6B, images corresponding to the Control (control medium) and to H

6B, images corresponding to the Control (control medium) and to HB-EGF + Gefitinib were substituted for a panel belonging to Fig. 6A. The corrected

versions of Figure 5C and 6B are provided below. The publisher regrets the error. “
“Distress in infancy is often related to abdominal symptoms or feeding. Infantile “colic” is very common and transient, and may be improved treating by associated gastro-oesophageal reflux and/or food allergy. An approach to assessment is described, aiming to identify rarer or less benign conditions, including a directed clinical examination and key investigations. “
“This chapter provides an approach to the immediate assessment and differential diagnosis of upper and lower gastrointestinal bleeding, with blood selleck chemical test and imaging investigations. “
“A 36-year-old man presented with two weeks of intermittent dull upper abdominal pain, fever and rigors.

He had no significant medical history and no previous surgical history. On examination, he was febrile (38°C) with severe tenderness over the upper abdomen. Laboratory examination disclosed marked elevated white blood cell count of 24,140/µL (normal range 3,500–9,100/µL). Abdominal sonography disclosed a heterogeneous mass over left lobe of the liver with a linear hyperechoic material in it (Figure 1, arrow). An abdominal computed tomography revealed a multi-cystic BAY 73-4506 research buy lesion in left lobe of the liver with a linear calcified material within (Figure 2). The findings of sonography and computed tomography check details suggested a pyogenic liver abscess associated with a penetrating fish bone. After controlling the sepsis, this patient was referred to the surgical department and the penetrating fish bone was removed. Perforation occurs in less than 1% of all cases of ingested foreign bodies. Perforation can occur at any level of the alimentarytract,

and the commonest site is the terminal ileum. A fish bone is the commonest type of foreign body causing gastrointestinal perforation. Liver abscess is a rare but potentially fatal complication of fish bone penetration. Less than 20 cases have been documented in the literature. The diagnosis is suggested by abdominal computed tomography showing the linear hyperattenuating structure within the abscess. The initial treatment of liver abscess caused by a penetrating fish bone includes both drainage and antibiotic therapy. Although medical therapy alone had been reported to be successful, surgical or percutaneous transhepatic removal of the fish bone remains the treatment of choice in the literature to prevent recurrence. Contributed by “
“Clinical perspectives in hepatology aims to engage two experts with opinions supporting differing perspectives on the management of a case. Typically, the case represents an area of debate or evolving practice in clinical hepatology. The case described by Drs.

Other studies promote individualized therapies based on host poly

Other studies promote individualized therapies based on host polymorphisms, age, and other such demographic factors. Over the last decade, it has been widely

reported that the success of Helicobacter pylori eradication treatment is falling. A steady decline was observed in the number of patients achieving eradication with standard first-line triple therapy of two antibiotics and a proton pump inhibitor [1–3]. It now appears that the first-line eradication Poziotinib therapies most commonly used in everyday clinical practice fall considerably short of the 80% intention-to-treat (ITT) eradication rates that are considered the minimal acceptable levels as recommended in the Maastricht guidelines [4]. Interestingly, two studies emerged from Asian centers in the last 12 months, which show that, in this part of the world at least, eradication levels using standard therapies remain

Doxorubicin concentration close to 80%. A Malaysian study showed a standard 1-week pantoprazole, amoxycillin, and clarithromycin regimen to be well tolerated and highly efficacious with a per-protocol eradication rate of 84% [5]. A Japanese study showed remarkably consistent per-protocol eradication rates from 2001 to 2009 fluctuating between 75 and 78% for standard 7-day triple-therapy regimens [6]. A limit of many studies especially those including clarithromycin or levofloxacin is that H. pylori susceptibility to the drugs, which is the main prediction of failure, was not tested. The use of levofloxacin selleckchem as a first-line therapy has been examined in great depth in the last year. Levofloxacin may be used as a substitute

