Serum gastrin levels in patients with inflammatory bowel disease

The aim of this study was to estimate the levels of serum gastrin in a group of patients with either ulcerative colitis or Crohn's disease and to compare the results with those of a group of normal controls. In 108 consecutive patients with IBD (66 with ulcerative colitis, 32 with Crohn's disease and 10 with indetermined colitis) serum levels of gastrin were measured by radioimmunoassay. One hundred and eight normal people were served as controls. The levels of serum gastrin were significantly elevated in patients with Crohn's disease compared to normal controls (74.4 +/- 43.9 pg/ml vs. 47.5 +/- 32.4 pg/ml, P<0.05), irrespectively of the activity of the disease. On the contrary, patients with ulcerative colitis exhibited no significant differences compared to normal controls. Differences between Crohn's disease and ulcerative colitis patients were statistically significant (P<0.001). The rate of infection by Helicobacter pylori in patients with inflammatory bowel disease was statistically significantly lower as compared with normal controls (31.7% vs. 55.1%, P<0.001). It is concluded that patients with active or inactive Crohn's disease have increased levels of serum gastrin. This may have implications concerning the high incidence of upper GI lesions found in patients with Crohn's disease despite the very low incidence of Helicobacter pylori infection.

EGFR alterations in pancreatic ductal adenocarcinoma: a chromogenic in situ hybridization analysis based on tissue microarrays

BACKGROUND/AIMS

To evaluate epidermal growth factor receptor (EGFR) gene status in pancreatic ductal adenocarcinoma correlating the results to protein expression and clinicopathological features

METHODOLOGY

Using tissue microarray technology (TMArrayer 100), fifty (n = 50) paraffin-embedded tissue samples of histologically-confirmed primary tumors were cored twice at a diameter of 1 mm and re-embedded into the final recipient block. Immunohistochemistry was performed by the use of anti-EGFR monoclonal antibody (31G7). Also, a chromogenic in situ hybridization protocol was applied based on the use of EGFR gene and chromosome 7 centromeric probes, respectively.

RESULTS

EGFR protein overexpression was observed in 29/50 (58%) cases and correlated to stage (p = 0.001) but not to grade (p = 0.206). EGFR gene analysis identified numerical alterations in 6/50 (12%), including 2 cases characterized by low-level gene amplification and 4 by absence of one allele. Gene status was associated to tumor grade (p = 0.023) and stage (p = 0.02). Chromosome 7 analysis detected aneuploidy in 14 (28%) cases.

CONCLUSIONS

A subset of pancreatic ductal adenocarcinomas (PDACs) is characterized by EGFR gene numerical alterations including sporadic cases of amplification or absence of one allele (maybe due to gene deletion or intragenic point mutation and allelic silence). Those alternative mechanisms maybe influence the efficacy of novel targeted therapeutic strategies based on monoclonal antibodies or intracellular tyrosine-kinase inhibitors in PDACs.

Use of Complementary and Alternative Medicine by Greek Patients with Inflammatory Bowel Disease

BACKGROUND AND OBJECTIVES

Complementary and alternative medicine (CAM) is regularly used by several patients with inflammatory bowel disease (IBD) in many countries. Data concerning the use of CAM in Greek patients with IBD are lacking. This study aimed to determine the prevalence and indicators of CAM use in Greek IBD patients.

PATIENTS AND METHODS

Adult patients with IBD attending our specialized IBD department in "Metropolitan General" Hospital, Holargos, Greece, completed a special questionnaire regarding the use of CAM. Several clinical and epidemiological characteristics were recorded. The results were compared with a disease-control group (patients with irritable bowel syndrome or gastroesophageal reflux disease). The study outcome was the prevalence of CAM use in both groups. In this study, 270 patients, of whom 128 were female, with IBD (Crohn's disease 134 and ulcerative colitis 136) and a median age of 42.3 ± 17.5 years (range 31-52), and 138 patients serving as the disease control group were analyzed.

RESULTS

The prevalence of previous and current CAM use in patients with IBD was 36.3% versus 27.5% in the control group (no significant differences). No significant differences were also noticed between the patients with either CD or UC. In the multivariable analysis, university education and treatment with steroids and TNF-α inhibitors were independent social indicators of CAM use.

CONCLUSIONS

The percentage of CAM use by the Greek patients with IBD was quite high, similar to other European countries. Although numerically higher, this percentage was not significantly different compared with the disease control group. The use of CAM in IBD patients in Greece is associated with a higher educational level, and treatment with steroids and TNF-α inhibitors.

