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Jia, Lin; Jiang, Shu-Man; Shang, Yuan-Yuan; Huang, Yao-Xing; Li, Yi-Jun; Xie, De-Rong; Huang, Kai-Hong; Zhi, Fa-Cao
doi: 10.1159/000253864pmid: 20145402
Aim: To investigate the incidence of pancreatic cancer-related depression and the relationship between symptoms of depression and the quality of life (QoL) of patients. Methods: 262 inpatients with cancer of the digestive system (pancreatic cancer, liver cancer, esophageal cancer, gastric cancer, and colorectal cancer) from four Guangzhou hospitals were enrolled into the study between June 2007 and June 2009. The Hamilton Rating Scale for Depression-24 questionnaire was used to assess the degree of depression. QoL of all patients was evaluated by EORTC QLQ-C30. Additionally, EORTC QLQ-PAN-26 was used for patients with pancreatic cancer. Results: The incidence of depression among pancreatic cancer patients was significantly higher than among other digestive cancers. More pancreatic cancer patients suffered severe depression than those with liver cancer and gastric cancer. Compared with other groups with depression, QoL of pancreatic cancer patients in each functioning scale was significantly worse, while the symptoms of fatigue and pain were significantly severe. QoL of pancreatic cancer patients with depression in role, emotional, and social functioning were sharply poorer than those without depression. The symptoms of fatigue, pain and appetite loss in cancer patients with depression were significantly more frequent than those without depression. Conclusion: Compared with other cancers of the digestive system, depressive symptoms are common psychological disturbances in pancreatic cancer patients. Moreover, depression significantly lowers QoL in pancreatic cancer patients.
Wada, Yoshihiro; Ito, Masanori; Takata, Shunsuke; Tanaka, Shinji; Yoshihara, Masaharu; Chayama, Kazuaki
doi: 10.1159/000265933pmid: 20145403
Background/Aims: Tyrosine phosphorylation of the EPIYA motif in Helicobacter pylori CagA (CagA-P) plays an important role in toxic reaction. Diffuse-type gastric cancer (DGC) has a poor prognosis. We tried to clarify the expression level of CagA-P in DGC patients. Methods: We enrolled 42 early-stage DGC patients (DGC group; 20 males, 22 females, mean age 58.2 years) and 42 age- and gender-matched atrophic gastritis (AG) patients (AG group) as controls. We evaluated histological and serological gastritis and examined two markers; the serum titer of anti-CagA-P antibody and CagA-P expression in gastric mucosa. Results: In the DGC group, we found significantly higher corpus histological gastritis scores for activity, atrophy, and intestinal metaplasia. The titer of anti-CagA-P antibody and CagA-P expression in the corpus were significantly higher in the DGC group, especially in females (p < 0.05). Sixteen patients (38.1%) in the DGC group showed both positive markers, and the odds ratio for DGC occurrence was 4.00 (95% CI = 1.07–14.91), while that for females was 9.00 (95% CI = 1.29–62.97). Conclusions: CagA-P plays a role in active corpus gastritis, which may link to DGC carcinogenesis. Clinical quantification of CagA-P-related markers may be useful for the evaluation of DGC risk, especially in females.
Yamamoto-Furusho, Jesús K.; Torijano-Carrera, Emma
doi: 10.1159/000273871pmid: 20145404
Background: Epidemiological and microbiologic studies suggest that enteropathogenic microorganisms play a substantial role in the clinical initiation and relapses of inflammatory bowel disease. Aim: To explore the prevalence of intestinal protozoa in patients with ulcerative colitis (UC) and its impact on clinical disease course. Methods: A total of 215 patients with definitive diagnosis of UC were studied. Fresh feces samples taken from all UC patients were examined immediately using trichrome-staining methods. Results: A total of 103 female and 112 male UC patients were analyzed. The mean age at diagnosis was 30.5 ± 10.8 years. The prevalence of overall parasitic infections was 24% and distributed as follows: Blastocystis hominis in 22 patients (10%), Endolimax nana in 19 cases (9%), and Entamoebahistolytica in 11 cases (5%). A significantly increased frequency of protozoa infection was found in those patients with persistent activity and intermittent activity as compared to active than inactive group (p = 1 × 10<sup>–7</sup>, OR 13.05, 95% CI 4.28–42.56, and p = 0.003, OR 1.42–14.47, respectively). Interestingly, this association remained significant when we compared the persistent activity group versus intermittent activity group (p = 0.003, OR 2.97, 95% CI 1.35–6.59). Subgroup analysis showed no association between protozoa infection (E. histolytica, B. hominis, and E. nana) and other clinical variables such as gender, extent of disease, extraintestinal complications, medical treatment and grade of disease activity. Conclusion: The prevalence of intestinal protozoa infections in Mexican UC patients was 24% and these microorganisms could be a contributing cause of persistent activity despite medical treatment in our population.
