THE OFFICIAL PATIENT’S SOURCEBOOK
on
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Gastritis: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83277-3 1. Gastritis-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of gastritis.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to gastritis. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to gastritis, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Appendicitis
·
The Official Patient's Sourcebook on Autoimmune Hepatitis
·
The Official Patient's Sourcebook on Bacteria and Foorborne Illness
·
The Official Patient's Sourcebook on Barrett's Esophagus
·
The Official Patient's Sourcebook on Celiac Disease
·
The Official Patient's Sourcebook on Cirrhosis of the Liver
·
The Official Patient's Sourcebook on Constipation
·
The Official Patient's Sourcebook on Crohn Disease
·
The Official Patient's Sourcebook on Cyclic Vomiting Syndrome
·
The Official Patient's Sourcebook on Diarrhea
·
The Official Patient's Sourcebook on Diverticular Disease
·
The Official Patient's Sourcebook on Fecal Incontinence
·
The Official Patient's Sourcebook on Gallstones
·
The Official Patient's Sourcebook on Gas
·
The Official Patient's Sourcebook on Gastroparesis
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The Official Patient's Sourcebook on Hemolytic Uremic Syndrome
·
The Official Patient's Sourcebook on Hemorrhoids
·
The Official Patient's Sourcebook on Hepatitis a
·
The Official Patient's Sourcebook on Hepatitis B
·
The Official Patient's Sourcebook on Hepatitis C
·
The Official Patient's Sourcebook on Hiatal Hernia
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The Official Patient's Sourcebook on Hirschsprung
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The Official Patient's Sourcebook on Indigestion
·
The Official Patient's Sourcebook on Inguinal Hernia
·
The Official Patient's Sourcebook on Intestinal Pseudo-obstruction
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The Official Patient's Sourcebook on Irritable Bowel Syndrome
·
The Official Patient's Sourcebook on Lactose Intolerance
·
The Official Patient's Sourcebook on Ménétrier
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The Official Patient's Sourcebook on Pancreatitis
·
The Official Patient's Sourcebook on Peptic Ulcer
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The Official Patient's Sourcebook on Porphyria
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The Official Patient's Sourcebook on Primary Biliary Cirrhosis
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The Official Patient's Sourcebook on Primary Sclerosing Cholangitis
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The Official Patient's Sourcebook on Proctitis
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The Official Patient's Sourcebook on Rapid Gastric Emptying
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·
The Official Patient's Sourcebook on Short Bowel Syndrome
·
The Official Patient's Sourcebook on Ulcerative Colitis
·
The Official Patient's Sourcebook on Whipple Disease
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The Official Patient's Sourcebook on Wilson's Disease
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The Official Patient's Sourcebook on Zollinger-ellison Syndrome
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents
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Table of Contents INTRODUCTION...................................................................................... 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 5 PART I: THE ESSENTIALS ............................................................................................................. 7
CHAPTER 1. THE ESSENTIALS ON GASTRITIS: GUIDELINES .................. 9 Overview ....................................................................................................................................... 9 What Is Gastritis? ....................................................................................................................... 11 Additional Information on Gastritis............................................................................................ 12 More Guideline Sources .............................................................................................................. 12 Vocabulary Builder...................................................................................................................... 16
CHAPTER 2. SEEKING GUIDANCE ....................................................... 21 Overview ..................................................................................................................................... 21 Associations and Gastritis........................................................................................................... 21 Finding Doctors........................................................................................................................... 23 Selecting Your Doctor ................................................................................................................. 25 Working with Your Doctor ......................................................................................................... 25 Broader Health-Related Resources .............................................................................................. 27 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 29
CHAPTER 3. STUDIES ON GASTRITIS ................................................... 31 Overview ..................................................................................................................................... 31 The Combined Health Information Database .............................................................................. 31 Federally-Funded Research on Gastritis...................................................................................... 41 E-Journals: PubMed Central ....................................................................................................... 57 The National Library of Medicine: PubMed................................................................................ 58 Vocabulary Builder...................................................................................................................... 58
CHAPTER 4. PATENTS ON GASTRITIS .................................................. 67 Overview ..................................................................................................................................... 67 Patents on Gastritis..................................................................................................................... 68 Patent Applications on Gastritis ................................................................................................. 73 Keeping Current .......................................................................................................................... 78 Vocabulary Builder...................................................................................................................... 78
CHAPTER 5. BOOKS ON GASTRITIS ...................................................... 81 Overview ..................................................................................................................................... 81 Book Summaries: Federal Agencies ............................................................................................. 81 Book Summaries: Online Booksellers .......................................................................................... 84 The National Library of Medicine Book Index............................................................................. 86 Chapters on Gastritis................................................................................................................... 88 Directories ................................................................................................................................... 96 General Home References ............................................................................................................ 97 Vocabulary Builder...................................................................................................................... 98
CHAPTER 6. MULTIMEDIA ON GASTRITIS ......................................... 103 Overview ................................................................................................................................... 103 Video Recordings....................................................................................................................... 103 Audio Recordings ...................................................................................................................... 104
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Contents Bibliography: Multimedia on Gastritis ..................................................................................... 105 Vocabulary Builder.................................................................................................................... 107
CHAPTER 7. PERIODICALS AND NEWS ON GASTRITIS ...................... 109 Overview ................................................................................................................................... 109 News Services & Press Releases ................................................................................................ 109 Newsletter Articles .................................................................................................................... 113 Academic Periodicals covering Gastritis ................................................................................... 115 Vocabulary Builder.................................................................................................................... 116
CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES ................... 119 Overview ................................................................................................................................... 119 NIH Guidelines ......................................................................................................................... 119 NIH Databases .......................................................................................................................... 120 Other Commercial Databases .................................................................................................... 126 The Genome Project and Gastritis............................................................................................. 126 Specialized References ............................................................................................................... 131 Vocabulary Builder.................................................................................................................... 131
CHAPTER 9. DISSERTATIONS ON GASTRITIS ..................................... 133 Overview ................................................................................................................................... 133 Dissertations on Gastritis.......................................................................................................... 133 Keeping Current ........................................................................................................................ 135 Vocabulary Builder.................................................................................................................... 135 PART III. APPENDICES .............................................................................................................. 137
APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 139
Overview ................................................................................................................................... 139 Your Medications: The Basics ................................................................................................... 139 Learning More about Your Medications ................................................................................... 141 Commercial Databases............................................................................................................... 144 Contraindications and Interactions (Hidden Dangers)............................................................. 147 A Final Warning ....................................................................................................................... 148 General References..................................................................................................................... 149 Vocabulary Builder.................................................................................................................... 149
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 153 Overview ................................................................................................................................... 153 What Is CAM? .......................................................................................................................... 153 What Are the Domains of Alternative Medicine? ..................................................................... 154 Can Alternatives Affect My Treatment?................................................................................... 157 Finding CAM References on Gastritis ...................................................................................... 158 Additional Web Resources......................................................................................................... 165 General References..................................................................................................................... 183 Vocabulary Builder.................................................................................................................... 184
APPENDIX C. RESEARCHING NUTRITION ......................................... 185 Overview ................................................................................................................................... 185 Food and Nutrition: General Principles .................................................................................... 185 Finding Studies on Gastritis ..................................................................................................... 190 Federal Resources on Nutrition................................................................................................. 194 Additional Web Resources......................................................................................................... 195 Vocabulary Builder.................................................................................................................... 205
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 207 Overview ................................................................................................................................... 207 Preparation ................................................................................................................................ 207
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Finding a Local Medical Library ............................................................................................... 208 Medical Libraries Open to the Public ........................................................................................ 208
APPENDIX E. NIH CONSENSUS STATEMENT ON THERAPEUTIC ENDOSCOPY AND BLEEDING ULCERS ............................................... 215 Overview ................................................................................................................................... 215 Abstract ..................................................................................................................................... 216 Clinical Features of Bleeding Ulcer Patients at Risk for Emergency Surgery .......................... 217 How Effective Is Endoscopic Hemostatic Therapy? .................................................................. 219 Most Promising Techniques...................................................................................................... 219 Other Techniques....................................................................................................................... 220 Techniques Not Recommended.................................................................................................. 220 How Safe Is Endoscopic Hemostatic Therapy? ......................................................................... 221 Which Bleeding Ulcer Patients Should Be Treated? ................................................................. 222 What Further Research Is Required? ........................................................................................ 223 Conclusions and Recommendations .......................................................................................... 224 Vocabulary Builder.................................................................................................................... 225 ONLINE GLOSSARIES ............................................................................................................... 227 Online Dictionary Directories................................................................................................... 232 GASTRITIS GLOSSARY ............................................................................................................. 235 General Dictionaries and Glossaries ......................................................................................... 256 INDEX.............................................................................................................................................. 258
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Gastritis
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Gastritis has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to gastritis, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on gastritis. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on gastritis should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching gastritis (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to gastritis. It also gives you sources of information that can help you find a doctor in your local area specializing in treating gastritis. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with gastritis. Part II moves on to advanced research dedicated to gastritis. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on gastritis. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with gastritis or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with gastritis. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with gastritis.
Scope While this sourcebook covers gastritis, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that gastritis is often considered a synonym or a condition closely related to the following: ·
Acute Gastritis
·
Erosive Gastritis
·
Hemorrhagic Gastritis
4
Gastritis
·
Reflux Gastritis
In addition to synonyms and related conditions, physicians may refer to gastritis using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for gastritis:4 ·
535 gastritis and duodenitis
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535.0 acute gastritis
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535.0 gastritis, acute
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535.1 atrophic (chronic) gastritis
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535.1 atrophic gastritis
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535.2 gastric mucosal hypertrophy
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535.2 hypertrophic gastritis
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535.3 alcoholic gastritis
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535.4 erosive gastritis
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535.4 other specified gastritis
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535.5 gastritis (unless otherwise specified)
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535.5 gastritis and gastroduodenitis, unspecified
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535.5 unspecified gastritis and gastroduodenitis
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535.6 duodenitis
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to gastritis. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
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Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with gastritis will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with gastritis is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of gastritis, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on gastritis. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of gastritis to you or even given you a pamphlet or brochure describing gastritis. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON GASTRITIS: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on gastritis. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on gastritis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on gastritis. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Gastritis
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with gastritis and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on gastritis.
What Is Gastritis?7 Gastritis, or dyspepsia, is an inflammation of the stomach lining. Some people have gastritis after drinking too much alcohol, eating too much, eating spicy food, or smoking. Others develop gastritis after prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) or infection with bacteria such as Escherichia coli, Salmonella, or Helicobacter pylori. Sometimes gastritis develops after major surgery, traumatic injury, burns, or severe infections. Certain diseases, such as pernicious anemia, autoimmune disorders, and chronic bile reflux, can cause gastritis as well. The most common symptoms are stomach upset or pain. You may also experience belching, abdominal bloating, nausea, and vomiting or a feeling of fullness or of burning in your stomach. If you see blood in your vomit or stool, your stomach lining may be bleeding a bit.
Diagnosis Gastritis is diagnosed through one or more medical tests: ·
Gastroscopy. The doctor eases a gastroscope, a thin tube containing a tiny camera, through your mouth and down into your stomach to look at the stomach lining. The doctor will check for inflammation and may remove a tiny sample of tissue for tests. This procedure to remove a tissue sample is called a biopsy.
·
Blood test. The doctor may check your red blood cell count to see whether you have anemia, which means that you do not have enough red blood cells. Anemia can cause gastritis.
·
Stool test. This test checks for the presence of blood in your stool, a sign of gastritis.
Adapted from The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/digest/summary/gastritis/gastritis.htm. 7
12 Gastritis
Treatment Treatment usually involves taking antacids and other drugs to reduce stomach acid and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the stomach.) You will also need to avoid any foods, beverages, or medicines that cause symptoms. If smoking is the problem, you should quit. If your gastritis is related to an illness or infection, that problem will have to be treated as well. For example, the doctor will prescribe antibiotics to clear up a bacterial infection or vitamin B12 to treat anemia. Once the underlying problem disappears, the gastritis usually does, too. Talk to your doctor before stopping any medicine or starting any gastritis treatment on your own.
Additional Information on Gastritis The National Digestive Diseases Information Clearinghouse collects resource information on digestive diseases for the Combined Health Information Database (CHID), which is produced by health-related agencies of the Federal Government. This database provides the titles, abstracts, and availability of health information and health education resources. To give you the most up-to-date resources, information specialists at the clearinghouse created an automatic CHID search. To obtain this information, you may view the results of the automatic search on gastritis. Or, if you wish to perform your own search of the database, you may access the CHID Online web site and search CHID yourself (http://chid.nih.gov/).
More Guideline Sources The guideline above on gastritis is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to gastritis. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with gastritis. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet
Guidelines 13
hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at the following: http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on gastritis and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Gastritis, Ulcers and Helicobacter Pylori Source: Overland Park, KS: Tri-Med Specialties, Inc. 199x. 2 p. Contact: Available from Tri-Med Specialties, Inc. P.O. Box 23306, Overland Park, KS 66223. (800) 874-6331. PRICE: Free. Available only to medical professionals.
14 Gastritis
Summary: This brochure provides information for patients about helicobacter pylori (H. pylori) infections. It defines H. pylori infection, describes its symptoms, and explains the relationship between H. pylori and ulcers. It then discusses diagnosis and treatment. A list of references for further information is included. ·
Gas in the Digestive Tract Source: Bethesda, MD: American Gastroenterological Association. 199x. [4 p.]. Contact: American Gastroenterological Association (AGA). 7910 Woodmont Avenue, Seventh Floor, Bethesda, MD 20814. (800) 668-5237 or (301) 654-2055. Fax (301) 652-3890. Website: www.gastro.org. PRICE: Single copy free; bulk copies available. Summary: When gas in the digestive tract does not pass out of the body easily, it can collect, causing bloating and discomfort. This brochure from the American Gastroenterological Association (AGA) reviews the problem of gas in the digestive tract (flatulence). Topics include the major causes of flatulence, the symptoms of the condition, repetitive belching, the causes of abdominal pain and bloating, and treatment strategies. A common source of upper intestinal gas is swallowed air. Sometimes belching accompanies movement of stomach contents backup (reflux) into the esophagus. Another cause of repeated belching is gastritis (inflammation of the stomach), including that caused by the Helicobacter pylori bacteria. The brochure explores the role of food in the production of gas in the lower intestine, including dietary fiber and problems with lactose (milk sugar) intolerance. Some over the counter drugs, such as simethicone, activated charcoal, and digestive enzymes, are prescribed as helpful for relieving gassiness. Sometimes doctors also prescribe a treatment plan designed to help move gas through the intestines more readily. One sidebar reminds readers of steps that can be taken to prevent excessive belching or flatus. The brochure includes a list of references and a diagram of the digestive tract, with organs labeled. 1 figure. 3 references.
·
Gastritis Source: Camp Hill, PA: Chek-Med Systems, Inc. 199x. [2 p.]. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011-1706. (800) 451-5797 or (717) 761-1170. Fax (717) 7610216. PRICE: $22.00 per pack of 50 brochures; 3 pack minimum. Summary: This patient education brochure describes gastritis, a condition defined as inflammation of the stomach. In gastritis, white blood cells
Guidelines 15
move into the wall of the stomach as a response to some type of injury. The brochure discusses the causes (etiology) of gastroparesis, including helicobacter pylori (a bacteria that can live in the mucous lining of the stomach), autoimmune gastritis (which results in pernicious anemia because the body can no longer absorb vitamin B12), side effects of aspirin and nonsteroidal antiinflammatory drugs (NSAIDs), alcohol and other chemicals, and hypertrophic gastritis. The symptoms of gastritis depend on how acute the illness is and how long it has been present. In the acute phase, there may be pain or gnawing in the upper abdomen, nausea, and vomiting. In the chronic phase, the pain may be dull and there may be loss of appetite with a feeling of fullness after several bites of food. The brochure cautions that often there are no symptoms at all. Diagnosis is made from the patient's medical history, in conjunction with endoscopy and biopsy of the stomach lining. An upper gastrointestinal (GI) x-ray exam and certain blood tests may also be helpful. Treatment depends on the cause; for most types of gastritis, reduction of stomach acid by medication is often helpful. Serious complications of gastritis are unusual. One exception is the H. pylori infection which, when present for a long time, may lead to stomach cancer in some individuals. 2 figures.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “gastritis” or synonyms. The following was recently posted: ·
Procedure guideline for gastrointestinal bleeding and Meckel's diverticulum scintigraphy. Source: Society of Nuclear Medicine, Inc..; 1999 July; 31 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0973&sSearch_string=gastritis
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-
16 Gastritis
SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to gastritis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Antibiotic: A chemical substance produced by a microorganism which has
Guidelines 17
the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Chronic: Persisting over a long period of time. [EU] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Flatulence: The presence of excessive amounts of air or gases in the stomach or intestine, leading to distention of the organs. [EU] Gastritis: Inflammation of the stomach. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gastroscopy: Endoscopic examination, therapy or surgery of the interior of the stomach. [NIH]
18 Gastritis
Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hematemesis: Vomiting of blood. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Pernicious: Tending to a fatal issue. [EU] Postmenopausal: Occurring after the menopause. [EU] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Reflux: A backward or return flow. [EU] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and
Guidelines 19
the treatment and prevention of toxic manifestations. [NIH] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Urea: One of the chief waste products of the body. When the body breaks down food, it uses what it needs and throws the rest away as waste. The kidneys flush the waste from the body in the form of urea, which is in the urine. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH]
Seeking Guidance 21
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with gastritis. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with gastritis. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Gastritis As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
22 Gastritis
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about gastritis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “gastritis” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “gastritis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making
Seeking Guidance 23
these selections and typing in “gastritis” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with gastritis. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “gastritis” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with gastritis must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
24 Gastritis
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified.
11
Seeking Guidance 25
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about gastritis?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for gastritis?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
12 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 13 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
26 Gastritis
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Seeking Guidance 27
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
29
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on gastritis. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on gastritis. In Part II, as in Part I, our objective is not to interpret the latest advances on gastritis or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with gastritis is suggested.
Studies 31
CHAPTER 3. STUDIES ON GASTRITIS Overview Every year, academic studies are published on gastritis or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on gastritis. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on gastritis and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and gastritis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
32 Gastritis
format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “gastritis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Improvement in Atrophic Gastritis and Intestinal Metaplasia in Patients in Whom Helicobacter Pylori Was Eradicated Source: Annals of Internal Medicine. 134(5): 380-386. March 6, 2001. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: Glandular atrophy and intestinal metaplasia (changes in the cells of the intestinal lining) are precancerous lesions; whether Helicobacter pylori infection or its eradication affects these lesions is controversial. This article reports on a study undertaken to determine whether eradication of H. pylori is associated with improvement in glandular atrophy and intestinal metaplasia after at least 1 year. The single blind prospective trial included 163 consecutive patients with dyspepsia and H. pylori infection, seen at an academic gastroenterology clinic in Japan. The intervention consisted of a 1 week course of a proton pump inhibitor and antibiotic therapy. In the 115 patients in whom H. pylori was eradicated, inflammation and mean neutrophil activity had decreased by 1 to 3 months, and both glandular atrophy in the corpus (the main body of the stomach) and intestinal metaplasia in the antrum had decreased by 12 to 15 months. Glandular atrophy in the corpus improved in 34 of 38 patients (89 percent) with atrophy before treatment, and intestinal metaplasia in the antrum improved in 28 of 46 patients (61 percent) who had metaplasia at baseline. In the 48 patients in whom eradication was unsuccessful, no significant histologic changes were observed. The authors conclude that in the year after successful H. pylori eradication, precancerous lesions improved in most patients. 1 figure. 1 table. 20 references.
·
Helicobacter Pylori Infection, Gastritis and Gastric Cancer: Helicobacter Pylori Infection Among Japanese Children Source: Journal of Gastroenterology and Hepatology. 15(12): 1382-1385. December 2000.
Studies 33
Contact: Available from Blackwell Science. 54 University Street, Carlton South 3053, Victoria, Australia. +61393470300. Fax +61393475001. E-mail:
[email protected]. Website: www.blackwell-science.com. Summary: In Japan, there are few reports describing Helicobacter pylori infection among young children. This article reports on a study undertaken to identify risk factors associated with H. pylori in school aged children in Japan. Subjects were first grade students of three elementary schools (n = 310) and second grade students of a junior high school (n = 300). Personal information, such as students' medical history, parents' history, family size, siblings, and household pets, was collected using a questionnaire. Saliva samples and personal information were collected twice. Among the children, factors related to Helicobacter antibody in saliva included spending a longer period of time in a nursery school or kindergarten and a maternal history of stomach disease. Birth order, sleeping situation, and number of siblings were not factors that were significantly related to Helicobacter antibody in the saliva. Chewing food for the infant, family size, rooms in the household, sharing a bedroom during childhood, pets, a past history, and a paternal history were not related to positivity. The results indicate that transmission is person to person, mainly through close contact with other children and intrafamilial infection. H. pylori infection seems to occur frequently early in life, probably before 6 years of age. 2 tables. 29 references. ·
Effects of High Dose Vitamin C Treatment on Helicobacter pylori Infection and Total Vitamin C Concentration in Gastric Juice Source: European Journal of Cancer Prevention. 7(6): 449-454. 1999. Summary: This journal article describes a study of the effects of high-dose vitamin C treatment on 'Helicobacter pylori' infection and on gastric juice total vitamin C concentration in patients with 'H. pylori' related chronic gastritis. Sixty patients were randomly assigned to treatment with 5 g vitamin C daily (n=32) or antacids (controls, n=28) for 4 weeks. Plasma and gastric juice total vitamin C levels were measured at baseline, the end of treatment, and 4 weeks later. 'H. pylori' infection and mean gastric juice total vitamin C concentration remained unchanged in the 24 controls who completed the study. In the vitamin C treatment group, the 'H. pylori' infection was eradicated in 8 of the 27 patients (30 percent) who completed the study. In these patients, the mean gastric juice total vitamin C concentration increased significantly from baseline to end of treatment, and this increase was maintained for at least 4 weeks after treatment ended. In the remaining 19 patients with persistent 'H. pylori' infection, there was a significant but less marked increase in mean gastric juice total vitamin C concentration during treatment that was not
34 Gastritis
maintained after treatment ended. The authors note that the mechanism by which vitamin C treatment appears to eradicate 'H. pylori' is unknown, and suggest that further studies are needed. The article has 2 tables and 40 references. ·
Peptic Ulcer Disease: Dietary Factors, Its Repair and Relationship with Helicobacter Pylori Infection: Endoscopic Duodenitis, Gastric Metaplasia and Helicobacter Pylori Source: Journal of Gastroenterology and Hepatology. 16(5): 513-518. May 2001. Contact: Available from Blackwell Science. 54 University Street, Carlton South 3053, Victoria, Australia. +61393470300. Fax +61393475001. E-mail:
[email protected]. Website: www.blackwell-science.com. Summary: This article reports on a study undertaken to investigate the relationship between gastric metaplasia (changes in the cell structure in the stomach lining) and Helicobacter pylori in patients with endoscopic duodenitis (inflammation of the first section of the small intestine, as measured by endoscopy). The subjects were 57 patients with endoscopic duodenitis with or without H. pylori associated gastritis. Biopsy specimens were obtained from the stomach and duodenal bulb to assess the histological findings and H. pylori infection. Gastric metaplasia was divided into three types: complete, intermediate, and incomplete, according to the amount of mucus in the metaplastic cells. In 10 H. pylori positive patients, endoscopic and histological findings of duodenitis were compared before and after eradication of the bacteria. There was no significant difference in the extent of gastric metaplasia or the appearance and severity of endoscopic duodenitis between H. pylori positive and H. pylori negative groups. The complete type of gastric metaplasia was frequently detected in the H. pylori negative group, whereas the incomplete type was frequently observed in the H. pylori positive group. After eradication of H. pylori, the incomplete type changed to the complete type with a decrease of histological inflammation. 3 figures. 6 tables. 16 references.
·
Hemorrhoids and More: Common Causes of Blood in the Stool Source: Digestive Health and Nutrition. 3(4): 24-26. July-August 2001. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. E-mail:
[email protected]. Summary: Most rectal bleeding is caused by hemorrhoids, which usually can be simply and effectively treated. This article reviews the many other
Studies 35
conditions, including some serious disorders, that can cause blood in the stool. The author reminds readers that bleeding from any part of the nearly 40 foot long digestive tract can cause blood in the stool. Accurate and timely diagnostic tests are important to determine the cause of any bleeding. Bleeding higher up in the gut, from the esophagus or stomach, can result in stools with a black, tarry appearance. Bleeding from the lower end, such as the colon, or in large amounts, can appear as pure blood, blood clots, or as blood mixed with or streaking the stool. Another kind of blood, occult or hidden blood, may not be visible at all. A number of prescription and over the counter (OTC) medications can cause bleeding in the stomach and small intestine. The blood thinning drug warfarin also can induce bleeding in the intestine, as can some antibiotics. Other causes of bleeding can include ulcers, gastritis (inflammation of the stomach lining), ulcerative colitis, Crohn's disease, polyps (small growths inside the intestine), diverticular disease, abnormalities in the blood vessels (vascular anomalies), anal fissures (tears) and fistulas (abnormal openings between the anal canal and other organs, such as the bladder), and abscesses (pockets of infection. The author reiterates the importance of timely diagnosis, including a thorough patient history and evaluation of symptoms. Diagnostic tests can include blood tests, digital rectal examination, endoscopy, colonoscopy, sigmoidoscopy, fecal occult blood test, barium x rays, angiography (x rays of blood vessels), and nuclear scanning. Treatment depends on the source and extent of the bleeding. ·
Favourable Effect of an Acidified Milk (LC-1) on Helicobacter Pylori Gastritis in Man Source: European Journal of Gastroenterology and Hepatology. 13(1): 2529. January 2001. Contact: Available from Lippincott Williams and Wilkins. 241 Borough High Street, London SE1 1GB, UK 44(0)20-7940-7502. Fax: 44(0)20-79407574. Website: http://www.eurojgh.com/. Summary: The supernatant of Lactobacillus johnsonii La1 culture was shown to be bactericidal and to have a partial, acid independent suppressive effect on Helicobacter pylori in humans. This study investigated the effect of L. johnsonii La1 acidified milk (LC-1) on H. pylori infection in 53 volunteers infected with H. pylori. Volunteers were randomized to received either LC-1 or placebo 180 milliliters twice a day for 3 weeks. All subjects also received clarithromycin 500 milligrams twice a day (bid) during the last two weeks of acidified milk therapy. Esophagogastroduodenoscopy and biopsies were performed at inclusion and repeated 4 to 8 weeks after the end of the treatment. H. pylori infection was confirmed by urease test and histology. Results showed
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that LC-1 ingestion induced a decrease in H. pylori density in the antrum (the passage from the esophagus to the stomach, i.e., the first part of the stomach) and the corpus (the body of the stomach). LC-1 also reduced inflammation and gastritis activity in the antrum and of activity in the corpus. Clarithromycin eradicated H. pylori in 26 percent of the subjects; LC-1 did not improve the antibiotic effect. These results suggest that H. pylori infection and gastritis can be down regulated by LC-1. 4 tables. 33 references. ·
Overexpression of Co-Stimulatory Molecules in Peripheral Mononuclear Cells of Helicobacter Pylori-Positive Peptic Ulcer Patients: Possible Difference in Host Responsiveness Compared With Non-Ulcer Source: European Journal of Gastroenterology and Hepatology. 13(1): 1118. January 2001. Contact: Available from Lippincott Williams and Wilkins. 241 Borough High Street, London SE1 1GB, UK 44(0)20-7940-7502. Fax: 44(0)20-79407574. Website: http://www.eurojgh.com/. Summary: Helicobacter pylori is the principal cause of gastritis and peptic ulcer disease. However, H. pylori positive patients do not always have peptic ulcer. This study was carried out in order to determine the difference in host immune reaction to H. pylori between patients with peptic ulcer and those without. The study included 10 H. pylori positive patients with peptic ulcer, 10 H. pylori positive nonulcer patients, and 10 healthy volunteers who were examined for expression of surface molecules in peripheral blood mononuclear cells. The results showed more mononuclear cells expressed molecules ICAM-1, VLA-4, Leu-M3 in H. pylori positive ulcer patients than in nonulcer patients and healthy volunteers. There were also more cells expressing CD28, SLex, CD4, HLA-DR, and NU-B2 in H. pylori positive ulcer patients than in nonulcer patients and healthy volunteers. There were fewer cells expressing CD8 in H. pylori positive ulcer patients than in nonulcer patients and healthy volunteers. The authors conclude that H. pylori infection may cause immunological reactions which are reflected in peripheral mononuclear cells. However, the activity and characteristics of peripheral mononuclear cells, in terms of expression of adhesion molecules, may differ between ulcer and nonulcer patients who are infected with H. pylori. 8 figures. 31 references.
