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

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundCrohn's disease (CD) is a chronic transmural inflammatory disease of unknown etiology. Genetic background may influence the nature of disease. The Jewish population in Israel is composed of Ashkenazi and Sephardic Jews, who differ in their genetic background. Previous studies have reported that the prevalence of CD in Sephardic Jews is lower than in Ashkenazi Jews; however, no information is available regarding disease characteristics in these patient populations.GoalsTo assess the demographic and clinical characteristics of CD in Israeli Jewish patients.StudyWe studied 189 CD patients who were observed in our department. Demographic and clinical data were collected and analyzed.ResultsForty-eight percent of the patients had ileum-only disease. Fistulizing disease was more frequently seen in ileocolonic than in ileal (p= 0.04) or colonic (p= 0.01) disease, whereas strictures occurred more often in ileal than in colonic disease (22% and 3%, respectively,p= 0.007). No association was found between current smoking and disease severity. Sephardic patients more frequently had extraintestinal disease than did Ashkenazi patients (35% vs. 17%, respectively,p= 0.019).ConclusionJewish Israeli patients show a predilection for ileum-only disease. Disease severity appears not to be influenced by smoking. These differences in disease behavior may be related to genetic factors.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

GoalsA clinical problem is posed by patients with symptoms suggestive of gluten sensitivity (diarrhea, weight loss, unresponsive iron-deficiency anemia, etc.); however, small intestinal biopsies reveal only minor abnormalities, such as lymphocytosis with or without crypt hyperplasia (Marsh I-II). Our aim was to assess the benefit of a gluten-free diet (GFD) in patients with these small bowel mucosal abnormalities.StudyWe studied 35 patients (11 men, 24 women; mean age, 28 years; range, 22–51 years) referred to us for gastrointestinal symptoms or unexplained or unresponsive diseases. Because celiac disease was suspected to be the underlying pathology, small intestinal biopsies were taken. These revealed only minor abnormalities: 11 patients showed Marsh I type lesions, whereas 24 patients demonstrated Marsh II type lesions. Although the histologic lesions were inconsistent for celiac disease and a suspicion of a borderline celiac disease persisted, all patients were motivated to adhere to GFD.ResultsOnly 23 patients adhered to our advice and followed a GFD; follow-up biopsies were taken after 8 to 12 months. In the Marsh I lesion group (seven patients), five patients showed mucosal normalization to Marsh 0 and two showed persistence of Marsh I lesions. In the Marsh II lesion group (16 patients), 9 patients revealed mucosal normalization, 5 improved to a Marsh I lesion, and 3 revealed persistence of Marsh II lesions. A dramatic clinical improvement in symptoms was noted in all patients who were on a GFD, with symptoms virtually disappearing in all patients. Seven patients who refused GFD were reevaluated 8 to 12 months later. Symptoms and histologic lesions were unchanged in six, all of whom refused again to adhere to a GFD. One of the seven with Marsh I lesions had a worsening of symptoms and of histologic lesions (from Marsh I to Marsh IIIa); so, this last patient adhered to a GFD.ConclusionsSymptoms disappeared after GFD in patients suspected to have celiac disease but with slight histologic lesions. Although Marsh I-II lesions cannot be classified as celiac lesions (ESPGAN criteria), the patients' symptoms at presentation and the clear improvement of symptoms when on GFD, with or without improvement of histologic lesions, supports the assumption that these patients are sensitive to gluten and may justify treatment with a GFD.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundIntussusception in adults is often diagnosed on computed tomography (CT), and the optimal treatment of this entity is not universally agreed upon. We report our experience in an attempt to clarify the usefulness of CT scan and the optimal treatment of this entity.StudySeven cases of adult intussusception were encountered at our institute between 1991 and 2001. Data related to presentation, diagnosis, treatment, and pathology were analyzed.ResultsPreoperative diagnosis was made in four patients by CT scan and/or ultrasonography. Two patients had colonic cancer and one had jejunal cancer. Three of four patients with small bowel intussusception underwent reduction before resection and the other one underwent resection without reduction because of severe ischemic bowel.ConclusionsThe CT scan is most useful in making the diagnosis of intussusception. Colonic lesions should be resected without reduction. Small bowel lesions should be reduced only in patients in whom a benign diagnosis has been strongly suggested preoperatively or in patients in whom resection may result in short gut syndrome.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