Tahara, Tomomitsu; Shibata, Tomoyuki; Nakamura, Masakatsu; Yamashita, Hiromi; Yoshioka, Daisuke; Okubo, Masaaki; Yonemura, Joh; Maeda, Yoshiteru; Maruyama, Naoko; Kamano, Toshiaki; Kamiya, Yoshio; Fujita, Hiroshi; Nakagawa, Yoshihito; Nagasaka, Mitsuo;
Tokoro, Chikako; Inamori, Masahiko; Uchiyama, Takasi; Iida, Hiroshi; Endo, Hiroki; Hosono, Kunihiro; Sakamoto, Yasunari; Takahashi, Hirokazu; Koide, Tomoko; Goto, Ayumu; Yasuzaki, Hiroaki; Abe, Yasunobu; Matsuda, Reikei; Takahashi, Daisuke; Kawana, Ichiro;
Avallone, E.V.; De Carolis, A.; Loizos, P.; Corrado, C.; Vernia, P.
doi: 10.1159/000277630pmid: 20197661
Background: Hydrogen breath tests are widely used in clinical practice. For a correct evaluation of data, low basal H<sub>2</sub> excretion is required, thus, 12-hour fasting is usually prescribed. An additional reduction in the intake of complex carbohydrates in the preceding 24 h is suggested in some centers. The issue, however, has never been directly investigated. Aim: The aim of the present study was to analyze the effect of the pretest diet on the basal H<sub>2</sub> excretion and the number of subjects excluded from the test due to high basal H<sub>2</sub> excretion. Methods: Two cohorts of 500 consecutive patients undergoing a lactose tolerance test in the years 1997–1998 (when 12-hour fasting was required) and in 2007–2008 (when a low-carbohydrate diet in the preceding 24 h was also prescribed) were retrospectively reviewed. Results: The mean basal H<sub>2</sub> excretion was significantly lower (p < 0.0001) in the low-carbohydrate diet group (2.46 ± 6.8 vs. 4.73 ± 3.3 ppm). In 1997–1998, 46/500 patients (9.2%) were excluded from the test due to basal H<sub>2</sub> values as compared to 7/500 (1.4%) in the period 2007–2008. Discussion: To the best of our knowledge, ours is the first study to provide objective data on the advantage offered by reducing the intake of complex carbohydrates before H<sub>2</sub> breath tests.
Jausset, F.; Delvaux, M.; Dumitriu, D.; Bressenot, A.; Bruot, O.; Mathias, J.; Regent, D.; Laurent, V.
doi: 10.1159/000265829pmid: 20203511
Invasive intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas may be associated with pancreaticogastric fistulas as shown by case reports. We report the case of a benign IPMN associated with pancreaticogastric and pancreaticoduodenal fistulas. A 70-year-old woman was admitted with intestinal obstruction. Computed tomography and MRI showed a large dilatation of the main pancreatic duct (>1 cm) with intraductal nodules, and pancreaticogastric and pancreaticoduodenal fistulas. Several features in imaging were present to support a malignant IPMN, so that the patient underwent a pancreaticoduodenectomy. The histopathological examination of the surgical specimen showed a benign IPMN. This case proves that a benign IPMN can cause pancreaticogastric and pancreaticoduodenal fistulas, probably resulting from mechanical factors.
