Angiogenesis and vascular malformations： Antiangiogenic drugs for treatment of gastrointestinal bleeding

Treatment of gastrointestinal bleeding in patients with angiodysplasias and Osler＇s disease （hereditary hemorrhagic teleangiectasia） is clinically challenging. Frequently, vascular malformations occur as multiple disseminated lesions, making local treatment an unfavorable choice or impossible. After local therapy, lesions often recur at other sites of the intestine. However, as there are few therapeutic alternatives, repeated endoscopic coagulations or surgical resections are still performed to prevent recurrent bleeding. Hormonal therapy has been employed for more than 50 years but has recently been shown to be ineffective. Therefore, new therapeutic strategies are required. Understanding of the pathophysiology of angiogenesis and vascular malformations has recently substantially increased. Currently, multiple inhibitors of angiogenesis are under development for treatment of malignant diseases. Experimental and clinical data suggest that antiangiogenic substances, which were originally developed for treatment of malignant diseases, may also represent long-awaited specific drugs for the treatment of vascular malformations. However, antiangiogenics display significantly different actions and side-effects. Although antiangiogenics like thalidomide seem to inhibit gastrointestinal bleeding, other substances like bevacizumab can cause mucosal bleeding. Therefore differential and cautious evaluation of this therapeutic strategy is necessary.     

Klippel-Trenaunay综合征并肠血管畸形致下消化道出血1例

肠道血管畸形引起下消化道出血较为少见,但在下消化道不明原因出血中占有重要地位,本病例肠道血管畸形合并Klippel-Trenaunay综合征(Klipple-Trenaunay syndrome,KTS).针对本病例,应首要解决脉管畸形所致的肠道出血,再联合其他学科进行综合治疗.     

糖原合成酶激酶-3在胃肠道肿瘤的作用及其研究进展

糖原合成酶激酶-3(GSK-3)是一种多功能的丝氨酸/苏氨酸蛋白激酶.实验证实,GSK-3通过多种途径在胃肠道肿瘤的生长、增殖及凋亡等方面起重要作用.现就近年来GSK-3在胃肠道肿瘤的研究进展作一综述.     

Vascular malformations of the gastrointestinal tract

Vascular malformations of the gastrointestinal tract may be diagnosed at any age. They may present with bleeding, anaemia, or if they form a mass lesion, with intussusception. Many lesions remain asymptomatic. In a minority of patients there are well-defined genetic conditions present, such as hereditary haemorrhagic telangiectasia. In others, particularly the angiodysplastic lesions that occur in the caecum in elderly patients, the lesions appear to be degenerative. Vascular malformations may affect any section of the gastrointestinal tract, and in some patients there are vascular anomalies elsewhere, particularly in the skin. Diagnosis is usually based on recognition endoscopically, or at angiography. Symptomatic lesions that are discrete and localized respond well to local treatment with laser or heat coagulation or sclerotherapy. Mass lesions, diffuse lesions and severe bleeding may require surgery.     

Carbonic anhydrases in normal gastrointestinal tract and gastrointestinal tumours

Carbonic anhydrases (CAs) catalyse the hydration of C02 to bicarbonate at physiological pH. This chemical interconversion is crucial since HCO3- is the substrate for several biosynthetic reactions. This review is focused on the distribution and role of CA isoenzymes in both normal and pathological gastrointestinal (GI) tract tissues. It has been known for many years that CAs are widely present in the GI tract and play important roles in several physiological functions such as production of saliva, gastric acid, bile, and pancreatic juice as well as in absorption of salt and water in intestine. New information suggests that these enzymes participate in several processes that were not envisioned earlier. Especially, the recent reports on plasma membrane-bound isoenzymes IX and XII have raised considerable interest since they were reported to participate in cancer invasion and spread. They are induced by tumour hypoxia and may also play a role in von Hippel-Lindau (VHL)-mediated carcinogenesis.     

Upper gastrointestinal bleeding from duodenal vascular ectasia in a patient with cirrhosis

We report a cirrhotic patient with duodenal vascular ectasia and spontaneous bleeding. The bleeding was successfully controlled with argon plasma coagulation.Duodenal vascular ectasia may be a cause of upper gastrointestinal bleeding in patients with cirrhosis, and argon plasma coagulation may be effective and safe to achieve hemostasis of this lesion.     

