RESUMO
Gastrointestinal bleeding is a common and sometimes life-threatening event in older people. There is often a drug-induced cause. Drugs that can lead to gastrointestinal bleeding include non-steroidal anti-inflammatory drugs (NSAIDs) like diclofenac and ibuprofen, platelet inhibitors such as acetylsalicylic acid (ASS), clopidogrel and prasugrel, as well as anticoagulants like vitamin-K antagonists, heparin or direct oral anticoagulants (DOAKs). Combination antiplatelet therapy or combined medication with platelet inhibitor and anticoagulants increase the risk of gastrointestinal bleeding compared to monotherapy. Primary and secondary prevention options include Helicobacter pylori eradication and co-medication with a proton pump inhibitor (PPI).
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Anticoagulantes/efeitos adversos , Aspirina/efeitos adversos , Hemorragia Gastrointestinal/induzido quimicamente , Inibidores da Agregação Plaquetária/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Helicobacter pylori , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Inibidores da Bomba de Prótons/administração & dosagem , Fatores de RiscoAssuntos
Infecções por Helicobacter/diagnóstico por imagem , Infecções por Helicobacter/terapia , Helicobacter pylori , Úlcera Péptica/diagnóstico por imagem , Úlcera Péptica/terapia , Guias de Prática Clínica como Assunto , Medicina Baseada em Evidências , Gastroenterologia/normas , Alemanha , Infecções por Helicobacter/virologia , Humanos , Resultado do TratamentoRESUMO
In the line "bismuth-containing quadruple therapy" of Table 7 (p 342), in the column "dosage" incorrectly at the three antibiotics respectively 1-1-1-1. The correct is: 3-3-3-3.
Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia , Gastroenterologia/normas , Alemanha , Humanos , Oncologia/normas , Guias de Prática Clínica como AssuntoRESUMO
The detection of a diffuse infiltrate of heterogeneous small B-cells in the lamina propria mucosae invading the epithelium and destroying the glandular tissue by discrete aggregates of three or more marginal zone B-cells above the basal membrane (so-called lymphoepithelial lesions) is suspicious of a mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach. The demonstration of a monoclonal B-cell population by immunohistochemistry, in situ hybridization or PCR excludes a benign lymphatic lesion. In the differential diagnosis with other small B-cell lymphomas in the stomach, a panel of five different immunohistochemical markers is useful to diagnose a small lymphocytic lymphoma (CD5 and CD23 positive), a mantle cell lymphoma (CD5 and cyclin D1 positive) or a follicular lymphoma (BCL2 and CD10 positive). The presence of the translocation t(11;18)(q21;q21) or the API2/MALT1 rearrangement could give further information about the clinical course and the prognosis of a gastric MALT lymphoma.
Assuntos
Linfoma de Zona Marginal Tipo Células B/patologia , Mieloma Múltiplo/patologia , Neoplasias Gástricas/patologia , Idoso , Linfócitos B/patologia , Diagnóstico Diferencial , Feminino , Mucosa Gástrica/patologia , Humanos , Hibridização In Situ , Linfoma de Zona Marginal Tipo Células B/genética , Técnicas de Diagnóstico Molecular , Mieloma Múltiplo/genética , Prognóstico , Neoplasias Gástricas/genéticaRESUMO
BACKGROUND: In current guidelines H. pylori eradication is recommended as first-line therapy in patients with gastric MALT lymphoma irrespective of stage and H. pylori status. However, data on treatment and clinical course of patients with H. pylori negative MALT lymphoma are rare. AIM: To evaluate therapeutical results in patients with H. pylori negative gastric MALT lymphoma. METHODS: 21 patients (13 male and 8 female; 63.9 years, range 43â-â80) with gastric MALT lymphoma were analysed retrospectively on the basis of medical reports in all cases and repeated outpatient visits at our center in 17 cases. H. pylori infection was excluded by negative histology, rapid urease test, or C13 urease breath test, and serology in all cases. Follow-up was 56.4 (5â-â142) months. RESULTS: Ten of 21 patients were treated with H. pylori eradication, and four of them received no further therapy. The other six patients underwent surgery, chemotherapy, and radiation, after eradication therapy. Those eleven patients without H. pylori eradication received radiation (nâ=â3), chemotherapy (nâ=â1), PPIs (nâ=â2), no treatment (nâ=â4) as first-line and radiation (nâ=â2) as second-line therapy while initial therapy remained unknown in one case. 13 patients (61.9â%) reached complete remission of lymphoma, and seven patients (33.3â%) showed minimal histological residuals. Overall and disease-free survival was found in 95â% and 90â%, respectively. CONCLUSION: Patients with H. pylori negative gastric MALT lymphoma have a good prognosis. We favor initial H. pylori eradication therapy and a watch-and-wait strategy in case of minimal histological residuals of MALT lymphoma. Non-responders to eradication therapy can be successfully treated by radiation and chemotherapy.
