In offering this book to what we hope will be interested readers, we have several aspirations. We have aspired to present to students and clinicians a rather narrow view of epidemiology concentrating on the causal factors and setting of the more usual gastroenterological problems and giving greater space to conditions of importance for which major knowledge of causation andcourse is available. Part of the rationale is thebelief that modern medicine lays excessive emphasis on therapy with increasingly expensive, and in many cases, dangerous drugs and too little emphasis on the causes and avoidance of disease. We are of the view that traditional views handed st down through generations of clinicians need scrutiny worthy of 21 century medicine whose currency includes topics like nanomoles, megabytes and logistic regression. We hope that clinicians will see that there is often a practical application to the findings of epidemiological exploration and that what passes for canonical knowledge is so often unsubstantiated myth and are fully aware of the reluctance of organized medicine to reject old paradigms in favor of the new, matched by an often uncritical enthusiasm for new therapies. Our researches have increased our belief in the major role of social factors especially diet, both in quantity and quality in many disorders and that clinicians have a responsibility to provide appropriate advice to policy makers as well as patients.

Endoscopy has revolutionized clinical gastroenterology. In 1961 Basil Hirschowitz published the first flexible endoscopic examination of the stomach and duodenal bulb. We moved from flexible fiberendoscopes to current video-endoscopic equip ment. Current video-endoscopes incorporate a black and white or color 'chip' at the tip of the instrument which transforms the visual image into electronic signals. The size of the pincet is constantly getting smaller, heading for 5 /Lm, further increasing the resolution. The signals are reassembled into high-quality color images in a video monitor. Endoscopes are now used to examine the entire gastrointestinal tract from esophagus to rectum, including the biliary and pancreatic ductal system. Targeted endoscopic biopsy offers rapid and precise diagnosis. Endoscopic ultrasonography is of unsurpassed accuracy in staging gastrointestinal tumors, in assessing pancreatic and biliary disease, and disorders of the rectum and anal canal. Moreover, targeted cytological sampling is possible of abnormalities of the intestinal wall or peri intestinal lymph node. Yet despite these glamorous achievements changes are to be expected in the overall emphasis of diagnostic endoscopy. Magnetic resonance cholangiopancreatography may very well compete for a substantial fraction of diagnostic ERCP. Virtual colonoscopy or computed tomographic colography may well compete with (and take over?) screening/surveillance colonoscopy."

This volume reviews the current state of research concerning bacterial virulence factors and the infection biology of Helicobacter pylori, which is the leading cause of peptic ulcers and gastric cancer worldwide. The chapters include cutting-edge findings on this fascinating microbe and discuss the general strategies of H. pylori infection and persistence, news on important H. pylori virulence factors, crosstalk with the microbiota, hot novel models and signaling mechanisms, risk factors of gastric disease and stomach cancer, and the impact of H. pylori infection on non-gastric diseases. Written by internationally respected scientists, this book will appeal to clinicians, researchers and advanced students alike.

Chronic inflammatory bowel diseases represent an important medical problem, since they have a devastating impact on the quality of life and require longstanding medical care. Many medical disciplines are involved in tackling the immensely complex studies on pathogenesis, clinical expression and treatment possibilities. This book, the proceedings of the Falk Symposium 105 on Innovative Concepts in Inflammatory Bowel Diseases', held in Rostock, Germany, on April 30 - May 2, 1998, brought together experts from different fields of science to allow a unified view on clinical and basic research. The main themes of the meeting were genetics, animal models, immunology, epithelial cells, endotoxin, diagnostic procedures, malignancy, medical therapies, and surgery. In each section of the book experts present state-of-the-art reviews with the very latest developments in the respective research areas followed by chapters on different aspects of inflammatory bowel diseases. They provide suggestions concerning future research and clinical management of patients with inflammatory bowel diseases.

