Volume 76 - 2013 - Fasc.4 - Case series
Optimal use of proton pump inhibitors for treating acid peptic diseases in primary care
Heartburn, reflux and epigastric pain are frequently encoun- tered symptoms in primary care medicine. Acid peptic diseases such as peptic ulcer and gastrointestinal reflux disease have a high prevalence, can have important impact on patient quality of life and represent a considerable health care cost. Proton pump inhibi- tors (PPIs) are the most potent pharmacological inhibitors of gas- tric acid secretion currently available and are the mainstay medical therapy for acid peptic diseases.
This review summarizes current evidence on treatment of acid- peptic diseases with proton pump inhibitors and provides primary care clinicians with best practice guidelines for optimal use of these drugs. (Acta gastroenterol. belg., 2013, 76, 393-402).
Gastrointestinal stromal tumor of the stomach : progresses in diagnosis and treatment
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal smooth muscle neoplasms that can arise anywhere within the gas- trointestinal tract. Approximately 60-70% are located in the stom- ach. Once considered variants of smooth muscle tumors, they are now understood as originating from the interstitial cells of Cajal or their stem cell precursors. The majority of GISTs (approximately 95%) express the CD117 antigen (KIT), a proto-oncogene product ; 85-95% of these neoplasms have mutations in the c-KIT gene ; only 5-7% has mutations in platelet-derived-growth factor a (PDGFRa).
GISTs can be asymptomatic and incidentally found during ex- amination for other pathologies or at autopsy. The most common symptoms of gastric GIST are abdominal pain and bleeding. Diag- nostic work up consists of endoscopy with ultrasonography and cross-sectional imaging studies (computed tomography and/or magnetic resonance imaging).
Surgery remains the first-line treatment for localized gastric GISTs. Both open and laparoscopic operations have been shown to reduce recurrence rates and improve long-term survival. The use of small-molecule selective tyrosine kinase receptor inhibitors has revolutionized the treatment of advanced GISTs. (Acta gastro- enterol. belg., 2013, 76, 403-406).
Eosinophilic esophagitis is a chronic, immune-mediated disor- der, isolated to the esophagus. Current theory suggests that the former may be caused by cell-mediated food hypersensitivity or may be a subset of eosinophilic gastrointestinal disease, an auto- immune disorder. During the last decade, the increasing prevalence of Eoe has been recognized in pediatric populations. Reports -support-the-efficacy-of-dietary-restriction-or-corticosteroid-therapy. Aditional research is needed to determine etiology, allow earlier clinical recognition and improve treatment. Because no single symptom,-endoscopic-finding-or-histopathologic-feature-is-pathog- nomonic, the diagnosis can frequently be challenging. The current article reviews the possible etiology, clinical presentation, diagno- sis, and treatment of this disorder, which has been called not only allergic esophagitis (which may be the most important cause), but also eosinophilic esophagitis, primary eosinophilic esophagitis, and idiopathic eosinophilic esophagitis. (Acta gastroenterol. belg., 2013, 76, 407-412).
Diagnostic accuracy of nuclear medicine imaging in protein losing enteropathy : systematic review and meta-analysis of the literature
Background and Aim : Scintigraphy using Tc-99m or In-111 labeled proteins is an important diagnostic modality for diagnosis of protein losing enteropathy (PLE). We systematically reviewed the available literature regarding the accuracy of scintigraphy using Tc-99m or In-111 labeled proteins for diagnosis of PLE.
Methods : Medline and SCOPUS were searched using (("protein losing") AND ("scintigraphy" OR "Nuclear Medicine")) as keywords without any language or date limit. All studies on the accuracy of scintigraphy using Tc-99m or In-111 labeled proteins in PLE were included in the systematic review.
Results : Overall 12 studies were included in our study. Pooled sensitivity and specificity were 87% [81-92%], and 62% [51-72%], respectively. Tc-99m labeled tracers had higher sensitivity but low- er specificity compared to In-111 labeled ones. Delayed imaging could increase the sensitivity of imaging despite the lower specific- ity compared to the early images. Restriction of the analyses to larger studies (more than 10 patients) and to studies with the gold standard of fecal alpha1-antitrypsin did not change the pooled indices.
Conclusion: Scintigraphy using Tc-99m or In-111 labeled proteins has high sensitivity for diagnosis and localization of PLE. Using Tc-99m labeled tracers and delayed imaging can further increase the sensitivity. Despite the high sensitivity, specificity of scintigraphy is suboptimal and false positive abdominal activities can limit the usefulness of this imaging method. (Acta gastroenterol. belg., 2013, 76, 413-422).