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The harm of Helicobacter pylori (Hp) infection has been fully recognized, and the eradication of Hp to prevent and treat Hp-associated diseases is highly cost-effective. Now, the statement "Hp infected individuals should be offered eradication therapy, unless there are competing considerations" has been widely accepted. However, the eradication rate of Hp in clinical practice is gradually decreasing, which affects negatively the prevention and control of Hp infection. The goals are unified, but difficulties are encountered in the implementation. Therefore, the treatment of "refractory Hp infection" has become a hot research spot today. In this paper, the controversy over the definition of "refractory Hp infection", the causes for "refractory" infection and related countermeasures are described in detail.
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The recently published paper titled "Management of Helicobacter pylori infection: the Maastricht /Florence consensus report" reached consensus on 87 statements concerning management of Helicobacter pylori infection in following 5 aspects: (1) indications/associations, (2) diagnosis, (3) treatment, (4) prevention/gastric cancer and (5) Helicobacter pylori and the gut microbiota. Detailed interpretations of this consensus were presented in this paper.
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Urea breath test (UBT) is the most important non-invasive method for diagnosis of Helicobacter pylori (Hp) infection. Citric acid in UBT reagents can increase the acidity of stomach and the detection value of delta over baseline (DOB), thereby reducing the false positive and false negative rates of UBT in patients with gastric hypochlorhydria (moderate-to-severe gastric mucosal atrophy/intestinal metaplasia, taking proton pump inhibitors), thus improving the diagnostic accuracy of Hp infection.
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Recently published paper titled "Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus" reached consensus in the following 5 aspects: (1) Disease burden of Helicobacter pylori (Hp) infection associated gastric cancer; (2) Implementation of Hp screening and eradication programs at population level; (3) Treatment of Hp infection in mass eradication programs; (4) Potentially adverse consequences of Hp eradication; (5) Endoscopic surveillance for gastric cancer after Hp eradication. Detailed interpretations of these 5 aspects were performed in this paper.
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Unintentional weight loss is one of the common clinical symptoms with potential serious clinical implications. There are a variety of potential etiologies and special factors to be considered. Comprehensive evaluation of these patients should be based on the relevant results found in the medical history,physical examination,and laboratory tests. The purpose of this paper is to discuss the clinical importance,underlying etiologies,and rational management of unintentional weight loss.
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Gastric cancer is one of the most common malignant tumors in China. The 5-year survival rate of advanced gastric cancer is less than 30%,while the 10-year survival rate of early gastric cancer can reach 90%. Gastric cancer screening is the primary means of detecting early gastric cancer and reducing its mortality. Helicobacter pylori(H. pylori) infection is the most important cause of gastric cancer. Eradication of H. pylori can reduce the incidence of gastric cancer and its mortality. This review summarized recent advances in screening methods,screening subjects,screening procedures, and the combination of gastric cancer screening with H. pylori detection/eradication strategy.
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Objective@#To investigate the metastatic sequence of cervical lymph node in hypopharyngeal carcinoma aimed at guiding neck exploration.@*Methods@#Seventy-five serial sections of integrally dissected lateral neck specimens from 67 patients of hypophayryngeal carcinoma were histopathologically observed, and the metastatic sequence of cervical lymph node of hypophayryngeal carcinoma were analysed.@*Results@#In 75 integrally dissected lateral neck specimens, 63 laterals were found to occur cervical lymph node metastases, the metastatic ratio was 84.0%. The analytic result of 63 dissected lateral neck specimens with positive lymph nodes showed that the metastatic lymph node ratio in descending order was level Ⅱ (90.5%), level Ⅲ (76.2%), level Ⅳ (41.3%), level Ⅴ (15.9%), level Ⅰ (7.9%) and level Ⅵ (3.2%). The metastatic ratio of lymph node between level Ⅰ~Ⅵ were significantly different from each other (P<0.01). When the tumor metastasized to one cervical lymph node, this could be found in levels Ⅱ or Ⅲ, when metastasized to two cervical lymph nodes, these could be found in levels Ⅱ, Ⅲ, Ⅳ, and when metastasized to more than 5 of cervical lymph nodes, these could be found in levels Ⅱ, Ⅲ, Ⅳ, Ⅴ, Ⅰand Ⅵ. According to the occurring sequence, metastatic ratio and number of cervical lymph node metastasis (LNM), levels Ⅱ and Ⅲ were identified as the first station, level Ⅳ was the second station and levels Ⅴ, Ⅰ and Ⅵ were the third station of cervical LNM in hypopharyngeal carcinoma.@*Conclusion@#The confirmation of metastatic sequence of cervical lymph node in hypophayryngeal carcinoma provides a reliable evidence for neck lymph node dissection and reference value for clinic therapy.
