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Llach J, Salces I, Guerra A, Peñas B, Rodriguez-Alcalde D, Redondo PD, Cubiella J, Murcia Ó, Escalante M, Gratacós-Ginès J, Pocurull A, Daca-Alvarez M, Luzko I, Sánchez A, Herrera-Pariente C, Ocaña T, Carballal S, Elizalde I, Castellví-Bel S, Fernández-Esparrach G, Castells A, Balaguer F, Moreira L. Endoscopic surveillance for familial intestinal gastric cancer in low-incidence areas: An effective strategy. Int J Cancer 2024; 154:124-132. [PMID: 37676082 DOI: 10.1002/ijc.34714] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
While clinical practice guidelines for hereditary diffuse gastric cancer are well established, there is no consensus on the approach for familial intestinal gastric cancer (FIGC). In low-incidence gastric cancer (GC) areas such as the United States or most European countries, there are no evidence-based recommendations on endoscopic assessment in FIGC families. We aim to describe the yield of GC surveillance in these families, and to identify epidemiological risk factors for the development of GC and its precursor lesions. This is a multicenter observational study involving nine tertiary Spanish hospitals, in which all individuals fulfilling FIGC criteria who underwent endoscopic surveillance were included between 1991 and 2020. Forty-one healthy individuals of 31 families were recruited. The median number of upper gastrointestinal endoscopies per individual was 3 (interquartile range, IQR, 1-4). The median interval time between tests was 2 years (IQR 1.5-2.5), and the median follow-up was 9 years (IQR 3-14.5). In 18 (43.9%) subjects, a precursor lesion of GC was found during follow-up, and in 2 (4.9%), an early GC was identified, in which curative treatment was offered. Helicobacter pylori (Hp) infection proved to be independently associated with an increased risk of developing precursor lesions or GC, adjusted by age, gender and follow-up, with an Odds Ratio of 6.443 (1.36-30.6, P value .019). We present the first outcomes that support endoscopic surveillance with biopsies and detection of Hp in FIGC families, although the periodicity has yet to be defined.
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Affiliation(s)
- Joan Llach
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | | | - Ana Guerra
- Complejo Hospitalario de Navarra, Navarra, Spain
| | - Beatriz Peñas
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Joaquin Cubiella
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Grupo de Investigación en Oncología Digestiva-Ourense, Hospital Universitario de Ourense, Ourense, Spain
| | - Óscar Murcia
- Hospital General Universitario de Alicante, Valencia, Spain
| | | | - Jordi Gratacós-Ginès
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Anna Pocurull
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Maria Daca-Alvarez
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Irina Luzko
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ariadna Sánchez
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Cristina Herrera-Pariente
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Teresa Ocaña
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Sabela Carballal
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Ignasi Elizalde
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Sergi Castellví-Bel
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Glòria Fernández-Esparrach
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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2
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Uchima H, Da Fieno A, Bonilla A, Melo-Borges J, Sánchez-Montes C, Cuatrecasas M, Córdova H, Elizalde I, Rakislova N, Gratacós-Ginès J, Bayarri C, Casanova G, Ginès À, Llach J, Balaguer F, Fernández-Esparrach G. Serological levels of IGF-1 and IGFBP-3 in patients with Barrett's esophagus and esophageal adenocarcinoma: Longitudinal study. Gastroenterol Hepatol 2023; 46:360-368. [PMID: 36179948 DOI: 10.1016/j.gastrohep.2022.09.005] [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] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Barrett's esophagus (BE) is an entity with a known histological progression to malignancy. The insulin-like growth factor (IGF) system is involved in the carcinogenesis through obesity-related mechanisms that include IGF and it has been associated with several types of cancer. OBJECTIVES To evaluate the serological levels of IGF-1 and IGFBP-3 in patients with BE and esophageal adenocarcinoma. PATIENTS AND METHODS Prospective study of patients with BE and esophageal adenocarcinoma who underwent upper endoscopy between September 2012 and December 2015. A baseline determination of IGF-1 and IGFBP-3 was performed. We included a control group of patients without BE. RESULTS One hundred sixteen patients were included: 36 controls, 62 with BE (42 without dysplasia and 20 with dysplasia) and 18 with adenocarcinoma. IGF-1 and IGF-1/IGFBP-3 molar ratio showed a progression to high levels in BE and adenocarcinoma than in controls (IGF-1: 135.55±66.07ng/ml, 148.33±81.5ng/ml, 108.19±46.69ng/ml, respectively; P=.049) (molar ratio: 0.23±0.91, 0.29±0.11, 0.19±0.06, respectively; P=.001), without differences between the histological types of BE. Fifty-four out of the 65 patients with BE were followed up (median of 58.50 months, range 12-113) and 11 of them (20.4%) presented progression to low-grade dysplasia (n=8) or high-grade dysplasia/adenocarcinoma (n=3), without differences in the IGF system compared with patients without progression. CONCLUSIONS Patients with BE and esophageal adenocarcinoma have changes in the IGF system although the serological levels of IGF-1 and IGFBP-3 do not correlate with histological progression of BE.
