OBJECTIVEThis review discusses the current status and progress in studies on gastric cancer with liver metastasis (GCLM), involving the routes, subtypes, and prognosis of GCLM; the genes and molecules associated with metastasis; the feasibility and value of each imaging modality; and current treatment options.

DATA SOURCESThe data used in this review were mainly from Medline and PubMed published in English from 2005 to August 2010. The search terms were "gastric cancer" and "liver metastasis".

STUDY SELECTIONArticles regarding the characteristics, diagnostic modalities, and various therapeutic options of GCLM were selected.

RESULTSThe prognosis of GCLM is influenced by the clinicopathological characteristics of primary tumors, as well as the presence of liver metastases. Improved understanding of related genes and molecules will lead to the development of methods of early detection and targeted therapies. For the diagnosis of GCLM, each imaging modality has its relative benefits. There remains no consensus regarding therapeutic options.

CONCLUSIONSEarly detection and characterization of liver metastases is crucial for the prognosis of gastric cancer patients. Multidisciplinary team discussions are required to design optimal treatment strategies, which should be based on the clinicopathological characteristics of each patient.

Humans ; Liver Neoplasms ; diagnosis ; drug therapy ; secondary ; surgery ; Stomach Neoplasms ; complications ; diagnosis ; drug therapy ; surgery

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma represents approximately 40% of gastric lymphomas, and its incidence is increasing. An early diagnosis for gastric MALT lymphoma is important, but not easy due to non-specific symptoms and endoscopic findings. Diagnosis is based on the histopathologic evaluation of multiple, deep and repeated biopsies taken from normal and any abnormal appearing sites of the stomach. In addition, the presence of Helicobacter pylori (H. pylori) infection must be determined to determine therapeutic approach. Endoscopic ultrasonography (EUS) is essential for the evaluation of regional lymph nodes and the depth of tumor invasion in the gastric wall, for predicting response to H. pylori eradication, and for monitoring tumor regression or recurrence. The eradication of H. pylori is recommended as an initial treatment for low-grade gastric MALT lymphoma with H. pylori infection. Both radiation therapy and chemotherapy are suitable alternative options for H. pylori-negative, refractory, or high-grade gastric MALT lymphoma. But, the role of surgery is diminishing. After treatment, strict endoscopic regular follow-up including EUS is recommended with multiple biopsies. However, controversy remains regarding the best diagnosis, treatment and follow-up strategy for this disease.
Biopsy, Fine-Needle ; Endosonography ; Gastroscopy ; Helicobacter Infections/complications/drug therapy ; Humans ; Lymphoma, B-Cell, Marginal Zone/complications/*diagnosis/therapy ; Stomach Neoplasms/complications/*diagnosis/therapy

Gastric cancer is associated with high morbidity and mortality worldwide. To reduce the socioeconomic burden related to gastric cancer, it is very important to identify and manage high risk group for gastric cancer. In this review, we describe the general risk factors for gastric cancer and define high risk group for gastric cancer. We discuss strategies for the effective management of patients for the prevention and early detection of gastric cancer. Atrophic gastritis (AG) and intestinal metaplasia (IM) are the most significant risk factors for gastric cancer. Therefore, the accurate selection of individuals with AG and IM may be a key strategy for the prevention and/or early detection of gastric cancer. Although endoscopic evaluation using enhanced technologies such as narrow band imaging-magnification, the serum pepsinogen test, Helicobacter pylori serology, and trefoil factor 3 have been evaluated, a gold standard method to accurately select individuals with AG and IM has not emerged. In terms of managing patients at high risk of gastric cancer, it remains uncertain whether H. pylori eradication reverses and/or prevents the progression of AG and IM. Although endoscopic surveillance in high risk patients is expected to be beneficial, further prospective studies in large populations are needed to determine the optimal surveillance interval.
Gastroscopy ; Helicobacter Infections/complications/diagnosis ; Humans ; Risk Factors ; Socioeconomic Factors ; Stomach Neoplasms/*diagnosis/etiology/prevention & control/therapy

Gastric lymphoepithelioma-like carcinoma is a rare carcinoma among gastric malignant tumor but has a good prognosis. The carcinoma has histologic feature characterized by small nest of cancer cells mixed with lymphoid stroma. We report a case with lymphoepithelioma-like carcinoma of stomach initially presenting as panperitonitis because of spontaneous tumor perforation. A 56-year-old man visited our emergency room because of epigastric pain. A preoperative abdominal CT scan showed a massive pneumoperitoneum in the upper abdomen, and the presence of gastric cancer in the lesser curvature of the stomach. An emergent laparotomy was performed followed by radical subtotal gastrectomy. Pathologic examination revealed that the tumor was a lymphoepithelioma-like gastric carcinoma.
Carcinoma/*diagnosis/pathology/therapy ; Combined Modality Therapy ; Humans ; Lymphoma/radiography/surgery ; Male ; Middle Aged ; Pneumoperitoneum/etiology/radiography/surgery ; Rupture, Spontaneous ; Stomach Neoplasms/*complications/*diagnosis/pathology/therapy ; Stomach Rupture/*complications/radiography/surgery ; Tomography, X-Ray Computed

Although the age-adjusted incidence of gastric cancer is declining, the absolute number of new cases of gastric cancer is increasing due to population growth and aging. An effective strategy is needed to prevent this deadly cancer. Among the available strategies, screen-and-treat for Helicobacter pylori infection appears to be the best approach to decrease cancer risk; however, implementation of this strategy on the population level requires a systematic approach. The program also must be integrated into national healthcare priorities to allow the limited resources to be most effectively allocated. Implementation will require adoption of an appropriate screening strategy, an efficient delivery system with a timely referral for a positive test, and standardized treatment regimens based on clinical efficacy, side effects, simplicity, duration, and cost. Within the population, there are subpopulations that vary in risk such that a "one size fits all" approach is unlikely to be ideal. Sensitivity analyses will be required to identify whether the programs can be utilized by heterogeneous populations and will likely require adjustments to accommodate the needs of subpopulations.
Health Priorities ; Helicobacter Infections/complications/diagnosis/microbiology/*therapy ; Helicobacter pylori ; Humans ; Mass Screening ; Stomach Neoplasms/microbiology/*prevention & control