for clarithromycin in either a standard triple or sequential regimen. A large study comparing the antibiotics in either regimen shows a clear advantage to levofloxacin in both combinations. Per-protocol cure rates for triple therapy were 66% for omeprazole–clarithromycin–amoxycillin compared with 83% for omeprazole–levofloxacin–amoxycillin and 81% for omeprazole–amoxycillin–clarithromycin–metronidazole vs 85% for omeprazole–amoxycillin–levofloxacin–metronidazole, with no difference in compliance rates or adverse events [7]. It has been proposed that sequential levofloxacin-based regimens are of most benefit in areas where clarithromycin resistance is in excess of 15%, and another study in such an area showed eradication rates of 81% with clarithromycin sequential therapy compared with 96% with levofloxacin sequential therapy. A third arm in this study looked at the dose of levofloxacin required and illustrated no benefit in increasing the dose from 250 to 500 mg [8]. Indeed, another study went so far as to suggest that once-daily dosing of a levofloxacin-based triple regimen may be as efficacious as twice daily [9]. The literature from Asia also seems to support levofloxacin as a good alternative first-line therapy.

23, 27, 28 Although serum autoantibodies against the E2 subunits

23, 27, 28 Although serum autoantibodies against the E2 subunits of mitochondrial 2-oxo-dehydrogenase have been well characterized in PBC,1, 6 the discovery that these proteins are intact only in ABs from HiBECs helps to explain the selective destruction of biliary cells in the disease. We previously reported a HiBEC-specific failure in the postapoptotic degradation (PAD) of antigenic PDC-E2, the major autoantigen.4 In this study, we demonstrated that defective PAD in HiBECs is not limited to PDC-E2, but also involves OGDC-E2 and BCOADC-E2 that are also intact

in HiBEC ABs. We identified in ABs from HiBECs the other PBC-specific mitochondrial autoantigens, OGDC-E2 and BCOADC-E2, which are recognized by serum antibodies in approximately 23% and 57%, respectively, of patients.9 Thus, all three mitochondrial 2-oxo acid Selleck Olaparib AZD1152 HQPA dehydrogenase complexes that are autoantigens in PBC can be traced to HiBEC ABs. These findings highlight the involvement of inappropriate PAD as the source of autoantigens and perhaps in the pathogenesis of biliary-selective damage in PBC. This study focused on the tissue specificity of the apotope. Upon being taken up by local professional phagocytotic cells, these incompletely processed proteins may critically challenge the balance between tolerance and autoimmunity, thus providing a structural basis for the eventual biliary

epithelial cell (BEC)-selective immune response of PBC. However, we hypothesize that the unique PAD pattern of HiBECs is not sufficient to initiate the pathologic damage in

PBC, not only because the HiBECs studied here are from donors without PBC and the autoantigen-loaded ABs may therefore occur in anyone, but because PBC frequently recurs even after allogenic liver transplantation. In addition, the constant leakage of intact cellular components may cause antigen accumulation in regions near BECs. Epithelial cells can either uptake and process ABs from their neighboring apoptotic cells as nonprofessional phagocytes29, 30 or present pathologic epitopes onto their surface as nonprofessional antigen-presenting cells.31-33 In PBC, the atypical distribution of PDC-E2 on the surface of BECs in patients has been described.34-37 The presence of pathological epitopes on the surface of BECs may selleck compound serve as targets to attract the autoantibody-mediated immunologic attack if tolerance has been broken. Our data suggest that the defect of cellular protein PAD is not unique to HiBECs. We found several intact autoantigens in ABs of different epithelial cells, implying human epithelial cells variably process their apoptotic leftovers due to factors yet to be determined. We found BCOADC-E2, a PBC autoantigen, to be immunologically intact in epithelial cells other than HiBECs. This finding would suggest that cells other than biliary epithelium could be targeted by the immune response in patients with PBC and anti–BCOADC-E2 autoantibodies.

Significant factors associated with GERD were education level, ec

Significant factors associated with GERD were education level, economic level, asthma status, and delayed gastric emptying. Studies with larger numbers of subjects needed to analysed factors which related with

GERD. Key Word(s): 1. GERD; 2. Prevalence; 3. Risk factor; 4. Socioepidemiological; Presenting Author: UDAYCHAND GHOSHAL Additional Authors: SUSHIL KUMAR, SAMIR MOHINDRA, RD MITTAL Corresponding Author: UDAYCHAND GHOSHAL Affiliations: SGPGIMS, Lucknow Objective: IL-8–251T/A and IL-10 (-1082G/A, -819C/T, -592C/A) polymorphisms may influence gastritis, selleck compound gastric atrophy, intestinal metaplasia (IM) and gastric cancer (GC) following H. pylori infection altering their expression. Methods: Genotyping of these genes was performed (ASO-PCR) in 180

each patients with GC and functional dyspepsia (FD) and 250 healthy subjects (HS). Serum IgG-antibody against H. pylori was tested in all subjects and IL-8 and IL-10 were measured in 60 subjects in each group using commercial ELISA. Results: IL-8 AA and IL-10–819 TT (-592 AA) genotypes were commoner among GC than HS (43/180 [23.9%] vs. 35/250 [14.0%]; OR 1.9 [1.09–3.3], p = 0.022 and 35/180 [19.4%] vs. Quizartinib molecular weight 30/250 [12.0%]; OR 2.03 [1.12–3.7], p = 0.02) but comparable with FD (35/180 [19.4%], p = 0.59 and 35/180 [19.4%], p = 0.68). IL-8 AA and Il-10 -819 T allele carriers were commoner in H. pylori-infected patients with GC than HS (28/101 [27.7%] vs. 22/168 [13.1%]; OR 2.8 [1.38–5.71], p = 0.004 and 18/101 [17.8%] vs. 21/168 [12.5%]; OR 1.7 [1.01–2.96], p = 0.046, respectively). IL-10–1082 G/A genotype and IL-10 haplotypes (ACC, GCC, ATA and GTA) were comparable in all groups. IL-8 level was higher among patients with GC and FD than HS (57.64 [6.44–319.46] vs. 54.35 [4.24–318.96] vs. 26.33 [4.67–304.54] pg/ml, and respectively; p = ns for GC vs. FD and p < 0.0001 for GC vs. HS). IL-10 level was lower in patients with GC

check details than HS and among H. pylori-infected than non-infected subjects (3.79 [1.24–56.65] vs. 15.468 [1.01–27.86], p = 0.0001 and 8.34 [1.24–54.43] vs. 12.28 [0.96–64.87], p = 0.012 pg/ml). Conclusion: IL-8–251AA and IL-10 -819TT gene polymorphisms is associated with GC. These cytokines may play role in H. pylori-associated gastric carcinogenesis in India. Key Word(s): 1. H. pylori; 2. gastric cancer; 3. Gene polymorphism; 4. Functional dyspepsia; Presenting Author: JEONG BAE PARK Additional Authors: YONG KOOK LEE, KANG KIM, CHANG HEON YANG Corresponding Author: JEONG BAE PARK Affiliations: Dongguk University College of Medicine; Soksiwon Objective: NOTES is performed by endoscope entering through the peritoneal or thoracic cavity without conventional skin excision, so that it is expected to decrease complications from surgical operation and increase patient’s quality of life.

Significant factors associated with GERD were education level, ec

Significant factors associated with GERD were education level, economic level, asthma status, and delayed gastric emptying. Studies with larger numbers of subjects needed to analysed factors which related with

GERD. Key Word(s): 1. GERD; 2. Prevalence; 3. Risk factor; 4. Socioepidemiological; Presenting Author: UDAYCHAND GHOSHAL Additional Authors: SUSHIL KUMAR, SAMIR MOHINDRA, RD MITTAL Corresponding Author: UDAYCHAND GHOSHAL Affiliations: SGPGIMS, Lucknow Objective: IL-8–251T/A and IL-10 (-1082G/A, -819C/T, -592C/A) polymorphisms may influence gastritis, FK228 gastric atrophy, intestinal metaplasia (IM) and gastric cancer (GC) following H. pylori infection altering their expression. Methods: Genotyping of these genes was performed (ASO-PCR) in 180

