Although there is a growing repertoire of prescription and over-the-counter medications available for the treatment of gastroesophageal reflux disease (GERD), antireflux surgery remains a viable alternative option for those patients whose symptoms persist, according to the results of a recent survey.
Gastroespohageal reflux – when the acidic contents of the stomach rise into the lower esophagus, causing the burning sensation known as heartburn – is a common occurrence; however, when this symptom becomes chronic an individual is considered to have GERD. As well as the persistent discomfort GERD causes, there can be a number of serious consequences of the disease, including bleeding of the esophageal lining and esophageal cancer.
Many GERD patients are able to ameliorate their symptoms through lifestyle changes and there are also many medications available for the condition but symptoms unfortunately persist for some patients.
For these individuals, laparoscopic antireflux surgery – to rebuild and strengthen the muscular valve between the esophagus and the stomach – is an option, not only to ameliorate their symptoms but also to allow them to avoid a lifetime of medication use.
Nevertheless, there are risks associated with undergoing any kind of surgery and some recent reports in the medical literature have questioned whether the long-term benefits of laparoscopic surgery outweigh the risks of this procedure.
The recent study set out to evaluate the long-term effectiveness of laparoscopic antireflux surgery and to assess the continuing quality of life of patients who had undergone the procedure. Surveys were mailed to 350 patients who had undergone the procedure at the Massachusetts General Hospital from 1997 to 2006.
Of the 191 patients who returned a completed survey, 71% were satisfied with the long-term results of their surgery. Furthermore, only three patients (1.2%) required a repeat operation, a finding that “does not support other’s assertions that approximately half of these procedures fail”, according to David Rattner, Chief of General and Gastrointestinal Surgery at Massachusetts General Hospital and senior author of the report.
The results of this survey are encouraging for those GERD patients who do not respond well to medication, indicating that antireflux surgery is an excellent treatment alternative and, contrary to the medical literature, individuals are able to have a very good quality of life following surgery. “When this surgery is performed by an expert surgical team at a high-volume center, the outcome for most patients is excellent”, suggested Rattner.
Source: Gee DW, Andreoli MT, Rattner DW. Measuring the effectiveness of laparoscopic antireflux surgery: long-term results. Arch. Surg. 143(5), 482–487 (2008).
Novel compound holds promise for treating diarrhea
Scientists have discovered a novel compound that could potentially be developed into a drug for the treatment of diarrhea. It is hoped the compound will be developed into an inexpensive, easy-to-administer, safe and effective drug that could save millions of lives in developing countries.
It has been estimated that, worldwide, diarrhea kills 1.6–2.5 million children each year. By far the most common cause of this condition is the colonization of the small intestine by enterotoxigenic strains of bacteria, a consequence of ingesting contaminated food or water.
These bacteria multiply in the gut and produce toxins that enter the intestinal cells, causing an increase in intracellular cyclic nucleotides – messengers that stimulate the cells to secrete salts and water into the gut lumen. The resulting diarrhea can lead to profound fluid loss, dehydration and death.
Currently, treatment of diarrhea is aimed at minimizing fluid loss through the use of intravenous or oral rehydration therapy; however, this is merely an indirect approach to tackling the problem, involving the treatment of the consequences of diarrhea, rather than the treatment of diarrhea itself.
In this recently published study, scientists discovered a relatively simple compound that directly targets acute secretory diarrhea caused by enterotoxigenic strains of bacteria. This newly discovered compound blocks the ability of the bacterial toxins to increase the production of the intracellular signalling molecules responsible for the increase in fluid secretion.
The compound has shown promise in preclinical testing; in an animal model of bacterial diarrhea, it was associated with a significant reduction in intestinal fluid secretion and was linked to reduced fluid build-up in experiments on human colon cells.
The compound is relatively easily synthesized and is thus anticipated to be inexpensive to manufacture, making it a very attractive option for use in developing countries and, although much work certainly remains to be done, it is hoped that the drug may help to lessen the epidemic of diarrhea-related deaths in children in the Third World.
