Predictors of colorectal cancer screening awareness among people working in a hospital environment

Abstract Background Compliance rates for colorectal cancer (CRC) screening are much lower than those desired. Appropriate information on CRC risks and screening methods is supposed to stimulate motivation for screening. We aimed to identify parameters associated with the decision for CRC screening and colonoscopy in a population expected to have high awareness of disease prevention

The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics

Influence of erythromycin on esophageal motility: study on healthy volunteers and patients with systemic sclerosis

Erythromycin (ERY) is a motilin agonist. Aims of our study: to evaluate 1) the l effects and the mechanism of action of intravenous ERY on esophageal motility in humans 2) the effect of oral ERY administration and 3) the effects of IV-ERY on esophageal motility in patients with systemic sclerosis (SS). Patients and methods: 8 healthy volunteers received in a double blind cross-sectional way placebo or ERY (150mg) IV for 20 min or ERY preceded by atropine (12μg/kg). 7 out of the 8 healthy volunteers received in a fourth session150mg of ERY per os. 32 patients with SS received randomly either placebo or ERY (150mg) IV for 20 min. Manometry was performed by means of a Dent sleeve. Results: IV-ERY significantly increased the lower esophageal sphincter pressure (PLES) compared to placebo (difference: [Δ]+16,8±4,7mmHg, p<0,05) and decreased peristaltic contraction velocity ([Δ]-0,029±1,4mmHg, p<0,05) in healthy volunteers. These effects were completely abolished by atropine. ERY increased the number of fundic contractions and this effect was not abolished by atropine. Oral administration of ERY (150mg) had no significant effect on esophageal motility. IV-ERY significantly increased the PLES and fundic contractions in patients with SS irrespectively of the SS duration and subsets, and the presence or not of esophagitis ([Δ]+5,61 ± 0,56mmHg, p<0,05). Conclusions: 1) ERY increases PLES by stimulating cholinergic nerves and decreases velocity of esophageal body 2) The action of ERY on gastric motility is not cholinergic 3) Oral ERY has less effects on esophageal motility 4) ERY increases PLES and the number of fundic contractions in SS patients.Η ερυθρομυκίνη (ΕΡΥ) είναι ισχυρός αγωνιστής της μοτιλίνης. Σκοπός της μελέτης: να εκτιμηθούν 1) η δράση της ΕΡΥ στην κινητικότητα του οισοφάγου του ανθρώπου 2) η από του στόματος δράση της 3) η δράση της στον οισοφάγο ασθενών με συστηματικό σκληρόδερμα (ΣΣ). Ασθενείς - Μέθοδοι : 8 υγιείς εθελοντές έλαβαν σε ΔΤΤΔ μελέτη είτε εικονικό φάρμακο (Pl) είτε ΕΡΥ (150mg) σε συνεχή ΕΦ έγχυση για 20 min είτε ΕΡΥ αφού είχε χορηγηθεί ατροπίνη (12μg/kg). Ακολούθως οι 7 υγιείς εθελοντές έλαβαν 150mg ΕΡΥ per os. 32 ασθενείς με ΣΣ τυχαιοποιήθηκαν και έλαβαν ΕΡΥ (150mg) ΕΦ για 20 min ή Pl. Η μανομετρία έγινε με Dent sleeve. Αποτελέσματα: Η ΕΡΥ αύξησε σημαντικά την πίεση του κατώτερου οισοφαγικού σφιγκτήρα (ΠΚΟΣ) σε σύγκριση με το Pl (διαφορά: [Δ]+16,8± 4,7 mmHg, p<0,05) ενώ μείωσε την ταχύτητα περισταλτισμού του σώματος του οισοφάγου ([Δ]-0,029±1,4mmHg, p<0,05) στους υγιείς εθελοντές. Η ατροπίνη κατήργησε πλήρως τη δράση της ΕΡΥ ενώ δεν μείωσε τις συσπάσεις του στομάχου (ΣυΣτ). Συνεπώς ο μηχανισμός δράσης της ΕΡΥ στον οισοφάγο επιτυγχάνεται μέσω χολινεργικών οδών ενώ στο στόμαχο είναι μη χολινεργικός. Η από του στόματος χορήγηση ΕΡΥ ήταν χωρίς αποτέλεσμα. Η ΕΦ χορήγηση ΕΡΥ αύξησε την ΠΚΟΣ ([Δ]+5,61 ± 0,56mmHg, p<0,05) και τον αριθμό των ΣυΣτ των ασθενών με ΣΣ ανεξάρτητα από τον τύπο της νόσου, τη διάρκειά της και την παρουσία ή όχι οισοφαγίτιδας. Συμπεράσματα: 1) Η ΕΡΥ αυξάνει την ΠΚΟΣ μέσω χολινεργικής διέγερσης και μειώνει την ταχύτητα περισταλτισμού του οισοφάγου 2) Η δράση της στο στομάχου οφείλεται σε μη χολινεργείς μηχανισμούς 3) Σε χαμηλές από του στόματος δόσεις τα αποτελέσματα δεν είναι προφανή. 4) Η ΕΡΥ αυξάνει την ΠΚΟΣ και τον αριθμό των ΣυΣτ ασθενών με ΣΣ

Management of hepatitis B virus infection in patients with inflammatory bowel disease under immunosuppressive treatment

Hepatitis B remains a significant global clinical problem, despite the implementation of safe and effective vaccination programs. The prevalence of hepatitis B virus (HBV) in patients with inflammatory bowel disease (IBD) largely follows the regional epidemiologic status. Serological screening with hepatitis B surface antigen (HBsAg), and antibodies to hepatitis B surface (anti-HBs) and core (anti-HBc) proteins is a key element in the management of IBD patients and, ideally, should be performed at IBD diagnosis. Stratification of individual cases should be done according to the serologic profile and the IBD-specific treatment, with particular emphasis in patients receiving immunosuppressive regimens. In patients who have not contracted HBV, vaccination is indicated to accomplish protective immunity. Vaccination in immunosuppressed patients, however, is a challenging issue and several strategies for primary and revaccination have been proposed. The risk of HBV reactivation in patients with IBD should be considered in both HBsAg-positive and HBsAg-negative/anti-HBc-positive patients, when immunosuppressive therapies are administered. HBV reactivation is preventable via the administration of prophylactic nucleot(s)ide analogues and should be the standard approach in HBsAg-positive patients. HBsAg-negative/anti-HBc-positive patients represent a non-homogeneous group and bear a significantly lower risk of HBV reactivation. Biochemical, serological and molecular monitoring is currently the recommended approach for anti-HBc patients. Acute HBV infection is rarely reported in IBD patients. In the present review, we outline the problems associated with HBV infection in patients with IBD and present updated evidence for their management

Acute Pancreatitis Following Endoscopic Ampullary Biopsies without Attempted Cannulation of the Ampulla of Vater

A 51-year-old man underwent diagnostic work-up for an abnormal-appearing ampulla of Vater. Three hours after biopsy of the ampulla, the patient presented with intense symptoms suggesting acute pancreatitis, which was later confirmed with laboratory and radiographic examinations. Other causes were excluded and the acute pancreatitis was considered a procedural complication. This is a rarely reported complication that must be taken into consideration when biopsies are performed in the ampulla of Vater