Scandinavian journal of gastroenterology. Supplement最新文献_第7页

Whom and how to treat: weighing the costs and effects. 谁和如何治疗:权衡成本和效果。

Scandinavian journal of gastroenterology. Supplement Pub Date : 2003-01-01 DOI: 10.1080/00855920310002627

B A van Hout

引用次数: 7

Safety of thiopurines in the treatment of inflammatory bowel disease. 硫嘌呤治疗炎症性肠病的安全性。

Scandinavian journal of gastroenterology. Supplement Pub Date : 2003-01-01 DOI: 10.1080/00855920310002726

D J de Jong, L J J Derijks, A H J Naber, P M Hooymans, C J J Mulder

{"title":"Safety of thiopurines in the treatment of inflammatory bowel disease.","authors":"D J de Jong, L J J Derijks, A H J Naber, P M Hooymans, C J J Mulder","doi":"10.1080/00855920310002726","DOIUrl":"https://doi.org/10.1080/00855920310002726","url":null,"abstract":"Background: Thiopurines have proven efficacy in inflammatory bowel disease. However, concerns regarding toxicity have limited the use of these agents as first line of medical therapy.Methods: Review of the literature regarding metabolism, efficacy and side effects.Results: In clinical trials, up to 15% of patients discontinued 6-mercaptopurine or its pro-drug azathioprine prematurely due to adverse events. These events may be divided into dose-independent idiosyncratic reactions and dose-related, pharmacologically explainable toxicity. Dose-independent reactions include skin rash, fever, diarrhoea and pancreatitis. Most frequently observed dose-dependent adverse events are nausea, malaise and myelotoxicity. Furthermore, dose-dependent and dose-independent hepatotoxicity may occur. Recent insights obtained by therapeutic drug monitoring in patients on azathioprine or 6-mercaptopurine have led to strategies to reduce toxicity. One strategy is to detect poor metabolisers of thiopurines by establishing the activity of the key enzyme thiopurine methyltransferase. However, the clinical relevance of this strategy is still a point of debate. Another strategy is to administer 6-thioguanine, which is an agent close to the effective 6-thioguanine nucleotides.Conclusion: Therapeutic drug monitoring of thiopurines resulted in strategies to reduce toxicity. The value of these strategies has yet to be proven in prospective randomized trials.","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 239","pages":"69-72"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24182705","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}

引用次数: 58

Role of cyclooxygenase-2 in the development and treatment of oesophageal adenocarcinoma. 环氧化酶-2在食管腺癌发生和治疗中的作用。

Scandinavian journal of gastroenterology. Supplement Pub Date : 2003-01-01 DOI: 10.1080/00855920310002753

C J Buskens, A Ristimäki, G J A Offerhaus, D J Richel, J J B van Lanschot

{"title":"Role of cyclooxygenase-2 in the development and treatment of oesophageal adenocarcinoma.","authors":"C J Buskens, A Ristimäki, G J A Offerhaus, D J Richel, J J B van Lanschot","doi":"10.1080/00855920310002753","DOIUrl":"https://doi.org/10.1080/00855920310002753","url":null,"abstract":"Background: Various studies suggest that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are promising anticancer agents. Epidemiological studies have found that long-term use of NSAIDs is associated with a reduced incidence of colorectal, gastric and oesophageal cancers, while experimental and clinical studies have demonstrated that treatment with NSAIDs causes a statistically significant reduction in both the number and the size of polyps in familial adenomatous polyposis (FAP) patients.Methods: In this review, the mechanisms by which NSAIDs exert their chemopreventive and antineoplastic effects are described.Results: Although the precise anticancer actions of NSAIDs are not fully explained, they probably involve inhibition of cyclooxygenase (COX), which is the rate-limiting enzyme in the conversion of arachidonic acid to prostaglandins. Two isoforms of this enzyme (COX-1 and COX-2) have been identified. COX-1 is constitutively expressed and considered to be a housekeeping gene, while COX-2 is not usually detectable in normal tissues, but can be readily induced in processes like inflammation, reproduction and carcinogenesis. The mechanisms by which COX-2 is thought to be involved in the carcinogenesis include resisting apoptosis, increasing cell proliferation, stimulating angiogenesis and modulating the invasive properties of cancer cells.Conclusion: This report reviews the mechanisms by which COX-2 can contribute to carcinogenesis, its role in prognosis, and the possible place of selective COX-2 inhibitors in the prevention and treatment of gastrointestinal malignancies, focusing particularly on oesophageal cancer.","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 239","pages":"87-93"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24182708","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}

引用次数: 38

Screening for colorectal cancer: medical and economic aspects. 结直肠癌筛查:医学和经济方面。

Scandinavian journal of gastroenterology. Supplement Pub Date : 2003-01-01 DOI: 10.1080/00855920310002735