each patients with GC and functional dyspepsia (FD) and 250 healthy subjects (HS). Serum IgG-antibody against H. pylori was tested in all subjects and IL-8 and IL-10 were measured in 60 subjects in each group using commercial ELISA. Results: IL-8 AA and IL-10–819 TT (-592 AA) genotypes were commoner among GC than HS (43/180 [23.9%] vs. 35/250 [14.0%]; OR 1.9 [1.09–3.3], p = 0.022 and 35/180 [19.4%] vs. selleck chemicals 30/250 [12.0%]; OR 2.03 [1.12–3.7], p = 0.02) but comparable with FD (35/180 [19.4%], p = 0.59 and 35/180 [19.4%], p = 0.68). IL-8 AA and Il-10 -819 T allele carriers were commoner in H. pylori-infected patients with GC than HS (28/101 [27.7%] vs. 22/168 [13.1%]; OR 2.8 [1.38–5.71], p = 0.004 and 18/101 [17.8%] vs. 21/168 [12.5%]; OR 1.7 [1.01–2.96], p = 0.046, respectively). IL-10–1082 G/A genotype and IL-10 haplotypes (ACC, GCC, ATA and GTA) were comparable in all groups. IL-8 level was higher among patients with GC and FD than HS (57.64 [6.44–319.46] vs. 54.35 [4.24–318.96] vs. 26.33 [4.67–304.54] pg/ml, and respectively; p = ns for GC vs. FD and p < 0.0001 for GC vs. HS). IL-10 level was lower in patients with GC

this website than HS and among H. pylori-infected than non-infected subjects (3.79 [1.24–56.65] vs. 15.468 [1.01–27.86], p = 0.0001 and 8.34 [1.24–54.43] vs. 12.28 [0.96–64.87], p = 0.012 pg/ml). Conclusion: IL-8–251AA and IL-10 -819TT gene polymorphisms is associated with GC. These cytokines may play role in H. pylori-associated gastric carcinogenesis in India. Key Word(s): 1. H. pylori; 2. gastric cancer; 3. Gene polymorphism; 4. Functional dyspepsia; Presenting Author: JEONG BAE PARK Additional Authors: YONG KOOK LEE, KANG KIM, CHANG HEON YANG Corresponding Author: JEONG BAE PARK Affiliations: Dongguk University College of Medicine; Soksiwon Objective: NOTES is performed by endoscope entering through the peritoneal or thoracic cavity without conventional skin excision, so that it is expected to decrease complications from surgical operation and increase patient’s quality of life.

The pooled estimate of BCLC B+C stage 1-year survival rate was 34

The pooled estimate of BCLC B+C stage 1-year survival rate was 34% (95%CI, 22-48; range, 3%-75%). There was a statistically significant heterogeneity among studies, P < 0.0001 (Fig. 4A). The pooled estimate of BCLC B stage 1-year survival rate was 49.6% (95%CI, 32-75; range, 3%-75%). There was a statistically significant heterogeneity among studies, P < 0.0001 (Supporting Fig. 1A). The pooled estimate of BCLC C stage 1-year survival rate was 25% (95%CI, 14-40; range, 3%-63%). There was

a statistically selleck screening library significant heterogeneity among studies, P < 0.0001 (Supporting Fig. 1B). The pooled estimate of BCLC D stage 1-year survival rate was 11% (95%CI, 4.7-22; range, 0-57%), and there was a statistically significant heterogeneity among studies, P < 0.0001 (Fig. 4B). We in turn excluded each study to ensure that no single study would be solely responsible for the heterogeneity of any result (so-called robust analysis). In all the robust analyses, heterogeneity among studies was significant. Moreover, in all the sensitivity analyses

excluding the 2 RCTs with the highest and the lowest survival rates, heterogeneity was significant. Regression analysis for the B+C stage studies showed that six variables were associated with an increased 1-year survival rate: studies published before 2000 (P = 0.001), low prevalence of alcohol-related disease (P = 0.016), high prevalence of HCV-related disease Midostaurin in vivo (P = 0.021), high

