The American journal of gastroenterology
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Am. J. Gastroenterol. · Nov 2008
Editorial CommentClinical guidelines versus universal molecular testing: are we ready to choose an optimal strategy for Lynch syndrome identification?
Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is the most common form of inherited colorectal cancer (CRC). Affected individuals need to undergo intensive CRC surveillance, screening for associated cancers, and possibly prophylactic surgery. Clinically-based guidelines have been used as the basis for Lynch syndrome screening in CRC patient populations. ⋯ In this issue of American Journal of Gastroenterology, Julie et al. compare the performance of clinical guidelines with a molecular strategy based on universal microsatellite instability (MSI) testing for identifying CRC patients who have Lynch syndrome. Although there is insufficient evidence to support universal molecular testing for all CRC patients at the current time, the study highlights the need for a systematic approach to identify patients with Lynch syndrome. Physicians and health care systems need to do a better job of identifying patients and families with early-onset of CRC and/or a consistent cancer family history so that they may undergo appropriate molecular evaluation, genetic counseling, and cancer risk management.
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Am. J. Gastroenterol. · Nov 2008
Somatosensory hypersensitivity in the referred pain area in patients with chronic biliary pain and a sphincter of Oddi dysfunction: new aspects of an almost forgotten pathogenetic mechanism.
Somatosensory hyperalgesia in the referred pain area (RPA) in patients with acute or chronic abdominal pain syndromes may result from the convergence of nerve fibers from visceral and somatic tissues at the spinal and supraspinal levels. Chronic biliary pain in patients with the postcholecystectomy syndrome (i.e., biliary hypersensitivity) may be explained by persistent hyperexcitability of neurons in the central nervous system (CNS). The aim of this study was to evaluate the cutaneous neural sensory perception in the RPA in patients with chronic postcholecystectomy biliary pain and a sphincter of Oddi (SO) dysfunction (SOD). ⋯ Continuous visceral pain (biliary pain) caused by local inflammatory/sensitizing processes or a CNS malfunction could lead to significant hypersensitivity of the peripheral nociceptive nerve fibers in SOD patients. Postcholecystectomy pain may be explained by persistent hyperexcitability of the nociceptive neurons in the CNS with or without objective motility disorders of the SO.
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Am. J. Gastroenterol. · Nov 2008
Intraductal papillary mucinous neoplasms of the pancreas: performance of pancreatic fluid analysis for positive diagnosis and the prediction of malignancy.
The preoperative diagnosis of intraductal papillary mucinous neoplasms (IPMN) of the pancreas must be as reliable as possible because large or even total pancreatectomy may be necessary. Early diagnosis of malignant forms is important to improve prognosis. The diagnostic accuracy of fluid analysis using endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been confirmed in cystic lesions of the pancreas. It is not known if these results can be applied to IPMN. ⋯ CEA and CA 72.4 in pancreatic cyst fluid have excellent NPVs in the preoperative differential diagnosis of benign versus malignant IPMN, and might reinforce the decision of not to operate on patients with BD-type without predictive factors of malignancy.