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Affiliation(s)
- Hugo Uchima
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Angella Da Fieno
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Araceli Bonilla
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Jordana Melo-Borges
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Cristina Sánchez-Montes
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Míriam Cuatrecasas
- Servicio de Anatomía Patológica, Hospital Clinic de Barcelona, Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España
| | - Ignasi Elizalde
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Natalia Rakislova
- Servicio de Anatomía Patológica, Hospital Clinic de Barcelona, Barcelona, España
| | - Jordi Gratacós-Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Carolina Bayarri
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Gherzon Casanova
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Àngels Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Josep Llach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Francesc Balaguer
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Glòria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España.
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Companioni O, Bonet C, García N, Ramírez-Lázaro MJ, Lario S, Mendoza J, Adrados MM, Poves E, Espinosa L, Pozo-Kreilinger JJ, Ortega L, Bujanda L, Cosme A, Ferrández A, Muñoz G, Cuatrecasas M, Elizalde I, Andreu V, Paules MJ, Madrigal B, Barrio J, Berdasco M, Calvet X, Sanz-Anquela JM, Gisbert JP, González CA, Sala N. Genetic variation analysis in a follow-up study of gastric cancer precursor lesions confirms the association of MUC2
variants with the evolution of the lesions and identifies a significant association with NFKB1
and CD14. Int J Cancer 2018; 143:2777-2786. [PMID: 30171605 DOI: 10.1002/ijc.31839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Osmel Companioni
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program; Catalan Institute of Oncology (ICO)-IDIBELL; Barcelona Spain
| | - Catalina Bonet
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program; Catalan Institute of Oncology (ICO)-IDIBELL; Barcelona Spain
| | - Nadia García
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program; Catalan Institute of Oncology (ICO)-IDIBELL; Barcelona Spain
- Translational Research Laboratory; Catalan Institute of Oncology (ICO)-IDIBELL; Barcelona Spain
| | - María José Ramírez-Lázaro
- Departament of Medicine, Digestive Diseases Service; Institut Universitari Parc Taulí, Sabadell, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Spain
| | - Sergio Lario
- Departament of Medicine, Digestive Diseases Service; Institut Universitari Parc Taulí, Sabadell, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Spain
| | - Jorge Mendoza
- Department of Gastroenterology; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and CIBEREHD; Madrid Spain
| | - Mª Magdalena Adrados
- Department of Pathology; Hospital Universitario de la Princesa, IIS-IP; Madrid, Spain
| | - Elvira Poves
- Department of Gastroenterology; Hospital Universitario Príncipe de Asturias; Alcalá de Henares Spain
| | - Laura Espinosa
- Department of Gastroenterology; Hospital Universitario Príncipe de Asturias; Alcalá de Henares Spain
| | | | - Luís Ortega
- Department of Pathology; Hospital Clínico San Carlos; Madrid Spain
| | - Luis Bujanda
- Department of Pathology and Hospital Donostia/Instituto Biodonostia; Universidad del País Vasco (UPV/EHU), and CIBEREHD; San Sebastián Spain
| | - Angel Cosme
- Department of Gastroenterology; Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), and CIBEREHD; San Sebastián Spain
| | - Angel Ferrández
- Department of Gastroenterology and Hospital Clínico Universitario Lozano Blesa Zaragoza, and CIBEREHD; Spain
| | - Guillermo Muñoz
- Department of Pathology; Hospital Clínico Universitario Lozano Blesa, Zaragoza, and CIBEREHD; Spain
| | - Miriam Cuatrecasas
- Department of Pathology; Hospital Clínic de Barcelona, IDIBAPS and CIBEREHD, and Universitat de Barcelona; Spain
| | - Ignasi Elizalde
- Department of Gastroenterology; Hospital Clínic de Barcelona, IDIBAPS and CIBEREHD; Spain
| | - Victoria Andreu
- Department of Gastroenterology; Hospital de Viladecans; Spain
| | - Mª José Paules
- Department of Pathology; Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat; Spain
| | - Beatriz Madrigal
- Department of Pathology; Hospital Universitario Río Hortega; Valladolid Spain
| | - Jesús Barrio
- Department of Gastroenterology; Hospital Universitario Río Hortega; Valladolid Spain
| | - María Berdasco
- Cancer Epigenetics and Biology Program, IDIBELL; Barcelona Spain
| | - Xavier Calvet
- Departament of Medicine, Digestive Diseases Service; Institut Universitari Parc Taulí, Sabadell, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Spain
| | - José Miguel Sanz-Anquela
- Department of Pathology; Hospital “Principe de Asturias” and University of Alcalá; Alcalá de Henares Spain
| | - Javier P. Gisbert
- Department of Gastroenterology; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and CIBEREHD; Madrid Spain
