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February 11, 2009, 6:22 AM CT

Mutation that causes inflammatory bowel disease

Mutation that causes inflammatory bowel disease
A team of researchers at The Scripps Research Institute has linked a mouse mutation to an increased susceptibility for developing inflammatory bowel disease -- represented in humans as Crohn's disease and ulcerative colitis, which together are estimated to affect more than a million people in the United States. The findings may one day lead to new and better therapys for the disease.

The work was reported in the February 6, 2009 Early Edition of the Proceedings of the National Academy of Sciences (PNAS).

Humans have a gene that is very similar to the mouse gene, called Mbtps1, and in certain rare instances, mutations of this gene may contribute to IBD in humans. The disease is linked to painful ulcers and bleeding in people's intestines and can place them at greater risk for colon cancer. Eventhough common, the disease is still somewhat mysterious. The Scripps Research study sheds light on a major mechanism through which it may develop.

"We are just beginning to get a sense of the complexity of inflammatory bowel disease as far as humans are concerned," says Bruce Beutler, M.D., who is the chair of the Scripps Research Department of Genetics.

Researchers have known for a long time that IBD is associated with geneticsit runs in families, for instance. However, there seems to be no single gene responsible. More likely, says Beutler, mutations in a number of different genes have additive effects and cause people to develop variably severe forms of the disease. One of the long-term goals of his laboratory is to identify these genes and the main biological processes they control.........

Posted by: Sue      Read more         Source


February 10, 2009, 6:04 AM CT

Cirrhosis, Inflammation And Heart Rhythm Problems

Cirrhosis, Inflammation And Heart Rhythm Problems
Liver cirrhosis is the seventh leading cause of death in the United States, taking 25,000 lives per year. It is often the result of alcohol over-consumption or exposure to hepatitis C, either of which can damage the liver and prevent it from filtering toxins. These toxins then accumulate in the blood stream and eventually reach the brain where they disrupt neurological and mental performance, a condition known as hepatic encephalopathy.

Individuals with cirrhosis are also susceptible to a change in heart rhythm (decreased heart rate variability). Since cirrhosis, hepatic encephalopathy and heart rate variability are known to be linked to inflammation, scientists have examined what role cytokines (inflammatory molecules) play.

A newly released study from The American Physiological Society suggests that these cytokines can lead to both the neurological and cognitive abnormalities and changes in heart rhythm in patients with cirrhosis. The results of the study may also apply to other conditions where heart rate variability is also decreased, such as bipolar disorder and post-menopausal depression.

The study, "Decreased heart rate variability in patients with cirrhosis relates to the presence and severity of hepatic encephalopathy," was carried out by Ali R. Mani, Sara Montagnese, Clive D. Jackson, Christopher W. Jenkins, Ian M. Head, Robert C. Stephens, Kevin P. Moore and Dr. Morgan. All are affiliated with the University College London Medical School, with the exception of Mr. Jackson, who is with the Royal Free Hospital, London. The study appears in The American Journal of Physiology-Gastrointestinal and Liver Physiology.........

Posted by: Sue      Read more         Source


February 2, 2009, 6:24 AM CT

Infliximab may prevent Crohn's disease recurrence

Infliximab may prevent Crohn's disease recurrence
The administration of infliximab after intestinal resective surgery was found to be effective at preventing endoscopic and histological recurrence of Crohn's disease, as per a newly released study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute. To date, there have been no randomized controlled trials evaluating infliximab for postoperative Crohn's disease prevention.

"Our study provides good evidence that infliximab is effective at preventing endoscopic, clinical and histological postoperative recurrence of Crohn's disease, and provides a rationale for aggressive postoperative chemoprevention with biologic treatment," said Miguel Regueiro, MD, of the University of Pittsburgh Medical Center. "We are encouraged by our findings, which warrant future study of the duration of post-operative infliximab maintenance and appropriate endoscopic follow up".

Crohn's disease is an inflammation and ulceration process that occurs in the deep layers of the intestinal wall and usually recurs after intestinal resection. Despite the advent of immunomodulator treatment, approximately 75 percent of Crohn's disease patients require an intestinal resection for complications.

Scientists randomly assigned 24 Crohn's disease patients who had undergone ileocolonic resection to receive intravenous infliximab (5 mg/kg), administered within four weeks of surgery and continued for one year, or placebo. The study's research team elected to use endoscopic recurrence at one year as the primary study endpoint. Secondary endpoints were clinical recurrence and remission and histological recurrence.........

Posted by: Sue      Read more         Source


January 14, 2009, 11:16 PM CT

Obesity may lead to complications at surgery

Obesity may lead to complications at surgery
A newly reported study in the recent issue of the Journal of the American College of Surgeons shows that morbidly obese patients are at higher risk than normal weight patients for complications after colectomy surgical removal of all or part of the colon for the therapy of cancer.

Obese patients are more likely than non-obese patients to develop and ultimately die from colon cancer, the second leading cause of cancer death in the United States. Surgical intervention remains the primary therapy for colon cancer, but it carries the risk of serious complications.

"Eventhough recent analyses have indicated that obese patients getting colectomy have higher rates of complications after the operation, this is the first major study to examine how body mass index affects the risk of specific adverse events such as infection, kidney failure and blood clots," said Ryan P. Merkow, MD, department of surgery, University of Colorado Denver School of Medicine. "These findings could help medical teams anticipate and manage post-operative risks in morbidly obese patients".

The scientists used the American College of Surgeons National Surgical Quality Improvement Project dataset to identify 3,202 patients who had colectomy for cancer. These patients were categorized into four patient populations based on body mass index (BMI): normal weight (BMI = 18.5 to 24 kg/m2, 33.4 percent); overweight (BMI = 25 to 29 kg/m2, 35.1 percent); obese (BMI = 30 to 34kg/m2, 19.0 percent); and morbidly obese (BMI ≥ 35 kg/m2, 12.4 percent). Logistic regression models were developed to assess risk-adjusted 30-day outcomes by BMI while adjusting for preoperative risk factors.........

Posted by: JoAnn      Read more         Source


January 14, 2009, 11:10 PM CT

laparoscopic removal of GIST

laparoscopic removal of GIST
New research reported in the recent issue of the Journal of the American College of Surgeons shows that laparoscopic removal of gastrointestinal stromal tumors (GISTs) is safe and effective, with a disease-free survival rate of nearly 80 percent after an average follow-up time of three and a-half years.

GIST is a type of cancer arising from special cells in the wall of the gastrointestinal tract that help coordinate the muscular movement of digestive organs. Each year, between 4,500 and 6,000 cases of GIST are diagnosed in the United States. Laparoscopic surgery is an attractive alternative to traditional "open" surgery the therapy of choice for GISTs that have not spread to nearby organs since it is requires smaller abdominal incisions and therefore appears to be safer and result in a quicker recovery.

"Based on our data, which represents the largest retrospective series of GIST patients reported to date, we think that laparoscopic resection is feasible in the management of these tumors, carries no additional risks and has comparable results to the open approach," said Celia Divino, MD, FACS, Chief, Division of General Surgery at The Mount Sinai Medical Center, New York, N.Y.

Parissa Tabrizian, MD, further noted that, "The biologic behavior of GISTs makes them amenable to laparoscopic resection because they do not require removal of large amounts of tissue or lymph nodes".........

Posted by: Sue      Read more         Source


January 14, 2009, 6:29 AM CT

Hepatitis C May Increase Pancreatic Cancer Risk

Hepatitis C May Increase Pancreatic Cancer Risk
A newly released study shows that infection with hepatitis C virus (HCV) increases a person's risk for a highly fatal cancer of the biliary tree, the bile carrying pathway between the liver and pancreas. This finding is in the recent issue of Hepatology, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases (AASLD). The article is also available online at Wiley Interscience (www.interscience.wiley.com).

More than 4 million Americans are infected with HCV, which causes chronic hepatitis, cirrhosis and liver cancer. However, the associations between the virus and other potentially-related cancers are less clear.

To better understand the associations between HCV and these cancers, scientists led by Hashem El-Serag of Baylor College of Medicine, conducted a retrospective cohort study of more than 718,000 U.S. veterans who were treated at Veterans Affairs medical facilities between October 1, 1988 and September 30, 2004. Among them, 146,394 were infected with HCV and 572,293 were not. Uninfected subjects were matched to infected ones by sex, age and type and date of visit.

The scientists followed the subjects for an average of 2.3 years to determine the incidence these cancers. They observed that "risk for biliary tree cancer in the HCV-infected cohort, eventhough low (4 per 100,000 person-years), was more than double that in the HCV-uninfected cohort".........

Posted by: Sue      Read more         Source


January 8, 2009, 9:08 PM CT

Genes and Crohn's disease

Genes and Crohn's disease
Scientists at McGill University, the Research Institute of the McGill University Health Centre (RI MUHC) and the McGill University and Gnome Qubec Innovation Centre, along with colleagues at other Canadian and Belgian institutions, have discovered DNA variations in a gene that increases susceptibility to developing Crohn's disease. Their study was reported in the recent issue of the journal Nature Genetics

The study was led by McGill PhD candidate Alexandra-Chlo Villani under the supervision of Dr. Denis Franchimont and Dr. Thomas Hudson. Dr. Franchimont, now with the Erasme Hospital in Brussels, Belgium, was a Canada Research Chair formerly affiliated with the Gastroenterology Dept. of the MUHC. Dr. Hudson, former Director of the McGill University and Gnome Qubec Innovation Centre, is now the President and Scientific Director of the Ontario Institute for Cancer Research (OICR), located in Toronto.

The scientists pinpointed DNA sequence variants in a gene region called NLRP3 that are linked to increased susceptibility to Crohn's disease. Crohn's is a chronic relapsing inflammatory disease of the digestive system that can affect any part of the gastrointestinal tract. Patients can suffer from many different symptoms in various combinations, including abdominal pain, bloody diarrhea, fever, vomiting and weight loss. Rarer complications include skin manifestations, arthritis and eye inflammation.........