Assuntos
Infecções por Helicobacter/complicações , Infecções por Helicobacter/terapia , Helicobacter pylori , Linfoma de Zona Marginal Tipo Células B/complicações , Linfoma de Zona Marginal Tipo Células B/terapia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Quimiorradioterapia/métodos , Terapia Combinada , Intervalo Livre de Doença , Infecções por Helicobacter/diagnóstico , Humanos , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/diagnóstico , Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Colonoscopy requires effective bowel preparation for adequate mucosal visualization. Safety and acceptability of bowel preparation are key components in colorectal cancer screening (CRC) populations. OBJECTIVE: To compare the efficacy, safety and acceptability of bowel preparation with polyethylene glycol (PEG), ascorbic acid, sodium ascorbate (ascorbate components), sodium sulfate and electrolytes (PEG+Asc) or sodium phosphate (NaP). METHODS: Consenting adults undergoing elective out-patient colonoscopy for CRC were randomized to take 2 L PEG+Asc or 90 mL NaP (control) following manufacturer's instructions. PEG+Asc was taken the evening before and morning of the colonoscopy; NaP was taken the morning and evening before colonoscopy. Participants followed a restricted diet specific to each preparation. Primary endpoint was bowel cleansing success (100% colon mucosa visible) rated by an independent expert panel (all experienced endoscopists) unaware of treatment allocations. Subject reported outcomes about the preparations were elicited. Adverse events were recorded. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov: NCT00427089. RESULTS: Successful bowel cleansing rate was significantly higher in the PEG+Asc (N = 242) than the NaP (N = 114) group (PEG+Asc 93.4% [95% CI 89.5-96.2] versus NaP 22.8% [15.5-31.6%], p < 0.0001). Subject reported outcomes on acceptability of the two different preparations were not significantly different (p = 0.238). However, taste ratings for PEG+Asc were significantly better versus NaP (mean VAS: 31.2 and 38.1 respectively, p = 0.0111). The proportion of patients prepared to receive the same preparation again was significantly higher in the PEG+Asc group (88.4% vs. 78.1%, p < 0.0001). CONCLUSIONS: PEG+Asc provided superior bowel cleansing to NaP and was well tolerated. Findings for PEG+Asc are aligned with previous similar studies; however, differences observed in NaP cleansing results, especially for the proximal colon segments, may be due to factors including: differences in demographics and population types and the use of the validated Harefield Cleansing Scale as an assessment tool combined with expert reviews, which may have resulted in conservative cleansing assessments.
Assuntos
Catárticos/administração & dosagem , Colonoscopia , Neoplasias Colorretais/diagnóstico , Polietilenoglicóis/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Fosfatos/administração & dosagem , Cuidados Pré-Operatórios , Adulto JovemRESUMO
INTRODUCTION: In earlier studies, involvement of the small intestine was reported in patients with gastrointestinal lymphoma. Prospective data on the involvement of the small intestine in patients suffering from gastric extranodal MZBCL of MALT do not exist so far. In this study, we investigated the frequency of the involvement of the small intestine and the role of capsule endoscopy in patients with gastrointestinal extranodal MZBCL of MALT and of follicular lymphoma. PATIENTS AND METHODS: 40 consecutive patients with gastrointestinal extranodal MZBCL of MALT (26 men, 14 women, aged 27 - 80 years), and 7 patients with known follicular lymphoma of the small intestine (5 men, 2 women, aged 34 - 63 years) underwent capsule endoscopy. RESULTS: Involvement of the small intestine was identified by capsule endoscopy in all 7 patients with known follicular lymphoma of the small intestine. In 6 of 40 patients with gastric extranodal MZBCL of MALT abnormal findings could be observed, three of these findings indicative for lymphoma involvement of the small intestine. However, in each of these 3 cases, intestinal involvement had been already diagnosed by conventional GI endoscopy before capsule endoscopy. CONCLUSIONS: Capsule endoscopy is able to detect involvement of the small intestine in patients with gastrointestinal lymphoma. However, involvement of the small intestine seems to be rare in patients with gastric extranodal MZBCL of MALT. In summary, routine diagnostic work-up of the small intestine, e. g. by capsule endoscopy seems unnecessary because of the rare involvement of the small intestine and an excellent long-term outcome irrespective of a possible intestinal manifestation.