Herbal and plant therapy in patients with inflammatory bowel disease

The use of herbal therapy in inflammatory bowel disease (IBD) is increasing worldwide. The aim of this study was to review the literature on the efficacy of herbal therapy in IBD patients. Studies on herbal therapy for IBD published in Medline and Embase were reviewed, and response to treatment and remission rates were recorded. Although the number of the relevant clinical studies is relatively small, it can be assumed that the efficacy of herbal therapies in IBD is promising. The most important clinical trials conducted so far refer to the use of mastic gum, tormentil extracts, wormwood herb, aloe vera, triticum aestivum, germinated barley foodstuff, and boswellia serrata. In ulcerative colitis, aloe vera gel, triticum aestivum, andrographis paniculata extract and topical Xilei-san were superior to placebo in inducing remission or clinical response, and curcumin was superior to placebo in maintaining remission; boswellia serrata gum resin and plantago ovata seeds were as effective as mesalazine, whereas oenothera biennis had similar relapse rates as ω-3 fatty acids in the treatment of ulcerative colitis. In Crohn's disease, mastic gum, Artemisia absinthium, and Tripterygium wilfordii were superior to placebo in inducing remission and preventing clinical postoperative recurrence, respectively. Herbal therapies exert their therapeutic benefit by different mechanisms including immune regulation, antioxidant activity, inhibition of leukotriene B4 and nuclear factor-kappa B, and antiplatelet activity. Large, double-blind clinical studies assessing the most commonly used natural substances should urgently be conducted.

Immunonutrition in Operated-on Gastric Cancer Patients: An Update

Enteral immune nutrition has attracted considerable attention over the past few years regarding its perioperative role in patients undergoing major surgery for digestive cancer. Today, the term enteral immune nutrition refers to the perioperative administration of nutritional preparations containing, among others, specific ingredients such as glutamine, omega-3 polyunsaturated fatty acids, and arginine. They provide nutritional support and exert pharmacological effects through the substances contained in these preparations. Their administration to patients with gastric cancer is necessary as malnutrition and other metabolic disorders are frequent symptoms with effects on the level of immune responses, affecting the function of intestinal permeability and, therefore, the effectiveness of chemotherapy. Existing clinical data and data from all meta-analyses published so far support the view that enteral immune nutrition enhances the immune responses of gastric cancer patients, and reduces the rate of postoperative complications, and the duration of hospitalization without, however, improving patient survival. The content of enteral immune nutrition, dose, administration interval, and the effect on patient survival should be more precisely determined through relevant extensive multicenter studies. This systematic review describes and analyses the clinical results and the findings of relevant meta-analyses of the application of enteral immune nutrition in gastric cancer patients, emphasize the importance of this therapeutic intervention for disease progression, and attempts to provide practical guidelines for applying enteral immune nutrition in daily clinical practice.

Pregnancy and inflammatory bowel disease: a prospective case-control study

OBJECTIVE

Taking into account the relative confusion in the literature concerning the influence of pregnancy on the underlying inflammatory bowel disease (IBD) and vice versa, as well as the influence of drugs on the foetus and the gestation itself, we performed this prospective study, in order to further elucidate this interesting topic.

PATIENTS AND METHODS

Prospective follow-up study of 9 pregnant women with previously established IBD, 4 with ulcerative colitis (UC) and 5 with Crohn's disease (CD). Results were compared to those of 9 non-pregnant women with IBD with similar clinico-demographic characteristics (disease control group), and 18 healthy pregnancy women (healthy control group).

RESULTS

(a) Patients with IBD and gestation vs. healthy control group: Significantly impaired body weight in newborns from IBD mothers compared to healthy women (2530 +/- 961 g vs. 3242 +/- 582 g, P = 0.035) was found. Significantly more cases of therapeutic or spontaneous abortion and premature delivery in pregnant women with IBD compared to healthy pregnant women [5/ 9(56.6%) vs 1/18 (5.6%), P = 0.008] were also noticed. Concerning drug consumption, it was noticed that azathioprine was taken regularly in one case of spontaneous abortion and in one case of premature delivery. No significant differences concerning other parameters such as smoking habit and death of foetus were observed. (b) Patients with IBD and gestation vs. patients with IBD without gestation: No significant differences in the history of various parameters of the disease (number of operations, presence of fistulas), previous gestations, and course of the disease during the period of gestation were found. (c) Course of the disease six months after delivery: No significant differences between patients with IBD and pregnancy and disease control group were noticed.

