Scandinavian journal of gastroenterology. Supplement最新文献

{"title":"Helicobacter pylori and functional dyspepsia. What to do after the Maastricht II consensus meeting?","authors":"R J L F Loffeld,&nbsp;R W M van der Hulst","doi":"10.1080/003655202320621409","DOIUrl":"https://doi.org/10.1080/003655202320621409","url":null,"abstract":"<p><strong>Background: </strong>Despite many clinical studies, there is still much discussion on the relation between Helicobacter pylori and functional dyspepsia.</p><p><strong>Methods: </strong>Critical review of recommendations for H. pylori eradication in dyspepsia.</p><p><strong>Results: </strong>The debate can be separated into three major problems. First, how to identify the dyspeptic patient suffering from H. pylori infection. Second, is H. pylori infection causative for complaints in this patient? Third, what is the clinical course of functional dyspepsia after successful H. pylori eradication? In the recent Maastricht II consensus, it is strongly recommended that H. pylori-positive patients with functional dyspepsia should be treated with anti-H. pylori therapy. In this review, the pros and cons of H. pylori eradication in patients with functional dyspepsia are discussed. The reader can decide what is the best management of an individual patient.</p><p><strong>Conclusions: </strong>This review gives the relevant background information allowing clinicians to decide what the best management is in individual H. pylori-positive patients with dyspepsia.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 236","pages":"19-21"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/003655202320621409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22090476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric lymphoma: the revolution of the past decade.","authors":"H Boot,&nbsp;D de Jong","doi":"10.1080/003655202320621427","DOIUrl":"https://doi.org/10.1080/003655202320621427","url":null,"abstract":"<p><strong>Background: </strong>Gastric MALT type lymphomas are distinct lymphomas that may develop after chronic antigenic stimulation caused by infection with Helicobacter pylori. An early antigen-dependent phase precedes the development of an antigen-independent phase.</p><p><strong>Methods: </strong>Narrative review.</p><p><strong>Results: </strong>The causative relationship between a chronic H. pylori infection and gastric MALT lymphomas has been based on epidemiological, histological, experimental and therapeutic studies. H. pylori eradication leads to a histological remission in +/- 70% of patients in early stage low-grade MALT lymphoma. There is no basis for therapeutic consequences in the case of persistent monoclonality. Full thickness invasion of the gastric wall and lymph node involvement and/or high-grade lymphoma denote the transition to an antigen-independent phase and calls for conventional treatment modalities. Molecular findings show a specific translocation in low-grade MALT lymphomas: t(11,18) and nuclear expression of bcl-10 that are highly indicative of the transition of the antigen-dependent into the antigen-independent phase. Other chromosomal and molecular findings are probably also involved.</p><p><strong>Conclusion: </strong>The multistep pathogenesis of chronic H. pylori gastritis into low-grade gastric MALT lymphoma and tumour progression to a higher stage and grade are characterized by multiple molecular biological events. Antigen-dependency during the early phase of this malignancy is proven by the results of H. pylori eradication.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 236","pages":"27-36"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/003655202320621427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22090478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New strategies for the treatment of gallstone disease.","authors":"Y C A Keulemans,&nbsp;N G Venneman,&nbsp;D J Gouma,&nbsp;G P van Berge Henegouwen","doi":"10.1080/003655202320621526","DOIUrl":"https://doi.org/10.1080/003655202320621526","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic gallstones are generally accepted as being the indication for cholecystectomy. Generally, severe abdominal pain in epigastrium and in the right upper abdominal quadrant, and lasting for more than 15 min, is thought to be caused by gallstones. However, many patients with other abdominal complaints undergo cholecystectomy and are satisfied with the outcome of surgery. Possible ways to improve the results of cholecystectomy are discussed.</p><p><strong>Methods: </strong>Review of previous work by the authors.</p><p><strong>Results: </strong>The introduction of laparoscopic cholecystectomy has even led to an increase in cholecystectomies; in a higher complication rate; and in increased costs of the treatment of gallstone disease. Because of faster recovery, 70% of symptomatic gallstone patients are able and willing to undergo laparoscopic cholecystectomy in day care. Cholecystectomy after sphincterotomy and stone extraction in patients who have stones in the gallbladder was demonstrated to prevent gallstone-related symptoms in at least 40% of patients. If the gallbladder had to be removed later for symptomatic disease, however, this did not result in a higher rate of conversions and complications. Because of shortage in operation capacity in The Netherlands, there is a considerable delay between the diagnosis of symptomatic stones and cholecystectomy. Better selection of patients for cholecystectomy will not only improve the results of cholecystectomy, it will also reduce the number of cholecystectomies and patients on waiting lists. Delay of cholecystectomy is associated with more complications, longer operative times, higher conversion rates to open cholecystectomy and prolonged hospitalization. The efficacy of the bile salt ursodeoxycholic acid in preventing gallstone-related pain attacks and complications in patients with contraindications for operation or waiting to undergo cholecystectomy should be investigated further, since two retrospective studies have demonstrated favourable outcomes for this strategy.