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Stolze T, Franke S, Haybaeck J, Moehler M, Grimminger PP, Lang H, Roth W, Gockel I, Kreuser N, Bläker H, Wittekind C, Lordick F, Vieth M, Veits L, Waidmann O, Lingohr P, Peitz U, Schildberg C, Kruschewski M, Vassos N, Goni E, Bruns CJ, Ridwelski K, Wolff S, Lippert H, Schumacher J, Malfertheiner P, Venerito M. Mismatch repair deficiency, chemotherapy and survival for resectable gastric cancer: an observational study from the German staR cohort and a meta-analysis. J Cancer Res Clin Oncol 2023; 149:1007-1017. [PMID: 35211781 PMCID: PMC9984318 DOI: 10.1007/s00432-022-03953-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/08/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE In a post hoc analysis of the MAGIC trial, patients with curatively resected gastric cancer (GC) and mismatch repair (MMR) deficiency (MMRd) had better median overall survival (OS) when treated with surgery alone but worse median OS when treated with additional chemotherapy. Further data are required to corroborate these findings. METHODS Between April 2013 and December 2018, 458 patients with curatively resected GC, including cancers of the esophagogastric junction Siewert type II and III, were identified in the German centers of the staR consortium. Tumor sections were assessed for expression of MLH1, MSH2, MSH6 and PMS2 by immunohistochemistry. The association between MMR status and survival was assessed. Similar studies published up to January 2021 were then identified in a MEDLINE search for a meta-analysis. RESULTS MMR-status and survival data were available for 223 patients (median age 66 years, 62.8% male), 23 patients were MMRd (10.3%). After matching for baseline clinical characteristics, median OS was not reached in any subgroup. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd and MMRp had a HR of 0.67 (95% CI 0.13-3.37, P = 0.63) and 1.44 (95% CI 0.66-3.13, P = 0.36), respectively. The meta-analysis included pooled data from 385 patients. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd had an improved OS with a HR of 0.36 (95% CI 0.14-0.91, P = 0.03), whereas those with MMRp had a HR of 1.18 (95% CI 0.89-1.58, P = 0.26). CONCLUSION Our data support a positive prognostic effect for MMRd in GC patients treated with surgery only and a differentially negative prognostic effect in patients treated with perioperative chemotherapy. MMR status determined by preoperative biopsies may be used as a predictive biomarker to select patients for perioperative chemotherapy in curatively resectable GC.
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Affiliation(s)
- T Stolze
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital Magdeburg, Magdeburg, Germany
| | - S Franke
- Institute of Pathology, Otto-von-Guericke University Hospital Magdeburg, Magdeburg, Germany
| | - J Haybaeck
- Institute of Pathology, Otto-von-Guericke University Hospital Magdeburg, Magdeburg, Germany.,Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria.,Diagnostic and Research Center for Molecular BioMedicine, Institute of Pathology, Medical University Graz, Graz, Austria
| | - M Moehler
- Department of Internal Medicine I, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - P P Grimminger
- Department of General, Visceral and Transplant Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - H Lang
- Department of General, Visceral and Transplant Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - W Roth
- Institute of Pathology, University Hospital Mainz, Mainz, Germany
| | - I Gockel
- Department of Medicine II and University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - N Kreuser
- Department of Medicine II and University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - H Bläker
- Institute of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - C Wittekind
- Institute of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - F Lordick
- University Cancer Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - M Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - L Veits
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - O Waidmann
- Department of Internal Medicine 1, Main Area Gastroenterology and Hepatology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Cancer Center, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - P Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - U Peitz
- Department of Gastroenterology, Raphaelshospital, Münster, Germany
| | - C Schildberg
- Department of General and Visceral Surgery, Brandenburg, University Hospital of Visceral Surgery, Brandenburg, Germany
| | - M Kruschewski
- Department of General and Visceral Surgery, Hospital Frankfurt (Oder), Frankfurt (Oder), Germany
| | - N Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - E Goni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - C J Bruns
- Department of General, Tumor and Transplantation Surgery, University Hospital Cologne, Köln, Germany
| | - K Ridwelski
- Department of General and Visceral Surgery, Municipal Hospital, Magdeburg, Germany.,AN-Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - S Wolff
- Department of General, Visceral, Vascular and Transplantation Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - H Lippert
- AN-Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University Hospital, Magdeburg, Germany.,Department of General, Visceral, Vascular and Transplantation Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - J Schumacher
- Human Genetics Center, Philipps University of Marburg, Marburg, Germany
| | - P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital Magdeburg, Magdeburg, Germany.,Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - M Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital Magdeburg, Magdeburg, Germany. .,Department of Gastroenterology, Hepatology and Infectious Diseases, Medizinische Fakultät der Otto-Von-Guericke-Universität, Leipziger Straße 66, 39120, Magdeburg, Germany.
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Malfertheiner P, Mayerle J. [Gastrointestinal innovations]. MMW Fortschr Med 2018; 160:58-63. [PMID: 30421194 DOI: 10.1007/s15006-018-1124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke Universität, Magdeburg, Deutschland.
- Medizinische Klinik und Poliklinik II, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland.
| | - J Mayerle
- Medizinische Klinik und Poliklinik II, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland
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Haas M, Waldschmidt D, Stahl M, Reinacher-Schick A, Freiberg-Richter J, Kaiser F, Kanzler S, Frickhofen N, Seufferlein T, Dechow T, Mahlberg R, Malfertheiner P, Illerhaus G, Kubicka S, Held S, Westphalen C, Kruger S, Boeck S, Heinemann V. Gemcitabine plus afatinib versus gemcitabine alone in metastatic pancreatic cancer: An explorative randomized AIO phase II trial (ACCEPT). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ricke J, Sangro B, Amthauer H, Bargellini I, Bartenstein P, De Toni E, Gasbarrini A, Klumpen HJ, Peck M, Popovic P, Rosmorduc O, Schott E, Verslype C, Malfertheiner P. The impact of combining Selective Internal Radiation Therapy (SIRT) with sorafenib on overall survival in patients with advanced hepatocellular carcinoma: The SORAMIC trial palliative cohort. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Venerito M, Schneider C, Costanzo R, Breja R, Röhl FW, Malfertheiner P. Contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients on nonsteroidal anti-inflammatory drugs, antiplatelet agents, anticoagulants, corticosteroids and selective serotonin reuptake inhibitors. Aliment Pharmacol Ther 2018; 47:1464-1471. [PMID: 29655196 DOI: 10.1111/apt.14652] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/02/2018] [Accepted: 03/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs, low-dose aspirin, non-aspirin antiplatelet agents, anticoagulants, selective serotonin reuptake inhibitors and corticosteroids increase the risk of gastroduodenal bleeding. AIM To determine in a retrospective cohort study the contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients taking these drugs. METHODS Among patients with peptic ulcer disease diagnosed by endoscopy from 01/2004 to 12/2014 (N = 1719, 60% males, age 65.8 ± 14.5), 56.9% had peptic ulcer bleeding (cases) and 43.1% uncomplicated peptic ulcer disease (controls). Demographics, intake of nonsteroidal anti-inflammatory drugs, aspirin, non-aspirin antiplatelet agents, anticoagulants, selective serotonin reuptake inhibitors, proton pump inhibitors and corticosteroids were documented. H. pylori status was determined by histology, rapid urease test or serology. Adjusted odds ratios (OR) were estimated by logistic regression analysis. RESULTS Helicobacter pylori infection increased the risk of peptic ulcer bleeding in nonsteroidal anti-inflammatory drug and aspirin users (OR = 2.91, 95% CI = 1.71-4.98 and OR = 2.23, 95% CI = 1.52-3.28, respectively), but not in patients on anticoagulants, selective serotonin reuptake inhibitor or corticosteroid therapy. H. pylori-positive status substantially increased the risk of peptic ulcer bleeding in patients on non-aspirin antiplatelet agents (OR = 4.37, 95% CI = 1.28-14.99), concomitant aspirin/nonsteroidal anti-inflammatory drug intake (OR = 5.85, 95% CI = 1.68-20.36) and combined antiplatelet therapy (OR = 8.43, 95% CI = 1.09-65.17). After further adjustment for proton pump inhibitor intake, H. pylori infection was still a risk factor for peptic ulcer bleeding in nonsteroidal anti-inflammatory drug and aspirin users. CONCLUSIONS Helicobacter pylori infection increases the risk of peptic ulcer bleeding in peptic ulcer disease patients on nonsteroidal anti-inflammatory drugs, aspirin and non-aspirin antiplatelet agents. H. pylori-positive patients on combined antiplatelet therapy carry the highest risk for peptic ulcer bleeding.
