Since the initial description of the diverticulosis of the colon in mid-1800, these saccular protrusions of the mucosa and submucosa of the colon through the bowel wall have progressively assumed more clinical importance over the 20th century and has become a common gastroenterological problem in the aging population.
There is no controversy that H. Pylori (HP) causes gastritis. However, to date, there is no direct evidence that HP causes any ulcers. There is good statistical correlation between ulcer diseases and HP yet statistical correlation does not imply causality. HP induced gastritis is associated with hypochlorohydria and increased bicarbonate secretion seen with gastric ulcer (GU). Low acid and high bicarbonate secretion associated with HP has been found to be protective against the development of reflux oesophagitis (GORD). This is believed to be the reason why GORD develops for the first time after eradication of HP for duodenal ulcers (DU)(1).Despite greater than 90% correlation of HP and DU, paradoxically acid secretion is increased and bicarbonate secretion is decreased in DU. Yet HP eradication reduces relapse of DU although not to the extent it was believed in the past. Recent meta-analysis of randomized trials indicate a relapse rate of 20% of DU 6 months after HP eradication(2).So what shall we do? The following are my suggestions:
Five year survival of oesophageal cancers is approximately 10% globally. Early cancers are operable. Of the two types of oesophageal cancers we see, incidence of squamous cell carcinomas (SCC) is declining while there is progressive rise of the incidence of the adenocarcinoma (AC) of the oesophagus. This article focuses on the identification of at risk individuals.
The poor outcome of pancreatic cancer (PC) is reflected by the overall less than 5% five year survival. Eighteen hundred people are diagnosed with PC every year in Australia. Approximately 33,730 new cases were expected to be diagnosed in USA in 2006 with 32,300 expected deaths. Mortality closely follows incidence as demonstrated in the 2002 Australian graph (page 2). However, appropriate attention to certain risk factors has the potential to reduce mortality by early diagnosis. Pancreatic cancer is rare before the age of 45 and slightly more common in the male than in the female (1.3:1).
This article will specifically focus on well known and not so well known risk factors for the development of CRC and adenomas. Also, since we live in an era when substantial misinformation is apparently legally disseminated in the field of preventive medicine by various stake holders, it is appropriate to identify protective factors scientifically proven to work towards prevention of CRC and adenomas.
Colorectal cancers (CRC) are the 3rd largest cause of death in Australia after cardiovascular diseases and lung cancer. Over 3,800 patients died of CRC in Australia in 2006.
In this issue of Gastroenterology Update, I have focused on common issues of gastroenterology and endeavored to bring you an update on these issues.
Haemospray(TC-325): once sprayed on the bleeding surface, it swells with moisture and stimulates platelet aggregation. Primary haemostasis has been reported in 85% of ulcer and variceal bleeding. I have used this agent recently and is now available in both Pindara and Allamanda private hospitals and presumably also in the public hospitals.