Endoscopic mucosal resection (EMR) is widely accepted as a standard treatment for early gastric cancer or gastric adenoma. However, EMR inevitably results in the formation of large iatrogenic ulcer at the resected area. Although the characteristics of EMR-induced ulceration are not fully understood, this type of ulcer is thought to heal faster and to recur less often than non-iatrogenic gastric ulcer. Current available evidences have suggested that EMR-induced ulcers heal within 2-3 months. Herein, we report two cases of non-healing persistent gastric ulcers after EMR. One is a case of gastric carcinoma which developed at the same site of previous EMR site for the low grade dysplasia. The other is a case in which persistent EMR-induced ulcer was healed in the long run after Helicobacter pylori eradication therapy.
Aged ; Endoscopy, Gastrointestinal ; Gastric Mucosa/pathology/*surgery ; Helicobacter Infections/complications/drug therapy ; Helicobacter pylori ; Humans ; Iatrogenic Disease ; Male ; Middle Aged ; Stomach Neoplasms/complications/diagnosis/*surgery ; Stomach Ulcer/diagnosis/*etiology/pathology

No abstract available.
Aged ; Antigens, CD38/analysis ; Biomarkers, Tumor/analysis ; Biopsy ; Gastrointestinal Hemorrhage/diagnosis/*etiology/therapy ; Gastroscopy ; Hematemesis/etiology ; Humans ; Immunohistochemistry ; Male ; Melena/etiology ; Membrane Glycoproteins/analysis ; Multiple Myeloma/*complications/immunology/pathology/therapy ; Recurrence ; Stomach Neoplasms/*complications/immunology/pathology/therapy

Postoperative complications after gastric cancer surgery has their own specificity and complexity, and the strategies for prevention and treatment should be of equal emphasis on both theory and technology. Based on the knowledge and familiarity with different postoperative complications, to efficiently prevent them, it is not only necessary to strengthen the training of acknowledged operative strategy, smooth and precise surgical techniques, but also to address the importance of overall preoperative assessment for patients, to treat the basic diseases, and to improve and correct their general conditions. Combining with the concept and basic protocol of enhanced recovery after surgery (ERAS), it is preferred to work out an individualized perioperative preventing strategy for patients who have high risk factors of specific postoperative complications. After the operation, to guarantee intensive and individual managements for patients, to catch early abnormal signs, then to make early and precise diagnosis, and to do timely response and accurate treatments, including timely and proper re-operations, can improve the efficacy of complications and promote the recovery of patients as soon as possible.
Digestive System Surgical Procedures ; adverse effects ; rehabilitation ; Humans ; Patient Care Planning ; standards ; Perioperative Care ; methods ; standards ; Postoperative Complications ; diagnosis ; prevention & control ; therapy ; Reoperation ; standards ; Stomach Neoplasms ; surgery

In 2010, a Korean guideline for the management of gastroesophageal reflux disease (GERD) was made by the Korean Society of Neurogastroenterology and Motility, in which the definition and diagnosis of GERD were not included. The aim of this guideline was to update the clinical approach to the diagnosis and management of GERD in adult patients. This guideline was developed by the adaptation process of the ADAPTE framework. Twelve guidelines were retrieved from initial queries through the Appraisal of Guidelines for Research & Evaluation II process. Twenty-seven statements were made as a draft and revised by modified Delphi method. Finally, 24 consensus statements for the definition (n=4), diagnosis (n=7) and management (n=13) of GERD were developed. Multidisciplinary experts participated in the development of the guideline, and the external review of the guideline was conducted at the finalization phase.
Antacids/therapeutic use ; Anti-Ulcer Agents/therapeutic use ; Antidepressive Agents/therapeutic use ; Barrett Esophagus/complications/diagnosis ; Databases, Factual ; Diet ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination ; Endoscopy, Digestive System ; Esophageal pH Monitoring ; Gastroesophageal Reflux/complications/*diagnosis/drug therapy ; Histamine Antagonists/therapeutic use ; Humans ; Peptic Ulcer/complications/diagnosis ; Proton Pump Inhibitors/therapeutic use ; Stomach Neoplasms/complications/diagnosis

A 63-year-old man with a history of hepatitis-B-related hepatocellular carcinoma (HCC) in the left lateral portion of the liver received repeated transcatheter arterial chemoembolization (TACE) and salvage radiotherapy. Two months after completing radiotherapy, he presented with dysphagia, epigastric pain, and a protruding abdominal mass. Computed tomography showed that the bulging mass was directly invading the adjacent stomach. Endoscopy revealed a fistula from the HCC invading the stomach. Although the size of the mass had decreased with the drainage through the fistula, and his symptoms had gradually improved, he died of cancer-related bleeding and hepatic failure. This represents a case in which an HCC invaded the stomach and caused a hepatogastric fistula after repeated TACE and salvage radiotherapy.
Carcinoma, Hepatocellular/complications/radiography/*therapy ; *Chemoembolization, Therapeutic ; Drainage ; Gastric Fistula/*etiology ; Gastroscopy ; Hepatitis B/diagnosis ; Humans ; Liver Diseases/*etiology ; Liver Neoplasms/complications/radiography/*therapy ; Male ; Middle Aged ; Neoplasm Invasiveness ; Stomach/pathology ; Tomography, X-Ray Computed