Japan has long been a leader of research into the carcinogenesis, pathology, diagnosis, and treatment of gastric carcinoma, which is still the second leading cause of cancer death worldwide. Distinguished experts in the field collaborated in creating this groundbreaking work, providing a comprehensive view of gastric cancer. This book encourages further development of gastric cancer research and its clinical application. Topics include all aspects of gastric carcinoma, such as the history of clinical and experimental gastric cancer research; updated issues of molecular and pathological research on gastric carcinogenesis; multidisciplinary methods in diagnosis, treatment, and chemotherapy; and perspectives in minimally invasive surgery. Color figures of histological specimens and other clinical features assist readers in readily understanding the textual descriptions, making this volume a valuable source for clinicians and researchers alike.

MRI has become an important tool in the management of patients with diseases of the gastrointestinal tract, such as rectal cancer and inflammatory bowel diseases. This book, written by distinguished experts in the field, discusses in detail the technical, practical, and clinical aspects of MRI of the gastrointestinal tract. The chapters on technique encompass the most recent developments and address such topics as contrast media, high field strength MRI, and perfusion MRI. Subsequently, individual chapters are devoted to the clinical applications of MRI in the different parts of the gastrointestinal tract. Both established applications and new frontiers are considered, with the aid of numerous high-quality illustrations. By combining chapters dedicated to technical aspects and clinically oriented chapters, this book will prove very instructive for the novice while simultaneously offering experienced practitioners further insights into the value of MRI of the gastrointestinal tract.

A convenient and user-friendly handbook of clinical gastroenterology providing systematic yet concise coverage of the diseases and disorders of the digestive tract. The wide experience of the authors' background in both clinical gastroenterology and imaging is reflected in the informative text which is illustrated with colour photos, imaging and diagrams of the highest quality.The book will appeal to those preparing for higher qualifications in gastroenterology and general medicine, and to physicians and medical students who want a handy general reference source to problems of the digestive system.

This book, the proceedings of Falk Symposium No. 104, organized in collaboration with the Society of Mucosal Immunology, and held in Saarbrucken, Germany, March 5-7 1998, is centered around the immunological mechanisms of mucosal protection and their disturbances leading to intestinal inflammation and destruction. This is a rapidly expanding field involving recent knowledge of basic immunology and cell biology as well as clinical observations. The conference and this book summarize very recent data in this field and suggest strategies for future research and clinical applications, and will be of interest to both basic scientists and clinicians.

The Third International Symposium on Inflammatory Bowel Diseases was held in Jerusalem during September 10-13, 1989. Four hundred physicians and scientists from 25 countries attended the meeting. The symposium was organized into five panels devoted to state of the art reviews of the latest findings and approaches on the etiology, pathogenesis, metabolic implications, clinical assessment of disease activity and the medical management of IBD. Several issues were discussed in debate form. The last panel was dedicated to discussion of three patients with computer assisted active participation of all the attendants. In addition, 03 abstracts were presented as posters, all of which were published in the Book of Abstracts. The organizing committee gratefully acknowledges the contributors who presented their work in clear and concise manner and the participants, whose active part in the discussions contributed to the success of the meeting. The Jerusalem International symposium on Inflammatory Bowel Diseases has become a tradition that will continue with the Fourth Symposium to be convened in September 1993. Joseph Zimmerman, M.D. Daniel Rachmi1ewitz, M.D. LIST OF FIRST AUTHORS Theodore M. Bayless, Michael J. Langman, Johns Hopkins University Department of Medicine, School of Medicine, Queen Elizabeth Hospital, Baltimore, Maryland. Birmingham, England. Michael D. Blackstone, J.E. Lennard-Jones, University of Chicago, St. Mark's Hospital, Chicago, Illinois. City Road, London, England. Charles O. Elson, Division of Gastroenterology, James Lee Madara, The University of Alabama Department of Pathology, at Birmingham, Brigham and Women's Hospital, Birmingham, Alabama. Boston, Massachusetts.

Through a series of essays concerning human eating seen from the perspective of contemporary biology/medicine and recent research articles, the book explores the links between food and Man's cultural and physical evolution. Each chapter has an introduction summarizing the basic knowledge in the field, discusses the recent research results, and confirms or challenges the established concepts, which opens new aspects and leads to new questions. This book catalyzes discussion between scientists working on one side in food science and on the other side in biological and biomedical research.

