Gastric cancer deaths by age group in Japan: Outlook on preventive measures for elderly adults.

In February 2013, Japan became the first country in the world to cover Helicobacter pylori eradication for chronic gastritis under its National Health Insurance (NHI) system. Now that eradication therapy is covered by NHI, its usage has increased dramatically, and gastric cancer deaths have begun to decrease. We undertook a detailed epidemiological analysis to investigate effects of expanded NHI coverage for H. pylori eradication therapy on gastric cancer deaths in specific age groups. Numbers of gastric cancer deaths were determined by referencing data from Ministry of Health, Labour and Welfare reports and "Cancer Statistics in Japan - 2018" published by the Foundation for Promotion of Cancer Research. Gastric cancer deaths across all age groups have been clearly decreasing since 2013, but deaths of people aged 80 years and older are still increasing. The number of gastric cancer deaths in people aged in their 80s was 2 times higher than in people aged in their 70s and 4 times higher than in people aged in their 60s. The number of people in their 80s who had an endoscopy was less than half that of people in their 60s and 70s. The eradication therapy has increased dramatically, and gastric cancer deaths are clearly decreasing in Japan. However, this decrease in deaths has not extended to elderly adults aged in their 80s, which suggests that measures to prevent gastric cancer in people aged 80 years and older will be critical to achieving the mission of eliminating gastric cancer in Japan.

Effect of diet on the incidence of and mortality owing to gastritis and renal disease in captive cheetahs (Acinonyx jubatus) in South Africa.

Seventy-two adult cheetahs were evaluated for the degree of gastritis by endoscopic biopsy and for renal disease by serum creatinine. Cheetahs free of Grade 3 gastritis and renal disease were placed on Trial A; remaining cheetahs were placed on Trial B, which ran concurrently. All cheetahs were monitored for 4 years. Cheetahs exited Trial A and entered Trial B if they developed Grade 3 gastritis or renal disease. Cheetahs exited Trial B if they developed clinical gastritis or renal disease that required a dietary change or aggressive medical therapy or died owing to either disease. Cheetahs on Trial A were fed either a supplemented meat diet (N = 26) or commercial cat food (N = 22). Cheetahs on Trial B were fed either the same meat diet (N = 28) or a commercial dry cat food formulated for renal disease (N = 16). Cheetahs fed meat on Trial A had a daily hazard of developing Grade 3 gastritis 2.21 times higher (95% CI 0.95-5.15) than cheetahs fed commercial cat food. This hazard was not statistically significant (P = 0.07). Mean gastritis scores were not significantly different between the two groups. Cheetahs fed commercial cat food in both Trials had lower serum urea levels and higher creatinine levels than those fed meat. Evidence for the effect of diet in cheetahs with gastritis and/or renal disease (Trial B) was inconclusive. The number of cheetahs dying of gastritis or renal disease at the facility has dropped markedly since the study began. These results indicate that diet may play an important role in the incidence of Grade 3 gastritis and that dietary and/or therapeutic management of gastritis may reduce mortality owing to gastritis and renal disease in captive cheetahs.

[Therapeutic morbidity rate among female military personnel, with exposure to occupational hazards in the period of service in the Armed Forces its influence on the course of pregnancy and fetal development].

The study was made into therapeutic incidence among female military personnel who had contact with various kinds of occupational hazards in the period of military service, its impact on pregnancy and fetal development. Special attention was also paid to long-term consequences of obstetric and therapeutic pathological comorbidity on the development of the child. It has been established, that in the spectrum of therapeutic morbidity among female military personnel chronic gastritis, pyelonephritis and autoimmune thyroiditis prevail and often have a chronic stress as a background for their development. Children born to mothers, who in the period of pregnancy showed the combination of chronic pyelonephritis, autoimmune thyroiditis and late gestosis are a group of high risk for the development of the intracranial hypertension in children and/or infectious diseases.

Cytomegalovirus gastritis: Clinicopathological profile.

BACKGROUND: Cytomegalovirus (CMV) gastritis is occasionally reported in case reports and limited case series. Up to now, it is the largest and most comprehensive retrospective study of CMV gastritis. METHODS: All patients who were histologically diagnosed with CMV gastritis at Linkou Chang Gung Memorial Hospital between January 2000 and April 2020 were included. Patients were divided into two groups according to immunity. Between-group differences in characteristics, manifestations, endoscopic features, prognostic factors, and outcomes were analyzed. The main endpoint was 3-month mortality. RESULTS: A total of 54 patients (34 immunocompromised, 20 immunocompetent) were enrolled. Common presentations included gastrointestinal bleeding (35.2%), abdominal pain (33.3%) and fever (31.5%). The endoscopic features included ulcer (88.9%) and inflammation (11.1%). The 3-month mortality rate was 20.4% and overall mortality rate was 40.7%. Acute kidney injury was the only independent risk factor for 3-month mortality (OR 53.89, 95%CI 1.56-1861.73, p = 0.027). Anti-viral therapy and host immune status did not affect 3-month mortality. CONCLUSION: Both immunocompromised and immunocompetent patients with CMV gastritis have high mortality rates, without significant between-group differences. Acute kidney injury is the only independent predictive factor for 3-month mortality. Prevention of acute kidney injury may possibly improve the 3-month mortality rate.