脑动静脉畸形的治疗

脑动静脉畸形（ cerebral arteriovenous malformation, AVM ）是临床常见的脑血管疾病。尽管对AVM 的治疗已有了广泛的研究,但是患者预后并没有获得明显改善。 AVM 的主要治疗目的是降低出血风险。文章就AVM 的出血风险和治疗方式进行了综述。     

Purinergic signaling in the gastrointestinal tract

Geoffrey Burnstock completed a BSc at King’s College London and a PhD at University College London. He held postdoctoral fellowships with Wilhelm Feldberg(National Institute for Medical Research),Edith Bülbring(University of Oxford) and C. Ladd Prosser(University of Illinois) . He was appointed to a Senior Lectureship in Melbourne University in 1959 and became Professor and Chairman of Zoology in 1964. In 1975 he became Head of Department of Anatomy and Developmental Biology at UCL and Convenor of the Center of Neuroscience. He has been Director of the Autonomic Neuroscience Institute at the Royal Free Hospital School of Medicine since 1997. He was elected to the Australian Academy of Sciences in 1971,the Royal Society in 1986,the Academy of Medical Sciences in 1998 and an Honorary Fellow of the Royal College of Surgeons and the Royal College of Physicians in 1999 and 2000. He was awarded the Royal Society Gold Medal in 2000. He is editor-in-chief of the journals Autonomic Neuroscience and Purinergic Signalling and on the editorial boards of many other journals. Geoffrey Burnstock’s major research interest has been autonomic neurotransmission and he is best known for his seminal discovery of purinergic transmission and receptors,their signaling pathways and functional relevance. He has supervised over 100 PhD and MD studentsand published over 1400 original papers,re-views and books. He was first in the Institute of Scientific Information list of most cited scientists in Pharmacology and Toxicology from 1994-2004 [59.083 citations(March 2011) and an h-index of 109].     

Long term results of treatment of vascular malformations of the gastrointestinal tract by neodymium Yag laser photocoagulation.

The effect of Yag laser photocoagulation on the course of bleeding of gastrointestinal vascular malformations was studied in 59 patients, with a total of 482 lesions. The lesions were located in the upper gastrointestinal tract alone in 25 patients, in the lower tract alone in 31 patients and in both the lower and the upper gastrointestinal tract in three patients. In the month before laser therapy the number of bleeding episodes averaged 1.09 +/- 0.6 (SD) per patient (n = 57) and the transfusion requirements 2.4 +/- 2.6 red blood cells units per patient, while in the month after treatment the bleeding incidence averaged 0.16 +/- 0.5 and the transfusion requirements 0.21 +/- 0.8 (both p less than 0.001). Long term results were analysed considering for each patient an equally long pretreatment and follow up period. After a mean follow up period of 11.5 months (1-48 months), 17 of the 57 patients available for follow up rebled. The reduction of the bleeding rate was statistically significant at one, six, 12, and 18 months of follow up, while transfusion rate was significantly decreased at one, six, and 12 months. The results were disappointing in patients with Osler-Weber-Rendu (n = 4) and in patients with angiomas associated with Von Willebrand's disease (n = 3), who all rebled. In angiodysplasia the treatment was successful in 82% of the 49 patients. The more numerous the lesions, the less effective the reduction in bleeding rate by laser treatment was. Histological studies showed that the haemostatic effect of Yag laser photocoagulation was obtained by destruction of the lesion. Rebleeding was due to lesions missed at the first treatment, incompletely treated lesions and recurrence of new lesions. In two patients a free caecal perforation necessitated a right hemicolectomy. In both patients numerous or very large lesions had been treated in the caecum.     

Abdominal tuberculosis of the gastrointestinal tract: Revisited

Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge, as the nonspecific features of the disease which may lead to diagnostic delays and development of complications. This condition is regarded as a great mimicker of other abdominal pathology. A high index of suspicion is an important factor in early diagnosis. Abdominal involvement may occur in the gastrointestinal tract, peritoneum, lymphnodes or solid viscera. Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis. Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality. Most of the patients respond very well to standard antitubercular therapy and surgery is required only in a minority of cases. Imaging plays an important role in diagnosis of abdominal tuberculosis because early recognition of this condition is important. We reviewed our experience with the findings on various imaging modalities for diagnosis of this potentially treatable disease.     

Long-term results of treatment of vascular malformations of the gastrointestinal tract by neodymium YAG laser photocoagulation

This study reports long-term results of treatment of vascular malformations of the gastrointestinal tract by neodymium YAG (Nd-YAG) laser photocoagulation in 60 patients (13 patients with hereditary hemorrhagic telangiectasia and 47 patients with angiodysplasias) and examines prognostic parameters of bleeding recurrence in 47 patients with angiodysplasias. In patients with hereditary hemorrhagic telangiectasia, the transfusion requirements were lower only in the second and third year following therapy than in the year before therapy; however, these differences were not significant. In patients with angiodysplasias, a median number of one laser session (range 1-8) was necessary to destroy angiodysplasias. A blood loss recurred in 15 patients. The cumulative probability of remaining free of blood loss recurrence at 24 months and at 54 months was 61 +/- 9%. Three parameters had an independent prognostic value, the initial number of angiodysplasias (P less than 0.02), the presence of coagulation disorders (P less than 0.05), and age (P less than 0.05).     