Source: Kots AY, Choi BK, Estrella-Jimenez M et al. Pyridopyrimidine derivatives as inhibitors of cyclic nucleotide synthesis: application for treatment of diarrhea. Proc. Natl Acad. Sci. USA 105, 8440–8445 (2008).
Rates of colorectal cancer screening differ among racial groups
White people are more likely to undergo screening for colorectal cancer (CRC) than either black people or Hispanics, according to a recently published study. The authors of the study state that the clear disparity in screening rates between ethnic or racial minority groups compared with non-Hispanic whites “may contribute to the higher colorectal cancer incidence and mortality rates observed in racial/ethnic minorities relative to non-Hispanic whites.”
Despite the fact that screening tests can discover the disease early enough to cure it, historically, the rates of screening for CRC have been lower than for other types of cancer and CRC is still the second leading cause of all cancer deaths in the US. However, rates of CRC have been declining in recent years, largely due to increased screening.
One diagnostic tool used to screen patients for CRC is the fecal occult blood test (FOBT), which is used to detect the presence of microscopic blood in the stool, an indication that cancer may be present in the bowel. In this recent study, researchers used national survey data from 22,973 adults aged 50 years and older and analyzed CRC screening behaviors. The breakdown according to race of those receiving a FOBT was 33.8% of Asians, 48.2% of blacks, 36.7% of Hispanics and 57.2% of whites.
The authors suggest a number of reasons for this racial disparity, including barriers related to socioeconomic status, healthcare access and language.
Importantly, the findings of this study could be used to help design programs aimed at targeting those minorities less likely to undergo CRC screening in order to increase the screening rates among these groups.
The authors propose a number of ways to aid the uptake of CRC screening in individuals from these minorities; for Asians, culturally targeted interventions are suggested; for blacks, enhancing access to healthcare is mentioned; and for Hispanics, offering language-appropriate care is proposed.
Since rapid detection of CRC allows for the appropriate treatment strategies to be implemented as early as possible, encouraging those individuals who would not otherwise undergo CRC screening to be tested could result in earlier identification of the cancer and therefore, hopefully, lead to better disease prognosis.
Source: Jerant AF, Fenton JJ, Franks P. Determinants of racial/ethnic colorectal cancer screening disparities. Arch. Intern. Med. 168(12), 1317–1324 (2008).
Predicting the efficacy of 5-fluorouracil prior to chemotherapy for colorectal cancer may be possible
By measuring the level of activity of four genes in tumor cells from patients with colorectal cancer (CRC), researchers have been able to accurately predict whether or not the tumors will respond to chemotherapy with 5-fluorouracil (FU), a drug widely used to treat CRC. Significantly, this gene test could be used as a tool to help doctors decide in advance whether or not to include 5-FU in the therapeutic regimen of CRC patients.
CRC is the third most common form of cancer and it is the second leading cause of cancer-related deaths in developed countries. Treatment options for CRC vary but include surgery, chemotherapy and radiotherapy.
5-fluorouracil is a drug that has been an established form of chemotherapy for the treatment of CRC for decades. The drug works by disrupting the ability of cells to divide; thus, although the drug acts systemically, the effects of 5-FU are most strongly felt by rapidly dividing cells, such as cancer cells. As a consequence of 5-FU’s systemwide effects, there can be a number of side-effects to treatment; for example, 5-FU can lower the levels of blood cells, making individuals more prone to bleeding, anemia and infections.
Despite these side effects, 5-FU is an important and effective chemotherapeutic, widely used to treat CRC; unfortunately, however, only 30% of patients respond to 5-FU and, until now, it has not been possible to ascertain in advance those patients who will benefit from the drug and those who will not.
In this recent study, by measuring the activity of genes within human CRC cell lines, scientists have found a pattern of gene activity of four genes that was associated with either resistance or sensitivity of tumours to 5-FU. Moreover, researchers have been able to apply the use of this four-gene ‘signature’ technique in a clinical setting; simply by examining the transcription profile of these four genes within CRC tumors, they were able to accurately predict the responses of patients undergoing chemotherapy with 5-FU.
To be able to predetermine the efficacy of 5-FU prior to initiating a patient on chemotherapy with the agent is highly beneficial; not only does it allow the patient to avoid the potentially serious side-effects of a drug that will in fact prove to be ineffective, it also enables the patient to commence a more effective treatment option at an earlier stage. Thus, this gene test – through helping to inform doctors of the best therapy for CRC patients – could increase the possibility of a more positive treatment outcome for these individuals.
Source: Albert Einstein College of Medicine www.aecom.yu.edu
Studies seeking alternative treatments for inflammatory bowel disease
Researchers looking for options other than medication for the amelioration of the symptoms of Crohn’s disease and ulcerative colitis are getting closer.
Two studies to find alternative cures for the two main forms of inflammatory bowel disease (IBD) have been launched at Rush University Medical Center. The aim of both studies is to find ways of treating IBD that will have fewer side-effects than conventional medication; one study aims to see whether reducing stress can have a beneficial effect for sufferers of ulcerative colitis (UC); the other aims to determine if dietary changes can ameliorate the symptoms of Crohn’s disease.
The term IBD encompasses a range of autoimmune conditions of the bowel and it is estimated that 1 million Americans have some form of the condition, a disease which is characterized by chronic inflammation of the gut, a consequence of an aberrant immune response within the intestinal tract.
By far the two most predominant forms of IBD are Crohn’s disease and UC and, although there are pathophysiological differences between the two diseases, they share a number of common symptoms, the most common of which are diarrhea and abdominal pain.
Throughout life, sufferers of each condition undergo constant cycles of flare-ups and remission and, over the course of their disease, most patients will undergo surgery for complications. Therapeutic drugs for IBD are aimed at managing the condition though controlling disease flare-ups.
Unfortunately, many IBD sufferers do not respond well to conventional medicine and the drugs for IBD are associated with a number of side-effects, some of which can be serious; “Unfortunately, the treatments for IBD can be toxic and risky. There are increased risks of cancer, infection and even death as a result of IBD treatment”, says Ali Keshavarzian, Director of Digestive Diseases and Nutrition at Rush and lead investigator of both new studies, “that’s why we’re looking at how diet as well as stress relate to the flare-ups. It may be that if we can lower stress and get the right diet, we may be able to control these illnesses.”
The first of the two studies, coinvestigated by Sharon Jedel, will examine the relationship between stress and flare-ups of UC. Participants in the trial – 100 subjects suffering from moderate-to-severe UC who have experienced a flare up of their condition within the last 6 months – will undergo 8-week courses on mind/body medicine to determine whether or not reducing stress – through education about stress, training individuals in certain stress-reduction technique and the use of complementary and alternative medicines – has the ability to lessen the symptoms of UC.
According to Keshavarzian, “Complementary treatments and services are a large, yet hidden section of our healthcare system”; however, there is currently a lack of scientific evidence to support their use. It is hoped that this study may provide some evidence that, for those UC sufferers in whom conventional medicine has failed to work, there may be some benefit to certain complementary or alternative stress-reduction therapies.
The second of the two studies will study the effect of diet on Crohn’s disease. The trial will enrol 90 Crohn’s patients and aims to see whether changes in the diet – through dietary adjustments as well as dietary food supplements – will promote the growth of beneficial bacteria that might help to control flare-ups of the condition. It is hoped that, through encouraging the growth of bacteria that have a favorable effect on the gut of their host, certain foods or food supplements may be able to reduce the symptoms of Crohn’s disease. “We are trying to improve the mix of bacteria in the intestines of patients with IBD”, says Ece Mutlu, principle investigator of the study, “We’re trying to create a harmonious environment in the intestines with the right types of bacteria”. This trial may provide evidence to support the idea that something as simple as changing one’s diet can be used to help control flare-ups of Crohn’s disease.
The principal goal of both of the studies is to find alternative ways of managing IBD that may have fewer side effects than drugs currently used to treat these debilitating conditions. The researchers are aiming to discover straightforward means by which sufferers of IBD are able to control their condition, ultimately hoping to find solutions that may even negate altogether the requirement for these individuals to take conventional medication.
Source: Rush University Medical Center: www.rush.edu