg/mL) or low normal (>180–250 pg/mL) vitamin B12levels than among those with vitamin B12>250 pg/mL; among 25 subjects with vitamin B12>145–180 pg/mL 92% were seropositive and among 47 subjects with vitamin B12>180–250 pg/mL 89% were seropositive as compared with 31/61 (51%) of subjects with B12>250 pg/mL, Fisher exact testp< 0.0001. Vitamin B12levels did not correlate with age (r = −0.07). Gastrin levels (pg/mL) did not differ significantly between groups; 70.2 ± 5.8 in HP(+) versus 56.0 ± 12.4 in HP(−).ConclusionsThe higher prevalence ofH. pyloriinfection among subjects with serum vitamin B12levels that are within the lower end of the normal range suggests a causal relationship betweenH. pyloriinfection and vitamin B12levels in healthy adults.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThe epidemiology ofHelicobacter pylori(Hp) still constitutes a relevant subject of investigation.GoalsThe goal of this study was to determine the seroprevalence rate of Hp antibodies in medical students and residents, and its relationship with medical practice, age, gender and parents' formal education level.StudyThe study was carried out from March 1999 to March 2000, on a population of 1,119 medical students and residents, from which a randomized and stratified sample was drawn. Each stratum comprised students attending the basic training level, students attending the professional training level, and residents. Independent samples were calculated for each group, making a total of 405 subjects. Each participant was interviewed using a questionnaire. After the interview, serum samples were collected and stored at −20°C for detecting IgG antibodies against Hp by an enzyme-linked immunosorbent assay.ResultsA 31.4% seroprevalence rate of Hp antibodies was observed, which significantly increased during the graduation course according to the medical practices, ranging from 23.4% in students up to 38.6% in residents. Seroprevalence rate increased according to the age (p= 0.002), where older individuals had spent more time in practical activities. Seroprevalence was higher in males and was smaller among those whose parents had a university degree.ConclusionThe seroprevalence rate of Hp antibodies amongst medical students and residents increases from the basic up to residence level, suggesting that contact with patients during clinical practice may constitute a risk factor for acquiring Hp infection.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundHelicobacter pyloriinfection is highly prevalent and may cause disease in 10% to 15% of infected individuals: duodenal and gastric ulcer, gastric cancer and gastric lymphoma. Guidelines for a test-and-treat policy have been published by the EuropeanH. pyloriworking group in Maastricht.GoalsTo assess the current approach toH. pylori–related diseases, indications for testing and eradication therapy, among internists and surgeons of a University affiliated medical center.StudyA 15-items questionnaire was formulated according to the Maastricht II test-and-treat recommendation and distributed among the physicians of 6 internal medicine departments and the department of surgery. The questionnaires were completed anonymously at the department's staff meeting, under the supervision of the head of the department. All questions required a yes/no answer; the maximum possible score was 15. The relative ratio (RR) of correct answers was calculated for every question and by subgroups as follows: all participants, internists, surgeons, experts and residents in internal medicine and surgery.ResultsThe response rate was 68% (55 out of 80 physicians). Total score for all participants was 10.9 (RR = 0.73), significantly lower than the maximum score of 15 (RR = 1.00). The internists had significantly higher average score than the surgeons for 2 questions: causative agent in gastric cancer (p= 0.003) or gastric lymphoma (p= 0.003), 1 question about triple therapy, PPI, penicillin and azythromycin being not recommended (p= 0.022), and for 1 question of test-and-treat policy: should this strategy apply to family members of gastric cancer patients (p= 0.045). Only 56% of the internists and 21% of surgeons knew what MALToma is, and the correlation withH. pyloriinfection.ConclusionKnowledge of Surgeons and Internists regardingH. pyloriinfection and correlation with diseases or test and treat policy should be improved.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID