The evolving role of endoscopy in the diagnosis of premalignant gastric lesions

Gastric adenocarcinoma is a disease that is often detected late, at a stage when curative treatment is unachievable. This must be addressed through changes in our approach to the identification of patients at increased risk by improving the detection and risk assessment of premalignant changes in the stomach, including chronic atrophic gastritis and intestinal metaplasia. Current guidelines recommend utilising random biopsies in a pathology-led approach in order to stage the extent and severity of gastritis and intestinal metaplasia. This random method is poorly reproducible and prone to sampling error and fails to acknowledge recent advances in our understanding of the progression to gastric cancer as a non-linear, branching evolutionary model. Data suggest that recent advances in endoscopic imaging modalities, such as narrow band imaging, can achieve a high degree of accuracy in the stomach for the diagnosis of these premalignant changes. In this review, we outline recent data to support a paradigm shift towards an endoscopy-led approach to diagnosis and staging of premalignant changes in the stomach. High-quality endoscopic interrogation of the chronically inflamed stomach mucosa, supported by targeted biopsies, will lead to more accurate risk assessment, with reduced rates of under or missed diagnoses.

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Chronic gastritis and carcinogenesis issues

Herald of Pancreatic Club ◽

10.33149/vkp.2019.04.09 ◽

2019 ◽

Vol 45 (4) ◽

pp. 65-70

Author(s):

M. M. Karimov ◽

G. N. Sobirova ◽

U. K. Abdullayeva

Keyword(s):

Gastric Cancer ◽

Intestinal Metaplasia ◽

Chronic Atrophic Gastritis ◽

Precancerous Conditions ◽

Increased Risk ◽

Operated Stomach ◽

Increasing Risk ◽

H Pylori ◽

Definition Of

Risk factors contributing to the transformation of chronic atrophic gastritis into gastric cancer are analyzed. Detection and monitoring of patients with precancerous conditions/lesions (precancerous changes), proper screening of H. pylori make early diagnosis of gastric cancer real. Features of precancerous conditions are given in order of increasing risk of developing gastric cancer. Adenomatous polyps of the stomach take the first place. Subsequent precancerous conditions include: cancer of the operated stomach, Menetria disease (hypertrophic gastropathy), B12-deficient anemia, and gastric ulcer. A definition of intestinal metaplasia subtypes is proposed as a risk factor for gastric cancer, dividing into complete and incomplete one, taking into account reduction in the expression of gastric mucins MUC1, MUC5AC and MUC6. Currently, the development of gastric cancer (mainly of the “intestinal type”) is considered as a multistage process involving the sequence of mucosal change, such as chronic inflammation, atrophy, intestinal metaplasia, dysplasia and adenocarcinoma. Role of the organism’s genetic susceptibility to H. pylori infection, factors of pathogenicity contributing to epithelial metaplasia, are analyzed. Role of Toll-like type 4 receptors (TLR4) involved in the recognition of H. pylori is clarified. It is with this type of receptors that the development of an excessive immune response of the host is associated, resulting in damage to the mucous membrane in H. pylori-infected individuals. In particular, carriers of TLR4+896A> G polymorphism have a more severe atrophy of the stomach and degree of inflammation, as well as an increased risk of non-cardiac gastric cancer.

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The role of a geriatrician in a cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.39 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 39-39 ◽

Cited By ~ 1

Author(s):

Beatriz Korc-Grodzicki ◽

Sung W. Sun ◽

Armin Shahrokni ◽

Koshy Alexander ◽

Soo Jung Kim ◽

...

Keyword(s):

Older Adults ◽

Risk Assessment ◽

Nurse Practitioners ◽

Transitional Care ◽

Unmet Need ◽

Cancer Center ◽

Ongoing Research ◽

Increased Risk

39 Background: Older adults are likely to have coexisting health conditions, polypharmacy and functional limitations. The geriatrician may have a pivotal role in risk assessment, prevention and treatment of comorbidities and addressing geriatric syndromes. The purpose of this study is to describe the growth and development of, and the role of a Geriatrics Service (GS) in a cancer center. Methods: A GS was founded in MSKCC in 2009. Since then it has grown to provide inpatient (IP) and outpatient (OP) care for older adults undergoing cancer diagnosis, surveillance or active treatment. It offers preoperative evaluations, geriatric assessment (GA) and follow-up shared- care. Recently, a Transitional Care Management (TCM) program was established for patients at increased risk of rehospitalization. The GS strives to develop an interprofessional educational geriatrics curriculum and to participate in quality and research projects focused on cancer and aging. Results: Between 2009 and 2014 a total of 6679 new patients were evaluated by the GS. 16% of the patients were 65-75, 70% were 76-85 and 14% were older than 85. 46% were male and 84% were white. 15% were IP and 85% were OP consultations. 13% of the OP consults were for GA, the rest were preoperative evaluations. All patients seen preoperatively who are admitted after surgery, are followed postoperatively by the IP geriatrics team. In total, 4 Geriatricians, 2 Geriatric Nurse Practitioners (GNP) and 3 RNs were recruited. The number of follow-up visits increased from 143 in 2009 to 733 in 2014. The new TCM program based on close communication between the IP and OP GNP has been successful in keeping frail patients from frequent rehospitalizations. Noon conferences on geriatrics for the house staff, a biannual course on “Advancing Nursing Expertise in the Care of Older Adults with Cancer” and a monthly interprofessional meeting for the discussion of Geriatric Clinical Complex Cases (GCCC) are ongoing. Research has focused on risk assessment and the use of telemedicine in geriatric patient care. Conclusions: The establishment of a GS in a cancer center was very well received and embraced by the oncologists showing an unmet need in the care of the older cancer patient. The potential reproducibility beyond the cancer center will be discussed.

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Trefoil Factor Family in Pre-neoplastic Lesions and Gastric Cancer

The Cancer Press ◽

10.15562/tcp.70 ◽

2018 ◽

Vol 4 ◽

Author(s):

Zahra Behrooznia ◽

Pouya Ghaderi ◽

Narges Jafarzadeh ◽

Azra Izanloo ◽

Sepideh Mansoori Majoofardi ◽

...

Keyword(s):

Gastric Cancer ◽

Gastrointestinal Tract ◽

Atrophic Gastritis ◽

Intestinal Metaplasia ◽

Chronic Atrophic Gastritis ◽

Suppressor Activity ◽

Neoplastic Lesions ◽

Tumor Suppressor Activity ◽

Trefoil Factor Family

Gastric cancer is the fourth most common cancer and the second leading cause of cancer death worldwide. Although the global incidence of gastric cancer has been decreased dramatically in recent decades, north and northwest of Iran have the highest incidence rate of gastric cancer. Whilst the surgical procedures for gastric cancer have been improved, there is no cure for that. The intestinal type of GC results from pre-neoplastic conditions including atrophic gastritis, intestinal metaplasia and dysplasia. Trefoil Factors Family proteins (TFFs) are small and stable molecules secreted by the mammalian gastrointestinal tract. TFFs constitute a family of three peptides (TFF1, TFF2and TFF3) that are widely expressed in a tissue specific manner in the gastrointestinal tract. Variable TFFs expression in gastric cancer and pre-neoplastic lesions has been found. TFF1 has a tumor suppressor activity and inhibits tumorogenesis in gastric cancer. Its expression decreases in gastritis, gastric atrophy, dysplasia, intestinal metaplasia and gastric cancer.TFF2 has a protective effect on gastrointestinal epithelium. As a prognostic factor, TFF2 expression decreases in gastric ulcer, chronic atrophic gastritis and gastric cancer. TFF3 is considered as an oncogenic factor in gastric tissues. Whilst the normal gastric tissues don’t express TFF3, it increases in intestinal metaplasia. Therefore, more studies are necessary to clarify the role of TFFs in GC and pre-neoplastic conditions. This review has focused on elucidating the important role of TFFs in gastric cancer and pre-neoplastic lesions.