| | - Carlos A. González
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program; Catalan Institute of Oncology (ICO)-IDIBELL; Barcelona Spain
| | - Núria Sala
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program; Catalan Institute of Oncology (ICO)-IDIBELL; Barcelona Spain
- Translational Research Laboratory; Catalan Institute of Oncology (ICO)-IDIBELL; Barcelona Spain
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González CA, Sanz-Anquela JM, Companioni O, Bonet C, Berdasco M, López C, Mendoza J, Martín-Arranz MD, Rey E, Poves E, Espinosa L, Barrio J, Torres MÁ, Cuatrecasas M, Elizalde I, Bujanda L, Garmendia M, Ferrández Á, Muñoz G, Andreu V, Paules MJ, Lario S, Ramírez MJ, Gisbert JP. Incomplete type of intestinal metaplasia has the highest risk to progress to gastric cancer: results of the Spanish follow-up multicenter study. J Gastroenterol Hepatol 2016; 31:953-8. [PMID: 26630310 DOI: 10.1111/jgh.13249] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 09/28/2015] [Revised: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM In high or moderate risk populations, periodic surveillance of patients at risk of progression from gastric precursor lesions (PL) to gastric cancer (GC) is the most effective strategy for reducing the burden of GC. Incomplete type of intestinal metaplasia (IIM) may be considered as the best candidate, but it is still controversial and more research is needed. To further assess the progression of subtypes of IM as predictors of GC occurrence. METHODS A follow-up study was carried-out including 649 patients, diagnosed with PL between 1995-2004 in 9 participating hospitals from Spain, and who repeated the biopsy during 2011-2013. Medical information and habits were collected through a questionnaire. Based on morphology, IM was sub-classified as complete (small intestinal type, CIM) and incomplete (colonic type, IIM). Analyses were done using Cox (HR) models. RESULTS At baseline, 24% of patients had atrophic gastritis, 38% CIM, 34% IIM, and 4% dysplasia. Mean follow-up was 12 years. 24 patients (3.7%) developed a gastric adenocarcinoma during follow-up. The incidence rate of GC was 2.76 and 5.76 per 1,000 person-years for those with CIM and IIM, respectively. The HR of progression to CG was 2.75 (95% CI 1.06-6.26) for those with IIM compared with those with CIM at baseline, after adjusting for sex, age, smoking, family history of GC and use of NSAIDs. CONCLUSIONS IIM is the PL with highest risk to progress to GC. Sub-typing of IM is a valid procedure for the identification of high risk patients that require more intensive surveillance.
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Affiliation(s)
- Carlos A González
- Unit of Nutrition, Environment and Cancer, Institut Català d'Oncología, Barcelona, Spain
| | - José Miguel Sanz-Anquela
- University of Alcalá (Department of Medicine and Medical Especialties), Department of Pathology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Osmel Companioni
- Unit of Nutrition, Environment and Cancer, Institut Català d'Oncología, Barcelona, Spain
| | - Catalina Bonet
- Unit of Nutrition, Environment and Cancer, Institut Català d'Oncología, Barcelona, Spain
| | - María Berdasco
- Cancer Epigenetics and Biology Program, IDIBELL, Barcelona
| | - Consuelo López
- Department of Pathology, Hospital Universitario de la Princesa, IIS-IP, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid
| | - Jorge Mendoza
- Department of Gastroenterology, Hospital Universitario de la Princesa, IIS-IP, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid
| | | | - Enrique Rey
- Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain
| | - Elvira Poves
- Department of Gastroenterology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares
| | - Laura Espinosa
- Department of Gastroenterology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares
| | - Jesús Barrio
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - M Ángeles Torres
- Department of Pathology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Miriam Cuatrecasas
- Department of Pathology, Hospital Clínic de Barcelona, IDIBAPS and CIBEREHD, and Universitat de Barcelona, Spain
| | - Ignasi Elizalde
- Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS and CIBEREHD, Spain
| | - Luis Bujanda
- Department of Pathology, and Department of Gastroenterology. Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU). CIBEREHD, San Sebastián, Spain
| | - Maddi Garmendia
- Department of Pathology, and Department of Gastroenterology. Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU). CIBEREHD, San Sebastián, Spain
| | - Ángel Ferrández
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Guillermo Muñoz
- Department of Pathology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, and CIBEREHD, Spain
| | - Victoria Andreu
- Department of Gastroenterology, Hospital de Viladecans, Spain
| | - M Jose Paules
- Department of Pathology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sergio Lario
- Departament of Medicine, Digestive Diseases Service, Institut Universitari Parc Taulí, Sabadell, and CIBEREHD, Spain
| | - M Jose Ramírez
- Departament of Medicine, Digestive Diseases Service, Institut Universitari Parc Taulí, Sabadell, and CIBEREHD, Spain
| | | | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de la Princesa, IIS-IP, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid
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5
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Rodríguez-D'Jesús A, Gordillo J, Uchima H, Araujo I, Saperas E, Elizalde I, Fernández-Esparrach G. [Prevalence and epidemiology of Barrett's esophagus in the province of Barcelona]. Gastroenterol Hepatol 2014; 37:397-401. [PMID: 24674710 DOI: 10.1016/j.gastrohep.2014.01.013] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The prevalence of Barrett's esophagus (BE) varies from 0.45% to 2.2% in patients who undergo upper endoscopy and is >12% when the indication is for reflux symptoms. The prevalence has progressively increased in recent years but is unknown in the population of the province of Barcelona. OBJECTIVES To determine the prevalence of BE and its epidemiological characteristics in our population. PATIENTS AND METHODS We prospectively evaluated patients referred to the Endoscopy Unit of Hospital Clinic and Hospital General de Catalunya for an upper endoscopy. We excluded patients with known BE, prior upper endoscopy, esophagogastric surgery or refusal to participate in the study. Demographic data, alcohol intake, Helicobacter pylori infection and consumption of antisecretory agents were recorded, among other information. Participants completed a standardized questionnaire to assess the presence of gastroesophageal reflux disease (GERD) symptoms and their severity. RESULTS Between July 2010 and July 2012, we included 200 patients (100 in each center). The mean age was 48.9 ± 15.6 years and the majority were women (n=120, 60%). Symptoms of GERD were present in 46 patients (23%) and some degree of esophagitis was present in 31 (15.5%). Infection by H. pylori was present in 29.7%. BE was found endoscopically in 14 (7%) patients, but was histologically confirmed in only 8 (4%). The only variable that correlated with the finding of BE was male sex. CONCLUSION The prevalence of BE in our environment is similar to that reported in Western countries. The absence of reflux symptoms does not rule out the possibility of BE.
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Affiliation(s)
| | - Jordi Gordillo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Hugo Uchima
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Isis Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Esteban Saperas
- Servicio de Digestivo, Hospital General de Catalunya, Barcelona, España
| | - Ignasi Elizalde
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España.
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6
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Vila JJ, Ruiz-Clavijo D, Fernández-Urién I, Martínez A, Kutz M, Elizalde I, Zozaya JM. Endoscopic retrieval of a proximally migrated pancreatic stent: variation of the lasso technique. Endoscopy 2010; 42 Suppl 2:E5-6. [PMID: 20066606 DOI: 10.1055/s-0029-1215418] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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: 12/10/2022]
Affiliation(s)
- J J Vila
- Endoscopy Unit, Department of Gastroenterology, Hospital de Navarra, Pamplona, Spain.
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7
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Vidal O, Metges JP, Elizalde I, Valentíni M, Volant A, Molina R, Castells A, Pera M. High preoperative serum vascular endothelial growth factor levels predict poor clinical outcome after curative resection of gastric cancer. Br J Surg 2009; 96:1443-51. [PMID: 19918848 DOI: 10.1002/bjs.6780] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tumour vascular endothelial growth factor (VEGF) and tumour urokinase-type plasminogen activator (uPA) are prognostic factors in gastric cancer but surgical specimens are required for testing. The prognostic value of preoperative serum VEGF (s-VEGF) and serum uPA (s-uPA) levels was evaluated in patients undergoing potentially curative (R0) gastric cancer resection. METHODS Concentrations of s-VEGF and s-uPA were measured 97 patients with gastric cancer and 20 controls. Angiogenesis was measured in vitro based on human endothelial cell tube formation. RESULTS Levels of s-VEGF were higher in patients with gastric cancer than controls (median 288 versus 189 pg/ml respectively; P = 0.002). They were associated with pathological tumour node metastasis (pTNM) stage, pT, pN, lymph node ratio and perineural invasion, and correlated with platelet counts. In multivariable analysis, s-VEGF over 320 pg/ml was the only preoperative predictor of both recurrence and disease-specific survival. Serum from patients with raised s-VEGF levels enhanced angiogenesis in vitro significantly more than serum from those with a s-VEGF level of 320 pg/ml or less. CONCLUSION High preoperative s-VEGF level is an independent prognostic factor for recurrence and survival after R0 resection of gastric cancer. This may provide a useful guide to decision making regarding neoadjuvant and adjuvant therapies.
