This month in Gastroenterology

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Abstract

GASTROENTEROLOGY 1999;117:1-2

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Trypsinogen mutations in chronic pancreatitis

Inappropriate conversion of trypsinogen to trypsin appears to play a role in the pathogenesis of pancreatitis. Recently, two mutations of the cationic trypsinogen gene were found in families with hereditary pancreatitis. Based on these considerations, Witt et al. conducted a study to determine the spectra and frequencies of the aforementioned mutations in 44 unrelated children and adolescents with either idiopathic (n = 30) or hereditary (n = 14) chronic pancreatitis (CP). The results show that

H. pylori and healing of reflux esophagitis

An exaggerated effect of proton pump inhibitors (PPIs) to reduce intragastric acidity in patients infected with Helicobacter pylori has been reported. Because the improvement and healing of symptoms with gastroesophageal reflux disease (GERD) is directly associated with an increase in intragastric pH during treatment, Holtmann et al. hypothesized that the response to PPI treatment in patients with GERD may be better in H. pylori–infected patients. These investigators now report that their

Safety of low-dose aspirin

Because the safety of low-dose daily aspirin consumption for the gastrointestinal tract remains uncertain, Cryer and Feldman evaluated long-term effects of very-low-dose aspirin in the gastrointestinal tract and effects on platelet-derived serum thromboxane in 29 healthy volunteers. Subjects were randomized to receive 10 mg (n = 8), 81 mg (n = 11), or 325 mg (n = 10) of aspirin daily for 3 months. Before aspirin administration, all subjects underwent gastroduodenoscopy, and most underwent

Achalasia and HLA phenotypes

Idiopathic achalasia is a motility disorder of the esophagus characterized by incomplete relaxation of the lower esophageal sphincter and by loss of normal peristaltic activity in the body of this organ. Loss of inhibitory neurons in the distal esophagus, as well as abnormalities in the vagus nerve, its dorsal motor nucleus, and in the autonomic nervous system, may contribute to this disorder. In addition, recent studies have described a significant association between the HLA-DQ1 phenotype and

Cortical topography of the anorectum

Although the muscles of the anorectum are very important in the volitional control of continence, little information exists on their cortical representation in humans. In this issue Turnbull et al. performed topographic cortical mapping of both cerebral hemispheres in 9 healthy subjects and show for the first time that the anorectal musculature has bilateral motor cortex representation with similar topography. However, they found that there was intersubject variation in the degree of symmetry

A potpourri on Crohn's disease

Three articles in this issue deal with diverse and interesting issues related to Crohn's disease.

In the first, Silverstein et al. describe the lifetime clinical course and cost of Crohn's disease in a 24-year population-based cohort of patients with this disease in Olmsted County, Minnesota. Disease states were defined by both medical and surgical treatments. A Markov model was used to calculate time in each disease state, as well as excess lifetime costs in comparison with an age- and

H. pylori–induced gastric MALTomas

Gastric mucosa-associated lymphoid tissue lymphoma (MALToma) occurs in a small percentage of patients infected with Helicobacter pylori, and eradication of this organism may lead to this malignancy's regression. Chang et al. now demonstrate that a mutation in a putative flavodoxin protein, FldA, leading to a truncated FldA form in H. pylori, is associated with gastric MALTomas. They suggest that FldA may not only be involved in the pathogenesis of this malignancy but that antibodies to this

Hepatic transplantation with HCV-positive grafts in HCV-associated liver failure

Chronic hepatitis C virus (HCV) infection is one of the leading causes of end-stage liver disease requiring hepatic transplantation. Approximately 25%–30% of candidate pools at major transplant centers consist of HCV-infected patients. About 4 million Americans are presently infected with this virus, and 20%–30% of these patients can be expected to progress to cirrhosis. Donor nonavailability is the major limiting factor to organ transplantation and has lead to the use of less than optimal

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