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·
Cure of Helicobacter Pylori Infection in Atrophic Body Gastritis Patients Does Not Improve Mucosal Atrophy But Reduces Hypergastrinemia and Its Related Effects on Body ECL-Cell Hyperplasia Source: Alimentary Pharmacology and Therapeutics. 14(5): 625-634. May 2000. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. E-mail:
[email protected]. Website: www.blackwell-science.com. Summary: The effects of Helicobacter pylori eradication on atrophic body gastritis are controversial. This article reports on a study undertaken to investigate the effect of triple therapy on atrophic body gastritis in H. pylori positive patients and its effect on morphofunctional gastric parameters. Consecutive patients (n = 35) with atrophic body gastritis with histological or serological evidence of H. pylori infection were treated. Before and 6 and 12 months after H. pylori eradication the patients were evaluated for fasting gastrinemia and pepsinogen I, basal and peak acid output, and detailed histological assessment including the ECL cell proliferative patterns. Six months after treatment, 25 out of 32 patients were cured (78 percent). Cure of infection was associated with improvement in both basal and stimulated acid secretion, as well as with reduction in hypergastrinemia. In contrast, the eradication had no effect on body corporal atrophy and intestinal metaplasia, or pepsinogen I levels. These results were confirmed at 12 months after eradication. A statistical inverse correlation was obtained between the corporal chronic infiltrate score and peak acid output values. A total of 53 percent of atrophic body gastritis patients showed a regression in severity of body ECL cell hyperplastic change. The authors conclude that cure of H. pylori infection in patients with atrophic gastritis reverses some adverse effects on gastric function and ECL cell hyperplasia. 3 figures. 2 tables. 38 references.
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Long-Term Omeprazole Treatment in Resistant Gastroesophageal Reflux Disease: Efficacy, Safety, and Influence on Gastric Mucosa Source: Gastroenterology. 118(4): 661-669. April 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: The efficacy and safety of long term acid suppression (to treat recurrent gastroesophageal reflux disease, or GERD) remains a subject for debate. This article reports on a study of patients refractory reflux
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esophagitis who were undergoing maintenance therapy with a regimen of greater than 20 mg omeprazole daily for a mean period of 6.5 years (range, 1.4 to 11.2 years). Patients with severe reflux esophagitis resistant to long term therapy with H2 receptor antagonists and who were not eligible for surgery were evaluated at least annually for endoscopic relapse and histological changes in the gastric corpus (the base of the stomach). In 230 patients (mean age, 63 years at entry; 36 percent were older than 70 years), there were 158 relapses of esophagitis during 1490 treatment years (1 per 9.4 years), with no significant difference in relapse rates between Helicobacter pylori positive and negative patients. All patients rehealed during continued therapy with omeprazole at the same or higher dose. The annual incidence of gastric corpus mucosal atrophy was 4.7 percent in H. pylori positive patients and 0.7 percent in H. Pylori negative patients, which was mainly observed in elderly patients who had moderate or severe gastritis at entry. In patients with baseline moderate or severe gastritis, the incidences were similar: 7.9 percent and 8.4 percent, respectively. Corpus intestinal metaplasia was rare, and non dysplasia or neoplasms were observed. The adverse event profile was as might be expected from this elderly group of patients. The authors conclude that long term omeprazole therapy (up to 11 years) is highly effective and safe for control of reflux esophagitis. 3 figures. 3 tables. 40 references. ·
Trend Toward a Reduced Prevalence of Helicobacter Pylori Infection, Chronic Gastritis, and Gastric Cancer in Japan Source: Gastroenterology Clinics of North America. 29(3): 623-631. September 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: Although there has been a remarkable decline in the prevalence and mortality (death) rates of gastric (stomach) cancer in developed countries, gastric cancer is one of the common malignancies in the world and is still the main cause of death in Japan. This article investigates the trends in Helicobacter pylori infection and gastritis in Japan over the past few decades. The author notes that it is important to investigate the relationship between H. pylori infection and gastric cancer and gastritis to understand better the mechanisms for carcinogenesis (the development of cancer) in the stomach. The author speculates that declines in H. pylori infection and gastritis over the past few decades may lead to a decline in gastric cancer in Japan, supplemented by excellent procedures for the early detection of gastric cancer. H. pylori infection rarely is acquired in adult life, so once it is eradicated,
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reinfection is not expected in adult patients. The author concludes that adequate treatment of H. pylori provides long term protection against gastric cancer. ·
Helicobacter Pylori Gastritis and Gastric Physiology Source: Gastroenterology Clinics of North America. 29(3): 687-703. September 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: This article reviews Helicobacter pylori gastritis and gastric physiology. Helicobacter pylori gastritis (stomach inflammation) can alter stomach physiology, leading to increased or decreased acid secretion, depending on the pattern of gastritis present. These changes in physiology are related to the disease outcome, with increased acid secretion leading to duodenal ulcer disease and reduced acid secretion being a risk factor for gastric (stomach) cancer. Gastric acid secretion also affects the pattern of gastritis induced by the infection, with low acid secretion leading a pangastritis and possibly atrophy. This two way interaction between H. pylori gastritis and gastric acid secretion is important in understanding the role of H. pylori infection in the response to proton pump inhibitor therapy. This interaction explains the more profound control of gastric acid secretion in H. pylori positive patients and why rebound acid hypersecretion is confined to H. pylori negative subjects. 6 figures. 60 references.
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Pediatric Gastrointestinal Mucosal Biopsy: Special Considerations in Children Source: Gastrointestinal Endoscopy Clinics of North America. 10(4): 669712. October 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: In most disorders of the gastrointestinal (GI) mucosa that occur in both children and adults, the mucosal manifestations are the same. This article focuses on those disorders and the approaches to GI procedures and mucosal biopsy that are of a particularly or peculiarly pediatric nature (i.e., are different from those in adults). The authors discuss issues pertaining to endoscopy and other techniques of mucosal biopsy in children, because some approaches and techniques are considerably different from those in adults. In children as in adults, most mucosal biopsies are taken at upper GI endoscopy or colonoscopy, with rectal suction biopsy (RSB) being performed occasionally and blind
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esophageal suction biopsy very rarely. The authors caution that major problems can arise in pediatric endoscopy when children are approached and instrumented like adults. The authors describe the preparation of the child and family, sedation, bowel preparation, and fasting. The authors include a section discussing disorders in which there are special features in children that may be significantly different from adults, including gastroesophageal reflux disease (GERD), idiopathic eosinophilic esophagitis, Barrett's esophagus, Helicobacter pylori infections, Crohn's disease, allergic gastritis, celiac gastritis, chronic granulomatous disease, Menetrier's disease, neonatal gastropathies, Henoch Schonlein gastritis, cow's milk protein enteritis, microvillous inclusion disease, tufting enteropathy, autoimmune enteropathy, inflammatory bowel disease, pseudomembranous colitis, necrotizing enterocolitis, glycogen storage disease, Hirschsprung's disease, intestinal neuronal dysplasia, and colorectal cancer. 217 references. ·
Gastric Biopsy Source: Gastrointestinal Endoscopy Clinics of North America. 10(4): 723738. October 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This article focuses on the global settings where biopsy is done, on the practical issues of how to perform gastric biopsy, and what might be the benefit. The section on biopsy tips is condensed to provide practical information that offers some new information even for experienced endoscopists. The authors cover the three histological zones of the stomach (cardiac, oxyntic, and antral), when to biopsy to rule out neoplasia, and biopsy in benign gastric mucosal disease. The biopsy tips section covers a description of the biopsy location, special information needed for the pathologist, biopsy of histological zones, mapping the stomach, focal lesions, and acid suppression after multiple biopsies or large snare biopsy or polypectomy. At the time of biopsy of suspected or overt neoplasms, the endoscopist should try to determine whether tissue for special studies should be obtained; and whether the setting is such that biopsies from multiple sites might be indicated. The authors stress that there is a poor correlation between color changes and histologic abnormalities and emphasize that red mucosa is not reliably associated with gastritis, even though many clinicians insist on diagnosing gastritis on this inaccurate conclusion. 1 figure. 1 table. 57 references.
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Federally-Funded Research on Gastritis The U.S. Government supports a variety of research studies relating to gastritis and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.15 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to gastritis and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore gastritis and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for gastritis: ·
Project Title: Immunomodulatory Strategies in Autoimmune Gastritis Principal Investigator & Institution: Kosiewicz, Michele M.; Assistant Professor; Microbiology and Immunology; University of Louisville Louisville, Ky 40292 Timing: Fiscal Year 2000; Project Start 5-AUG-1999; Project End 1-JUL2003 Summary: Many autoimmune diseases appear to be mediated by antigen-specific T cells that produce the pro-inflammatory cytokines, IFNgamma and TNFalpha. It would be of great value to develop a strategy to specifically downregulate or eliminate these autoreactive T cells without interfering with other immune functions. The goal of this grant proposal is to study the mechanisms that are involved in two strategies designed to specifically downregulate the activity of antigenspecific T cells and to test these strategies in a well-characterized murine model of autoimmune disease. Previous studies have demonstrated that antigen presenting cells (APCs) pulsed with antigen in the presence of TGFbeta2 transmit a potent tolerance-inducing signal to the peripheral
15 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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immune system when injected intravenously into naive mice. Accumulating evidence suggests that CD4 and CD8 regulatory T cells are induced and mediate antigen-specific tolerance in this system. The goal of the first specific aim is to understand the mechanisms involved in tolerance induced by TGFbeta-treated APCs. In this aim, the role that regulatory T cells play in this system of tolerance as well as their general mechanism(s) of action will be examined in in vivo studies using knockout mice, neutralizing antibodies and a TCR transgenic T cell transfer system. Further studies will involve in vitro analyses of the precise mechanisms utilized by regulatory T cells to downregulate effector T cell function. The goal of the second specific aim is to investigate the therapeutic potential of TGFbeta-treated APCs using a murine model of autoimmune gastritis. Neonatal thymectomy (Tx-3) in BALB/c mice induces an autoimmune gastritis that markedly resembles human pernicious anemia. Tile T cell response has been well characterized in this model and is Th1-type cytokine-mediated and targeted to the alpha and beta subunits of H/K ATPase of parietal cells. This aim is designed to determine whether treatment of Tx-3 mice with ATPase-pulsed TGFbetatreated APCs can "cure" or ameliorate autoimmune gastritis and to characterize the T cell response that is associated with this treatment. The goal of the third specific aim is to explore the ability of FasL-expressing APCs to treat autoimmune disease either independently or as a supplement to treatment with TGFbeta-treated APCs. This aim is designed to characterize the T cell response after activated T cells have been targeted for elimination in vivo by treatment with antigen-pulsed APCs genetically engineered to express FasL. This strategy may be used in conjunction with TGFbeta-treated APCs to successfully treat established autoimmune disease. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Immunoprevention of H. Pylori Gastritis Principal Investigator & Institution: Cummins, Joseph; ; Amarillo Bioscience, Inc. 800 W 9Th Ave Amarillo, Tx 79101 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 9-SEP-2002 Summary: (provided by applicant): Helicobacter pylori (Hp) gastric infection is a common and serious infectious disease of humans. Current therapeutic regimens, while successful in 80 percent of the instances of infection, are complicated by expense, duration of treatment, emergence of resistant strains of Hp and lack of patient compliance. An ideal alternative to antimicrobial therapy is prophylactic or therapeutic vaccination for Hp. In this phase I SBIR, we will test the hypothesis that proteolytic digests of Hp incorporated into a novel adjuvant formulation
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will prevent manifestations of bacterial gastritis and promote gastric bacterial clearance in Hp-infected gnotobiotic piglets, an established animal model of this disease. Piglets will be parenterally immunized with Hp digests prior to and after established gastric infection. Evidence for protection (reduced/absent bacterial cfu, local and systemic immunity, etc) will be sought. Protection will be correlated to patterns of Western blot immunoreactivity of convalescent immune sera and isolated leukocyte in vitro responses to putative bacterial antigen(s). Reactive peptides will be isolated by HPLC, sequenced and identified. From these data, the feasibility of parenteral vaccination for Hp will be determined in this nonrodent model of bacterial gastritis and a phase II SBIR will be prepared if the protection data are positive. PROPOSED COMMERCIAL APPLICATION: NOT AVAILABLE Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Mucosal Immunology of Helicobacter Induced Gastritis Principal Investigator & Institution: Czinn, Steven J.; Professor; Pediatrics; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2000; Project Start 5-DEC-1993; Project End 0-NOV2002 Summary: (Adapted from the applicant's abstract): Since the rediscovery of Helicobacter pylori (H. pylori) in the early 1980's, studies have now demonstrated that H. pylori plays an etiologic role in the development of gastritis, peptic ulcer disease, and gastric cancer. The investigators have previously demonstrated the importance of the host as a factor in disease outcome following gastric Helicobacter infection. A related issue, is whether the host immune response contributes to the pathogenesis or acts to protect the host from infection. Using the H.felis/mouse model, the investigators have demonstrated that the T-cell mediated immune response to Helicobacter infection can contribute either to the pathogenesis or act in concert with the humoral immune response to clear this infection. Specifically, the results of studies funded during the previous granting period indicate the Helicobacter infection activates antigen specific cell-mediated immune responses in immunized or infected hosts. These responses have a phenotype which is either proinflammatory in nature (TH1) or protective in nature (TH2). Adoptive transfer of Helicobacter-specific TH1 lymphocytes exacerbates gastric inflammation in recipients. However, transfer of a TH2 cell line from immunized/protected mice decreases the magnitude of infection in the recipients. There continues to be a number of unanswered questions, however, which are the focus of this proposal. Using the recently
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developed H. pylori/mouse model, a number of contemporary techniques, such as the use of knock-out or transgenic mice, recombinant cytokine therapy, and adoptive transfer studies, will be used to further investigate the role of the host immune response in preventing or promoting chronic H. pylori gastroduodenal disease. the investigators will specifically assess the contribution of the humoral immune system in preventing H. pylori gastroduodenal disease following immunization as well as assess the contribution of the host cellular immune response in preventing or promoting H. pylori gastroduodenal disease. An in-depth understanding of the pro-inflammatory mechanisms employed by the host in this model will contribute to our general understanding of immune regulation and the pathogenesis of infectious disease. Finally, these aims are a logical extension of the work previously performed in their laboratory and may ultimately allow them to develop a safe and efficacious sub-unit vaccine to prevent morbidity and potential long-term consequences of Helicobacter infection. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Bacterial Induced Colitis in HLA-B27 Rats Principal Investigator & Institution: Dieleman, Levinus A.; Medicine; University of North Carolina Chapel Hill Box 2688, 910 Raleigh Rd Chapel Hill, Nc 27515 Timing: Fiscal Year 2000; Project Start 0-MAY-1998; Project End 0-NOV2002 Summary: (taken from application) Genetic and environmental factors are extremely important in the pathogenesis of the idiopathic chronic inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn's disease (CD). New rodent models of chronic intestinal inflammation have contributed substantially to our knowledge of the pathogenesis of IBD. One better characterized model is HLA-B27 transgenic rats, in which the overexpression of the gene for the MHC class I molecule HLA-B27 leads to the spontaneous development of colitis, gastroduodenitis, peripheral arthritis and spondylitis. Our hypothesis is that chronic colitis and gastritis is the result of an overly aggressive immune response to luminal bacteria in a genetically susceptible host. This T Iymphocyte-dominated immune response to specific luminal bacteria is regulated by antigen presenting cells (APC). This hypothesis will be evaluated in HLA-B27 transgenic rats, which develop progressive colitis, gastritis and arthritis when raised in specific pathogen-free environment or when colonized with Bacteroides vulgatus, but which have no clinical or histological disease when raised in a sterile environment or monoassociated with E. coli. However, the immunological mechanisms determining how these
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bacteria initiate and perpetuate a chronic immune response need to elucidated. The unraveling of these mechanisms will answer several fundamental questions concerning the pathogenesis of chronic inflammatory bowel diseases. We will address several fundamental questions of IBD pathogenesis in the following specific aims: 1) Determine which bacterial components induce gastrointestinal inflammation and conversely, whether certain resident luminal bacteria can prevent this inflammation. 2) Define the mechanisms by which T lymphocytes induce or prevent gastrointestinal inflammation. Successful completion of these specific aims will not only provide essential insights into the pathogenesis of experimental intestinal inflammation, but will also reveal pathogenetic mechanisms of IBD and suggest novel therapeutic approaches targeting etiologic mechanisms. This MD/PhD has considerable experience with various studies on the role of cytokines in several murine models of acute and chronic intestinal inflammation. The research project for this grant will enable the candidate to expand his knowledge in new areas of cellular immunology and gnotobiotic technology, which will be complemented by formal immunology/microbiology courses. This training experience will take place in a Digestive Disease Center focused on inflammation and fibrosis under the sponsorship of experts in animal studies, gnotobiotic research and cellular immunology. This expertise will foster the development of an independent investigator with skills in both clinical and basic science. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Immunization
Cytokine
Responses
to
H
Pylori
Infection
or
Principal Investigator & Institution: Ernst, Peter B.; Professor; Pediatrics; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2000; Project Start 1-SEP-1997; Project End 1-JUL-2001 Summary: (Adapted from the applicant's abstract): H. pylori causes gastritis and can contribute to recurrent peptic ulceration. However, investigations have shown that family members can express different manifestations of gastric disease even though they are infected with genetically identical strains of H. pylori. This and other evidence suggest that virulence factors of H. pylori interact with other elements within the gastric milieu to cause the more severe sequelae observed in a subset of infected patients. The immune system is one element that can contribute to the pathogenesis and prevention of disease associated with H. pylori infection. Control of the local immune response to luminal flora depends on the balance of helper T cell subsets. Helper T cells are implicated in
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the pathogenesis of gastritis and peptic ulceration since, during infection, gastric T cells are markedly increased in numbers and skewed toward a Th1 phenotype and cell-mediated immune responses. Moreover, patients receiving T cell-derived cytokines as immunotherapy can develop gastric ulceration. H. pylori is relatively non-invasive so T cells enhancing cellmediated immune responses may promote inflammation and, in susceptible individuals, contribute to epithelial damage. This leads to our hypothesis that a relative imbalance in helper T cell subsets favors the stimulation of inflammation and epithelial damage in response to persistent infection with H. pylori. More specifically, Th1 responses increase during natural infection and contribute to epithelial damage, while Th2 cells will favor tissue integrity and immunity. The following specific aims will be addressed to test the hypothesis: 1) characterize the helper T cell subsets which develop in response to H. pylori, 2) elucidate the mechanisms of epithelial damage by Th1 cells, 3) compare the differential effects of Th1 and Th2 cells on the function of gastric epithelium, and 4) characterize the expression of IL-10 receptors on gastric epithelium. In summary, this proposal addresses unanswered questions regarding the molecular basis for the gastric T cell response and defines the mechanisms by which an imbalance in helper T cells modulates inflammation and epithelial damage. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Effects of Dietary Polyunsaturated Fat On Helicobacter Pylori Principal Investigator & Institution: Smoot, Duane T.; ; Howard University 2400 6Th St Nw Washington, Dc 20059 Timing: Fiscal Year 2000 Summary: Helicobacter pylori (H. pylori) infection is the most common cause of chronic gastritis in man, and it has been implicated as an etiological factor in the development of peptic ulcer disease. More recently, epidemiological studies have demonstrated that H. pylori is an independent risk factor for gastric cancer and that people infected with H. pylori have a 3-6 fold higher risk of developing this condition than non-infected persons. Progression from H. pylori-related superficial gastritis to atrophic gastritis with intestinal metaplasia is felt to be a precursor to gastric cancer development. Investigators have postulated that the natural progression of H. pylori-associated chronic gastritis is to atrophic gastritis, which may be prolonged or shortened by dietary factors. Diets rich in fruits and vegetables and low in starch and salt are associated with a decreased risk of gastric cancer. The presence of antioxidants in these diets has been postulated to be the factors
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responsible for the decrease in cancer risk. These diets are also high in polyunsaturated fat which, as opposed to saturated ft, has been shown to inhibit bacterial growth. Recent studies have confirmed that polyunsatuated hat will inhibit H. pylori (named as a Class I carcinogen with an estimated attributable risk of 50-60% for gastric cancer by the World Health Organization) growth in vitro. Therefore, agents which inhibit bacterial growth, i.e., polyunsaturated fats are likely to decrease the risk of cancer due to this carcinogen. Investigators for this project postulate that diets high in fruits and vegetables protect gastric cancer because of the bacterial static properties of polyunsaturated fats. Since antioxidants such as vitamin E are present in oils rich in polyunsaturated fat, they feel that they serve mainly as a marker for ingestion of these fats, and are not the primary agents protecting against gastric cancer. This grant proposes to document in a cross-sectional study, the indirect correlation between polyunsaturated fat ingestion and gastric bacterial load. In vitro studies will be performed to elucidate the extent to which polynsaturated fat will not only inhibit growth, but also inhibit cytotoxicity induced by adherence of this bacterium to human gastric epithelial cells. Confirming this hypothesis would be very important to areas of the world which have a high incidence of gastric cancer, since these areas have both a high incidence of H. pylori and a high rate of reinfection with this organism after successful antibiotic treatment. Knowledge that dietary intake rich in polyunsaturated fat will reduce gastric cancer risk is likely to be a cost-effective way of preventing this disease, since there is a vaccine available and antibiotic therapy is not practical in certain countries. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: H Pylori Induced Oxidative DNA Damage Principal Investigator & Institution: Groopman, John D.; Associate Director of Cancer Prevention; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 3-JUL-2001; Project End 0-APR2006 Summary: The discovery of Helicobacter pylori (H. pylori) infection has greatly changed our understanding of upper G.I. tract, diseases, including peptic ulcer disease and stomach cancer. Antibiotics are firstline treatment for ulcer patients which are infected with this bacterium. Also, the World Health Organization has classified H. pylori as a group I or definite carcinogen. People infected with H. pylori have a 3 to 6 fold higher risk of developing gastric cancer than non-infected persons. Progression from superficial gastritis caused by H. pylori to atrophic
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gastritis with intestinal metaplasia is felt to be a precursor to gastric cancer development. Investigators have postulated that the natural progression of H. pylori-associated chronic gastritis is to atrophic gastritis, which may be prolonged or shortened by dietary factors. A diet rich in fruits and vegetables and low in starch and salt is associated with a decreased risk of developing gastric cancer. The presence of antioxidants in this diet has been postulate to be responsible for the decrease in cancer risk. We postulate that H. pylori increases the susceptibility of gastric cells to injury from reactive oxygen species, in part by generating the production of intracellular reactive oxygen species. The specific aims of this grant are to (1) determine the ability of H. pylori exposure (live bacteria vs. bacterial proteins) to induce related DNA damage in gastric epithelial cell lines; and elucidate the spectrum and repair course of oxidant related DNA adducts formed after exposure to H. pylori. (2) identify the types of reactive oxygen species that are generated by exposure to H. pylori (live bacteria vs. bacterial proteins) using fluorescent microscopy, fluorometer and lucigenin- and luminolderived chemiluminescence, and determine whether or not cytochrome p450s and/or mitochondria are important in the generation of reactive oxygen species after exposure to H. pylori. (3) Further evaluate the role of glutathione peroxidase and catalase in the detoxification of intracellular reactive oxygen species, and their association with oxidant induced DNA adducts and cell injury. These studies will demonstrate the potential significant role for bacteria in stimulating oxidative cell injury and DNA damage which may increase the susceptibility of lining epithelial cells to carcinogenic conversion. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: H. Pylori Infection and GI Disease in Alaska Natives Principal Investigator & Institution: Berg, Douglas E.; Professor; Molecular Microbiology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2000; Project Start 0-SEP-1999; Project End 9-SEP-2004 Summary: (Adapted from the Applicant's Abstract): Helicobacter pylori (Hp), one of the most genetically diverse of bacterial species, chronically infects the gastric mucosa of more than half of all persons world wide. It is the major cause of severe gastritis and peptic ulcers, and a risk factor for gastric cancer, although most infections are asymptomatic. Infection is more common in Alaska Natives than in mainstream US populations, and the spectrum of associated diseases is distinct. Most striking is an Hp-associated hemorrhagic gastritis and iron deficiency anemia that is common only in Alaska Natives. Here the investigators propose to study
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the genetics of Hp from Alaska natives. First, they will seek to define the population genetic structure of Hp in Alaska Natives. In these experiments they will (a) test the view that the Alaska Native Hp gene pool is far less diverse than that in other human populations, (b) learn whether Hp from some regions or linguistic/ethnic groups of Alaska Natives differs significantly from that in others, and (c) test the idea that Hp lineages in this population are far more nearly clonal (less scrambled by recombination) than has been seen in other human populations. They propose that recombination is important, assuming that Hp colonization of individual hosts is often associated with considerable adaptation on the part of the bacterium to that given person, and that the formation of recombinants during even transiently mixed infection can markedly speed this process. These tests will entail arbitrarily primed PCR (RAPD) typing of several hundred Hp isolates from Alaska Natives, and then multilocus DNA sequence typing (MLST) of informative gene loci from many representative strains. The data will also help assess whether much or any significant portion of the Hp gene pool of Alaska Natives is of Asian origin, as defined by studies of Hp isolates from Eastern China and Japan, and as might be expected if the ancestors of current Alaska Natives carried Hp with them when they migrated from Asia many millennia ago. Second, they will search for previously unknown genes affecting Hp virulence, with special interest in genes affecting the risk of hemorrhagic gastritis or iron deficiency anemia. This will be based on new subtractive hybridization and DNA microarray-based comparative genomic methods. Third, they will search for genes or alleles of divergent gene families that may contribute to the growth of individual strains in particular human hosts. This will entail analyses of recombinant derivatives of individual strains that emerge in Alaska Native populations, often, they postulate, as the result of selection for a gene or allele that may have been transferred from an unrelated Hp strain. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Helicobacter Pylori and Gastrointestinal Biology Principal Investigator & Institution: Peek, Richard M.; Medicine; Vanderbilt University 2101 W End Ave Nashville, Tn 37240 Timing: Fiscal Year 2001; Project Start 1-AUG-2001; Project End 0-JUN2006 Summary: (provided by applicant): Persistent H. pylori infection is a risk factor for atrophic gastritis and distal gastric adenocarcinoma; however, only a small percentage of colonized persons develop neoplasia. Enhanced cancer risk may be related to differences in expression of specific bacterial products, to differences in host response to the bacteria,