percentage click here of ECOG PS = 0 patients (P = 0.001), low percentage of patients with ascites (P = 0.001), and high percentage of Okuda stage I patients (P = 0.001) (Table 3). Regression analysis for the D stage studies showed that three variables were associated with an increased 1-year survival rate: North American and European studies (P = 0.006), low percentage of HBV-related disease (P = 0.004), and low percentage of portal vein thrombosis (P = 0.01) To examine any potential differences in study features, we next calculated pooled estimates of the 1-year survival rate within each stratum and evaluated heterogeneity among strata. However, heterogeneity was equally evident in all strata (Supporting Table 5). The funnel and the Egger publication bias plots for 1-year survival rates are shown in Supporting Fig. 2. The plots and the Egger test for publication bias showed that the risk of having missed or overlooked trials was significant: the P value was 0.0003 with the Egger test. The funnel and the Egger publication bias plots for 2-year survival rates are shown in Supporting Fig. 3. The plots and the Egger test for publication bias showed that the risk of having missed or overlooked trials was significant: the P value was 0.003 with the Egger test.

There are several possible contributory factors predisposing the

There are several possible contributory factors predisposing the older gastrointestinal tract to disease. With these changes

and the ageing population, the number of older people consulting with gastrointestinal symptoms will increase. Evidence-based studies examining the management of gastrointestinal problems in older people are rare, and in most of the current literature older people are specifically excluded from studies. As a result, a great deal of clinical practice in the elderly is extrapolated from studies in the young. “
“We read with much interest the recently published study on the association MI-503 cell line between carotid atherosclerosis and chronic hepatitis C by Salvatore Petta and colleagues.1 The authors demonstrate that severe hepatic fibrosis is associated with a high selleck kinase inhibitor risk of early carotid atherosclerosis in patients with genotype 1 chronic hepatitis C.1 We have also described in rats with long-term prehepatic portal hypertension (PH) the development of chronic inflammatory impairment of the abdominal aorta, which could be considered an atherosclerosis-like disease.2 Consequently, 22 months after PH, the rats developed aortic oxidative and nitrosative stress, with increased aortic mRNA expressions of nicotinamide adenine dinucleotide

phosphate oxidase (NAD(P)H) p22phox, xanthine dehydrogenase (XDh), superoxide dismutase (SOD), and endothelial nitric oxide synthase (eNOS); higher aortic levels of proinflammatory cytokines, including tumor necrosis factor-α, interleukin (IL)-1β and IL-6 and remodeling

markers such as collagen I, connective tissue growth factor (CTGF), and matrix metalloproteinase-9 (MMP-9); and higher collagen and extracellular matrix production. Very long-term PH in the rat, therefore, induces an aortic chronic inflammatory response that is associated with fibrosis (Fig. this website 1).2 Because the role of inflammation in the initiation and progression of vascular diseases is increasingly recognized,3 the cause of this morphofunctional aortic alteration in the prehepatic portal hypertensive rat could also be of an inflammatory nature. Additionally, the coexistence in this experimental model of liver steatosis and dyslipidemia4 suggests the involvement of an atherogenic pathogenic mechanism in the production of an aortic disease related to PH.2 Although animal studies require judicious interpretation and recognition of their limitations when extrapolating to human diseases,5 these results suggest that inflammation related to prehepatic PH could be an atherogenic risk during long-term follow-up in humans. Particularly, this pathogenic portal hypertension-aortic disease relationship must be researched in patients with hepatic fibrosis. PH per se seems to represent a systemic inflammatory risk factor for developing atherosclerosis.

breath test; 4 GERD; Presenting Author: XIONG YANYAN Correspondi

breath test; 4. GERD; Presenting Author: XIONG YANYAN Corresponding Author: XIONG YANYAN Affiliations: ying tan people’s hospital Objective: To compare the eradication efficacy of 10-day sequential therapy and quadruple therapy for patients with failed H. pylari eradication. Methods: Eight-nine patients who had failed H. pylori eradication were randomly divided two groups. Forty-five patients received a 10-day sequential therapy [rabeprazole (10 mg, twice daily) plus amoxicillin (1000 mg, twice daily) for the first days, followed by rabeprazole (10 mg), clarithromycin