S Sanduleanu, R W Stockbrügger

{"title":"Screening for colorectal cancer: medical and economic aspects.","authors":"S Sanduleanu, R W Stockbrügger","doi":"10.1080/00855920310002735","DOIUrl":"https://doi.org/10.1080/00855920310002735","url":null,"abstract":"Background: Colorectal cancer (CRC) is the second commonest cause of cancer death in the Western world. In The Netherlands, CRC causes about 4400 deaths per year, and its diagnosis and treatment make up for a large share of health-care costs.Methods: Review and discussioN.Results: Experts in the field presently assume that screening for CRC and its precursor lesions, colorectal adenomas (CRAs), could prevent death from colorectal neoplasia by more than 80%. Additionally, there is increasing acknowledgement that CRC screening programmes can save lives at a cost similar to, or even less than, the generally accepted breast cancer or cervical cancer screening programmes. Nonetheless, while neighbouring countries have taken vigorous measures to fight CRC, the Dutch are still hesitating in this matter. This is partly due to some yet unanswered questions concerning the acceptability of screening for CRC in the general population, the starting age and the frequency of screening, the type of screening tests to be used, and the programme organization. In this commentary, general epidemiological and pathogenetic aspects of CRC are addressed. In addition, some frequently asked questions (FAQ) and (very subjective) answers about screening for CRC are offered, as potential substrate for further in-depth discussions.Conclusion: The emerging message for the community is that an effective national screening programme is urgently required to reduce the substantial morbidity and mortality from this disease.","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 239","pages":"73-7"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24182706","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}

引用次数: 4

Modern therapy for inflammatory bowel disease. 炎症性肠病的现代疗法。

Scandinavian journal of gastroenterology. Supplement Pub Date : 2003-01-01 DOI: 10.1080/00855910310001467

P Rutgeerts

引用次数: 10

Transanal endoscopic microsurgery. 经肛门内镜显微手术。

Scandinavian journal of gastroenterology. Supplement Pub Date : 2003-01-01 DOI: 10.1080/00855920310002672

E J R de Graaf

{"title":"Transanal endoscopic microsurgery.","authors":"E J R de Graaf","doi":"10.1080/00855920310002672","DOIUrl":"https://doi.org/10.1080/00855920310002672","url":null,"abstract":"BACKGROUND Transanal endoscopic microsurgery (TEM) is a newly developed, minimally invasive technique for the local resection of rectal tumours. Its place needs to be defined. METHODS Literature review. RESULTS Local excision of rectal tumours is associated with low mortality and morbidity. It is indicated in adenomas for curation and in rectal cancer for palliation. Transanal resection is used most frequently, but its use is limited. Other local techniques have no added value and are used sparingly. TEM is a newly developed, minimally invasive technique. Its technical characteristics allow an excellent view also in larger and more proximal tumours. Compared to other local techniques, mortality and morbidity are minimal and a laparotomy is more often preventable. Proper histological examination is possible and free margins are almost always observed. In adenomas it results in hardly any recurrences and in rectal cancer it can be adequately used for palliation. The results following local resection for rectal cancer with curative intent are promising, but they are only described anecdotally. CONCLUSIONS TEM is an elegant technique with excellent results. It imposes itself as a method of choice for the local resection of rectal adenomas and of rectal cancer for palliation. If curation is intended in rectal carcinomas, TEM should be exercised with caution. Proper judgement over existing local techniques and TEM is being impeded by a lack of scientific argumentation.","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 239","pages":"34-9"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24181048","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}

引用次数: 21

Transjugular intrahepatic portosystemic shunt (TIPS): indications and long-term patency. 经颈静脉肝内门静脉系统分流术(TIPS):适应症和长期通畅。

Scandinavian journal of gastroenterology. Supplement Pub Date : 2003-01-01 DOI: 10.1080/00855920310002771

H R van Buuren, P C J ter Borg

{"title":"Transjugular intrahepatic portosystemic shunt (TIPS): indications and long-term patency.","authors":"H R van Buuren, P C J ter Borg","doi":"10.1080/00855920310002771","DOIUrl":"https://doi.org/10.1080/00855920310002771","url":null,"abstract":"Background: Since the introduction of TIPS (the transjugular intrahepatic portosystemic shunt) into clinical practice in 1989, substantial knowledge, partially derived from controlled trials, has become available regarding technical and clinical aspects of the procedure. A number of prospective studies have assessed the long-term patency of radiological shunts, the recognized main technical weakness of the procedure.Methods: Review of published data regarding the optimal indications and long-term patency of TIPS.Results: Information on the long-term patency of TIPS is surprisingly scarce. Within 2 years of TIPS creation, re-interventions to re-establish or maintain the patency of the shunt are required in 70%-90% of patients, and in 20%-40% total occlusion develops. Limited available data suggest, however, that in about 80% of patients the shunt is patent after 3-5 years. There is consensus that TIPS is a main, second-line treatment option for variceal haemorrhage not responding to other therapies. Although widely used for treating refractory ascites, gastric variceal bleeding and Budd-Chiari syndrome, these indications require more study. A number of other potential indications remain poorly defined.Conclusion: TIPS is a major treatment modality to manage the complications of portal hypertension and Budd-Chiari syndrome. The available data indicate that TIPS is not only a short-term treatment option but may provide long-term portosystemic decompression. Technical improvements, e.g. the use of covered or drug-eluting stents, are essential to reduce the high rate of shunt dysfunction.","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 239","pages":"100-4"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24182710","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}