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or to the specific interactions between host and microbe. H. pylori strains that possess the cag pathogenicity island induce more severe gastritis and are associated with an additional risk for developing atrophy and gastric cancer. A specific mechanism by which cagA+ strains may lower the threshold for carcinogenesis is by altering epithelial cell proliferation and apoptosis, processes that can be regulated by host inflammatory mediators such as prostaglandin products of cyclooxygenase-2 (COX-2). Over-expression of COX-2 in vitro inhibits apoptosis, and COX-2 is upregulated within H. pylori-induced gastritis, atrophic gastritis, and gastric adenocarcinoma specimens. In vitro, H. pylori cagA+ strains stimulate COX-2 expression in gastric epithelial cells. Since we and others have shown that cagA+ strains are associated with increased gastric epithelial cell proliferation but attenuated apoptosis in vivo, induction of COX-2 by strain-specific microbial factors may represent a specific mechanism by which certain H. pylori strains heighten the risk for gastric adenocarcinoma. The long-term objective of this proposal is to examine the molecular mechanisms by which H. pylori strains selectively affect COX-2 regulated epithelial cellular turnover in vitro and in vivo. To address this, we will first determine whether H. pylori or secreted bacterial products alter COX-2-dependent apoptosis in a novel in vitro model of bacterial:gastric epithelial cell interaction (conditionally immortalized gastric epithelial cells). COX-2 expression will also be examined in myofibroblasts co-cultured with H. pylori and epithelial cells to more closely approximate events occurring within native gastric mucosa. Second, we will determine whether H. pylori infection affects COX-2-dependent cellular turnover in wild-type and COX-2 deficient mice. Third, we will investigate the role of specific H. pylori determinants on COX-2-regulated cellular responses by inactivating strain-specific genes identified by H. pylori whole genome microarray. H. pylori parental and isogenic mutant strains will then be co-incubated with conditionally immortalized cells and infected into mice. The effects of strain-specific bacterial factors and COX-2 generated products also will be investigated in a murine model of gastric carcinogenesis, INS-GAS hypergastrinemic mice. Systematic studies of each of these variables in vitro and in animal systems that reflect H. pylori pathogenesis in humans should help elucidate their relative importance, direct the course of future intervention and prevention strategies, and potentially provide a model of carcinogenesis arising within the context of chronic mucosal inflammation. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Host and Bacterial Factors in Disease Due to H Pylori Principal Investigator & Institution: Eaton, Kathryn A.; Associate Professor; Veterinary Biosciences; Ohio State University 1800 Cannon Dr, Rm 1210 Columbus, Oh 43210 Timing: Fiscal Year 2000; Project Start 1-MAY-1998; Project End 0-APR2002 Summary: In its most extreme manifestations H. pylori can be responsible for severe and even life-threatening disease ranging from peptic ulcer to gastric cancer. In spite of the frequent occurrence of infection by H. pylori, however (up to 100 percent in some populations), severe manifestations of disease are relatively rare. Only a minority of infected individuals develop severe or clinically significant disease. The factors which determine disease severity in an individual host are not known. Understanding of these factors is vital to the effective control of H. pylori associated disease, however. Because infection is so common, eradication is not practical, and because most infections are subclinical, severe manifestations of disease cannot be predicted or prevented. Thus, treatment and prevention of disease associated with H. pylori necessitate understanding of the factors that determine disease severity. The goal of this proposal is to identify host and bacterial factors which predispose infected individuals to severe manifestations of disease. The central hypothesis is that gastric disease associated with H. pylori is due to uncontrolled or dysregulated mucosal immune responses to specific bacterial antigens. These host responses result in inflammation and subsequent tissue damage and are responsible for the clinical manifestations of infection by H. pylori. Thus, the two main hypotheses to be addressed are: 1) that severe manifestations of disease are due to dysregulated host immunity; and 2) that specific bacterial virulence factors induce the pathogenic immune response. We will test these hypotheses by 1) identifying the immune cell subsets and cytokines involved in gastritis (via adoptive transfer of lymphocytes, in situ identification of cells and cytokines, and evaluation of the dependence of gastritis on T cells and cytokines in immunologic mouse mutants), 2) determining the role of specific bacterial proteins (cag-related proteins and others) in induction of the pathogenic host response, and 3) determining if loss of expression of these proteins (by insertional or deletional mutagenesis) is associated with diminished ability of H. pylori to induce severe disease in a susceptible host. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Host Response to Helicobacter Pylori Infection Principal Investigator & Institution: Correa, Pelayo; Professor; Pathology; Louisiana State Univ Hsc New Orleans Health Sciences Ctr New Orleans New Orleans, La 70112 Timing: Fiscal Year 2000; Project Start 0-SEP-1999; Project End 9-SEP-2002 Summary: Gastritis due to Helicobacter Pylori is the most common chronic infection in the world today. It has been classified by IARC (WHO) as a Class I human carcinogen. Obviously only a very small portion of the infected population develops gastric cancer. This neoplasia, however, is the second most frequent in the world. In the United States, certain groups display higher risk, especially African Americans, Hispanics, Asian Americans and immigrants from Russia and Eastern Europe. This application addresses the question of different outcomes of H. Pylori infection, which in some subjects leads to gastric carcinogenesis and in others does not. The central hypothesis is that the dichotomy in outcome of the infection is driven by immunologic forces. The proposed small grant application will make it possible to conduct a feasibility study which will determine if a more definitive test of the hypothesis is possible. We will be focused on the cellular-mediated immune response studied in lymphocytes from the peripheral blood and from the gastric mucosa. Two major comparisons will be done: A) In Colombia H. pylori infected subjects living in Nari$o, at very high gastric cancer risk, will be compared with infected subjects living in the coastal city of Cartagena, at very low risk. b) In New Orleans, subjects diagnosed with multiphocal atrophic gastritis (MAG), a cancer precursor lesion, will be compared with subjects with non-atrophic gastritis (diffuse antral gastritis or DAG), which is not associated with increased gastric cancer risk. A full battery of immunologic tests will be carried out to explore if the cytokines characteristic of the T-lymphocyte helper cells responses (Th1 vs. Th2) are different in the contrasting populations. If approved, this application will make it possible to collect the material needed and complement other resources of the department of Pathology to conduct the tests in our laboratories. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Ident of H Pylori Virul Factors in Ethnic Populations Principal Investigator & Institution: Graham, David Y.; Medicine; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2000; Project Start 0-SEP-1997; Project End 9-SEP-2001 Summary: (taken from the application) Helicobacter pylori (Hp) is a common worldwide infection; it is now known to be etiologically related
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to gastritis, peptic ulcer disease, gastric adenocarcinoma, and primary gastric lymphoma. The outcome of Hp infection differs among different ethnic groups. For example, in the United States although Hp infection is detected in all ethnic groups, gastric cancer is more common in Hispanics, Blacks, Vietnamese, Koreans, Japanese, and American Indians, compared to the white population. Possible factor(s) responsible for these differences include subtle distinctions in host or environmental factors (e.g., in diet) or differences in virulence in the common Hp strain(s) circulating within an ethnic group. While environmental or host factors are likely to be important, differences in virulence is a likely possibility because in many other bacterial diseases the expression of a disease can be directly related to specific virulence factors. Data from a number of laboratories suggest that different groups of Hp strains exist. Putative virulence markers, such as cagA and vacA genes and their protein products, have also been identified and they may be differentially present or expressed in different Hp-related gastrointestinal diseases. Our primary hypothesis is that different disease manifestations of Hp infection in different ethnic groups is a reflection of the heterogeneity and expression of different virulence factors in the predominant Hp strain(s) circulating in the ethnic group. The specific objectives of this study are: To determine whether the presence of Hp virulence factors, including genetic and/or phenotypic variations in Hp isolates within different ethnic groups in the US, can be correlated with severity, extent, or pattern of gastritis. We also plan to use the DNA fingerprinting method, REPPCR, to assess genetic similarity among Hp isolates within and between different ethnic groups. This study will also determine whether differences in prevalence and heterogeneity of specific candidate virulence factors may be the underlying mechanism leading to differences in the extent and severity of Hp-related gastric damage and diseases in different ethnic groups in the United States. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Immunobiology and Prevention of H Pylori Disease Principal Investigator & Institution: Smith, Phillip D.; Professor of Medicine; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2000; Project Start 0-SEP-1998; Project End 1-AUG2003 Summary: Worldwide, the most common bacterial pathogen of the gastrointestinal tract among humans is Helicobacter pylori. Chronic infection with this noninvasive organism is the leading cause of gastritis, gastroduodenal ulcer and gastric carcinoma. In the U.S., the cohort
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prevalence of H. pylori increases approximately 10 percent per decade, whereas in developing countries, such as Chile, up to 80 percent of school-age children are already infected. Prolonged infection and its attendent inflammation predispose the gastric mucosa to malignant transformation, causing gastric cancer to be the leading cause of death in many developing countries. Since therapeutic eradication of H. pylori is expensive and unlikely in many countries, an effective vaccine is highly desirable, but its development will require elucidation of the mechanism(s) by which H. pylori causes mucosal inflammation. Accordingly, we hypothesize that: 1) After colonization of gastric mucosa, H. pylori releases antigens that are absorbed Into the lamina propria where they stimulate T helper type 1 (Th1) mucosal lymphocytes to produce cytokines that promote a cellular inflammatory response. 2) H. pylori antigens, such as urease, can be delivered in novel vaccines to induce protection against infection. 3) Along with the antigen, regulatory cytokines can be delivered in the vaccine to direct the local response from a Th1 inflammatory response to a Th2 humoral response. These hypotheses will be tested with the following four specific aims: 1) Determine whether human H. pylori gastritis in geographically diverse populations is associated predominantly with Th1 CD4+ lymphocytes, which promote a delayed hypersensitivity response, or with Th2 CD4+ lymphocytes, which promote a humoral B cell response. 2) Determine which H. pylori products stimulate purified primary mucosal cells to produce the cytokines associated with H. pylori gastritis (Specific Aim 1). 3) Characterize the cytokine response in mice infected with H. pylori in order to identify the dominant antigens that induce gastric inflammation and the Th cytokines (Specific Aim 2). 4) Using two new vaccine strategies readily adaptable to the human, determine whether oral vaccination with the dominant H. Pylori antigen(s) (Specific Aim 3) and immunoregulatory cytokines (Specific Aims 1 and 2) protect mice against challenge infection. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: in Vivo Pathogenesis of Helicobacter Pylori Principal Investigator & Institution: Fox, James G.; Director and Professor; Div of Comparative Medicine; Massachusetts Institute of Technology 77 Massachusetts Ave Cambridge, Ma 02139 Timing: Fiscal Year 2000; Project Start 1-SEP-1996; Project End 1-AUG2005 Summary: (Adapted from the Applicant's Abstract): H. pylon, an infection approaching 100 percent in developing countries, has been strongly linked epidemiologically to gastric cancer, but the mechanism
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and cofactors required for gastric cancer are poorly understood. Furthermore, it is not known at what stage in progression to gastric cancer that eradication of H. pylon would interrupt the carcinogenic process. Polyparasitism is also ubiquitous in developing populations where H. pylori is endemic. The investigators have developed a C57BL/6 mouse model of chronic H. pylori/felis gastritis that is characterized by the progressive development of gastric atrophy, intestinal metaplasia and invasive gastric cancer. The mechanism of lesion development appears to involve increased apoptosis, mucus neck proliferation, intestinal metaplasia leading to altered cellular differentiation and changes in mucin phenotype and progression of invasive cancer in submucosal vasculature. They have also investigated bacterial and environmental factors that influence disease pathogenesis by generating isogenic mutants lacking specific candidate virulence determinants and by maintaining Helicobacter infected animals on diets high in salt. They have recently shown that in mice coinfected with helicobacter and a helminth infection, H. polygyrus, the gastric cytokine Thl/Th2 profile switches and the gastric phenotype changes from a Thl to a Th2 type gastritis. They now propose to explore the effects of specific genetic alterations, environmental influences and coinfections on the mucosal response and progression of Helicobacter associated gastric lesions. Specifically, they will ask whether 1) progression of H. pylon gastritis can be interrupted at critical points in the disease by antimicrobials or therapeutic vaccination to prevent development of premalignant lesions and gastric adenocarcinoma in the gerbil and/or mouse model 2) Alternatively, do environmental factors such as dietary salt, accelerate or otherwise alter the carcinogenic process, and importantly does the strain of H. pylon (with and without specified pathogenic determinants) influence the outcome of gastric disease in the mouse and gerbil model 3) Does modulation of the Thl/Th2 axis of the immune system by various helminth infections influence the severity and progression of gastritis in rodent models. Overall, these rodent models of Helicobacter infection will be used to study the mechanism by which Helicobacter contributes to neoplasia, and the factors (host, bacteria, dietary or co-infections) which confer susceptibility and/or resistance to premalignant lesions and gastric cancer. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Regulation of Colitis by Cyclooxygenase-2 Principal Investigator & Institution: Wilson, Keith T.; Associate Professor of Medicine; Medicine; University of Maryland Balt Prof School Professional Schools Baltimore, Md 21201
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Timing: Fiscal Year 2000; Project Start 1-APR-2000; Project End 1-JAN2002 Summary: (adapted from the application) Our investigations to date indicate that inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX)-2, enzymes which produce high output nitric oxide and prostanoids, respectively, are consistently upregulated in gastrointestinal mucosal inflammation. Further, expression of these genes can regulate inflammatory pathways. We have identified important protective effects of iNOS and COX-2 in specific in vivo and in vitro models. We have also found important differences in the effects of NOS and COX-2 on inflammatory events. We have used mice with targeted deletion of either iNOS or COX-2 to assess mucosal responses to a known and common pathogen, Helicobacter pylori. iNOS deletion had no effect on H. pylori infection or the severity of gastritis. In contrast, COX-2 deletion resulted in a marked exacerbation of both acute and chronic histologic gastritis, resulted in frequent duodenal ulcer formation, which was not present in controls, and increased colonization levels of H. pylori. In addition, the tissues from H. pylori-infected COX-2-deficient [COX-2(-/-)] mice exhibited an exacerbation of the Th1-predominant, IL-12-driven dysfunctional immune response which characterizes H. pylori gastritis. COX-2 deletion was also associated with increased epithelial injury due to apoptosis. We have also confirmed these alterations of the immune response and apoptosis in vitro. The importance of understanding the role of COX-2 in different forms of GI mucosal inflammation is highlighted by the recent FDA approval and rapid utilization of multiple COX-2 selective inhibitors for treatment of musculoskeletal diseases. Based on our preliminary data and my long-standing interest in inflammatory bowel disease, in the current proposal we will determine the role of COX-2 in several important mouse models of colitis. We will use hapten models in which the mucosal immune response has been described, as well as two pertinent colonic infections, namely Helicobacter hepaticus and Citrobacter rodentia. These infection models were selected because of our findings in H. pylori gastritis and the recognition that murine IBD models appear to depend on the presence of enteric bacteria. Our specific aims are to compare COX-2(-/-) vs. (+/+) mice and wild-type mice treated with COX-2 inhibitors vs. placebo and determine the regulatory role of COX-2 in: 1. models of Th1 (TNBS) and Th2 (oxazolone) mediated colitis and 2. Colonic inflammation and injury due to H. hepaticus and C. rodentia. In both aims we will assess the effect of COX-2 on A. gross and microscopic injury; B. I1-12, Th1, proinflammatory and Th2 cytokine levels; and C. epithelial apoptosis. These studies are designed to establish these models and the role of COX-2 in
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the associated diseases, and will serve as the basis for future investigations and funding applications. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central16 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).17 Access to this growing archive of e-journals is free and unrestricted.18 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “gastritis” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for gastritis in the PubMed Central database: ·
CagA Antibodies in Japanese Children with Nodular Gastritis or Peptic Ulcer Disease by Seiichi Kato, Toshiro Sugiyama, Mineo Kudo, Kenji Ohnuma, Kyoko Ozawa, Kazuie Iinuma, Masahiro Asaka, and Martin J. Blaser; 2000 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86021&ren dertype=external
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Healthy Cats Are Commonly Colonized with "Helicobacter heilmannii" That Is Associated with Minimal Gastritis by C. R. Norris, S. L. Marks, K. A. Eaton, S. Z. Torabian, R. J. Munn, and J. V. Solnick; 1999 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84203&ren dertype=external
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Note:Direct Evidence by DNA Fingerprinting that Endoscopic CrossInfection of Helicobacter pylori Is a Cause of Postendoscopic Acute Gastritis by Toshiro Sugiyama, Hiroji Naka, Akira Yachi, and Masahiro Asaka; 2000 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86812&ren dertype=external
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 17 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 18 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 16
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The 60- to 90-kDa Parietal Cell Autoantigen Associated with Autoimmune Gastritis is a [beta] Subunit of the Gastric H+/K+-ATPase (Proton Pump) by B Toh, PA Gleeson, RJ Simpson, RL Moritz, JM Callaghan, I Goldkorn, CM Jones, TM Martinelli, F Mu, DC Humphris, JM Pettitt, Y Mori, T Masuda, P Sobieszczuk, J Weinstock, T Mantamadiotis, and GS Baldwin; 1990 August 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54545
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.19 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with gastritis, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “gastritis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “gastritis” (hyperlinks lead to article summaries):
Vocabulary Builder Adenocarcinoma: organization. [NIH]
A malignant epithelial tumor with a glandular
Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
19
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Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an allergic or bad reaction to the beef or pork insulins. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigens: Substances that cause an immune response in the body. The body "sees" the antigens as harmful or foreign. To fight them, the body produces antibodies, which attack and try to eliminate the antigens. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Asymptomatic: No symptoms; no clear sign of disease present. [NIH] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Bacteroides: A genus of gram-negative, anaerobic, rod-shaped bacteria. Its organisms are normal inhabitants of the oral, respiratory, intestinal, and urogenital cavities of humans, animals, and insects. Some species may be pathogenic. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH]
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Benign: Not malignant; not recurrent; favourable for recovery. [EU] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Pertaining to the heart. [EU] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]
Catalase: An oxidoreductase that catalyzes the conversion of hydrogen peroxide to water and oxygen. It is present in many animal cells. A deficiency of this enzyme results in ACATALASIA. EC 1.11.1.6. [NIH] Citrobacter: A genus of gram-negative, rod-shaped enterobacteria that can use citrate as the sole source of carbon. [NIH] Clarithromycin: A semisynthetic macrolide antibiotic derived from erythromycin that is active against a variety of microorganisms. It can inhibit protein synthesis in bacteria by reversibly binding to the 50S ribosomal subunits. This inhibits the translocation of aminoacyl transfer-RNA and prevents peptide chain elongation. [NIH] Colitis: Inflammation of the colon. [EU] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU]
Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU]
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Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterocolitis: Inflammation involving both the small intestine and the colon; see also enteritis. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU]
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Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour now often used of endocrine factors as opposed to neural or somatic. [EU] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein Hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypersecretion: Excessive secretion. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunization: The induction of immunity. [EU] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals,
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including humans. Pathogenicity from this genus is rare. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Luminol: 5-Amino-2,3-dihydro-1,4-phthalazinedione. Substance that emits light on oxidation. It is used in chemical determinations. [NIH] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Metaplasia: The change in the type of adult cells in a tissue to a form which is not formal for that tissue. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Occult: Obscure; concealed from observation, difficult to understand. [EU]
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Ornithine: An amino acid produced in the urea cycle by the splitting off of urea from arginine. [NIH] Oxazolone: Immunologic adjuvant and sensitizing agent. [NIH] Parietal: 1. of or pertaining to the walls of a cavity. 2. pertaining to or located near the parietal bone, as the parietal lobe. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peroxidase: A hemeprotein from leukocytes. Deficiency of this enzyme leads to a hereditary disorder coupled with disseminated moniliasis. It catalyzes the conversion of a donor and peroxide to an oxidized donor and water. EC 1.11.1.7. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Proteolytic: 1. pertaining to, characterized by, or promoting proteolysis. 2. an enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU]
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Refractory: Not readily yielding to treatment. [EU] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Rodentia: A mammalian order which consists of 29 families and many genera. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spondylitis: Inflammation of the vertebrae. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Urease: An enzyme that catalyzes the conversion of urea and water to carbon dioxide and ammonia. EC 3.5.1.5. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or
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treatment of infectious diseases. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH]
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CHAPTER 4. PATENTS ON GASTRITIS Overview You can learn about innovations relating to gastritis by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.20 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with gastritis within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with gastritis. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
Adapted from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
20
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Patents on Gastritis By performing a patent search focusing on gastritis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on gastritis: ·
Composition and method for treating and preventing helicobactorpylori-associated stomach gastritis, ulcers and cancer Inventor(s): Segelman; Alvin Burton (Orem, UT) Assignee(s): Nature's Sunshine Products, Inc. (Provo, UT) Patent Number: 6,187,313 Date filed: February 17, 1998 Abstract: The present invention is an orally-administrable composition for preventing and treating Helicobacter pylori-associated stomach gastritis and ulcers, and for preventing Helicobacter pylori-associated stomach cancer. The invention is a herb or herb extract containing an anti-H. pylori activity. The invention further includes methods for making and methods for using the invention. Excerpt(s): This invention relates to the field of compositions and methods for treating and preventing Helicobactor pylori-associated stomach gastritis, ulcers and cancer. More specifically, this invention relates to the field of compositions of herbs, herb parts or herb extracts which can be used to treat or prevent Helicobactor pylori-associated stomach gastritis, ulcers and cancer, and methods for making and using such compositions. ... Twelve years ago it was first reported and subsequently verified by many scientific studies that a particular bacterium known as Helicobacter pylori ("H. pylori") commonly infects the human stomach. Many people so infected subsequently acquire what is known as chronic superficial gastritis ("stomach inflammation") which may continue on for many decades. It is now known that left untreated, this condition may lead to stomach ulcers and even stomach cancer disease. (Marshall, B. J. and Warren, J. B. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet,
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No.8390: 1311-1315 (1984); Nomura, A., Stemmermann, G. N., Chyou, P.H., et al., Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. New Engl. J. Med., 325: 1132-1136 (1991); Blaser, M. J. and Parsonnet, J., Parasitism by the "slow" bacterium Helicobacter leads to altered gastric homeostasis and neoplasia. J. Clin, Invest., 94: 4-8 (1994).) Extensive laboratory as well as clinical studies have been reported which clearly show that people suffering from chronic gastritis and/or stomach ulcer disease caused by H. pylori infection can be cured when administered certain antibiotics which eradicate H. pylori [Rubinstein, G., Dunkin, K. and Howard, A. J., The susceptibility of Helicobacter pylori to 12 antimicrobial agents, omeprazole and bismuth salts. J. Antimicrob. Chemother., 34: 409-413 (1994); Rosioru, C. Glassman, M. S., Berezin, S. H., et al., Treatment of Helicobacter pylori--associated gastroduodenal disease in children. Dig. Dis. Sci., 38: 123-128 (1993); Blaser, M. J., The bacteria behind the ulcers. Sci. Amer., February 1996, 104-107]. On the other hand, the use of antibiotics has some drawbacks, including the rapid resistance of H. pylori to antimicrobial agents (Rubinstein, G. et al., op. cit.) as well as the well known fact that many people are allergic to antibiotics and some develop severe diarrhea and/or secondary infections which complicate antibiotic therapy. Furthermore, the antibiotics used to treat (i.e., kill H. pylori) ulcers also kill a wide variety of non-pathogenic bacteria in the body, a most undesirable feature of antibiotic therapy (i.e., "nonselectivity"). ... The present invention is based on the unexpected discovery that several herbs and an insect product are capable of being orally administered to humans, either singly or in combination, to destroy or inhibit the growth of H. pylori so that gastritis and ulcer disease can be prevented or cured. In this manner stomach cancer can also be prevented. The composition may also be combined with certain other beneficial and healing substances (i.e., licorice root (Glycyrrhiza glabra)). Web site: http://www.delphion.com/details?pn=US06187313__ ·
Treatment of gastrointestinal ulcers or gastritis caused by microbial infection Inventor(s): Pfirrmann; Rolf W. (Lucerne, CH) Assignee(s): Ed. Geistlich Sohne AG fur chemische Industrie (CH) Patent Number: 6,117,868 Date filed: May 20, 1999
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Abstract: A method and composition for the treatment of infectious gastrointestinal ulcer disease or infectious gastritis disease of microbially infected gastrointestinal tissue in a mammal involves administration of an antimicrobial amount of an antimicrobial medicament which is cell wall constituent-inactivating by chemical reaction with cell wall constituents, endotoxin non-releasing, exotoxin-inactivating or a combination thereof. Excerpt(s): The present invention relates to the field of treating patients having gastrointestinal ulcers or gastritis caused by microbial infection. ... In the past, chronic gastritis with prolonged dyspeptic symptoms in the upper stomach, the peptic ulcer, duodenal ulcer (UD) and ventral ulcer (UV) with pain in the upper stomach after meals or epigastric pain on empty stomach being a syndrome with unclear etiology. Its pathogenesis had not been clarified in detail. Generally, it can still be said today that there is no peptic ulcer without proteolytic gastric acid. Differentialdiagnostic measures usually succeed in differentiating the peptic formation of ulcers from psychogenic gastrointestinal malfunctions. The final diagnosis depends on X-ray results. ... Marshall et al. only succeeded in 1983-1985 to prove the connection between the infection and gastritis through the rediscovery and ability to cultivate the germ Campylobacter pylori and through an oral infection in a self-test. This way the actual pathogenic factor of the ulcer was recognized. Initially, the germ was gained from biopsies of the antrum and corpus mucous membrane. In vitro cultivation did not succeed until later. Web site: http://www.delphion.com/details?pn=US06117868__ ·
Therapeutic agent for gastritis Inventor(s): Kasuga; Kazunori (Saitama, JP), Sekiguchi; Haruo (Saitama, JP), Hamada; Katsuhiro (Tochigi, JP), Imai; Jun (Kanagawa, JP), Kamijo; Shinji (Tokyo, JP) Assignee(s): Kyorin Seiyaku Kabushiki Kaisha (Tokyo, JP) Patent Number: 5,238,946 Date filed: August 21, 1989 Abstract: A therapeutic pharmaceutical composition containing 3,4,5trimethoxy-N-3-piperidylbenzamide (troxipide) as an active ingredient for gastritis in admixture with an inert pharmaceutical carrier. The composition may be administered orally in the forms of tablets, capsules, granules and fine granules.
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Excerpt(s): Gastritis is pathologically an inflammatory process of stomach, particularly of the gastric mucosa. It has been known that an acute gastritis is often induced by ingestion by anti-inflammatory agents (aspirin, etc.) or alcohol (ethanol), by the emotional stress or by the flowback of bile into the stomach. Furthermore, it may occasionally result from a mistaken ingestion of corrosive acid or alkali. ... The object of the present invention relates to a novel therapeutic agent containing troxipide which is effective for gastritis. ... The present invention has been achieved by our discovery of prominent effects of troxipide on acute gastric lesions which are known as experimental models of the gastritis. Namely, the present inventors have searched for an effective compound which protects gastric lesions induced by aspirin, 0.6N HCl, waterimmersion stress and ethanol, respectively, in rats, and it has been revealed that troxipide is highly effective though it differs entirely in chemical structure from the known effective compounds for gastritis. Web site: http://www.delphion.com/details?pn=US05238946__ ·
Method for treating helicobacter pylori gastritis Inventor(s): Harris; Richard Y. (381 Rampart Range Rd., Woodland Park, CO 80863) Assignee(s): none reported Patent Number: 5,229,380 Date filed: June 28, 1991 Abstract: The invention relates to a method of arresting and treating duodenal and gastric ulcers, and chronic gastritis comprising administering an effective amount of [4S(4.alpha.,4a.alpha.,5a.alpha.,12a.alpha.)]-4,7-bis (dimethylamino)1,4,4a,5,5a,6,11,12a-octahydro-3,10,12, 2a-tetrahydroxy-1,11-dioxo-2napthacenecarboxymide monohydrochloride. Excerpt(s): This invention relates to a method for arresting and treating duodenal and gastric ulcers, and chronic gastritis, and more particularly the use of the compound [4S-(4.alpha.,4a.alpha.,5a.alpha.,12a.alpha.)]-4,7bis (dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,10,12,12atetrahydroxy-1, 11-dioxo-2-napthacenecarboxymide monohydrochloride, commonly known as minocycline, to eradicate the bacterium Helicobacter pylori (previously named Campylobacter pylori), which is believed to play an etiologic role in these disorders. ... For some time now, it has been speculated that the bacterium Helicobacter pylori plays an etiologic role in the development of both duodenal and gastric ulcers, and in chronic gastritis. Specifically, some Australian researchers have
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hypothesized that the Helicobacter pylori microorganism lives and grows between the inner lining of the stomach and under the protective mucous coat which protects the stomach lining from the corrosive effects of stomach acid. See Lancet. 1983; Vol. 1, pages 1273-5; Lancet. 1984; Vol. 1, pages 1311-5. ... Research studies have established a link between the presence of chronic antral gastritis, and gastric and duodenal ulcers, and Helicobacter pylori gastric infection. Seventy to eighty-five percent of biopsy specimens from patients with chronic gastritis test positive for this organism. Web site: http://www.delphion.com/details?pn=US05229380__ ·
Composition and method for the treatment of duodenal ulcers, gastritis and gastro-duodenitis Inventor(s): Puscas; Ioan (Simleul Silvaniei, RO), Orban; Ioan (Jud Salaj, RO), Voicu; Livia (Simleul Silvaniei, RO), Breazu; Dorin (Cluj-Napoca, RO), Pop; Ioan (Cluj-Napoca, RO), Ciupe; Iuliu (Cluj-Napoca, RO), Terec; Lazar (Gherla, RO), Butan; Mioara R. (Cluj-Napoca, RO), Chiu; Aurel (Simleul Silvaniei, RO), Lerintiu; Aurel (Simleul Silvaniei, RO), Turi; Zoltan (Simleul Silvaniei, RO) Assignee(s): Centrala Industriala de Medicamente Cosmetice Coloranti si Lacuri (Bucharest, RO) Patent Number: 4,221,783 Date filed: February 9, 1979 Abstract: Gastro-duodenal ulcers, gastritis and gastro-duodenitis may be effectively treated with a composition comprising a sulfonamide having an --SO.sub.2 NH.sub.2 group linked to a thiazolic or benzothiazolic ring together with an alkali metal bicarbonate, an alkali metal citrate, a magnesium compound and optionally aluminum hydroxide. Excerpt(s): This invention relates to medicinal compositions, more particularly, the present invention relates to compositions suitable for use in the treatment of gastritis; gastro-duodenitis and gastro-duodenal ulcers. Web site: http://www.delphion.com/details?pn=US04221783__
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·
Remedy for treating gastritis, gastric and duodenal ulcers Inventor(s): Bogdanov; Ivan Georgiev (Sofia, BG) Assignee(s): DSO "Pharmachim" (Sofia, BG) Patent Number: 3,988,440 Date filed: October 10, 1974 Abstract: A preparation is disclosed for treating gastritis and gastric and duodenal ulcers which comprises dried soya medium, sucrose, and dried Lactobacillus bulgaricus culture which has been obtained by cultivating the culture in a soya medium under anaerobic conditions at a temperature of between 35.degree.-42.degree. C, followed by spray drying the culture at a temperature of 150.degree.-190.degree. C. The culture consists of 25-35% protein, 45-52% sucrose, and 4-5.5% lactic acid. Excerpt(s): This invention relates to a remedy for treating gastritis, gastric and duodenal ulcers and a method for obtaining same on the basis of Lactobacilus bulgaricus. ... Out of all 360 patients 238 (66%) were suffering from ulcer of the duodenum, 93 (26%) had gastritis and 29 (3%) had gastric ulcer. Most of the patients were chronically ill, having been several times to hospitals and whose diagnosis has been defined as a result of numerous clinical and paraclinical examinations. Web site: http://www.delphion.com/details?pn=US03988440__
Patent Applications on Gastritis As of December 2000, U.S. patent applications are open to public viewing.21 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to gastritis: ·
Food containing active strains for inhibiting infection and treating gastritis, gastric and duodenal ulcers Inventor(s): Heo, Cheol Seong ; (Chunan, KR), Lee, Jeong Jun ; (Suwon, KR), Baek, Young Jin ; (Seoul, KR), Kim, Hyung Soo ; (Granger, IN) Correspondence: Alfred D. Lobo, Esq.; LOBO & CO., L.P.A.; 933 The Leader Building; 526 Superior Avenue; Cleveland; OH; 44114-1401; US Patent Application Number: 20020037341 Date filed: October 10, 2001
21
This has been a common practice outside the United States prior to December 2000.