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Satisfaction of pharmaceutical specialists with the material and moral side of their job: a study

Acta Medica Leopoliensia ◽

10.25040/aml2020.02-03.089 ◽

2020 ◽

Vol 26 (2-3) ◽

pp. 89-93

Author(s):

B.P. Hromovyk ◽

◽

Yu.I. Kremin ◽

Keyword(s):

Online Survey ◽

Sampling Error ◽

Staff Turnover ◽

Average Salary ◽

Bonus System ◽

High Staff Turnover ◽

Occupied Territories ◽

High Degree ◽

Autonomous Republic

Aim. Study of the opinion of pharmaceutical specialists working at pharmacies on the role of material and moral incentives and obstacles in their implementation in the process of motivating professionals to work. Material and Methods. The study was conducted in the period from June 26 to August 26, 2020 via an anonymous online survey of 348 pharmaceutical specialists working at pharmacies in Ukraine on a questionnaire developed in Google form and posted in nine pharmaceutical groups on Facebook social network. The respondents represented all regions of Ukraine, except for the annexed Autonomous Republic of Crimea and the occupied territories of Donetsk and Luhansk regions. The marginal sampling error was 5.1%. Results and Discussion. It was found that the vast majority of respondents believe they should be paid higher salaries for that the amount of work they do. The ratio of the average salary of Ukrainian pharmaceutical specialists to the minimum wage in the country is at least twofold less than that of their European counterparts. It was found that among the incentives, employers primarily use the accrual of interest on sales and the bonus system. It is determined that respect on the part of colleagues and visitors of pharmacies, a proper moral climate in the team and good working conditions are important for the respondents. At the same time, the concern of pharmaceutical specialists with a high degree of carried responsibility, very hard work, inexpediency of management requirements, and penalties at the pharmacy was revealed. Conclusion. It is established that pharmaceutical professionals do not receive the desired material and moral satisfaction from working at pharmacies, and employers underuse the existing forms of incentives for work achievements, which leads to disappointment of pharmaceutical professionals in the chosen profession and to the high staff turnover at pharmacies. Key words: pharmaceutical specialist, salary, material and moral incentives

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Histologic changes in type A chronic atrophic gastritis indicating increased risk of neuroendocrine tumor development: the predictive role of dysplastic and severely hyperplastic enterochromaffin-like cell lesions

Human Pathology ◽

10.1016/j.humpath.2013.02.005 ◽

2013 ◽

Vol 44 (9) ◽

pp. 1827-1837 ◽

Cited By ~ 30

Author(s):

Alessandro Vanoli ◽

Stefano La Rosa ◽

Ombretta Luinetti ◽

Catherine Klersy ◽

Rachele Manca ◽

...

Keyword(s):

Atrophic Gastritis ◽

Neuroendocrine Tumor ◽

Tumor Development ◽

Type A ◽

Chronic Atrophic Gastritis ◽

Increased Risk ◽

Predictive Role ◽

Histologic Changes

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Recent advances in the understanding and management of atrial fibrillation: a focus on stroke prevention

F1000Research ◽

10.12688/f1000research.10176.1 ◽

2016 ◽

Vol 5 ◽

pp. 2887 ◽

Cited By ~ 2

Author(s):

Farhan Shahid ◽

Eduard Shantsila ◽

Gregory Y. H. Lip

Keyword(s):

Atrial Fibrillation ◽

Risk Assessment ◽

Stroke Prevention ◽

Bleeding Risk ◽

Assessment Tools ◽

The European Union ◽

Mortality And Morbidity ◽

Recent Advances ◽

Increased Risk ◽

Direct Head

Atrial fibrillation (AF) is associated with an increased risk of stroke compared with the general population. It is anticipated that by 2030 an estimated 14–17 million patients will be diagnosed with this most prevalent arrhythmia within the European Union. AF-related stroke confers a higher mortality and morbidity risk, and thus early detection and assessment for the initiation of effective stroke prevention with oral anticoagulation (OAC) is crucial. Recent guidelines point to the use of non-vitamin K antagonist OACs (NOACs) where appropriate in stroke prevention of patients with non-valvular AF. At present, there are four NOACS available, with no direct head-to-head comparisons to suggest the superiority of one drug over another. Simple and practical risk assessment tools have evolved over the years to facilitate stroke and bleeding risk assessment in busy clinics and wards to aid decision-making. At present, the CHA2DS2VASc (congestive heart failure, hypertension, age 65–74/>75, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, vascular disease, female sex) score is recommended by many international guidelines as a simple and practical method of assessing stroke risk in such patients. Alongside this, use of the HAS BLED (hypertension systolic blood pressure >160 mmHg, abnormal liver/renal function [with creatinine ≥200 μmol/L], stroke, bleeding history or predisposition, labile international normalized ratio [range <60% of the time], elderly [>65], concomitant drugs/alcohol) score aims to identify patients at high risk of bleeding for more regular review and follow-up and draws attention to potentially reversible bleeding risk factors. The aim of this review article is to provide an overview of recent advances in the understanding and management of AF with a focus on stroke prevention.

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Potential Role of Narrow Band Imaging (NBI) and Magnifying Endoscopy in the Diagnosis and Surveillance of Intestinal Metaplasia of the Stomach

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2007.03.241 ◽

2007 ◽

Vol 65 (5) ◽

pp. AB159

Author(s):

Enders K. Ng ◽

Wai K. Leung ◽

Philip W. Chiu ◽

Ka-Fai to ◽

Joseph J. Sung

Keyword(s):

Intestinal Metaplasia ◽

Potential Role ◽

Narrow Band ◽

Narrow Band Imaging ◽

Magnifying Endoscopy

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Extending magnifying NBI diagnosis of intestinal metaplasia in the stomach: the white opaque substance marker

Endoscopy ◽

10.1055/s-0043-103409 ◽

2017 ◽

Vol 49 (06) ◽

pp. 529-535 ◽

Cited By ~ 24

Author(s):

Takao Kanemitsu ◽

Kenshi Yao ◽

Takashi Nagahama ◽

Kentaro Imamura ◽

Shoko Fujiwara ◽

...

Keyword(s):

Intestinal Metaplasia ◽

Sensitivity And Specificity ◽

Diagnostic Performance ◽

Narrow Band ◽

Narrow Band Imaging ◽

Magnifying Endoscopy ◽

Endoscopic Diagnosis ◽

Light Blue ◽

White Light Endoscopy ◽

Increased Risk

Abstract Background and aims Intestinal metaplasia (IM) of the stomach is associated with an increased risk of differentiated gastric cancer. While it is important to diagnose IM endoscopically, it can be difficult to observe by white-light endoscopy. In magnifying endoscopy with narrow-band imaging (M-NBI) of the stomach, a light-blue crest (LBC) is widely known to be a useful marker in the endoscopic diagnosis of IM. However, IM that exhibits only white opaque substance (WOS) without an LBC can also occur. The aim of this study was to elucidate whether the presence of WOS on M-NBI of the stomach could serve as a marker of IM in the same way that an LBC does. Methods The subjects were 40 consecutive patients who underwent M-NBI between July and December 2014. The primary endpoint in this study was to evaluate the diagnostic performance of M-NBI for histologically observed IM in WOS- and LBC-positive mucosa. Results The sensitivity and specificity of WOS for histologically diagnosed IM were 50.0 % (95 % confidence interval [CI] 40.0 % – 50.0 %) and 100.0 % (95 %CI 85.0 % – 100.0 %), respectively. Meanwhile, the sensitivity and specificity of LBC were 62.5 % (95 %CI 51.1 % – 65.9 %) and 93.8 % (95 %CI 76.7 % – 98.9 %), respectively. The sensitivity and specificity of WOS and/or LBC (WOS positive and LBC positive, WOS positive and LBC negative, or WOS negative and LBC positive) for histologically diagnosed IM were 87.5 % (95 %CI 76.9 % – 90.9 %) and 93.8 % (95 %CI 77.9 % – 98.9 %), respectively. Conclusions LBC and WOS are both useful markers for endoscopic diagnosis of IM. Combining both markers improves the sensitivity.Clinical trial number: UMINCTR000014453.

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АSSESSMENT OF OCCUPATIONAL RISK DRIVERS OF SPECIALIZED VEHICLES

Hygiene and Sanitation ◽

10.18821/0016-9900-2017-96-4-357-362 ◽

2019 ◽

Vol 96 (4) ◽

pp. 357-362

Author(s):

S. V. Grebenkov ◽

L. V. Dovgysha ◽

E. B. Kolesova ◽

Ya. M. Sukhova ◽

S. B. Fedorova ◽

...

