ISSN:0267-1379    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0267-1379    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0267-1379    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This review of the past year's literature focuses on progress in the elucidation of the pathways and mechanisms controlling gastric exocrine (ie, acid and pepsin) and endocrine (ie, gastrin, histamine, and somatostatin) secretion at the central, peripheral, and intracellular levels by neural, hormonal, and paracrine agents. Molecular biological techniques continue to further our knowledge into the function of receptors regulating gastric secretion and the transduction pathways to which they are coupled. Techniques for purification and enrichment of fundic enterochromaffin-like cells have proven useful tools with which to examine the mechanisms regulating histamine secretion. Somatostatin, acting as a paracrine agent, is the main inhibitor of exocrine and endocrine secretion by the stomach and additional evidence is provided that the hypergastrinemia induced byHelicobacter pyloriis mediated via a decrease in somatostatin secretion. The role of trefoil peptides and nitric oxide in the regulation of gastric secretion remains to be determined.

ISSN:0267-1379    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The recognition that most peptic ulcer disease occurs as a consequence of eitherHelicobacter pyloriinfection or ingestion of nonsteroidal anti-inflammatory drugs has renewed interest in the hypothesis that ulcer disease occurs principally as a consequence of impaired mucosal defense. Studies published over the past year have advanced our understanding of the many complex interactions among the various components of mucosal defense, such as the microcirculatory response, mucus and bicarbonate secretion, and restitution. It is becoming increasingly clear that mediators such as nitric oxide, previously regarded solely as vasoactive substances, also affect the epithelium, parietal cells, and mast cells to produce effects that alter mucosal resistance to injury. Progress has also been made in understanding the influence of many mediators and growth factors on the ability of the mucosa to repair damage.

ISSN:0267-1379    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Strong advice to stop smoking and careful prescription of nonsteroidal anti-inflammatory drugs remain basic steps in peptic ulcer management. Long-term, low-dose treatment with an H2-blocker provides effective prophylaxis against recurrent ulceration, but most patients with peptic ulceration should now be offered treatment to eradicate infection withHelicobacter pylori.An H+, K+-APTase inhibitor is the treatment of choice for a patient with the Zollinger-Ellison syndrome. Treatment of peptic ulceration is usually safe, but there are concerns about increased hazards of enteric infection due to decreased gastric acid, and the accelerated development of gastric atrophy during long-term treatment with omeprazole. Finding an effective and convenient regimen for the eradication ofH. pyloriremains the major problem in the medical management of peptic ulceration.

ISSN:0267-1379    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Upper gastrointestinal tract endoscopy plays a key role in the investigation of iron deficiency anemia and upper gastrointestinal hemorrhage. Therapeutic endoscopy improves the outcome in bleeding peptic ulcers, but better prognostic factors are needed for the selection of successful endoscopic hemostasis. A novel concept for predicting re-bleeding based on the appearance of the ulcer base has been proposed and transendoscopic Doppler has been used to examine vessels in ulcers. In variceal bleeding, transjugular intrahepatic portosystemic stent-shunt has been applied with increasing success, although the exact role of this technique has not been determined. Further evidence is given that estrogen-progesterone treatment is effective in the management of patients with severe, recurrent bleeding from gastrointestinal vascular malformations leading to high transfusion requirements. The role of endoscopic ultrasonography (mainly in the preoperative staging of gastric cancer) is further defined, suggesting that this technique, in certain situations, may be superior to radiologic staging methods.

ISSN:0267-1379    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Laparoscopic techniques continue to replace conventional open surgery in the treatment of many gastrointestinal disorders. Excellent results from the “minimal access” approach have been reported for gastroesophageal reflux and peptic ulcer disease. The incidence of gastric cancer continues to decline and lesions become more proximally located. However, aggressive surgical therapies have not resulted in increased cure rates. Treatment of pancreatic and extrapancreatic gastrinomas centers on surgical resection for potential malignancy. Gastric bypass seems to provide the best weight reduction in morbid obesity, with acceptably low side effects and complications.

ISSN:0267-1379    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Despite the decline in the incidence of gastric cancer in Western countries over the past four decades, adenocarcinoma of the proximal stomach and gastroesophageal junction are increasing steadily. Although little is known about the etiologic factors responsible for the increased incidence of these tumors, recent studies have identified molecular alterations in gastric cancers including mutations in oncogenes, tumor suppressor genes, and genes involved in cellular adhesion processes. Reduced expression and mutation of the cell adhesion molecule, E-cadherin, has been found in gastric cancers and may underlie their tendency toward invasion and metastasis. The carbohydrate-associated antigen sialosyl-Tn antigen has been shown to be of prognostic value in colon cancer and its role in the clinical behavior of gastric cancers is under evaluation. Interesting data on the use of chemopreventive agents have been obtained from a nutritional intervention trial in Linxian, China. Linxian has one of the highest rates of esophageal and gastric cardia cancer in the world and dietary deficiencies in vitamins and minerals are believed to contribute to cancer causation in this population. Regarding the treatment of local-regional gastric cancer, there is continued interest in combined pre- and postoperative chemotherapy in an effort to downstage disease prior to resection. However, more efficacious regimens are needed before the theoretical benefits of this approach can be fully realized. Chemotherapy for advanced disease remains experimental and current approaches aim to maximize existing regimens while the search for new agents continues.

ISSN:0267-1379    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Gastroduodenal motility disturbances are considered to be of major importance in the pathogenesis of a number of diseases, including functional dyspepsia. The topics chosen for review this year highlight new advances in both physiology and pathophysiology. Human rather than animal studies were generally selected for review because of their direct relevance to human disease. Important contributions have included the development of new approaches for measuring gastric emptying and further insights into how gastric emptying occurs and is controlled. Useful studies of the epidemiology, classification, pathogenesis, and treatment of functional dyspepsia are also reviewed.

ISSN:0267-1379    

出版商:OVID    

年代:1994

数据来源: OVID