Assessment of necropsy findings in sled dogs that died during Iditarod Trail sled dog races: 23 cases (1994-2006).

OBJECTIVE: To describe the character and frequency of causes of death and associated lesions in long-distance racing sled dogs. DESIGN: Retrospective case series. ANIMALS: 23 dogs. PROCEDURES: Medical records of dogs that died during or soon after competition in the Iditarod Trail sled dog races (1994 through 2006) were examined for fi ndings of gross necropsy and histologic evaluation of tissue samples. From the data, descriptive and comparative statistics were obtained. RESULTS: Recognized causes of death included aspiration of gastric contents (n = 4), aspiration pneumonia (4), acute blood loss secondary to gastric ulceration (3), and sled dog myopathy (2). A cause of death was not established for 7 dogs. Prevalent lesions among the study population included rhabdomyolysis (n = 15), enteritis (10), gastritis (10), aspiration pneumonia (8), and gastric ulceration (8). All dogs with aspiration pneumonia had concurrent gastric mucosal lesions. Subjective biventricular cardiac hypertrophy was evident in most dogs; other lesions detected frequently included centrilobular hepatic fibrosis, gastric dilatation, and mild cardiac myodegeneration and necrosis. CONCLUSIONS AND CLINICAL RELEVANCE: Unexpected death is a rare event among conditioned sled dogs during competition in endurance races. Potentially life-threatening conditions of dogs that are associated with periods of long-distance physical exertion include aspiration pneumonia, gastric mucosal lesions, and severe rhabdomyolysis. Dogs that develop clinical signs suggestive of these conditions should be excluded from strenuous activities. Epidemiologic investigations are required to clarify the risk for death associated with these lesions in dogs competing in endurance races.

The predictors of mortality and secular changes in management strategies in emphysematous gastritis.

BACKGROUND AND AIMS: Emphysematous gastritis (EG) is caused by invasion of the gastric wall by gas-producing organisms and carries mortality rate up to 60%. Our investigation aimed to determine the predictors of survival and the secular trends in survival rates of subjects with EG. METHODS: PubMed search was completed to identify previous cases of EG. In addition, we included a recent case from our center. Statistical analysis was completed with two-sided Chi2 tests for categorical data and t-tests for continuous variables using SPSS v. 22.0 (SPSS Inc, Chicago, IL). RESULTS: Study cohort included 59 adults. Mean age was 55.5 years; mean LOS was 28.6 days, and 44.1% of subjects were female. Subjects who had EG before 2000 had significantly higher rates of exploratory laparotomy compared to subjects who had EG after 2000 (62.5% vs. 22.2%, P=0.002). In contrast, subjects with EG after 2000 had significantly higher rates of EGD (55.6% vs. 18.8%, P=0.003) and lower rates of mortality (33.3% vs. 59.4%, P=0.046) compared to subjects with EG on or before 2000. In multivariate logistic regression analysis, the only independent predictor of mortality was length of stay (P=0.047). CONCLUSION: We showed that previously reported 60% mortality rate of EG has been reduced to 33.3% for cases reported after 2000. EGD has been utilized more often while surgical interventions are used only in carefully selected cases. Our data suggests that early endoscopic evaluation and optimal medical management can perhaps continue to improve survival in subjects with EG.

Mortality is associated with inflammation, anemia, specific diseases and treatments, and molecular markers.

Lifespan is a complex trait, and longitudinal data for humans are naturally scarce. We report the results of Cox regression and Pearson correlation analyses using data of the Study of Health in Pomerania (SHIP), with mortality data of 1518 participants (113 of which died), over a time span of more than 10 years. We found that in the Cox regression model based on the Bayesian information criterion, apart from chronological age of the participant, six baseline variables were considerably associated with higher mortality rates: smoking, mean attachment loss (i.e. loss of tooth supporting tissue), fibrinogen concentration, albumin/creatinine ratio, treated gastritis, and medication during the last 7 days. Except for smoking, the causative contribution of these variables to mortality was deemed inconclusive. In turn, four variables were found to be associated with decreased mortality rates: treatment of benign prostatic hypertrophy, treatment of dyslipidemia, IGF-1 and being female. Here, being female was an undisputed causative variable, the causal role of IFG-1 was deemed inconclusive, and the treatment effects were deemed protective to the degree that treated subjects feature better survival than respective controls. Using Cox modeling based on the Akaike information criterion, diabetes, mean corpuscular hemoglobin concentration, red blood cell count and serum calcium were also associated with mortality. The latter two, together with albumin and fibrinogen, aligned with an"integrated albunemia" model of aging proposed recently.