引用次数: 8

Probiotics: a perspective on problems and pitfalls. 益生菌:问题和陷阱的视角。

Scandinavian journal of gastroenterology. Supplement Pub Date : 2003-01-01 DOI: 10.1080/00855910310001476

F Shanahan

引用次数: 47

Haemostasis in inflammatory bowel diseases: clinical relevance. 炎症性肠病的止血:临床意义。

Scandinavian journal of gastroenterology. Supplement Pub Date : 2003-01-01 DOI: 10.1080/00855920310002708

A A van Bodegraven

{"title":"Haemostasis in inflammatory bowel diseases: clinical relevance.","authors":"A A van Bodegraven","doi":"10.1080/00855920310002708","DOIUrl":"https://doi.org/10.1080/00855920310002708","url":null,"abstract":"Background: In inflammatory bowel disease (IBD), many alterations of haemostasis have been reported. Furthermore. IBD is associated with thromboembolic disease.Methods: Literature on new insights into the physiology of haemostasis. the interaction between haemostasis and inflammation, plasmatic and mucosal changes in haemostasis in IBD, and haemostasis-interfering therapy in patients with IBD are reviewed.Results: Haemostasis is a vascular-bed-specific, locally regulated, physiological phenomenon aimed at the maintenance of fluidity of blood, and not a simple cascade-shaped chain of reactions. Coagulation activation is part of the inflammatory response, but coagulation activation induces pro-inflammatory effects at the same time. Coagulation and fibrinolysis are activated in the course of IBD. but sometimes in a misbalanced way. Overall, this may induce a state of plasmatic hypercoagulation, irrespective of disease activity. Thromboembolic disease is a common extra-intestinal manifestation of IBD. Established treatment of thromboembolism is similarly useful in IBD patients: concurrent aggressive treatment of exacerbations is recommended. Intractable gastrointestinal bleeding seldom occurs, and has mainly been reported in patients with untreated active IBD. Thrombophilic genetic background does not seem to be responsible for either the increased risk of thromboembolism, or the prevalence of IBD. Haemostasis-interfering therapy to alter the course of IBD is experimental.Conclusion: Thromboembolism is an extraintestinal manifestation of IBD, partly because of the associated state of plasmatic hypercoagulation. Thrombophilic genetic background does not contribute to prevalence or course of IBD: genetic investigations may be restricted to patients with clinically proven thrombophilia. Anticoagulant therapy can normally be given to patients. but not as an established therapy against IBD.","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 239","pages":"51-62"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24181051","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}

引用次数: 27

New developments in systemic chemotherapy in advanced colorectal cancer. 晚期结直肠癌全身化疗的新进展。

Scandinavian journal of gastroenterology. Supplement Pub Date : 2003-01-01 DOI: 10.1080/00855920310002744

A Cats

{"title":"New developments in systemic chemotherapy in advanced colorectal cancer.","authors":"A Cats","doi":"10.1080/00855920310002744","DOIUrl":"https://doi.org/10.1080/00855920310002744","url":null,"abstract":"Background: The majority of patients with newly diagnosed colorectal cancer who present with concurrent metastases are considered to be incurable from the disease. For their treatment, these patients depend on systemic anticancer therapy and supportive care.Methods: This article reviews recent developments in systemic treatment of disseminated colorectal cancer.Results: Until recently, the fluoropyrimidines were the only cytotoxic drugs available, but during recent years three other classes of active conventional cytotoxic drugs and a new class of target-directed drugs have become available. New cytotoxic drug therapies include raltitrexed, irinotecan and oxaliplatin. Patients receiving irinotecan experience a better quality of life than those treated with best supportive care alone. Irinotecan or oxaliplatin in combination with 5-fluoro-uracil (5-FU) and leucovorin are currently the most active treatment regimens. Oral prodrugs of 5-FU, such as capecitabine and uracil, have been developed in order to mimic the protracted infusion schedule of 5-FU, and these drugs may change the daily practice of palliative chemotherapy for colorectal cancer in the coming years. Therapeutic agents that target specific molecular processes that promote proliferation, vascularization and metastasis, and inhibit apoptosis, are being designed and may offer a rational approach to anticancer therapy. Examples of this novel approach are monoclonal antibodies and small molecules adhering to the epithelial growth factor receptor and vascular endothelial growth factor receptor in order to inhibit growth stimulation and angiogenesis.Conclusion: The current debate is no longer whether to use palliative chemotherapy in metastatic colorectal, but which patient will benefit from which combination and in what sequence.","PeriodicalId":21517,"journal":{"name":"Scandinavian journal of gastroenterology. Supplement","volume":" 239","pages":"78-86"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24182707","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}

引用次数: 11