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Affiliation(s)
- M Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - C Schneider
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - R Costanzo
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - R Breja
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - F-W Röhl
- Institute for Biometrics and Medical Informatics, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
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7
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Rouzade-Dominguez ML, Pezous N, David OJ, Tutuian R, Bruley des Varannes S, Tack J, Malfertheiner P, Allescher HD, Ufer M, Rühl A. The selective metabotropic glutamate receptor 5 antagonist mavoglurant (AFQ056) reduces the incidence of reflux episodes in dogs and patients with moderate to severe gastroesophageal reflux disease. Neurogastroenterol Motil 2017; 29. [PMID: 28337838 DOI: 10.1111/nmo.13058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 02/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transient lower esophageal sphincter relaxations (TLESRs) induced by gastric distension are modulated by the metabotropic glutamate receptor 5 (mGluR5) that influences the vagal reflex loop. We therefore aimed to examine the effects of the selective mGluR5 antagonist mavoglurant (AFQ056) on the number of TLESRs in dogs and reflux episodes in patients with gastroesophageal reflux disease (GERD). METHODS In a dog model, the number of meal-induced TLESRs was determined after intravenous (0.03, 0.1, 0.3, and 1 mg kg-1 ) and oral (1, 3, and 10 mg kg-1 ) doses of mavoglurant with reference to vehicle. In a multicenter, randomized, double-blind, placebo-controlled, three-period crossover study, the incidence of meal-induced reflux episodes was assessed by esophageal impedance monitoring after single, oral doses of mavoglurant (50 and 400 mg) or baclofen (40 mg) in 30 patients with moderate to severe GERD. KEY RESULTS In dogs, mavoglurant reduced the number of TLESRs after intravenous and oral administration. In patients with GERD, the incidence of postprandial reflux episodes was significantly lower at a dose of 400 mg mavoglurant (-37.5% ; 90% confidence interval [CI]: -57.8, -17.2), whereas there was no significant difference at 50 mg of mavoglurant compared to placebo. A significantly lower incidence of reflux episodes was also noted with the active comparator baclofen (-50.3%; 90% CI: -66.2, -34.3), thereby validating this study. CONCLUSIONS AND INFERENCES These data suggest a potential clinical benefit of mGluR5 antagonists such as mavoglurant in patients with GERD, particularly in those with persisting symptoms despite treatment with proton pump inhibitors.
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Affiliation(s)
| | - N Pezous
- Novartis Institutes for Biomedical Research, Novartis Pharma AG, Basel, Switzerland
| | - O J David
- Novartis Institutes for Biomedical Research, Novartis Pharma AG, Basel, Switzerland
| | - R Tutuian
- Universitätsspital Zürich, Zürich, Switzerland
| | | | - J Tack
- University Hospitals Leuven, Leuven, Belgium
| | | | - H-D Allescher
- Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - M Ufer
- Novartis Institutes for Biomedical Research, Novartis Pharma AG, Basel, Switzerland
| | - A Rühl
- Novartis Institutes for Biomedical Research, Novartis Pharma AG, Basel, Switzerland
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8
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Rosania R, Varbanova M, Wex T, Langner C, Bornschein J, Giorgio F, Ierardi E, Malfertheiner P. Regulation of apoptosis is impaired in atrophic gastritis associated with gastric cancer. BMC Gastroenterol 2017; 17:84. [PMID: 28662697 PMCID: PMC5492920 DOI: 10.1186/s12876-017-0640-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/22/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Gastric premalignant conditions, atrophic gastritis (AG) and intestinal metaplasia (IM) are characterized by an increase of proliferation and a reduction of apoptosis in epithelial cells. The epithelial cell kinetics in AG and IM in gastric mucosa adjacent to gastric cancer is still unclear. The aim of this study was to evaluate the epithelial cell turnover and expression of proliferation and apoptosis-related genes in gastric cancer (GC) and adjacent mucosa with atrophic gastritis or intestinal metaplasia (AG/IM GC+), as well as in atrophic gastritis or intestinal metaplasia mucosa of patients without GC (AG/IM GC-) and in control biopsy samples of non-transformed gastric mucosa (Control). METHODS We selected 58 patients (M: F = 34:24; age range 20-84 years, median 61.06 years) with 4 well defined histological conditions: 20 controls with histological finding of non-transformed gastric mucosa, 20 patients with AG or IM (AG/IM GC-), and 18 patients with intestinal type gastric adenocarcinoma (GC) and AG or IM in the adjacent mucosa (3 cm from the macroscopic tumour margin, AG/IM GC+). We performed an immunohistochemical staining of Ki67 and TUNEL and quantitative RT-PCR to determine the expression of PCNA and Bax/Bcl-2. RESULTS The immunohistochemical expression of Ki67 and TUNEL in AG/IM GC- was significantly increased compared to not transformed gastric mucosa (p < 0.0001) but not compared to AG/IM in gastric mucosa adjacent to GC. Levels of Bcl-2 were reduced in GC and AG/IM GC- compared to controls as well as in AG/IM GC- compared to AG/IM in mucosa adjacent to GC+ (p < 0.05). Proliferation and apoptosis markers did not correlate with H.pylori status in our study population. CONCLUSIONS In AG/IM associated with GC, no significant changes in the epithelial cell turnover were detected. Decreased Bcl-2 gene expression signified atrophic gastritis and IM in presence of cancer, as well as intestinal type gastric adenocarcinoma.
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Affiliation(s)
- R Rosania
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy.
| | - M Varbanova
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - T Wex
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - C Langner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - J Bornschein
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - F Giorgio
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - E Ierardi
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
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von Arnim U, Röhl FW, Miehlke S, Jechorek D, Reinhold D, Wex T, Malfertheiner P. Letter: multivariate clinical model for eosinophilic oesophagitis - is this generalisable to a general population? Authors' reply. Aliment Pharmacol Ther 2017; 45:861. [PMID: 28211624 DOI: 10.1111/apt.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- U von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto- von- Guericke University, Magdeburg, Germany
| | - F W Röhl
- Institute of Biometrics and Medical Informatics, Otto- von- Guericke University, Magdeburg, Germany
| | - S Miehlke
- Centre for Digestive Diseases, Hamburg-Eppendorf, Germany
| | - D Jechorek
- Institue of Pathology, Otto- von- Guericke University, Magdeburg, Germany
| | - D Reinhold
- Institute of Molecular and Clinical Immunology, Otto- von- Guericke University, Magdeburg, Germany
| | - T Wex
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto- von- Guericke University, Magdeburg, Germany
| | - P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto- von- Guericke University, Magdeburg, Germany
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10
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von Arnim U, Miehlke S, Madisch A, Vieth M, Straumann A, Malfertheiner P. [Eosinophilic Esophagitis - Update - Pathogenesis, Diagnosis and Therapy]. Laryngorhinootologie 2017; 96:11-21. [PMID: 28192821 DOI: 10.1055/s-0042-119417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Eosinophilic esophagitis (EoE) is a clinicopathological condition of the esophagus that has become increasingly recognised over the last decade. EoE represents a chronic immune-mediated inflammatory disease of the esophagus. In adults dysphagia is the predominant symptom. Upper gastrointestinal endoscopy is required in order to take biopsies from the esophagus. The diagnose is confirmed histologically by typical eosinophilic infiltration of the esophagus mucosa. Until now there is no approved therapy world-wide although we know that topic and systemic steroids are highly effective in EoE. Elimination diet is another option and in well selected patients endoscopic balloon dilation represents a therapeutic possibility.
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Affiliation(s)
- Ulrike von Arnim
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg AöR, Magdeburg
| | - S Miehlke
- Magen-Darm-Zentrum, Facharztzentrum Eppendorf, Hamburg
| | - A Madisch
- Medizinischen Klinik I, KRH Klinikum Siloah, Hannover
| | - M Vieth
- Institut für Pathologie, Klinikum Bayreuth GmbH, Bayreuth
| | | | - P Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg AöR, Magdeburg
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11
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von Arnim U, Röhl FW, Miehlke S, Jechorek D, Reinhold D, Wex T, Malfertheiner P. Clinical symptom tool that raises the index of suspicion for eosinophilic oesophagitis in adults and drives earlier biopsy for definitive diagnosis. Aliment Pharmacol Ther 2017; 45:417-426. [PMID: 27896821 DOI: 10.1111/apt.13869] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/16/2016] [Accepted: 10/29/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Eosinophilic oesophagitis (EoE) and gastro-oesophageal reflux disease (GERD) present with overlapping symptomatology and it is challenging to distinguish EoE from GERD clinically before endoscopy. AIM To investigate the prognostic value of a set of clinical symptoms and laboratory values in patients with EoE and GERD. METHODS In this prospective, single-centre, observational study, we compared clinical and laboratory data from 202 patients with EoE or GERD (10 relevant characteristics). Those characteristics showing potential significance in a univariate analysis were then included in a multivariate analysis. RESULTS The set of 10 characteristics (10-marker set) was able to distinguish between EoE and GERD with good reliability (correct assignment, i.e. agreement with subsequent EGD, of 94.4%). Reduction of the set to the six statistically and clinically most relevant markers continued to give good reliability (88.9%), and further stepwise reduction led to four-marker sets comprising history of atopy, history of food impaction, proton pump inhibitor refractory symptoms and either immunoglobulin E or peripheral eosinophilia, with correct assignment rates of 91.3% and 85.1% respectively. CONCLUSIONS We have developed a simple and easily applicable clinical/laboratory marker set that helps to distinguish EoE from GERD earlier in the treatment course, thus guiding the endoscopist to perform biopsies from the oesophagus to ensure the diagnosis. The application of the scoring system is expected to diagnose EoE earlier and avoiding delay of adequate treatment.
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Affiliation(s)
- U von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
| | - F-W Röhl
- Institute of Biometrics and Medical Informatics, Otto von Guericke University, Magdeburg, Germany
| | - S Miehlke
- Centre for Digestive Diseases, Hamburg- Eppendorf, Germany
| | - D Jechorek
- Institute of Pathology, Otto von Guericke University, Magdeburg, Germany
| | - D Reinhold
- Institute of Molecular and Clinical Immunology, Otto von Guericke University, Magdeburg, Germany
| | - T Wex
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
| | - P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
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Malfertheiner P, Megraud F, O'Morain CA, Gisbert JP, Kuipers EJ, Axon AT, Bazzoli F, Gasbarrini A, Atherton J, Graham DY, Hunt R, Moayyedi P, Rokkas T, Rugge M, Selgrad M, Suerbaum S, Sugano K, El-Omar EM. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017; 66:6-30. [PMID: 27707777 DOI: 10.1136/gutjnl-2016-312288] [Citation(s) in RCA: 1745] [Impact Index Per Article: 249.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/09/2016] [Indexed: 02/06/2023]
Abstract
Important progress has been made in the management of Helicobacter pylori infection and in this fifth edition of the Maastricht Consensus Report, key aspects related to the clinical role of H. pylori were re-evaluated in 2015. In the Maastricht V/Florence Consensus Conference, 43 experts from 24 countries examined new data related to H. pylori in five subdivided workshops: (1) Indications/Associations, (2) Diagnosis, (3) Treatment, (4) Prevention/Public Health, (5) H. pylori and the Gastric Microbiota. The results of the individual workshops were presented to a final consensus voting that included all participants. Recommendations are provided on the basis of the best available evidence and relevance to the management of H. pylori infection in the various clinical scenarios.