Cytomegalovirus infection and development of biliary complications after liver transplantation.

BACKGROUND: Cytomegalovirus (CMV) infection is known to cause ulceration and mucosal hemorrhage in the gastrointestinal tract. Gastroduodenal and biliary complications were prospectively evaluated in 100 consecutive liver transplant patients in whom CMV was monitored during the first posttransplant year. METHOD: Gastroduodenal biopsy specimens were taken from 36 patients by endoscopies and in 28 patients by endoscopic retrograde cholangiopancreatography, and bile duct specimens were taken from three patients who underwent surgical reconstruction because of biliary complication. CMV was demonstrated from blood by the pp65 antigenemia test and from frozen sections of tissue specimens by immunohistochemistry and in situ hybridization. RESULTS: Symptomatic CMV infection, treated with ganciclovir, developed in 49 recipients: 13 (100%) of CMV seropositive donor (D+) seronegative recipient (R-) cases, 29 (45%) D+/R+ cases, and 7 (32%) D-/R+ cases. Duodenal ulcer developed in three and hemorrhagic gastritis in three recipients. CMV antigens were found from the gastroduodenal mucosa in 37 (69%) of the 54 studied recipients. The biliary complication rate was 24%. Preceding or concomitant CMV antigenemia was demonstrated in 75% of patients with a biliary complication (68% in CMV D+/R+ or D-/R+ and 100% in D+/R- recipients). The biliary complication rate was higher among recipients with CMV antigenemia, compared with recipients without (P<0.05). CMV antigenemia, CMV infection, or both in the duodenal mucosa was found in 96% of patients with a biliary complication. In two patients who underwent surgical reconstruction, CMV antigens and DNA were demonstrated in the bile ducts. CONCLUSIONS: Liver transplant patients are at risk of developing biliary complications after CMV infection, especially those with primary CMV infection.

Upper gastrointestinal bleeding: predictors of outcome.

We reviewed the records of 115 patients treated for upper gastrointestinal (UGI) bleeding on a general surgical and trauma service from January 1981 to June 1984. Clinical variables were analyzed with regard to three outcome criteria: mortality rate, blood transfusion requirements, and need for operation. Endoscopy was performed in all patients, usually within 24 hours of detection of bleeding. Thirty-six patients required greater than or equal to 5 U of blood, 27 patients required an operation for bleeding, and 26 patients (23%) died in the hospital. In 19 patients, death was attributed to the patient's underlying disease; in seven patients, death was due to bleeding or operation. Significant predictors of death were: age greater than or equal to 60 years old (p less than or equal to 0.02), disease in three organ systems (p less than 0.05), 5 U transfusion requirement (p less than 0.001), operation for bleeding necessary (p less than 0.03), lung/liver disease (p less than 0.03), and recent stress of major operation, trauma, or sepsis. Mortality rates were highest for bleeding varices (36%) and lowest for duodenal ulcers (7.7%) and gastric ulcers (15.8%). Endoscopy accurately determined the cause of UGI bleeding in most patients. The data suggest that the unchanging mortality rate for UGI bleeding is largely due to underlying disease or injury for which the success of current treatment is limited.

Outcome of operations for upper gastrointestinal tract bleeding.

The outcome of operations for upper gastrointestinal tract bleeding during a six-year period was compared with that of the previous four years, in which indications for operation and guidelines for surgical procedures were similar. Between 1973 and 1978, 392 patients were hospitalized for hemorrhage. Endoscopy diagnosed a bleeding lesion in 92% of 234 patients studied. Of 75 patients (19%) who required operation for uncontrollable hemorrhage, 20 (27%) died and two (3%) rebled postoperatively. Most deaths (80%) were caused by esophageal variceal bleeding. Among 47 patients with nonvariceal hemorrhage, mortality was only 9%. No patient with stress ulcer bleeding was encountered. Compared with our 1969 to 1972 experience, the present study shows no improvement in overall mortality. Rebleeding was less frequent than earlier. The most significant differences in outcome were decreased mortality in alcoholic gastritis patients, no deaths from stress ulcer, and increased mortality after portosystemic shunting. Endoscopy, used frequently from 1973 to 1978, helped to improve preoperative diagnostic rates (85% vs 65%). Combined with innovations in nonoperative treatment, such as infusion of vasopressin, it did not appear to decrease the proportion of patients requiring operation.