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The Fifth Chinese National Consensus Report on Management of Helicobacter pylori Infection has been published.Contents of the consensus consist of six parts, including indications for Helicobacter pylori eradication, diagnosis, treatment, Helicobacter pylori and gastric cancer, Helicobacter pylori infection in special populations, Helicobacter pylori and gastrointestinal microbiota.Most of the contents are understandable, and this paper mainly explains 7 controversial issues.
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Gastric cancer ranks second among the most common causes of cancer death in China. More than 90% of gastric cancer are considered as the ultimate consequence of a longstanding mucosal inflammation. Helicobacter pylori (H. pylori)infection is the leading etiological cause of gastritis,which may result in atrophy,intestinal metaplasia and dysplasia of the gastric mucosa,and finally the occurrence of gastric cancer (Correa's Cascade of intestinal type of gastric cancer). This well-understood natural history provides the rationale for primary and secondary cancer prevention strategies. A large body of evidence demonstrates that combined strategies of primary (H. pylori eradication) and secondary (endoscopic screening and surveillance)prevention may prevent or limit the progress of gastric oncogenesis. In this article, the importance of primary prevention of gastric cancer is emphasized.
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“Management of Helicobacter pylori infection — the Maastricht Ⅴ Consensus Conference”held in Florence, Italy,October 8-9th,2015 was convened for developing a new consensus on the management of Helicobacter pylori infection in following aspects:1. Indication/ Associations,2. Diagnosis,3. Treatment,4. Prevention/ Public Health,5. Helicobacter pylori and the Gastric Microbiota. A detailed interpretation of these contents was made in this paper.
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The indication for eradication of Helicobacter pylori( Hp)has been gradually expanded from peptic ulcer to“confirmed Hp infection”. Kyoto global consensus report on Hp gastritis has defined Hp gastritis as an infectious disease, and proposed that eradication therapy should be given to Hp infected individuals unless there are competing considerations. Currently the issue of Hp infection is no longer whether it should be eradicated,but rather how it can be effectively eradicated. With the rise of antibiotic resistance,Hp eradication is much more difficult than beforehand. This series of lectures on how to improve the eradication rate of Hp has been elaborated in detail in following aspects:current status of Hp eradication therapy,how to improve the eradication rate of drug-resistant strains of Hp,and to explore suitable eradication regimens for Chinese patients in reference with international consensus.
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Objective To detect the effect of E6AP on gastric cancer cell proliferation and migration.Methods The expression of E6AP in different gastric cancer cell lines and normal gastric mucosa epithelial cell lines was detected by Western blotting.Gastric cancer cells BGC-823 stably expressing E6AP short hairpan RNA(shRNA) were obtained by lentiviral vector of E6AP.The effect of E6AP on BGC-823 cell growth and migration was determined by CCK-8 kit, Tran-swell and wound healing assay.Results Gastric cancer cell line BGC-823 in which E6AP was stably knocked down was established.Knockdown of E6AP inhibited the proliferation and migration of BGC-823 cells.Conclusion E6AP plays a key role in gastric cancer proliferation and migration.
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Peptic ulcer bleeding is a common emergency. Management of peptic ulcer bleeding needs prompt pre-endoscopy risk stratification,initiation of pharmacotherapy,endoscopic assessment and hemostasis if necessary. This article reviewed the proper management of patients with peptic ulcer bleeding based on the most recent relevant international guidelines and consensus.
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The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2015. The revised guidelines consist of the following items:bleeding gastric and duodenal ulcers, Helicobacter pylori(Hp)eradication therapy and non-eradication therapy,drug-induced ulcer,non-Hp/ non-nonsteroidal anti-inflammatory drug( NSAID)-induced ulcer,and surgical treatment. This guideline describes the abovementioned content in detail and is a good reference for clinical practice. A full interpretation of this guideline was performed in this paper.
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Gastrointestinal(GI)bleeding is one of the commonly seen clinical problems in departments of emergency and gastroenterology. Acute massive bleeding may be life-threatening,and chronic blood loss can present symptoms of anemia. GI bleeding is the clinical manifestation of some serious diseases,including GI malignancies. Familiar with and mastering the clinical manifestations,classification and principles of management of GI bleeding will help to improve its prevention and treatment.