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Affiliation(s)
- P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - F Megraud
- Laboratoire de Bactériologie, Inserm U853, Université de Bordeaux, Bordeaux, France
| | - C A O'Morain
- Faculty of Health Sciences, Trinity College, Dublin, Ireland
| | - J P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - E J Kuipers
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - F Bazzoli
- Internal Medicine and Gastroenterology, University of Bologna Italy, Bologna, Italy
| | - A Gasbarrini
- Gastroenterology, and Liver Unit, Internal Medicine, Roma, Italy
| | | | - D Y Graham
- Department of Medicine (111D), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - R Hunt
- Department of Medicine, McMaster University, Hamilton, Canada.,Hillcroft, Beaconsfield, Buckinghamshire, UK
| | - P Moayyedi
- Department of Gastroenterology, McMaster University, Hamilton, Canada
| | - T Rokkas
- Department of Gastroenterology, Henry Dunant Hospital, Athens, Greece
| | - M Rugge
- Department of Diagnostic Sciences, University of Padova, Padova, Italy
| | | | - S Suerbaum
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie, Hannover, Germany
| | - K Sugano
- Department of Medicine, Jichi Medical School, Tochigi, Japan
| | - E M El-Omar
- St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
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13
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Kandulski A, Fuchs KH, Weigt J, Malfertheiner P. Jackhammer esophagus: high-resolution manometry and therapeutic approach using peroral endoscopic myotomy (POEM). Dis Esophagus 2016; 29:695-6. [PMID: 24460870 DOI: 10.1111/dote.12182] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We present the first report on peroral endoscopic myotomy (POEM) in the treatment of jackhammer esophagus. A 34-year-old female patient was newly diagnosed with a jackhammer esophagus. After failure of medical treatment, the patient underwent POEM procedure for myotomy of the spastic segment. Postoperatively, a mild emphysema and pneumothorax occurred that required drainage and antibiotic therapy until full recovery. Discharge was possible after 5 days. Six months later, she presented with recurrent but mild pain due to a remnant spastic segment proximal to the myotomy. Endoscopic balloon dilation was performed twice within 6 weeks with full symptomatic relief of pain and mild symptoms of dysphagia.
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Affiliation(s)
- A Kandulski
- Department of Gastroenterology Hepatology and Infectious Disease, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - K-H Fuchs
- Department of General-, Abdominal- and Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - J Weigt
- Department of Gastroenterology Hepatology and Infectious Disease, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - P Malfertheiner
- Department of Gastroenterology Hepatology and Infectious Disease, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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14
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Venerito M, Helmke C, Jechorek D, Wex T, Rosania R, Antweiler K, Weigt J, Malfertheiner P. Leukotriene receptor expression in esophageal squamous cell cancer and non-transformed esophageal epithelium: a matched case control study. BMC Gastroenterol 2016; 16:85. [PMID: 27475906 PMCID: PMC4967508 DOI: 10.1186/s12876-016-0499-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/21/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Leukotriene B4 (LTB4R and LTB4R2) and cysteinyl leukotriene receptors (CYSLTR1 and CYSLTR2) contribute to malignant cell transformation. We aimed to investigate the expression of LTB4R, LTB4R2, CYSLTR1 and CYSLTR2 in esophageal squamous cell carcinoma and adjacent non-transformed squamous epithelium of the esophagus, as well as in control biopsy samples from esophageal squamous epithelium of patients with functional dyspepsia. METHODS Expression of LTB4R, LTB4R2, CYSLTR1 and CYSLTR2 was analyzed by immunohistochemistry (IHC) and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) in biopsy samples of 19 patients with esophageal squamous cell cancer and 9 sex- and age-matched patients with functional dyspepsia. RESULTS LTB4R, LTB4R2, CYSLTR1 and CYSLTR2 were expressed in all biopsy samples. Major findings were: 1) protein levels of all leukotriene receptors were significantly increased in esophageal squamous cell cancer compared to control mucosa (p < 0.05); 2) CYSLTR1 and CYSLTR2 gene expression was decreased in cancer tissue compared to control at 0.26-fold and 0.23-fold respectively; 3) an up-regulation of LTB4R (mRNA and protein expression) and a down-regulation of CYSLTR2 (mRNA expression) in non-transformed epithelium of cancer patients compared to control (p < 0.05) was observed. CONCLUSIONS The expression of leukotriene receptors was deregulated in esophageal squamous cell cancer. Up-regulation of LTB4R and down-regulation of CYSLTR2 gene expression may occur already in normal squamous esophageal epithelium of patients with esophageal cancer suggesting a potential role of these receptors in early steps of esophageal carcinogenesis. Larger studies are warranted to confirm these observations.
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Affiliation(s)
- M Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - C Helmke
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - D Jechorek
- Institute of Pathology, Otto-von-Guericke University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - T Wex
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - R Rosania
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - K Antweiler
- Department of Biometrics and Medical Informatics, Otto-von-Guericke University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - J Weigt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany.
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15
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Fischbach W, Malfertheiner P, Lynen Jansen P, Bolten W, Bornschein J, Buderus S, Glocker E, Hoffmann CJ, Koletzko S, Labenz J, Mayerle J, Miehlke S, Mössner J, Peitz U, Prinz C, Selgrad M, Suerbaum S, Venerito M, Vieth M. [S2k-guideline Helicobacter pylori and gastroduodenal ulcer disease]. Z Gastroenterol 2016; 54:1. [PMID: 27168132 DOI: 10.1055/s-0035-1567086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the line "bismuth-containing quadruple therapy" of Table 7 (p 342), in the column "dosage" incorrectly at the three antibiotics respectively 1-1-1-1. The correct is: 3-3-3-3.
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16
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Fätkenheuer G, Jessen H, Stoehr A, Jung N, Jessen AB, Kümmerle T, Berger M, Bogner JR, Spinner CD, Stephan C, Degen O, Vogelmann R, Spornraft-Ragaller P, Schnaitmann E, Jensen B, Ulmer A, Kittner JM, Härter G, Malfertheiner P, Rockstroh J, Knecht G, Scholten S, Harrer T, Kern WV, Salzberger B, Schürmann D, Ranneberg B. PEPDar: A randomized prospective noninferiority study of ritonavir-boosted darunavir for HIV post-exposure prophylaxis. HIV Med 2016; 17:453-9. [PMID: 27166295 DOI: 10.1111/hiv.12363] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES PEPDar compared the tolerability and safety of ritonavir-boosted darunavir (DRV/r)-based post-exposure prophylaxis (PEP) with the tolerability and safety of standard of care (SOC). The primary endpoint was the early discontinuation rate among the per-protocol population. METHODS PEPDar was an open-label, randomized, multicentre, prospective, noninferiority safety study. Subjects were stratified by type of event (occupational vs. nonoccupational, i.e. sexual) and were randomized to receive DRV/r plus two nucleoside reverse transcriptase inhibitors (NRTIs) or SOC PEP. Twenty-two private or university HIV clinics in Germany participated. Subjects were ≥ 18 years old and had documented or potential HIV exposure and indication for HIV PEP. They initiated PEP not later than 72 h after the event and were HIV negative. RESULTS A total of 324 subjects were screened, the per-protocol population was 305, and 273 subjects completed the study. One hundred and fifty-five subjects received DRV/r-based PEP and 150 subjects received ritonavir-boosted lopinavir (LPV/r)-based PEP for 28-30 days; 298 subjects also received tenofovir/emtricitabine. The early discontinuation rate in the DRV/r arm was 6.5% compared with 10.0% in the SOC arm (P = 0.243). Adverse drug reactions (ADRs) were reported in 68% of DRV/r subjects and 75% of SOC subjects (P = 0.169). Fewer DRV/r subjects (16.1%) had at least one grade 2 or 3 ADR compared with SOC subjects (29.3%) (P = 0.006). All grades of diarrhoea, nausea, and sleep disorders were significantly less frequent with DRV/r, while headache was significantly more frequent. No HIV seroconversion was reported during follow-up. CONCLUSIONS Noninferiority of DRV/r to SOC was demonstrated. DRV/r should be included as a standard component of recommended regimens in PEP guidelines.
