In order to investigate the mechanism of Xiaokuiling prescription (XKL) in the treatment of Helicobacter pylori (HP) associated duodenal ulcer (DU) and the pathophysiologic role of heat shock proteins (HSPs) in the he...In order to investigate the mechanism of Xiaokuiling prescription (XKL) in the treatment of Helicobacter pylori (HP) associated duodenal ulcer (DU) and the pathophysiologic role of heat shock proteins (HSPs) in the healing of ulcer, the expression of HSP 72 and HSP B in gastric mucosa was detected by using SABC immunohistochemistry method and processed by micro image analysis system. The method of Western blotting was used to measure the contents of HSP 72 and HSP B in the tissue emulsion of gastric mucosa. The results were as follows: (1) HSP 72 expression of the gastric mucosa in the treated group was obviously increased as compared with that in the control group ( P <0.05); (2) HSP B expression of the gastric mucosa in the treated group was significantly decreased as compared with that in the control group ( P <0.01). It was suggested that the increased expression of HSP 72 and the elimination of HP might be related to the mechanism of action of XKL. HSPs might play an pathological and physiological role in the process of healing of gastric ulcer.展开更多
BACKGROUND Acute gastrointestinal bleeding(GIB)is a life-threatening medical emergency with high morbidity and mortality.Transcatheter embolization with endovascular coils under digital subtraction angiography guidanc...BACKGROUND Acute gastrointestinal bleeding(GIB)is a life-threatening medical emergency with high morbidity and mortality.Transcatheter embolization with endovascular coils under digital subtraction angiography guidance is a common and effective method for the treatment of GIB with high technical success rates.Duodenal ulcers caused by coils wiggled from the branch of the gastroduodenal artery,which is a rare complication,have not previously been reported in a patient with right intrathoracic stomach.CASE SUMMARY A 62-year-old man had undergone thoracoscopy-assisted radical resection of esophageal cancer and gastroesophageal anastomosis 3 years ago,resulting in right intrathoracic stomach.He was admitted to the hospital 15 mo ago for dizziness and suffered acute GIB during his stay.Interventional surgery was urgently performed to embolize the branch of the gastroduodenal artery with endovascular coils.After 15 mo,the patient was re-admitted with a chief complaint of melena for 2 d,esophagogastroduodenoscopy and abdominal computed tomography revealed that some endovascular coils had migrated into the duodenal bulb,leading to a deep ulcer.Bleeding was controlled after conservative treatment.Seven months later,duodenal balloon dilatation was performed to relieve the stenosis after the removal of a few coils,and the patient was safely discharged with only one coil retained in the duodenum due to difficulties in complete removal and risk of bleeding.Mild melena recurred once during the long-term follow-up.CONCLUSION Although rare,coil wiggle after interventional therapy requires careful attention,effective precautionary measures,and more secure alternative treatment methods.展开更多
BACKGROUND A post-bulbar duodenal ulcer(PBDU)is an ulcer in the duodenum that is distal to the duodenal bulb.PBDU may coexist with a synchronous posterior ulcer in rare occurrences,resulting in a kissing ulcer(KU).Duo...BACKGROUND A post-bulbar duodenal ulcer(PBDU)is an ulcer in the duodenum that is distal to the duodenal bulb.PBDU may coexist with a synchronous posterior ulcer in rare occurrences,resulting in a kissing ulcer(KU).Duodenocaval fistula(DCF)is another uncommon but potentially fatal complication related to PBDU.There is limited knowledge of the scenarios in which PBDU is complicated by KU and DCF simultaneously.CASE SUMMARY A 22-year-old man was admitted to the emergency department with abdominal pain,stiffness,and vomiting.The X-ray showed pneumoperitoneum,suggesting a perforated viscus.Laparotomy revealed a KU with anterior perforation and a DCF.After Kocherization,venorrahphy was used to control caval bleeding.Due to the critical condition of the patient,only primary duodenorrahphy with gastrojejunostomy was performed as a damage control strategy.However,later,the patient developed obstructive jaundice and leakage,and two additional jejunal perforations were detected.Due to the poor condition of the duodenum and the involvement of the ampulla in the posterior ulcer,neither primary repair nor pancreatic-free duodenectomy and ampull-oplasty/ampullary reimplantation were considered viable;therefore,an emergency pancreaticoduodenectomy was performed,along with resection and anastomosis of the two jejunal perforations.The patient had a smooth recovery after surgery and was discharged after 27 d.CONCLUSION The timely diagnosis of PBDU and radical surgery can aid in the smooth recovery of patients,even in the most complex cases.展开更多
Objective: To observe the clinical efficacy of Yunnan Baiyao (云南白药, YNBY) combined with antibiotics in treating Helicobacter pylori (HP) related duodenal ulcer (DU). Methods: Eighty two HP positive DU patients wer...Objective: To observe the clinical efficacy of Yunnan Baiyao (云南白药, YNBY) combined with antibiotics in treating Helicobacter pylori (HP) related duodenal ulcer (DU). Methods: Eighty two HP positive DU patients were randomly divided into two groups: Treated group (44 cases) used YNBY plus amoxicillin and metronidazole; control group (38 cases) used de nol plus amoxicillin and metronidazole). Results: After a 2 week treatment course, the effect of epigastric pain relief was 68.3% in treated group, and 44.4% in control group, the difference between them was significant ( P <0.05). Marked effect in acid regurgitation and belching relief was observed in both groups. The rate of DU healing in treated and control group was respectively 88.6% and 89.5%; the clearance of HP 84.1% and 89.5%; and the side effects 4.5% and 13.5%, with insignificant difference between these two groups. Conclusion: YNBY combined with antibiotics in treating DU, and clearance of HP is an economic, safe and effective therapy.展开更多
BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades,but the incidence of reported peptic ulcer complications has not decreased.Perforating peptic ulcer(PPU)is a severe form of th...BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades,but the incidence of reported peptic ulcer complications has not decreased.Perforating peptic ulcer(PPU)is a severe form of the disease.AIM To assess trends in the incidence,presentation,and outcome of PPU over a period of 40 years.METHODS This was a single-centre,retrospective,cohort study of all patients admitted to Levanger Hospital,Norway,with PPU from 1978 to 2017.The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases(ICD),revision 8,ICD-9,and ICD-10 codes for perforated gastric and duodenal ulcers.We reviewed the medical records of the patients to retrieve data.Vital statistics were available for all patients.The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable,and sex,age,and calendar year from 1978 to 2017 as covariates.Relative survival analysis was performed to compare long-term survival over the four decades.RESULTS Two hundred and nine patients were evaluated,including 113(54%)men.Fortysix(22%)patients were older than 80 years.Median age increased from the first to the last decade(from 63 to 72 years).The incidence rate increased with increasing age,but we measured a decline in recent decades for both sexes.A significant increase in the use of acetylsalicylic acid,from 5%(2/38)to 18%(8/45),was observed during the study period.Comorbidity increased significantly over the 40 years of the study,with 22%(10/45)of the patients having an American Society of Anaesthesiologists(ASA)score 4-5 in the last decade,compared to 5%(2/38)in the first decade.Thirty-nine percent(81/209)of the patients had one or more postoperative complications.Both 100-day mortality and long-term survival were associated with ASA score,without significant variations between the decades.CONCLUSION Declining incidence rates occurred in recent years,but the patients were older and had more comorbidity.The ASA score was associated with both short-term mortality and long-term survival.展开更多
BACKGROUND:Dyspnea is one of the most common complaints facing the emergency medicine physician.Some of the gastrointestinal causes of dyspnea are self-limited and not lifethreatening,yet others are,and early diagnosi...BACKGROUND:Dyspnea is one of the most common complaints facing the emergency medicine physician.Some of the gastrointestinal causes of dyspnea are self-limited and not lifethreatening,yet others are,and early diagnosis and treatment are crucial.METHODS:In this article we presented one of these life-threatening conditions through a clinical description of a patient presenting with acute respiratory distress that was finally diagnosed to be the result of a perforated gastric ulcer.RESULTS:An emergent thoracotomy revealed a small ulcer with perforation in the fundus of the stomach.The patient was transferred after the operation to the intensive care unit and after a prolonged hospitalization discharged home.Biopsies taken from the ulcer showed diffuse inflammation,with no evidence of microorganisms or malignancy.CONCLUSION:Perforation of gastric and duodenal ulcers is a rare yet existing cause of dyspnea and respiratory failure and should be kept in mind by the emergency physician,especially when other more common causes are ruled out.展开更多
BACKGROUND Oesophagogastroduodenoscopy is the gold standard investigation for the upper gastrointestinal(UGI)tract.Orientation during endoscopy is challenging and United Kingdom training focusses on technical competen...BACKGROUND Oesophagogastroduodenoscopy is the gold standard investigation for the upper gastrointestinal(UGI)tract.Orientation during endoscopy is challenging and United Kingdom training focusses on technical competence and procedural safety.The reported location of UGI pathologies is crucial to post-endoscopic planning.AIM To evaluate endoscopists’ability to spatially orientate themselves within the UGI tract.METHODS A cross sectional descriptive study elicited,using an anonymised survey,the ability of endoscopists to orientate themselves within the UGI tract.The primary outcome was percentage of correct answers from all surveyed;secondary outcomes were percentage of correct answers from experienced vs novice endoscopists.Pearson’sχ2 test was applied to compare groups.RESULTS Of 188 respondents,86 were experienced endoscopists having completed over 1000 endoscopies.44.4%of respondents correctly identified the anterior stomach and 47.3%correctly identified the posterior of the second part of the duodenum(D2).Experienced endoscopists were significantly more likely than novice to identify the anterior stomach correctly[61.6%vs 31.3%,X2(1,n=188)=11.10,P=0.001].There was no significant difference between the two groups in identifying the posterior of D2.CONCLUSION The majority of endoscopists surveyed were unable to identify key landmarks within the UGI tract.Endoscopic orientation appears to improve with experience yet there are some areas still not well recognised.This has potential considerable impact on post-endoscopic management of patients with posterior duodenal ulcers being more likely to perforate and associated with a higher rebleeding risk.We suggest the development of a consensus statement on endoscopic description.展开更多
Helicobacter pylori(H.pylori)is a microaerophilic,Gram-negative,human gastric pathogen found usually in the mucous lining of stomach.It infects more than 50%of the world’s population and leads to gastroduodenal disea...Helicobacter pylori(H.pylori)is a microaerophilic,Gram-negative,human gastric pathogen found usually in the mucous lining of stomach.It infects more than 50%of the world’s population and leads to gastroduodenal diseases.The outcome of disease depends on mainly three factors:Host genetics,environment and bacterial factors.Among these,bacterial virulence factors such as cagA,vacA are well known for their role in disease outcomes.However,based on the global epidemiological results,none of the bacterial virulence(gene)factors was found to be associated with particular diseases like duodenal ulcer(DU)in all populations.Hence,substantial importance has been provided for research in strain-specific genes outside the cag pathogenicity island,especially genes located within the plasticity regions.dupA found within the plasticity regions was first demonstrated in 2005 and was proposed for duodenal ulcer development and reduced risk of gastric cancer in certain geographical regions.Due to the discrepancies in report from different parts of the world in DU development related to H.pylori virulence factor,dupA became an interesting area of research in elucidating the role of this gene in the disease progression.In this review,we shed light on the detailed information available on the polymorphisms in dupA and their clinical relevance.We have critically appraised several pertinent studies on dupA and discussed their merits and shortcomings.This review also highlights dupA gene as an important biomarker for DU in certain populations.展开更多
BACKGROUND Monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL)is a rare primary intestinal T-cell lymphoma,previously known as enteropathy-associated T-cell lymphoma type II.MEITL is an aggressive T-cell lym...BACKGROUND Monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL)is a rare primary intestinal T-cell lymphoma,previously known as enteropathy-associated T-cell lymphoma type II.MEITL is an aggressive T-cell lymphoma with a poor prognosis and high mortality rate.The known major complications of MEITL are intestinal perforation and obstruction.Here,we present a case of MEITL that was diagnosed following upper gastrointestinal bleeding from an ulcerative duodenal lesion,with recurrence-free survival for 5 years.CASE SUMMARY A 68-year-old female was admitted to our hospital with melena and mild anemia.An urgent esophagogastroduodenoscopy(EGD)revealed bleeding from an ulcerative lesion in the transverse part of the duodenum,for which hemostatic treatment was performed.MEITL was diagnosed following repeated biopsies of the lesion,and cyclophosphamide,doxorubicin,vincristine,and prednisone(CHOP)chemotherapy was administered.She achieved complete remission after eight full cycles of CHOP therapy.At the last follow-up examination,EGD revealed a scarred ulcer and 18Fluorodeoxyglucose(18FDG)positron emission tomography/computed tomography showed no abnormal FDG accumulation.The patient has been in complete remission for 68 mo after initial diagnosis.CONCLUSION To rule out MEITL,it is important to carefully perform histological examination when bleeding from a duodenal ulcer is observed.展开更多
BACKGROUND Polymorphisms of human leukocyte antigen(HLA)genes are suggested to increase the risk of gastric cancer(GC).AIM To investigate the HLA allele frequencies of patients with GC relative to a control group in t...BACKGROUND Polymorphisms of human leukocyte antigen(HLA)genes are suggested to increase the risk of gastric cancer(GC).AIM To investigate the HLA allele frequencies of patients with GC relative to a control group in terms of CagA+multiple(≥2)EPIYA-C repeats.METHODS The patient group comprised 94 patients[44 GC and 50 duodenal ulcer(DU)patients],and the control group comprised 86 individuals[(50 non-ulcer dyspepsia patients and 36 people with asymptomatic Helicobacter pylori(H.pylori)].Polymerase chain reaction was performed for the amplification of the H.pylori cagA gene and typing of EPIYA motifs.HLA sequence-specific oligonucleotide(SSO)typing was performed using Lifecodes SSO typing kits(HLA-A,HLA-B HLA-C,HLA-DRB1,and HLA-DQA1-B1 kits).RESULTS The comparison of GC cases in terms of CagA+multiple(≥2)EPIYA-C repeats showed that only the HLA-DQB1*06 allele[odds ratio(OR):0.37,P=0.036]was significantly lower,but significance was lost after correction(Pc=0.1845).The HLA-DQA1*01 allele had a high ratio in GC cases with multiple EPIYA-C repeats,but this was not significant in the univariate analysis.We compared allele frequencies in the DU cases alone and in GC and DU cases together using the same criterion,and none of the HLA alleles were significantly associated with GC or DU.Also,none of the alleles were detected as independent risk factors after the multivariate analysis.On the other hand,in a multivariate logistic regression with no discriminative criterion,HLA-DQA1*01(OR=1.848),HLA-DQB1*06(OR=1.821)and HLA-A*02(OR=1.579)alleles were detected as independent risk factors for GC and DU.CONCLUSION None of the HLA alleles were detected as independent risk factors in terms of CagA+multiple EPIYA-C repeats.However,HLA-DQA1*01,HLA-DQB1*0601,and HLA-A*2 were independent risk factors with no criterion in the multivariate analysis.We suggest that the association of these alleles with gastric malignancies is not specifically related to cagA and multiple EPIYA C repeats.展开更多
文摘In order to investigate the mechanism of Xiaokuiling prescription (XKL) in the treatment of Helicobacter pylori (HP) associated duodenal ulcer (DU) and the pathophysiologic role of heat shock proteins (HSPs) in the healing of ulcer, the expression of HSP 72 and HSP B in gastric mucosa was detected by using SABC immunohistochemistry method and processed by micro image analysis system. The method of Western blotting was used to measure the contents of HSP 72 and HSP B in the tissue emulsion of gastric mucosa. The results were as follows: (1) HSP 72 expression of the gastric mucosa in the treated group was obviously increased as compared with that in the control group ( P <0.05); (2) HSP B expression of the gastric mucosa in the treated group was significantly decreased as compared with that in the control group ( P <0.01). It was suggested that the increased expression of HSP 72 and the elimination of HP might be related to the mechanism of action of XKL. HSPs might play an pathological and physiological role in the process of healing of gastric ulcer.
文摘BACKGROUND Acute gastrointestinal bleeding(GIB)is a life-threatening medical emergency with high morbidity and mortality.Transcatheter embolization with endovascular coils under digital subtraction angiography guidance is a common and effective method for the treatment of GIB with high technical success rates.Duodenal ulcers caused by coils wiggled from the branch of the gastroduodenal artery,which is a rare complication,have not previously been reported in a patient with right intrathoracic stomach.CASE SUMMARY A 62-year-old man had undergone thoracoscopy-assisted radical resection of esophageal cancer and gastroesophageal anastomosis 3 years ago,resulting in right intrathoracic stomach.He was admitted to the hospital 15 mo ago for dizziness and suffered acute GIB during his stay.Interventional surgery was urgently performed to embolize the branch of the gastroduodenal artery with endovascular coils.After 15 mo,the patient was re-admitted with a chief complaint of melena for 2 d,esophagogastroduodenoscopy and abdominal computed tomography revealed that some endovascular coils had migrated into the duodenal bulb,leading to a deep ulcer.Bleeding was controlled after conservative treatment.Seven months later,duodenal balloon dilatation was performed to relieve the stenosis after the removal of a few coils,and the patient was safely discharged with only one coil retained in the duodenum due to difficulties in complete removal and risk of bleeding.Mild melena recurred once during the long-term follow-up.CONCLUSION Although rare,coil wiggle after interventional therapy requires careful attention,effective precautionary measures,and more secure alternative treatment methods.
文摘BACKGROUND A post-bulbar duodenal ulcer(PBDU)is an ulcer in the duodenum that is distal to the duodenal bulb.PBDU may coexist with a synchronous posterior ulcer in rare occurrences,resulting in a kissing ulcer(KU).Duodenocaval fistula(DCF)is another uncommon but potentially fatal complication related to PBDU.There is limited knowledge of the scenarios in which PBDU is complicated by KU and DCF simultaneously.CASE SUMMARY A 22-year-old man was admitted to the emergency department with abdominal pain,stiffness,and vomiting.The X-ray showed pneumoperitoneum,suggesting a perforated viscus.Laparotomy revealed a KU with anterior perforation and a DCF.After Kocherization,venorrahphy was used to control caval bleeding.Due to the critical condition of the patient,only primary duodenorrahphy with gastrojejunostomy was performed as a damage control strategy.However,later,the patient developed obstructive jaundice and leakage,and two additional jejunal perforations were detected.Due to the poor condition of the duodenum and the involvement of the ampulla in the posterior ulcer,neither primary repair nor pancreatic-free duodenectomy and ampull-oplasty/ampullary reimplantation were considered viable;therefore,an emergency pancreaticoduodenectomy was performed,along with resection and anastomosis of the two jejunal perforations.The patient had a smooth recovery after surgery and was discharged after 27 d.CONCLUSION The timely diagnosis of PBDU and radical surgery can aid in the smooth recovery of patients,even in the most complex cases.
文摘Objective: To observe the clinical efficacy of Yunnan Baiyao (云南白药, YNBY) combined with antibiotics in treating Helicobacter pylori (HP) related duodenal ulcer (DU). Methods: Eighty two HP positive DU patients were randomly divided into two groups: Treated group (44 cases) used YNBY plus amoxicillin and metronidazole; control group (38 cases) used de nol plus amoxicillin and metronidazole). Results: After a 2 week treatment course, the effect of epigastric pain relief was 68.3% in treated group, and 44.4% in control group, the difference between them was significant ( P <0.05). Marked effect in acid regurgitation and belching relief was observed in both groups. The rate of DU healing in treated and control group was respectively 88.6% and 89.5%; the clearance of HP 84.1% and 89.5%; and the side effects 4.5% and 13.5%, with insignificant difference between these two groups. Conclusion: YNBY combined with antibiotics in treating DU, and clearance of HP is an economic, safe and effective therapy.
文摘BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades,but the incidence of reported peptic ulcer complications has not decreased.Perforating peptic ulcer(PPU)is a severe form of the disease.AIM To assess trends in the incidence,presentation,and outcome of PPU over a period of 40 years.METHODS This was a single-centre,retrospective,cohort study of all patients admitted to Levanger Hospital,Norway,with PPU from 1978 to 2017.The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases(ICD),revision 8,ICD-9,and ICD-10 codes for perforated gastric and duodenal ulcers.We reviewed the medical records of the patients to retrieve data.Vital statistics were available for all patients.The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable,and sex,age,and calendar year from 1978 to 2017 as covariates.Relative survival analysis was performed to compare long-term survival over the four decades.RESULTS Two hundred and nine patients were evaluated,including 113(54%)men.Fortysix(22%)patients were older than 80 years.Median age increased from the first to the last decade(from 63 to 72 years).The incidence rate increased with increasing age,but we measured a decline in recent decades for both sexes.A significant increase in the use of acetylsalicylic acid,from 5%(2/38)to 18%(8/45),was observed during the study period.Comorbidity increased significantly over the 40 years of the study,with 22%(10/45)of the patients having an American Society of Anaesthesiologists(ASA)score 4-5 in the last decade,compared to 5%(2/38)in the first decade.Thirty-nine percent(81/209)of the patients had one or more postoperative complications.Both 100-day mortality and long-term survival were associated with ASA score,without significant variations between the decades.CONCLUSION Declining incidence rates occurred in recent years,but the patients were older and had more comorbidity.The ASA score was associated with both short-term mortality and long-term survival.
文摘BACKGROUND:Dyspnea is one of the most common complaints facing the emergency medicine physician.Some of the gastrointestinal causes of dyspnea are self-limited and not lifethreatening,yet others are,and early diagnosis and treatment are crucial.METHODS:In this article we presented one of these life-threatening conditions through a clinical description of a patient presenting with acute respiratory distress that was finally diagnosed to be the result of a perforated gastric ulcer.RESULTS:An emergent thoracotomy revealed a small ulcer with perforation in the fundus of the stomach.The patient was transferred after the operation to the intensive care unit and after a prolonged hospitalization discharged home.Biopsies taken from the ulcer showed diffuse inflammation,with no evidence of microorganisms or malignancy.CONCLUSION:Perforation of gastric and duodenal ulcers is a rare yet existing cause of dyspnea and respiratory failure and should be kept in mind by the emergency physician,especially when other more common causes are ruled out.
文摘BACKGROUND Oesophagogastroduodenoscopy is the gold standard investigation for the upper gastrointestinal(UGI)tract.Orientation during endoscopy is challenging and United Kingdom training focusses on technical competence and procedural safety.The reported location of UGI pathologies is crucial to post-endoscopic planning.AIM To evaluate endoscopists’ability to spatially orientate themselves within the UGI tract.METHODS A cross sectional descriptive study elicited,using an anonymised survey,the ability of endoscopists to orientate themselves within the UGI tract.The primary outcome was percentage of correct answers from all surveyed;secondary outcomes were percentage of correct answers from experienced vs novice endoscopists.Pearson’sχ2 test was applied to compare groups.RESULTS Of 188 respondents,86 were experienced endoscopists having completed over 1000 endoscopies.44.4%of respondents correctly identified the anterior stomach and 47.3%correctly identified the posterior of the second part of the duodenum(D2).Experienced endoscopists were significantly more likely than novice to identify the anterior stomach correctly[61.6%vs 31.3%,X2(1,n=188)=11.10,P=0.001].There was no significant difference between the two groups in identifying the posterior of D2.CONCLUSION The majority of endoscopists surveyed were unable to identify key landmarks within the UGI tract.Endoscopic orientation appears to improve with experience yet there are some areas still not well recognised.This has potential considerable impact on post-endoscopic management of patients with posterior duodenal ulcers being more likely to perforate and associated with a higher rebleeding risk.We suggest the development of a consensus statement on endoscopic description.
基金Supported by Council of Scientific and Industrial Research,Government of India,No.12458Department of Science and Technology,India,No.IF140909and the Council of Scientific and Industrial Research,India,No.09/482(0065)/2017-EMR-1.
文摘Helicobacter pylori(H.pylori)is a microaerophilic,Gram-negative,human gastric pathogen found usually in the mucous lining of stomach.It infects more than 50%of the world’s population and leads to gastroduodenal diseases.The outcome of disease depends on mainly three factors:Host genetics,environment and bacterial factors.Among these,bacterial virulence factors such as cagA,vacA are well known for their role in disease outcomes.However,based on the global epidemiological results,none of the bacterial virulence(gene)factors was found to be associated with particular diseases like duodenal ulcer(DU)in all populations.Hence,substantial importance has been provided for research in strain-specific genes outside the cag pathogenicity island,especially genes located within the plasticity regions.dupA found within the plasticity regions was first demonstrated in 2005 and was proposed for duodenal ulcer development and reduced risk of gastric cancer in certain geographical regions.Due to the discrepancies in report from different parts of the world in DU development related to H.pylori virulence factor,dupA became an interesting area of research in elucidating the role of this gene in the disease progression.In this review,we shed light on the detailed information available on the polymorphisms in dupA and their clinical relevance.We have critically appraised several pertinent studies on dupA and discussed their merits and shortcomings.This review also highlights dupA gene as an important biomarker for DU in certain populations.
文摘BACKGROUND Monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL)is a rare primary intestinal T-cell lymphoma,previously known as enteropathy-associated T-cell lymphoma type II.MEITL is an aggressive T-cell lymphoma with a poor prognosis and high mortality rate.The known major complications of MEITL are intestinal perforation and obstruction.Here,we present a case of MEITL that was diagnosed following upper gastrointestinal bleeding from an ulcerative duodenal lesion,with recurrence-free survival for 5 years.CASE SUMMARY A 68-year-old female was admitted to our hospital with melena and mild anemia.An urgent esophagogastroduodenoscopy(EGD)revealed bleeding from an ulcerative lesion in the transverse part of the duodenum,for which hemostatic treatment was performed.MEITL was diagnosed following repeated biopsies of the lesion,and cyclophosphamide,doxorubicin,vincristine,and prednisone(CHOP)chemotherapy was administered.She achieved complete remission after eight full cycles of CHOP therapy.At the last follow-up examination,EGD revealed a scarred ulcer and 18Fluorodeoxyglucose(18FDG)positron emission tomography/computed tomography showed no abnormal FDG accumulation.The patient has been in complete remission for 68 mo after initial diagnosis.CONCLUSION To rule out MEITL,it is important to carefully perform histological examination when bleeding from a duodenal ulcer is observed.
基金Supported by the Istanbul University Research Fund,No.45151.
文摘BACKGROUND Polymorphisms of human leukocyte antigen(HLA)genes are suggested to increase the risk of gastric cancer(GC).AIM To investigate the HLA allele frequencies of patients with GC relative to a control group in terms of CagA+multiple(≥2)EPIYA-C repeats.METHODS The patient group comprised 94 patients[44 GC and 50 duodenal ulcer(DU)patients],and the control group comprised 86 individuals[(50 non-ulcer dyspepsia patients and 36 people with asymptomatic Helicobacter pylori(H.pylori)].Polymerase chain reaction was performed for the amplification of the H.pylori cagA gene and typing of EPIYA motifs.HLA sequence-specific oligonucleotide(SSO)typing was performed using Lifecodes SSO typing kits(HLA-A,HLA-B HLA-C,HLA-DRB1,and HLA-DQA1-B1 kits).RESULTS The comparison of GC cases in terms of CagA+multiple(≥2)EPIYA-C repeats showed that only the HLA-DQB1*06 allele[odds ratio(OR):0.37,P=0.036]was significantly lower,but significance was lost after correction(Pc=0.1845).The HLA-DQA1*01 allele had a high ratio in GC cases with multiple EPIYA-C repeats,but this was not significant in the univariate analysis.We compared allele frequencies in the DU cases alone and in GC and DU cases together using the same criterion,and none of the HLA alleles were significantly associated with GC or DU.Also,none of the alleles were detected as independent risk factors after the multivariate analysis.On the other hand,in a multivariate logistic regression with no discriminative criterion,HLA-DQA1*01(OR=1.848),HLA-DQB1*06(OR=1.821)and HLA-A*02(OR=1.579)alleles were detected as independent risk factors for GC and DU.CONCLUSION None of the HLA alleles were detected as independent risk factors in terms of CagA+multiple EPIYA-C repeats.However,HLA-DQA1*01,HLA-DQB1*0601,and HLA-A*2 were independent risk factors with no criterion in the multivariate analysis.We suggest that the association of these alleles with gastric malignancies is not specifically related to cagA and multiple EPIYA C repeats.