</p><p><strong>Conclusion: </strong>The results of cholecystectomy are likely to be improved by better selection of patients, prevention of delay of the procedure and possibly treatment with ursodeoxycholic acid.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 236","pages":"87-90"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/003655202320621526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22091019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coeliac disease: changing views on gluten-sensitive enteropathy.","authors":"P J Wahab,&nbsp;J W R Meijer,&nbsp;M S Goerres,&nbsp;C J J Mulder","doi":"10.1080/003655202320621472","DOIUrl":"https://doi.org/10.1080/003655202320621472","url":null,"abstract":"<p><strong>Background: </strong>The continuing flow of scientific development in coeliac disease in the past decade points to the need for the formulation of a new concept of pathophysiology and clinical approach to the coeliac condition. Immunogenetic studies have shown a correlation of the disease to the HLA region on the short arm of chromosome 6; immunological research has led to the concept of a T-cell-driven immunologic response of the small intestine, with the identification of highly sensitive and specific antibodies; and our understanding of the histopathology of coeliac disease has changed dramatically, initiated by the proposition of a spectrum of gluten-sensitive enteropathy by Marsh in 1992. Clinical studies report a significant change in patient characteristics and epidemiology. The incidence of the disease has shifted to a majority of adult coeliacs, and it may present with less severe symptoms of malabsorption. Screening studies suggest an overall prevalence of up to 1 in 200-300.</p><p><strong>Methods: </strong>Update on histopathology concentrating on the work of our research group.</p><p><strong>Results: </strong>We specifically describe the work of our group in Arnhem concerning the identification and validation of the spectrum of intestinal histopathology in gluten-sensitive enteropathy, i.e. lymphocytic enteritis (Marsh I lesion), lymphocytic enteritis with crypt hyperplasia (Marsh II lesion), and villous atrophy, subdivided into partial villous atrophy (Marsh IIIA), subtotal villous atrophy (Marsh IIIB) and total villous atrophy (Marsh IIIC). Special attention is given to a subgroup of 'refractory coeliacs', including the identification of (pre-)malignant aberrant T cells in the intestinal mucosa of these patients.</p><p><strong>Conclusion: </strong>New data on immunogenetics, epidemiology, histopathology and patient characteristics point to a significant change of view on coeliac disease.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 236","pages":"60-5"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/003655202320621472","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22091014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The serological gastric biopsy: a non-endoscopical diagnostic approach in management of the dyspeptic patient: significance for primary care based on a survey of the literature.","authors":"A Korstanje,&nbsp;G den Hartog,&nbsp;I Biemond,&nbsp;C B H W Lamers","doi":"10.1080/003655202320621418","DOIUrl":"https://doi.org/10.1080/003655202320621418","url":null,"abstract":"<p><strong>Background: </strong>Measurement of the serum concentration of the secretory products of the gastric mucosa, pepsinogen A (PgA), pepsinogen C (PgC) and gastrin is called the serological gastric biopsy. Additional measurement of Helicobacter pylori antibodies and antibodies to parietal cells and intrinsic factor supports the non-invasive diagnostic value of the serum markers. In many clinical studies, the diagnostic potential of the serum markers in predicting the topography and severity of gastric mucosal disorders has been established. The aim was to assess the diagnostic value of the serological gastric biopsy for primary care.</p><p><strong>Method: </strong>Survey of the literature.</p><p><strong>Results: </strong>The cell-physiological background of the serological gastric biopsy, the interpretation of the outcome of serum markers and the relation of these parameters to various gastric mucosal disorders are described. Measurement of PgA is a reliable way to discriminate between mucosal gastritis and functional dyspepsia. PgA is raised in duodenal, gastric and pyloric ulcer even though gastrin is normal. Both PgA and gastrin are raised in renal insufficiency and the Zollinger-Ellison syndrome. A low PgA is indicative of mucosal atrophy and a good indicator for gastric hypoacidity. An additional low PgA:C ratio is indicative of atrophic gastritis or extensive intestinal metaplasia of the stomach. A hypopepsinogenaemia can also be an alarm symptom for gastric cancer. A low PgA and a high gastrin is indicative of corpus atrophy.