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Affiliation(s)
- G Fätkenheuer
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany
| | - H Jessen
- Praxis Jessen2 + Kollegen, Berlin, Germany
| | - A Stoehr
- ifi - Institute for Interdisciplinary Medicine, Study Centre St. Georg, Hamburg, Germany
| | - N Jung
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - A B Jessen
- Praxis Jessen2 + Kollegen, Berlin, Germany
| | - T Kümmerle
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - M Berger
- Immunology Outpatient Clinic, Vivantes Auguste Viktoria Hospital, Berlin, Germany
| | - J R Bogner
- Section Infectcious Diseases, Med IV, University Hospital of Munich, Munich, Germany
| | - C D Spinner
- Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich, Germany
| | - C Stephan
- Department of Medicine, Center for Internal Medicine, J. W. Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - O Degen
- Outpatient Infectious Diseases Unit, University Center Hamburg Eppendorf, Hamburg, Germany
| | - R Vogelmann
- Department of Internal Medicine, Medical Clinic II, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | | | | | - B Jensen
- Department of Gastroenterology, Hepatology and Infectiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Ulmer
- Group Practice Ulmer/Frietsch/Müller/Roll, Stuttgart, Germany
| | - J M Kittner
- Medical Clinic and Outpatient Clinic I, University Hospital Mainz, Mainz, Germany
| | - G Härter
- Clinic for Internal Medizin III, Ulm University Medical Center, Ulm, Germany
| | - P Malfertheiner
- Clinic for Gastroenterology, Hepatology and Infectiology, University Hospital Magdeburg, Magdeburg, Germany
| | - J Rockstroh
- Internal Medicine I, Gastroenterology, Infectious Diseases, University Hospital Bonn, Bonn, Germany
| | - G Knecht
- Internal Medicine Specialist Center Stresemannallee, Frankfurt am Main, Germany
| | - S Scholten
- Practice Hohenstaufenring, Cologne, Germany
| | - T Harrer
- Department of Medicine 3, University Medicine Erlangen, Erlangen, Germany
| | - W V Kern
- Division of Infectious Diseases, University Hospital, Freiburg, Germany
| | - B Salzberger
- Department Internal Medicine I, University Regensburg, Regensburg, Germany
| | - D Schürmann
- Division of Infectiology and Pneumonology, Medical Department, Charité-University Medicine Berlin, Berlin, Germany
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17
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von Arnim U, Wex T, Link A, Messerschmidt M, Venerito M, Miehlke S, Malfertheiner P. Helicobacter pylori infection is associated with a reduced risk of developing eosinophilic oesophagitis. Aliment Pharmacol Ther 2016; 43:825-30. [PMID: 26898731 DOI: 10.1111/apt.13560] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 01/11/2016] [Accepted: 01/26/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Eosinophilic oesophagitis (EoE) represents a chronic immune-antigen-mediated allergic disease of the oesophagus of still unknown aetiology. Environmental exposure has been postulated to play a pathogenetic role. Helicobacter pylori (H. pylori) infection has been inversely associated with allergic diseases including atopic dermatitis, asthma and allergic rhinitis and H. pylori may play a protective role in these conditions. Little is known about the relationship between EoE and H. pylori. AIM To investigate in a case-control study whether H. pylori infection is associated with a reduced risk of developing EoE. METHODS H. pylori infection was evaluated by serology in 58 [11(19%) female, 47 (81%) male, median age: 36.5 years, range 20-72 years] patients with a clinical and histologically proven diagnosis of EoE and 116 age and sex-matched controls (1 case: 2 controls). Antibodies against H. pylori were identified by enzyme-linked immunosorbent assay. Patients with H. pylori-specific IgG ≥ 30 enzyme immunounits were classified as H. pylori-positive. RESULTS 3/58 (5.2%) patients with EoE had serological evidence of H. pylori infection (EoE - H. pylori current infection) and 5/58 (8.6%) reported prior eradication therapy for H. pylori infection (EoE - H. pylori former infection). The control group demonstrated significantly higher seroprevalence of H. pylori (37.9%, P < 0.0001) when compared to patients with EoE. EoE was inversely associated with H. pylori infection [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.11-0.50]. CONCLUSION Helicobacter pylori infection is inversely associated with EoE. Our results may contribute to further understanding the pathogenesis and evolving aetiology of EoE.
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Affiliation(s)
- U von Arnim
- Department of Gastroenterology, Hepatology and Infectious diseases, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - T Wex
- Department of Gastroenterology, Hepatology and Infectious diseases, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - A Link
- Department of Gastroenterology, Hepatology and Infectious diseases, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - M Messerschmidt
- Department of Gastroenterology, Hepatology and Infectious diseases, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - M Venerito
- Department of Gastroenterology, Hepatology and Infectious diseases, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - S Miehlke
- Cooperation of Internal Medicine, Center for Digestive Diseases, Hamburg, Germany
| | - P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious diseases, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
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18
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Weigt J, Kandulski A, Obst W, Malfertheiner P. [Resection of small colorectal polyps using a dedicated cold resection snare]. Z Gastroenterol 2015; 53:1422-4. [PMID: 26666279 DOI: 10.1055/s-0041-106852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND According to actual German guidelines the resection of small colorectal polyps can be performed using a biopsy forceps. The guidelines recommend surveillance colonoscopy within 2 - 6 months if complete resection cannot be prooven. Cold snare resection of polyps allows easy and complete resection of small and diminutive polyps. AIM OF THE STUDY To develop and evaluate a snare for cold resections of colorectal polyps. METHODS We conducted a monocentric observational trial in our university hospital to test the performance of the cold snare resection for colorectal polyps < 10 mm. Consecutive patients were enrolled in the study. No submucosal injection was performed. Polyps were grasped with the snare and after accurate positioning of the snare polyps were resected. Primary endpoint was the rate of complete resection as defined by histology. Complications such as bleeding, perforation or abdominal pain were recorded. RESULTS In total 99 polyps were resected in 58 patients (15 female, 43 male, age 62.8 years (31 - 85 years). The mean polyp size was 5.3 mm (2 - 10 mm). Of the 99 polyps 88 were adenoma (74 tubular adenomas, 4 tubulo-villous adenoma and 2 serrated adenoma), 18/99 polys were hyperplastic polyps and one polyp revealed as a leiomyoma. In total 74 adenoma (92.5 %) were completely resected en bloc. In polyps of 1 - 4 mm of size the R0 resection rate was 90 % (27/30). In polyps of 5 - 10 mm of size the R0 resection rate was 94 % (47/50). No complications occurred. DISCUSSION This study demonstrated a high R0 Resection rate for small colorectal polyps using a dedicated cold resection snare. Cold snare resection of small polyps helps to reduce the rate of piece meal resections in small colorectal polyps.
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Hunt RH, Camilleri M, Crowe SE, El-Omar EM, Fox JG, Kuipers EJ, Malfertheiner P, McColl KEL, Pritchard DM, Rugge M, Sonnenberg A, Sugano K, Tack J. The stomach in health and disease. Gut 2015; 64:1650-68. [PMID: 26342014 PMCID: PMC4835810 DOI: 10.1136/gutjnl-2014-307595] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/14/2015] [Indexed: 12/12/2022]
Abstract
The stomach is traditionally regarded as a hollow muscular sac that initiates the second phase of digestion. Yet this simple view ignores the fact that it is the most sophisticated endocrine organ with unique physiology, biochemistry, immunology and microbiology. All ingested materials, including our nutrition, have to negotiate this organ first, and as such, the stomach is arguably the most important segment within the GI tract. The unique biological function of gastric acid secretion not only initiates the digestive process but also acts as a first line of defence against food-borne microbes. Normal gastric physiology and morphology may be disrupted by Helicobacter pylori infection, the most common chronic bacterial infection in the world and the aetiological agent for most peptic ulcers and gastric cancer. In this state-of-the-art review, the most relevant new aspects of the stomach in health and disease are addressed. Topics include gastric physiology and the role of gastric dysmotility in dyspepsia and gastroparesis; the stomach in appetite control and obesity; there is an update on the immunology of the stomach and the emerging field of the gastric microbiome. H. pylori-induced gastritis and its associated diseases including peptic ulcers and gastric cancer are addressed together with advances in diagnosis. The conclusions provide a future approach to gastric diseases underpinned by the concept that a healthy stomach is the gateway to a healthy and balanced host. This philosophy should reinforce any public health efforts designed to eradicate major gastric diseases, including stomach cancer.
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Affiliation(s)
- R H Hunt
- Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University Health Science Centre, Hamilton, Ontario, Canada
| | - M Camilleri
- Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - S E Crowe
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - E M El-Omar
- Division of Applied Medicine, Aberdeen University, Institute of Medical Sciences, Foresterhill, Aberdeen, UK
| | - J G Fox
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - E J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - P Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologi Universitätsklinikum Magdeburg A.ö.R.Leipziger Str. 44, Magdeburg, Germany
| | - K E L McColl
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D M Pritchard
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M Rugge
- Department of Medicine DIMED, Pathology & Cytopathology Unit, University of Padova, Padova, Italy
| | - A Sonnenberg
- Department of Gastroenterology, Oregon Health Science University, Portland, Oregon, USA
| | - K Sugano
- Department of Internal Medicine, Jichi Medical School, Shimotsuke, Japan
| | - J Tack
- Translational Research in GastroIntestinal Disorders, Leuven, Belgium
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20
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Malfertheiner M, Malfertheiner P, Costa SD, Pfeifer M, Ernst W, Seelbach-Göbel B, Fill Malfertheiner S. Extraesophageal symptoms of gastroesophageal reflux disease during pregnancy. Z Gastroenterol 2015; 53:1080-3. [PMID: 26367023 DOI: 10.1055/s-0034-1399453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Typical symptoms of gastroesophageal reflux disease (GERD) are known to be frequent in pregnancy. The aim of this study was to gain a first estimation of the occurrence of extraesophageal symptoms in this context. METHODS A prospective longitudinal study was performed on 166 pregnant women and in a control group of 285 women. The diagnosis of GERD was based on the Montreal classification using the reflux disease questionnaire (RDQ). Extraesophageal symptoms were recorded with a self-administered questionnaire. Typical GERD symptoms and extraesophageal GERD symptoms were recorded in each trimester of pregnancy. RESULTS The prevalence of GERD during pregnancy was 16.9% in the first, 25.3% in the second and 51.2% in the third trimester. The prevalence of GERD in the control group was 6.3%. Asthma was reported by 3.5% of controls and by 6% of pregnant women during pregnancy. Chest pain occurred in 6% of the controls and in 1.8%, 2.4% and 2.4% during the trimesters of pregnancy, chronic cough was reported by 1.1% of controls and 1.2% of pregnant women. With the diagnosis of GERD the odds ratios and 95% confidence intervals for asthma, chronic cough and chest pain in the third trimester of pregnancy were as follows: 1.56 (0.58-4.22) for asthma, 0.91 (0.08-10.28) for chronic cough and 2.04 (0.49-8.46) for chest pain. CONCLUSION GERD is very frequent during pregnancy with progressive incidence during the course of pregnancy. Extraesophageal symptoms of GERD have an unexpected low prevalence during pregnancy.
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Affiliation(s)
| | - P Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg, Germany
| | - S D Costa
- Gynäkologie und Geburtshilfe, Universitätsklinikum Magdeburg, Germany
| | - M Pfeifer
- Pneumologie, Barmherzige Brüder, Regensburg, Germany
| | - W Ernst
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Regensburg, Germany
| | - B Seelbach-Göbel
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Regensburg, Germany
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21
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Varbanova M, Wex T, Jechorek D, Röhl FW, Langner C, Selgrad M, Malfertheiner P. Impact of the angulus biopsy for the detection of gastric preneoplastic conditions and gastric cancer risk assessment. J Clin Pathol 2015; 69:19-25. [DOI: 10.1136/jclinpath-2015-202858] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 06/21/2015] [Indexed: 12/31/2022]
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22
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Zhu A, Kudo M, Park J, Ryoo BY, Yen CJ, Chung HC, Baron A, Okusaka T, Poon R, Pastorelli D, Blanc JF, Flesch Pfiffer T, Kubackova K, Trojan J, Sastre J, Malfertheiner P, Peck-Radosavljevic M, Chang SC, Abada P, Yang L, Girvan A, Chau I. O-005 Ramucirumab (RAM) as second-Line treatment in patients with advanced hepatocellular carcinoma (HCC) following first-line therapy with sorafenib: comprehensive results from the randomized phase III REACH study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv235.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Hagel S, Epple HJ, Feurle GE, Kern WV, Lynen Jansen P, Malfertheiner P, Marth T, Meyer E, Mielke M, Moos V, von Müller L, Nattermann J, Nothacker M, Pox C, Reisinger E, Salzberger B, Salzer HJF, Weber M, Weinke T, Suerbaum S, Lohse AW, Stallmach A. [S2k-guideline gastrointestinal infectious diseases and Whipple's disease]. Z Gastroenterol 2015; 53:418-59. [PMID: 25965989 DOI: 10.1055/s-0034-1399337] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Venerito M, Radünz M, Reschke K, Reinhold D, Frauenschläger K, Jechorek D, Di Mario F, Malfertheiner P. Autoimmune gastritis in autoimmune thyroid disease. Aliment Pharmacol Ther 2015; 41:686-93. [PMID: 25648057 DOI: 10.1111/apt.13097] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 12/22/2014] [Accepted: 01/11/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Autoimmune gastritis leads to oxyntic gastric atrophy, a condition at increased risk for gastric cancer. Autoimmune gastritis in conjunction with autoimmune thyroid disease has been reported previously. AIM In a case-control study in patients with autoimmune thyroid disease to evaluate the usefulness of serum pepsinogens for the identification of oxyntic gastric atrophy, and to determine the relationship of Helicobacter pylori with oxyntic gastric atrophy. METHODS Patients with autoimmune thyroid disease (cases) and goitre (controls) were prospectively enrolled in the study. Pepsinogen (PG) I levels ≤25 μg/mL and PG I/II ratio ≤3 were indicative for oxyntic gastric atrophy. Antibodies against H. pylori, CagA and parietal cells were also determined. Esophagogastroduodenoscopy with biopsies was offered to patients with serological oxyntic gastric atrophy. RESULTS In total, 34 autoimmune thyroid disease patients and 30 controls were enrolled. Serological oxyntic gastric atrophy was present only in autoimmune thyroid disease patients (8/34, 23.5%, OR 8.3, 95% CI = 1.9-36.2). In all eight patients oxyntic gastric atrophy was confirmed by histology. OLGA stage I, II, III and IV was described in 0%, 33%, 50% and 17% of the cases, respectively. About, 89% and 11% of oxyntic gastric atrophy patients were seropositive for antibodies against parietal cells or H. pylori infection, respectively. Gastric atrophy involved the angulus/antrum in 50% of patients with autoimmune gastritis. CONCLUSIONS The seroprevalence of oxyntic gastric atrophy is high in patients with autoimmune thyroid disease, and testing of serum pepsinogens should be included in the clinical assessment of these patients. H. pylori infection is unlikely to be a principal factor in the pathogenesis of oxyntic gastric atrophy in patients with autoimmune thyroid disease. In autoimmune gastritis, gastric atrophy can spread from the oxyntic towards the antral mucosa.
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Affiliation(s)
- M Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
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Shaheen NJ, Adler J, Dedrie S, Johnson D, Malfertheiner P, Miner P, Meulemans A, Poole L, Tack J, Thielemans L, Troy S, Vakil N, Zerbib F, Ruth M. Randomised clinical trial: the 5-HT4 agonist revexepride in patients with gastro-oesophageal reflux disease who have persistent symptoms despite PPI therapy. Aliment Pharmacol Ther 2015; 41:649-61. [PMID: 25693609 PMCID: PMC5024018 DOI: 10.1111/apt.13115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 10/16/2014] [Accepted: 01/23/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND A substantial proportion of patients with gastro-oesophageal reflux disease (GERD) have only a partial response to proton pump inhibitor (PPI) therapy. Prokinetic drugs may improve reflux symptoms by enhancing oesophageal motility and gastric emptying. AIM To evaluate the effect of revexepride, a novel prokinetic 5-hydroxytryptamine type 4 (5-HT4 ) receptor agonist, compared with placebo, in patients with GERD who have a partial response to PPIs. METHODS A phase 2b, double-blind, parallel-group study was conducted, in which patients were randomised to one of three revexepride treatment groups (0.1, 0.5 and 2.0 mg three times daily) or placebo (1:1:1:1 ratio). Daily e-diary data captured patients' symptoms over an 8-week treatment period. The primary efficacy outcome was the weekly percentage of regurgitation-free days in the second half of the study (weeks 5-8). RESULTS In total, 480 patients were randomised and 477 received treatment (mean age 47.9 years; 61% women). The mean percentage of regurgitation-free days increased from baseline (range, 15.0-18.8%) to week 8 (62.3-70.5%) in all four study arms; however, there were no statistically significant differences in this change between placebo and the three treatment arms. No dose-dependent relationship in treatment effect was observed for any of the study endpoints. The incidence of treatment-emergent adverse events (TEAEs) was revexepride dose-dependent. Only one serious TEAE occurred and none resulted in death. CONCLUSIONS Revexepride was no more effective than placebo in controlling regurgitation in patients with GERD symptoms partially responsive to PPIs. Revexepride was well tolerated. ClinicalTrials.gov Identifier: NCT01472939.
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Affiliation(s)
- N. J. Shaheen
- Center for Esophageal Diseases and SwallowingUniversity of North Carolina School of MedicineChapel HillNCUSA
| | - J. Adler
- Hahn & Adler Gastroenterology & Internal MedicineLLCPlantationFLUSA
| | | | - D. Johnson
- Division of GastroenterologyEastern Virginia Medical SchoolNorfolkVAUSA
| | - P. Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious DiseasesOtto‐von‐Guericke UniversityMagdeburgGermany
| | - P. Miner
- Department of Digestive DiseasesOklahoma Foundation for Digestive ResearchOklahoma CityOKUSA
| | | | | | | | | | - S. Troy
- Global Clinical Pharmacology and PharmacokineticsShireWaynePAUSA
| | - N. Vakil
- School of Medicine and Public HealthUniversity of WisconsinMadisonWIUSA
| | - F. Zerbib
- CHU de BordeauxHôpital Saint AndréBordeauxFrance
| | - M. Ruth
- Shire‐Movetis NVTurnhoutBelgium
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Schütte K, Seidensticker R, Milbradt O, Bornschein J, Kandulski A, Pech M, Kropf S, Ricke J, Malfertheiner P. Assessment and monitoring of liver function by ¹³C-aminopyrine breath test after selective transarterial chemoembolisation of hepatocellular carcinoma. Z Gastroenterol 2015; 53:21-7. [PMID: 25594703 DOI: 10.1055/s-0034-1385230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Liver function and tumor staging are essential parameters for selection of treatment modalities in patients with hepatocellular carcinoma (HCC). Transarterial chemoembolization (TACE) is associated with a risk of deterioration of liver function. In clinical routine hepatic function in patients with liver cirrhosis is assessed by the Child-Pugh-classification. Dynamic breath tests allow the assessment of the hepatic functional mass and have the potential to give more accurate information on hepatic function periinterventionally. PATIENTS AND METHODS A prospective clinical study was performed in 13 patients receiving a total of 18 TACE sessions. (13)C-aminopyrine breath test was performed the day before TACE, 2 days and 30 days after TACE and correlated with standard laboratory work-up of the patients. RESULTS Fourteen TACE sessions were performed in Child A liver cirrhosis, 4 in Child B cirrhosis. All patients presented with impaired aminopyrine metabolism at baseline. No significant changes in the (13)C aminopyrine breath test following TACE were observed. Two patients treated in Child A cirrhosis decompensated to Child B, one of them recovered. No further decompensation was observed in patients treated in Child B cirrhosis. DISCUSSION AND CONCLUSION Liver function assessment with (13)C-aminopyrine breath test and Child-Pugh-classification following TACE was discordant in a large proportion of patients. Whether a quantification of mitochondrial liver function in patients planned to undergo locoregional treatment of HCC in liver cirrhosis is helpful in the prediction of postprocedural liver decompensation needs to be addressed in larger prospective clinical trials.