Keyword(s):

Risk Assessment ◽

Preventive Measures ◽

Circulatory System ◽

Occupational Risk ◽

Moderate Degree ◽

Increased Risk ◽

Circulatory System Diseases ◽

High Degree ◽

The Impact ◽

The Relationship

Introduction. The problem of preservation of the health of drivers is a topical for most of countries. In the process of working, the mentioned group is exposed to a complex of harmful occupational factors, that both leads to an elevated increased risk for health disorders and increases the risk of road accidents. However, in available sources it was not possible to reveal reports devoted to the study of the impact of the labor conditions of drivers on various health indices on the base of the methodology of occupational risk assessment. The aim of the study is to assess the occupational risk for drivers of specialized vehicles on the basis of indices of pathological affection, calculated on the results of periodic medical examinations. Material and Methods. As a core group there were selected truck drivers (n = 1050), as a comparison group - engineering and technical personnel of the enterprise (n = 1220), matched by age and social indices. The assessment of the occupational morbidity rate was carried out on the base of the analysis of fourfold tables with the use of c2 criteria. The assessment of the degree of the occupational dependence was executed with the calculation of risk indices in accordance with the Guidelines for Risk Assessment. Results. In the course of the study there were obtained results showing drivers to suffer most frequently from diseases of eyes (65.4%), circulatory system (46.6%) and digestive system (11.6%). The main reason for the recognition of drivers as unfit to drive vehicles is hypertension at the II stage and above (71.1%). Also, there is noted an increased occupational risk in drivers for such diseases such as hypertension at the I stage (RR=2.2, CI95%=1.8-2.8, EF=54.5%, a high degree of the relationship with the work); encephalopathy of the vascular genesis (RR = 1.6, CI95%=1.1-2.4, EF = 37.5%), moderate degree of the relationship with the work in the age of older 60 years - is very high); dorsopathies at the lumbosacral level (RR=2.9, CI95%=1.6-5.3, EF=65.7%), a high degree of the relationship with the work at the age of over 50 is almost total); sensorineural hearing loss (RR=1.2, CI95%=0.7-2.0, EF=16.4%), a low degree of the relationship with the work over the age of older 60 years - moderate); hyperopia (RR=2.1, CI95%=1.7-2.5, EF=52.4%, a high degree of the relationship with the work), which determines the priority of preventive measures in relation to these diseases. The potential effect of the preventive measures is most pronounced for the circulatory system diseases in total (NNT = 13.6) and hypertensive disease at the I stage (NNT = 10.0).

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Helicobacter pylori as a crucial factor in intestinal metaplasia development of gastric mucosa

Advances in Modern Oncology Research ◽

10.18282/amor.v2.i3.72 ◽

2016 ◽

Vol 2 (3) ◽

pp. 173

Author(s):

Sergii Vernygorodskyi

Keyword(s):

Helicobacter Pylori ◽

Gastric Mucosa ◽

Intestinal Metaplasia ◽

Chronic Atrophic Gastritis ◽

Gastric Epithelium ◽

Number Of Genes ◽

Activating Transcription Factor ◽

H Pylori ◽

Gene Inhibition

Helicobacter pylori (H. pylori) is detected on the surface of gastric epithelium and in goblet cells, predominantly in patients with chronic atrophic gastritis and incomplete intestinal metaplasia (IM). H. pylori infection persistence leads to the formation of gastrointestinal phenotype of IM. H. pylori can be considered as an etiological factor of IM. It inhibits the expression of SOX2 in gastric epithelial cells, hence activating transcription factor CDX2 as a counterpart to MUC5AC gene inhibition and MUC2 gene induction. Thus, in metaplastic cells, programming differentiation after intestinal phenotype will develop. The role of H. pylori in the origin of intestinal metaplasia of gastric mucosa was defined in this study to elucidate the probable mechanism of cell reprogramming. The activation of CDX2, with simultaneous inactivation and decreased number of genes (e.g., SHH, SOX2, and RUNX3) responsible for gastric differentiation, was identified to cause the appearance of IM.

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