At the Mie International Symposium held in Japan in April 1994, leading scientists reviewed recent advances in the understanding of the contractile mechanism in smooth muscle. The present volume collects the papers presented at the symposium, summarizing the latest advances in smooth muscle function and emphasizing important components of the contraction-relaxation cycle. Topics include a discussion of the smooth muscle cell membrane, with emphasis on its ion channels; the regulation of cytosolic Ca2+ levels and the relationship to force in smooth muscle; aspects of the two key regulatory enzymes involved with myosin phosphorylation-dephosphorylation; the molecular basis for pharmacomechanical coupling in smooth muscle; developments in the basic contractile mechanisms involving the crossbridge cycle of tonic and phasic muscle; the role of myosin light chains; and many others. The approach is broad and presents contemporary opinions in pharmacology, physiology, and biochemistry as they relate to smooth muscle function. The book will appeal not only to those working in these disciplines, but to vascular clinicians, obstetric-gynecological physicians, and gastroenterologists as well.

Since the publication of the previous edition of Tumors of the Esophagus and Stomach, great advances in many areas of tumor biology have led to a better understanding of the pathogenesis, pathology, and molecular biology of epithelial and stromal malignancies of the upper gastrointestinal tract. Many of these advances have led to specific improvements in diagnosis, prognosis, treatment, and thus, survival in patients affected by these tumors. This edition of the Fascicle was written to highlight these advances, and more specifically, to help pathologists diagnose diseases more accurately and understand how pathology contributes to clinical treatment in the new age of personalized and targeted therapy. Notable advances described in this publication include: 1) expansion of our understanding of the pathologic features and molecular pathogenesis of carcinomas of the esophagus and stomach, most of which develop through a chronic inflammation-metaplasia-dysplasia-carcinoma sequence. Important refinements in the classification of neoplastic precursor lesions have been made since the last AFIP series, including the morphologic and endoscopic subtypes, and this has led to improvements in surgical treatment with a strong trend toward minimization in the form of endoscopic mucosal and submucosal dissections 2) discovery of new diseases, such as gastric adenocarcinoma and proximal polyposis syndrome (GAPPS), a special variant of familial adenomatous polyposis, and significant advances in our knowledge regarding the molecular characterization of genetic polyposis syndromes 3) great expansion in the molecular-pathology correlation, morphologic diversity, classification, and therapeutic options of gastrointestinal stromal tumors (GISTs) 4) reclassification and refinement of prognostic factors related to neuroendocrine tumors 5) improvements in the role of cytology in the diagnosis of tumors of the upper gastrointestinal tract. This book has been written with the pathologist in mind first by using tables that illustrate salient pathologic, molecular, and differential diagnostic features of key entities that are often difficult to distinguish from each other. Specific color photographs of classic tumors and morphologic variants often difficult to recognize are used throughout.

Short chain fatty acids (SFCA) are synthesized by the colonic microflora primarily from non-absorbed carbohydrate; there is also some limited production from non-absorbed protein. In contrast, SFCA are not normally present in the diet. During the past 15 years SFCA have attracted considerable interest in human nutrition, physiology and pathophysiology as a result of the realization that SFCA represent an important mechanism for carbohydrate and calorie conservation and may play a role in various types of colitides and possibly in colonic neoplasia. In addition, SFCA, produced in large amounts by ruminants and other herbivores, have long been the province of veterinary physiologists. This book is based upon the presentations at the 73rd Falk Symposium held in Strasbourg, France, September 8--10, 1993, which brought together researchers and clinicians from five continents. It provides an excellent statement of the present state-of-the-art knowledge of SFCA.

