ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In this report we examine biologic and epidemiologic data with the aim of understanding any correlations betweenHelicobacter pyloriinfection and preneoplastic and neoplastic changes.As far as biologic data are concerned, some elements point to the role ofH. pyloriin the development of preneoplastic and neoplastic changes, such as intestinal metaplasia and dysplasia. The relationship withH. pyloriwould mainly be due to an increased cellular proliferation with the presence of immature cells in the superficial layers, susceptible to metaplastic or dysplastic modifications. The subsequent passage toward cancer is probably caused by other factors inasmuch asH. pyloriis not able to colonize metaplastic or dysplastic areas and hyperproliferation remains at comparable levels, even in the absence of infection.In fact, available epidemiologic data show a high prevalence ofH. pyloriinfection in some geographic areas with a high incidence of gastric cancer. It is also true, however, that there are several populations in which a low neoplastic risk is associated with a high prevalence of infection.We stress the methodologic weaknesses of several studies that attempt to establish a strict association between cancer andH. pylori.Therefore, epidemiologic data are still contradictory and do not permit identifying a precise role ofH. pylorias a predominant causative agent in the onset of preneoplastic and neoplastic changes.We conclude thatH. pyloribehaves as a possible cofactor of other known damaging agents to the gastric mucosa, contributing to the risk of developing neoplastic modifications that may also be subject to individual genetic susceptibility.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Iron deficiency anemia in men and in postmenopausal women is assumed to be the result of occult blood loss from the gastrointestinal tract. Endoscopists are often asked to evaluate iron deficiency anemia and to identify the source of bleeding. Opinions differ on the approach to be used in the evaluation of these patients. There are no clear guidelines for evaluation of patients with iron deficiency anemia or for follow-up methods and procedures in elderly (older than age 50) patients in whom no cause for anemia was found, even after extensive gastrointestinal evaluation. This review offers an effective diagnostic strategy for this common clinical problem.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Although esophageal cancer is uncommon in the united states, its high mortality rate and recent increased incidence make it an important malignancy. Because there appears to be significant racial variation in the types of esophageal cancer, we examined a group of black patients with esophageal cancer and compared their risk factors, histology, and location with those of a cohort of white patients with esophageal cancer seen during the same period.We retrospectively reviewed patients with esophageal cancer seen at three major hospitals in Atlanta, Georgia from January 1990 to April 1996. Patients of races other than white or black were excluded from this study. the esophagus was separated into upper, middle, and lower thirds by defined criteria.Of the eligible 234 patients, 129 were black and 105 were white. In blacks with esophageal cancer, squamous cell cancer was the predominant type (92%), and adenocarcinoma was infrequent. in whites, adenocarcinoma was more common than squamous cell cancer (66% vs. 32%). Although Barrett's esophagus was distinctly uncommon, smoking and alcohol consumption were significantly more common in blacks. Only 43% of the patients with adenocarcinoma had evidence of barrett's esophagus. all adenocarcinomas were located in the lower third of the esophagus.There appear to be significant racial differences in the types, risk factors, and location of esophageal cancer. Adenocarcinoma and Barrett's esophagus are uncommon in blacks.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Peptic ulcer is associated with low socioeconomic status. In this study we used longitudinal population-based data to investigate factors other thanHelicobacter pylorithat might contribute to this association.Of 4597 Alameda County Study participants, 104 developed ulcers between 1965 and 1974. We examined the impact of baseline risk factors on the association between education and incident ulcer. Among women, high school dropouts had a higher risk of incident ulcer than those who attended college (age-adjusted odds ratio [OR], 3.3; 95% confidence interval [CI], 1.5, 7.3). Adjustment for smoking, alcohol, lack of sleep, skipping breakfast, chronic pain, and liver disease eliminated 21.7% of this excess risk, whereas adjustment for psychological characteristics and life stress eliminated 56.5% of the risk; adjusted for all risk factors, the OR was 1.9. Among men, the risk associated with low education was weaker (OR, 1.9; 95% CI, 0.9, 3.9). Health risk behaviors and poor health had a greater impact (55.5% drop in excess risk with adjustment) and psychosocial factors a lesser impact (33.3% drop) in men than in women. Adjustment for heavy on-the-job labor decreased the risk by 77.8%, whereas the fully adjusted OR was 1.0.We conclude that psychological stress, health risk behaviors, analgesic use, and hard physical labor may contribute to the increased risk of ulcer in low socioeconomic populations.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

