Neurology
Gina Johnson, Ian Hill-Smith, Chirag Bakhai in The Minor Illness Manual, 2018
Headache is common, but patients often fear that they have an underlying brain tumour. The headache is severe, usually unilateral and often associated with tenderness of the scalp and temples, aching of the jaw muscles on eating and visual disturbance. In children, visual symptoms are less common and may be simultaneous with the headache, or they may have abdominal pain, vomiting or dizziness without headache. Vestibular neuronitis, benign paroxysmal positional vertigo, and vestibular migraine are common causes of vertigo in primary care. Adults with frequent dyspepsia or heartburn as well as migraine should be tested for Helicobacter pylori – if the presence of Helicobacter is confirmed, eradication therapy may abolish the migraine as well as the gut symptoms. For migraine in adults, National Institute for Health and Care Excellence recommends a combination of a triptan and a non-steroidal anti-inflammatory drug, although monotherapy with a triptan is nearly as effective.
Gastric cancer
Louisa Baxter, Neel Sharma, Ian Mann in The Junior Doctor’s Guide to Gastroenterology, 2018
The development of gastric cancer has been shown to be associated with increased consumption of foods with high salt content, and low intake of fruit and vegetables. Helicobacter pylori infection and cigarette smoking have been shown to be associated with gastric cancer. A barium meal can help to diagnose cases of suspected gastric outflow obstruction. This is particularly useful in cases where the gastric tumour prevents the physical passage of the scope, and it can help to provide a crude estimate of the extent of tumour bulk. Malnutrition is a significant problem as a result of both reduced appetite and the catabolic state of malignancy. Dietary requirements should be ascertained by a dietician and supplemented as appropriate. It is important to optimise the patient’s condition prior to either chemotherapy or surgery. The pathogenesis of gastric cancer involves an array of growth factors, and studies have demonstrated the potential role of inhibitors targeted against epidermal and vascular endothelial growth factor receptors.
Future Prospects
Tariq I Mughal, John M Goldman, Sabena T Mughal in Understanding Leukemias, Lymphomas, and Myelomas, 2017
The development led to the availability of imatinib mesylate which results in a significant reduction of leukemia cells and a prolongation of survival for the majority of patients with chronic myeloid leukemia. The treatment remains difficult and is fairly toxic, particularly in patients with acute leukemias, many of whom are probably overreacted and so unnecessarily exposed to the risk of side effects, in particular the long-term effects. A number of candidate leukemia-associated antigens, such as the Wilms tumor antigen, which is known to be over expressed in a variety of myeloid leukemias and other cancers, have been identified and trials to assess the potential usefulness of such strategies are in progress. The use of autologous transplants continues to increase for patients with lymphomas, Hodgkin and non-Hodgkin, myelomas, and acute myeloid leukemias. A good example is the gastric mucosa-associated lymphoid tissue lymphomas associated with infection by the Helicobacter pylori bacterium.
Is There Seasonal Periodicity in the Prevalence of Helicobacter Pylori?
Published in Chronobiology International, 1999
Christoph Raschka, Wolfgang Schorr, Horst J. Koch
The objective of the present study was to evaluate seasonal periodicity in the prevalence of Helicobacter pylori. A prospective study was performed on 1076 consecutive patients who were investigated in our hospital over a 3-year span because of epigastric complaints. Our findings indicate a significant accumulation of positive Helicobacter pylori tests in October. Gastric acidity, gender, and age did not influence Helicobacter pylori infection significantly. There was no significant correlation between potential seasonal influence on the diagnosis of ulcer disease and the seasonal fluctuation of Helicobacter pylori infection. The seasonality was confirmed by cosinor analysis for the absolute frequencies of H. pylori infections and also for the number of cases positive for H. pylori per number of presenting patients per month. A seasonal concept of a sensitivity threshold for positive Helicobacter pylori testing is introduced, taking into account such factors as immune system, nutrition, and medication status.
Tinidazole: from protozoa to Helicobacter pylori – the past, present and future of a nitroimidazole with peculiarities
Published in Expert Review of Anti-infective Therapy, 2004
Gianpiero Manes, Antonio Balzano
Tinidazole (Fasigyn®, Pfizer Ltd), like metronidazole – to which it is structurally related – was initially introduced for treating protozoal infections. However, both of these nitroimidazole compounds are active against most clinically important obligate anaerobes. In the last few years, the discovery of Heliobacter pylori and of its susceptibility to nitroimidazoles focused new attention on these drugs. Tinidazole, as a part of this class of drugs, shares the characteristics and indications of other nitroimidazoles. However, it has a number of desirable features that could potentially make it very successful: a better pharmacokinetic and pharmacodynamic profile, a better safety and tolerability spectrum, and a preserved activity against some bacteria that are resistant to metronidazole.
Gastric cancer and gastrin: on the interaction of Helicobacter pylori gastritis and acid inhibitory induced hypergastrinemia
Published in Scandinavian Journal of Gastroenterology, 2019
Helge L. Waldum, Jens F. Rehfeld
Gastric cancer, a disease with a reduced frequency for decades, now appears to be on the rise again in young Americans. The epidemiology of gastric cancer differs between tumors in the cardia and those of the more distal parts of the stomach. The tumors are divided into the intestinal type showing glandular growth pattern and the diffuse type with a different pattern. The latter often expresses neuroendocrine and more specifically ECL-cell markers suggesting that they originate from the ECL cell, the target cell for the antral hormone, gastrin. Helicobacter pylori gastritis is accepted as the major cause of gastric cancer, but only after having induced oxyntic atrophy which reduces gastric acid secretion and thus induces hypoacidity leading to hypergastrinemia. Long-term hypergastrinemia is known to induce malignant neoplasia in the stomach of animals as well as man. Recently treatment with proton pump inhibitor after Helicobacter pylori eradication in patients with gastroesophageal reflux disease, has been reported to predispose to gastric cancer. Since profound acid inhibition is a well-known cause of gastric neoplasia, it is to be expected that Helicobacter pylori infection and profound acid inhibition has an additive or possibly potentiating effect on the development of gastric cancer.