Trends in incidence, management, and survival of gastric and cardia carcinomas in the area of Finistere (France) between 1984 and 2003.

OBJECTIVE: The aim of this study was to evaluate trends in incidence and prognosis of gastric and cardia carcinomas in the area of Finistère (France) between 1984 and 2003. METHODS: The Digestive Tumor Registry of Finistère recorded all new cases of gastric and cardia carcinomas from January 1, 1984 to December 31, 2003. Raw incidence data were standardized using the direct method based on the reference world population. The data and survival rates were studied in univariate and multivariate analyses. RESULTS: Between 1984-1988 and 1999-2003 the standardized incidence of distal gastric carcinomas decreased (10.74 ± 0.39-5.68 ± 0.27/year/100 000 inhabitants, P < 0.001). There was no significant increase in the incidence of cardia carcinomas (0.83 ± 0.11-1.25 ± 0.14/year/100 000 inhabitants). The frequency of macroscopically infiltrating tumors doubled (P < 0.001) and linitis plastica increased from 9 to 16.2% (P < 0.001). Overall survival rates increased only for patients with metastatic carcinomas of both locations (P < 0.001) and with advanced tumors of distal stomach (P < 0.001) receiving therapy. CONCLUSION: This study showed a significant decrease over time in the incidence of distal gastric carcinomas but no significant increase in the incidence of cardia carcinomas. Despite improvement in the management of patients, prognosis remains dismal, probably because of an increased incidence of poor prognosis of histological and anatomical types.

Diminution of Circulating CD4+CD25 high T cells in naïve Crohn's disease.

Crohn's disease is considered to be caused either by an excess of T-cell effector functions and/or by a defective regulatory T-cell compartment. The aim of this study was to assess in Crohn's disease the frequency of circulating CD4(+)CD25(high) T cells that possess regulatory T-cell functions and CD4(+)CD25(low) T cells that contain activated T cells. Flow cytometry of peripheral blood was used to assess CD4(+)CD25(high) and CD4(+)CD25(low) T-cell frequencies in a cohort of 66 patients with Crohn's disease in comparison to 19 patients with ulcerative colitis and 31 healthy individuals enrolled as controls. The CD4(+)CD25(high) T-cell frequency was significantly lowered in naïve Crohn's disease (P = 0.013) and in ulcerative colitis (P = 0.001). CD4(+)CD25(low) T-cell frequency was increased in Crohn's disease (P = 0.0001) and in ulcerative colitis (P = 0.0002). Both CD4(+)CD25(high) and CD4(+)CD25(low) T-cell frequencies are altered in naïve Crohn's disease resulting in an imbalance between both populations and a relative contraction of the CD4(+)CD25(high) T-cell population.

[Gastroesophageal reflux disease and malignancy]. / Reflux gastro-oesophagien et risque de cancérisation.

Severe gastroesophageal reflux disease (GERD) predisposes to the development of Barrett's esophagus defined by the replacement of the squamous epithelium of the distal esophagus by a columnar epithelium. Barrett's esophagus is a precancerous condition which has a risk of malignant transformation to adenocarcinoma. Barrett's adenocarcinoma remains a relatively rare condition. Its incidence among patients followed up for Barrett's esophagus is approximately 0.5% patients per year. Besides GERD, obesity, male gender and age are the main risk factors for the development of Barrett's mucosa and esophageal adenocarcinoma. Men above 50 presenting with ancient and frequent GERD symptoms could benefit from an upper-GI endoscopy to detect Barrett's esophagus. Though still controversial, surveillance of Barrett's mucosa could allow detection of high grade dysplasia and esophageal adenocarcinoma at an early stage, enabling a curative treatment. Patients who cannot undergo surgery may be treated using endoscopic techniques such as endoscopic mucosal resection.

Diagnostic value of C-reactive protein for predicting activity level of Crohn's disease.

BACKGROUND AND AIMS: Measuring Crohn's disease (CD) activity is useful in clinical trials as well as in clinical practice, but each available instrument to measure such activity has some limitations. C-reactive protein (CRP) is a sensitive marker for inflammation and tissue injury. The aims of the study were: to assess the diagnostic value of low level of CRP for predicting a low CD activity, and to calculate optimal CRP cutoff value for selecting patients with moderate or high CD activity. METHODS: One hundred fifty consecutive patients with active or nonactive CD were included in the study without any pre-selection criteria. CRP was measured, and CD activity was calculated by means of the van Hees index (VHI). RESULTS: The median VHI score was 154.4 (interquartile range, 126.0-193.4), and the median CRP was 19.1 mg/L (interquartile range, 6.1-50.1 mg/L; upper limit of normal [N], 4 mg/L). Forty-nine percent of our patients had CRP >20 mg/L. CRP was significantly correlated to VHI (P = .0001). The probability that VHI was <150 if CRP was below upper limit of normal was equal to 1 (confidence interval, 0.891-1.000). The diagnostic value for CRP predicting a VHI > or =150 was high; the area under the receiver operating characteristic curve was equal to 0.844 (confidence interval, 0.783-0.906; P = .0001) with an optimal cutoff value of 21.6 mg/L, about 5 x N. CONCLUSIONS: CRP appears useful to evaluate CD activity, especially to predict inactive or low activity CD.