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Two distinct aetiologies of cardia cancer, evidence from premorbid serological markers of gastric atrophy and Helicobacter pylori status
No full textBackground: Non-cardia gastric adenocarcinoma is positively associated with Helicobacter pylori infection
and atrophic gastritis. The role of H pylori infection and atrophic gastritis in cardia cancer is unclear.
Aim: To compare cardia versus non-cardia cancer with respect to the premorbid state of the stomach.
Methods: Nested case–control study. To each of 129 non-cardia and 44 cardia cancers, three controls were
matched. Serum collected a median of 11.9 years before the diagnosis of cancer was tested for anti-H pylori
antibodies, pepsinogen I:II and gastrin.
Results: Non-cardia cancer was positively associated with H pylori (OR 4.75, 95% CI 2.56 to 8.81) and
gastric atrophy (pepsinogen I:II ,2.5; OR 4.47, 95% CI 2.71 to 7.37). The diffuse and intestinal histological
subtypes of non-cardia cancer were of similar proportions and both showed a positive association with
H pylori and atrophy. Cardia cancer was negatively associated with H pylori (OR 0.27, 95% CI 0.12 to
0.59), but H pylori-positive cardia cancer showed an association with gastric atrophy (OR 3.33, 95% CI 1.06
to 10.5). The predominant histological subtype of cardia cancer was intestinal and was not associated with
gastric atrophy compared with the diffuse subtype ((OR 0.72, 95% CI 0.19 to 2.79) vs (OR 3.46, 95% CI 0.32
to 37.5)). Cardia cancer in patients with atrophy had an intestinal: diffuse ratio (1:1) similar to non-cardia
cancer (1.9:1), whereas cardia cancers in patients without atrophy were predominantly intestinal (7:1).
Conclusion: These findings indicate two aetiologies of cardia cancer, one associated with H pylori atrophic
gastritis, resembling non-cardia cancer, and the other associated with non-atrophic gastric mucosa,
resembling oesophageal adenocarcinoma. Serological markers of gastric atrophy may provide the key to
determining gastric versus oesophageal origin of cardia cancer
Combination of gastric atrophy, reflux symptoms and histological subtype indicates two distinct aetiologies of gatric cardia cancer.
No full text<b>INTRODUCTION</b>
Atrophic gastritis is a risk factor for non-cardia gastric cancer, and gastro-oesophageal reflux
disease (GORD) for oesophageal adenocarcinoma. The role of atrophic gastritis and GORD in the
aetiology of adenocarcinoma of the cardia remains unclear. We have investigated the association
between adenocarcinoma of the different regions of the upper gastrointestinal tract and atrophic
gastritis and GORD symptoms.
<b>METHODS</b>
138 patients with upper GI adenocarcinoma and age and sex matched controls were studied.
Serum pepsinogen I/II was used as a marker of atrophic gastritis and categorised to five quintiles.
History of GORD symptoms, smoking and H.pylori infection was incorporated in logistic regression
analysis. Lauren classification of gastric cancer was used to subtype gastric and oesophageal
adenocarcinoma.
<b>RESULTS</b>
Non-cardia cancer was associated with atrophic gastritis but not with GORD symptoms; 55% of
these cancers were intestinal subtype. Oesophageal adenocarcinoma was associated with GORD
symptoms, but not with atrophic gastritis; 84% were intestinal subtype. Cardia cancer was positively
associated with both severe gastric atrophy [OR, 95% CI: 3.92 (1.77 – 8.67)] and with frequent
GORD symptoms [OR, 95% CI: 10.08 (2.29 – 44.36)] though the latter was only apparent in the nonatrophic
subgroup and in the intestinal subtype. The association of cardia cancer with atrophy was
stronger for the diffuse versus intestinal subtype and this was the converse of the association
observed with non-cardia cancer.
<b>CONCLUSION</b>
These findings indicate two distinct aetiologies of cardia cancer, one arising from severe atrophic
gastritis and being of intestinal or diffuse subtype similar to non-cardia cancer, and one related to
GORD and intestinal in subtype, similar to oesophageal adenocarcinoma. Gastric atrophy, GORD
symptoms and histological subtype may distinguish between gastric versus oesophageal origin of
cardia cancer
Gastric Cardia Cancer; The Most Common Type of Upper Gastrointestinal Cancer in Ardabil, Iran: An Endoscopy Clinic experience
No full textBackground-According to a recent report published by the Ministry of Health and
Medical Education of the I. R. of Iran, gastric cancer (GC) is the most common fatal cancer in
this country and its prevalence is highest in Ardabil province, Northwest of Iran. This
descriptive endoscopic survey was designed to determine the type of upper gastrointestinal
(GI) malignancy in this high prevalence area.