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Abstract: Live strains of Lactobacillus acidophilus HY2177 and Lactobacillus casei HY2743 maintained in nutritious foods, such as yogurt, imbue them with prophylactic and/or therapeutic properties. Such foods are beneficial in the prevention and/or treatment of gastritis, duodenal and gastric ulcers caused by infection from Helicobacter pylori (also referred to as H. pylori). The properties of these bacteria are boosted by the addition of egg yolk containing antibodies specific to H. pylori antigen derived from "fractionated H. pylori" and may be administered as active strains alone in a food supplement, or the active strains may be combined with H. pylori-antibodies (IgY). Excerpt(s): A result of interaction of H. pylori on the mucous membrane is the stimulation of numerous cytokines. The predominant immune response to infection is the production of interleukin-8 (IL-8). IL-8induced neutrophils or macrophages are a direct cause of gastritis. To date, treatment to subdue secretion of gastric acid, for example with H.sub.2 isolator, is deemed unsatisfactory over the long term due to recrudescence which is now countered with medicines which act directly on the H. pylori. Presently, trends in the fight against infection by H. pylori may be categorized as follows: (a) development of antibiotics showing a direct effect against H. pylori, (b) development of vaccines for H. pylori, and (c) using anti-H. pylori antibodies which allow the live H. pylori to be terminated. For prophylaxis, (b) and (c) are preferred. ... Confirmation of the ineffectiveness of the live organism, by itself, is stated as follows: "L. acidophilus alone was almost the same as that of the control group, and there was no significant difference between the two groups, as shown in Table 3. Also, gastritis conditions were observed and L. acidophilus had no efficacy on suppressing gastritis." (see page 10, lines 49-52). The tests were performed on hairless mice (NS:Hr/ICR) having a high sensitivity to H. pylori infection. Such mice do not have the normal flora found in a BALB/c mouse which provides a better comparison with a human stomach. ... A natural or synthetic food is supplemented with particular strains of live bacteria which by themselves are effective against Helicobacter pylori (also referred to as H. pylori) not only in vitro but in vivo. The effectiveness of such bacteria is strain-specific, that is, a specific strain of a species may be effective while other strains of that same species are not. Effectiveness of "active strains" identified herein may be preserved and/or enhanced with egg yolk containing antibodies specific to H. pylori antigens, so that consuming the food will prevent and/or treat gastritis, and/or gastric and duodenal ulcers. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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·
Method for Preventing Gastritis Using Amylin or Amylin Agonists Inventor(s): Young, Andrew A. ; (San Diego, Ca), Gedulin, Bronislava ; (San Diego, Ca), Beynon, Gareth W. ; (Brightwell-Cum Sotwell, UA) Correspondence: Bradford J. Duft, Esq; Brobeck, Phleger & Harrison LLP; 12390 El Camino Real; San Diego; CA; 92130; US Patent Application Number: 20020010133 Date filed: May 6, 1997 Abstract: Methods for treating or preventing gastritis or gastric injury are disclosed, comprising administering a therapeutically effective amount of an amylin or an amylin agonist. Methods are also disclosed for the treatment of pain, fever, inflammation, arthritis, hypercoagulability, or other conditions for which a non-steroidal anti-inflammatory drug would be indicated, comprising administering an amylin or amylin agonist in conjunction with administering a therapeutically effective amount of a non-steroidal anti-inflammatory agent. Pharmaceutical compositions comprising an amylin or amylin agonist and a non-steroidal antiinflammatory drug are also disclosed. Excerpt(s): The present invention relates to methods for treating or preventing gastritis or gastric injury by administering an amylin or an amylin agonist. The present invention also relates to the treatment of pain, fever, inflammation, arthritis, hypercoagulability, or other conditions for which a non-steroidal anti-inflammatory drug would be indicated, comprising administering an amylin or an amylin agonist in conjunction with a non-steroidal anti-inflammatory drug. Pharmaceutical compositions comprising an amylin or an amylin agonist and a nonsteroidal anti-inflammatory agent are also described by the present invention. ... Amylin or amylin agonists potently inhibit gastric emptying in rats (Young et al., Diabetologia 38(6):642-648 (1995)), dogs (Brown et al., Diabetes 43(Suppl 1):172A (1994)) and humans (Macdonald et al., Diabetologia 38(Suppl 1):A32 (abstract 118)(1995)). Gastric emptying is reportedly accelerated in amylin-deficient type 1 diabetic BB rats (Young et al., Diabetologia, supra; Nowak et al., J. Lab. Clin. Med., 123(1):110-6 (1994)) and in rats treated with the selective amylin antagonist, AC187 (Gedulin et al., Diabetologia, 38(Suppl 1):A244 (1995). Methods for reducing gastric motility and slowing gastric emptying comprising the administration of an amylin agonist (including amylin) are the subject of U.S. patent application Ser. No. 08/118,381, filed Sep. 7, 1993, and U.S. patent application Ser. No. 08/302,069, filed Sep. 7, 1994 (and corresponding PCT application, Publication No. WO 95/07098, published Mar. 16, 1995). The effect of amylin on gastric emptying appears to be physiological (operative at concentrations that normally circulate).
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Supraphysiological levels of amylin have also been studied with regard to the inhibition of gastric acid secretion (Guidobono, F., et al., Peptides 15:699-702 (1995)) and in regard to protection from gastritis. (Guidobono et al., Brit. J. Pharm. 120:581-86 (1997)). The latter authors reported that subcutaneous injections of amylin had no effect on ethanol- or indomethacin-induced gastritis in rats, although intracerebroventricular injections did have an effect. The same authors also concluded that any gastroprotective effects of amylin were distinct from effects to inhibit acid secretion. ... Non-steroidal anti-inflammatory drugs or agents (NSAIDS) are useful analgesics, however, they have the adverse property of inducing various gastric effects in a large fraction of patients; such gastric effects include gastritis, gastric ulcer, epigastric distress, nausea, vomiting, and hemorrhage. (Woodbury, D. M. and Fingl, E. Analgesicantipyretics, anti-inflammatory agents, and drugs employed in the therapy of gout, in The Pharmacological Basis of Therapeutics (Goodman, L. S., and Gilman, A., eds.) 325-43 (1975)). Such NSAIDS include salicylate, phenylbutazone, indomethacin, acetominophan, phenacetin, naproxen, and ibuprofen. This side effect is particularly a problem in patients that must continually ingest NSAIDs, such as in patients with chronic inflammatory conditions, such as rheumatoid arthritis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Specific Antibodies for Use in Preparation of Pharmaceutical Compositions Useful in the Prevention or Treatment of Gastritis, Gastric Ulcers and Duodenal Ulcers Inventor(s): Kodama, Yoshikatsu ; (Gifu-Shi, JP), Icatlo, Faustino C. JR. ; (Gifu-Shi, JP), Kimura, Nobutake ; (Saitama-Ken, JP), Ariga, Masato ; (Saitama-Ken, JP) Correspondence: Burns Doane Swecker & Mathis L L P; Post Office Box 1404; Alexandria; VA; 22313-1404; US Patent Application Number: 20010021393 Date filed: April 8, 1998 Abstract: The present invention provides specific antibodies obtained from eggs laid by hens which have been immunized against urease of Helicobacter pylori as an antigen, and specific antibodies obtained from eggs laid by hens which have been immunized against flagella of Helicobacter pylori as an antigen. These antibodies are useful for the prevention or treatment of gastritis, gastric ulcers and duodenal ulcers caused by infection of Helicobacter pylori. At least one organism selected
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from lactic acid bacteria, Enterococcuses, yeasts, and Baillus can be used along with the antibodies. Excerpt(s): The present invention relates to specific antibodies for use in preparing pharmaceutical compositions useful for the prevention or treatment of gastritis, gastric ulcers and duodenal ulcers caused by infection of Helicobacter pylori (hereinafter referred to as H. pylori or Hp), and for use as an additive to foods useful for the prevention of gastritis, gastric ulcers and duodenal ulcers. ... Since then, many reports have been published based on epidemiological studies, indicating that this bacterium causes gastritis, gastric ulcers and duodenal ulcers and is associated with diseases such as gastric cancer. Once H. pylori colonizes gastric mucosa, it cannot be eradicated in the stomach and continues to inhabit the stomach, although the immune response to infection thereof is strong, i.e., the antibody titer is high. Therefore, unless H. pylori is completely eliminated from the stomach by antibiotic therapy, the condition of infection will return to the same level as before treatment within about a month after the administration of antibiotics is stopped. Additionally, the pH of the stomach is maintained very low by HCl, which is a strong acid, and therefore most antibiotics are apt to be inactivated. For this reason, the combination of an antibiotic and a proton pump inhibitor which strongly suppresses the secretion of gastric acid is utilized often in a greater dose than usual for eradication of H. pylori. Recently, a new treatment employing a combination of bismuth subsalicylate, metronidazole, and tetracycline has proved to have the highest rate of elimination of H. pyroli, but metronidazole in this combination is known to cause the rapid emergence of an antibioticresistant strain when used alone. In developing countries this medicine has been used widely for treating diarrhea patients, and as a result there is a high rated infection with metronidazole-resistant H. pylori. Thus, the administration of antibiotics for a long time has the serious problems of increasing antibiotic-resistant strains as well as causing side effects. ... However, these results were obtained using mice which do not have normal flora in the oral cavity, stomach and intestines, and it is not expected that such results can be obtained in conventional mice having normal flora. Generally, when mice having inherent normal flora are inoculated with human lactic acid bacteria, the bacteria are eliminated by the normal flora and do not colonize. Also, the antibodies used in the above experiments were those against whole cells of Hp, and the number of Hp in the stomach became only 10 times less than that of the control group, i.e., Hp was not eliminated completely. Furthermore, there is no reference to the relation between the decrease of Hp and the lessening of gastritis.
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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with gastritis, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “gastritis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on gastritis. You can also use this procedure to view pending patent applications concerning gastritis. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Bifidobacterium: A rod-shaped, gram-positive, non-acid-fast, non-sporeforming, non-motile bacterium that is a genus of the family actinomycetaceae. It inhabits the intestines and feces of humans as well as the human vagina. [NIH] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Duodenum: The first or proximal portion of the small intestine, extending from the pylorus to the jejunum; so called because it is about 12
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fingerbreadths in length. [EU] Epigastric: Pertaining to the epigastrium. [EU] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Glycyrrhiza: A genus of leguminous herbs or shrubs whose roots yield glycyrrhetinic acid and its derivatives, carbenoxolone for example. Licorice toxicity is manifested as hypokalemia, low blood potassium. Licorice is used as flavoring and aromatic in pharmaceuticals and as candy. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Granule: A small pill made from sucrose. [EU] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Medicament: A medicinal substance or agent. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Motility: The ability to move spontaneously. [EU] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH]
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Prophylaxis: The prevention of disease; preventive treatment. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU] Rheumatoid: Resembling rheumatism. [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Ventral: 1. pertaining to the belly or to any venter. 2. denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are saccharomyces cerevisiae; therapeutic dried yeast is yeast, dried. [NIH]
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CHAPTER 5. BOOKS ON GASTRITIS Overview This chapter provides bibliographic book references relating to gastritis. You have many options to locate books on gastritis. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on gastritis include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “gastritis” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on gastritis:
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Clinical Practice of Gastroenterology. Volume Two Source: Philadelphia, PA: Current Medicine. 1999. 861 p. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: This lengthy textbook brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. This second volume includes 113 chapters in five sections: liver, gallbladder and biliary tract, pancreas, pediatric gastroenterology, and special topics. Specific topics include hepatic (liver) structure and function, jaundice, viral hepatitis, alcoholic liver injury, liver tumors, parasitic diseases of the liver, Wilson's disease, hemochromatosis, the pregnancy patient with liver disease, portal hypertension, hepatic encephalopathy, fulminant hepatic failure, liver transplantation, the anatomy of the gallbladder and biliary tract, gallstones, laparoscopic cholecystectomy (gallbladder removal), cholecystitis (gallbladder infection), primary sclerosing cholangitis, biliary obstruction, pancreatic anatomy and physiology, acute pancreatitis, pancreatic fistulas and ascites (fluid accumulation), chronic pancreatitis, cancer of the pancreas, endoscopic retrograde cholangiopancreatography, esophageal atresia, gastroesophageal reflux in infants and children, achalasia and esophageal motility disorders, caustic and foreign body ingestion, vomiting, chronic abdominal pain, gastritis and peptic ulcer disease in children, malabsorption syndromes in children, inflammatory bowel disease in children and adolescents, acute appendicitis, cystic fibrosis, constipation and fecal soiling (incontinence), hepatitis in children, liver transplantation in children, failure to thrive, pediatric AIDS, the gastrointestinal manifestations of AIDS, the evaluation and management of acute upper gastrointestinal bleeding, principles of endoscopy, eating disorders, nutritional assessment, enteral and parenteral nutrition, gastrointestinal diseases in the elderly and in pregnancy, nosocomial infections, and the psychosocial aspects of gastroenterology (doctor patient interactions). The chapters include figures, algorithms, charts, graphs, radiographs, endoscopic pictures, intraoperative photographs, photomicrographs, tables, and extensive references. The volume concludes with a detailed subject index and a section of color plates.
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Diagnosis and Management of Peptic Ulcer Disease. 2nd ed Source: West Islip, NY: Professional Communications, Inc. 1997. 203 p.
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Contact: Available from Professional Communications, Inc. 400 Center Bay Drive, West Islip, NY 11795. (800) 337-9838. PRICE: $17.95. ISBN: 1884735304. Summary: This handbook reviews the diagnosis and management of peptic ulcer disease. The author emphasizes its functional and structural setting, causes, complications, and therapy, with particular attention to H. pylori, the worldwide infection known to account for the majority of duodenal and gastric ulcers. Both of these types of ulcers are now seen as common chronic diseases which are multifactorial, involving both genetic and environmental factors. The handbook, in pocket-size for ease of reference, includes 17 chapters in six sections: gastrointestinal structure and function, including etiology; the role of H. pylori, including epidemiology and natural history; NSAIDs (nonsteroidal antiinflammatory drugs) and stress-induced ulcers; diagnostic considerations, including clinical presentation, laboratory tests, and radiology and endoscopy; treatment, including general therapeutic measures and drug therapy; and complications, including bleeding ulcers, perforation, penetration, and gastric outlet obstruction. The association of both duodenal and gastric ulcers with antral inflammation and, perhaps most influential, the discovery of Helicobacter pylori as a cause of antral gastritis has alerted clinicians to the importance of mucosal inflammation in the pathogenesis and recurrent nature of peptic ulceration. The finding that H. pylori can usually be eliminated by antibiotics carries potentially revolutionary therapeutic implications. Black and white photographs and charts illustrate the handbook, each chapter includes references, and a subject index concludes the volume. 30 figures. 13 tables. (AA-M). ·
Gastroenterology and Hepatology: The Comprehensive Visual Reference. Volume 3: Stomach and Duodenum Source: Philadelphia, PA: Current Medicine. 1996. [200 p.]. Contact: Available from Current Medicine. 400 Market Street, Suite 700, Philadelphia, PA 19106. (800) 427-1796 or (215) 574-2266. Fax (215) 5742270. E-mail:
[email protected]. Website: current-medicine.com. PRICE: $125.00 plus shipping and handling. ISBN: 0443078432. Summary: This atlas is one in an 8-volume collection of images that pictorially displays the gastrointestinal tract, liver, biliary tree, and pancreas in health and disease, both in children and adults. This volume includes 12 chapters on the stomach and duodenum, each written by experts in their respective fields. The first chapter reviews the current concepts of regulation of gastric acid secretion; the second chapter reviews the complex endocrinology of the stomach and duodenum.
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Chapter 3 presents a pictorial of the gastrointestinal immune system, covering the basic science of gut immunology and using the examples of H. pylori gastritis and celiac sprue as examples of immunopathic disorders of the stomach and duodenum, respectively. Chapters 4 to 8 summarize in some detail the current concepts and risk factors for ulcerative and inflammatory diseases of the stomach and duodenum. Chapter 9 covers bleeding lesions of the stomach and duodenum, both benign and malignant. Chapter 10 illustrates the many types of neoplasms of the stomach and duodenum with emphasis on gastric adenocarcinoma; Chapter 11 depicts the various surgical procedures on the stomach and duodenum available for the treatment of benign and malignant disorders, including morbid obesity. The volume concludes with a chapter on the dermatologic manifestations of gastrointestinal diseases as well as cutaneous lesions that, when present, are markers for disease of the gastrointestinal tract, liver, biliary tree, or pancreas. The format of the atlas is visual images supported by relatively brief text. Tables, charts, diagrams, and photomicrographs are used extensively.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to gastritis (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Campylobacter Pylori in Gastritis and Peptic Ulcer Disease (1989); ISBN: 4260141627; http://www.amazon.com/exec/obidos/ASIN/4260141627/icongroupin terna
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Campylobacter Pylori in Gastritis and Peptic Ulcer Disease by Martin J. Blaser (Editor) (1989); ISBN: 0896401626; http://www.amazon.com/exec/obidos/ASIN/0896401626/icongroupin terna
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Chronic Atrophic Gastritis by F. Di Mario (1991); ISBN: 8829909971; http://www.amazon.com/exec/obidos/ASIN/8829909971/icongroupin terna
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Chronic Gastritis and Hypochlorhydria in the Elderly by Peter R. Holt, Robert M. Russell (Editor) (1993); ISBN: 0849369703;
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http://www.amazon.com/exec/obidos/ASIN/0849369703/icongroupin terna ·
Gastric Anisakiasis in Japan: Epidemiology, Diagnosis, Treatment by H. Ishikura, M. Namiki (Editor) (1989); ISBN: 0387700366; http://www.amazon.com/exec/obidos/ASIN/0387700366/icongroupin terna
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Gastritis by Robert A. Kozol (Editor) (1993); ISBN: 0849354978; http://www.amazon.com/exec/obidos/ASIN/0849354978/icongroupin terna
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Gastritis by David Y. Graham (Editor), et al (1999); ISBN: 0397516754; http://www.amazon.com/exec/obidos/ASIN/0397516754/icongroupin terna
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Gastritis: A Critical Review by R. Cheli, et al; ISBN: 0387174664; http://www.amazon.com/exec/obidos/ASIN/0387174664/icongroupin terna
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Helicobacter Pylori in Peptic Ulceration and Gastritis by Barry J. Marshall, et al; ISBN: 0865421080; http://www.amazon.com/exec/obidos/ASIN/0865421080/icongroupin terna
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Helicobacter Pylori Infection in Childhood by Uwe Blecker; ISBN: 1581120737; http://www.amazon.com/exec/obidos/ASIN/1581120737/icongroupin terna
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Helicobacter Pylori, Gastritis and Peptic Ulcer (1990); ISBN: 3540520309; http://www.amazon.com/exec/obidos/ASIN/3540520309/icongroupin terna
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Helicobacter Pylori, Gastritis and Peptic Ulcer by P. Malfertheiner, H. Ditschuneit (Editor) (1990); ISBN: 0387520309; http://www.amazon.com/exec/obidos/ASIN/0387520309/icongroupin terna
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Helicobacter Pylori: Biology and Clinical Practice by C. Stewart Goodwin (Editor), Bryan W. Worsley (Editor); ISBN: 0849364515; http://www.amazon.com/exec/obidos/ASIN/0849364515/icongroupin terna
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The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “gastritis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:22 ·
Basic and clinical aspects of Helicobacter pylori infection. Author: G. Gasbarrini, S. Pretolani (eds.); Year: 1994; Berlin; New York: SpringerVerlag, c1994; ISBN: 3540567208 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540567208/icongroupin terna
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Campylobacter pylori: defining a cause of gastritis and peptic ulcer disease: proceedings from a symposium on the occasion of the 13th International Congress of Gastroenterology, Rome, 7 September 1988. Author: edited by G.N.J. Tytgat; Year: 1989; Oslo, Norway: Universitetsforlaget, c1989
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Chronic atrophic gastritis: pathophysiological and clinical features. Author: [edited by] F. Di Mario, F. Farinati, G. Leandro; Year: 1991; Padua: Piccin, c1991; ISBN: 8829909971 http://www.amazon.com/exec/obidos/ASIN/8829909971/icongroupin terna
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Chronic gastritis and hypochlorhydria in the elderly. Author: edited by Peter R. Holt, Robert M. Russell; Year: 1993; Boca Raton: CRC Press, c1993; ISBN: 0849369703 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0849369703/icongroupin terna
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Contemporary diagnosis and management of H pylori-associated gastrointestinal diseases. Author: Kathleen S. Graham, David Y.
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
22
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Graham; Year: 1998; Newtown, Pa.: Handbooks in Health Care, c1998; ISBN: 1884065260 http://www.amazon.com/exec/obidos/ASIN/1884065260/icongroupin terna · ·
Gastritis, peptic ulcer, and gastric cancer. Author: edited by M. Kekki; Year: 1991; Oslo, Norway: Universitetsforlaget, c1991 Gastritis. Author: editors, David Y. Graham, Robert M. Genta, Michael F. Dixon; Year: 1999; Philadelphia: Lippincott Williams & Wilkins, c1999; ISBN: 0397516754 http://www.amazon.com/exec/obidos/ASIN/0397516754/icongroupin terna
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Gastritis. Author: edited by Robert A. Kozol; Year: 1993; Boca Raton: CRC Press, c1993; ISBN: 0849354978 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0849354978/icongroupin terna
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Helicobacter pylori: biology and clinical practice. Author: edited by C. Stewart Goodwin, Bryan W. Worsley; Year: 1993; Boca Raton: CRC Press, c1993; ISBN: 0849364515 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0849364515/icongroupin terna
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Helicobacter pylori 1990: proceedings of the Second International Symposium on Helicobacter pylori, Bad Nauheim, August 25-26th, 1989. Author: H. Menge ... [et al.] (eds.); Year: 1991; Berlin; New York: Springer-Verlag, c1991; ISBN: 3540526161 (alk. paper) Helicobacter pylori handbook. Author: Richard V. Heatley; Year: 1998; Oxford, England; Malden, Mass.: Blackwell Science, 1998; ISBN: 0632051760 http://www.amazon.com/exec/obidos/ASIN/0632051760/icongroupin terna
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Helicobacter pylori in peptic ulceration and gastritis. Author: edited by Barry J. Marshall, Richard W. McCallum, Richard L. Guerrant; foreword by Gerald L. Mandell; Year: 1991; Boston: Blackwell Scientific Publications; St. Louis, Mo.: Distributors, USA and Canada, Mosby-Year Book, 1991; ISBN: 0865421080 http://www.amazon.com/exec/obidos/ASIN/0865421080/icongroupin terna
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Helicobacter pylori infection and immunity. Author: edited by Yoshimasa Yamamoto, Herman Friedman, and Paul S. Hoffman; Year: 2002; New York: Kluwer Academic/Plenum Publishers, c2002; ISBN: 0306466589 http://www.amazon.com/exec/obidos/ASIN/0306466589/icongroupin terna
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Helicobacter pylori infection in gastroduodenal lesions: the second decade. Author: editors, J.M. Pajares García, P. Correa, G.I. Pérez Pérez; Year: 2000; Barcelona; Philadelphia: Prous Science, c2000; ISBN: 8481241733 Herbal treatment for peptic ulcer. Author: Vaidya Bhagwan Dash; Year: 1987; New Delhi: B. Jain Publishers, 1987
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Malignancy and chronic inflammation in the gastrointestinal tract: new concepts: proceedings of the 81st Falk Symposium, held in Berlin, Germany, November 3-5, 1994. Author: Falk Symposium 81; edited by E.O. Riecken ... [et al.]; Year: 1995; Dordrecht; Boston: Kluwer Academic Publishers, c1995; ISBN: 0792388895 (cloth bound: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0792388895/icongroupin terna
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Mechanisms of injury and sequelae of Helicobacter pylori infection: proceedings of an international workshop at Deerhurst, Huntsville, Ontario, Canada, 21-24 February 1991. Author: edited by Richard H. Hunt; Year: 1991; Oslo: Universitetsforlaget, c1991
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Moderne Gastritis- und Ulkustherapie mit Wismut: eine Lehrmeinung im Wandel. Author: B. Achten; Year: 1990; München; San Francisco: Zuckschwerdt, c1990; ISBN: 3886033600
Chapters on Gastritis Frequently, gastritis will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with gastritis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and gastritis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “gastritis” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on gastritis: ·
Gastritis and Ulcers in Children Source: in Wyllie, R. and Hyams, J.S., eds. Pediatric Gastrointestinal Disease. 2nd ed. Philadelphia, PA: W.B. Saunders Company. 1999. p. 221243. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 11830 Westline Industrial Drive, Saint Louis,
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MO 63146-9988. (800) 545-2522 or (314) 453-7010. Fax (800) 568-5136 or (314) 453-7095. E-mail:
[email protected]. Website: customerservice.wbsaunders.com. PRICE: $155.00 plus shipping and handling. ISBN: 0721674615. Summary: This chapter on gastritis and ulcers in children is from a medical textbook that covers all facets of clinical pediatric gastrointestinal disease. The text emphasizes a clinical focus and incorporates anatomy and physiology considerations into each chapter rather than a separate section. The authors of this chapter maintain that although the overall prevalence of gastritis in children is not defined, an understanding of the causes of pediatric gastritis and mucosal ulceration is critical for the management of children with abdominal pain. The authors review the pathogenesis of gastritis, including acid secretion, the bicarbonate mucus barrier, and genetic factors; and causes of secondary peptic ulcer disease (PUD), including excessive acid secretion (due to Zollinger Ellison syndrome, or gastrinoma), other disorders of acid hypersecretion, Crohn's disease, eosinophilic gastroenteritis, Menetrier's disease (hypertrophic gastritis), autoimmune gastritis, and stress related gastritis and ulcers. The authors then discuss drug related gastritis and ulcers, primarily those due to nonsteroidal antiinflammatory agents. The role of Helicobacter pylori is explored next, including its epidemiology, pathogenesis, microbiology, methods for detection, H. pylori associated gastroduodenal disease in children (including gastric cancer and gastric lymphomas), treatment of H. pylori infection and vaccine development, and indications for treatment (patient selection). The authors then review the clinical findings (including diagnosis, histopathology, classification) of primary and secondary gastritis and primary and secondary peptic ulcer disease. The chapter concludes with a brief discussion of treatment strategies for gastric inflammation, including mucosal cytoprotection, enhancement of mucosal barrier function, and acid secretion inhibition and acid neutralization. 7 figures. 4 tables. 348 references. ·
Protein-Losing Disorders of the Gastrointestinal Tract Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume One. Philadelphia, PA: Current Medicine. 1999. p. 476-484. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Protein losing disorders of the gastrointestinal (GI) tract do not represent a single disease entity; any process that results in excessive
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loss of protein into the GI lumen falls into this category and is referred to as protein losing gastroenterology. This chapter on protein losing disorders of the GI tract is from a lengthy textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. These disorders can be classified into three subsets: primary nonulcerative mucosal diseases, mucosal inflammation and ulceration, and increased interstitial pressure. Hypoproteinemia (low protein levels in the blood) is the hallmark of protein losing disorders. All other clinical findings in protein losing disorders are a result of the underlying disease process causing the protein loss, such as dyspepsia and vomiting in gastric diseases, anemia and malabsorption in small bowel disorders, and lymphocytopenia in primary or secondary lymphangiectasia. After a diagnosis of GI protein loss is made (based on the alpha 1 antitrypsin clearance rate, or nuclear imaging, or both), further evaluation is necessary to determine the causative disease process. Management of protein losing disorders consists of treating the underlying disease. A high protein diet helps to replace protein losses. A low fat diet appears to have a beneficial effect on albumin metabolism. Surgery also may be indicated for hypertrophic gastritis and inflammatory bowel disease (IBD) refractory to medical treatment, chronic ischemic colitis with protein loss, and neoplasia. Most of the causes of protein losing disorders of the GI tract are treatable and many are curable, so the prognosis for these patients is good. However, the diagnosis is commonly delayed because hypoproteinemia and edema (fluid accumulation) often are attributed to malnutrition or chronic illness. 6 figures. 2 tables. 32 references. ·
Gastritis and Peptic Ulcer Disease in Children Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume Two. Philadelphia, PA: Current Medicine. 1999. p. 1294-1300. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Gastritis in children remains underrecognized and poorly characterized. This chapter on gastritis and peptic ulcer disease in children is from a lengthy textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. This chapter covers anatomy and physiology; etiology, pathology and clinical features; nonerosive, nonspecific gastritis or chronic active gastritis; specific and distinctive types of gastritis; peptic
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ulcer disease (PUD), and duodenitis. Specific types of gastritis covered include Crohn's disease, chronic granulomatous disease, eosinophilic gastropathy, allergic gastropathy, Menetrier's disease, chronic varioliform gastritis, graft versus host disease, and cytomegalovirus. The author notes that in children with chronic peptic ulcer disease, duodenal ulcers are far more prevalent than are gastric ulcers. Secondary PUD usually occurs in association with an identifiable ulcerogenic agent or circumstance, including ulcers caused by physiologic stress, drugs, and those associated with other diseases. The ulcers are more often acute and are more prevalent in the stomach than in the duodenum. The treatment of specific disorders in children is similar to that in adults. The difference in treatment results from the issues specific to children: the management of fluid and electrolyte balance in resuscitation; dosage, palatability and appropriate form of medications; and the potential adverse effects of medications. 3 tables. 34 references. ·
Gastrointestinal Disorders Source: in Lysen, L.K. Quick Reference to Clinical Dietetics. Gaithersburg, MD: Aspen Publishers, Inc. 1997. p. 43-57. Contact: Available from Aspen Publishers, Inc. Fulfillment, 7201 McKinney Circle, Frederick, MD 21704. (800) 234-1660 or (800) 638-8437. PRICE: $35.00. ISBN: 0834206293. Summary: This section on gastrointestinal disorders is from a reference book on clinical dietetics and is part of a chapter on the use of nutrition management for specific medical conditions. Gastrointestinal (GI) disorders often result in maldigestion and malabsorption of nutrients and present as diarrhea. Diarrhea can have severe nutritional consequences through loss of essential nutrients such as water, minerals, vitamins, electrolytes, and micronutrients. Severe diarrhea can disrupt nutrient absorption to such an extent that malnutrition can occur. GI disorders can be both the cause and result of life threatening conditions. Disruption of the normal processes of nutrient digestion and absorption causes malnutrition, which may lead to serious clinical complications. After a brief review of the anatomy of the GI tract, the author discusses digestion, absorption, secretion, motility, adaptation, the immunologic barrier of the GI tract (the mucosa), nutritional implications in the assessment of the GI tract, factors that may affect the ability to deliver appropriate nutritional support, and specific disorders. These include swallowing difficulties (dysphagia); reflux esophagitis or gastroesophageal reflux disease (GERD); achalasia (motility disorder of the esophagus); esophageal perforation, obstruction, and varices; peptic ulcer disease; gastritis; vomiting; hiatal hernia; gastric outlet obstruction;
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GI bleeding; dumping syndrome; bezoar formation; absorption disorders; obstruction of the small intestine; lactase deficiency; inflammatory bowel disease; and short bowel syndrome. 7 tables. 10 references. ·
Gastrointestinal Tract Hemorrhage in Children Source: in Snape, W.J., ed. Consultations in Gastroenterology. Philadelphia, PA: W.B. Saunders Company. 1996. p. 145-154. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. PRICE: $125.00. ISBN: 0721646700. Summary: This chapter from a gastroenterology textbook covers gastrointestinal (GI) tract hemorrhage in children. The authors note that, although typically associated with a benign prognosis, the problem can occasionally be serious and life threatening; therefore prompt assessment, diagnosis, and treatment is required. The widespread use and application of fiberoptic endoscopy, coupled with radionuclide imaging and selective angiography, have significantly improved the capability to diagnose and treat GI tract hemorrhage. The author stress that the patient's age must be considered during the initial assessment and is helpful in developing a differential diagnosis. Topics include the initial stabilization for acute GI tract hemorrhage in infants and children; the role of various diagnostic tests; factors causing upper GI tract bleeding and the treatment for each; and factors causing lower GI tract bleeding and the treatment for each. Common causes of upper GI tract hemorrhage in children include swallowed maternal blood, peptic ulcer, gastritis, esophageal varices, and Mallory-Weiss lesions. Common causes of lower GI tract hemorrhage in children include upper GI tract bleeding, milk or soy protein allergy, necrotizing enterocolitis, intussusception, Meckel's diverticulum, midgut malrotation with volvulus, infectious diarrhea, ulcerative colitis, Crohn's disease, juvenile polyposis, and perianal lesion or fissure. One diagram illustrates the recommended diagnostic approach for GI tract blood loss. 1 figure. 3 tables. 36 references. (AA-M).
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Gastrointestinal Disorders of the Stomach and Duodenum in the Elderly Source: in Gelb, A.M., ed. Clinical Gastroenterology in the Elderly. New York, NY: Marcel Dekker, Inc. 1996. p. 37-72. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701-5185. (800) 228-1160 or (914) 796-1919. Fax (914) 796-1772. E-mail:
[email protected]. Website:
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www.dekker.com. PRICE: $135.00 plus shipping and handling. ISBN: 0824793986. Summary: This chapter on gastrointestinal disorders of the stomach and duodenum is from a textbook that offers an up to date reference source on geriatric gastroenterology. The author notes that older people account for a disproportionate share of the morbidity and mortality from gastritis, peptic ulcer, and gastric cancer. The chapter begins with a review of physiologic changes that occur with aging in the areas of acid secretion, gastric motility, gastroduodenal mucosal prostaglandins, and gastrointestinal proliferation. The next section reviews gastritis, particularly caused by Helicobacter pylori infection, and covers symptoms, diagnostic tests, and eradication of the bacteria. Conservative recommendations have been broadened recently to include treating most patients with H. pylori infection. The next section covers peptic ulcer disease (PUD), a condition that is more serious in older people and presents in an atypical manner. The author covers epidemiology, NSAIDs as a cause of PUD, clinical features of gastric and duodenal ulcers, and complications, including gastrointestinal hemorrhage, perforation, and obstruction. Long term maintenance therapy for PUD is often given to older persons who have had relapses or complications, or who would be at particular risk for another ulcer or serious outcome. The final section covers gastric carcinoma, discussing gastric adenocarcinoma following ulcer surgery, H. pylori infection, and gastric polyps. 54 references. ·
Gastrointestinal Disease in the Aged Source: in Reichel, W., et al., eds. Care of the Elderly: Clinical Aspects of Aging. 4th ed. Baltimore, MD: Williams and Wilkins. 1995. p. 198-205. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 4478438 or (410) 528-8550. PRICE: $69.00 (as of 1996). ISBN: 0683072099. Summary: This chapter on gastrointestinal (GI) disease in the aged is from a text on the clinical aspects of aging. This chapter covers problems associated with the esophagus, the stomach, the small bowel and pancreas, and the colon and rectum; liver disease; biliary disease; and pancreatic disease. Specific conditions discussed include appendicitis, heartburn, dysphagia, drug-induced gastritis, gastroparesis, lactose intolerance, inflammatory bowel disease, diverticulosis, colon cancer, constipation, fecal incontinence, irritable bowel syndrome, jaundice, hepatitis, gallstones, pancreatitis, and pancreatic cancer. 1 table. 22 references.
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Functional Gastroduodenal Disorders Source: in Drossman, D.A., et al. Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology, and Treatment: A Multinational Consensus. Boston, MA: Little, Brown and Company. 1994. p. 71-113. Contact: Available from Little, Brown and Company. Order Department, 200 West Street, Waltham, MA 02154. (800) 343-9204. PRICE: $87.50 (as of 1995). ISBN: 0316193429. Summary: This chapter, from a medical text on functional gastrointestinal (GI) disorders, presents an overview of functional gastroduodenal disorders. The authors propose a classification of these disorders, namely functional dyspepsia and aerophagia, and outline management strategies. Topics in the section on functional dyspepsia include specific criteria for diagnosis; overlap syndromes, including irritable bowel syndrome, gastroesophageal reflux, and biliary tract disease; dyspepsia subgroups based on symptom criteria; epidemiology; diagnostic criteria; clinical evaluation; physiologic features, including gastric acid, H. pylori and chronic gastritis, chronic duodenitis, erosive prepyloric changes, perception threshold, upper GI tract motility, myoelectric activity, hormonal changes, and diet; psychological features; and pharmacologic management options. The chapter concludes with a brief section on aerophagia. 5 figures. 9 tables. 205 references.
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Gastrointestinal System Source: in Saxon, S.V.; Etten, M.J. Physical Change and Aging: A Guide for the Helping Professions. 3rd ed. New York, NY: Tiresias Press, Inc. 1994. p. 176-201. Contact: Available from Tiresias Press, Inc. 116 Pinehurst Avenue, New York, NY 10033. (212) 568-9570. PRICE: $24.90. ISBN: 0913292478. Summary: This chapter on the gastrointestinal (GI) system is from a guide for the helping professions on physical change and aging. Topics include components and functions of the GI system, including digestion, the mouth, the pharynx and esophagus, the stomach, the small intestine, liver, gallbladder, pancreas, and the large intestine; age-related changes in the mouth, esophagus, stomach, and other areas of the GI tract; and age-related disorders, including xerostomia, dysphagia, dental caries, periodontal disease, oral cancer, cancer of the esophagus, hiatal hernia, gastritis, peptic (gastric) ulcer, pernicious anemia, cancer of the stomach, appendicitis, diarrhea, constipation, diverticulosis, colorectal cancer, hemorrhoids, cirrhosis, and gallstones. The authors conclude that many functional disorders and diseases can very likely be avoided by more
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careful attention and adherence to healthy diets, regular exercise, stress reduction, and other positive lifestyle regimens. 1 figure. 29 references. ·
Recognition and Management of Premalignant Gastrointestinal Lesions Source: in Danzi, J.T.; Scopelliti, J.A., eds. Office Management of Digestive Diseases. Malvern, PA: Lea and Febiger. 1992. p. 188-195. Contact: Available from Lea and Febiger. Box 3024, Malvern, PA 193559725. (215) 251-2230. PRICE: $39.50. ISBN: 0812114361. Summary: A precancerous lesion or disease is a condition that is associated with the development of a specific cancer that is not likely to be found in a matched population lacking the associated condition. This chapter, from a medical textbook about the office management of common gastrointestinal diseases, discusses the recognition and management of premalignant gastrointestinal lesions. Topics include surveillance, gastrointestinal oncologists and primary physicians, and premalignant gastrointestinal conditions of the esophagus, stomach, small bowel, colon, liver, and pancreas. Specific conditions discussed include achalasia, Barrett's esophagus, chronic gastroesophageal reflux disease, lye stricture, Plummer-Vinson syndrome, tylosis, pernicious anemia, atrophic gastritis, Menetrier's disease, gastric ulceration, gastric polyp, gastric remnant, primary cancers of the small bowel, glutensensitive enteropathy or celiac sprue, Crohn's disease, immunodeficiency syndromes, postureterosigmoidostomy, chronic radiation enteritis-colitis, Bowen's disease, liver cancer, hepatocarcinogen exposure, cholangiocarcinoma, and pancreatic cancer. 36 references.
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Acute Upper Gastrointestinal Tract Bleeding Source: in Snape, W.J., ed. Consultations in Gastroenterology. Philadelphia, PA: W.B. Saunders Company. 1996. p. 126-139. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. PRICE: $125.00. ISBN: 0721646700. Summary: This chapter from a gastroenterology textbook covers acute upper gastrointestinal (GI) tract bleeding. Upper GI (UGI) tract bleeding is a life threatening emergency requiring immediate attention and evaluation, with effective treatment based on accurate diagnosis. Although many patients have minimal or self-limited bleeding, significant hemorrhage is common and mortality is approximately 10 percent. This chapter covers UGI tract bleeding that occurs within the area from the proximal esophagus to the ligament of Treitz. Bleeding site
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or the lesion responsible for UGI tract bleeding has been shown to be remarkably similar in studies on unselected patients. Peptic ulcer accounts for 40 to 50 percent of bleeding, with varices, gastritis, esophagitis, Mallory-Weiss lesion, vascular extasia, tumors, and others accounting for the majority of the remaining identified sites of bleeding. The authors outline the clinical presentation, stabilizing the patient, and developing an appropriate diagnostic and therapeutic plan. Endoscopy is recommended as it provides not only excellent visualization of the UGI tract, but can also permit assessment of multiple potential sites of bleeding, as well as offer therapeutic modalities to control bleeding. The latter half of the chapter outlines therapy for specific bleeding lesions, including bleeding peptic ulcer, variceal hemorrhage, erosive gastritis, portal hypertensive gastropathy, Mallory-Weiss tear, peptic esophagitis, neoplasm, vascular ectasia, Dieulafoy's lesion, aortoenteric fistula, and miscellaneous lesions. The authors conclude that the ultimate successful approach to managing UGI tract bleeding relies on the efforts of a skilled multidisciplinary team working together to effect the best outcome for the patient. 6 figures. 3 tables. 11 references. (AA-M).
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to gastritis have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on gastritis. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:23 ·
1998-1999 Complete Directory for People with Rare Disorders Source: Lakeville, CT: Grey House Publishing, Inc. 1998. 726 p. Contact: Available from Grey House Publishing, Inc. Pocket Knife Square, Lakeville, CT 06039. (860) 435-0868. Fax (860) 435-0867. PRICE: $190.00. ISBN: 0939300982.
You will need to limit your search to “Directories” and gastritis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “gastritis” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with gastritis. You should check back periodically with this database as it is updated every three months. 23
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Summary: This directory, from the National Organization for Rare Disorders (NORD) provides a wealth of information on diseases and organizations. The directory offers four sections: disease descriptions, disease specific organizations, umbrella organizations, and government agencies. In the first section, the directory includes descriptions of 1,102 rare diseases in alphabetical order. Each entry defines the disorder, then refers readers to the organizations that might be of interest. Diseases related to digestive diseases include achalasia, Addison's disease, Alagille syndrome, Barrett's esophagus, Budd Chiari syndrome, Caroli disease, celiac sprue, cholangitis, cholecystitis, cirrhosis, colitis, Crohn's disease, Cushing syndrome, cystic fibrosis, diverticulitis, Dubin Johnson syndrome, fructose intolerance, galactosemia, gastritis, gastroesophageal reflux, hepatitis, Hirschprung's disease, Hurler syndrome, imperforate anus, irritable bowel syndrome, jejunal atresia, Korsakoff's syndrome, lipodystrophy, maple syrup urine disease, Morquio syndrome, polyposis, porphyria, proctitis, prune belly syndrome, sarcoidosis, Stevens Johnson syndrome, Tropical sprue, tyrosinemia, valinemia, vitamin E deficiency, Whipple's disease, Wilson's disease, and Zollinger Ellison syndrome. Each of the 445 organizations listed in the second section is associated with a specific disease or group of diseases. In addition to contact information, there is a descriptive paragraph about the organization and its primary goals and program activities. Entries include materials published by the organization as well as the diseases the organizations cover, which refer readers to Section I. The third section lists 444 organizations that are more general in nature, serving a wide range of diseases (for example, the American Liver Foundation). The final section describes 74 agencies that are important federal government contacts that serve the diverse needs of individuals with rare disorders. A name and key word index concludes the volume.
General Home References In addition to references for gastritis, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Digestive System (21st Century Health and Wellness) by Regina Avraham; Library Binding (February 2000), Chelsea House Publishing (Library); ISBN: 0791055264; http://www.amazon.com/exec/obidos/ASIN/0791055264/icongroupinterna
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· American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna · The Merck Manual of Medical Information : Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna
Vocabulary Builder Anisakiasis: Infection with roundworms of the genus ANISAKIS. Human infection results from the consumption of fish harboring roundworm larvae. The worms may cause acute nausea and vomiting or may penetrate into the wall of the digestive tract, where they give rise to eosinophilic granulomas in the stomach, intestine, or the omentum. [NIH] Anus: The distal or terminal orifice of the alimentary canal. [EU] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU]
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Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cholangitis: Inflammation of a bile duct. [EU] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoprotection: The process by which chemical compounds provide protection to cells against harmful agents. [NIH] Dietetics: The study and regulation of the diet. [NIH] Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Dysphagia: Difficulty in swallowing. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Encephalopathy: Any degenerative disease of the brain. [EU] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hepatitis: Inflammation of the liver. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an
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abnormal opening. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Lipodystrophy: 1. any disturbance of fat metabolism. 2. a group of conditions due to defective metabolism of fat, resulting in the absence of subcutaneous fat, which may be congenital or acquired and partial or total. Called also lipoatrophy and lipodystrophia. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH]
Neutralization: An act or process of neutralizing. [EU] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by
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disease in the gallbladder, or by a virus. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Perianal: Located around the anus. [EU] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Proctitis: Inflammation of the rectum. [EU] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU]
Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Stabilization: The creation of a stable state. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Ulcerogenic: Causing ulceration; leading to the production of ulcers. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]
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CHAPTER 6. MULTIMEDIA ON GASTRITIS Overview Information on gastritis can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on gastritis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on gastritis is the Combined Health Information Database. You will need to limit your search to “video recording” and “gastritis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “gastritis” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on gastritis:
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·
Clinical Case Reviews: Management of H. Pylori in Gastrointestinal Disease Source: Secaucus, NJ: Network for Continuing Medical Education. 1995. (videocassette). Contact: Available from Network for Continuing Medical Education. 1425 Broad Street, Clifton, NJ 07013. (800) 223-0272 or (973) 473-9500. Fax (973) 591-1224. Order Number: S102. PRICE: Call for pricing information. Summary: Helicobacter pylori (H. pylori) is now known to be an etiology in more than 90 percent of peptic ulcer cases. This knowledge has led to the evolution of therapies that make it possible to cure nearly all ulcers. This medical continuing education program reviews the management of H. pylori in gastrointestinal disease and presents three case studies involving H. pylori in peptic ulcer disease. The first section explores the discovery of H. pylori as an etiologic factor in peptic ulcer, including the history and evolution of this discovery (Marshall and Warren's research). The next section discusses the three possible mechanisms of gastric mucosal injury caused by H. pylori (ammonia, cytotoxins, and mucosal immune response). The instructional portion of the videotape also covers the types of illnesses related to H. pylori (from asymptomatic gastritis to PUD), the incidence and other epidemiologic factors of the infection, transmission, the role of H. pylori infection in ulcer recurrence rates, diagnostic tests, drug therapy regimens, and patient selection issues. The remaining portion of the tape presents three case studies. The video features live action of real physicians and patients, and graphics and anatomic illustrations.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” By making these selections and typing “gastritis” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most diseases do not have results, so do not expect to find many). The following is a typical result when searching for sound recordings on gastritis:
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·
Helicobacter Pylori Source: Timonium, MD: Milner-Fenwick, Inc. 199x. (audiocassette). Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093-9989. (800) 638-8652 or (301) 252-1700. PRICE: $14.95. Order number CAS 19. Summary: This audiocassette includes three programs about Helicobacter pylori. Chaired by Dr. Martin Blaser, the topics are: the microbiology and pathogenesis of Helicobacter pylori (Dr. Blaser, Seattle); drug therapy of Helicobacter pylori (Dr. David Y. Graham, Houston, TX); and gastritis and Helicobacter pylori (Dr. Cyrus Rubin, Seattle, WA). (AA-M).
Bibliography: Multimedia on Gastritis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in gastritis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on gastritis. For more information, follow the hyperlink indicated: ·
Atrophic gastritis : recorded at DDW 1990, San Antonio. Year: 1990; Format: Sound recording; [Bethesda, Md.]: American Gastroenterological Association, c1990
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Campylobacter pyloridis as a cause of gastritis and peptic ulcer : fact or fiction. Source: with Harold C. Neu; Year: 1987; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1987
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Common gastric lesions. Source: National Medical Audiovisual Center; Year: 1974; Format: Motion picture; [Atlanta]: The Center, [1974]
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Correction of Alkaline reflux gastritis. Source: Stephen B. Vogel; Year: 1999; Format: Videorecording; Woodbury, CT: Cine-Med, 1999
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Diagnosis and treatment of campylobactor pylori. Source: [presented by] Marshfield Video Network, in cooperation with Marshfield Medical Research Foundation, Marshfield Clinic, [and] St. Joseph's Hospital; Year: 1987; Format: Videorecording; Marshfield, WI: The Network, c1987
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Helicobacter pylori : diagnosis: recorded at DDW 1994 in New Orleans. Source: AGA; Year: 1994; Format: Sound recording; [Bethesda, Md.]: The Association, [1994?]
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Helicobacter pylori : epidemiology: recorded at DDW 1994 in New Orleans. Source: AGA; Year: 1994; Format: Sound recording; [Bethesda, Md.]: The Association, [1994?]
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Helicobacter pylori : treatment. Source: AGA; Year: 1994; Format: Sound recording; [Bethesda, Md.]: American Gastroenterology Association, [1994?]
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Instructions for performing the 13C-urea breath test for diagnosis of helicobacter pylori infection [videorecording]. Source: [written, produced, directed, and narrated by Antone R. Opekun, Jr.]; Year: 1993; Format: I.e. C13-urea; Houston, Tex.: Baylor College of Medicine, 1993
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Medical terminology: gastroenterological disorders and surgery. Source: Au-Vid, inc; Year: 1975; Format: Sound recording; [Garden Grove, Calif.]: Au-Vid, [1975]
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Neoplasms of the stomach. Source: Walter Lawrence, Jr., William Gayle, Jose J. Terz; [made by Medical College of Virginia Visual Education Dept.]; Year: 1971; Format: Slide; [Richmond: Medical College of Virginia Learning Resource Center; Chapel Hill, N.C.: for loan by Health Sciences Consortium, 1971]
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New developments in gastroenterology. Source: Institute of Continuing Education; Year: 1976; Format: Sound recording; Sawyer, Mich.: The Institute, p1976
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New magic bullets and the fight against gastritis. Source: Barry Marshall; Year: 1996; Format: Sound recording; [Bethesda, Md.: National Institutes of Health, 1996]
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Pathological findings in the stomach : fluoroscopic observations. Source: produced by Norman P. Schenker for the Medical Audio-Visual Institute, Association of American Medical Colleges; Year: 1953; Format: Motion picture; [United States]: The Institute, c1953
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Pharmacotherapeutics for a patient with gastric pain and distress. Source: MEPC Software; Year: 1987; Format: Electronic resource; New York, N.Y.: Elsevier Science Pub. Co., c1987
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Radiographic upper G.I. exam. Source: Marshfield Medical Foundation, in cooperation with Marshfield Clinic & St. Joseph's Hospital; Year: 1982; Format: Videorecording; Marshfield, WI: Marshfield Regional Video Network, 1982
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Role of gastroscopy in the diagnosis and treatment of gastric pathology. Source: a Jam Handy picture; presented by Leo L. Hardt; produced in cooperation with Department of Medicine, Loyola University, Cook County Hospital and the Hektoen Insti; Year: 1947; Format: Motion picture; [United States: s.n., 1947]
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Vocabulary Builder Alkaline: Having the reactions of an alkali. [EU] Ammonia: Ammonia. A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Cytotoxins: Substances elaborated by microorganisms, plants or animals that are specifically toxic to individual cells; they may be involved in immunity or may be contained in venoms. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH]
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CHAPTER 7. PERIODICALS AND NEWS ON GASTRITIS Overview Keeping up on the news relating to gastritis can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on gastritis. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover gastritis beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on gastritis is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “gastritis” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased.
Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to gastritis. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “gastritis” (or synonyms). The following was recently listed in this archive for gastritis: ·
Helicobacter-induced gastritis increases hyperglycemia in diabetic mice Source: Reuters Medical News Date: June 12, 2002 http://www.reuters.gov/archive/2002/06/12/professional/links/20020 612scie001.html
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Soluble transferrin receptor levels identify anemia, gastritis in diabetics Source: Reuters Medical News Date: September 25, 2000 http://www.reuters.gov/archive/2000/09/25/professional/links/20000 925clin016.html
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Corpus gastritis protects against reflux esophagitis Source: Reuters Medical News Date: July 28, 1999 http://www.reuters.gov/archive/1999/07/28/professional/links/19990 728clin007.html
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H pylori vaccine protection correlates with secretory IgA, gastritis in mice Source: Reuters Medical News Date: May 12, 1999 http://www.reuters.gov/archive/1999/05/12/professional/links/19990 512scie001.html
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·
H. pylori infection linked to atrophic gastritis Source: Reuters Medical News Date: February 25, 1999 http://www.reuters.gov/archive/1999/02/25/professional/links/19990 225clin006.html
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Severe corpus gastritis may identify patients at increased risk of gastric cancer Source: Reuters Medical News Date: August 05, 1998 http://www.reuters.gov/archive/1998/08/05/professional/links/19980 805clin013.html
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Focal Gastritis May Be Early Warning Of Crohn's Disease Source: Reuters Medical News Date: March 19, 1997 http://www.reuters.gov/archive/1997/03/19/professional/links/19970 319clin005.html
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H. Pylori: "The Major Risk Factor For Atrophic Gastritis" Source: Reuters Medical News Date: May 20, 1996 http://www.reuters.gov/archive/1996/05/20/professional/links/19960 520clin007.html
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Omeprazole Increases Risk Of Atrophic Gastritis In Subset Of Patients With Reflux Esophagitis Source: Reuters Medical News Date: April 18, 1996 http://www.reuters.gov/archive/1996/04/18/professional/links/19960 418clin007.html
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H. Pylori May Cause Atrophic Gastritis And Increase Gastric Cancer Risk Source: Reuters Medical News Date: December 06, 1995 http://www.reuters.gov/archive/1995/12/06/professional/links/19951 206clin006.html
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Atrophic Gastritis A "Direct" Result Of Helicobacter Pylori Infection Source: Reuters Medical News Date: June 16, 1995 http://www.reuters.gov/archive/1995/06/16/professional/links/19950 616clin009.html
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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “gastritis” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “gastritis” (or synonyms). If you know the name of a company that is relevant to gastritis, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
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BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “gastritis” (or synonyms).
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “gastritis” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on gastritis: ·
Helicobacter Pylori Infection and Gastric Cancer in the Asia Pacific Region Source: Asian Pacific Gastroenterology News. Issue 4: 11. June 2000. Contact: Available from Blackwell Science Asia. 54 University Street, Carlton, Victoria 3053, Australia. 61 3 9347 0300. Fax 61 3 9347 5001. Email:
[email protected]. Summary: Helicobacter pylori infection causes histological gastritis; chronic gastritis from long term H. pylori infection results in gastric mucosal atrophy, which eventually progresses to intestinal metaplasia and sometimes to gastric (stomach) cancer. This brief article reviews the problem of H. pylori infection and gastric cancer in the Asia Pacific region. The author reports data that show just over 10 percent of H. pylori infected persons in Japan may develop gastric cancer. The prevalence of asymptomatic H. pylori infection differs greatly between countries, being low in developed countries and high in developing countries. Because H. pylori is transmitted via the fecal to oral route, and children are more readily infected than adults, the author notes that conducting a survey on H. pylori infection is the same as assessing the
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water supply and sewage systems of a country. The present prevalence of H. pylori infection in Japan is extremely low at an early age, as in other developed countries, and subsequently shows a rapid increase until it reaches a plateau of approximately 70 percent at 50 years of age. The author also explores the different incidence of gastric cancer as it varies between countries. It is suggested that H. pylori infection leads to histological chronic gastritis, regardless of the strain of the organism, and after that the course of the disease depends on environmental factors (diet, age), virulence of H. pylori strains, and host factors including genetics. The author concludes by calling for additional research collaboration between countries in the Asia Pacific region. 1 figure. ·
Is Cyclic Vomiting Different from Chronic Vomiting? Source: Code V. p. 5. Spring 1994. Contact: Available from Cyclic Vomiting Syndrome Association. 13180 Caroline Court, Elm Grove, WI 53122. (414) 784-6842. Fax (414) 821-5494. E-mail:
[email protected]. PRICE: Single copy free. Summary: In this brief letter, a physician reviews the differences between cyclic vomiting and chronic vomiting. The author reports on his observations that, of children who were vomiting repeatedly for more than three months duration, one-third had the cyclic pattern and twothirds had the chronic pattern. He goes on to describe the differences, including the criteria used to separate the cyclic from chronic groups; addresses the problem of dehydration; and notes the different etiologies of the two types of vomiting. Children with cyclic vomiting were more likely to have disorders outside the gastrointestinal tract, such as abdominal migraine, sinus infection, or metabolic disorders. Children with chronic vomiting were more likely to have diseases within the gastrointestinal tract, including esophagitis, gastritis (Helicobacter infection), duodenitis (acid-induced), Giardia, and irritable bowel syndrome (IBS).
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Younger Adults at Risk for Low B12, Too Source: Tufts University Health and Nutrition Letter. 18(7):7. September 2000. Contact: 10 High St., Suite 706, Boston, MA 02110.
[email protected] www.healthletter.tufts.edu. Summary: A new study by Tufts University researchers suggests that adults in their 20s, 30s, and 40s may be at risk for low vitamin B12 levels. People over 50 are known to be at increased risk for this vitamin deficiency because they are more likely to have atrophic gastritis, a
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condition in which there is too little stomach acid to allow for proper absorption of the nutrient. A lack of vitamin B12 levels, if it is severe enough, can cause neurologic damage ranging from tingling sensations to a lack of balance, memory changes, and disorientation. Tufts researchers measured blood levels of B12 in 3,000 men and women aged 26 to 83. While overall blood levels of the vitamin did decline with age, the percentage of people whose blood levels fell below the cutoff point for suspected deficiency was not any greater among the older participants. More research needs to be conducted before scientists know precisely why B12 deficiency risk appears to be more common among younger adults than previously thought. Researchers theorize that the people with low B12 levels in the study used antacids which if taken habitually, could cause the same drop in stomach acid as atrophic gastritis. Vitamin B12 is found in meat, fish, poultry, dairy products, and fortified cereal.
Academic Periodicals covering Gastritis Academic periodicals can be a highly technical yet valuable source of information on gastritis. We have compiled the following list of periodicals known to publish articles relating to gastritis and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on gastritis published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit the Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on gastritis: ·
Digestive Diseases and Sciences. (Dig Dis Sci) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Di gestive+Diseases+and+Sciences&dispmax=20&dispstart=0
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·
Scandinavian Journal of Gastroenterology. (Scand J Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Sc andinavian+Journal+of+Gastroenterology&dispmax=20&dispstart=0
·
The American Journal of Gastroenterology. (Am J Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+American+Journal+of+Gastroenterology&dispmax=20&dispstart=0
Vocabulary Builder Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Giardia: A genus of flagellate intestinal protozoa parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. [NIH] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Neurologic: Pertaining to neurology or to the nervous system. [EU] Parathyroid: 1. situated beside the thyroid gland. 2. one of the parathyroid glands. 3. a sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic,
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especially in the treatment of acute hypoparathyroidism with tetany. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU]
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CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.24 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:25 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 25 See http://www.nlm.nih.gov/databases/databases.html. 24
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·
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat gastritis, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and gastritis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “gastritis” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with gastritis. The following is a sample result:
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·
Digestive Diseases in the United States: Epidemiology and Impact Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1994. 799 p. Contact: Available from National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. (800) 8915389 or (301) 654-3810. E-mail:
[email protected]. PRICE: $15.00. Summary: This monograph is a compendium of descriptive statistics about the scope and impact of digestive diseases in the United States. Each chapter provides national and population data based on the prevalence, incidence, medical care, disability, mortality, and research needs. Twenty chapters cover the following conditions: infectious diarrheas, viral hepatitis, esophageal cancer, gastric cancer, colorectal cancer, liver cancer, pancreatic cancer, hemorrhoids, esophageal diseases, peptic ulcer, gastritis and nonulcer dyspepsia, acute appendicitis, abdominal wall hernia, inflammatory bowel diseases, diverticular disease of the colon, constipation, irritable bowel syndrome, chronic liver disease and cirrhosis, gallstones, and pancreatitis. These chapters compare the impact and costs of the disease to other diseases. The book also includes an overview chapter, a chapter about the cost of digestive diseases in the United States, and a listing of all digestive diseases diagnostic codes for the ninth and tenth editions of the International Classification of Diseases. Extensive figures are used throughout the volume. 3 appendices.