Demir, Mehmet; Göktürk, Savaş; Öztürk, Nevin Akçaer; Serin, Ender; Yilmaz, Uğur
doi: 10.1159/000236024pmid: 20410684
Background/Aim: The primary aim of this study was to assess the efficacy of a bismuth-based quadruple regimen as first-line therapy for Helicobacter pylori (HP) eradication in diabetes mellitus (DM) patients. The secondary aim was to study the effect of HP eradication on dyspeptic symptoms in DM patients. Method: Eighty-nine consecutive type 2 DM and 48 non-diabetic age- and sex-matched patients were enrolled in this study. Diabetic patients were randomized to receive either pantoprazole (40 mg b.i.d.), clarithromycin (500 mg b.i.d.), and amoxicillin (1 g b.i.d., PCA-DM group) for 14 days, or pantoprazole (40 mg b.i.d.), bismuth citrate (400 mg b.i.d.), tetracycline (500 mg q.i.d.), and metronidazole (500 mg b.i.d., PBTM-DM group) for 14 days as the eradication regimen. All non-diabetic patients were treated by quadruple therapy (PBTM-non-DM group) for 14 days. We used the validated Leeds Dyspepsia Questionnaire (LDQ) to assess dyspeptic symptoms at baseline and 6 weeks after the end of treatment. Results: The HP eradication rates with intention-to-treat (ITT) and per-protocol (PP) analyses were 51% (for both) in the PCA-DM group; 81 and 85% in the PBTM-DM group, and 85 and 87% in the PBTM-non-DM group. The eradication rates are not different between the PBTM-DM and PBTM-non-DM groups (p > 0.05). The eradication rate was significantly lower in the PCA-DM group with both ITT and PP analysis than in the PBTM-DM and PBTM-non-DM groups (p < 0.05). LDQ score was 4.53 ± 7.7 in DM patients with successful eradication and 14.68 ± 5.9 in DM patients without successful eradication (p < 0.05). Conclusion: The bismuth-based quadruple eradication regimen as first-line therapy is safe, tolerable and achieves a high cure rate in patients with DM, and successful eradication may be beneficial on dyspeptic symptoms.
Showing 1 to 10 of 14 Articles
doi: 10.1159/000252766pmid: 20150736
Background/Aim: We investigated the relationship of gastric cancer (GC) and CpG island hypermethylation (CIHM) in tumor suppressor genes of non-neoplastic gastric mucosa. Methods: Gastric mucosa samples were obtained from 125 GC and 180 non-GC subjects. CIHM of p14, p16, DAP-kinase and CDH1 genes were determined by methylation-specific polymerase chain reaction. High CIHM was defined as three or all methylated CpG islands. Results: Rates of CIHM of p14, CDH1, DAP-kinase, and high CIHM were significantly higher in all GC samples than non-GC samples (p14: 32.2 vs. 50.4%; OR = 1.70, 95% CI = 1.03–2.80, p = 0.04, CDH1: 36.1 vs. 84.0%; OR = 8.65, 95% CI = 14.74–15.77, p < 0.0001, DAP-kinase: 42.2 vs. 83.2%; OR = 5.98, 95% CI = 3.37–10.62, p < 0.0001, and high CIHM: 44.4 vs. 80.8%; OR = 4.40, 95% CI = 2.51–7.72, p < 0.0001). CIHM in CDH1 and DAP-kinase were associated with a greater risk of GC including all of its different subtypes. An increased number of CIHM was associated with an increased risk of all GC (1 CIHM; OR = 2.33, 95% CI = 0.82–6.64, p = 0.11, 2 CIHM; OR = 4.89, 95% CI = 1.79–13.37, p = 0.002, 3 CIHM; OR = 9.43, 95% CI = 3.20–27.78, p < 0.0001, and all CIHM OR = 24.71, 95% CI = 6.70–91.18, p < 0.0001). Three and all CIHM were closely associated with a higher risk of intestinal-type GC, Helicobacter pylori-positive infection status, male gender, and middle and older GC while 3 CIHM was closely associated with a higher risk of diffuse-type GC, H. pylori-negative infection status and younger GC. Conclusions: CIHM of CDH1 and DAP-kinase in non-neoplastic gastric mucosa corresponded to a risk of GC regardless of histological subtype, H. pylori infection status, gender and generation. An increased number of CIHM correlates with a higher GC risk including its various clinico-pathological subtypes.
doi: 10.1159/000276896pmid: 20185918