(500 mg) and metronidazole (400 mg) twice daily for the Cilomilast remaining 5 days]. Forty-four patients received quadruple therapy [rabeprazole (10 mg), clarithromycin (500 mg) and metronidazole (400 mg)], and bismuth subcitrate 220 mg, twice daily for 7 days]. Four weeks after the end of reeatment, 14C-urea breath test was re-examined to assess H. pylori eradication rate. Results: The eradication rate of

the 10-day sequential therapy was 91.1%, and merely 75% for quadruple therapy group. The difference between the two groups was significant (P < 0.05). There was no difference in incidence of side of fects between the two grorps (P > 0.05). Conclusion: Both http://www.selleckchem.com/products/XL184.html sequential therapy and quadruple therapy can be used as a rescue therapy for eradication of H. pylori in patients with failed H. pylori in patients cradication. And the sequential therapy is more effective and better treatment for pylori eradication. Key Word(s): 1. Sequential therapy; 2. Helicobacter

pylori; 3. Qradruple therapy; Presenting Author: TINGTING XIE Additional Authors: BO JIANG Corresponding Author: BO JIANG Affiliations: Department of Gastroenterology, Nanfang Hospital, Southern Medical University Objective: he role of H. pylori infection in the pathogenesis of Gastro-esophageal reflux disease (GERD) is controversial. We aimedto evaluate the relationship between H. pylori and GERD and confirm whether the eradication is associated with the development of GERD. Methods: Case-control click here studies comparing the prevalence of H. pylori infection between patients with and those without endoscopic GERD, cohort studies (A) comparing the incidence of de novoendoscopicGERD between patients with and those without anti-H. pylori eradication therapy and cohort studies (B) comparing the incidence of endoscopicGERD between H. pylori positive patients with and those without successful eradication were included. Moreover, effects of H. pylori eradication on the development of endoscopicGERD in randomized controlled trials (RCTs) were also analyzed. Results: 44 studies were analyzed, including 20 case-controls, 3 cohort studies (A), 9 cohort studies (B) and 12 RCTs. Whereas case-control studies showed a lower prevalence of H. pylori infection in patients with GERD (OR = 0.67, 95% CI: 0.51–0.88), cohort studies (A) showed an increasedincidence of de novo GERD in patients whose H. pylori infection was successfully eradicated (RR = 2.50, 1.

Highest prevalence of NAFLD was seen among Indian and Malay males

Highest prevalence of NAFLD was seen among Indian and Malay males at 33.3 click here % and 25.5 %, respectively. The prevalence of NAFLD among Chinese males was 6.8 %. Independent factors associated with NAFLD were: age, male gender, obesity and elevated serum ALT level. Conclusion: The particularly high prevalence of NAFLD among Indian and Malay males is observed as early as young adulthood and is consistent with the higher prevalence of obesity in these groups. Key

Word(s): 1. NAFLD; 2. ethnicity; 3. young adult; 4. epidemiology; Presenting Author: WAH KHEONG CHAN Additional Authors: ALEXANDER TONG BOON TAN, SHIREENE RATNA VETHAKKAN, PEI CHIEN TAH, ANUSHYA VIJAYANANTHAN, KHEAN LEE GOH Corresponding Author: WAH KHEONG CHAN Affiliations: University of Malaya Objective: Non-alcoholic fatty liver disease (NAFLD) has been associated with increased cardiovascular diseases independent of traditional risk factors for atherosclerosis. We embarked on http://www.selleckchem.com/products/Maraviroc.html this study to determine if ultrasonography-diagnosed

NAFLD is associated with prevalent ischemic heart disease (IHD) among diabetics in a hospital clinic setting. Methods: This is a cross-sectional study on consecutive patients seen at the Diabetic Clinic of University of Malaya Medical Centre. Diagnosis of NAFLD was by ultrasonography following exclusion of significant alcohol intake and other causes of chronic liver disease. The medical record for each patient was reviewed for documented IHD. Patients without documented IHD but had symptoms and/or electrocardiographic changes suggestive of IHD were referred for cardiac evaluation. Results: Data for 399 patients were analyzed. Mean age was 62.8 ± 10.5 years with 43.1% male. Mean duration of diabetes mellitus was 16.2 ± 9.7 years and mean serum HbA1c level was 8.1 ± 1.8%. NAFLD and IHD were present in 49.6% and 26.6%, respectively. Ultrasonography-diagnosed NAFLD and serum ALT and GGT levels