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Understanding GI Bleeding: A Consumer Education Brochure Source: Arlington, VA: American College of Gastroenterology. 200x. 13 p. Contact: Available from American College of Gastroenterology. 4900 B South 31st Street, Arlington, VA 22206-1656. (703) 820-7400. Fax (703) 9314520. PRICE: Single copy free. Also available for free at http://www.acg.gi.org/acg-dev/patientinfo/frame_gibleeding.html. Summary: This consumer education brochure outlines the symptoms, causes and treatment of gastrointestinal (GI) bleeding. Bleeding in the gastrointestinal tract means that some part of the GI tract (esophagus, stomach, small intestine, large intestine, and rectum) is bleeding internally, either slightly (which may or may not be very serious) or heavily (which may have serious health consequences). The symptoms of GI bleeding vary, depending on which part of the digestive tract is involved. Symptoms can include vomiting blood, vomiting dark material that looks like coffee grounds, passing black tarry stools, or passing pure blood or blood mixed in stool. Cause of GI bleeding include ulcers, varices, liver disease, gastritis, tumors, colon cancer, polyps, colitis,
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diverticular disease, and hemorrhoids. The brochure focuses on ulcers and their causes (usually Helicobacter pylori infection) and treatment. The brochure also explores the use of nonsteroidal antiinflammatory drugs (NSAIDs) and the need to balance pain relief and concerns with side effects of these drugs (including GI bleeding). Conventional treatments for ulcers (H2 blockers and proton pump inhibitors) have been found to have a beneficial effect in treating NSAID induced ulcers and in preventing GI bleeding. The brochure concludes by encouraging ongoing monitoring of the patient taking NSAIDs, since problems with GI bleeding can arise with few, if any, symptoms. 2 figures. 2 tables. ·
Digestive Do's and Don'ts Source: Bethesda, MD: National Institute on Aging. 1992. 4 p. Contact: Available from National Institute on Aging (NIA) Information Center. P.O. Box 8057, Gaithersburg, MD 20898-8057. (800) 222-2225 or (301) 495-3450. Fax (301) 589-3014. TTY (800) 222-4225. E-mail:
[email protected]. PRICE: Single copy free; bulk copies available. Summary: This Age Page explains the digestive system, how it works and how to take care of the system in order to help avoid future difficulties. Information is provided on the types of symptoms requiring a doctor's attention. Following the symptomatic conditions, several digestive diseases are listed and described, along with their possible treatment plans. The digestive disorders discussed are constipation, diarrhea, diverticulosis and diverticulitis, functional disorders, gallbladder disease, gas, gastritis, heartburn, peptic ulcer, indigestion, hemorrhoids, hiatal hernia, milk intolerance, and ulcerative colitis.
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Helicobacter Pylori. [Helicobacteria Pilorica] Source: Camp Hill, PA: Chek-Med Systems, Inc. 199x. 2 p. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797. Fax (717) 761-0216. PRICE: $22 per packet of 50 pamphlets for order of 3 to 10 packets; minimum order 3 packets. Discounts available for larger quantities and complete kits of gastroenterology pamphlets. Summary: This patient education brochure, available in English and Spanish, provides basic information about Helicobacter pylori (H. pylori) infection. Topics include H. pylori infection; gastritis; nonulcerative dyspepsia; duodenal ulcers; stomach ulcers; diagnostic tests used to diagnose H. pylori infection; and treatment options to eradicate the infection. The brochure includes a blank space for the physician to
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provide individualized patient instructions. Simple line drawings illustrate some concepts. 3 figures.
The NLM Gateway26 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.27 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.28 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “gastritis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 343187 Books / Periodicals / Audio Visual 2561 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 349233
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 28 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 26 27
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HSTAT29 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.30 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.31 Simply search by “gastritis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists32 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.33 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.34 This site has new Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 31 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 32 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 33 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 34 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 29 30
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articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
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Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
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Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Gastritis With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to gastritis. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
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Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).35 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “gastritis” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for gastritis: ·
Cystic Fibrosis with Helicobacter Pylori Gastritis, Megaloblastic Anemia, and Subnormal Mentality Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?219721
·
Gastritis, Familial Giant Hypertrophic Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?137280
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center Biotechnology Information of the National Library of Medicine at National Institutes of Health. This Web site categorizes each disorder by system of the body associated with it. Go
for the the to
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
35
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http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
·
Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
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·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genom e, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “gastritis” (or synonyms) and click “Go.”
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Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database36 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At the following Web site you can also search across syndromes using an alphabetical index: http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html. You can search by keywords at this Web site: http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database37 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “gastritis” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 37 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 36
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database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in gastritis (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Blackwell’s Primary Care Essentials: Gastointestinal Disease by David W. Hay; Paperback, 1st edition (December 15, 2001), Blackwell Science Inc; ISBN: 0632045035; http://www.amazon.com/exec/obidos/ASIN/0632045035/icongroupinterna · Gastrointestinal Problems by Martin S. Lipsky, M.D. (Editor), Richard Sadovsky, M.D. (Editor); Paperback - 194 pages, 1st edition (August 15, 2000), Lippincott, Williams & Wilkins Publishers; ISBN: 0781720540; http://www.amazon.com/exec/obidos/ASIN/0781720540/icongroupinterna · Rome II: The Functional Gastrointestinal Disorders by Douglas A. Drossman (Editor); Paperback - 800 pages, 2nd edition (March 1, 2000), Degnon Associates Inc.; ISBN: 0965683729; http://www.amazon.com/exec/obidos/ASIN/0965683729/icongroupinterna
Vocabulary Builder Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU]
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CHAPTER 9. DISSERTATIONS ON GASTRITIS Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to gastritis. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Gastritis ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to gastritis. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with gastritis: ·
Contributions to the Pathology of Kidney, Liver and Other Diseases (helicobacter Pylori) by Sinniah, Rajalingam; Dsc from Queen's University of Belfast (northern Ireland), 2001 http://wwwlib.umi.com/dissertations/fullcit/f461793
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·
Endoscopic and Morphologic Characterization of the Gastroesophageal Junction, with Special Emphasis on Barrett's Esophagus by Wallner, Bengt; Phd from Umea Universitet (sweden), 2001, 136 pages http://wwwlib.umi.com/dissertations/fullcit/f444049
·
Helicobacter Pylori Infection in a Mouse Model: Development, Optimization and Inhibitory Effects of Antioxidants by Wang, Xin; , Phd from Lunds Universitet (sweden), 2001, 128 pages http://wwwlib.umi.com/dissertations/fullcit/f101905
·
Helicobacter Pylori Urease: Significance and Mechanism of Its Surface Association by Krishnamurthy, Parthasarathy Chage; Phd from The Medical College of Wisconsin, 2001, 193 pages http://wwwlib.umi.com/dissertations/fullcit/3007635
·
Lymphocyte Development and Pathologic Responses in the Gastrointestinal Tract (helicobacter) by Martin, Steven Michael; Phd from Washington University, 2001, 155 pages http://wwwlib.umi.com/dissertations/fullcit/3032728
·
Microsatellite Instability and Cyclooxygenase-2 Expression in Gastric Carcinogensis by Leung, Wai-keung; Md from Chinese University of Hong Kong (people's Republic of China), 2001, 237 pages http://wwwlib.umi.com/dissertations/fullcit/3025881
·
Staphylococcus Leei: Metabolic Profile; Antimicrobial Susceptibility; Purification of Microbial Urease; Cloning, Sequencing and Expression of the Urease Gene in Escherichia Coli; Development of Elisa and Pcr Methods to Determine the Incidence of Infection by Jin, Ming; , Phd from City University of New York, 2002, 105 pages http://wwwlib.umi.com/dissertations/fullcit/3037406
·
Study on Cyclooxygenase 2 Expression in Gastric Carcinoma with Reference to Genetic and Epigenetic Alterations by Lee, Tin Lap; Phd from Chinese University of Hong Kong (people's Republic of China), 2001, 185 pages http://wwwlib.umi.com/dissertations/fullcit/3001514
·
The Impact of Piped Water on Child Mortality and Breastfeeding in Ecuador and Brazil (latin America) by Marcotte, John Edwin, Phd from The University of Wisconsin - Madison, 1988, 228 pages http://wwwlib.umi.com/dissertations/fullcit/8901177
·
The Regulation of Urease Activity in the Gastric Pathogen Helicobacter Pylori by Weeks, David Lewis; Phd from University of California, Los Angeles, 2001, 78 pages http://wwwlib.umi.com/dissertations/fullcit/3005998
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Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to gastritis is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
Vocabulary Builder Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]
137
PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with gastritis and related conditions.
Researching Your Medications 139
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with gastritis. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for gastritis. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of gastritis. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
Your Medications: The Basics38 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of gastritis. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with gastritis take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: 38
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
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·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for gastritis. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for gastritis). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of
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medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for gastritis. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially
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derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.39 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of gastritis. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to gastritis: Caffeine ·
Systemic - U.S. Brands: Cafcit; Caffedrine Caplets; Dexitac Stay Alert Stimulant; Enerjets; Keep Alert; Maximum Strength SnapBack Stimulant Powders; NoDoz Maximum Strength Caplets; Pep-Back; Quick Pep; Ultra Pep-Back; Vivarin http://www.nlm.nih.gov/medlineplus/druginfo/caffeinesystemic 202105.html
Clarithromycin ·
Systemic - U.S. Brands: Biaxin http://www.nlm.nih.gov/medlineplus/druginfo/clarithromycins ystemic202667.html
Metronidazole ·
Systemic - U.S. Brands: Flagyl; Protostat http://www.nlm.nih.gov/medlineplus/druginfo/metronidazoles ystemic202365.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
39
Researching Your Medications 143
·
Vaginal - U.S. Brands: MetroGel-Vaginal http://www.nlm.nih.gov/medlineplus/druginfo/metronidazolev aginal202704.html
Misoprostol ·
Systemic - U.S. Brands: Cytotec http://www.nlm.nih.gov/medlineplus/druginfo/misoprostolsyst emic202375.html
Omeprazole ·
Systemic - U.S. Brands: Prilosec http://www.nlm.nih.gov/medlineplus/druginfo/omeprazolesyst emic202423.html
Orlistat ·
Oral--Local - U.S. Brands: Xenical http://www.nlm.nih.gov/medlineplus/druginfo/orlistatorallocal 500006.html
Orphenadrine ·
Systemic - U.S. Brands: Antiflex; Banflex; Flexoject; Mio-Rel; Myolin; Myotrol; Norflex; Orfro; Orphenate http://www.nlm.nih.gov/medlineplus/druginfo/orphenadrinesy stemic202426.html
Orphenadrine and Aspirin ·
Systemic - U.S. Brands: Norgesic; Norphadrine; Orphenagesic http://www.nlm.nih.gov/medlineplus/druginfo/orphenadrinean daspirinsystemic202427.html
Penicillins ·
Systemic - U.S. Brands: Amoxil; Bactocill; Beepen-VK; BetapenVK; Bicillin L-A; Cloxapen; Crysticillin 300 A.S.; Dycill; Dynapen; Geocillin; Geopen; Ledercillin VK; Mezlin; Nafcil; Nallpen; Omnipen; Omnipen-N; Pathocil; Pen Vee K; Pentids; Permapen; Pfizerpen; Pfizerpen-AS; Pi http://www.nlm.nih.gov/medlineplus/druginfo/penicillinssyste mic202446.html
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Ranitidine Bismuth Citrate ·
Systemic - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/orphenadrinean daspirinsystemic202427.html
Sucralfate ·
Oral - U.S. Brands: Carafate http://www.nlm.nih.gov/medlineplus/druginfo/sucralfateoral20 2533.html
Urea ·
Intra-Amniotic - U.S. Brands: Ureaphil http://www.nlm.nih.gov/medlineplus/druginfo/ureaintraamniot ic202584.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with gastritis (including those with contraindications):40 ·
Allopurinol http://www.reutershealth.com/atoz/html/Allopurinol.htm
·
Amoxicillin http://www.reutershealth.com/atoz/html/Amoxicillin.htm
·
Auranofin http://www.reutershealth.com/atoz/html/Auranofin.htm
·
Carbenicillin Indanyl Sodium http://www.reutershealth.com/atoz/html/Carbenicillin_Indanyl_Sodiu m.htm
40
Adapted from A to Z Drug Facts by Facts and Comparisons.
Researching Your Medications 145
·
Cetirizine http://www.reutershealth.com/atoz/html/Cetirizine.htm
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Chloral Hydrate http://www.reutershealth.com/atoz/html/Chloral_Hydrate.htm
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Cidofovir http://www.reutershealth.com/atoz/html/Cidofovir.htm
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Cyclosporine http://www.reutershealth.com/atoz/html/Cyclosporine.htm
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Cyclosporine(Cyclosporin A) http://www.reutershealth.com/atoz/html/Cyclosporine(Cyclosporin_ A).htm
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Delavirdine Mesylate http://www.reutershealth.com/atoz/html/Delavirdine_Mesylate.htm
·
Dicloxacillin Sodium http://www.reutershealth.com/atoz/html/Dicloxacillin_Sodium.htm
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Entacapone http://www.reutershealth.com/atoz/html/Entacapone.htm
·
Estradiol http://www.reutershealth.com/atoz/html/Estradiol.htm
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Estrogens Conjugated http://www.reutershealth.com/atoz/html/Estrogens_Conjugated.htm
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Estropipate http://www.reutershealth.com/atoz/html/Estropipate.htm
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Estropipate (Piperazine Estrone Sulfate) http://www.reutershealth.com/atoz/html/Estropipate_(Piperazine_Est rone_Sulfate).htm
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Etidronate Disodium http://www.reutershealth.com/atoz/html/Etidronate_Disodium.htm
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Etodolac http://www.reutershealth.com/atoz/html/Etodolac.htm
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Iodine http://www.reutershealth.com/atoz/html/Iodine.htm
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Itraconazole http://www.reutershealth.com/atoz/html/Itraconazole.htm
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Lopinavir Ritonavir http://www.reutershealth.com/atoz/html/Lopinavir_Ritonavir.htm
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·
Loratadine http://www.reutershealth.com/atoz/html/Loratadine.htm
·
Magaldrate http://www.reutershealth.com/atoz/html/Magaldrate.htm
·
Magnesium Oxide http://www.reutershealth.com/atoz/html/Magnesium_Oxide.htm
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Mycophenolate Mofetil http://www.reutershealth.com/atoz/html/Mycophenolate_Mofetil.htm
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Oxacillin Sodium http://www.reutershealth.com/atoz/html/Oxacillin_Sodium.htm
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Pamidronate Disodium http://www.reutershealth.com/atoz/html/Pamidronate_Disodium.htm
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Penicillin G http://www.reutershealth.com/atoz/html/Penicillin_G.htm
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Penicillin V http://www.reutershealth.com/atoz/html/Penicillin_V.htm
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Rivastigmine Tartrate http://www.reutershealth.com/atoz/html/Rivastigmine_Tartrate.htm
·
Rofecoxib http://www.reutershealth.com/atoz/html/Rofecoxib.htm
·
Salicylate Combination http://www.reutershealth.com/atoz/html/Salicylate_Combination.htm
·
Sibutramine Hydrochloride http://www.reutershealth.com/atoz/html/Sibutramine_Hydrochloride. htm
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Sildenafil http://www.reutershealth.com/atoz/html/Sildenafil.htm
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Sirolimus http://www.reutershealth.com/atoz/html/Sirolimus.htm
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Spironolactone http://www.reutershealth.com/atoz/html/Spironolactone.htm
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Tacrolimus http://www.reutershealth.com/atoz/html/Tacrolimus.htm
·
Tiludronate Disodium http://www.reutershealth.com/atoz/html/Tiludronate_Disodium.htm
Researching Your Medications 147
·
Tolmetin Sodium http://www.reutershealth.com/atoz/html/Tolmetin_Sodium.htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with gastritis--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat gastritis or potentially create deleterious side effects in patients with gastritis. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments.
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Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with gastritis. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with gastritis. The FDA warns patients to watch out for41: ·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
·
Quick, painless, or guaranteed cures
41
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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·
If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Development: Molecular Targets for Gi Diseases by Timothy S. Gaginella (Editor), Antonio Guglietta (Editor); Hardcover - 288 pages (December 1999), Humana Press; ISBN: 0896035891; http://www.amazon.com/exec/obidos/ASIN/0896035891/icongroupinterna · Drug Therapy for Gastrointestinal and Liver Diseases by Michael J.G. Farthing, M.D. (Editor), Anne B. Ballinger (Editor); Hardcover - 346 pages, 1st edition (August 15, 2001), Martin Dunitz Ltd.; ISBN: 1853177334; http://www.amazon.com/exec/obidos/ASIN/1853177334/icongroupinterna · Immunopharmacology of the Gastrointestinal System (Handbook of Immunopharmacology) by John L. Wallace (Editor); Hardcover (October 1997), Academic Press; ISBN: 0127328602; http://www.amazon.com/exec/obidos/ASIN/0127328602/icongroupinterna · A Pharmacologic Approach to Gastrointestinal Disorders by James H. Lewis, M.D. (Editor); Hardcover – (February 1994), Lippincott, Williams & Wilkins; ISBN: 0683049704; http://www.amazon.com/exec/obidos/ASIN/0683049704/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Acetone: A chemical formed in the blood when the body uses fat instead of glucose (sugar) for energy. If acetone forms, it usually means that the cells do not have enough insulin, or cannot use the insulin that is in the blood, to use
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glucose for energy. Acetone passes through the body into the urine. Someone with a lot of acetone in the body can have breath that smells fruity and is called "acetone breath." See also: Ketone bodies. [NIH] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Auranofin: An oral chrysotherapeutic agent for the treatment of rheumatoid arthritis. Its exact mechanism of action is unknown, but it is believed to act via immunological mechanisms and alteration of lysosomal enzyme activity. Its efficacy is slightly less than that of injected gold salts, but it is better tolerated, and side effects which occur are potentially less serious. [NIH] Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Chloral Hydrate: A hypnotic and sedative used in the treatment of insomnia. The safety margin is too narrow for chloral hydrate to be used as a general anesthetic in humans, but it is commonly used for that purpose in animal experiments. It is no longer considered useful as an anti-anxiety medication. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the alleviation of postoperative pain. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]
Loratadine: A second-generation histamine H1 receptor antagonist used in the treatment of allergic rhinitis and urticaria. Unlike most classical antihistamines it lacks central nervous system depressing effects such as drowsiness. [NIH] Misoprostol: A synthetic analog of natural prostaglandin E1. It produces a
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dose-related inhibition of gastric acid and pepsin secretion, and enhances mucosal resistance to injury. It is an effective anti-ulcer agent and also has oxytocic properties. [NIH] Orphenadrine: A muscarinic antagonist used to treat drug-induced parkinsonism and to relieve pain from muscle spasm. [NIH] Penicillin G: A penicillin derivative commonly used in the form of its sodium or potassium salts in the treatment of a variety of infections. It is effective against most gram-positive bacteria and against gram-negative cocci. It has also been used as an experimental convulsant because of its actions on GABA mediated synaptic transmission. [NIH] Penicillin V: A broad-spectrum penicillin antibiotic used orally in the treatment of mild to moderate infections by susceptible gram-positive organisms. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acidbinding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to gastritis. Finally, at the conclusion of this chapter, we will provide a list of readings on gastritis from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?42 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 42
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?43 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
43
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.44
44
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Gastritis Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for gastritis. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “gastritis” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Chinese System of Using Foods to Stay Young Source: New York: Sterling Publishing. 1996. 192 p.
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Contact: Available from Sterling Publishing Co. Inc. 387 Park Avenue South, New York, NY 10016. 212-532-7160. PRICE: $10.95. ISBN: 0806994606. Summary: This book describes traditional Chinese food remedies for common aging-related ailments. Chapter 1 introduces the traditional Chinese interpretation of illness as an imbalance between the body's opposing elements of yin and yang, which the author describes as either deficiency in immunity (yin) or overcompensation by immunity (yang) in a person's system. He contends that particular foods have yin or yang properties that can restore this balance. In chapter 2, the author provides dietary explanations and conventional Chinese wisdom about longevity. Chapters 3 and 4 describe deficiency and excess diseases in regard to aging and Chinese foods. Chapters 5 through 16 cover foods that are believed to be tonics for energy, blood, yin, yang, lung and liver, heart and stomach, and spleen; foods that may remedy toxic heat, damp heat, and sputum; and foods to promote energy and blood circulation. Chapter 17 provides tips on improving health by identifying weeknesses by symptoms and through the senses; learning more about one's heredity and growth patterns; selecting five foods to correct physical weaknesses; and using animal organ meats to strengthen one's own. Chapter 18 discusses coping with age-related diseases, including the common cold, chronic inflammation of the trachea, conornary heart disease, hypertension, low blood pressure, chronic gastritis, enlargement of the prostate gland, peptic ulcers, diabetes mellitus, obesity, and cancer. The book includes an index. ·
Herbs To Improve Digestion: Herbal Remedies for Stomach Pain, Constipation, Ulcers, Colitis and Other Gastrointestinal Problems Source: New Canaan, CT: Keats Publishing, Inc. 1996. 90 p. Contact: Available from Keats Publishing, Inc., division of NTC/Contemporary. 203 Kitchawan Road, South Salem, NY 10590. 914533-1175, FAX: 914-533-0035. PRICE: $4.95. ISBN: 087983742X. Summary: This book describes the use of herbs to improve digestion, including herbal remedies for stomach pain, constipation, ulcers, colitis, and other gastrointestinal problems. It provides an overview of the digestive system, including the digestive process and the role of bacteria. It discusses juicing, food sensitivities, digestive enzymes, and the role of exercise in improving digestion. It contains descriptions of frequently occurring digestive disorders such as colic, constipation, Crohn's disease, diarrhea, diverticulitis, flatulence, gastritis, heartburn, hemorrhoids, indigestion, irritable bowel syndrome, and ulcers. It provides suggestions
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on using herbs to treat these problems, and describes 12 steps to better digestion. This book contains a resource list and an index. ·
Hydrastis Canadensis L: Ranunculaceae Source: Protocol Journal of Botanical Medicine. 2(2): 25-28. 1996. Summary: This article discusses medicinal applications of goldenseal ('Hydrastis canadensis L.', Ranunculaceae). First, it provides a botanical description, a history of the herb's use by Native Americans, and information about the constituents of the rhizome, the herb's actions, and the pharmacology of berberine (the most widely studied of goldenseal's isoquinolone alkaloids). Then, it describes the herb's antimicrobial, anticancer, antielastolytic, and cardiac effects, focusing primarily on the pharmacologic effects of berberine; and presents findings from clinical studies of berberine. Finally, it reviews the toxicology, dosage, regulatory status, and indications and contraindications for goldenseal's use. According to the author, goldenseal use is indicated for infectious diarrhea, gastritis, infection and inflammation of the mucous membrane, and in digestive disorders. In clinical studies using berberine, no side effects have been noted other than relapse. There is no current toxicological data available on goldenseal rhizome and root preparations. Berberine has been reported to be well tolerated in therapeutic doses of 0.5 g, but herbs containing berberine are not recommended during pregnancy. The article has 35 references.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to gastritis and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “gastritis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to gastritis: ·
A double-blind study of effectiveness of hericium erinaceus pers therapy on chronic atrophic gastritis. A preliminary report. Author(s): Xu CP, Liu WW, Liu FX, Chen SS, Liao FQ, Xu Z, Jiang LG, Wang CA, Lu XH.
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Source: Chin Med J (Engl). 1985 June; 98(6): 455-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3932005&dopt=Abstract ·
A study of Helicobacterium pylori and prevention and treatment of chronic atrophic gastritis. Author(s): Zhang L, Yang L, Zheng X. Source: J Tradit Chin Med. 1997 March; 17(1): 3-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10437235&dopt=Abstract
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Ascorbic acid and total vitamin C concentrations in plasma, gastric juice, and gastrointestinal mucosa: effects of gastritis and oral supplementation. Author(s): Waring AJ, Drake IM, Schorah CJ, White KL, Lynch DA, Axon AT, Dixon MF. Source: Gut. 1996 February; 38(2): 171-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8801192&dopt=Abstract
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Comparative observations on the types of atrophic gastritis and biopsy pathology of gastric mucosa. Author(s): Ren H, Liu W, Niu L, Lu G, Lu Y. Source: J Tradit Chin Med. 1994 December; 14(4): 303-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7877344&dopt=Abstract
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Effect of beta-carotene supplementation on the activity of ornithine decarboxylase (ODC) in stomach mucosa of patients with chronic atrophic gastritis. Author(s): Bukin YV, Zaridze DG, Draudin-Krylenko VA, Orlov EN, Sigacheva NA, Dawei F, Kurtzman MYa, Schlenskaya IN, Gorbacheva ON, Nechipai AM, et al. Source: European Journal of Cancer Prevention : the Official Journal of the European Cancer Prevention Organisation (Ecp). 1993 January; 2(1): 61-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8428179&dopt=Abstract
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Effect of liu-junzi-tang on the symptom of bitter taste in patients with chronic gastritis. Author(s): Motoo Y, Watanabe H, Okai T, Sawabu N.
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Source: Am J Chin Med. 1995; 23(2): 153-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7572776&dopt=Abstract ·
Effect of N alpha-methyl-histamine on acid secretion in isolated cultured rabbit parietal cells: implications for Helicobacter pylori associated gastritis and gastric physiology. Author(s): Beales IL, Calam J. Source: Gut. 1997 January; 40(1): 14-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9155569&dopt=Abstract
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Effects of pH on mineral-phytate, protein-mineral-phytate, and mineral-fiber interactions. Possible consequences of atrophic gastritis on mineral bioavailability from high-fiber foods. Author(s): Champagne ET. Source: J Am Coll Nutr. 1988 December; 7(6): 499-508. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2852683&dopt=Abstract
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Effects of the clearing-heat and nourishing-stomach method in the treatment of chronic gastritis with positive Campylobacter pylori. Author(s): Wu D, Sun B, Sun L, Chai K, Ye C. Source: J Tradit Chin Med. 1995 March; 15(1): 28-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7783456&dopt=Abstract
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Gastric cancer and premalignant lesions in atrophic gastritis: a controlled trial on the effect of supplementation with alpha-tocopherol and beta-carotene. The Helsinki Gastritis Study Group. Author(s): Varis K, Taylor PR, Sipponen P, Samloff IM, Heinonen OP, Albanes D, Harkonen M, Huttunen JK, Laxen F, Virtamo J. Source: Scandinavian Journal of Gastroenterology. 1998 March; 33(3): 294-300. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9548624&dopt=Abstract
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Gastritis varioliformis. Chronic erosive gastritis with protein-losing gastropathy. Author(s): Clarke AC, Lee SP, Nicholson GI.
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Source: The American Journal of Gastroenterology. 1977 December; 68(6): 599-602. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=612216&dopt=Abstract ·
Green tea consumption and chronic atrophic gastritis: a cross-sectional study in a green tea production village. Author(s): Shibata K, Moriyama M, Fukushima T, Kaetsu A, Miyazaki M, Une H. Source: J Epidemiol. 2000 September; 10(5): 310-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11059513&dopt=Abstract
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Inducible nitric oxide synthase, nitrotyrosine, and apoptosis in Helicobacter pylori gastritis: effect of antibiotics and antioxidants. Author(s): Mannick EE, Bravo LE, Zarama G, Realpe JL, Zhang XJ, Ruiz B, Fontham ET, Mera R, Miller MJ, Correa P. Source: Cancer Research. 1996 July 15; 56(14): 3238-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8764115&dopt=Abstract
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Observation on 110 cases of chronic atrophic gastritis treated with Gastric Ease capsules. Author(s): Yang XZ, Hu CH, Zhuang KY, Zhu HL. Source: J Tradit Chin Med. 1983 March; 3(1): 55-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6553133&dopt=Abstract
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Production of metalloproteinase in gastric tissue with acetic acidinduced ulcer or taurocholic acid-induced gastritis. Author(s): Nakanishi J, Murakami S, Ishikura Y, Tsuchiya S, Mori Y. Source: J Pharmacobiodyn. 1987 February; 10(2): 92-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3298612&dopt=Abstract
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Protective effect of green tea on the risks of chronic gastritis and stomach cancer. Author(s): Setiawan VW, Zhang ZF, Yu GP, Lu QY, Li YL, Lu ML, Wang MR, Guo CH, Yu SZ, Kurtz RC, Hsieh CC.
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Source: International Journal of Cancer. Journal International Du Cancer. 2001 May 15; 92(4): 600-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11304697&dopt=Abstract ·
Reflux bile gastritis. Author(s): Thorfinnson PC, Brow JR. Source: J Can Assoc Radiol. 1974 December; 25(4): 263-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4443360&dopt=Abstract
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Relationship between serologically diagnosed chronic atrophic gastritis, Helicobacter pylori, and environmental factors in Japanese men. Author(s): Kuwahara Y, Kono S, Eguchi H, Hamada H, Shinchi K, Imanishi K. Source: Scandinavian Journal of Gastroenterology. 2000 May; 35(5): 47681. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10868449&dopt=Abstract
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TCM differential treatment of 57 cases of chronic gastritis complicated by ulcerative colitis. Author(s): Meng M. Source: J Tradit Chin Med. 1999 March; 19(1): 10-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10453577&dopt=Abstract
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Treatment of 910 cases of atrophic gastritis with wei you decoction. Author(s): Ma S, Liang F, Wang S, Dong S, Yin S, Xue C, Lin Z. Source: J Tradit Chin Med. 1990 September; 10(3): 168-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2277511&dopt=Abstract
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Treatment of bile reflux gastritis with traditional Chinese medicine. An analysis of 21 cases. Author(s): Jiang YQ.