To evaluate if the infection with strains of cytotoxin-associated gene A (CagA)-positiveHelicobacter pyloriis associated with either peptic ulcer and gastric atrophy or intestinal metaplasia in the elderly, we studied 71H. pylori-positive patients older than 62 years old (34 men, 37 women; mean age, 77.5 years; range, 62-89 years) affected with gastric ulcer (GU) (n = 10), duodenal ulcer (DU) n = 22), or chronic gastritis (CG) (n = 39).H. pyloriinfection was documented by means of gastric histology, rapid urease test, and polymerase chain reaction (PCR) assay performed on gastric biopsies using two sets of primers: one for the ureC gene specific forH. pylori,and the second specific for the CagA gene.H. pylori-CagA positivity was significantly more common in patients with GU (9 of 10, 90%) than with DU (11 of 22, 50%; p < 0.05) or CG(17 of 39, 43.5%; p = 0.01). Gastric atrophy and intestinal metaplasia were significantly more common in CagA-positive patients than in CagA-negative patients (gastric atrophy: 40.54% vs 11.76, p = 0.007; intestinal metaplasia: 40.54% vs 14.70%, p = 0.01). No difference in prevalence of gastric atrophy and intestinal metaplasia was found in patients divided according to pathology (GU, DU, or CG). Logistic regression demonstrated that gastric atrophy and intestinal metaplasia were independent factors significantly associated with CagA-positivity (gastric atrophy: odds ratio = 4.53, 95% confidence interval 1.25-16.4; intestinal metaplasia: odds ratio = 3.44, 95% confidence interval 1.01-11.7). Our findings help to confirm the hypothesis that an infection with CagA-positiveH. pyloristrains may be catalytic in inducing gastric changes which can evolve into malignancies.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Eighty-two consecutive patients with oral mucosal disorders were screened for celiac sprue with serum immunoglobulin A (IgA)-class endomysial and gliadin antibodies. In positive cases the diagnosis of celiac sprue was established by duodenal biopsy. Four patients were positive for endomysial antibodies and 22 for gliadin antibodies. Four (4.9%) patients were found to have celiac sprue: three of them by screening and one was previously diagnosed. Endomysial antibodies were present in all three newly diagnosed patients with celiac sprue, and gliadin antibodies were present in one. Sixteen of 22 patients positive for gliadin antibodies underwent small bowel biopsy, and 15 had normal mucosa. Patients with chronic oral mucosal disorders and a positive endomysial antibody test may suffer from celiac sprue. By contrast, gliadin antibodies were very prevalent even in the absence of celiac sprue.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Crohn's disease (CD) is rare in the Chinese population, but lately there seems to be an increasing trend of CD in the Singapore Chinese population. We carried out a retrospective study of all Chinese patients with CD seen from 1987 to 1993 at the Singapore General Hospital. All patients were regularly followed up and treated. Disease activity was defined by the Organisation Mondiale de Gastroenterologie index. We also compared our series with our first series reported in 1987 and a Western series.There were 32 patients (20 men, 12 women) giving a hospital prevalence of 26.7 per 100,000 patients compared with 3.5 per 100,000 patients in 1986. The mean age was 37.1 years (range, 19-80 years). Twelve patients had small intestinal disease, 9 had colonic disease, and 11 had both. The common presenting symptoms were bloody diarrhea (67%), abdominal pain (53%), loss of weight (47%), and fever (34%). Extraintestinal manifestations were rare. Six patients had no relapse during the follow-up period, whereas the remaining 26 patients had an average of two relapses(range, 1-5). These relapses were complicated by fistulas in 8 patients and strictures in 11 patients. Response to steroids and sulfasalazine was good in most patients. Four patients required repeated surgery despite medical treatment.The prevalence of CD appears to be increasing among the Singapore Chinese population. The clinical features are similar to those of the Western population. Most of our patients responded to standard medical therapy, but further follow-up is needed to assess their long-term clinical outcome.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We assessed the clinical and biochemical parameters associated with the development of posttransplantation diabetes (PTDM) in 52 liver transplant recipients followed up for 1 year. Diabetes was present before transplantation in 9.6% (5 of 52) of patients, and PTDM occurred in 23% (11 of 47) of the remaining liver transplant recipients. Of the 13 patients who had hepatitis C as the cause of their liver failure (HC-LD), 8 (62%) developed PTDM; of the 34 patients with other causes of liver failure, 3 (9%) developed PTDM (p < 0.001). Posttransplantation diabetes was also associated with the development of early posttransplantation hyperglycemia, a higher number of liver rejection episodes, and lower serum albumin levels at 6 months. The association of PTDM with HC-LD remained significant in a logistic regression model after adjustment for potential confounding variables.We conclude that PTDM is common in liver transplant recipients. Associated clinical parameters predictive of PTDM include a diagnosis of HC-LD before transplantation, the development of early hyperglycemia after transplantation, multiple episodes of posttransplantation liver rejection and low serum albumin levels at 6 months. The fact that HC-LD remained an independent risk factor for the development of PTDM may suggest a direct or immune-mediated pancreatic effect of the virus.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We examined the feasibility of the lipase-amylase(L/A) ratio to differentiate alcoholic from nonalcoholic acute pancreatitis in a large prospective series of patients with acute pancreatitis. One hundred fifty-eight consecutive patients with acute pancreatitis were studied. The pancreatitis was of biliary origin in 112 patients, due to alcohol abuse in 26, due to other causes in 8, and of unknown origin in 12. For all patients, serum, amylase, and lipase levels were determined simultaneously, and the L/A ratio was calculated using the amylase and lipase serum levels expressed as multiples of the respective upper normal limit. The ratios in patients with alcoholic acute pancreatitis ranged from 0.3 to 8 and in patients with nonalcoholic acute pancreatitis from 0 to 19.9. A value of 2.2 for the serum L/A ratio was found to be the best cutoff value for differentiating alcoholic from nonalcoholic acute pancreatitis. Using this limit, the sensitivity, specificity, and diagnostic accuracy of the L/A ratio in determining the alcoholic form of acute pancreatitis were 54%, 82%, and 77% respectively. Our study showed that the L/A ratio is not useful in distinguishing alcoholic from nonalcoholic acute pancreatitis.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID