ABSTRACT
China is a country with high incidence of gastrointestinal (GI) cancer. Gastric cancer, esophageal cancer and colon cancer seriously threaten the health of people, and leads to heavy medical burdens. This review discusses the current screening protocol of GI cancer and pancreatic cancer. It also interprets the relevant policies issued by the state in recent years, and evaluates the effects of new technologies such as serum pepsinogen combined with gastrin in detecting gastric cancer, fecal and blood gene detection for colon cancer, and "serum liquid biopsy" of pancreatic cancer for early cancer screening. We also point out the difficulties and challenges in cancer screening at early stage, and the significance of promoting early cancer screening to reduce the mortality of GI cancer in China.
ABSTRACT
Acute pancreatitis (AP) is the most common severe disease of digestive system, with high morbidity and mortality. In 2019, the latest version of guidelines for the management of acute pancreatitis (Shenyang, 2019) was launched. Starting from the etiology and classification of AP, the guidelines proposed 30 statements on the diagnosis and treatment of AP. The guideline fully reflected the level of evidence and consensus level of experts and provided suggestions for the clinical management of AP in the future. This review summarizes the key points of updating the guidelines, focusing on the classification principle of AP, the change of etiology, the unification of diagnostic name, the strategy of fluid resuscitation and antibiotic use to strenthen the understanding of the guidelines for better clinical practice.
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Small bowel endoscopy (enteroscopy) is an important technique for diagnosis and treatment of small intestinal diseases. This review summarizes the updated points of the 2018 edition of the Chinese Guideline for Clinical Application of Enteroscopy. It expounds the contents of the guideline from four aspects: indications and contraindications of enteroscopy, the role of enteroscopy in the diagnosis process of small intestinal diseases, the operation skills of enteroscopy, and the expansion of the therapy field of enteroscopy. The current guideline also included many native clinical evidences, which is of great significance in guiding the clinical practice of enteroscopy in China.
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Gastric cancer is the one of human tumor disease that is directly related to bacterial infection disease. Helicobacter pylori(Hp)is a cancer-causing pathogen, whose prevalence rate in the population is as high as 50%. The indications for Hp eradication have been developong; however, for infected people, especially for the asymptomatic infection group, it remains controversial whether to perform the eradication therapy. This review describes the cost-effectiveness of eradicating Hp and the prevention and treatment of gastric cancer,based on the current situation of health care in China and from the perspective of health economics, so as to provide some ideas for the prevention and treatment of gastric cancer with domestic Hp infected people.
ABSTRACT
Helicobacter pylori(Hp)is a persistent infection that affects more than 60% of the global population.It is associated with many gastrointestinal diseases and even can lead to cancer.H. pylori-infected individuals should be offered eradication therapy, which can also prevent the morbidity of gastrointestinal diseases effectively. Due to the extensive use of antibiotics and the increase of adverse reactions,the eradication rate shows a downward tendency. In recent years, researches have been done focusing on the treatments which can reduce the antibiotic resistance of Helicobacter pylori. This article aims to elaborate the current situation of antibiotic resistance and the eradication of Helicobacter pylori, and discuss the relationship between them.
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Since the National Institute of the United States proposed the first Helicobacter pylori(Hp)eradication indication, peptic ulcer,in 1994, the indications of Hp eradication has been modified and expanded continuously.In 2015, Kyoto global consensus report on Helicobacter pylori gastritis proposed that “H. pylori-infected individuals should be offered eradication therapy, unless there are competing considerations”, which means that Hp eradication indications are no longer needed. This article aims to elaborate the evolution process of Hp eradication indications in China based on the five Chinese consensus reports of Hp infection treatment, and provide an outlook of the indications in the future.
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Gastric cancer is a serious threat to human health. A large number of studies have found that Helicobacter pylori(Hp)infection is closely related to gastric cancer. Japan has reduced the incidence of gastric cancer by eradicating Hp, which is worth learning.This review shows the evidence that Hp infection increases the risk of gastric cancer, and draws on Japan's strategy of radically treating Hp to prevent gastric cancer. Based on China's national conditions, this review proposes the method to eradicate Hp and prevent gastric cancer in China.
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Gastric cancer has become the world's fourth most common malignant tumor, and the second leading cause of cancer death worldwide. Helicobacter pylori(H.pylori) infection is a major risk factor of occurrence and development of gastric cancer. In the multistage pathogenesis of gastric cancer, H.pylori infection induces chronic active gastritis slowly, which develops into gastric cancer in the end through precancerous stage of atrophic gastritis, intestinal metaplasia and hyperplasia. Related researches prove that eradication of H.pylori, particularly in the early stage, can effectively prevent the occurrence of gastric cancer. In some cases, the eradication of H.pylori can prevent the development of gastric precancerous lesions and reverse them. This paper will elaborate on the role of H.pylori eradication in the prevention of gastric cancer.
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Severe acute pancreatitis is a common critical emergency in the digestive system. It is difficult to treat in clinic and has high mortality. According to the new Atlanta classification standard proposed in 2012, the treatment of acute pancreatitis mainly focused on early indentification, maintenance of organ function, anti-inflammatory response, intestinal function maintenance and other measures, so as to improve the success rate of the treatment. As more patients with severe acute pancreatitis have successfully crossed the acute phase, the prevention and treatment of subsequent complications of acute pancreatitis have been increasingly valued. To focus on the “secondary attack” of acute pancreatitis, it is necessary to carry out clinical research on the subsequent complications such as the accumulation of peripancreatic fluid, infectious necrosis, and vascular complications, and to reduce the mortality. This is a change in the focus of acute pancreatitis treatment and a further extension of the concept of multidisciplinary collaboration in acute pancreatitis.
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<p><b>BACKGROUND</b>The role of gastro-protecting agents on symptomatic chronic gastritis is unclear. This multicenter, open, randomized trial was designed to compare the comprehensive effects of gefarnate with sucralfate on erosive gastritis with dyspeptic symptoms.</p><p><b>METHODS</b>Totally 253 dyspepsia patients confirmed with erosive gastritis were enrolled from six centers in China. They randomly received either daily 300 mg gefarnate or 3 g sucralfate for six weeks. The primary endpoint was the effective rate of both treatments on endoscopic erosion at week six.</p><p><b>RESULTS</b>Gefarnate showed an effective rate of 72% and 67% on endoscopic score and dyspeptic symptom release, which is statistically higher than sucralfate (40.1% and 39.3%, P < 0.001, intension-to-treat). For histological improvement, gefarnate showed both effective in decreasing mucosal chronic inflammation (57.7% vs. 24.8%, P < 0.001, intension-to-treat) and active inflammation (36.4% vs. 23.1%, P < 0.05, intension-to-treat) than the control. A significant increase of prostaglandins and decrease of myeloperoxidase in mucosa were observed in gefarnate group. Severity of erosion is non-relevant to symptoms but Helicobacter pylori (H. pylori) status does affect the outcome of therapy.</p><p><b>CONCLUSIONS</b>Gefarnate demonstrates an effective outcome on the mucosal inflammation in patients with chronic erosive gastritis. Endoscopic and inflammation score should be the major indexes used in gastritis-related trials.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Anti-Ulcer Agents , Therapeutic Uses , Dyspepsia , Drug Therapy , Gastritis , Drug Therapy , Gefarnate , Therapeutic Uses , Sucralfate , Therapeutic Uses , Treatment OutcomeABSTRACT
Objective To construct a nucleic acid vaccine expressing H.pylori HpaA and inter- leukin-2 gene and to identify the immunogenicity of the vaccine proteins in vitro and protection in vivo. Methods The H paA gene fragment was amplified by polymerase chain reaction(PCR) from the genomic DNA of the standard H.pylori strain 17874.Mouse interlukin(IL)-2 gene was amplified from pClneo- IL-2.The HpaA and IL-2 were cloned into pUCmT vector.After DNA sequences of the amplified HpaA gene and IL-2 were confirmed,both were cloned into the eukaryotic expression vector pIRES through a serial of enzyme digestion and ligation reactions.The recombinant plasmids were screened by PCR and restriction enzyme digestion.Then,recombinant pIRES-HpsA-IL-2 was transfected to COS-7 cells using Lipofectamine~(TM)2000.The immunogenicity of HpaA and IL-2 protein was detected by SDS- PAGE and Western blot.The recombinant plasmids were transformed to LB5000 and then to final host SL7207.The recombinant strains were passaged repeatedly.The mice were challenged with H.pylori after 4 weeks of inoculation of nucleic acid vaccine.H.pylori infection was detected by rapid urease test.Results The amplified HpaA gene fragment and IL-2 were confirmed by sequence analysis.The eukaryotic expression vector plRES and the pIRES-HpaA-IL-2 construction were confirmed by PCR and restriction digestion.The expressions of HpaA(30 000) and IL-2(14 000)protein by pIRES-HpaA-IL- 2 were detected by Western blot.The in vivo study showed that 75.0% and 58.4% of mice vaccinated by HpaA-IL-2 and HpaA,respectively,were protected anaigst H.pylory infection,which was signifi- cant different in comparison with PBS control (P