CONCLUSION

It is concluded that gestation in women with IBD is accompanied by some unwanted events such as premature delivery, therapeutic or spontaneous abortion, and reduced newborn body weight. Clinicians must bear in mind the possibility of the appearance of some unwanted events in pregnant women with IBD during their gestation.

Surgery for ulcerative colitis in Greece: clinicoepidemiological features and long-term outcome of 69 consecutive patients

BACKGROUND/AIMS

In this study, the various clinicoepidemiological characteristics and long-term follow-up of patients operated on for ulcerative colitis in Greece over a period of 15 years, are reviewed.

METHODOLOGY

A total number of 69 out of 413 patients with ulcerative colitis (17.8%) seen and followed-up for a mean period of 12 years, had undergone ileorectal anastomosis (45.6%), total proctocolectomy with permanent ileostomy (35.6%), ileal-anal pouch anastomosis (17.6%) and Kock ileostomy (1.5%), mainly for bad response to conservative treatment (78.3%). Other causes for operation were large bowel cancer (8.7%), profound hemorrhage (4.3%), toxic megacolon (1.4%), and rectovaginal fistula (1.4%). Almost half of the operations (45%) were performed between the first and fourth year after the establishment of diagnosis.

RESULTS

A number of statistically highly significant differences between the operated and non-operated group of patients were noticed. So, patients operated on had more extensive disease in comparison with non-operated ones and were younger at the time of diagnosis. The overall perioperative morbidity and mortality were 6% and 5% respectively. Survival was not statistically significantly different between operated and non-operated patients and also did not differ significantly between men and women. Most of the deaths in the operated and non-operated group of patients were unrelated to ulcerative colitis.

CONCLUSION

It is concluded that the clinicoepidemiological features and outcome of the Greek patients operated on for ulcerative colitis have similarities with those reported from other developed countries of the world.

Colorectal cancer and inflammatory bowel disease: epidemiology, risk factors, mechanisms of carcinogenesis and prevention strategies

Patients with long-standing ulcerative colitis and Crohn's disease have an increased risk of developing colorectal cancer and patients with small intestinal Crohn's disease are at increased risk of small bowel adenocarcinoma. Colorectal cancer appearing on the ground of inflammatory bowel disease is the result of a process which is believed to begin from no dysplasia progressing to indefinite dysplasia, low-grade dysplasia, high-grade dysplasia and finally to invasive adenocarcinoma, although colorectal cancer can arise without proceeding through each of these steps. Ulcerative colitis patients with total proctocolectomy and ileal pouch anal-anastomosis have a rather low risk of dysplasia in the ileal pouch, although the anal transition zone should be monitored periodically, especially if chronic pouchitis is present with associated severe villous atrophy. Concerning the risk factors predisposing to colorectal cancer in the setting of ulcerative colitis or Crohn's disease, it seems that the risk increases with longer duration and greater anatomic extent of colitis, the degree of inflammation, and the presence of primary sclerosing cholangitis and family history of colorectal cancer. Concerning the mechanisms of carcinogenesis, it is now well established that the molecular alterations responsible for sporadic colorectal cancer, namely chromosomal instability, microsatellite instability and hypermethylation, also play a role in colitis-associated colon carcinogenesis. Chemoprevention strategies include the administration of agents such as aminosalicylates, ursodeoxycholic acid, and possibly folic acid and statins, the exact role of which remains to be further elucitated.

Immunotherapy of gastric cancer: Present status and future perspectives

In this editorial, we comment on the article entitled "Advances and key focus areas in gastric cancer immunotherapy: A comprehensive scientometric and clinical trial review (1999-2023)," which was published in the recent issue of the World Journal of Gastroenterology. We focused on the results of the authors' bibliometric analysis concerning gastric cancer immunotherapy, which they analyzed in depth by compiling the relevant publications of the last 20 years. Before that, we briefly describe the most recent data concerning the epidemiological parameters of gastric cancer (GC) in different countries, attempting to give an interpretation based on the etiological factors involved in the etiopathogenesis of the neoplasm. We then briefly discuss the conservative treatment (chemotherapy) of the various forms of this malignant neoplasm. We describe the treatment of resectable tumors, locally advanced neoplasms, and unresectable (advanced) cases. Special attention is given to modern therapeutic approaches with emphasis on immunotherapy, which seems to be the future of GC treatment, especially in combination with chemotherapy. There is also a thorough analysis of the results of the study under review in terms of the number of scientific publications, the countries in which the studies were conducted, the authors, and the scientific centers of origin, as well as the clinical studies in progress. Finally, an attempt is made to draw some con-clusions and to point out possible future directions.