Posted by: Sue      Read more         Source


January 2, 2009, 10:26 AM CT

Chronic pancreatitis pain: Relief with antioxidants

Chronic pancreatitis pain: Relief with antioxidants
Antioxidant supplementation was found to be effective in relieving pain and reducing levels of oxidative stress in patients with chronic pancreatitis (CP), reports a newly released study in Gastroenterology CP is a progressive inflammatory disease of the pancreas in which patients experience abdominal pain (in early stage) and diabetes and maldigestion (in late stage). Pain is the major problem in 90 percent of patients with CP and currently, there is no effective medical treatment for pain relief. Gastroenterology is the official journal of the American Gastroenterological Association (AGA) Institute.

In this placebo-controlled, double blind trial, 127 patients, ages 30.5+/-10.5, were assigned to placebo or antioxidant groups. After six months, the reduction in the number of painful days/month was significantly higher in the antioxidant group, compared with the placebo group (7.46.8 versus 3.24, respectively). The reduction in the number of analgesic tablets/month was also higher in the antioxidant group (10.511.8 versus 4.45.8, respectively). Furthermore, 32 percent and 13 percent of patients became pain free in the antioxidant and placebo groups, respectively; the beneficial effect of antioxidants on pain relief was noted early at three months.

"Abdominal pain, the predominant symptom in patients with CP, is difficult to treat. The main reason for a largely ineffective medical therapy is that the mechanism of pain in CP is not well understood," said Pramod Kumar Garg, MD, DM, of the All India Institute of Medical Sciences, New Delhi and main author of the study. "We are encouraged by our findings, as significant improvement was noted with antioxidants in respect to all the parameters of pain in this study. In addition, reduction in pain resulted in fewer man-days lost, thus providing functional employment gain to the patients. The findings should spur further research in this exciting area".........

Posted by: Sue      Read more         Source


December 31, 2008, 7:16 AM CT

Evaluating the century old treatment for peptic ulcer

Evaluating the century old treatment for peptic ulcer
Bismuth compounds have been used for centuries in medicine. The discovery of H. pylori in 1983 led to renewed interest in bismuth compounds, because these were found to successfully treat the infection in combination with antibiotics. However, in the 1970s bismuth salts, used at high doses for prolonged periods, were found to lead to neurotoxicity. There has been no summary of evidence for the toxicity of bismuth when used for short periods as part of H. pylori eradication treatment.

A research article would be published on December 28, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Professor Paul Moayyedi from McMaster University, Canada performed a systematic review and meta-analysis to assess the safety of bismuth compounds, when used in a 1 or 2-week course of H. pylori eradication treatment. They examined the risk of adverse events in randomized controlled trials using bismuth compounds as part of H. pylori eradication treatment in comparison to other regimens.

Thirty-five randomized controlled trials containing over 4500 patients were identified comparing bismuth with placebo or no therapy, or bismuth salts in combination with antibiotics as part of eradication treatment with the same dose and duration of antibiotics alone or in combination with acid suppression. There were no differences in the total number of adverse events with bismuth versus comparison regimen. Individual adverse events were also no more frequent with bismuth, with the exception of dark stools. There were no significant differences detected in the number of adverse events leading to withdrawal of treatment with bismuth versus comparison regimen.........

Posted by: Sue      Read more         Source


December 1, 2008, 5:53 PM CT

Antibiotics: Single largest class of drugs causing liver injury

Antibiotics: Single largest class of drugs causing liver injury
Antibiotics are the single largest class of agents that cause idiosyncratic drug-induced liver injury (DILI), reports a new study in Gastroenterology, an official journal of the American Gastroenterological Association (AGA) Institute. DILI is the most common cause of death from acute liver failure and accounts for approximately 13 percent of cases of acute liver failure in the U.S. It is caused by a wide variety of prescription and nonprescription medications, nutritional supplements and herbals.

"DILI is a serious health problem that impacts patients, physicians, government regulators and the pharmaceutical industry," said Naga P. Chalasani, MD, of the Indiana University School of Medicine and lead author of the study. "Further efforts are needed in defining its pathogenesis and developing means for the early detection, accurate diagnosis, prevention and therapy of DILI".

In this prospective, ongoing, multi-center observational study the largest of its kind patients with suspected DILI were enrolled based upon predefined criteria and followed for at least six months. Those with acetaminophen liver injury were excluded.

Scientists observed that DILI was caused by a single prescription medicine in 73 percent of the cases, by dietary supplements in 9 percent and by multiple agents in 18 percent. More than 100 different agents were linked to DILI; antimicrobials (45.5 percent) and central nervous system agents (15 percent) were the most common. Of the dietary supplements causing DILI, compounds that claim to promote weight loss and muscle building accounted for nearly 60 percent of the cases. The study observed that at least 20 percent of patients with DILI ingest more than one potentially hepatotoxic agent.........

Posted by: Mark      Read more         Source



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Did you know?
The number of bariatric surgeries performed in the U.S. increased by 450 percent between 1998 and 2002, a growth the scientists say could be linked with use of the minimally invasive laparoscopic technique, according to an article in the recent issue of Archives of Surgery, one of the JAMA/Archives journals.

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