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Source: J Tradit Chin Med. 1984 September; 4(3): 233-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6570156&dopt=Abstract ·
Treatment of chronic gastritis with acupuncture. Author(s): Chen Z. Source: J Tradit Chin Med. 1994 September; 14(3): 233-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7799660&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to gastritis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation:
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General Overview Gastritis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Gastritis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/gas tritis.html Gastritis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html
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Alternative Therapy Homeopathy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Homeo pathycm.html Chinese Medicine Anwei Pian Alternative names: (An Wei Pian) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Anwei%20Pian&m h=10&sb=---&view_records=View+Records
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Herbs and Supplements Achillea Alternative names: Yarrow; Achillea millefolium L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org
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Hyperlink: http://www.herbmed.org/ Acidophilus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Activated charcoal Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Allopurinol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Alpha-Lipoic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Aluminum Hydroxide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Aluminum_Hydroxide.h tm Amoxicillin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Amoxicillin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html
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Amoxil Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Antacids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Antibiotics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Antibiotics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Anti-Inflammatory Drugs Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Arginine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Arginine.htm Arginine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Aspirin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Aspirin Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Drug/Aspirin.htm Aspirin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html BARBERRY Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Beta_Carotene.htm Caffeine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Caffeine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Caffeine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Calendula Alternative names: Calendula officinalis L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/
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Capsaicin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Carnosine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Cayenne Alternative names: Capsicum annuum, Capsicum frutescens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Cayenne.htm Chamomile Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Chamomile Alternative names: Matricaria recutita Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Chamomile.htm Chamomile Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Chamomile Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Chemotherapy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html
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Chemotherapy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Chili Pepper Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Cimetidine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Cimetidine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Ciprofloxacin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Clarithromycin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Clarithromycin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html CLOVES Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm
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Comfrey Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Corydalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Cysteine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Cysteine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Dandelion Alternative names: Taraxacum officinale Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Dandelion.htm Deglycyrrhizinated Licorice Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Deglycyrrhizinated Licorice Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Devil’s Claw Alternative names: Harpagophytum procumbens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Devils_Claw.htm
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DMSO Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Doxycycline Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Electrolytes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Flavonoids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Flavonoids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Flaxseed Alternative names: Linum usitatissimum, Linseed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Flaxseedch.h tml Gamma Oryzanol Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Gamma Oryzanol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Gamma_Oryzanol.htm Gamma-oryzanol Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 28,00.html Gentian Alternative names: Gentiana lutea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Gentian.htm Ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Glutamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Glutamine.htm Glutamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Glutamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Glutathione Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Glycyrrhiza glabra Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricech.ht ml Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Goldenseal Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Goldenseal Alternative names: Hydrastis canadensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Goldenseal.htm Herbal Medicine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Herbal Medicine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Horehound Alternative names: Marrubium vulgare Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Horehound.htm Horseradish
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Alternative names: Cochlearia armoracia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Horseradish.htm Ipecac Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Lansoprazole Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Lansoprazole Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Lansoprazole.htm L-Arginine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Licorice Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Licorice Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Licorice Alternative names: Glycyrrhiza glabra, Glycyrrhiza uralensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Licorice.htm Licorice Alternative names: Glycyrrhiza glabra, Spanish Licorice
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Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricech.ht ml Linseed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Flaxseedch.h tml Linum usitatissimum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Flaxseedch.h tml LIQUORICE Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm LIQUORICE Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsj-l.htm Maalox Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm MARSHMALLOW Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Marshmallow Alternative names: Althea officinalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Marshmallow.htm
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MARSHMALLOW Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html MARSHMALLOW Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsm-o.htm Matricaria Alternative names: Chamomile; Matricaria chamomilla Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ MEADOWSWEET Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsm-o.htm Metronidazole Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html MILK THISTLE Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Mylanta Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm N-Acetyl Cysteine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/N_Acetyl_Cysteine.htm
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N-Acetyl Cysteine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Non-steroidal Anti-Inflammatory Drugs Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Omeprazole Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Omeprazole.htm Piper Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Proton Pump Inhibitors Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Proton Pump Inhibitors Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Proton Pump Inhibitors Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000386.html Proton Pump Inhibitors (Gastric Acid Secretion Inhibitors) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/UlcerM edicationsProtonPumpInhibitorscl.html Slippery Elm Alternative names: Ulmus rubra, Ulmus fulva
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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Slippery_Elm.htm Slippery Elm Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Slippery Elm Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000236.html Slippery elm Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 56,00.html Spanish Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricech.ht ml Tea Tree Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Tetracycline Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Thyme Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html
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Willow Alternative names: Salix alba Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/White_Willow.htm Willow Bark Alternative names: There are several species of willow includingSalix alba, Salix nigra, Salix fragilis, Salix purpurea, Salix babylonica, White Willow, European Willow, Black Willow, Pussy Willow, Crack Willow, Purple Willow, Weeping Willow, Liu-zhi Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/WillowBark ch.html ·
Related Conditions Chronic Obstructive Pulmonary Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Chroni cObstructivePulmonaryDiseasecc.html Dermatitis Herpetiformis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Dermatitis_Herpetifo rmis.htm Diabetes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diabetes.htm Emphysema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Chroni cObstructivePulmonaryDiseasecc.html Food Poisoning
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Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html High Cholesterol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/High_Cholesterol.ht m Indigestion, Heartburn, and Low Stomach Acidity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Indigestion.htm Peptic Ulcer Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Pyloric Stenosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pyloric Stenosiscc.html Stomach Inflammation Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Vitamin B12 Deficiency Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Vitamin_B12_Deficie ncy.htm
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Gastrointestinal Disorders and Nutrition by Tonia Reinhard; Paperback 192 pages (January 24, 2002), McGraw-Hill Professional Publishing; ISBN: 0737303611; http://www.amazon.com/exec/obidos/ASIN/0737303611/icongroupinterna · Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson, et al; Paperback - 256 pages, 1st edition (February 2000), John Wiley & Sons; ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupinterna · No More Heartburn: Stop the Pain in 30 Days--Naturally!: The Safe, Effective Way to Prevent and Heal Chronic Gastrointestinal Disorders by Sherry A. Rogers, M.D.; Paperback - 320 pages (February 2000), Kensington Publishing Corp.; ISBN: 1575665107; http://www.amazon.com/exec/obidos/ASIN/1575665107/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
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Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Alkaloid: One of a large group of nitrogenous basis substances found in plants. They are usually very bitter and many are pharmacologically active. Examples are atropine, caffeine, coniine, morphine, nicotine, quinine, strychnine. The term is also applied to synthetic substances (artificial a's) which have structures similar to plant alkaloids, such as procaine. [EU] Berberine: An alkaloid from Hydrastis canadensis L., Berberidaceae. It is also found in many other plants. It is relatively toxic parenterally, but has been used orally for various parasitic and fungal infections and as antidiarrheal. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Sputum: Matter ejected from the lungs, bronchi, and trachea, through the mouth. [EU] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH]
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with gastritis. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with gastritis may be given different recommendations. Some recommendations may be directly related to gastritis, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of gastritis. We will then show you how to find studies dedicated specifically to nutrition and gastritis.
Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet:
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Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs.
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Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:45 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
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DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
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RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
45
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge.
What Are Dietary Supplements?46 Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”47 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.48 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 47 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 48 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 46
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symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Gastritis The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.49 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “gastritis” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on gastritis: ·
Gastric acidity, atrophic gastritis, and calcium absorption. Author(s): USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111. Source: Wood, R J Serfaty Lacrosniere, C Nutr-Revolume 1992 February; 50(2): 33-40 0029-6643
The following information is typical of that found when using the “Full IBIDS Database” when searching using “gastritis” (or a synonym): ·
47 cases of chronic atrophic gastritis treated with the modality of depressing the upward adverse flow of qi. Source: Xie, Q S J-Tradit-Chin-Med. 1989 December; 9(4): 285-6 0254-6272
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A placebo controlled trial of bismuth salicylate in Helicobacter pylori associated gastritis. Author(s): Department of Pathology, Pakistan Medical Research Council, Karachi. Source: Kazi, J I Jafarey, N A Alam, S M Zuberi, S J Kazi, A M Qureshi, H Ahmed, W J-Pak-Med-Assoc. 1990 July; 40(7): 154-6 0030-9982
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A prospective study of atrophic gastritis and stomach cancer risk. Author(s): Division of Epidemiology, Aichi Cancer Center Hospital, Nagoya. Source: Kato, I Tominaga, S Ito, Y Kobayashi, S Yoshii, Y Matsuura, A Kameya, A Kano, T Ikari, A Jpn-J-Cancer-Res. 1992 November; 83(11): 1137-42 0910-5050
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Apoptosis in human gastric mucosa, chronic gastritis, dysplasia and carcinoma: analysis by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labelling. Author(s): First Department of Pathology, Faculty of Medicine, Tottori University, Japan. Source: Ishida, M Gomyo, Y Tatebe, S Ohfuji, S Ito, H Virchows-Arch. 1996 July; 428(4-5): 229-35 0945-6317
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Atrophic gastritis and vitamin C status in two towns with different stomach cancer death-rates. Author(s): MRC Epidemiology Unit, Cardiff, UK. Source: Burr, M L Samloff, I M Bates, C J Holliday, R M Br-J-Cancer. 1987 August; 56(2): 163-7 0007-0920
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Campylobacter pylori-associated gastritis: attempts to eradicate the bacteria by various antibiotics and anti-ulcer regimens. Source: Glupczynski, Y Burette, A Nyst, J F De Prez, C De Koster, E Deltenre, M Acta-Gastroenterol-Belg. 1988 Jul-October; 51(4-5): 329-37 0001-5644
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Clinical and experimental studies of chronic gastritis in patients with qi-deficiency of spleen. Source: Jin, J S Zhao, Z H Wei, B H Hu, Y F Chen, L H Li, W S He, J R Liang, D Y Zheng, M Z Li, J D et al. J-Tradit-Chin-Med. 1989 December; 9(4): 297-8 0254-6272
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Dementia patients with low serum cobalamin concentration: relationship to atrophic gastritis. Author(s): Department of Psychiatry and Neurochemistry, St. Jorgen Hospital, Goteborg, Sweden. Source: Regland, B Gottfries, C G Lindstedt, G Aging-(Milano). 1992 March; 4(1): 35-41 0394-9532
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Determinants for the development of chronic atrophic gastritis and intestinal metaplasia in the stomach. Author(s): Cattedra Malattie Aparato Digerente, Istituto di Medicina Interna, Policlinico Universitario, Padova, Italy. Source: Farinati, F Cardin, R Libera, G D Rugge, M Herszenyi, L Di Mario, F Molari, A Plebani, M Naccarato, R Eur-J-Cancer-Prevolume 1995 April; 4(2): 181-6 0959-8278
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Duodenogastric reflux is associated with antral metaplastic gastritis. Author(s): Department of Internal Medicine, Hiroshima Prefectural Hiroshima Hospital, Hiroshima, Japan. Source: Nakamura, M Haruma, K Kamada, T Mihara, M Yoshihara, M Imagawa, M Kajiyama, G Gastrointest-Endosc. 2001 January; 53(1): 53-9 0016-5107
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Green tea consumption and chronic atrophic gastritis: a cross-sectional study in a green tea production village. Author(s): Department of Public Health, School of Medicine, Fukuoka University, Japan. Source: Shibata, K Moriyama, M Fukushima, T Kaetsu, A Miyazaki, M Une, H J-Epidemiol. 2000 September; 10(5): 310-6 0917-5040
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Helicobacter pylori infection, gastritis, and the temperature of choice for hot drinks. Author(s): Department of Medicine, Veterans Affairs Medical Center, Houston, TX 77030, USA. Source: Graham, D Y Abou Sleiman, J el Zimaity, H M Badr, A Graham, D P Malaty, H M Helicobacter. 1996 September; 1(3): 172-4 1083-4389
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Helicobacter pylori, gastritis, and ulcers in pediatrics. Author(s): University of Wisconsin Hospitals, Madison. Source: Judd, R H Adv-Pediatr. 1992; 39283-306 0065-3101
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Neonatal acute haemorrhagic gastritis and antenatal exposure to indomethacin for tocolysis. Author(s): Neonatal Intensive Care Unit, Kirwan Hospital for Women, Townsville, Queensland, Australia.
[email protected] Source: Bolisetty, S Patole, S Koh, G Stalewski, H Whitehall, J ANZ-JSurg. 2001 February; 71(2): 122-3 1445-1433
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Short- and long-term treatment with rosaprostol of patients with gastritis. Author(s): Department of Medical Pathology, I School of Medicine and Surgery, University of Naples, Italy. Source: Di Simone, A Riegler, G Esposito, P Ciani, D Int-J-ClinPharmacol-Res. 1988; 8(3): 217-21 0251-1649
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Sucralfate gel for symptomatic chronic gastritis: multicentre comparative trial versus sucralfate suspension. Author(s): Divisione Gastroenterologia, Ospedale S. Raffaele, Universita di Milano, Italy. Source: Guslandi, M Ferrero, S Fusillo, M Ital-J-Gastroenterol. 1994 December; 26(9): 442-5 0392-0623
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The interaction between vitamin K nutriture and warfarin administration in patients with bacterial overgrowth due to atrophic gastritis. Author(s): Jean Mayer, United States Department of Agriculture, Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA. Source: Camilo, M E Paiva, S A O'Brien, M E Booth, S L Davidson, K W Sokoll, L J Sadowski, J A Russell, R M J-Nutr-Health-Aging. 1998; 2(2): 73-8 1279-7707
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Traditional Chinese treatment of chronic gastritis with gastric dysplasia--a clinical analysis of 70 cases. Source: Zhang, W Y Shen, L H Xu, H Wang, X L Xu, Y R J-Tradit-ChinMed. 1989 June; 9(2): 79-83 0254-6272
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Treatment of 910 cases of atrophic gastritis with wei you decoction. Author(s): Qindao Navy Sanatorium, PLA. Source: Ma, S Liang, F Wang, S Dong, S Yin, S Xue, C Lin, Z J-TraditChin-Med. 1990 September; 10(3): 168-71 0254-6272
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Treatment of Campylobacter pylori gastritis: a pilot study using pirenzepine dihydrochloride (Gastrozepin) and three formulations of colloidal bismuth subcitrate (De-Nol). Author(s): Department of Microbiology, Middlemore Hospital, Otahuhu, Auckland. Source: Morris, A Brown, P Ali, M R Lane, M Palmer, R N-Z-Med-J. 1988 October 26; 101(856 Pt 1): 651-4 0028-8446
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&pag e=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to gastritis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Ascorbic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Vitamin A Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_A.htm Vitamin B12 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B12.htm Vitamin B12 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000134.html
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Vitamin B3 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B3.htm Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_C.htm ·
Minerals Betaine Hydrochloride Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Betaine_HCl.htm Calcium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Copper Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Copper Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Magnesium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Potassium Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Sulfur Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Zinc Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Zinc.htm ·
Food and Diet Apple juice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Bananas Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Barley Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Beef Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Bread Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm
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Broccoli Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Brussels sprouts Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Cabbage Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Cabbage Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Cauliflower Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Chili Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Chips Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Chocolate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm
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Chocolate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Chocolate.htm Cinnamon Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Clams Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Coffee Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Coffee Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Coffee.htm Coffee Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Coffee Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Corn Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Eggs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Fish Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Fruit Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Garlic Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Garlic Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Grains Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Ham Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Honey Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Low-Salt Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Salt_Diet.htm Mayonnaise Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Meat Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Milk Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Mushrooms Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Mussels Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Onions Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Oysters Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Peppers Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Poultry Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Rice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Shrimp Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Spinach Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Sprouts Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Sucralfate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Sucralfate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Sugar Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Syrup Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Tea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm
204 Gastritis
Tea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Tea.htm Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Vegetables Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodPo isoningcc.html Water Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastriti scc.html Weight Loss Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm White Bread Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm Wine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Peptic_Ulcer.htm
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Acidity: L. aciditas) the quality of being acid or sour; containing acid (hydrogen ions). [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Colloidal: Of the nature of a colloid. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational
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functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Pirenzepine: An antimuscarinic agent that inhibits gastric secretion at lower doses than are required to affect gastrointestinal motility, salivary, central nervous system, cardiovascular, ocular, and urinary function. It promotes the healing of duodenal ulcers and due to its cytoprotective action is beneficial in the prevention of duodenal ulcer recurrence. It also potentiates the effect of other antiulcer agents such as cimetidine and ranitidine. It is generally well tolerated by patients. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tocolysis: Any drug treatment modality designed to inhibit uterine contractions in pregnant women at risk for preterm labor. [NIH]
Finding Medical Libraries 207
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.50
50
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):51 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
·
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
·
California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
·
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
51
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 209
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
·
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 211
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
·
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
·
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
·
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
·
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
·
New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
·
New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
·
New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
·
New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
·
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
·
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 213
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
·
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
·
Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
·
Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
·
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
·
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
·
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
·
Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
·
Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
·
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
·
Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Therapeutic Endoscopy and Bleeding Ulcers 215
APPENDIX
E.
NIH CONSENSUS STATEMENT ON THERAPEUTIC ENDOSCOPY AND BLEEDING ULCERS
Overview NIH Consensus Development Conferences are convened to evaluate available scientific information and resolve safety and efficacy issues related to biomedical technology. The resultant NIH Consensus Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.52 Each NIH consensus statement is the product of an independent, non-Federal panel of experts and is based on the panel’s assessment of medical knowledge available at the time the statement was written. Therefore, a consensus statement provides a “snapshot in time” of the state of knowledge of the conference topic. The NIH makes the following caveat: “When reading or downloading NIH consensus statements, keep in mind that new knowledge is inevitably accumulating through medical research. Nevertheless, each NIH consensus statement is retained on this website in its original form as a record of the NIH Consensus Development Program.”53 The following concensus statement was posted on the NIH site and not indicated as “out of date” in March 2002. It was originally published, however, in March 1989.54
52 This paragraph is adapted from the NIH: http://odp.od.nih.gov/consensus/cons/cons.htm. 53 Adapted from the NIH: http://odp.od.nih.gov/consensus/cons/consdate.htm. 54 Therapeutic Endoscopy and Bleeding Ulcers. NIH Consens Statement Online 1989 Mar 6-8 [cited 2002 February 19];7(6):1-22. http://consensus.nih.gov/cons/072/072_statement.htm.
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Abstract Peptic ulcer disease is a major health problem in the United States that affects more than 4 million people each year. Bleeding is one of the most dread complications of peptic ulcer. Upper gastrointestinal (UGI) bleeding is a common cause of emergency hospitalization in the United States. It has been estimated that more than 100,000 patients with peptic ulcer disease bleed each year. Morbidity and mortality from ulcer bleeding remain significant despite major improvements in the accurate diagnosis of peptic ulcer disease and the use of H2 receptor antagonist drugs and other pharmacological agents. The mortality rate from bleeding ulcers has averaged between 6 and 10 percent over the past 30 years despite advances in diagnosis and treatment. During the past decade there has been a remarkable transition of the application of the endoscope from solely a diagnostic tool to a therapeutic modality. With the advent of this therapeutic role there has been much enthusiasm in utilizing endoscopic techniques in managing high-risk patients. A variety of approaches for endoscopic management of bleeding have evolved, and there has been continuing improvement over the past decade, resulting in considerable interest in evaluating the various treatment options for managing patients with bleeding ulcers. Unfortunately, there have been limited and conflicting clinical studies on the efficacy and safety of the various hemostatic modalities available for treating these ulcers. In an effort to define the role of these methods, the National Institute of Diabetes and Digestive and Kidney Diseases and the Office of Medical Applications of Research of the National Institutes of Health sponsored a Consensus Development Conference on Therapeutic Endoscopy and Bleeding Ulcers. The conference brought together research clinicians and other health professionals and representatives of the public on March 6-8, 1989. Following 2 days of presentations and discussion by the invited experts and the audience, members of a consensus panel drawn from the health care and medical communities weighed the scientific evidence in formulating a statement in response to several questions: ·
Which bleeding ulcer patients are at risk for rebleeding and thus emergency surgery?
·
How effective is endoscopic hemostatic therapy?
·
How safe is endoscopic hemostatic therapy?
·
Which bleeding patients should be treated?
·
What further research is required?
Therapeutic Endoscopy and Bleeding Ulcers 217
It is important that certain limitations be considered when applying the findings of this conference to a particular bleeding patient. The conference was charged to address specifically the question of therapeutic endoscopy for the treatment of bleeding peptic ulcer. Other causes of UGI bleeding, including gastric and esophageal varices, diffuse erosive gastritis, and Mallory-Weiss tears were necessarily excluded from consideration. It should be noted that the conclusions reached should not be extrapolated to those diseases excluded from consideration. Moreover, a striking finding from the review of available clinical trials of therapeutic endoscopy was the selective inclusion of only a small proportion (10 to 25 percent) of the total population of patients who presented with UGI bleeding. In addition to patients with the above diagnoses, many other patients were also excluded, quite appropriately, due to hemorrhage too massive or too little to justify prudent therapeutic endoscopy. In this conference, the need for emergency surgery was taken as one indicator of inadequately controlled bleeding. Although many patients treated with surgery do well, they are subjected to additional discomfort and cost and to approximately a 10-percent risk of mortality when the surgery must be performed under such emergency conditions. On the other hand, when temporary hemostasis achieved by endoscopic therapy allows resuscitation and hemodynamic control of an unstable patient, considerable benefit may be realized even if surgery must be performed ultimately. For a variety of reasons, a surgeon should be involved from the outset in the team caring for the patient with bleeding peptic ulcer.
Clinical Features of Bleeding Ulcer Patients at Risk for Emergency Surgery Magnitude of Bleeding There is consensus that a major predictor of significant persistent or recurrent bleeding is the magnitude of blood loss before initial evaluation. Clear indications of a large and clinically significant volume of blood loss are hemodynamic instability, hematemesis of grossly red material, or red stool. The hazard of hemodynamic instability underlies the importance of careful hemodynamic evaluation in order to detect significant hypovolemia before the appearance of overt shock. Another commonly used indicator of the magnitude of hemorrhage is estimation of the volume of blood lost, often quantitated as the number of units transfused or as a transfusion rate. Although there is general agreement that the volume of blood loss is
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important, there is substantial uncertainty about the best way to estimate it. Persistent red blood in the nasogastric aspirate correlates with an increased requirement for subsequent transfusion. Although failure of the nasogastric aspirate to clear with irrigation often is taken as an indication of rapid bleeding, this criterion may be misleading
Host Factors Patient-related factors also predict persistent or recurrent bleeding. The panel finds that documented coagulopathy and the onset of bleeding in a patient already hospitalized for a related or unrelated condition are predictive of recurrent bleeding. Two other factors, age and the existence of concurrent illnesses, while clearly related to mortality, bear a less clear relationship to prognosis for continued bleeding or rebleeding.
Endoscopic Features The first and most important endoscopic predictor of persistent or recurrent bleeding is active bleeding at the time of endoscopy, as evidenced by arterial spurting or oozing. Also of importance is the presence of a discrete protuberance within the ulcer crater, often referred to by endoscopists as a “visible vessel” or “sentinel clot.” There is consensus that some pigmented protuberances (red, blue, or purple) imply a high risk of rebleeding, even when not associated with bleeding at the time of endoscopy. There is less agreement on the prognostic significance of a white or black protuberance. A white protuberance may be indicative of an older, more organized process. Although any such lesions often are referred to as “visible vessels,” pathologic studies indicate that only some are true vessels. Most frequently, they represent a hemostatic plug (clot) in the underlying vessel or a false aneurysm. The prognostic implications of these distinctions remain unclear. An additional endoscopic predictor of recurrent bleeding is the presence of a clot that adheres to the ulcer base despite gentle washing (adherent clot). Whereas the anatomic location of the ulcer crater often is cited as a prognostic factor, the panel members do not agree that site is clearly predictive. Nevertheless, many endoscopists feel that deep ulcers located high on the lesser curvature of the stomach or in the posterior-inferior wall of the duodenal bulb are at greater risk for severe bleeding due to their proximity to large vessels.
Therapeutic Endoscopy and Bleeding Ulcers 219
Features that clearly appear to be associated with a low frequency of recurrent bleeding include a clean ulcer base or one that contains a flat pigmented spot indicative of old hemorrhage. Value of Combined Clinical and Endoscopic Predictors Whereas the above clinical and endoscopic features are predictive when considered singly, they may become particularly useful as prognostic indicators when considered together.
How Effective Is Endoscopic Hemostatic Therapy? The following consensus statements on the effectiveness of the various endoscopic hemostatic therapies are based on the limited number of studies performed. Results were reported only for the acute hospital stay; only sparse followup data are available. The level of efficacy of individual treatment modalities varies from study to study. Some factors that may account for this variability are small sample sizes, variation in patient characteristics such as age, entry criteria, differing definitions of such terms as “visible vessel” or “rebleed,” and timing of endoscopy. Nonetheless, certain conclusions can be drawn from these studies.
Most Promising Techniques Multipolar Electrocoagulation (MPEC). MPEC (also known as bipolar) appears to be an effective modality for achieving immediate hemostasis and preventing rebleeding in actively bleeding patients and patients with “visible vessels.” The data are less clear that MPEC decreases the need for emergency surgical intervention or decreases mortality. Further advantages of this modality are that it does not require an en face approach to the bleeding point, the endoscopist can control the depth of tissue injury, and the equipment is portable and easy to use. Recommendations are evolving concerning technique in terms of probe size, power setting, pressure applied, and duration and number of pulses delivered.
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Heater Probe In comparison with “conventional” medical therapy, the heater probe appears to achieve immediate hemostasis and to reduce rebleeding and the need for emergency surgery. The advantages of heater probe therapy are the same as for MPEC. Early data for MPEC and heater probe suggest no delay in ulcer healing in treated patients.
Other Techniques Neodymium-Yttrium-Aluminum-Garnet (ND-YAG) Laser Nd-YAG laser appears to be effective for achieving immediate hemostasis and preventing rebleeding. Studies have also shown a trend toward reducing need for emergency surgery and lowering mortality. Difficulties in using this instrument include gaining access to the bleeding lesion for an en face approach and training endoscopists in its use. Laser therapy is difficult to master and apply. Furthermore, the Nd-YAG laser is costly to use in relation to other modalities. Although portability has been an obstacle to its use, new portable instrumentation is now available. Injection Therapy Some agents (e.g., sodium chloride, epinephrine, and ethanol) appear promising for early control of bleeding. Currently there are insufficient data to make specific recommendations concerning the proper role of this approach. However, injection therapies warrant further study because of their technical ease of use, low cost, and promise.
Techniques Not Recommended Topical There is no current evidence for efficacy of the following agents: cyanoacrylate glue, clotting factors, ferromagnetic tamponade, epinephrine lavage, and microcrystalline collagen hemostat.
Therapeutic Endoscopy and Bleeding Ulcers 221
Argon Laser This technique appears to be effective for immediate hemostasis, but available data do not demonstrate significant reduction in rebleeding, mortality, or need for emergency surgery. This technique has been superseded by other, more effective treatment modalities. Monopolar/Electrohydrothermal Coagulation This modality appears to be effective for immediate hemostasis. However, monopolar therapy has been replaced by other techniques because of difficulty in its use due to the necessity to meet the bleeding point en face, to control the depth of injury, and the need for multiple cleanings of the probe.
How Safe Is Endoscopic Hemostatic Therapy? Safety may be compromised by: ·
Patient characteristics: Hemodynamic instability and associated illnesses.
·
Ulcer characteristics: Depth and location, especially posterior-inferior duodenal bulb and high lesser curvature of the stomach because of the proximity to large arteries.
·
Method of therapy: Excessive depth of penetration of energy or injectant.
The consensus of the panel is that therapeutic endoscopy should be performed only by an endoscopist experienced and qualified in the specific therapeutic techniques. Appropriate professional organizations should develop guidelines for training and for quality assurance. The goal of endoscopic hemostatic treatment is to stop active bleeding and prevent rebleeding while controlling depth of tissue injury and avoiding excessive necrosis, increased bleeding, and perforation. The only indication to remove an adherent clot other than by low-pressure irrigation is in the actively bleeding patient or the patient who has rebled. After clot removal, the endoscopist must be prepared to apply therapy. The risk of precipitating bleeding with therapy is variable but has been as high as 20 percent. While this bleeding can usually be controlled by the same endoscopic hemostatic therapy, occasionally uncontrollable bleeding will
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require emergency surgical intervention. The risk of perforation has been approximately 1 percent and may require laparotomy should it occur. In the patient population at high risk of rebleeding, the rate of complications of endoscopic hemostatic therapy appears to be acceptably low considering the natural history of the disease. As the technology in this field advances, controlled observations of potential complications are needed to ensure that safety remains within acceptable limits.
