Ulcerative colitis and xenobiotic metabolism

Any hypothesis on the cause of ulcerative colitis must account for genetic influences, geographic and ethnic variations, effects of smoking and oral contraception, anatomical distribution, the relapsing and remitting nature of the disease, and association with primary sclerosing cholangitis. This hypothesis proposes that ulcerative colitis is caused by a reactive xenobiotic metabolite which is conjugated before excretion into bile. The amount of metabolite produced is determined by exposure to its parent compound, by the inherited pattern of metabolism, and by inhibition and induction of enzymes catalysing alternative pathways. Deconjugation by bacteria within the colonic lumen releases the reactive metabolite, damaging the colonic epithelial barrier and exposing the mucosal immune system to luminal contents. Biliary epithelial damage by the metabolite leads to an immune response in those individuals carrying appropriate HLA molecules, thereby initiating an inflammatory process within the biliary tree. © 1994

ETHANOL AND UPPER GASTROINTESTINAL BLEEDING

ETHANOL AND UPPER GASTROINTESTINAL BLEEDIN

An urgent challenge: new training opportunities for junior medical officers.

There will be a massive increase in the number of medical school graduates over the next 5-10 years--there were 1287 Australian resident graduates in 2004, and there will be more than 3000 by the middle of the next decade. A workshop held during the 11th National Prevocational Medical Education Forum explored ways to provide the additional prevocational training posts that will be required. Four possible sites for additional training posts were discussed: expansion of public hospital training posts; general practice; private hospitals; and other sites, including private rooms and community placements. Current accreditation procedures will need to be amended to accommodate more interns. There will be limited access to prevocational training posts for non-resident (full-fee-paying) graduates and international medical graduates. There is an urgent need for postgraduate medical councils, state health departments, the federal government, and medical boards to work together to identify, develop and accredit new training posts

Upper gastrointestinal tract

Drug therapy for upper gastrointestinal disease in the elderly must be moderated by the likelihood of increased sensitivity to the side effects of drugs. For example, in the frail elderly with helicobacter-associated duodenal ulcers, maintenance therapy with an H2-receptor antagonist or omeprazole may be preferable to attempting to eradicate Helicobacter pylori with the current antimicrobial regimens

Infectious diarrhoea revisited

Infectious diarrhoea revisite

Crohn's and colitis: Science progresses steadily

Crohn's and colitis: Science progresses steadil

Alcohol and drug interactions

Alcohol and drug interaction

Gastroenterology

Gastroenterolog

Investigating diarrhea in patients with acquired immunodeficiency syndrome

Investigating diarrhea in patients with acquired immunodeficiency syndrom

Risk of gastric cancer is not increased after partial gastrectomy

Background: It has been suggested that there is an increased risk of gastric cancer following partial gastrectomy. This question has not been studied in an Australian population. Methods: The records of a total of 569 patients who had a partial gastrectomy for peptic ulcer disease at Repatriation General Hospital, Heidelberg, between 1957 and 1976 were reviewed. All were followed to date of death or 31 December 1996. The expected rate of gastric cancer for this population was estimated from published Australian age-and sex-specific gastric cancer mortality rates over this period, and a standardized incidence ratio was calculated. Results: The mean age at surgery was 53.5 years (range 27-83 years). There were 547 male (96.4%) and 22 female (3.6%) patients. Five hundred and seven (83.5%) had a Billroth II procedure. Thirty-eight patients (6.3%) were lost to follow up and were not included in the analysis. From the records of the Department of Veterans' Affairs, it was established that 125 (20.6%) were alive in December 1996, a mean survival after surgery of 18.8 years. The mean documented duration of follow up was 17.3 years (range 1-41 years). Nine patients developed cancer in the gastric remnant. The expected number of cancers in this population was 6.5. Assuming all survivors were free of gastric cancer, the standardized incidence ratio was 1.39 (95% confidence intervals 0.64- 2.65, P=0.313). Conclusion: The risk of gastric cancer was not increased after partial gastrectomy in this Australian population. (C) 2000 Blackwell Science Asia Pty Ltd