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A global consensus meeting on Helicobacter pylori(H. pylori)gastritis was held in Kyoto,Japan from January 31st to February 1st ,2014,which was convened to develop consensus on:(1)H. pylori gastritis is an infectious disease,(2)clinical distinction of dyspepsia caused by H. pylori from functional dyspepsia,(3)appropriate diagnostic assessment of gastritis and(4)when,whom and how to treat H. pylori gastritis. All 24 statements for 22 clinical questions achieved a consensus level of > 80% . In this paper,the statements were interpreted in detail.
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In patients with gastrointestinal bleeding,the elderly patients have the unique features in bleeding incidence,etiologic constitution,clinical manifestations,management and prognosis. The aging of population makes the evaluation and management of gastrointestinal bleeding in elderly a special and increasingly common clinical challenge. This paper reviewed this topic in detail.
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Objective To study the expressions of hypoxia inducible factor (HIF)-1 and angiopoietin (Ang)-2 in repeated gastrointestinal bleeding due to vascular malformation, and the efficacy of treatment with thalidomide. Methods Twenty-five patients with repeated gastrointestinal bleeding due to vascular malformation confirmed by capsule endoscopy or enteroscopy were collected and 18 subjects without severe diseases were served as controls. Ten patients with gastrointestinal vascular malformation, who received 25 mg of thalidomide 4 times daily for 4 months and were followed up for at least one year, were also enrolled. The serum samples from all participauts were detected for expressions of HIF-1 and Ang-2 using enzyme-linked immunosorbent assay (ELISA).The expressions of HIF-1 and Ang-2 were compared between angiodysplasia group and control group.The expressions of HIF-1 and Ang-2 were comparatively evaluated before and after treatment with thalidomide in treatment group. Results The expressions of HIF-1 and Ang-2 in vascular malformation group [( 113. 84 ± 26. 66 ) ng/ml and ( 652. 11 ± 140. 39) ng/ml, respectively] were significantly higher than that of control group [(43.28±17.30) ng/ml and (265.60±53.88) ng/ml,respectively, P=0. 000]. The expression of HIF-1 was positively associated with that of Ang-2. (r=0. 700, P= 0. 000). There was no difference in expressions of HIF-1 and Ang-2 before and after treatment with thalidomide (P=0. 498 and =0. 136, respectively). However, significant reduction of Ang-2 [(113. 80±73. 60) ng/ml(P=0. 003)] was found in 8 effectively treated patients after thalidomide treatment. Conclusions HIF-1 and Ang-2 might play an important role in the formation of vascular malformation. The extent of Ang-2 reduction after thalidomide treatment may be helpful in evaluating its efficacy or prognosis.
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Objective To introduce a new method for correction of epicanthal folds, which could avoid obvious scar in medial canthus. Methods First, through upper and lower palpebral margin incisions, the connective and orbicularis oculi muscle dense fibers underlying epicanthal folds as well as the superficial head of medial canthal ligament were thoroughly released and excised. After repositioning the medial canthus, the redundant skin tissue was removed and then the incisions closed. Results 122 epicanthoplasties had been performed. Postsurgical scars were invisible in all cases. All patients were satisfied with operation results. No recurrence of epicanthal fold was observed. Conclusions The introduced method has advantages in avoiding scar formation and is an especially suitable approach for epicanthoplasty in Asian patients.
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Objective To evaluate the therapeutic effect of endoscopic cryotherapy for Barrett's esophagus (BE). Methods A total of 22 consecutive patients, who were diagnosed as BE from January 2008 to May 2009, underwent endoscopic cryotherapy by using pressurized gas of C02. The data including effective rate, therapy courses and procedure related complications were retrospectively analyzed.Results Except for 2 cases of withdrawal, the other 20 patients completed the treatment with a total therapy number of 42 times (mean 2. 1 times/patient) and were followed up for 6 months. Complete histologic reversal of BE mucus was achieved in all 20 patients after 1-3 times of cryotherapy, among whom complete endoscopic reversal was obtained in 9 and effective endoscopic reversal in 11. Histologic recurrence was observed in 3 cases during the follow-up, including 2 of occult intestinal metaplasia and 1 of mild intestinal metaplasia, which achieved a BE mucosal reversal rate of 85% (17/20). Procedure related complications included 1 case of esophageal ulcer and 3 cases of mild or severe esophagitis, which were all cured after acid suppression treatment. Conclusion Endoscopic cryotherapy in BE is effective and safe, with the advantages of easy manipulation, less complications and good compliances.