Carcinoma of the gastric stump: risks and pathogenesis
Article Abstract:
Gastric stump carcinoma (GSC), which is a cancer that can develop five or more years following surgery for nonmalignant gastric disease, is now recognized as a distinct disorder. GSC may develop after gastric surgery for a variety of gastrointestinal problems, most frequently following surgical treatments for peptic ulcer disease such as removal of part of the intestine or severing the vagus nerve (the nerve responsible for increased acid secretion into the stomach). Patients are at risk of developing GSC beginning 15 to 20 years subsequent to the original surgery, and the likelihood increases with time thereafter. Not enough data have been published for an accurate appraisal of the influence of patient age, type of operation, or preoperative ulcer type. The causal factors involved in development of the malignancy are unknown. One hypothesis is that a family of chemicals, N-nitroso compounds, often found in processed foods (as well as naturally in some foods, such as vegetables) may increase the risk of gastric cancers in general, and GSC in particular. Experimental studies in dogs, hamsters and rats support this notion, and epidemiological studies in man also support this causal link. There is evidence to suggest that achlorhydria (decreased secretion of acid into the stomach), and the reflux of bile from the intestine into the stomach may facilitate the cancer-causing effects of N-nitroso compounds. Both of these conditions are commonly seen after gastric surgery. The resulting low-acidity environment in the stomach causes an increase in the levels of N-nitroso compounds, which may ultimately lead to the development of GSC. As alternative treatments for ulcerative diseases become more effective, the incidence of elective gastric surgery will decrease, which should make the problem less prevalent in the future. Most patients who will require gastric surgery for benign diseases in the future will be elderly and/or suffering from serious systemic disease, either of which make it unlikely that they will survive long enough to develop CSC. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Gut
Subject: Health
ISSN: 0017-5749
Year: 1990
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Changes in asthma prevalence: two surveys 15 years apart
Article Abstract:
There is concern that the incidence of childhood asthma is increasing. Factors contributing to the rise in asthmatic cases may be changes in the household and atmospheric environment (pets, foods or air pollution) or changes in the way asthma is diagnosed. In 1973 and again in 1988, a survey consisting of a questionnaire and exercise test was given to 12-year-old children and their parents to estimate the changes in the occurrence of asthma over a 15-year period. The survey contained questions about symptoms of asthma, such as incidence of current asthma, wheezing, breathlessness, eczema and hay fever, and was sent to parents of 818 children in 1973 and 965 children in 1988. In addition, these children were subjected to exercise testing to establish peak expiratory flow rates (PEFR), an index of lung function. Between the two dates, history of wheezing increased from 17 to 22 percent and asthma from 6 to 12 percent. Current asthma rose from 4 to 9 percent. Results of exercise testing suggest that both mild and severe asthma cases had become more abundant. Allergy-related conditions such as eczema and hay fever also increased noticeably. It appears that asthma has become more widespread during the 15 years of this study and that increase cannot be entirely attributed to an increased ability to diagnose the disease. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1989
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