GoalsTo evaluate the prevalence ofHelicobacter pylori(Hp) infection in a group of inflammatory bowel disease (IBD) outpatients and the possible influence of treatment.BackgroundThe low prevalence of Hp infection in these patients is usually attributed to environmental factors; the role of drugs has not been fully investigated.StudySeventy-two consecutive outpatients underwent a C13-urea breath test for Hp: 32 with Crohn's disease (13 men; mean age, 48 years; range, 20–72 years) and 40 with ulcerative colitis (25 men; mean age, 49 years; range, 25–71 years). Thirty-one patients were treated with sulfasalazine and 41 with 5-ASA. The control group consisted of 72 age- and sex-matched subjects.ResultsThe prevalence of Hp infection was 47% in the IBD patients and 61% in the controls (p= 0.089; odds ratio = 0.55; 95% CI = 0.283–1.089) with a statistically significant increase for each year of age (p= 0.044; odds ratio = 1.02; 95% CI = 1.001–1.052). Among the IBD patients, age and gender, the type, activity, duration, extent of the disease, or the calendar year of diagnosis, had no influence on Hp infection.H. pyloriwas detected in 65% of the patients treated with sulfasalazine and in 34% treated with 5-ASA (p= 0.017).ConclusionsAlthough low, the prevalence of Hp infection in our patients was not significantly different from that in the controls. 5-ASA, and not sulfasalazine, may have a protective effect against Hp infection.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Pathogenesis of chronic inflammation at the gastric cardia is not yet clear. It is controversial whether cardiac-type mucosa is normal structure at the cardiac region. Therefore, we studied the existence of correlations between carditis,Helicobacter pyloriinfection, and gastroesophageal reflux disease, and determined the prevalence of cardiac mucosa at the endoscopically defined cardiac region. Gastric biopsy specimens were analyzed from 27 patients with reflux esophagitis and 30 subjects without reflux esophagitis. Carditis was not associated with reflux esophagitis, but withH. pyloriinfection. Moreover, the degree of gastritis and atrophy at the cardia were closely related to those of the antrum and body. Cardiac mucosa was not always present in the endoscopically defined cardiac region, and its prevalence was positively correlated with gastritis and atrophy grade of the cardia and age. In conclusion,H. pylori-induced pangastritis may lead to the development of carditis, which is associated with occurrence of cardiac-type mucosa at the cardiac region.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThere is a significant association between a positive family history of cancer and gastric cancer risk; however, the clinicopathologic characteristics and prognoses of gastric cancer patients with a positive family history of cancer are not clear.GoalsTo define the clinicopathologic characteristics and prognoses of gastric cancer patients with a positive family history of cancer.StudyWe reviewed 548 patients with pathologically confirmed primary gastric cancer who had undergone a gastrectomy between 1990 and 1996. The average age was 59.7 years, and the male-to-female ratio was 1.7. The familial cancer histories of these patients were reviewed, and the various clinicopathologic characteristics of those patients with a positive family history of cancer were compared with those with a negative history.ResultsAmong this cohort, 74 (13.5%) patients had a positive family history of cancer in their primary or secondary relatives. The most common cancer was gastric cancer in 29 patients, followed by colorectal cancer in 10 and lung cancer in 7. Patients with a positive family history of cancer were associated with bigger tumors, and more patients received a total gastrectomy than did patients with a negative family history. Immunopathologic study disclosed a higher rate of p53 overexpression but not of neu or c-met in patients with a positive family history of cancer. There were no differences in the mean age, gender, site, depth of invasion, or TNM stage. The survival curve of patients with a positive family history of malignancy was similar to that of patients without a family cancer history.ConclusionPatients with gastric cancer with a positive family history of cancer appeared to have bigger tumors with a higher rate of p53 overexpression, and more patients required a total gastrectomy compared with those with a negative family history. This study suggests a genetic component in the aggressiveness of gastric cancer and indicates that higher caution should be exercised with people who have a positive family history of cancer.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID