Development of gastric dysplasia in pernicious anaemia: a clinical and endoscopic follow up study of 80 patients
Article Abstract:
Stomach cancer is frequently preceded by the appearance of atrophic gastritis (inflammation of the stomach with atrophy of the cells lining the organ) and intestinal metaplasia (conversion of intestinal cells to other cell types). These latter two conditions, which are considered to be precancerous lesions, frequently appear concomitantly with pernicious anemia (a condition characterized by a decrease in the number of red blood cells and a drastic reduction in gastric acid secretion). Hence, pernicious anemia is sometimes taken as a harbinger of stomach cancer. To investigate the development of gastrointestinal abnormalities in patients diagnosed with pernicious anemia, a study was carried out with 80 patients suffering from this disorder who underwent endoscopy (viewing the inner surface of the stomach with a fiber optic device). One patient underwent total gastrectomy (surgical removal of the stomach) for gastric cancer shortly after the endoscopic procedure. Twelve additional patients were closely watched and underwent follow-up endoscopy 14 months later. Two of these patients displayed cancer-like growths. The remaining 67 patients were followed-up six to seven years after the initial screening. At this follow-up, eight of these patients had died; two of unknown causes, and six of causes unrelated to the anemia or gastrointestinal disease. In 38 patients, endoscopy was not repeated, but there was no evidence of progression towards gastric cancer. Twenty-seven patients in whom repeat endoscopy was performed showed no change in the status of the gastrointestinal tract. Based on these findings, it is recommended that patients with pernicious anemia undergo endoscopic evaluation as soon as possible after diagnosis; patients with severe mucosal dysplasia or polyps should be re-examined regularly; and follow-up endoscopies should be performed at five-year intervals is sufficient for most patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Gut
Subject: Health
ISSN: 0017-5749
Year: 1990
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Palliation of malignant obstructive jaundice: surgery or stent?
Article Abstract:
Bile is a substance secreted by the liver that is important in the digestion of food. It passes from the liver to the lumen of the intestine via the bile duct. When the bile ducts become obstructed, either by primary cancer (cholangiocarcinoma) or by complications of colonic or gastric carcinoma, the bile cannot pass to the intestine, resulting in jaundice (a condition caused by the absorption of bile constituents into the blood, characterized by yellow skin). Two forms of treatment for malignant obstructive jaundice are available; surgically restoring the bile duct by removing the obstruction, or implanting a more temporary prosthetic device that restores bile flow through the duct (biliary stent). Comparative evaluations of the two procedures have been plagued by methodological flaws in the study designs. The biliary stent procedure is most frequently used on older, frail patients who cannot undergo surgical treatment. Hence, patients receiving the stents invariably do worse, as a group, than the surgically treated patients. When comparable groups are subjected to either the stenting procedure or surgery, the short-term results are roughly comparable. After about six months, the stent must be replaced. Consequently, it is suggested that for patients with very limited survival prognosis (less than three or four months), the stent be used. The much shorter recovery period allows the patient to return home and make the best use of the short time remaining for him or her. On the other hand, patients with an expected survival time of greater than six months would benefit more from the surgical repair, since the greater duration of improved biliary function would require fewer return visits to the hospital than would be necessary with the biliary shunt procedure. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Gut
Subject: Health
ISSN: 0017-5749
Year: 1990
User Contributions:
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