Assuntos
Endoscopia por Cápsula/métodos , Linfoma de Zona Marginal Tipo Células B/patologia , Linfoma Folicular/patologia , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeAssuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Dor/tratamento farmacológico , Dor/prevenção & controle , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , HumanosAssuntos
Terapia Neoadjuvante , Neoplasias Gástricas/terapia , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia , Terapia Combinada , Gastrectomia , Humanos , Estadiamento de Neoplasias , Prognóstico , Neoplasias Gástricas/patologiaRESUMO
BACKGROUND: Paclitaxel embedded in cationic liposomes (EndoTAG™-1; ET) is an innovative agent targeting tumor endothelial cells. This randomized controlled phase II trial evaluated the safety and efficacy of ET in combination with gemcitabine (GEM) in advanced pancreatic cancer (PDAC). PATIENTS AND METHODS: Chemotherapy-naive patients with locally advanced or metastatic disease were randomly assigned to receive weekly GEM 1000 mg/m(2) or GEM plus twice-weekly ET 11, 22 or 44 mg/m(2) for 7 weeks. After a safety run-in of 100 patients, a second cohort continued treatment. End points included overall survival (OS), progression-free survival (PFS), tumor response and safety. RESULTS: Two hundred and twelve patients were randomly allocated to the study and 200 were treated (80% metastatic, 20% locally advanced). Adverse events were manageable and reversible. Transient thrombocytopenia and infusion reactions with chills and pyrexia mostly grade 1 or 2 occurred in the ET groups. Disease control rate after the first treatment cycle was 43% with GEM and 60%, 65% and 52% in the GEM + ET cohorts. Median PFS reached 2.7 compared with 4.1, 4.6 and 4.4 months, respectively. Median OS was 6.8 compared with 8.1, 8.7 and 9.3 months, respectively. CONCLUSIONS: Treatment of advanced PDAC with GEM + ET was generally well tolerated. GEM + ET showed beneficial survival and efficacy. A randomized phase III trial should confirm this positive trend.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/tratamento farmacológico , Desoxicitidina/análogos & derivados , Paclitaxel/administração & dosagem , Neoplasias Pancreáticas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma/mortalidade , Carcinoma/patologia , Cátions , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Progressão da Doença , Formas de Dosagem , Feminino , Humanos , Lipossomos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Estadiamento de Neoplasias , Paclitaxel/efeitos adversos , Paclitaxel/química , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Análise de Sobrevida , GencitabinaRESUMO
BACKGROUND: Previous reviews of bowel preparation for colonoscopy have given contradictory answers. AIM: To provide a definitive insight, using PRISMA-compliant methodology. METHODS: A comprehensive literature review identified randomised controlled trials comparing bowel preparation regimens. Data for quality of bowel preparation were pooled in multiple meta-analyses exploring a range of inclusion criteria. RESULTS: A total of 104 qualifying studies were identified, the majority of which involved comparisons of sodium phosphate (NaP) or polyethylene glycol (PEG). There was no significant difference demonstrated between NaP and PEG overall (OR = 0.82; 95% CI = 0.56-1.21; P = 0.36). Cumulative meta-analysis demonstrated that this conclusion has been qualitatively similar since the mid 1990s, with little quantitative change for the past 10 years. Amongst studies with previous day dosing in both study arms there was a significant advantage in favour of PEG (OR = 1.78; 95% CI = 1.13-2.81; P = 0.006). Studies focussing on results in the proximal colon also favoured PEG (OR = 2.36; 95% CI = 1.16-4.77; P = 0.012). PEG was also significantly more effective than non-NaP bowel preparation regimens (OR = 2.02; 95% CI = 1.08-3.78; P = 0.03). Other comparisons showed no significant difference between regimens. CONCLUSIONS: Although there is no compelling evidence favouring either of the two most commonly used bowel preparation regimens, this may reflect shortcomings in study design. Where studies have ensured comparable dosage, or the clinically relevant outcome of proximal bowel clearance is considered, PEG-based regimens offer the most effective option.
Assuntos
Catárticos/uso terapêutico , Colonoscopia/métodos , Fosfatos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Tensoativos/administração & dosagem , Humanos , Cuidados Pré-Operatórios/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Irrigação TerapêuticaRESUMO
BACKGROUND: Both surgical and conservative treatment strategies offer an excellent outcome to patients with gastric lymphoma. No comparison of surgical resection with primary radiation or chemotherapy on a prospective randomised basis was available up to now. AIMS: The aim of this study was to compare surgery with radiation and surgery plus chemotherapy with chemotherapy alone in patients with marginal zone B-cell lymphoma (MZBCL) of MALT and diffuse large B-cell lymphoma (DLBCL), respectively, with respect to long-term outcome and quality of life. METHODS: 49 patients [21 male and 28 female; age 65 (35 - 75) years] with newly diagnosed MZBCL of MALT (n = 19) and DLBCL (n = 30) of stage I and II were recruited. Outcome was evaluated after a follow-up of 74 (7 - 102) months and quality of life was measured using the SF-36 health survey and the gastrointestinal life quality index (GLQI). RESULTS: Complete remission rates in MZBCL of MALT were 88 % and 89 % in patients treated by surgery or radiotherapy, respectively. The corresponding rates for patients with DLBCL were 93 % following surgery plus chemotherapy and 92 % after chemotherapy alone, respectively. The results in the different treatment groups did not differ significantly. Posttherapeutic quality of life was generally high with a significant advantage for patients treated conservatively compared to those who underwent surgery. CONCLUSION: Long-term outcome of patients with gastric lymphoma is excellent irrespective of the lymphoma type and the treatment approach. Considering quality of life a conservative therapeutic strategy should be favoured.