Heterotopic pancreas in the gastrointestinal tract

Heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomical location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathological changes such as inflammation, bleeding, obstruction, and malignant transformation. In this report, a 60-year-old man with carcinoid syndrome caused by heterotopic pancreatic tissue in the duodenum is described, along with a 62-year-old man with abdominal pain caused by heterotopic pancreatic tissue in the gastric antrum. The difficulty of making an accurate diagnosis is highlighted. The patients remain healthy and symptom-free after follow-up of 1 year. Frozen sections may help in deciding the extent of resection intraoperatively. Although heterotopic pancreas is rare, it should be considered in the differential diagnosis of gastrointestinal stromal tumor.     

Endoscopic submucosal dissection for the treatment of neoplastic lesions in the gastrointestinal tract

AIM: To investigate the indications, resection rate, and safety of endoscopic submucosal dissection (ESD) for neoplastic lesions in the gastrointestinal tract at a European referral center. METHODS: We carried out a retrospective analysis of the ESD procedures performed in our center for mucosal neoplastic and submucosal lesions of the gastrointestinal tract. The duration of the procedure, en bloc and complete (R0) resection rates, and complication rates were evaluated. Variables were reported as mean ± SD or simple proportions. Univariate analysis and comparisons of procedure times and resection rates were performed using Mann-Whitney U tests, or χ2 tests for dichotomous variables.RESULTS: Between 2007 and 2011, ESD was performed in a total of 103 patients (46.7% male, mean age 64.0 ± 12.7 years). The indications for the procedure were epithelial tumor (n = 54), submucosal tumor (n = 42), or other (n = 7). The total en bloc resection rate was 90.3% (93/103) and R0 resection rate 80.6% (83/103). The median speed of the procedure was 15.0 min/cm2 . The complete resection rate was lower for submucosal tumors arising from the muscle layer (68%, 15/22, P < 0.05). Resection speed was quicker for submucosal tumors localized in the submucosal layer than for lesions arising from the muscularis propria layer (8.1 min/cm 2 vs 17.9 min/cm 2 , P < 0.05). The R0 resection rate and speed were better in the last 24 mo (90.1%, 49/54 and 15.3 min/cm 2 ) compared to the first 3 years of treatment (73.5%, 36/49, P < 0.05 and 22.0 min/cm2 , P < 0.05). Complications occurred in 14.6% (n = 15) of patients, including perforation in 5.8% (n = 6), pneumoperitoneum in 3.9% (n = 4), delayed bleeding in 1.9% (n = 2), and other in 2.9% (n = 3). Only one patient with delayed perforation required surgical treatment. During the mean follow-up of 26 ± 15.3 mo, among patients with R0 resection, recurrence occurred in one patient (1.2%).CONCLUSION: ESD is an effective and safe method for resection of neoplastic lesions with low re     

胃肠道间质瘤的临床特征及治疗进展

胃肠道间质瘤(gastrointestinal stromal tumor,GIST)是胃肠道最常见的间叶性肿瘤,近年来随着分子生物学、组织病理学和临床医学的研究进展,对其认识不断加深.传统手术与分子靶向药物相结合对GIST的治疗显得尤为重要,以伊马替尼和舒尼替尼等药物为代表的多靶点和多激酶抑制剂在治疗不可切除及复发性GIST中更是受到高度关注.本文主要对该病的基因分析、病理组化特点、手术及辅助治疗相关进展作一综述.     

Expression of vascular endothelial growth factor and its receptors VEGFR-1 and 2 in gastrointestinal stromal tumors, leiomyomas and schwannomas

INTRODUCTION Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the gastrointestinal (GI) tract that may occur from the oesophagus to the anus, including the omentum[1,2]. Despite their rarity, GISTs are the most common primary mesench…     

