Gastric cancer: who is at risk?

Gastric cancer is a multifactorial disease. Helicobacter pylori infection, host genetic factors and dietetic factors play an important role in the development of gastric cancer. Individuals with a positive family history of gastric cancer and/or pro-inflammatory polymorphisms of the interleukin-1 and tumor necrosis factor A genes infected by H. pylori virulent strains (cagA-, vacA s1-, vacA m1- and babA2-positive) have the highest risk of gastric cancer development. Diets rich in salted and smoked food and poor in fresh fruit and vegetables favor gastric carcinogenesis. Genetic combined with bacterial and host genotyping may allow for the identification of patients at high risk of gastric cancer who can benefit from preventive eradication therapy. Copyright (c) 2004 S. Karger AG, Basel

Barrett's esophagus

Barrett\u2019s esophagus is a precancerous condition associated with an increased risk of esophageal adenocarcinoma. A diagnosis of Barrett\u2019s esophagus may cause psychological stress with a negative impact on patients\u2019 quality of life. In line with the increasing prevalence of gastro-esophageal reflux disease, the incidence of Barrett\u2019s esophagus has raised dramatically over the last decades, particularly in Europe. Several international guidelines and experts consensus on the diagnosis and management of Barrett\u2019s esophagus have been published over the last years. There are still areas of controversy surrounding the diagnosis of Barrett\u2019s esophagus, in particular concerning the histological type of metaplastic epithelium, and treatment modalities, including medical therapy for chemoprevention and endoscopic techniques. The purpose of this review is to examine the current guidelines and recommendations, and report recent evidence from systematic reviews and clinical trials on epidemiology, diagnosis, surveillance and treatment of Barrett\u2019s esophagus

Gastric cancer prevention strategies: A global perspective

Gastric cancer (GC) is the fifth most common cancer worldwide, and mortality rates are still high. Primary preventive strategies, aimed to reduce risk factors and promote protective ones, will lead to a decrease in GC incidence. Helicobacter pylori infection is a well-established carcinogen for GC, and its eradication is recommended as the best strategy for the primary prevention. However, the role of other factors such as lifestyle, diet, and drug use is still under debate in GC carcinogenesis. Unfortunately, most patients with GC are diagnosed at late stages when treatment is often ineffective. Neoplastic transformation of the gastric mucosa is a multistep process, and appropriate diagnosis and management of preneoplastic conditions can reduce GC-related mortality. Several screening strategies in relation to GC incidence have been proposed in order to detect neoplastic lesions at early stages. The efficacy of screening strategies in reducing GC mortality needs to be confirmed. This review provides an overview of current international guidelines and recent literature on primary and secondary prevention strategies for GC

Role of Ultrasound Elastography in the Detection of Fibrotic Bowel Strictures in Patients with Crohn's Disease: Systematic Review and Meta-Analysis

PURPOSE: To perform a systematic review with meta-analysis to assess whether ultrasound elastography can have a diagnostic role in detecting fibrotic bowel strictures in patients with Crohn's disease. MATERIALS AND METHODS: MEDLINE via the PubMed, Ovid Embase, Scopus and Cochrane Library databases, and abstracts of international conference proceedings were searched up to March 31, 2018. Studies were included if they assessed the performance of abdominal ultrasound elastography in detecting fibrotic bowel strictures in patients with Crohn's disease using histology or the need for surgery after medical treatment as a reference standard. The quality of the studies was assessed using Quality Assessment of Diagnostic Accuracy Studies. RESULTS: 6 studies including a total of 217 patients with Crohn's disease and 231 bowel segments, of which 76 were bowel segments with fibrotic stricture, were selected. Three studies used strain ratio and three studies used strain value as parameters of bowel stiffness. Both the pooled standardized mean strain ratio and the pooled standardized mean strain value were higher in bowel segments with fibrotic strictures than in those without fibrotic strictures with a standardized mean difference of 0.85 (95\u200a% confidence level [CI]: 0 to 1.71; p\u200a=\u200a0.05) and 1.0 (95\u200a% CI: -0.11 to 2.10; p\u200a=\u200a0.08), respectively. There was a high heterogeneity between studies. All studies were at "high risk" or "unclear risk" of bias. CONCLUSION: Ultrasound elastography could be able to detect fibrotic bowel strictures in patients with Crohn's disease. Well-designed high quality diagnostic studies with a large sample size are needed

Endoscopic submucosal dissection for superficial premalignant and malignant epithelial neoplasms of the digestive tract: A real-life experience in Italy