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Affiliation(s)
- K Schütte
- Klinik für Gastroenterologie, Hepatologie & Infektiologie, Universitätsklinikum Magdeburg A. ö. R
| | - R Seidensticker
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A. ö. R
| | - O Milbradt
- Klinik für Gastroenterologie, Hepatologie & Infektiologie, Universitätsklinikum Magdeburg A. ö. R
| | - J Bornschein
- Klinik für Gastroenterologie, Hepatologie & Infektiologie, Universitätsklinikum Magdeburg A. ö. R
| | - A Kandulski
- Klinik für Gastroenterologie, Hepatologie & Infektiologie, Universitätsklinikum Magdeburg A. ö. R
| | - M Pech
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A. ö. R
| | - S Kropf
- Institut für Biometrie und Medizinische Informatik, Otto-von-Guericke-Universität Magdeburg
| | - J Ricke
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A. ö. R
| | - P Malfertheiner
- Klinik für Gastroenterologie, Hepatologie & Infektiologie, Universitätsklinikum Magdeburg A. ö. R
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Malfertheiner SF, Eckart A, Ernst W, Costa SD, Malfertheiner P, Seelbach-Göbel B. Gesundheitsbezogene Lebensqualität von schwangeren Patientinnen mit gastroösophagealer Refluxkrankheit. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ganten T, Stauber R, Schott E, Malfertheiner P, Buder R, Galle P, Goehler T, Bernard I, Gerken G. Final Analysis of Overall Survival Per Subgroups of Hcc Patients in the Prospective, Non-Interventional Insight Study Treated with Sorafenib. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Malfertheiner P, Delchier JC. Letter: Bismuth quadruple therapy with Pylera for Helicobacter pylori infection--authors' reply. Aliment Pharmacol Ther 2014; 40:736-7. [PMID: 25123392 DOI: 10.1111/apt.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 12/08/2022]
Affiliation(s)
- P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of Magdeburg, Magdeburg, Germany.
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Selgrad M, Meyer F, Malfertheiner P. [Helicobacter pylori: short overview on selected data from the history and their value for clinical medicine, in particular, surgery - what does the (general/abdominal) surgeon need to know]. Zentralbl Chir 2014; 139:399-405. [PMID: 25119578 DOI: 10.1055/s-0034-1368631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The discovery of Helicobacter pylori (H. pylori) represents one of the most notable events in the field of experimental and clinical medicine with great impact to daily practice even to surgery. It has led to a paradigm shift in the treatment of peptic ulcer disease. For the time period of almost one century, several scientists had described spiral-shaped bacteria in the stomach of animals and humans. However, it lasted till the early 1980s when Robin Warren and Barry Marshall successfully cultured H. pylori and recognised its causal relationship to chronic gastritis and peptic ulcer disease. Since then, our knowledge about H. pylori and related diseases has been continuously growing. Today, the bacterium is known to be mainly responsible for the development of chronic gastritis, peptic ulcer disease, MALT lymphoma and is considered as the main risk factor for the development of gastric cancer - all this led to a switch in the basic aetiopathogenetic considerations. In particular, eradication of H. pylori helped to i) develop an aetiology-based therapeutic and preventive approach to the diseases listed above according and adapted to findings, stage and manifestation, and ii) define a new role of surgery in the treatment concept. In addition, more and more evidence is being gathered for a possible association between the bacterium and several extragastric diseases.
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Affiliation(s)
- M Selgrad
- Klinik für Gastroenterologie, Hepatologie & Infektiologie, Universitätsklinikum Magdeburg A. ö. R. Deutschland
| | - F Meyer
- Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - P Malfertheiner
- Klinik für Gastroenterologie, Hepatologie & Infektiologie, Universitätsklinikum Magdeburg A. ö. R. Deutschland
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Venerito M, Malfertheiner P. [Is mass eradication of Helicobacter pylori infection effective for preventing gastric cancer?]. Z Gastroenterol 2014; 52:744-5. [PMID: 25026011 DOI: 10.1055/s-0034-1366273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Delchier JC, Malfertheiner P, Thieroff-Ekerdt R. Use of a combination formulation of bismuth, metronidazole and tetracycline with omeprazole as a rescue therapy for eradication of Helicobacter pylori. Aliment Pharmacol Ther 2014; 40:171-7. [PMID: 24863854 DOI: 10.1111/apt.12808] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/17/2014] [Accepted: 05/06/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Helicobacter pylori infection occurs in children and adults worldwide. Standard triple therapy of omeprazole, amoxicillin and clarithromycin (OAC) may not be optimal. AIM To evaluate quadruple therapy with bismuth subcitrate potassium, metronidazole and tetracycline hydrochloride, given with omeprazole in H. pylori infected subjects who failed previous OAC eradication therapy. METHODS This was a multicenter, open-label, single-arm, multinational study. Helicobacter pylori-positive subjects who had failed ≥1 previous course of OAC therapy with or without up to three supplemental treatments in the previous year. Subjects were treated for 10 days with a combination formulation containing bismuth subcitrate potassium 140 mg, tetracycline hydrochloride 125 mg, and metronidazole 125 mg, three capsules four times daily (q.d.s.), and omeprazole 20 mg twice daily (b.d.). The primary endpoint was H. pylori eradication rate defined as one negative (13) C-urea breath test ≥28 days post-treatment. RESULTS Helicobacter pylori eradication rates ranged from 93.2% to 93.8% in the intent-to-treat population (n = 49), and from 94.7% to 95.0% in the PP population (n = 40). No clinically meaningful differences were observed when analysed by country. Metronidazole resistance was observed in 16/49 (32.7%) subjects and clarithromycin resistance in 31/49 (63.3%) subjects. Thirty-three subjects (67.3%) reported 87 adverse events, and only one (2%) discontinued the study for an adverse event. CONCLUSIONS A quadruple regimen of bismuth, metronidazole and tetracycline plus omeprazole produces a high eradication rate in subjects previously failing H. pylori eradication regimens. This bismuth-based regimen offers an effective option as rescue therapy.
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Affiliation(s)
- J C Delchier
- Gastroenterology Unit, Albert Chenevier-Henri Mondor Hospital AP-HP, UPEC Université Paris 12, Paris, France
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Malfertheiner P. [Helicobacter pylori: screen and treat?]. Dtsch Med Wochenschr 2014; 139:905-8. [PMID: 24760696 DOI: 10.1055/s-0034-1369946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Current evidence assigns to the Helicobacter pylori infection an essential role and major risk in gastric carcinogenesis. In high risk groups and populations a H. pylori screen-and-treat strategy is recommended and already implemented in some countries. A general screen-and-treat is the way to go as it may reduce the burden of gastric cancer for the community and prevent deleterious individual destinies.
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Affiliation(s)
- P Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke Universität Magdeburg
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Abstract
Since the first European Consensus Report on Helicobacter pylori management in 1996 and the strong indication for therapy of peptic ulcer disease and other benign gastroduodenal pathologies, the list of indications for therapeutic interventions has been extended to selected extradigestive diseases. Test-and-treat and search-and-treat strategies have been implemented for patients with dyspeptic symptoms and prevention of H. pylori-related complications (gastric cancer included), respectively. Screen and treat strategies are in discussion but are still lacking any structured implementation. For diagnosis of H. pylori, accurate noninvasive and endoscopy-based tests are widely available across Europe, and individual tests are selected according to patient needs and clinical settings. Standard proton pump inhibitor-based triple therapy faces increasing failure rates mainly because of clarithromycin resistance, but alternative first-line options bismuth quadruple, or non-bismuth quadruples in various combinations have emerged as effective first-line alternatives. After treatment failure, defined rescue therapies including individual antibiotic-sensitive testing are recommended.
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Affiliation(s)
- P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of Magdeburg, Magdeburg, Germany
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35
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von Arnim U, Miehlke S, Madisch A, Vieth M, Straumann A, Malfertheiner P. [Eosinophilic esophagitis - update - pathogenesis, diagnosis and therapy]. Z Gastroenterol 2014; 52:296-305. [PMID: 24622873 DOI: 10.1055/s-0033-1356135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Eosinophilic esophagitis (EoE) is a clinicopathological condition of the esophagus that has become increasingly recognised over the last decade. EoE represents a chronic immune-mediated inflammatory disease of the esophagus. In adults dysphagia is the predominant symptom. Upper gastrointestinal endoscopy is required in order to take biopsies from the esophagus. The diagnose is confirmed histologically by typical eosinophilic infiltration of the esophagus mucosa. Until now there is no approved therapy world-wide although we know that topic and systemic steroids are highly effective in EoE. Elimination diet is another option and in well selected patients endoscopic balloon dilation represents a therapeutic possibility.
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Affiliation(s)
- U von Arnim
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg AöR, Magdeburg
| | - S Miehlke
- Magen-Darm-Zentrum, Facharztzentrum Eppendorf, Hamburg
| | - A Madisch
- Medizinischen Klinik I, KRH Klinikum Siloah, Hannover
| | - M Vieth
- Institut für Pathologie, Klinikum Bayreuth GmbH, Bayreuth
| | | | - P Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg AöR, Magdeburg
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Schulz C, Schütte K, Jacobi CA, Hülsemann JL, Malfertheiner P. TV news and concerns about - the EHEC-outbreak 2011 in Germany. Z Gastroenterol 2014; 52:277-80. [PMID: 24622869 DOI: 10.1055/s-0033-1350189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIM In the beginning of May 2011 and finally terminated on July 26th 2011 an outbreak of infections with enterohaemorrhagic Escherichia (E.) coli (EHEC) strain O104:H4 occurred in Germany. The aim of this study is to analyse whether media coverage of the outbreak influenced the number of patients presenting with diarrhoea to the emergency room of a tertiary centre and to evaluate the influence of information on perception and rating of symptoms. METHODS Prospectively collected data in a tertiary centre on the number of patients presenting to the emergency room with diarrhea during the EHEC outbreak was correlated with retrospectively collected data about the media coverage of the outbreak on TV and compared to the number of patients that had presented with diarrhea during a comparative period in 2010. RESULTS A total of 1,625 patients presented to our emergency room during the observation period in 2011 between May 31st and June 13th, including 72 patients (4.4%) presenting with the predominant symptom of diarrhoea, of whom six patients (0.4%) reported haemorrhagic diarrhoea. In the comparative period in 2010, between May 31st and June 13th, twelve patients (1.6%) presenting the symptom of diarrhea were treated in our emergency room. The analysis of the news reports in 2011 revealed a total of 1,150 reports broadcast in the ARD and a total of 173 reports broadcast in the regional news channel MDR between May 29th and June 11th. In 2010 not a single report regarding our search terms was broadcast in the corresponding time period. CONCLUSION Our data suggest a clear positive correlation of the frequency of TV reports dealing with the epidemic disease outbreak and the rate of outpatient consultations in emergency rooms because of diarrhoea and could make an important contribution for future discussions.
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Affiliation(s)
- C Schulz
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of Magdeburg, Germany
| | - K Schütte
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of Magdeburg, Germany
| | - C A Jacobi
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of Magdeburg, Germany
| | - J L Hülsemann
- University of Magdeburg, Hospitals and Clinics, Magdeburg, Germany
| | - P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of Magdeburg, Germany
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Kandulski A, Malfertheiner P. Commentary: biopsy to diagnose GERD--better, but not yet a stand-alone test; authors' reply. Aliment Pharmacol Ther 2013; 38:1140-1. [PMID: 24099478 DOI: 10.1111/apt.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/02/2013] [Indexed: 12/08/2022]
Affiliation(s)
- A Kandulski
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Kandulski A, Jechorek D, Caro C, Weigt J, Wex T, Mönkemüller K, Malfertheiner P. Histomorphological differentiation of non-erosive reflux disease and functional heartburn in patients with PPI-refractory heartburn. Aliment Pharmacol Ther 2013; 38:643-51. [PMID: 23895770 DOI: 10.1111/apt.12428] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 03/30/2013] [Accepted: 07/04/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Proton pump inhibitor (PPI)-refractory heartburn may be due to persistent gastro-oesophageal reflux, oesophageal hypersensitivity or functional heartburn (FH). The differentiation between non-erosive reflux disease (NERD) and FH may be very difficult. However, this differentiation is important for appropriate therapeutic management. Dilated intercellular spaces (DIS), papillary elongation (PE) and basal cell hyperplasia (BCH) can be all assessed by light microscopy. Whether these mucosal abnormalities allow the differentiation of NERD from FH in PPI-refractory patients is uncertain. AIM To assess histopathological findings by light microscopy in patients with refractory heartburn to differentiate NERD from FH. METHODS Sixty-two patients with PPI-refractory symptoms underwent EGD and MII-pH after pausing PPI medication for 2 weeks before investigation. Twenty-five subjects without upper gastrointestinal symptoms were included as controls. Symptom assessment was based on the reflux disease questionnaire (RDQ). Biopsies were taken 3-5 cm above the gastro-oesophageal junction. DIS, PE, BCH and infiltration of immune cells were evaluated and a sum score was calculated. RESULTS Based on endoscopy and MII-pH, GERD was diagnosed in 43 patients (NERD: 20; ERD: 23) and FH in 19 patients. There was no difference in symptoms between the groups. Each individual histopathological item was different between the groups (P < 0.0001). Between NERD and FH, the most significant difference was found for DIS and the histopathological sum score (P < 0.001). CONCLUSIONS These findings suggest that oesophageal biopsies are useful to differentiate NERD from FH. Increased DIS and a histological sum score are the most significant histopathological abnormalities in NERD as compared with FH.
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Affiliation(s)
- A Kandulski
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
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Weigt J, Malfertheiner P. Small volume acid reflux in gastroesophageal reflux disease patients with hiatal hernia is only detectable by pH-metry but not by multichannel intraluminal impedance. Dis Esophagus 2013; 26:544-8. [PMID: 22862140 DOI: 10.1111/j.1442-2050.2012.01379.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Until now, it is uncertain if the so-called pH-only reflux episodes that consist of a pH drop without evidence of retrograde bolus movement in multichannel intraluminal impedance (MII) represent reflux episodes or artifacts. Hiatal hernia (HH) may allow reflux of small volumes to occur that can be detected by pH-metry but not by MII. The aim was to search for a mechanism that can explain pH-only reflux, 20 patients (12 females and 8 males, median age 52 years, interquartile range [IQR]: 40.5-60.75 years) were investigated with MII-pH off PPI. Impedance and pH-metry data were analyzed separately. The differences in detection rate of acid reflux between pH-metry and MII were correlated with the presence of HH. In an in vitro experiment, MII-pH probes were flushed with citric acid in plastic tubes of different size with capillary diameter and diameters of 2.5 mm and 4.5 mm, while recording pH values and impedance. HH was present in six patients and absent in 14 patients. In patients with HH in comparison with patients with absent HH, the difference of acid reflux detection between pH-metry and MII is significantly higher (70%, IQR: 15-88% and 3.6%, IQR: 0-31%, respectively). In vitro all simulated reflux lead to a fall in pH whereas a corresponding decrease in impedance was only recognizable in the 4.5-mm plastic tubes. Acid reflux episodes in patients with HH are more frequently detected by pH-metry than by MII. Small volume reflux that does not lead to a decrease in impedance is the likely explanation for this phenomenon.
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Affiliation(s)
- J Weigt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-v.-Guericke University, 39129 Magdeburg, Germany.
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40
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Piazzi G, Selgrad M, Garcia M, Ceccarelli C, Fini L, Bianchi P, Laghi L, D'Angelo L, Paterini P, Malfertheiner P, Chieco P, Boland CR, Bazzoli F, Ricciardiello L. Van-Gogh-like 2 antagonises the canonical WNT pathway and is methylated in colorectal cancers. Br J Cancer 2013; 108:1750-6. [PMID: 23579212 PMCID: PMC3668461 DOI: 10.1038/bjc.2013.142] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Aberrant activation of the canonical WNT signaling is a feature of colorectal cancer (CRC). Van-Gogh-like 2 (VANGL2) belongs to the non-canonical WNT pathway whose activation inhibits canonical WNT signaling. In this study, we investigated the role of VANGL2 and its epigenetic regulation in CRC. Methods: Van-Gogh-like 2 expression and promoter methylation after 5-aza-2′-deoxycytidine (5-aza) treatment were evaluated in CRC cells. DNA samples from 418 sporadic CRCs were tested for VANGL2 promoter methylation and microsatellite instability (MSI). Proliferation, colony formation and activation of the WNT pathway were tested in cells after VANGL2 overexpression. Results: Van-Gogh-like 2 mRNA was significantly higher in 5-aza-treated RKO, LOVO and SW48, whereas no differences were found in SW480. Van-Gogh-like 2 was fully methylated in RKO, SW48, HCT116, DLD1 and Caco2; partially methylated in LOVO, LS174T and SW837; and unmethylated in SW480, SW620 and HT29. Higher expression of VANGL2 mRNA was found in the unmethylated cell lines. In CRC specimens (8.93% MSI), methylated VANGL2 was associated with MSI, higher grade, proximal colon location and BRAF mutation. Van-Gogh-like 2 overexpression in SW480 significantly decreased proliferation, colony formation and β-catenin levels. Conclusion: Van-Gogh-like 2 is frequently methylated in MSI-CRCs with BRAF mutation and may act as a tumour suppressor gene, counteracting WNT/β-catenin signaling.