健胃消胀片对胃肠系统药理作用研究

[目的]研究健胃消胀片对胃肠系统的药理作用。[方法]建立盐酸乙醇致大鼠胃黏膜损伤模型和幽门结扎大鼠模型,测定小鼠小肠对碳末的推进率和小鼠胃对酚红液的排空率,观察健胃消胀片对胃黏膜保护、胃液分泌、小肠推进及胃排空的作用。[结果]健胃消胀片对盐酸乙醇所致大鼠胃黏膜损伤有保护作用,对幽门结扎大鼠有抑制胃酸分泌作用,对正常小鼠小肠推进有促进作用,与阳性对照组比较差异无统计学意义(P0.05),但显著高于正常对照组(P0.01或0.05);健胃消胀片对胃排空无明显影响(P0.05)。[结论]健胃消胀片能保护胃黏膜、抑制胃酸分泌、促进小肠运动。     

Follow-up after surgical treatment for cancer of the gastrointestinal tract

BACKGROUND: Presently, no evidence-based guidelines for the follow-up of patients after surgery for gastrointestinal cancer are available. As a consequence, follow-up strategies may differ between hospitals depending on preference of physicians. We investigated which follow-up procedures are currently employed after surgery for gastrointestinal cancer in the Netherlands. METHOD: A questionnaire was sent to all surgical departments in the Netherlands. The questionnaire focused on frequency of follow-up visits and diagnostic procedures after surgical treatment for oesophageal, gastric, pancreatic and colorectal cancer and psychosocial issues during follow-up. RESULTS: The response rate was 90% (83/92). In the majority of hospitals, surgeons treated patients with colorectal (100%) and gastric (96%) cancer in their own centre, whereas patients with pancreatic (64%) and oesophageal (61%) cancer were more often referred to a tertiary centre. For all patients treated for gastrointestinal cancer, three to four follow-up visits were made in the first year, followed by at least two annual visits thereafter. After colorectal surgery, blood tests (78%), colonoscopy (75%) and abdominal ultrasound (57%) were frequently performed. In other gastrointestinal malignancies, procedures were in most cases only performed if symptoms occurred. In almost three-quarters of patients, psychosocial problems were observed, which were dealt with by surgeons in two-thirds of patients. The majority of patients treated for gastrointestinal cancer were pre- and postoperatively discussed in a multidisciplinary setting. Oncologists, gastroenterologists and dieticians were the most frequently consulted specialists after surgery for gastrointestinal cancer. CONCLUSION: Patients frequently visit the outpatient clinic after surgery for gastrointestinal cancer in the Netherlands. Whereas follow-up after colorectal cancer surgery focuses on finding recurrent disease and metachronous lesions in the colorectum, this is less clear after oesophageal, gastric and pancreatic cancer surgery. Further studies are needed to establish what is the most effective follow-up protocol after different types of gastrointestinal cancer surgery.     

Effects of occupational stress on the gastrointestinal tract

The aim of this review is to provide a general overview of the relationship between occupational stress and gastrointestinal alterations. The International Labour Organization suggests occupational health includes psychological aspects to achieve mental well-being. However, the definition of health risks for an occupation includes biological, chemical, physical and ergonomic factors but does not address psychological stress or other affective disorders. Nevertheless, multiple investigations have studied occupational stress and its physiological consequences, focusing on specific risk groups and occupations considered stressful. Among the physiological effects of stress, gastrointestinal tract (GIT) alterations are highly prevalent. The relationship between occupational stress and GIT diseases is evident in everyday clinical practice; however, the usual strategy is to attack the effects but not the root of the problem. That is, in clinics, occupational stress is recognized as a source of GIT problems, but employers do not ascribe it enough importance as a risk factor, in general, and for gastrointestinal health, in particular. The identification, stratification, measurement and evaluation of stress and its associated corrective strategies, particularly for occupational stress, are important topics to address in the near future to establish the basis for considering stress as an important risk factor in occupational health.     

糖尿病病人胃肠道X线造影改变的临床观察

目的 探讨糖尿病（ＤＭ）病人胃肠道异常的Ｘ线表现及临床价值。方法 全消化道钡餐检查ＤＭ病人６６例,健康人３０例,非ＤＭ性慢性腹泻病人３０例。结果 ＤＭ性胃肠道异常Ｘ线主要为非特异性功能性改变,阳性检出率８３．３％;小肠的扩张或／和弛张改变具有相对特征性意义。结论 本方法可作为对ＤＭ性植物神经病变的间接、简便临床检查手段。     

Optical coherence tomography and Doppler optical coherence tomography in the gastrointestinal tract

Optical coherence tomography(OCT) is a noninvasive,high-resolution,high-potential imaging method that has recently been introduced into medical investigations.A growing number of studies have used this technique in the field of gastroenterology in order to assist classical analyses.Lately,3D-imaging and Doppler capabilities have been developed in different configurations,which make this type of investigation more attractive.This paper reviews the principles and characteristics of OCT and Doppler-OCT in conn...