Changing patterns of gastrointestinal bleeding.

This study, a retrospective analysis of 351 patients with acute gastrointestinal (GI) hemorrhage, was undertaken to define patterns of disease and age-related operative and mortality rates and to determine changes over time related to changes in management. One third (116 patients) of the admissions had bleeding esophageal varices. Upper GI hemorrhage accounted for 85% (N = 200) and lower GI hemorrhage for 15% (N = 35). Emergency surgical intervention was required in 90 patients (38%), 40% of the upper and 29% of the lower GI hemorrhage patients. Benign ulcer disease accounted for 86% of the cases requiring emergency surgery and was treated with vagotomy and drainage and/or oversewing. Lower GI bleeding is seen in older patients; it has a lower operative intervention rate and a higher mortality. Stress bleeding as a surgical lesion has disappeared since 1979. A more assertive policy for surgical intervention has decreased operative mortality for all age groups. Bleeding duodenal ulcers are decreasing in incidence while gastric lesions appear to be increasing. These population-specific patterns, different from earlier periods, may have implications for training and patient management decisions.

Bleeding from stress gastritis. Has prophylactic pH control made a difference?

Control of intragastric pH with antacids or H2-receptor antagonists is a standard prophylactic treatment routinely used to prevent or control bleeding from acute erosive gastritis (AEG) in critically ill patients on trauma and surgical services. The incidence of bleeding from AEG was documented on these services retrospectively before and after the institution of standard prophylaxis treatment to determine the relative morbidity, mortality, and risk factors of each era. During the preprophylaxis and postprophylaxis era, the incidence of bleeding was the same, 2.3 per cent (13 of approximately 550 patients in each study period). Prior to prophylaxis, three times as many patients required operation (1 versus 3 patients) although the average transfusion requirement was the same (4.4 units of blood). During both eras the majority of patients were septic and showed other signs of organ failure. Inadequate prophylaxis (failure to prescribe or early discontinuation) was documented in over half of the patients who bled and in the patient requiring operation in spite of a departmental interest in stress gastritis prophylaxis. If antacids and H2-receptor antagonists are used routinely, complications from AEG should be reduced. Even with improved methods of pH control, it appears unlikely that this problem will be eliminated.

Lung transplantation in patients with pulmonary emphysema.

Lung transplantation is a viable option for patients with chronic obstructive pulmonary disease (COPD), and emphysema is the most common indication to undergo lung transplantation. A total of seven lung and one heart-lung transplantations were performed between July 1996 and June 2004 at the Yongdong Severance Hospital, and herein, three emphysema patients who underwent single lung transplantations are reviewed. There were 2 males and 1 female, with a mean age of 50 years (35, 57 and 58 years). They all underwent an operation, without cardiopulmonary bypass, and there was no operative mortality. The mean survival was 12 months (4 months, 15 months and 17 months) and all succumbed to death due to activation of pulmonary tuberculosis, post-transplantation lymphoproliferative disease and cytomegalovirus (CMV) gastritis associated with asphyxia. Infection was the most common postoperative complication, resulting in longer hospital stays, higher medical expenses and shorter survival rates, necessitating aggressive prophylactic management. The accumulation of experience, modifications to operative procedures and perioperative care may lead to improved early and long-term survival in patients with emphysema undergoing single or bilateral lung transplantations.

[Experience with the transjugular intrahepatic portocaval shunt]. / Expérience avec la dérivation portocave intrahépatique transjugulaire.

Liver transplantation and the intrahepatic shunt have changed the management of variceal hemorrhage and refractory ascites. The purpose of this work is to review the results obtained with intrahepatic shunting. From January 1991 to May 1993, 45 patients underwent a transjugular intrahepatic portosystemic shunt. In 23 patients, liver insufficiency was considered moderate and in 21 severe. Indications for the procedure were: variceal bleeding (23), refractory ascites (19) and portal hypertensive gastritis (3). The portocaval gradient was lowered from 24.2 +/- 5.1 mm Hg to 12.9 +/- 3.9 (-47%). The procedure was effective in 78% of variceal bleeders and in 89% of patients with ascites. Thirty-day mortality was 22%. One-year survival was 39%. Liver failure or severe encephalopathy occurred in 27% of patients. Four patients (9%) presented intra-abdominal bleeding. Four patients developed renal failure. Transjugular intrahepatic portosystemic shunts are effective in lowering portal pressure and controlling complications of portal hypertension. However, important side effects are present and controlled studies are required to evaluate this new treatment.