</p><p><strong>Conclusion: </strong>In primary care, the serological gastric biopsy might be a feasible and appropriate diagnostic method for management of the dyspeptic patient. Further research in general practice has to be done to validate the predictive value of the serological gastric biopsy and to define a diagnostic strategy.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 236","pages":"22-6"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/003655202320621418","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22090477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bioinformatics and rational drug design: tools for discovery and better understanding of biological targets and mode of action of drugs.","authors":"U Thibaut","doi":"10.1080/003655202320621544","DOIUrl":"https://doi.org/10.1080/003655202320621544","url":null,"abstract":"<p><strong>Background: </strong>With the advent of modern high throughput technologies in both genomics and biological screening, and at the same time the enormous advances in computer technology, it is now feasible to use these tools in rational approaches in the search for new medicines. The role of bioinformatics in the search for new medicines is discussed.</p><p><strong>Methods: </strong>Discussion of the author's own work on bioinformatics in drug research in future perspective.</p><p><strong>Results: </strong>The emerging discipline of Bioinformatics plays a central role in the concert of technologies of the 'biological revolution' because it allows for handling of the enormous data load that comes with sequencing efforts and subsequent analyses of whole genomes, with mRNA profiling techniques and, last but not least, at a later stage of drug discovery the up-to-date application of rational drug design techniques to 3D structures of target proteins. This article covers and explains parts of the steps used in modern pharmaceutical research by means of a small number of examples.</p><p><strong>Conclusion: </strong>Bioinformatics is likely to play a pivotal role in the rational approaches for the search of new medicines.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 236","pages":"95-9"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/003655202320621544","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22090895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A liver tumour as an incidental finding: differential diagnosis and treatment.","authors":"S de Rave,&nbsp;S M Hussain","doi":"10.1080/003655202320621517","DOIUrl":"https://doi.org/10.1080/003655202320621517","url":null,"abstract":"<p><strong>Background: </strong>A liver tumour is occasionally found by coincidence during upper abdominal imaging. The diagnostic and therapeutic strategy for incidental liver tumours is discussed.</p><p><strong>Methods: </strong>Review of the literature.</p><p><strong>Results: </strong>When a liver tumour is found by coincidence, the questions to be answered are whether a definite diagnosis can be reached by imaging alone, and whether treatment is indicated. To answer the first question we have to know the characteristics of the various liver tumours with different imaging techniques, and the added value of more invasive diagnostic procedures. For an answer to the second question, information on the natural course of the specific tumour and on the risks and benefit of treatment is required. Of course, the a priori chance of certain diagnoses depends on the presence or absence of risk factors. Using simple imaging techniques, liver lesions can be categorized as single or multiple and as cystic or solid. Cystic lesions are usually benign, either congenital or parasitic. Solid lesions can be benign or malignant. The most common benign lesions are haemangioma, focal nodular hyperplasia and hepatocellular adenoma. Malignant tumours arising in the normal liver can be primary, in the form of hepatocellular carcinoma, or secondary, resulting from dissemination of a primary tumour outside the liver. All these tumour types can present with typical features in various imaging studies. A definite diagnosis based on imaging alone, however, is not always possible. On the other hand, even histological examination of biopsy samples sometimes does not differentiate between benign and malignant tumours. In the case of an asymptomatic liver tumour the main indication for treatment is proven or suspected malignancy. Large adenomas form a notable exception, these should be removed if they are over 5 cm in diameter or when they grow during follow-up, especially during pregnancy. Therapy will usually consist of liver resection, either partial or, when this is not possible, complete resection followed by liver transplantation. An important caveat is that a surgical procedure without morbidity and mortality does not exist. For symptomatic benign liver tumours the options are the same, but there may be equally effective and less risky alternatives in specific cases, such as embolization for focal nodular hyperplasia and irradiation for haemangioma.</p><p><strong>Conclusion: </strong>The diagnostic and therapeutic approach to incidental liver tumours depends on several factors, including size, aspect and number of the tumours, the clinical background, the a priori chance of a certain type of tumour and especially the risk of malignancy.