Method-This study was conducted in the first established subspeciality outpatient GI
clinic in the city of Ardabil. From 11,518 patients who attended this clinic in a one-year
period, 1,152 (10%) with persistent upper GI symptoms underwent upper GI fiberoptic
endoscopy and 162 (14.1%) had a tumor with malignant appearance. At least six endoscopic
punch biopsies were obtained from all the tumors and sent for histopathologic examination.
Demographic data was obtained from all 162 patients. Statistical analysis was performed
using the SPSS statistical software.
Results-The mean age of the patients with cancer was 63.5 ± 10.8 years and the male to
female ratio was 2.14:1. Villagers constituted 111 (70.7%) and urban dwellers constituted 46
(29.3%) patients. Upper GI cancer was diagnosed by histopathology in 157 patients (13.4%).
Stomach cancer constituted 107 cases (68.2%), 53 (49.5%) of which were cancers of the
gastric cardia and 50(31.8%) were esophageal cancer. The most common site of upper GI
malignancy was the gastric cardia 53 (33.8%) followed by the antrum 32(20.4%), esophageal
body 27 (17.2%), distal esophagus 23 (14.6%), and gastric body 22 (14.0%).
Conclusion-Cancer of the gastric cardia is now the most common upper GI malignancy
in Ardabil and constitutes almost half of all gastric cancers. It is recommended that subsitespecific
gastric cancer risk factors, including H. pylori and dietary nitrates, be studied in the
future in this region.
Keywords • Gastri
Incidence and survival of oesophageal and gastric cancer in England between 1998 and 2007, a population-based study.
No full textBACKGROUND: Major changes in the incidence of oesophageal and gastric cancers have been reported internationally. This study describes recent trends in incidence and survival of subgroups of oesophageal and gastric cancer in England between 1998 and 2007 and considers the implications for cancer services and policy. METHODS: Data on 133,804 English patients diagnosed with oesophageal and gastric cancer between 1998 and 2007 were extracted from the National Cancer Data Repository. Using information on anatomical site and tumour morphology, data were divided into six groups; upper and middle oesophagus, lower oesophagus, oesophagus with an unspecified anatomical site, cardia, non-cardia stomach, and stomach with an unspecified anatomical site. Age-standardised incidence rates (per 100,000 European standard population) were calculated for each group by year of diagnosis and by socioeconomic deprivation. Survival was estimated using the Kaplan-Meier method. RESULTS: The majority of oesophageal cancers were in the lower third of the oesophagus (58%). Stomach with an unspecified anatomical site was the largest gastric cancer group (53%). The incidence of lower oesophageal cancer increased between 1998 and 2002 and remained stable thereafter. The incidence of cancer of the cardia, non-cardia stomach, and stomach with an unspecified anatomical site declined over the 10 year period. Both lower oesophageal and cardia cancers had a much higher incidence in males compared with females (M:F 4:1). The incidence was also higher in the most deprived quintiles for all six cancer groups. Survival was poor in all sub-groups with 1 year survival ranging from 14.8-40.8% and 5 year survival ranging from 3.7-15.6%. CONCLUSIONS: An increased focus on prevention and early diagnosis, especially in deprived areas and in males, is required to improve outcomes for these cancers. Improved recording of tumour site, stage and morphology and the evaluation of focused early diagnosis programmes are also needed. The poor long-term survival reinforces the need for early detection and multidisciplinary care
Gastric Cancer in Ardabil, Iran - a Review and Update on Cancer Registry Data
No full textThe incidence rate of gastric cancer in western countries has shown a remarkable decline in recent years
while it is still the most common cancer among men in Iran. Ardabil, a North Western province, was found to
have the highest rate of GC in Iran and one of the highest gastric cardia cancer rates in the world. We used the
most recent data from Ardabil cancer registry to update on the incidence and mortality of GC and performed
an extensive search of the English and Persian literature in Pub Med, Embase and all 5 Persian web-based
databases, respectively, to summarize all possible risk factors for GC in Ardabil. The age-standardized incidence
rate of gastric cancer was 51.8 (95% CI: 47.8-55.8) in men and 24.9 (95% CI: 21.5-27.2) in women per 100,000.
