Clinical Review

Recent developments in gastroenterology

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7377.1399 (Published 14 December 2002) Cite this as: BMJ 2002;325:1399
  1. Paul Moayyedi, professor (p.moayyedi@bham.ac.uk)a,
  2. Alex Ford, research registrarb
  1. a Gastroenterology Unit, City Hospital NHS Trust, Birmingham B18 7QH
  2. b Gastroenterology Unit, Leeds General Infirmary, Leeds LS1 3EX
  1. Correspondence to: P Moayyedi

Gastroenterology, like many other disciplines, is expanding rapidly. In the past four years there have been exciting advances in screening, diagnosis, and therapy. This article describes some of the most clinically relevant developments.

Methods

We selected the topics after discussion with colleagues and attending the British Society of Gastroenterology meeting, Birmingham 2002. We subjectively assessed the most important recent innovations and evaluated these in more depth by searching Medline and the Cochrane Controlled Trials Register. We also hand searched recent issues of Gastroenterology, Gut, and Gastrointestinal Endoscopy.

Screening

Gastric cancer

Gastric cancer is the second commonest cause of cancer mortality worldwide, causing around 660 000 deaths annually. In England and Wales it is the fifth commonest cause of cancer death, with an annual mortality of about 7000. A meta-analysis of nested case-control studies reported that patients infected with Helicobacter pylori were nearly six times more likely to develop distal gastric adenocarcinoma than uninfected controls.1 A recent randomised trial suggests that eradication of H pylori will improve gastric atrophy and intestinal metaplasia, which are thought to be premalignant changes.2 Studies have also identified subgroups of people infected with H pylori who may be at particular risk of developing gastric cancer.3 A randomised trial showed that H pylori screening and treatment might save money because of the reduced costs of treating dyspepsia.4

Oesophageal and proximal gastric adenocarcinoma have been increasing in recent years, and this parallels the fall in prevalence of H pylori infection. Some investigators have therefore suggested that H pylori infection protects against the development of cancers of the proximal stomach and oesophagus. This hypothesis is not supported by a meta-analysis of nested case-control trials,1 but the benefits and harms of population screening and treatment for H pylori can properly be evaluated only in a randomised controlled …

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