In this issue of Thoracic Surgery Clinics, guest editors Drs. Jonathan Yeung and Elena Elimova bring their considerable expertise to the topic of Esophageal Cancer. Nearly 20,000 new cases of esophageal cancer are diagnosed each year in the U.S. alone. In this issue, top experts provide a timely update of this perennially important topic with coverage of pathology, genetics, staging, adjuvant therapies, and surgical management, as well as two special articles on controversies in esophageal cancer. Contains 12 practice-oriented topics, including staging of esophageal cancer; endoscopic treatment of esophageal cancer; immunotherapy and targeted therapy for esophageal cancer; Ongoing Controversies in Esophageal Cancer I: feeding tubes, pyloroplasty, thoracic duct clipping; Ongoing Controversies in Esophageal Cancer II: gastrectomy vs esophagectomy for Siewert 2 esophageal cancer; and more. Provides in-depth clinical reviews on esophageal cancer, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

This volume is the proceedings of the symposium 'Trends in Inflammatory Bowel Disease Therapy 1999' held in Vancouver, Canada, August 27-29, 1999, and sponsored by the Canadian Association of Gastroenterology, The Crohn's and Colitis Foundation of Canada and Axcan Pharma. It is the seventh international IBD symposium to be held in Canada and focuses on all areas of IBD therapy.Topics include: genetics; pathogenesis with reference to the role of autoimmunity, bacterial factors and neutrophil -- epithelial interactions; special clinical problems such as difficult diagnoses and challenges presented by children and the elderly; bone disease in IBD; an overview of current therapy; and a discussion of alternative therapy.

In this issue of Diagnosis and Treatment of Gastrointestinal Cancers, guest editors Drs. Marta Davila and Raquel E. Davila bring their considerable expertise to the topic of Diagnosis and Treatment of Gastrointestinal Cancers. The early detection, diagnosis, and accurate staging of GI cancers, along with enhanced imaging techniques, new therapies, and a greater understanding of GI tumors at the molecular level, has revolutionized the approach to GI cancer patients in recent years. In this issue, distinguished authors recognized internationally as leading authorities in the field provide an exhaustive review of the latest topics in GI cancer. Contains 13 practice-oriented topics including management of Barrett's esophagus and early esophageal adenocarcinoma; familial pancreatic cancer; colorectal cancer: screening and early detection; the microbiome in gastrointestinal cancers; and more. Provides in-depth clinical reviews on diagnosis and treatment of gastrointestinal cancers, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Immune Mechanisms in Inflammatory Bowel Disease is a highly, concise update of the most recent advances in the immunobiology, genetics and microbiology related to Inflammatory Bowel Disease. This book broadly treats the topics that lead to understanding of the pathogenesis of this disease in an organized, systematic approach.

Our own experience shows that there is no simple, yet of good scientific and clinical quality guide for practitioners and patients on gastrointestinal diseases. In the proposed book we will cover a vast area in the field, from GI tract physiology to disease diagnosis and treatment, in a comprehensive and approachable manner. The guide will not replace online resources (often used by patients) or specialized editions addressing experienced medical doctors, but rather fill the gap between those two. Our aim is to design this book so that it appeals to a wider audience; yet - if needed - encourages to explore the field further.

As we approach the end of this millennium, enteric diseases remain impor tant public health problems. In many parts of the world, sanitary measures have advanced little over the last century, although some of the governments in those areas are striving to improve facilities for sanitation and to educate their people in proper handling of food, water, sewage, and other modes of transmission of pathogenic microbes. Even in highly developed countries, outbreaks of diarrheal diseases occur today. Globally, the annual morbidity from enteric infections is estimated at several billion and deaths at several million per year. In this volume, descriptions of some of these diseases, of immunity that results from them, of clinical studies that promote under standing of individual and community immunity, of molecular factors of pathogenesis, and/or of advances in vaccine development have been pro vided by leading researchers. At present, the application of molecular methods is enhancing the identification of protective antigens of many microorganisms. In addition, new methods for design and delivery of vac cines are being devised. Perhaps then more effective tools for reducing at least some of these diseases will be available within the next decade. Lois J. Paradise Herman Friedman Mauro Bendinelli vii Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv LOIS J. PARADISE 1. Indigenous Microorganisms as a Host Defense 1 KENNETH H. WILSON 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Composition of Intestinal Biota. . . . . . . . . . . . . . . . . . . . . . . . 2 3. Molecular Approaches to Determine Composition of the Biota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4. Role of the Host in Determining the Composition of the Biota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ."