Prevention of gastric cancer: a challenging but feasible task.

Despite its declining incidence gastric cancer still ranks as the second most common malignancy of the digestive tract, accounting for 10% of cancer deaths worldwide. At the time of the diagnosis less than 15% of the patients are in the stage of early cancer, the only stage in which a definite cure of gastric cancer is possible. Therefore the challenges are either early detection or even better prevention of gastric cancer. H. pylori has become recognized as the major risk factor for gastric adenocarcinoma. Epidemiological, biological, histomorphologic, molecular-genetic, epidemiological evidence and more recently few clinical trails have shown that H. pylori eradication has the potential to prevent the development of gastric cancer. Currently H. pylori eradication is an indication for the prevention of gastric cancer in patients and groups of individuals with strongly increased risk, but further investigations are still required before an implementation of a general and global policy to eradicate H. pylori for the prevention of gastric cancer can be instituted. At present time, the main challenge remains to find out at what point mucosal abnormalities are no longer reversible and gastric cancer development cannot be prevented despite H. pylori eradication.

Prevention of gastric cancer: a challenging but feasible task

Despite its declining incidence gastric cancer still ranks as the second most common malignancy of the digestive tract, accounting for 10% of cancer deaths worldwide. At the time of the diagnosis less than 15% of the patients are in the stage of early cancer, the only stage in which a definite cure of gastric cancer is possible. Therefore the challenges are either early detection or even better prevention of gastric cancer. H. pylori has become recognized as the major risk factor for gastric adenocarcinoma. Epidemiological, biological, histomorphologic, molecular-genetic, epidemiological evidence and more recently few clinical trails have shown that H. pylori eradication has the potential to prevent the development of gastric cancer. Currently, H. pylori eradication is an indication for the prevention of gastric cancer in patients and groups of individuals with strongly increased risk, but further investigations are still required before an implementation of a general and global policy to eradicate H. pylori for the prevention of gastric cancer can be instituted. At present time, the main challenge remains to find out at what point mucosal abnormalities are no longer reversible and gastric cancer development cannot be prevented despite H. pylori eradication.(AU)

A pesar de la disminución en su incidencia, aún hoy el cáncer gástrico se presenta como la segunda causa más común de muerte por enfermedad maligna del tubo digestivo, siendo responsable del 10% de las muertes por cáncer a nivel mundial. Al momento del diagnóstico menos del 15% de los pacientes se encuentran en la etapa de cáncer gástrico temprano, el único estadío en el cual es posible su curación. Por lo tanto, el desafío está en la detección temprana o aún mejor, en la prevención del cáncer gástrico. H. pylori ha sido reconocido como el factor de riesgo más importante para el desarrollo del adenocarcinoma de estómago. Evidencia epidemiológica, biológica, histológica, molecular y más recientemente algunos estudios clínicos han demostrado que la erradicación del H. pylori tiene el potencial de prevenir el desarrollo de lesiones premalignas y del cáncer gástrico. Actualmente la erradicación del H. pylori está indicada para la prevención del cáncer gástrico en pacientes y grupos de individuos con alto riesgo, pero futuras investigaciones son aún necesarias antes de que sea establecida una política global para la erradicación del H. pylori en la prevención del cáncer gástrico. Actualmente el mayor desafío radica en encontrar en qué punto los cambios en la mucosa gástrica se tornan irreversibles, siendo el cáncer gástrico no prevenible a pesar de la erradicación del H. pylori.(AU)

Prevention of gastric cancer: a challenging but feasible task / Prevención del cáncer gástrico: una tarea difícil pero factible

Despite its declining incidence gastric cancer still ranks as the second most common malignancy of the digestive tract, accounting for 10% of cancer deaths worldwide. At the time of the diagnosis less than 15% of the patients are in the stage of early cancer, the only stage in which a definite cure of gastric cancer is possible. Therefore the challenges are either early detection or even better prevention of gastric cancer. H. pylori has become recognized as the major risk factor for gastric adenocarcinoma. Epidemiological, biological, histomorphologic, molecular-genetic, epidemiological evidence and more recently few clinical trails have shown that H. pylori eradication has the potential to prevent the development of gastric cancer. Currently, H. pylori eradication is an indication for the prevention of gastric cancer in patients and groups of individuals with strongly increased risk, but further investigations are still required before an implementation of a general and global policy to eradicate H. pylori for the prevention of gastric cancer can be instituted. At present time, the main challenge remains to find out at what point mucosal abnormalities are no longer reversible and gastric cancer development cannot be prevented despite H. pylori eradication.

A pesar de la disminución en su incidencia, aún hoy el cáncer gástrico se presenta como la segunda causa más común de muerte por enfermedad maligna del tubo digestivo, siendo responsable del 10% de las muertes por cáncer a nivel mundial. Al momento del diagnóstico menos del 15% de los pacientes se encuentran en la etapa de cáncer gástrico temprano, el único estadío en el cual es posible su curación. Por lo tanto, el desafío está en la detección temprana o aún mejor, en la prevención del cáncer gástrico. H. pylori ha sido reconocido como el factor de riesgo más importante para el desarrollo del adenocarcinoma de estómago. Evidencia epidemiológica, biológica, histológica, molecular y más recientemente algunos estudios clínicos han demostrado que la erradicación del H. pylori tiene el potencial de prevenir el desarrollo de lesiones premalignas y del cáncer gástrico. Actualmente la erradicación del H. pylori está indicada para la prevención del cáncer gástrico en pacientes y grupos de individuos con alto riesgo, pero futuras investigaciones son aún necesarias antes de que sea establecida una política global para la erradicación del H. pylori en la prevención del cáncer gástrico. Actualmente el mayor desafío radica en encontrar en qué punto los cambios en la mucosa gástrica se tornan irreversibles, siendo el cáncer gástrico no prevenible a pesar de la erradicación del H. pylori.

[Diagnostic and therapeutic utility of double balloon endoscopy: experience with 225 procedures]. / Utilidad diagnóstica y terapéutica de la endoscopía de doble balón: experiencia con 225 exámenes.

INTRODUCTION: Double balloon enteroscopy (DBE) is a new endoscopic method for the examination of the small intestine. OBJECTIVE: To determine the diagnostic yield and therapeutic utility of DBE. PATIENTS AND METHODS: All patients undergoing DBE using a Fuji-non intestinoscope for suspected small bowel diseases during a 2 1/2 year period were studied in a prospective single-center cohort study. All patients underwent prior EGD and colonoscopy. Patients underwent small bowel cleansing on the day before the procedure using a standard colon lavage solution. RESULTS: 225 DBE in 178 patients, (95 males, 83 females; mean age 59 years-old, range 12-93); oral route (n=160), anal (n=65). Indications (one or more per patient): GI bleeding (n=83), suspected Crohn's disease or evaluation of small bowel involvement or complications (n=35), diarrhea or malabsorption or suspected celiac disease (n=11), polyp removal in Peutz-Jeghers' syndrome or familial polyposis (n=23), tumor surveillance or search of primary tumor (n=14), abdominal pain (n=6) and miscellaneous (n=6). Mean duration of the procedure was 50 min, range 20 min to 150 min. Mean radiation exposure: 206 d Gy/cm2 (range 0-1492). The overall mean depth of small bowel insertion was 180 cm, ranging from 5 cm to the entire small bowel (650 cm). The mean depth of insertion via the oral route was 240 cm (range 20 cm to 650 cm) and via the anal route it was 65 cm (range 10 cm a 150 cm). A new diagnosis was reached in 108/178 patients (60%). Findings included: angiodysplasia, ulcerations, stenosis, polyps, portal jejunopathy, ischemic jejunitis and normal. DBE resulted in a therapeutic intervention (endoscopic, medical or surgical, excluding blood transfiusions) in 64% (115/178) of the patients. CONCLUSIONS: DBE was clinically useful for reaching a new diagnosis and to start new therapies, change existing therapies, and perform an operative intervention or to provide therapeutic endoscopy in two-thirds of the investigated patients. DBE is a useful and safe method to obtain tissue for diagnosis, to provide hemostasis and to perform polypectomy.

Utilidad diagnóstica y terapéutica de la endoscopía de doble balón: experiencia con 225 exámenes / Diagnostic and therapeutic utility of double balloon endoscopy: experience with 225 procedures

Introducción: la endoscopía de doble balón (EDB) es un nuevo método endoscópico para examinar el intestino delgado. Objetivo: evaluar el rendimiento diagnóstico y terapéutico de la EDB. Pacientes y métodos: todos los pacientes que fueron evaluados por sospecha de patología del intestino delgado durante un período de 2 1/2 años en un estudio de cohorte prospectivo unicéntrico. A todos los pacientes se les realizó al menos una EGD y una colonoscopía previa. Todos los pacientes recibieron preparación del intestino delgado el día previo al procedimiento usando preparación estándar de colon. Resultados: se realizaron 225 EDB en 178 pacientes (95 hombres, 83 mujeres; edad mediana 59 años, rango 12-93); vía oral (n=160), vía anal (n=65). Las indicaciones de EDB incluyeron (una o más indicaciones por paciente): sangrado gastrointestinal de origen oscuro (n=83), sospecha o evaluación de pacientes con enfermedad de Crohn (n=35), diarrea, malabsorción o sospecha de enfermedad celíaca (n=11), búsqueda y remoción de pólipos en pacientes con síndrome de Peutz-Jehgers o síndrome de poliposis adenomatosa familiar (n=23), búsqueda de tumor primario o seguimiento (n=14), dolor abdominal(n=6) y misceláneas (isquemia, engrosamiento de pliegues en estudios radiológicos, etc); (n=6). La duración media del procedimiento fue de 50 minutos (rango 20- 150 min). La exposición media a radiación fue 206 d Gy/cm2 (rango 0-1492). La inserción media en intestino delgado fue de 180 cm, con un rango de 5 cm a a totalidad del intestino delgado (650 cm, rango 20 cm a 650 cm), inserción media por vía oral fue de 240 cm, y por vía anal 65 cm (rango 10 cm a 150 cm). Un nuevo diagnóstico fue realizado o confirmado en 108 de 178 pacientes (60%). Los hallazgos incluyeron: angiodisplasias, ulceraciones, yeyunopatía por hipertensión portal, estenosis, pólipos (incluyendo hamartomas en pacientes con síndrome de Peutz-Jeghers y lipoma), yeyunitis isquémica y normal. DBE resultó en una intervención...

Introduction: Double balloon enteroscopy (DBE) is a new endoscopic method for the examination of the small intestine. Objective: To determine the diagnostic yield and therapeutic utility of DBE. Patients and methods: All patients undergoing DBE using a Fujinon intestinoscope for suspected small bowel diseases during a 2 1/2 year period were studied in a prospective single-center cohort study. All patients underwent rior EGD and colonoscopy. Patients underwent small bowel cleansing on the day before the procedure using a standard colon lavage solution. Results: 225 DBE in 178 patients, (95 males, 83 females; mean age 59 years-old, range 12-93); oral route (n=160), anal (n=65). Indications (one or more per patient): GI bleeding (n=83), suspected Crohn’s disease or evaluation of small bowel involvement or complications (n=35), diarrhea or malabsorption or suspected celiac disease (n=11), polyp removal in Peutz-Jeghers’ syndrome or familial polyposis (n=23), tumor surveillance or search of primary tumor (n=14), abdominal pain (n=6) and miscellaneous (n=6). Mean duration of the procedure was 50 min, range 20 min to 150 min. Mean radiation exposure: 206 d Gy/cm2 (range 0-1492). The overall mean depth of small bowel insertion was 180 cm, ranging from 5 cm to the entire small bowel (650 cm). The mean depth of insertion via the oral route was 240 cm (range 20 cm to 650 cm) and via the anal route it was 65 cm (range 10 cm a 150 cm). A new diagnosis was reached in 108/178 patients (60%). Findings included: angiodysplasia, ulcerations, stenosis, polyps, portal jejunopathy, ischemic jejunitis and normal. DBE resulted in a therapeutic intervention (endoscopic, medical or surgical, excluding blood transfusions) in 64% (115/178) of the patients. Conclusions: DBE was clinically useful for reaching a new diagnosis and to start new therapies, change existing therapies, and perform an operative intervention or to provide therapeutic endoscopy in...

Comparison of 13C- urea blood test to 13C-breath test and rapid urease test for the diagnosis of Helicobacter pylori infection.

At present, the available methods to diagnose active H. pylori infection are endoscopy with biopsy for histology, culture, rapid urease tests, 13C or 14C urea breath test, urine antibody and the stool antigen test. The aims of this study were to simplify the 13C urea test by measuring 13C in blood rather than breath, and to evaluate the usefulness of the 13C urea blood test for the diagnosis of H. pylori infection. Patients who underwent upper endoscopy for standard clinical indications (e.g. dyspepsia, abdominal pain) were enrolled. A total of 161 patients (93F, 68M, mean age 47 +/- 14.2) were evaluated; 50 (31%) of them were H. pylori positive, and 111(69%) were H. pylori negative. H. pylori infection was diagnosed with a rapid urease test (CLO-test) and 13C urea breath test (UBT). Performance characteristics for the 13C urea blood test for diagnosis and evaluation of H. pylori eradication were calculated using UBT and CLO as gold standards. The fifty H. pylori-positive patients were treated with triple antibiotic therapy for two weeks. Four weeks after finishing antibiotic therapy patients were retested with a commercial UBT and urea blood test. The 13C blood test had sensitivities of 92 and 98% and specificities of 96 and 100% as compared with urea breath test and CLO, respectively. We conclude that the 13C urea blood test is highly sensitive and specific for the initial diagnosis and control of eradication of H. pylori infection.

[Crohn's disease associated with Takayasu's arteritis]. / Enfermedad de Crohn asociada a arteritis de Takayasu.

A 26-year-old woman with Crohn's disease presented with increase of her abdominal pain, abdominal fremitus and decrease in peripheral pulses. The CT scan and the angiography revealed occlusive stenosis of several arteries: left subclavian, celiac, renal, superior mesenteric and abdominal aorta. This findings were consistent with Takayasu's arteritis. The patient underwent surgical revascularization to bypass the occlusive lesions in celiac and superior mesenteric arteries, and the stenosis in abdominal aorta. Subsequent controls showed that she remains free of cardiovascular symptoms three years after surgery but presents progression of her inflammatory bowel disease.

Comparison of 13C- urea blood test to 13C-breath test and rapid urease test for the diagnosis of Helicobacter pylori infection.

At present, the available methods to diagnose active H. pylori infection are endoscopy with biopsy for histology, culture, rapid urease tests, 13C or 14C urea breath test, urine antibody and the stool antigen test. The aims of this study were to simplify the 13C urea test by measuring 13C in blood rather than breath, and to evaluate the usefulness of the 13C urea blood test for the diagnosis of H. pylori infection. Patients who underwent upper endoscopy for standard clinical indications (e.g. dyspepsia, abdominal pain) were enrolled. A total of 161 patients (93F, 68M, mean age 47 +/- 14.2) were evaluated; 50 (31

) of them were H. pylori positive, and 111(69

) were H. pylori negative. H. pylori infection was diagnosed with a rapid urease test (CLO-test) and 13C urea breath test (UBT). Performance characteristics for the 13C urea blood test for diagnosis and evaluation of H. pylori eradication were calculated using UBT and CLO as gold standards. The fifty H. pylori-positive patients were treated with triple antibiotic therapy for two weeks. Four weeks after finishing antibiotic therapy patients were retested with a commercial UBT and urea blood test. The 13C blood test had sensitivities of 92 and 98

and specificities of 96 and 100

as compared with urea breath test and CLO, respectively. We conclude that the 13C urea blood test is highly sensitive and specific for the initial diagnosis and control of eradication of H. pylori infection.

Enfermedad de Crohn asociada a arteritis de Takayasu. / [Crohns disease associated with Takayasus arteritis]

A 26-year-old woman with Crohns disease presented with increase of her abdominal pain, abdominal fremitus and decrease in peripheral pulses. The CT scan and the angiography revealed occlusive stenosis of several arteries: left subclavian, celiac, renal, superior mesenteric and abdominal aorta. This findings were consistent with Takayasus arteritis. The patient underwent surgical revascularization to bypass the occlusive lesions in celiac and superior mesenteric arteries, and the stenosis in abdominal aorta. Subsequent controls showed that she remains free of cardiovascular symptoms three years after surgery but presents progression of her inflammatory bowel disease.