Age-standardized mortality rates for gastric cancer in this population were 32.2 (95% CI: 29.1-35.3) and 16.3
(95% CI: 13.9-18.6). The gastric cardia sub-site was the most common location (32.7%) in Ardabil. According
to our review H.pylori infection, gastroesphageal reflux symptoms, tobacco smoking, and high intakes of salt,
red meat and dairy products increase the risk of GC while diets with a high content of allium vegetables and
fruits, especially citrus fruits, and consumption of fresh fish, were significantly protective against GC. We
conclude that Ardabil has the highest rate of GC in Iran and one the highest rates of gastric cardia cancer in
the world, with no evidence of decline in incidence since 2000. In addition to H.pylori infection, the epidemic
of gastroesphageal reflux disease and several dietary factors may be responsible for the very high incidence of
gastric cardia cancer in Ardabil
The Iterative Pole Density Estimation, a new approach to assess the stability of rock masses from 3D point clouds
No full textAssessment of the stability of rock masses is crucial in the process of risk mitigation. Among the many factors
predisposing the Italian territory to geohazards, it has to be mentioned the geological and geomorphological
setting, often characterized by karst processes and widespread presence of cavities, of both natural and
anthropogenic origin, potentially leading to sinkholes and other instability mechanisms. For these reasons, the
geological instability and to safeguard the environment.
out, over the last decade the implementation of new digitalized methods, such as close- and long-range
remote sensing techniques, has become essential to quantitatively describe the structural arrangement of rock
masses. This necessarily requires robust and reliable methods dedicated to extracting the primitive geometries
representing the discontinuities on a rock outcrop. A novel approach, combining observations made in situ with
digital results, has been recently proposed (Cardia et al., 2021). This method is able to extract discontinuities
tolerance angle ranges for both dip/dip direction.
We provide here an ongoing development of the method, based on an algorithm that has been implemented
in the software GeoDS. The algorithm takes as input a K value, representing a density threshold, from which
it will start searching for coplanar points in a given range of 10° for both dip and dip direction, and a seed
range value, that is the number of sample points that the system chooses randomly to evaluate each cluster. The
greater this value is set, the more successful is going to be the result; however, this comes with a computation
time cost, which extent depends on the computer capability.
This new algorithm, called IPDE (Iterative Pole Density Estimation) is then coupled with a KDE (Kernel
Density Estimation), extremely useful to plot the graphic projection, on which the user can choose to manually
select points or to evaluate the sets with two different automatic clustering techniques, K-means and Gaussian
Mixture. The proposed method aims to improve the evaluation of discontinuities on a rock outcrop in a new
and original way
Peroral Endoscopic Myotomy in a Patient with Achalasia Cardia with Prior Heller's Myotomy
No full textAchalasia cardia is an esophageal myenteric plexus disorder characterized by absence of or incomplete lower esophageal sphincter relaxation and esophageal aperistalsis; Heller's myotomy is the main treatment of choice due to a lower failure rate. Recently, peroral endoscopic myotomy (POEM) has been reported as an alternative treatment for Achalasia due to persistent symptoms after Heller's myotomy. An Indian male, aged 18 years, was admitted to the hospital due to dysphagia which had started more than 3 years ago. He also complained of occasional regurgitation and retrosternal pain with Eckardt score 6. Heller's myotomy was performed 2 years ago. Barium swallow showed Achalasia cardia and upper gastrointestinal endoscopy found liquid residue and resistance at the gastroesophageal junction. Esophageal manometry is concluded as Achalasia cardia type II with a median integrated relaxation pressure (IRP) of 25.6 mm Hg. He underwent POEM; with the help of a submucosal tunnel, an extension of up to 1 cm beyond the gastroesophageal junction could be achieved with a posterior orientation of myotomy. There were no adverse events after the POEM procedure. He was treated with a soft diet for 10 days and other supportive treatments. Following POEM, barium swallow showed a significant improvement and esophageal manometry exhibited that the basal lower esophageal sphincter pressure was normal with complete relaxation on swallowing and normal median IRP. The post-procedure Eckardt score was 0. We reported an Achalasia patient who received POEM after unsuccessful Heller's myotomy and showed clinical improvement. © 2020 The Author(s). Published by S. Karger AG, Basel
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