Management and screening of patients with cancer-prone lesions of the stomach

Les procédés de dépistage constituent un luxe propre aux pays riches. Le coût de la découverte d'une lésion au stade clinique doit toujours être apprécié en fonction du rapport coût/bénéfice d'autres méthodes de diagnostic. Le procédé de dépistage le plus coûteux du cancer de l'estomac est celui qui concerne une population générale, même à haut risque, comme c'est le cas en Amérique du Sud, au Japon, en Italie et au Portugal. Le dépistage devient plus abordable dans une population symptomatique («surconsommation d'endoscopies») ou dans des pathologies qui prédisposent au cancer (ex: l'anémie pernicieuse) ou encore chez des porteurs de «macro- ou micro-lésions précancéreuses». Les macro-lésions importantes sont la gastrite atrophique achlorhyridrique de type A, le moignon post-gastrectomie et éventuellement la gastrite atrophique de type B associée à H. pylori. Les micro-lésions précancéreuses sont la dysplasie et la métaplasie intestinale en particulier le sous-groupe III producteur de sulfomucines. Dans la gastrite atrophique achlorhydrique de type A et 15 à 20 ans après une gastrectomie partielle, une surveillance endoscopique tous les 3 à 5 ans est recommandée chez les patients bénéficiaires de mesures thérapeutiques. La dysplasie modérée et la métaplasie intestinale du sous-groupe III justifient des contrôles plus fréquents (annuels?). Chez les patients porteurs de façon répétée d'une dysplasie sévère, une gastrectomie totale est indiquée à titre thérapeutique pour un cancer déjà présent ou à titre préventif vis-à-vis d'un cancer potentie

The patient after total gastrectomy

The patient after total gastrectomy] [Article in German] Armbrecht U. Marbachtalklinik, Bad Kissingen

Nutrient malassimilation following total gastrectomy.

Nutrient malassimilation following total gastrectomy. Bragelmann R, Armbrecht U, Rosemeyer D, Schneider B, Zilly W, Stockbrugger RW. Dept. of Gastroenterology, Academisch Hospital Maastricht, The Netherlands. BACKGROUND: The aim of the study was to elucidate the degree and the pathophysiology of abdominal symptoms, malnutrition and malassimilation after total gastrectomy. METHODS: In 174 consecutive patients, with potentially curative total gastrectomy for gastric malignancy, subjective symptoms and objective parameters of malassimilation were evaluated. RESULTS: Abdominal symptoms were present in 86% of the patients. In spite of a high daily calorie intake (median 37.8 kcal/kg body weight) mean body mass index had been decreasing since good health. Anaemia was found in 46%, sideropenia in 31% and oesophagitis in 26%. Mean faecal fat excretion was 17.4 (1.4) g/day and mean fat malassimilation 14.8% (1.1) of the intake. A shortened small-bowel transit was measured in 21.7% of the patients, and bacterial overgrowth was present in 37.7%. CONCLUSIONS: Malassimilation post total gastrectomy seems to be multifactorial. Shortened small-bowel transit and subsequent dyssynchrony of pancreatic enzyme supply seem to be of major importance

The effect of pancreatic enzyme supplementation in patients with steatorrhoea after total gastrectomy.

Department of Gastroenterology, Academisch Ziekenhuis, Maastricht, The Netherlands.OBJECTIVE: To assess the influence of pancreatic enzyme supplementation on symptoms, energy intake, bowel habits, and fat malassimilation in patients after total gastrectomy. DESIGN: A prospective, double-blind, randomized, parallel, placebo-controlled, multi-centre trial. SETTING: Institutionalized patients in three gastroenterological rehabilitation clinics. PARTICIPANTS: 52 institutionalized patients with a faecal fat output > or = 14 g/day, operated on for malignant gastric disease a median of 198 days (interquartile range (IQR) 47-608) previously, and free from recurrence and/or metastasis. INTERVENTIONS: Nine sachets of pancreatic enzymes per day (each containing lipase 36,000, amylase 27,000, protease 2400 FIP (Federation International Pharmaceutique)) or identical-looking placebo were given for 14 days. MAIN OUTCOME MEASURES: Abdominal symptoms, energy intake, bowel habits and fat malassimilation. RESULTS: After treatment, patients on enzyme therapy felt better overall (P = 0.006), but no improvement of a specific symptom could be identified. During the intervention, the median kilojoule intake per kilogram body weight was 9% higher in the placebo group (170.8 (IQR 146.9-202.6)) than in the enzyme-treated group (157.0 (IQR 134.8-170.4)) (P = 0.03). Enzyme treatment did not result in a significant difference between the placebo and the enzyme-treated group regarding bowel habits or fat malassimilation. CONCLUSIONS: The effect of high-dose pancreatic enzymes supplementation on symptoms and steatorrhoea after total gastrectomy is marginal and does not justify its routine use.Publication Types: Clinical Trial Multicenter Study Randomized Controlled Tria