Which Bleeding Ulcer Patients Should Be Treated? Acute peptic ulcer bleeding will stop spontaneously in approximately 70 to 80 percent of patients. Therefore, there is consensus that a need exists for selectivity in applying endoscopic hemostatic therapy to bleeding ulcers. Such therapy should be directed at selected high-risk patients. A clinical feature of high risk for rebleeding or death is rapid bleeding with substantial blood loss manifested by hemodynamic instability, ongoing transfusion requirement, red hematemesis, or red stool. Other patient characteristics that predict a poor outcome from ulcer bleeding include age greater than 60 years and major associated diseases. Patients whose onset of bleeding occurs in the hospital or who rebleed during hospitalization are also at high risk. Patients with high-risk clinical features are candidates for therapeutic/hemostatic endoscopy. The observations at endoscopy should then determine whether endoscopic hemostatic therapy should be carried out. There is consensus that the findings of pulsatile bleeding (“spurting”) or oozing from the ulcer are indications for treatment. In addition, the finding of a pigmented protuberance (“visible vessel” or “sentinel clot”) in the ulcer crater is an indication for endoscopic hemostatic therapy. There is agreement that patients with ulcer craters that are clean with or without flat pigmented spots do not require endoscopic hemostatic treatment. In the absence of the clinical risk factors described above, adherent clots (resisting gentle washing) without evident active bleeding should not be removed because of the possible risk of precipitating bleeding. In a deteriorating clinical situation, adherent clots may be removed as long as
Therapeutic Endoscopy and Bleeding Ulcers 223
there is satisfactory endoscopic access and capability for treatment. Surgical backup should be readily available to deal with the possibility of precipitating active bleeding that cannot be controlled endoscopically, and thus the need for early surgical consultation. Patients exsanguinating with torrential bleeding from peptic ulcer represent a special case. The panel agrees that endoscopic localization and treatment should be attempted in concert with the surgeon and without undue delay. It should be recognized that deep ulcers near the left gastric artery high on the lesser curvature of the stomach and those near the gastroduodenal artery in the posterior-inferior duodenal bulb may be at high risk for major bleeding. This emphasizes that surgical support must be available before endoscopic treatment of ulcers in these anatomic locations is undertaken. It is important to resuscitate patients and correct coagulopathy as completely as possible before endoscopic hemostatic therapy. Uncontrollable coagulopathy appears to be a contraindication to endoscopic hemostatic therapy in the patient who is not actively bleeding. However, in the patient who is actively bleeding, endoscopic hemostatic therapy may be attempted despite uncorrectable coagulopathy with the awareness that control of hemorrhage may be temporary. Endoscopic treatment of patients with bleeding peptic ulcers should be carried out only by individuals qualified in therapeutic endoscopy.
What Further Research Is Required? Despite the considerable technical advances that have been made in the past decade in endoscopic hemostatic therapy, firm conclusions regarding clinical applications are limited by a paucity of controlled trials. There is consensus that a number of important issues remain to be resolved and that high priority should be given to continuing scientific evaluation of techniques. There is a strong need to use rigorous scientific methods to resolve the following issues: ·
Standardize use of terminology, particularly descriptive terms such as “visible vessel” (e.g., white, blue, red, black or bare), adherent clot, persistent and recurrent bleeding.
·
Quantitate rebleeding risk associated with endoscopic features such as “visible vessel,” adherent clot, size, depth and location of ulcer, and timing of endoscopy.
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·
Quantitate rebleeding risk associated with different host factors such as aging, nonsteroidal anti-inflammatory drug use (including aspirin), and associated diseases.
·
Develop a composite system using clinical and endoscopic features to predict risk of persistent or recurrent bleeding.
·
Define optimal treatment regimens for individual and combined treatment modalities to maximize therapeutic effectiveness.
·
Explore improved diagnostic and therapeutic technology through collaboration with bioengineers.
Clinical effectiveness and safety of endoscopic hemostatic therapies would be best assessed by multicenter, randomized controlled trials. Ulcer patients at high risk but without active bleeding at endoscopy should be entered into studies comparing endoscopic therapies with medical therapies. There is a lack of consensus regarding the need for a medical therapy control group of patients with active bleeding at endoscopy.
Conclusions and Recommendations ·
In the United States, more than 100,000 patients a year bleed from peptic ulcers.
·
Despite advances in diagnosis and treatment, the mortality rate from bleeding ulcers has remained largely unchanged, averaging between 6 and 10 percent over the past 30 years.
·
Bleeding from peptic ulcers will stop spontaneously in 70 to 80 percent of patients.
·
A surgeon should be involved from the outset in the team caring for the patient with a bleeding peptic ulcer.
·
Patients at high risk for persistent or recurrent bleeding are those with a large initial blood loss and active bleeding or a pigmented protuberance (“visible vessel”) at endoscopy.
·
Patients at low risk for subsequent bleeding are those with a clean ulcer base or one that contains a flat pigmented spot at endoscopy.
·
Heater probe and multipolar electrocoagulation (also known as bipolar) are the most promising modalities for endoscopic hemostatic therapy.
·
In the hands of the qualified therapeutic endoscopist, the rate of complications of endoscopic hemostatic therapy is acceptably low considering the natural history of bleeding peptic ulcers.
Therapeutic Endoscopy and Bleeding Ulcers 225
·
Endoscopic hemostatic therapy should be used only in patients who are at high risk for persistent or recurrent bleeding and death.
·
Clinical efficacy and safety of endoscopic hemostatic therapy should be assessed by multicenter, randomized controlled trials.
Vocabulary Builder Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. The chief signs of arterial aneurysm are the formation of a pulsating tumour, and often a bruit (aneurysmal bruit) heard over the swelling. Sometimes there are symptoms from pressure on contiguous parts. [EU]
Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: A large blood vessel that carries blood from the heart to other parts of the body. Arteries are thicker and have walls that are stronger and more elastic than the walls of veins. [NIH] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Criterion: A standard by which something may be judged. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH] Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU]
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Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neodymium: Neodymium. An element of the rare earth family of metals. It has the atomic symbol Nd, atomic number 60, and atomic weight 144.24, and is used in industrial applications. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Standardize: To compare with or conform to a standard; to establish standards. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU]
Online Glossaries 227
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to gastritis and keep them on file. The NIH, in particular, suggests that patients with gastritis visit the following Web sites in the ADAM Medical Encyclopedia: ·
Basic Guidelines for Gastritis
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Gastritis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001150.htm Gastritis - acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000240.htm Gastritis - chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000232.htm Helicobacter pylori Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000229.htm Peptic ulcer Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000206.htm ·
Signs & Symptoms for Gastritis Abdominal indigestion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003260.htm Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Anemia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000560.htm Dark stools Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm Emesis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm
Online Glossaries 229
Erosion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003225.htm Erythema Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Hematemesis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm Hiccups Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003068.htm Indigestion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003260.htm Loss of appetite Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003121.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Stress gastritis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000225.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm
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Vomiting blood Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm ·
Diagnostics and Tests for Gastritis ANA Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003535.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm EGD Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003888.htm EGD (esophagogastroduodenoscopy) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003888.htm Endoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003338.htm Esophagogastroduodenoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003888.htm Gastric acid Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003883.htm Gastroscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003728.htm
Online Glossaries 231
GI series Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003816.htm HCT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003646.htm Stool guaiac Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003393.htm Upper GI and small bowel series Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003816.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm ·
Nutrition for Gastritis Vitamin B12 Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002403.htm
·
Background Topics for Gastritis Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Aggravated by Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002227.htm Alcohol use Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001944.htm
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Bile Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002237.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Head trauma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm Helicobacter pylori Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000229.htm Helicobacter pylori gastritis (chronic gastritis) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000229.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Lymph system Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002247.htm Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
Online Glossaries 233
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 235
GASTRITIS GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Acetone: A chemical formed in the blood when the body uses fat instead of glucose (sugar) for energy. If acetone forms, it usually means that the cells do not have enough insulin, or cannot use the insulin that is in the blood, to use glucose for energy. Acetone passes through the body into the urine. Someone with a lot of acetone in the body can have breath that smells fruity and is called "acetone breath." See also: Ketone bodies. [NIH] Acidity: L. aciditas) the quality of being acid or sour; containing acid (hydrogen ions). [EU] Adenocarcinoma: organization. [NIH]
A malignant epithelial tumor with a glandular
Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: One of a large group of nitrogenous basis substances found in plants. They are usually very bitter and many are pharmacologically active. Examples are atropine, caffeine, coniine, morphine, nicotine, quinine, strychnine. The term is also applied to synthetic substances (artificial a's) which have structures similar to plant alkaloids, such as procaine. [EU] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH]
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Ammonia: Ammonia. A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anal: Pertaining to the anus. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. The chief signs of arterial aneurysm are the formation of a pulsating tumour, and often a bruit (aneurysmal bruit) heard over the swelling. Sometimes there are symptoms from pressure on contiguous parts. [EU]
Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Anisakiasis: Infection with roundworms of the genus ANISAKIS. Human infection results from the consumption of fish harboring roundworm larvae. The worms may cause acute nausea and vomiting or may penetrate into the wall of the digestive tract, where they give rise to eosinophilic granulomas in the stomach, intestine, or the omentum. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an allergic or bad reaction to the beef or pork insulins. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced
Glossary 237
its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigens: Substances that cause an immune response in the body. The body "sees" the antigens as harmful or foreign. To fight them, the body produces antibodies, which attack and try to eliminate the antigens. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Approximate: Approximal [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: A large blood vessel that carries blood from the heart to other parts of the body. Arteries are thicker and have walls that are stronger and more elastic than the walls of veins. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Asymptomatic: No symptoms; no clear sign of disease present. [NIH] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Auranofin: An oral chrysotherapeutic agent for the treatment of rheumatoid arthritis. Its exact mechanism of action is unknown, but it is believed to act via immunological mechanisms and alteration of lysosomal enzyme activity. Its efficacy is slightly less than that of injected gold salts, but it is better tolerated, and side effects which occur are potentially less serious. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess
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rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteroides: A genus of gram-negative, anaerobic, rod-shaped bacteria. Its organisms are normal inhabitants of the oral, respiratory, intestinal, and urogenital cavities of humans, animals, and insects. Some species may be pathogenic. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Berberine: An alkaloid from Hydrastis canadensis L., Berberidaceae. It is also found in many other plants. It is relatively toxic parenterally, but has been used orally for various parasitic and fungal infections and as antidiarrheal. [NIH] Bifidobacterium: A rod-shaped, gram-positive, non-acid-fast, non-sporeforming, non-motile bacterium that is a genus of the family actinomycetaceae. It inhabits the intestines and feces of humans as well as the human vagina. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU]
Glossary 239
Carcinogenic: Producing carcinoma. [EU] Cardiac: Pertaining to the heart. [EU] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]
Catalase: An oxidoreductase that catalyzes the conversion of hydrogen peroxide to water and oxygen. It is present in many animal cells. A deficiency of this enzyme results in ACATALASIA. EC 1.11.1.6. [NIH] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Chloral Hydrate: A hypnotic and sedative used in the treatment of insomnia. The safety margin is too narrow for chloral hydrate to be used as a general anesthetic in humans, but it is commonly used for that purpose in animal experiments. It is no longer considered useful as an anti-anxiety medication. [NIH] Cholangitis: Inflammation of a bile duct. [EU] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Citrobacter: A genus of gram-negative, rod-shaped enterobacteria that can use citrate as the sole source of carbon. [NIH] Clarithromycin: A semisynthetic macrolide antibiotic derived from erythromycin that is active against a variety of microorganisms. It can inhibit protein synthesis in bacteria by reversibly binding to the 50S ribosomal subunits. This inhibits the translocation of aminoacyl transfer-RNA and prevents peptide chain elongation. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH]
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Colitis: Inflammation of the colon. [EU] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Colloidal: Of the nature of a colloid. [EU] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Criterion: A standard by which something may be judged. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoprotection: The process by which chemical compounds provide protection to cells against harmful agents. [NIH] Cytotoxins: Substances elaborated by microorganisms, plants or animals that are specifically toxic to individual cells; they may be involved in immunity or may be contained in venoms. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH]
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Detoxification: Treatment designed to free an addict from his drug habit. [EU]
Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dietetics: The study and regulation of the diet. [NIH] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Duodenum: The first or proximal portion of the small intestine, extending from the pylorus to the jejunum; so called because it is about 12 fingerbreadths in length. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dysphagia: Difficulty in swallowing. [EU] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Encephalopathy: Any degenerative disease of the brain. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterocolitis: Inflammation involving both the small intestine and the colon; see also enteritis. [EU] Enzyme:
A protein molecule that catalyses chemical reactions of other
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substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Pertaining to the epigastrium. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the
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alleviation of postoperative pain. [NIH] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Flatulence: The presence of excessive amounts of air or gases in the stomach or intestine, leading to distention of the organs. [EU] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gastroscopy: Endoscopic examination, therapy or surgery of the interior of the stomach. [NIH] Giardia: A genus of flagellate intestinal protozoa parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its
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tough elastic character. [EU] Glycyrrhiza: A genus of leguminous herbs or shrubs whose roots yield glycyrrhetinic acid and its derivatives, carbenoxolone for example. Licorice toxicity is manifested as hypokalemia, low blood potassium. Licorice is used as flavoring and aromatic in pharmaceuticals and as candy. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Granule: A small pill made from sucrose. [EU] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hematemesis: Vomiting of blood. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH] Hepatitis: Inflammation of the liver. [EU] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation,
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which in turn causes a decrease in carbon dioxide concentration. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour now often used of endocrine factors as opposed to neural or somatic. [EU] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein Hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypersecretion: Excessive secretion. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunization: The induction of immunity. [EU] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH]
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Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]
Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH]
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Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Lipodystrophy: 1. any disturbance of fat metabolism. 2. a group of conditions due to defective metabolism of fat, resulting in the absence of subcutaneous fat, which may be congenital or acquired and partial or total. Called also lipoatrophy and lipodystrophia. [EU] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Loratadine: A second-generation histamine H1 receptor antagonist used in the treatment of allergic rhinitis and urticaria. Unlike most classical antihistamines it lacks central nervous system depressing effects such as drowsiness. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Luminol: 5-Amino-2,3-dihydro-1,4-phthalazinedione. Substance that emits light on oxidation. It is used in chemical determinations. [NIH] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medicament: A medicinal substance or agent. [EU] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU]
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Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Metaplasia: The change in the type of adult cells in a tissue to a form which is not formal for that tissue. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH]
Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Misoprostol: A synthetic analog of natural prostaglandin E1. It produces a dose-related inhibition of gastric acid and pepsin secretion, and enhances mucosal resistance to injury. It is an effective anti-ulcer agent and also has oxytocic properties. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Motility: The ability to move spontaneously. [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neodymium: Neodymium. An element of the rare earth family of metals. It has the atomic symbol Nd, atomic number 60, and atomic weight 144.24, and is used in industrial applications. [NIH]
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Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Pertaining to neurology or to the nervous system. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neutralization: An act or process of neutralizing. [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Occult: Obscure; concealed from observation, difficult to understand. [EU] Ornithine: An amino acid produced in the urea cycle by the splitting off of urea from arginine. [NIH] Orphenadrine: A muscarinic antagonist used to treat drug-induced parkinsonism and to relieve pain from muscle spasm. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Oxazolone: Immunologic adjuvant and sensitizing agent. [NIH] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU]
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Parathyroid: 1. situated beside the thyroid gland. 2. one of the parathyroid glands. 3. a sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parietal: 1. of or pertaining to the walls of a cavity. 2. pertaining to or located near the parietal bone, as the parietal lobe. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Penicillin G: A penicillin derivative commonly used in the form of its sodium or potassium salts in the treatment of a variety of infections. It is effective against most gram-positive bacteria and against gram-negative cocci. It has also been used as an experimental convulsant because of its actions on GABA mediated synaptic transmission. [NIH] Penicillin V: A broad-spectrum penicillin antibiotic used orally in the treatment of mild to moderate infections by susceptible gram-positive organisms. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Perianal: Located around the anus. [EU] Pernicious: Tending to a fatal issue. [EU] Peroxidase: A hemeprotein from leukocytes. Deficiency of this enzyme leads to a hereditary disorder coupled with disseminated moniliasis. It catalyzes the conversion of a donor and peroxide to an oxidized donor and water. EC 1.11.1.7. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Pirenzepine: An antimuscarinic agent that inhibits gastric secretion at lower doses than are required to affect gastrointestinal motility, salivary, central nervous system, cardiovascular, ocular, and urinary function. It promotes the healing of duodenal ulcers and due to its cytoprotective action is beneficial in the prevention of duodenal ulcer recurrence. It also potentiates the effect of other antiulcer agents such as cimetidine and ranitidine. It is generally well tolerated by patients. [NIH] Porphyria: A pathological state in man and some lower animals that is often
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due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Occurring after the menopause. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Proctitis: Inflammation of the rectum. [EU] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prophylaxis: The prevention of disease; preventive treatment. [EU] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Proteolytic: 1. pertaining to, characterized by, or promoting proteolysis. 2. an enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than
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organic factors. [EU] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reflux: A backward or return flow. [EU] Refractory: Not readily yielding to treatment. [EU] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Respiratory: Pertaining to respiration. [EU] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU]
Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Rheumatoid: Resembling rheumatism. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Rodentia: A mammalian order which consists of 29 families and many genera. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH]
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Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spondylitis: Inflammation of the vertebrae. [EU] Sputum: Matter ejected from the lungs, bronchi, and trachea, through the mouth. [EU] Stabilization: The creation of a stable state. [EU]
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Standardize: To compare with or conform to a standard; to establish standards. [EU] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]
Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acidbinding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH]
Glossary 255
Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tocolysis: Any drug treatment modality designed to inhibit uterine contractions in pregnant women at risk for preterm labor. [NIH] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Ulcerogenic: Causing ulceration; leading to the production of ulcers. [EU] Urea: One of the chief waste products of the body. When the body breaks down food, it uses what it needs and throws the rest away as waste. The kidneys flush the waste from the body in the form of urea, which is in the urine. [NIH] Urease: An enzyme that catalyzes the conversion of urea and water to carbon dioxide and ammonia. EC 3.5.1.5. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU]
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Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Ventral: 1. pertaining to the belly or to any venter. 2. denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are saccharomyces cerevisiae; therapeutic dried yeast is yeast, dried. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
Glossary 257
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
258 Gastritis
INDEX A Abdomen .........................15, 18, 248, 254 Abdominal...... 11, 14, 61, 82, 89, 98, 114, 122, 184, 237, 239, 243 Acetone .......................................149, 235 Acidity ..................................................191 Adenocarcinoma............49, 53, 55, 84, 93 Adjuvant...................................42, 64, 249 Adverse .......................37, 38, 76, 91, 191 Algorithms..............................................82 Alimentary........................18, 98, 237, 246 Alkaline ..........................59, 107, 236, 238 Alkaloid ........................................184, 238 Alleles ....................................................49 Aluminum...............................72, 151, 254 Ammonia ...............................65, 104, 255 Anaerobic ...17, 18, 59, 73, 135, 238, 242, 252, 254 Anal .......................................................35 Analgesic ...............79, 150, 242, 245, 248 Anemia .......11, 12, 15, 42, 48, 90, 94, 95, 110, 128 Aneurysm ............................218, 225, 236 Angiography ....................................35, 92 Anomalies ..............................................35 Antibiotic ...18, 32, 36, 47, 60, 69, 77, 79, 80, 150, 151, 236, 239, 248, 250, 253, 254 Antibodies......42, 59, 74, 76, 77, 236, 237 Antibody...............33, 60, 63, 77, 240, 247 Antigens.........51, 54, 59, 64, 74, 237, 252 Antimicrobial ......................42, 69, 70, 160 Antipyretic ......................................79, 248 Anus ..............................97, 101, 236, 250 Appendicitis .........82, 93, 94, 99, 122, 241 Approximate ..........................................50 Arterial .................100, 218, 225, 236, 245 Arteries ................................221, 225, 237 Ascites ...................................................82 Asymptomatic ........................48, 104, 113 Atrophy ....32, 37, 38, 39, 50, 55, 113, 128 Atypical ..................................................93 B Barium ...................................................35 Benign .........................40, 63, 84, 92, 249 Berberine .............................................160 Bile....11, 71, 99, 100, 151, 164, 238, 239, 246, 254 Biliary...................................82, 83, 93, 94 Bioavailability.......................................162 Biopsy....................11, 15, 39, 40, 72, 161
Bismuth ........................... 69, 77, 191, 194 C Capsules ............................... 70, 163, 189 Carbohydrate ...................................... 188 Carcinogenic ................................... 48, 55 Cardiac.......... 40, 101, 160, 225, 242, 252 Carotene ..................................... 161, 162 Catalase................................................ 48 Caustic .................................................. 82 Chloral Hydrate ........................... 150, 239 Cholangitis ...................................... 82, 97 Cholecystectomy .................................. 82 Cholecystitis.................................... 82, 97 Cholesterol.................................. 186, 188 Cirrhosis.................................. 94, 97, 122 Clarithromycin ....................................... 35 Colic .................................................... 159 Colitis . 35, 40, 44, 56, 90, 92, 95, 97, 122, 123, 159, 164 Colloidal .............................................. 194 Colonoscopy ................................... 35, 39 Colorectal................................ 40, 94, 122 Constipation ...... 82, 93, 94, 122, 123, 159 Criterion .............................................. 218 Cyclic .................................................. 114 Cytokines . 41, 45, 46, 51, 52, 54, 74, 151, 253 Cytomegalovirus ................................... 91 Cytoprotection....................................... 89 Cytotoxins ........................................... 104 D Degenerative ........................ 99, 187, 241 Dehydration......................................... 114 Detoxification ........................................ 48 Diarrhea 69, 77, 91, 92, 94, 123, 159, 160, 186 Dietetics ................................................ 91 Disorientation ...................................... 115 Distal ......... 49, 64, 98, 101, 237, 251, 252 Diverticulitis........................... 97, 123, 159 Diverticulum ...................... 15, 92, 99, 241 Duodenum ... 17, 61, 73, 83, 91, 93, 238, 243 Dyspepsia ........... 11, 32, 90, 94, 122, 123 Dysphagia ................................. 91, 93, 94 Dysplasia ................ 38, 40, 128, 191, 193 E Edema................................................... 90 Electrolyte ............................. 91, 206, 251 Encephalopathy .................................... 82 Endemic ................................................ 55
Index 259
Endocrinology........................................83 Endoscopy..... 15, 34, 35, 39, 82, 83, 92, 217, 218, 219, 221, 222, 223, 224 Enteritis..............................40, 61, 95, 241 Enterocolitis .......................40, 61, 92, 241 Enzyme...... 17, 60, 64, 65, 150, 237, 239, 242, 250, 251, 255 Epidemiological ...............................46, 77 Epigastric ...........................17, 70, 76, 241 Epinephrine .........................................220 Epithelium..............................................46 Esophagitis .38, 40, 91, 96, 110, 114, 151, 254 Ethanol ....................................71, 76, 220 F Fats...17, 47, 61, 185, 186, 205, 238, 239, 243 Fibrosis ........45, 82, 97, 99, 101, 239, 253 Fissure...................................................92 Fistula ................................17, 61, 96, 243 Flatulence ......................................14, 159 Fructose.................................................97 G Gastroduodenal 44, 53, 61, 69, 88, 89, 93, 94, 223, 243 Gastroenteritis .........................18, 89, 252 Gastroscopy ........................................106 Gluten ....................................................95 Gout .........................................76, 79, 248 H Heartburn...............................93, 123, 159 Helicobacter.14, 15, 55, 71, 106, 133, 134 Hematemesis...............................217, 222 Hematology ...........................................10 Hemorrhage.76, 92, 93, 95, 217, 219, 223 Hemorrhoids ............34, 94, 122, 123, 159 Hemostasis..................217, 219, 220, 221 Hepatitis.............................82, 93, 97, 122 Heredity ...............................................159 Hernia ..............................91, 94, 122, 123 Histamine.....................150, 162, 239, 247 Homeostasis..........................................69 Hormonal ...............................................94 Hormones ..........60, 63, 64, 240, 247, 252 Hybridization..........................................49 Hyperplasia............................................37 Hypersecretion ................................39, 89 Hypersensitivity .....................................54 Hypertension .................................82, 159 I Ibuprofen ...............................................76 Idiopathic .........40, 44, 100, 101, 245, 253 Immersion..............................................71 Immunity .43, 46, 51, 62, 65, 87, 107, 159, 240, 245, 255 Immunization ...........44, 62, 206, 245, 253
Immunotherapy..................................... 46 Incontinence ................................... 82, 93 Indicative....... 66, 218, 219, 226, 248, 256 Induction ........................... 50, 51, 62, 245 Ingestion ..................... 36, 47, 71, 82, 189 Insulin... 59, 100, 116, 149, 235, 236, 246, 249 Interstitial................................. 90, 99, 239 Intestines............. 14, 61, 77, 78, 238, 243 Invasive........................................... 46, 55 Irrigation ...................................... 218, 221 J Jaundice.......................................... 82, 93 L Lesion .. 52, 55, 92, 95, 96, 220, 225, 226, 242, 247 Ligament ............................... 95, 184, 251 Lipodystrophy ....................................... 97 Localization ......................................... 223 Lumen ................................................... 90 Luminol ................................................. 48 Lymphoma .............................. 53, 63, 247 M Malabsorption ................... 82, 90, 91, 128 Malignant .... 54, 58, 60, 63, 84, 235, 238, 247 Membrane............................... 70, 74, 160 Menopause ................................... 18, 251 Mental .. 80, 116, 153, 156, 205, 240, 241, 251 Metaplasia 32, 34, 37, 38, 46, 48, 55, 113, 192 Microbiology.............. 45, 89, 99, 105, 237 Micronutrients ....................................... 91 Microorganism ........................ 16, 72, 236 Microscopy............................................ 48 Minocycline ........................................... 71 Molecular .... 10, 46, 50, 64, 78, 120, 125, 127, 236, 252 Motility........... 75, 82, 91, 93, 94, 206, 250 Mucus ....................................... 34, 55, 89 Mutagenesis ......................................... 51 N Naproxen .............................................. 76 Nausea.......... 11, 15, 61, 76, 98, 236, 243 Necrosis .............................. 101, 221, 253 Neonatal................................................ 40 Neoplasms .................. 38, 40, 63, 84, 249 Neural ................................... 62, 187, 245 Neurologic........................................... 115 Neuronal ............................................... 40 Neutralization ........................................ 89 Neutrophil.............................................. 32 Niacin .................................................. 186 Nosocomial ........................... 82, 100, 249
260 Gastritis
O Occult ....................................................35 Ornithine ..............................................161 Overdose .............................................187 Oxazolone .............................................56 P Pancreas ..... 82, 83, 93, 94, 95, 100, 116, 246, 249 Pancreatitis..............................82, 93, 122 Parasitic .................82, 116, 184, 238, 243 Parathyroid ..................................116, 250 Pediatrics.............................................193 Perforation ...83, 91, 93, 99, 221, 222, 241 Perianal .................................................92 Pernicious ......11, 15, 42, 94, 95, 131, 247 Peroxidase.............................................48 Pharmacist...................................140, 148 Phenotype ...................43, 46, 55, 64, 250 Pirenzepine..........................................194 Porphyria ...............................................97 Posterior ..............................218, 221, 223 Potassium..............79, 151, 188, 244, 250 Precursor ...................................46, 48, 52 Prevalence...........38, 53, 54, 89, 113, 122 Proctitis ..................................................97 Progressive......44, 55, 206, 226, 240, 248 Prophylaxis ..............................66, 74, 256 Prostaglandins.......................................93 Prostate ...............................................159 Proteins 48, 51, 60, 62, 64, 186, 188, 240, 245, 251 Proteolytic ........................................42, 70 Proximal.............................60, 78, 95, 241 Psychogenic ..........................................70 R Radiology...............................................83 Receptor ................38, 110, 150, 216, 247 Recombinant ...................................44, 49 Rectal ..............................................34, 39 Recurrence ..........................104, 206, 250 Reflux ...11, 14, 37, 40, 82, 91, 94, 95, 97, 105, 110, 151, 164, 192, 254 Refractory ........................................37, 90 Reinfection.............................................39 Respiratory ....................................59, 238 Resuscitation .................................91, 217 Rheumatoid .....76, 79, 150, 237, 242, 248 Riboflavin.............................................186 Rodentia ................................................56 S Saliva .....................................................33 Sarcoidosis ............................................97
Secretion ... 37, 39, 62, 63, 65, 74, 76, 77, 83, 89, 91, 93, 151, 162, 206, 244, 245, 247, 248, 250, 253 Selenium ............................................. 188 Serum ................. 150, 192, 206, 236, 253 Sigmoidoscopy ..................................... 35 Species 17, 48, 59, 60, 61, 62, 65, 66, 74, 135, 225, 238, 242, 243, 246, 253, 254, 256 Spectrum......... 10, 48, 150, 151, 236, 250 Sphincter..................................... 117, 253 Spondylitis............................. 44, 150, 242 Sputum................................................ 159 Stabilization........................................... 92 Staphylococcus............................. 79, 248 Stimulant ....................................... 62, 244 Subclinical............................................. 51 Sucralfate............................................ 193 Suction .................................................. 39 Suppressive .......................................... 35 Surgical ........... 19, 84, 219, 222, 223, 255 Systemic 43, 66, 101, 151, 225, 242, 253, 254, 256 T Tears............................................. 35, 217 Tetracycline............................. 77, 79, 248 Thermoregulation................................ 186 Thyroxine ............................................ 187 Tocolysis ............................................. 193 Topical .......................... 79, 226, 242, 255 Toxicology............................. 10, 121, 160 Trachea............................... 159, 184, 253 Transplantation ..................................... 82 U Ulceration. 45, 68, 83, 87, 89, 90, 95, 101, 255 Ulcerogenic ........................................... 91 Urea .................. 19, 64, 65, 106, 249, 255 Urease ...................................... 35, 54, 76 Urology.................................................. 10 V Vaccination ............................... 42, 54, 55 Vaccine .. 44, 47, 54, 58, 65, 89, 110, 235, 255 Vascular .......................................... 35, 96 Ventral................................................... 70 Viral............................................... 82, 122 Virulence ............... 45, 49, 51, 53, 55, 114 W Warfarin ........................................ 35, 193 X Xerostomia............................................ 94 Y Yeasts ..................................... 77, 80, 256
Index 261
262 Gastritis
Index 263
264 Gastritis