One fifth of hospitalizations for peptic ulcer-related bleeding are potentially preventable.

AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED). METHODS: Retrospective cohort study using ICD-10 codes to identify all patients with upper gastrointestinal hemorrhage secondary to endoscopically proven PUD, EG or ED during the period from March 2007 to October 2010 in three major metropolitan hospitals in Melbourne, Australia. Patients were divided into "high risk" (those who would benefit from gastroprotection) and "not high risk" groups as defined by established guidelines. Mean Rockall score, transfusion requirement, length of stay, rebleeding rates, need for surgery and in-hospital mortality was compared between "high risk" and "not high risk" groups. Within the "high risk" group, those on gastroprotection and those with no gastroprotection were also compared. RESULTS: Five hundred and seven patients were included for analysis of which 174 were classified as high risk. Median values of complete Rockall Score (5 vs 4, P = 0.002) and length of stay (5 d vs 4 d, P = 0.04) were higher in the high risk group but in-hospital mortality was lower (0.6% vs 3.9%, P = 0.03). 130 out of the 174 patients in the high risk group were not taking recommended gastroprotective therapy prior to hospitalization. Past history of PUD (OR = 3.7, P = 0.006) and clopidogrel use (OR = 3.2, P = 0.007) significantly predicted prescription of gastroprotective therapy. Using proton pump inhibitor protection rates of 50%-85% from published studies, an estimation of 13% to 22% of the total number of the hospitalizations due to PUD or EG/ED related bleeding may have been preventable. CONCLUSION: Up to one fifth of all hospitalizations for bleeding secondary to PUD or EG/ED are potentially preventable.

Matrix metalloproteinase 2 (MMP-2) and their tissue inhibitor 2 (TIMP-2) in gastric cancer patients.

BACKGROUND: Matrix metalloproteinase 2 (MMP-2) is able to degrade type IV collagen and its activity is mostly regulated by tissue inhibitor of matrix metalloproteinase 2 (TIMP-2). These proteins might play a role in tumor progression, including gastric cancer (GC). METHODS: The study included 108 individuals, GC patients and healthy subjects. Serum levels of all analyzed markers were evaluated by the immunological methods, while immunohistochemistry was used to assess the expression of these proteins in GC, interstitial inflammatory cells and normal tissues. RESULTS: The percentage of positive reactions of MMP-2 and TIMP-2 was higher in GC and inflammatory cells compared to normal tissue, while serum levels of these proteins were statistically lower in GC patients in comparison to healthy subjects. There was a significant positive correlation between TIMP-2 immunoreactivity in inflammatory cells and the presence of lymph node metastasis. Area under ROC curve (AUC) for TIMP-2 was higher than MMP-2, while serum MMP-2 was an independent prognostic factor of GC patients' survival. CONCLUSION: Our findings suggest that TIMP-2 seems to be a predictor of tumor progression, especially for nodal involvement, whereas serum MMP-2 might be useful as an independent prognostic factor of patients' survival.

Effect of long-term Helicobacter felis infection in a mouse model of streptozotocin-induced diabetes.

BACKGROUND: We previously REPORTED that mice with diabetes and short-term Helicobacter felis infection had an increase in glycated hemoglobin (HbA1c). Here we report the effect of long-term infection. MATERIALS AND METHODS: Six-week-old C57BL/6 mice were injected with streptozotocin to induce diabetes and started on daily insulin. Following streptozotocin injection, animals were paired according to their HbA1c values and randomized to orally receive either H. felis or culture medium alone. Weight and HbA1c were monitored monthly for 6 months. RESULTS: Thirty animals corresponding to 15 pairs were included in the study. H. felis-infected diabetic mice developed significantly more gastritis than uninfected animals. Sixteen mice died during the observation period. As compared to uninfected animals, infected mice died more frequently (40% versus 67%, p = .14) and earlier (160 versus 61 days, p = .20); both variables combined showed that H. felis infection significantly decreased the chances of survival during the study period (p = .045). In addition, infected mice showed a trend for higher increase in their HbA1c (0.97 +/- 2.5% versus - 0.22 +/- 3.0%; p = .21) and lower weight gain (2.0 +/- 3.4 g versus 2.9 +/- 2.0 g; p = .15) than uninfected mice. CONCLUSION: Long-term H. felis infection had a deleterious effect in mice with streptozotocin-induced diabetes resulting in increased mortality. If the same phenomenon occurs in humans this could lead to interventions to improve the long-term outcome of patients with diabetes.