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Affiliation(s)
- G Piazzi
- Department of Internal Medicine, Baylor Research Institute and Sammons Cancer Center, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA
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Malfertheiner P. [Is sequential eradication of Helicobacter pylori effective? Sequential treatment more effective than triple therapy in patients with clarithromycin resistance]. Dtsch Med Wochenschr 2013; 138:628. [PMID: 23512360 DOI: 10.1055/s-0032-1329041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- P Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Magdeburg, Germany
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Ganten T, Schott E, Galle P, Göhler T, Malfertheiner P, Stauber R, Buder R, Achilles K, Gerken G. Interim Analysis of Overall Survival Per Subgroups in the Prospective, Non-Interventional Insight Study in Patients with Hepatocellular Carcinoma Treated with Sorafenib. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33248-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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43
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Chow P, Ricke J, Malfertheiner P, Vilgrain V. Evolving clinical evidence for selective internal radiation therapy in hepatocellular carcinoma. EJC Suppl 2012. [DOI: 10.1016/s1359-6349(12)70038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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44
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Selgrad M, Malfertheiner P. Commentary: is Helicobacter pylori antibiotic resistance surveillance needed and how can it be delivered? Aliment Pharmacol Ther 2012; 36:197-8; discussion 198-9. [PMID: 22703454 DOI: 10.1111/j.1365-2036.2012.05135.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- M Selgrad
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
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Caro C, Schütte K, Pech M, Malfertheiner P, Meyer F. [Successful control of iatrogenic bleeding after endoscopic papillotomy by means of supraselective microcatheterisation and coiling in a patient with a suspicious tumour mass at the pancreatic head and atypical arteriohepatic perfusion (Michels Type IV)]. Zentralbl Chir 2012; 139:326-8. [PMID: 22565498 DOI: 10.1055/s-0031-1283919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C Caro
- Universitätsklinikum Magdeburg A. ö. R., Klinik für Gastroenterologie, Hepatologie & Infektiologie, Magdeburg, Deutschland
| | - K Schütte
- Universitätsklinikum Magdeburg A. ö. R., Klinik für Gastroenterologie, Hepatologie & Infektiologie, Magdeburg, Deutschland
| | - M Pech
- Universitätsklinikum Magdeburg A. ö. R., Klinik für Radiologie & Nuklearmedizin, Magdeburg, Deutschland
| | - P Malfertheiner
- Universitätsklinikum Magdeburg A. ö. R., Klinik für Gastroenterologie, Hepatologie & Infektiologie, Magdeburg, Deutschland
| | - F Meyer
- Universitätsklinikum Magdeburg A. ö. R., Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Magdeburg, Deutschland
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Abstract
Barrett's esophagus (BE) is one of the most common premalignant lesions in which normal squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium. Esophageal adenocarcinoma (EA) develops through progression from BE to low- and high-grade dysplasia (LGD/HGD) and to adenocarcinoma. It is widely accepted that inflammation can increase cancer risk, promoting tumor progression. Therefore, inflammation is regarded as the seventh hallmark of cancer. In recent years, the inflammation-cancer connection of Barrett's carcinogenesis has been intensively studied, unraveling genetic abnormalities. Besides genetic alterations, inflammation is also epigenetically linked to loss of protein expression through transcriptional silencing via promoter methylation. Key mediators linking inflammation and Barrett's carcinogenesis include reactive oxygen species (ROS), NFκB, inflammatory cytokines, prostaglandins, and specific microRNAs (miRNAs). Therefore, the decipherment of molecular pathways that contain these and novel inflammatory key mediators is of major importance for diagnosis, therapy, and prognosis. The detailed elucidation of the signaling molecules involved in Barrett's carcinogenesis will be important for the development of pharmaceutical inhibitors. We herein give an overview of the current knowledge of the inflammation-mediated genetic and epigenetic alterations involved in Barrett's carcinogenesis. We highlight the role of oxidative stress and deregulated DNA damage checkpoints besides the NFκB pathway.
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Affiliation(s)
- A Poehlmann
- Department of Pathology, Otto-von-Guericke University Magdeburg, Germany.
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Malfertheiner P. Evolution of GERD over 5 years: author’s reply. Aliment Pharmacol Ther 2012; 35:395-396. [DOI: 10.1111/j.1365-2036.2011.04961.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Malfertheiner P, Nocon M, Vieth M, Stolte M, Jaspersen D, Koelz HR, Labenz J, Leodolter A, Lind T, Richter K, Willich SN. Evolution of gastro-oesophageal reflux disease over 5 years under routine medical care--the ProGERD study. Aliment Pharmacol Ther 2012; 35:154-64. [PMID: 22070159 DOI: 10.1111/j.1365-2036.2011.04901.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The evolution of gastro-oesophageal reflux disease (GERD) under current management options remains uncertain. AIM To examine whether, depending on the initial presentation, non-erosive (NERD) and erosive reflux disease (ERD) without Barrett's oesophagus will progress to more severe disease under current routine care following the resolution of the initial condition. METHODS Patients with the primary symptom of heartburn were included at baseline, and stratified into non-erosive (NERD) and erosive reflux disease (ERD), LA grades A-D (Los Angeles classification). After a 2- to 8-week course with esomeprazole therapy to achieve endoscopic healing in ERD and symptom relief in NERD, patients were treated routinely at the discretion of their physician. We report oesophagitis status and the presence of endoscopic and confirmed Barrett's oesophagus after 5 years. RESULTS A total of 6215 patients were enrolled in the study of whom 2721 patients completed the 5-year follow-up. Progression, regression and stability of GERD severity were followed from baseline to 5 years. Only a few patients with NERD and mild/moderate ERD progressed to severe forms of ERD and even Barrett's oesophagus. Most patients remained stable or showed improvement in their oesophagitis; 5.9% of the NERD patients, 12.1% of LA grade A/B patients and 19.7% of LA grade C/D patients in whom no Barrett's oesophagus was recorded at baseline progressed to endoscopic or confirmed Barrett's oesophagus at 5 years. CONCLUSION Most GERD patients remain stable or improve over a 5-year observation period under current routine clinical care.
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Affiliation(s)
- P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany.
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Dinis-Ribeiro M, Areia M, de Vries AC, Marcos-Pinto R, Monteiro-Soares M, O'Connor A, Pereira C, Pimentel-Nunes P, Correia R, Ensari A, Dumonceau JM, Machado JC, Macedo G, Malfertheiner P, Matysiak-Budnik T, Megraud F, Miki K, O'Morain C, Peek RM, Ponchon T, Ristimaki A, Rembacken B, Carneiro F, Kuipers EJ. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy 2012; 44:74-94. [PMID: 22198778 PMCID: PMC3367502 DOI: 10.1055/s-0031-1291491] [Citation(s) in RCA: 451] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Atrophic gastritis, intestinal metaplasia, and epithelial dysplasia of the stomach are common and are associated with an increased risk for gastric cancer. In the absence of guidelines, there is wide disparity in the management of patients with these premalignant conditions. The European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter Study Group (EHSG), the European Society of Pathology (ESP) and the Sociedade Portuguesa de Endoscopia Digestiva (SPED) have therefore combined efforts to develop evidence-based guidelines on the management of patients with precancerous conditions and lesions of the stomach (termed MAPS). A multidisciplinary group of 63 experts from 24 countries developed these recommendations by means of repeat online voting and a meeting in June 2011 in Porto, Portugal. The recommendations emphasize the increased cancer risk in patients with gastric atrophy and metaplasia, and the need for adequate staging in the case of high grade dysplasia, and they focus on treatment and surveillance indications and methods.
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Affiliation(s)
- M. Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Portugal, Centre for Research in Health Technologies and Information Systems (CINTESIS), Medical Faculty, Porto, Portugal
| | - M. Areia
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Portugal, Centre for Research in Health Technologies and Information Systems (CINTESIS), Medical Faculty, Porto, Portugal
| | - A. C. de Vries
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
| | - R. Marcos-Pinto
- Department of Gastroenterology, Centro Hospitalar do Porto, Portugal, Institute of Biomedical Sciences, University of Porto (ICBAS/UP), Porto, Portugal
| | - M. Monteiro-Soares
- Centre for Research in Health Technologies and Information Systems (CINTESIS), Medical Faculty, Porto, Portugal
| | - A. O'Connor
- AMNCH/TCD, Adelaide and Meath Hospital/Trinity College, Gastroenterology Department, Dublin, Ireland
| | - C. Pereira
- Molecular Oncology Research Group, Portuguese Oncology Institute of Porto, Portugal
| | - P. Pimentel-Nunes
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Portugal
| | - R. Correia
- Centre for Research in Health Technologies and Information Systems (CINTESIS), Medical Faculty, Porto, Portugal
| | - A. Ensari
- Department of Pathology, Ankara University Medical School, Ankara, Turkey
| | - J. M. Dumonceau
- Département de Gastroénterologie et d'Hépatopancréatologie, H.U.G. Hôpital Cantonal, Geneve, Switzerland
| | - J. C. Machado
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
| | - G. Macedo
- Department of Gastroenterology, Centro Hospitalar S. João/Medical Faculty, Porto, Portugal
| | - P. Malfertheiner
- Klinik der Gasroenterologie, Hepatologie und Infektologie, Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| | - T. Matysiak-Budnik
- Service d'Hépato-Gastroentérologie, Hôtel Dieu, CHU de Nantes, Nantes, France
| | - F. Megraud
- Inserm U853 & Université Bordeaux, Laboratoire de Bacteriologie, Bordeaux, France
| | - K. Miki
- Japan Research Foundation of Prediction, Diagnosis and Therapy for Gastric Cancer (JRF PDT GC), Tokyo, Japan
| | - C. O'Morain
- AMNCH/TCD, Adelaide and Meath Hospital/Trinity College, Gastroenterology Department, Dublin, Ireland
| | - R. M. Peek
- Division of Gastroenterology, Vanderbilt University School of Medicine, Nashville, USA
| | - T. Ponchon
- Hôpital Edouard Herriot, Department of Digestive Diseases, Lyon, France
| | - A. Ristimaki
- Department of Pathology, HUSLAB and Haartman Institute, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland., Genome-Scale Biology, Research Program Unit, University of Helsinki, Helsinki, Finland
| | - B. Rembacken
- Centre for Digestive Diseases, The General Infirmary at Leeds, Leeds, United Kingdom
| | - F. Carneiro
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal, Department of Pathology, Medical Faculty/Centro Hospitalar S. João, Porto, Portugal
| | - E. J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
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50
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Dinis-Ribeiro M, Areia M, de Vries AC, Marcos-Pinto R, Monteiro-Soares M, O’Connor A, Pereira C, Pimentel-Nunes P, Correia R, Ensari A, Dumonceau JM, Machado JC, Macedo G, Malfertheiner P, Matysiak-Budnik T, Megraud F, Miki K, O’Morain C, Peek RM, Ponchon T, Ristimaki A, Rembacken B, Carneiro F, Kuipers EJ. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Virchows Arch 2011; 460:19-46. [DOI: 10.1007/s00428-011-1177-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 10/13/2011] [Accepted: 10/19/2011] [Indexed: 12/16/2022]
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