Latest development in the management of acid-related diseases

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A teacher with weight loss and fever

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Dyspepsia

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Who should be treated for Helicobacter pylori infection?

Helicobacter pylori infection affects approximately half of the worldԸ?s population. In Hong Kong, approximately 55% of the population is infected with this organism. But symptoms and clinical disease develop in only a minority of infected individuals during their lifetime. Treatment should thus be appropriately targeted. It is imperative that infected patients who have either a current or past history of peptic ulcer disease, with or without bleeding or a perforation complication, and those with low-grade gastric, mucosal-associated lymphoid tissue lymphoma should all have the organism eliminated. There is evidence that antiԸ?Helicobacter pylori therapy reduces the recurrence of gastric cancer after the successful removal of early gastric cancer lesions. Patients with non-ulcer dyspepsia, particularly those with severe symptoms, should also be considered for a trial of eradication therapy. Whether or not eradication therapy should be given to those who require long-term non-steroidal anti-inflammatory drug therapy, but who do not have a history of peptic ulcer disease is still not decided. The use of prophylactic eradication to stop the development of gastric cancer or peptic ulceration in H pylori--positive but asymptomatic individuals should be considered only in research settings.published_or_final_versio

Current understanding of the role of PPAR γ in gastrointestinal cancers

Numerous studies have indicated that PPAR plays multiple roles such as in inflammation, cell cycle control, cell proliferation, apoptosis, and carcinogenesis, thus PPAR contributes to the homeostasis. Many in vitro studies have showed that ligand-induced activation of PPAR possess antitumor effect in many cancers including CRC. However, the role of PPAR in gastrointestinal cancers, especially in colorectal cancer, is rather controversial. Nevertheless, some recent studies with the positive results on the possible application of PPAR ligands, such as Bezafibrate or Rosiglitazone in gastrointestinal cancers, have suggested a potential usefulness of PPAR agonists in cancer prevention and therapy. In this review, the authors discuss the recent developments in the role of PPAR in gastrointestinal cancers. Copyright © 2009 Bing Zou et al.published_or_final_versio

Helicobacter pylori infection and gastric cancer

Gastric cancer is the second most common fatal malignant neoplasm in the world. In mainland China, gastric cancer is now the second most common malignant neoplasm while in Hong Kong, the mortality rate ranked fourth of all cancers in 1995. Dietary factors seem to be involved in gastric carcinogenesis, and beta carotene, selenium, and vitamin E (tocopherols) have been shown to help reduce gastric cancer mortality. Prospective case-control studies have shown an increased risk for the development of gastric cancer of between 2.8 and 6.0 among carriers of Helicobacter pylori. In addition, cagA-positive strains of Helicobacter pylori have been found to be associated with gastric cancer and duodenal ulceration. The exact role of Helicobacter pylori in gastric carcinogenesis is still being investigated. Helicobacter pylori eradication programmes to help prevent gastric cancer are being conducted in China and other parts of the world. In high-risk areas such as China, a combination approach that includes Helicobacter pylori eradication and dietary supplementation may be necessary.published_or_final_versio

An evaluation of PyloriTek test for the diagnosis of Helicobacter pylori infection in Chinese - before and after eradication therapy

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Risk of liver cancer in patients with hepatitis B or C

Key Messages1. Among hepatitis B virus carriers, infection with genotype C significantly increases the risk of developing hepatocellular cancer compared to those without this genotype.2. Among hepatitis C virus carriers, infection with genotype 1b increases the risk of hepatocellular cancer two fold compared to controls without this genotype.3. Such increased risk should be explained as risk over and above the existing risk associated with each infection.4. Hepatitis C virus genotypes1a and 2a are associated with decreased risk of hepatocellular cancer.published_or_final_versio

Change in endogenous nitric oxide production in the healing of gastric ulcer induced by acetic acid

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Do patients with non-ulcer dyspepsia respond differently to Helicobacter pylori eradication treatments from those with peptic ulcer disease? A systematic review

Aim: It is controversial whether patients with non-ulcer dyspepsia (NUD) respond differently to Helicobacter pylori (H pylori) eradication treatment than those with peptic ulcer disease (PUD). To review the evidence for any difference in H pylori eradication rates between PUD and NUD patients. Methods: A literature search for full articles and meeting abstracts to July 2004 was conducted. We included studies evaluating the efficacy of a proton pump inhibitor (P) or ranitidine bismuth citrate (RBC) plus two antibiotics of clarithromycin (C), amoxicillin (A), metronidazole (M), or P-based quadruple therapies for eradicating the infection. Results: Twenty-two studies met the criteria. No significant difference in eradication rates was found between PUD and NUD patients when treated with 7-d RBCCA, 10-d PCA or P-based quadruple therapies. When the 7-d PCA was used, the pooled H pylori eradication rate was 82.1% (431/525) and 72.6% (448/617) for PUD and NUD patients, respectively, yielding a RR of 1.15 (95%CI 1.01-1.29). However, the statistically significant difference was seen only in meeting abstracts, but not in full publications. Conclusion: There is no convincing evidence to suggest that NUD patients respond to H pylori eradication treatments differently from those with PUD, although a trend exists with the 7-d PCA therapy. © 2005 The WJG Press and Elsevier Inc. All rights reserved.published_or_final_versio