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Affiliation(s)
- O Vidal
- Service of General and Digestive Surgery, Institut de Malalties Digestives i Metabolisme, Barcelona, Spain
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8
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Borobio E, Fernández-Urién I, Elizalde I, Jiménez Pérez FJ. Hiatal hernia and lesions of gastroesophageal reflux disease diagnosed by capsule endoscopy. Rev Esp Enferm Dig 2009; 101:355-356. [PMID: 19527082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- E Borobio
- Department of Gastroenterology, Hospital de Navarra, Pamplona, Spain
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9
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Vidal O, Metges JP, Soriano-Izquierdo A, Palacín A, Elizalde I, Castells A, Fondevila C, Robaszkiewiecz M, Volant A, Pera M. Prognostic value of angiogenesis in patients following curative resection of gastric cancer (GC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.9605] [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: 11/20/2022] Open
Affiliation(s)
- O. Vidal
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - J. P. Metges
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - A. Soriano-Izquierdo
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - A. Palacín
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - I. Elizalde
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - A. Castells
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - C. Fondevila
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - M. Robaszkiewiecz
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - A. Volant
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
| | - M. Pera
- IMD, Hosp Clinic, IDIBAPS, Barcelona, Spain; CHU Cavale Blanche et Morvan, Brest, France; IMD, Hosp Clínic, IDIBAPS, Barcelona, Spain
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10
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Iñarrairaegui M, Elizalde I, Martínez Echeverría A, Zozaya JM, Beloqui R, Martínez-Peñuela JM. Infección crónica por el VHC. An Sist Sanit Navar 2004. [DOI: 10.4321/s1137-66272004000400009] [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: 11/11/2022]
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11
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Elizalde I, Iñarrairaegui M, Rodríguez Gutierrez C, Zozaya JM. [Treatment of chronic hepatitis C virus infection]. An Sist Sanit Navar 2004; 27 Suppl 2:81-90. [PMID: 15381946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
At present the treatment of chronic hepatitis C virus infection is based on the combination of pegylated interferon (PEG-INF) and rivabirin (RBV) and basically attempts to eradicate the viral infection (sustained viral response). The pattern depends above all on the viral genotype, hence, patients with genotype 1, 4 and 5 require 48 weeks of treatment and high doses of RBV, while those with genotype 2 and 3 require 24 weeks of treatment and low doses of RBV. All patients with chronic C infection are possible candidates for antiviral therapy. However, given that the response to treatment is variable, that the treatment has secondary effects and supposes a high economic cost, it is recommendable in patients with hypertransaminasemia and moderate-severe chronic hepatitis in the histological study, as long as there are no counter-indications. This does not exclude other groups of patients who should be evaluated individually. In those patients with compensated hepatic cirrhosis, treatment can stabilise the disease and reduce the risk of complications appearing, although the rate of response is lower and some adverse effects are more frequent. In patients who have received previous antiviral treatment with standard interferon, alone or in association with RBV, without response to this or with response but later relapse, the decision on treatment must be individual. In patients with coinfection by human immunodeficiency virus (HIV), special attention must be paid to the degree of evolution of the disease due to HCV and to HIV, as well as the possible hepatoxicity of the antiretroviral treatment and the risk of secondary effects.
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Affiliation(s)
- I Elizalde
- Servicio de Aparato Digestivo, Hospital de Navarra, 31008 Pamplona, Spain
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12
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Iñarrairaegui M, Elizalde I, Martínez Echeverría A, Zozaya JM, Beloqui R, Martínez Peñuela JM. [Chronic hepatitis C virus infection]. An Sist Sanit Navar 2004; 27 Suppl 2:69-80. [PMID: 15381945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Following acute hepatitis C virus infection (HCV), a significant percentage of patients do not clear the virus and develop a chronic hepatitis C. The symptoms, when they exist, are usually unspecific. Besides, approximately one third of the patients present extrahepatic manifestations of the infection, basically due to the lymphotropism of HCV. Outstanding amongst these, due to their clear association with HCV, are mixed cryoglobulinaemia and the production of autoantibodies (autoAb). Other diseases such as non-Hodgkin lynphoma (NHL) or autoimmune thyroiditis do not have a clearly established association. Although the majority of patients with chronic hepatitis C have slight or moderately high levels and fluctuations of transaminases, as many as one third of those infected can show persistently normal levels of transaminases. The diagnosis of chronic HCV infection is based on serological tests, which detect the presence of antibodies against HCV, and on virological tests that detect RNA of the HCV, which confirm the existence of active infection. Finally, an important topic of chronic HCV infection, following diagnosis, is to ascertain the stage of fibrosis and the degree of inflammation, since both characteristics are very important for predicting the natural evolution and the need for treatment. Nowadays, this information can only be obtained through liver biopsy, which is recommended in patients with chronic HCV infection and high transaminases. Whether liver biopsy should be performed in patients with normal transaminases is still subject of controversy.
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Affiliation(s)
- M Iñarrairaegui
- Servicio de Aparato Digestivo, Hospital de Navarra, 31008 Pamplona, Spain.
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13
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Elizalde I, Iñarrairaegui M, Rodríguez Gutiérrez C, Zozaya JM. Tratamiento de la infección crónica por el VHC. An Sist Sanit Navar 2004. [DOI: 10.4321/s1137-66272004000400010] [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: 11/11/2022]
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14
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Martínez Echeverría A, Rodríguez Gutiérrez C, Elizalde I, Zozaya JM. [Acute hepatitis C virus infection]. An Sist Sanit Navar 2004; 27 Suppl 2:59-68. [PMID: 15381944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Acute hepatitis C virus infection produces clinical and biochemical features that is non-specific and indistinguishable from those caused by other hepatotropic viruses. The specific diagnosis of acute hepatitis C virus infection is based on the detection of serum RNA-HCV through a technique of PCR whose result will be positive after 1-2 weeks of the initial contact with the virus. The anti-bodies against HCV are detected later (after 7-8 weeks on average), and are not useful, as an isolated determination, in distinguishing acute infection from chronic infection or in clearing the virus (spontaneous or following treatment). Fifty-five to eighty-five percent of patients with acute HCV infection do not clear the virus and develop a chronic infection with risk of evolution to cirrhosis and of developing hepatocellular carcinoma. For this reason, the present tendency is to treat with interferon all those patients in whom RNA-HCV remains positive after 3-4 months following diagnosis of acute infection
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Affiliation(s)
- A Martínez Echeverría
- Servicio de Aparato Digestivo, Hospital García Orcoyen, 31200 Estella, Navarra, Spain
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15
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Martínez Echeverría A, Rodríguez Gutiérrez C, Elizalde I, Zozaya JM. Infección aguda por el VHC. An Sist Sanit Navar 2004. [DOI: 10.4321/s1137-66272004000400008] [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: 11/11/2022]
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16
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Sionis A, Elizalde I, Heras M, Casanovas N, Diez-Aja S, Martorell T, Lozano M, Perez S, Gonzalez J, Sanz G, Pique JM. Helicobacter pylorieradication improves prognosis of coronary artery disease through a mechanism not related with platelet activation. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81104-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: 10/26/2022]
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17
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Elizalde I, Borda F. [Current treatment of carcinoid tumor]. Gastroenterol Hepatol 2002; 25:508-13. [PMID: 12361534 DOI: 10.1016/s0210-5705(02)70302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- I Elizalde
- Servicio de Aparato Digestivo, Hospital de Navarra, Pamplona, España
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18
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Rodríguez C, Borda F, Elizalde I, Jiménez Pérez FJ, Carral D. How accurate is preoperative diagnosis by endoscopic biopsies in ampullary tumours? Rev Esp Enferm Dig 2002; 94:585-92. [PMID: 12647408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION The benign or malignant nature of ampullary tumours has prognostic and therapeutic implications. On the other hand the difficulty of reaching a correct preoperative diagnosis in these lesions is well known, even when we have a histological study obtained by endoscopic biopsies. MATERIAL AND METHODS We review all ERCP's in which biopsies of the papilla were taken, performed between January 1991 and September 2000. We analyse the concordance rate between preoperative diagnosis (endoscopic biopsies obtained during ERCP) and definitive diagnosis (surgical specimen) (n = 32), and the possible influence of previous sphincterotomy in our results. RESULTS In the 32 patients studied global accuracy between pre- and postsurgical diagnosis was 68.7%. This accuracy was markedly higher in the group with ampullary cancer (82.7%) than in the group with ampullary adenoma (50%) (p = 0.12). In the group of patients with sphincterotomy accuracy was 56.25% and increased up to 81.25% in the group of patients without sphincterotomy, although statistical significance was not reached (p = 0.25). CONCLUSIONS In our series, the accuracy of endoscopic biopsies is higher in the adenocarcinoma group than in the adenoma group, obtaining better results in patients without previous sphincterotomy. The impossibility of a preoperative and absolutely certain confirmation of the benign or malignant nature of ampullary tumours forces us to be cautious in deciding type of surgical resection.
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Affiliation(s)
- C Rodríguez
- Digestive Service, Hospital de Navarra, Pamplona, Spain
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19
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Elizalde JI, Piqué JM, Moreno V, Morillas JD, Elizalde I, Bujanda L, De Argila CM, Cosme A, Castiella A, Ros E. Influence of Helicobacter pylori infection and eradication on blood lipids and fibrinogen. Aliment Pharmacol Ther 2002; 16:577-86. [PMID: 11876713 DOI: 10.1046/j.1365-2036.2002.01202.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND An association between Helicobacter pylori infection and heart disease has been suggested. A potential mechanism may be inflammation-induced atherogenic changes of lipoproteins, but epidemiological studies have provided conflicting results. METHODS In a prospective multicentre study, 830 patients submitted for endoscopy and H. pylori testing were evaluated. Of the 686 H. pylori-positive patients, 487 received and 199 did not receive eradication treatment. Serum lipids and plasma fibrinogen were measured at baseline in all patients and 3 months later in those initially positive for H. pylori. RESULTS H. pylori had no influence on baseline lipid or fibrinogen levels. Increases in high-density lipoprotein cholesterol were observed in 368 patients who received eradication treatment and in 193 untreated patients: 0.06 mmol/L (P=0.000) and 0.07 mmol/L (P=0.009), respectively. Similar minor increases in total cholesterol and triglycerides occurred in both groups. Lipid changes were related to symptom relief and a reduction in smoking. Eradication therapy was associated with a minor decrease in plasma fibrinogen irrespective of the resolution of infection. CONCLUSIONS H. pylori has no influence on blood lipids or fibrinogen. Both the eradication of infection and symptomatic treatment without eradication are associated with minor lipid changes related to symptom relief and lifestyle modifications. Thus, the inflammatory changes associated with H. pylori are unlikely to affect lipoprotein or fibrinogen metabolism.
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Affiliation(s)
- J I Elizalde
- Gastroenterology Department, Institut Malaties Digestive, Hospital Clínic, Barcelona, Spain
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20
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Elizalde I, Zozaya JM. [Treatment of ascites in cirrhotic patients]. An Sist Sanit Navar 2001; 24:327-37. [PMID: 12876580 DOI: 10.23938/assn.0402] [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: 11/18/2022]
Abstract
Ascites is the most frequent complication of hepatic cirrhosis and its appearance brings a reduction of survival. The treatment aims to mobilise the intraperitoneal liquid and to prevent its reaccumulation. The first step of treatment includes rest in bed, a hyposodic and spironolactone diet, alone or in combination with furosemide or torasemide. However, 10-20% of patients do not respond to treatment or develop adverse effects that limit its use, which is termed refractory ascites. These patients must be considered as possible candidates for a liver transplant and, when this is not possible, the chosen treatment is total paracentesis with an intravenous infusion of albumin. In patients who do not tolerate paracentesis, or who require its realisation with great frequency, other therapeutic options can be evaluated, such as surgical anastomoses, intrahepatic portosystemic percutaneous derivation and, in the final instance, peritoneo-venous shunt.
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Affiliation(s)
- I Elizalde
- Servicio de Aparato Digestivo, Hospital de Navarra, Pamplona
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21
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Elizalde I, Zozaya JM, Rodríguez C, Carral D, Jiménez FJ, Borda F. [Upper digestive haemorrhage due to Mallory-Weiss syndrome. Role of endoscopic sclerotherapy]. An Sist Sanit Navar 2001; 24:301-6. [PMID: 12876577 DOI: 10.23938/assn.0399] [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: 11/18/2022]
Abstract
BACKGROUND Although Mallory-Weiss syndrome is responsible for between 0.5 and 17% of the cases of upper digestive haemorrhage, the information existing on the endoscopic treatment of this syndrome is scarce. MATERIAL AND METHODS We made a retrospective study of 71 patients with haemorrhage due to Mallory-Weiss syndrome, dividing them into two groups according to the treatment they had received (medical or medical-endoscopic). Hence, 60 patients (30 with clean laceration, 9 with signs of prior haemostasia and 21 with fresh clotting) had been treated with procinetics and/or antisecretories alone, while the 11 remaining (8 with active haemorrhage, 2 with visible vessel and 1 with fresh clotting) had also received endoscopic treatment with sclerotherapy. We compared the clinical and analytical characteristics and the evolution of both groups of patients, analysing the data by means of the Mann-Whitney U and the chi 2 test. RESULTS The endoscopic sclerosis group showed maelenas more frequently and more severe analytical data of haemorrhage (p<0.01). Endoscopic sclerosis brought initial control of the haemorrhage in all the patients, with a low index of haemorrhage relapse, similar to the group receiving exclusively medical treatment. CONCLUSIONS In our series, the patients with Mallory-Weiss syndrome with active bleeding or visible vessel presented a haemorrhage with a greater clinical and analytical repercussion. In this group of patients, endoscopic sclerotherapy controlled the haemorrhage and/or prevented rebleeding, in the absence of complications.
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Affiliation(s)
- I Elizalde
- Servicio de Aparato Digestivo, Hospital de Navarra, 31008 Pamplona
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22
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Elizalde I, Borda F. [Should Helicobacter pylori be eradicated in patients with functional dyspepsia?]. Gastroenterol Hepatol 2000; 23 Suppl 2:43-6. [PMID: 11968334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- I Elizalde
- Servicio de Aparato Digestivo, Hospital de Navarra, Pamplona
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23
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Borda F, Echarri A, Elizalde I, Martínez A. [Dyspepsia and infection by Helicobacter pylori: the view of the digestologist]. An Sist Sanit Navar 1998; 21:85-7. [PMID: 12891424 DOI: 10.23938/assn.0655] [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: 11/18/2022]
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24
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Andreu V, Elizalde I, Mallafré C, Caballería J, Salmerón JM, Sans M, Mas A, Bruguera M, Rodś J. Plexiform neurofibromatosis and angiosarcoma of the liver in von Recklinghausen disease. Am J Gastroenterol 1997; 92:1229-30. [PMID: 9219811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- V Andreu
- Department of Pathology, Hospital Clńic i Provincial, University of Barcelona, Spain
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25
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Bordas JM, Elizalde I, Llach J, Mondelo F, Bataller R, Terés J. Biliary reflux due to sphincter of Oddi ablation: a new pathogenetic explanation for long-term major biliary symptoms after endoscopic-sphincterotomy. Endoscopy 1996; 28:642. [PMID: 8911818 DOI: 10.1055/s-2007-1005568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J M Bordas
- Digestive Endoscopy Section, Hospital Clinic, University of Barcelona, Spain
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26
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Pastor P, Moitinho E, Elizalde I, Cirera I, Tolosa E. Reversible oral-facial dyskinesia in a patient receiving ciprofloxacin hydrochloride. J Neurol 1996; 243:616-7. [PMID: 8865032 DOI: 10.1007/bf00900953] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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27
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Casadevall M, Piqué JM, Cirera I, Goldin E, Elizalde I, Panés J, Martínez-Cuesta MA, Bosch J, Terés J, Rodés J. Increased blood hemoglobin attenuates splanchnic vasodilation in portal-hypertensive rats by nitric oxide inactivation. Gastroenterology 1996; 110:1156-65. [PMID: 8613005 DOI: 10.1053/gast.1996.v110.pm8613005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND & AIMS Nitric oxide, which is quenched by hemoglobin, has been implicated in the pathogenesis of portal hypertension. The aim of this study was to investigate the effects of increasing blood hemoglobin concentration by erythropoietin treatment on the gastrointestinal vasodilation associated with portal hypertension. METHODS Portal-hypertensive and sham-operated rats treated with erythropoietin were studied 2 weeks after surgery. Hemodynamic and rheological parameters were measured in baseline conditions and after N(G)-nitro-L-arginine methyl ester (L-NAME) or sodium nitroprusside treatment. RESULTS In portal-hypertensive rats, erythropoietin attenuated the increase in gastric mucosal and superior mesenteric artery blood flows and the decrease in arterial blood pressure and splanchnic vascular resistances. Those parameters were not affected by erythropoietin in sham-operated rats. A direct vascular effect of erythropoietin was ruled out by the lack of changes in blood pressure or mesenteric blood flow after intravenous erythropoietin administration and by a similar in vitro relaxation to acetylcholine in mesenteric artery rings. In portal-hypertensive rats, erythropoietin blunted the blood pressure response to sodium nitroprusside and attenuated the gastric and mesenteric blood flow response to L-NAME. CONCLUSIONS Gastrointestinal vasodilation associated with portal hypertension can be attenuated by increasing blood hemoglobin concentration. Inactivation of overproduced NO by hemoglobin may account for this effect.
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Affiliation(s)
- M Casadevall
- Gastroenterology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
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28
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Sort P, Elizalde I, Llach I, Feu F, Garcia-Pagan JC, Salmeron JM, Mas A, Bosch J, Bordas JM, Rodes J. Duodenal variceal bleeding treated with a transjugular intrahepatic portosystemic shunt. Endoscopy 1995; 27:626-7. [PMID: 8608762 DOI: 10.1055/s-2007-1005773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- P Sort
- Liver Unit, Hospital Clinic de Barcelona, Spain
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Nieto I, Llach J, Bordas JM, Mondelo F, Elizalde I, Bataller R, Terés J. [Endoscopic gastrointestinal findings in patients with human immunodeficiency virus infection]. Gastroenterol Hepatol 1995; 18:57-60. [PMID: 7621275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
From January 1992 to August 1993, 150 endoscopies (114 fiber gastroscopies, 29 fiber colonoscopies and 7 CPRE) were carried out in a total of 142 anti HIV positive patients. The most frequent clinical manifestations leading to the exploration were dysphagia, epigastric pain, diarrhea and upper or lower gastrointestinal bleeding. Endoscopic alterations were observed in most of the exploration although specific diagnosis was only achieved in approximately one third of the patients with the most frequent being esophagitis by Candida and CMV (21% and 5%, respectively in the fiber gastroscopies performed). Digestive manifestations were varied in the patients in whom esophagitis by Candida was diagnosed while dysphagia and diarrhea were the symptoms commonly observed in the patients with esophagitis or colitis by CMV. The diagnostic profitability of endoscopy was high in patients presenting dysphagia, diarrhea, gastrointestinal bleeding or in those in whom endoscopy was performed for tumoral staging or to evaluate the possible existence of manifestations secondary to the presence of portal hypertension.
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Affiliation(s)
- I Nieto
- Servicios de Gastroenterología, Hospital Clínic i Provincial, Barcelona
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