were not associated with IHD. The prevalence of IHD was highest among the Indians (34.1%) followed by the Malays (29.2%) and the Chinese (20.1%). No association selleck compound was found between ultrasonography-diagnosed NAFLD or serum ALT and GGT levels and IHD when analyzed according to ethnicity. On multivariate analysis, independent factors associated with IHD were older age, lower levels of physical activity, greater waist circumference and higher serum glycated hemoglobin level. Conclusion: Ultrasonography-diagnosed NAFLD was not associated with prevalent IHD among long-standing poorly-controlled diabetics. Better characterization of NALFD using non-invasive methods may allow more accurate risk stratification for cardiovascular disease. Key Word(s): 1. NAFLD; 2. IHD; 3. diabetes mellitus; Presenting Author: ROMMELPARULAN ROMANO Additional Authors: MELCHORMESA CHAN, CARMELITADADO DALUPANG, CHANDY LOUPATIAG MALONG, ABIGAIL MILO, MARIO MILO Corresponding Author: ROMMELPARULAN ROMANO Affiliations: University of Santo Tomas Hospital Objective: Background.

(HEPATOLOGY 2011;) Cholangiocarcinoma (CC) is a malignant neoplas

(HEPATOLOGY 2011;) Cholangiocarcinoma (CC) is a malignant neoplasm of the biliary-duct system accounting for 3% of gastrointestinal tumors.1-3 It is the second most common primary hepatic malignancy, representing 10%-25% of primary hepatic malignancies worldwide.1, 4, 5 CC rarely occurs before the age of 40; the typical age at presentation is the seventh decade of life.3, 4 Men have a higher incidence of CC than do women,3, 6-9 with ratios of 1:1.2-1.5. The incidence of CC varies greatly by geographic region secondary to variations in risk factors.3, 5 The prognosis click here of CC is poor;

therefore, mortality and incidence rates are similar. Although there are established risk factors for the development of CC, most patients

do not have an identifiable risk aside from age.1, 4 Anatomically, CC can be classified as intra- or extrahepatic in location.2 Hilar CC (i.e., Klatskin tumors) is typically considered extrahepatic. The distinction between this website intrahepatic CC (ICC) and extrahepatic CC (ECC) has become increasingly important, as the epidemiological feature (i.e., incidence and risk factors) associated with each may be different.1, 2 In this review, we will distinguish between ICC and ECC, because epidemiological differences may exist between them. Otherwise, CC will be used when studies do not distinguish between ICC and ECC. Population-based incidence data on CC are sparse. Most cancer registries combine cases of CC with other hepatobiliary malignancies, such as hepatocellular cancer (HCC) and gallbladder cancer.6, 8 Worldwide, the incidence of CC varies greatly.3,

8 Regions such as Thailand in Southeast Asia have the highest incidence of CC, as high as 113 per 100,000 in men and 50 per 100,000 in women, whereas in Western countries such as Australia, the incidence is low, at 0.2 per 100,000 in men and 0.1 per 100,000 in women.3, 5 Differing exposure to risk factors is thought to account for the varying geographic incidences, with parasitic infections and selleck chemicals llc hepatolithiasis being more prevalent in Asia.3, 5 Several studies published in the early 2000s reported international trends in increased incidence of ICC and decreased incidence of ECC,6, 8 but the role that misclassification of hepatobiliary cancer plays in explaining epidemiological trends may be substantial. The incidence of CC in the United States is reported from the population-based registries of the Surveillance, Epidemiology, and End Results (SEER) program. The age-adjusted annual incidence of ICC increased from 0.13 per 100,000 persons in 1973 to 0.67 per 100,000 in 19977 and to 0.85 per 100,000 persons during 1995-1999 and a decline in ECC incidence from 1.08 per 100,000 in 1979 to 0.82 per 100,000 in 1998.3 However, the recent SEER data from 2000 to 2005 show that the annual incidence of ICC has declined to 0.58 per 100,000 and that of ECC has increased to 0.88 per 100,000.