Endocrine function in abetalipoproteinemia: a study of a female patient of Greek origin

AIM

To investigate the pituary, genitalia, adrenal, thyroid, parathyroid and pancreatic endocrine function of a female patient aged 37 with abetalipoproteinemia at the time of diagnosis and 5 years thereafter (after application of a modified diet). SUBJECT-METHODS: Serum concentrations of cortisol, A4, ACTH, aldosteron, renin, dehydroepiandrosterone sulfate (DHEA-5), progesterone, 17-OH progesterone, testosterone, SH13G, estradiol, luteinizing hormone, follicle stimulating hormone, T3, T4, TSH, FT3, FT4, parathormone, osteocalcin, prolactin, proinsuline, insulin, glucagon, somatomedin-C (Insulin-like Growth Factor-1, IGF-1), IG171-13P3, 25 (OH) Vitamin D3 and 1-25 (OH) 2 Vitamin D3, were measured by radioimmunoassay. Synactlien test, and 24-hour urine cortisol, were also estimated. Serum leptin estimation was carried-out using a sensitive enzymatic technique. Ionized part of serum calcium was measured by the use of a special machine (CORNING), while bone alkaline phosphatase was measured by radioimmunoassay.

RESULTS

Serum progesterone and 17-OH-progesterone were reduced in both examinations. Estimation of serum progesterone performed on the 21th day of the menstrual cycle revealed again values below the lowest normal limit. Serum prolactin was increased both in rest and during movement. The levels of both, somatomedin-C (IGF-1) and leptin were below the lowest normal limit. Despite normal serum parathormone, serum-ionized calcium and 25-OH vitamin D were low, while serum bone alkaline phosphatase was increased. Serum proinsulin was increased, and serum insulin was low. Serum thyroid hormone, glucagon, parathormone, FSH, LH, ACTH, testosterone, estradiol and SH13G were normal. The hormonal profile of the patient estimated 5 years later did not differ substantially suggesting that the metabolic improvement due to the adoption of the modified diet had not any significant impact on it.

CONCLUSION

Female patients with abetalipoproteinernia have reduced production of progesterone by the corpus luteum and slightly abnormal bone metabolism. The reduced production of progesterone is probably due to the low levels of serum LDL and cholesterol, while reduced serum levels of Leptin and IG17-1 are probably due to the impairment nutritional status. The adoption of a modified diet does not alter the hormonal profile significantly.

Prognostic factors affecting the survival of operated patients with colorectal cancer: significance of delayed hypersensitivity skin reactions and nutritional status

We examined whether an immune status measured with a series of delayed hypersensitivity skin reactions was associated with the survival of colorectal cancer patients. Clinical, laboratory and pathological data and various anthropometric parameters were prospectively measured in a series of 100 Greek patients diagnosed with colorectal cancer between 1987-1989 and followed up to mortality until 31 December 1992. The Kaplan-Meier method and Cox's Proportional Hazards Regression Model were used for the survival analysis. Age and stage of the disease were the most powerful predictors of survival. Other factors associated with survival of patients were various indices of nutritional status, tumour marker CEA, erythrocyte sedimentation rate and haematocrit. Immune status was statistically significantly related to survival, with anergic patients having a threefold risk of mortality compared to immunocompetent patients. Mortality risk decreased with the increasing number of positive hypersensitivity reactions (relative risk = 0.72; 95% confidence intervals 0.52-1.00), after adjustment for age, sex, stage and body mass index. Similar but attenuated results were obtained when analyses were limited to patients without a disseminated disease. These findings indicate that immune status is significantly associated with the stage of the disease; patients with advanced stages have a lower immune response. The immune response may be an important factor for the survival of cancer patients irrespective of the stage of the disease.

Diagnostic evaluation of patients with early gastric cancer--a literature review

Despite the reduction in the incidence and mortality of gastric cancer in recent years, it remains one of the most common and lethal malignant neoplasms worldwide. The diagnosis of gastric cancer at an early stage (early gastric cancer) represents the only hope for improving survival of these patients. Upper GI endoscopy (including chromoendoscopy and magnifying endoscopy) remains the corner-stone for diagnosis, although other modalities such as endoscopic ultrasonography, conventional radiographs, computed tomography, magnetic resonance imaging and virtual endoscopy, are helpful. Histology always seals the correct diagnosis, and makes the final staging. The experience of the endoscopist is a critical point related to correct diagnosis. Better awareness by endoscopists of the various appearances of early gastric cancer, is mandatory. In this review, we discuss the epidemiology, biological characteristics and diagnosis of early gastric cancer based on data derived from the currently available literature.