OBJECTIVE: Endoscopic submucosal dissection (ESD) is a technique for en bloc resection of neoplastic lesions of the digestive tract. Endoscopic submucosal dissection was developed in Asia. and data from Western countries are scarce. Our study aimed to assess the efficacy and safety of ESD for resection of superficial premalignant and malignant epithelial neoplasms in a tertiary center in Italy.PATIENTS AND METHODS: All patients with gastrointestinal lesions who underwent ESD between January 2013 and December 2018 in our center were retrospectively evaluated. Technical success, en bloc, R0, curative resection, and complication rates were assessed.RESULTS: A total of 107 lesions (stomach, no.=41: rectum, no.=32; colon. no.=28: esophagus, no.=5; duodenum, no.=1) were resected by ESD in 93 patients. Endoscopic submucosal dissection was technically successful in 99.1% (106/107) of lesions. Among the 90 superficial premalignant and malignant epithelial neoplasms, en bloc, and R0 resection rates were 97.8% (no.=88) and 75.6% (no.=68), respectively. Major complications occurred in 9.3% (10/107) of cases: 4 (3.7%) were perforations and 6 (5.6%) were major bleedings. All complications, but two which needed surgery, were managed endoscopically.CONCLUSIONS: Our study shows that ESD is a feasible, effective, and safe technique in a Western country

Attending Training Courses on Barrett\u2019s Esophagus Improves Adherence to Guidelines: A Survey from the Italian Society of Digestive Endoscopy

Background: Little is known on practice patterns of endoscopists for the management of Barrett\u2019s esophagus (BE) over the last decade. Aims: Our aim was to assess practice patterns of endoscopists for the diagnosis, surveillance and treatment of BE. Methods: All members of the Italian Society of Digestive Endoscopy (SIED) were invited to participate to a questionnaire-based survey. The questionnaire included questions on demographic and professional characteristics, and on diagnosis and management strategies for BE. Results: Of the 883 SIED members, 259 (31.1%) completed the questionnaire. Of these, 73% were males, 42.9% had > 50 years of age and 68.7% practiced in community hospitals. The majority (82.9%) of participants stated to use the Prague classification; however 34.5% did not use the top of gastric folds to identify the gastro-esophageal junction (GEJ); only 51.4% used advanced endoscopy imaging routinely. Almost all respondents practiced endoscopic surveillance for non-dysplastic BE, but 43.7% performed eradication in selected cases and 30% practiced surveillance every 1\u20132 years. The majority of endoscopists managed low-grade dysplasia with surveillance (79.1%) and high-grade dysplasia with ablation (77.1%). Attending a training course on BE in the previous 5 years was significantly associated with the use of the Prague classification (OR 4.8, 95% CI 1.9\u201312.1), the top of gastric folds as landmark for the GEJ (OR 2.45, 95% CI 1.27\u20134.74) and advanced imaging endoscopic techniques (OR 3.33, 95% CI 1.53\u20137.29). Conclusions: Practice patterns for management of BE among endoscopists are variable. Attending training courses on BE improves adherence to guidelines

13C-urea breath test to assess Helicobacter pylori bacterial load.

BACKGROUND: Some authors have reported, using different protocols, that 13C-urea breath test (13C-UBT) is capable of assessing the intragastric Helicobacter pylori bacterial load, whereas others have not confirmed these data. Our aim is to evaluate the correlation between 13C-UBT values and H. pylori bacterial load. MATERIALS AND METHODS: One hundred ninety-two patients diagnosed H. pylori-positive by rapid urease test, histology, and 13C-UBT were enrolled. H. pylori bacterial load (H. pylori score) and gastritis activity (activity score) were evaluated according to the Updated Sydney System. 13C-UBT was performed according to the European Standard Protocol. Breath samples were obtained every 10 minutes for 60 minutes in 52 patients and at 30 minutes (T30) in 140 patients and analyzed by mass spectrometry. RESULTS: At T30, mean +/- SD excess delta 13CO2 excretion was 17.4 +/- 1.1, 29.9 +/- 2.2, and 48.7 +/- 4.8 in patients with H. pylori scores 1, 2, and 3, respectively. This difference was statistically significant: H. pylori score 1 versus 2, p < .005; score 1 versus 3, p < .05; score 2 versus 3, p < .05. A significant positive correlation (G = 0.59) was found between H. pylori score and activity score of chronic gastritis. At T40 and T50 significant correlation between mean excess delta 13CO2 excretion and bacterial load was achieved only in patients with H. pylori scores 1 and 3. CONCLUSIONS: 13C-UBT European Standard Protocol values correlate with H. pylori bacterial load and the activity of gastritis at T30 breath sampling time