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 236","pages":"81-6"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/003655202320621517","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22091018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disease management in ulcer disease.","authors":"W A de Boer,&nbsp;E A Joosen","doi":"10.1080/003655299750025507","DOIUrl":"https://doi.org/10.1080/003655299750025507","url":null,"abstract":"<p><strong>Background: </strong>Our knowledge of Helicobacter pylori infection indicates that it is possible to eliminate ulcer disease and improve quality of life for ulcer patients. Treatment is evidence-based and cost-effective. However, though we now have the tools, we have not yet been able to eliminate ulcer disease from society. Dissemination of knowledge and treatment implementation have been problematic. In primary care, there is diagnostic and therapeutic chaos regarding this infection. Disagreement exists on indications for treatment. Expenditure on acid-reducing drugs has greatly increased. Clearly we are not treating all ulcer patients properly (undertreatment); instead we have incorporated H. pylori therapy ('test and treat') into our approach to dyspepsia (overtreatment). Anti-H. pylori therapy in patients with non-ulcer dyspepsia may increase costs because most patients still suffer from symptoms after antibiotic therapy, and therefore require further diagnostic procedures and prescription of new drugs. In order to redeem the great promise of H. pylori, we must focus less on new ulcer patients, because the incidence is rapidly decreasing in Western Europe. Prevalence of ulcer disease, however, is still high. Thus we need to focus more on prevalent cases. We ought to seek and treat those persons already known to have ulcer disease. Systematic 'case-finding' strategies must be performed using standard protocols. Only such 'disease management' programmes performed at the primary care level will suffice to eliminate ulcer disease while also being cost-effective.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":"230 ","pages":"23-8"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/003655299750025507","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21363342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of iatrogenic bile duct injury.","authors":"L T De Wit,&nbsp;E A Rauws,&nbsp;D J Gouma","doi":"10.1080/003655299750025606","DOIUrl":"https://doi.org/10.1080/003655299750025606","url":null,"abstract":"<p><p>At the Academic Medical Center, 133 patients with a bile duct injury after laparoscopic cholecystectomy were treated between 1991 and April 1998. The management of these patients is discussed in a hepato-pancreato-biliary team consisting of radiologist, gastroenterologists and surgeons. In this paper, a summary of the previously reported AMC experience is presented in combination with a reflection of the findings in the literature concerning incidence, aetiology, symptoms, classification, diagnosis and treatment of iatrogenic bile duct injury after laparoscopic cholecystectomy.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":"230 ","pages":"89-94"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/003655299750025606","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21362520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coffee and gastrointestinal function: facts and fiction. A review.","authors":"P J Boekema,&nbsp;M Samsom,&nbsp;G P van Berge Henegouwen,&nbsp;A J Smout","doi":"10.1080/003655299750025525","DOIUrl":"https://doi.org/10.1080/003655299750025525","url":null,"abstract":"<p><strong>Background: </strong>Effects of coffee on the gastrointestinal system have been suggested by patients and the lay press, while doctors tend to discourage its consumption in some diseases.</p><p><strong>Methods: </strong>The literature on the effects of coffee and caffeine on the gastrointestinal system is reviewed with emphasis on gastrointestinal function.</p><p><strong>Results: </strong>Although often mentioned as a cause of dyspeptic symptoms, no association between coffee and dyspepsia is found. Heartburn is the most frequently reported symptom after coffee drinking. It is demonstrated that coffee promotes gastro-oesophageal reflux. Coffee stimulates gastrin release and gastric acid secretion, but studies on the effect on lower oesophageal sphincter pressure yield conflicting results. Coffee also prolongs the adaptive relaxation of the proximal stomach, suggesting that it might slow gastric emptying. However, other studies indicate that coffee does not affect gastric emptying or small bowel transit. Coffee induces cholecystokinin release and gallbladder contraction, which may explain why patients with symptomatic gallstones often avoid drinking coffee. Coffee increases rectosigmoid motor activity within 4 min after ingestion in some people. Its effects on the colon are found to be comparable to those of a 1000 kCal meal. Since coffee contains no calories, and its effects on the gastrointestinal tract cannot be ascribed to its volume load, acidity or osmolality, it must have pharmacological effects. Caffeine cannot solely account for these gastrointestinal effects.</p><p><strong>Conclusions: </strong>Coffee promotes gastro-oesophageal reflux, but is not associated with dyspepsia. Coffee stimulates gallbladder contraction and colonic motor activity.</p>","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":"230 ","pages":"35-9"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/003655299750025525","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21362612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}