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Helicobacter pylori has attracted widening interest from basic
scientists and clinical investigators and the information on this
organism is increasing exponentially. It is now accepted that H.
Pylori is the most important cause of chronic active gastritis.
Furthermore, data have confirmed a marked reduction in the relapse
rate of both duodenal and gastric ulcer after eradication of the
organism. These important clinical observations have served as a
strong stimulus to the investigation of the basic mechanisms
involved in the pathogenesis of H. pylori-associated inflammation
and the subsequent alterations of gastroduodenal function and
gastric mucosal architecture. The book contains chapters by a
multidisciplinary, international group of basic scientists and
clinical investigators who focus on various microbiological aspects
of H. pylori, on the role of H. pylori in peptic ulcer and gastric
cancer, and the current status of therapy. The book contains the
proceedings of the conference on `Helicobacter pylori: Basic
Mechanisms to Clinical Cure', held at Amelia Island, Florida,
U.S.A., on November 3--6, 1993.
IS CROHN'S DISEASE A MYCOBACTERIAL DISEASE'! The fact that the
differential diagnosis of inflammatory bowel disease includes
intestinal infections has been a source of much interest and
clinical concern for many years. Since the recognition of
ulcerative colitis and Crohn's disease as clinical entities,
numerous attempts have been made to identify a specific organism
resulting in the clinical and pathologic picture of Inflammatory
Bowel Disease. The first suggestion about a connection between
Johne's disease, a chronic mycobacterial enteritis in cattle, and
Crohn' s disease occurred in 1913, when Dalziel described enteritis
in humans which, although resembling intestinal tuberculosis, he
believed to be a new disorder. Since the work of Crohn in the
thirties a few investigators attempted to look for mycobacteria in
Crohn's disease. Until now the work of Van Patter, Burnham and
others did not receive widespread recognition. In 1984 the
isolation of M. paratuberculosis was reported by Chiodini et al.
This report initiated the current interest and controversy about a
mycobacterial etiology in Crohn's disease. The hypothesis "Crohn's
disease is Johne's disease" did not receive widespread recognition,
but has lead to the first muIticentered efforts to determine
whether or not mycobacteria are associated with Crohn's disease.
The explosion of new information on Helicobacter pylori-related
disease, both in the basic sciences and in clinical medicine, has
continued to progress at an unprecedented pace. In many instances
H. pylori infection, both in man and in the laboratory animal, has
become a model to investigate fundamental biological issues such as
micro-organism host interactions, intracellular signaling,
development of mucosal atrophy, mechanism of microbial resistance,
disease modifying factors etc. In view of this bewildering flood of
new information, another meeting on H. pylori in the successful
series Basic mechanisms to clinical cure' was organized in January
1998 in San Diego, California, to define the state-of-affairs' in
H. pylori research at this time. The main objective was to
integrate this new information in a series of top-quality
presentations and discussions between investigators and clinicians
addressing all aspects of H. pylori research and to review the
current position and future research directions. The format
included state-of-the-art presentations by world experts heavily
involved in H. pylori research followed by in-depth discussion on
intriguing or controversial issues. The presentations were grouped
according to the leading theme: characteristics of the organism,
mode of transmission, mechanisms of H. pylori-induced inflammation,
causation of disturbances of gastric secretory and motor function,
aspects of clinical presentation and management, problems related
to H. pylori-associated gastric adenocarcinoma and MALT-lymphoma,
novel aspects of antimicrobial therapy and vaccination. The meeting
concluded with a synoptic agenda of suggested future studies for
the microbiologist, the histopathologist and the clinician. The
chapters published in these proceedings accurately reflect the
content of the superb presentations. The reader will readily
appreciate the excellent level of the cutting-edge' research which
was described and discussed. These proceedings are another
testimony to the enormous impact on basic science and clinical
medicine of the H. pylori discovery. Although much was achieved, it
is also readily apparent that many questions remain to be answered
and many problems remain to be solved.
The impact of Helicobacter pylori on basic science and the clinical
management of patients with the complications of this infection is
bewildering. The explosion of new information both in the
laboratory and at the bedside has progressed at an unprecedented
rate. Our main objective in furthering this progress has been to
integrate this new information and organize a series of top-quality
presentations and discussions between investigators and clinicians
on all aspects of H. pylori research and to review the current
position and future research directions. To that end, the second
meeting 'Helicobacter pylori: Basic Mechanisms to Clinical Cure'
was organized in June 1996 in Ottawa, Canada, following the
successful format of the first such meeting held in Amelia Island,
Florida, in 1993. The meeting again focused on all timely aspects
of H. pylori research. Internationally renowned basic and clinical
scientists, all experts in their respective fields, explored in
depth the spectrum of H. pylori infection and the related
complications of gastritis, peptic ulcer, gastric cancer and
lymphoma.
H. pylori infection, both in man and in the laboratory animal, has
become a standard model to investigate fundamental problems in
biology, such as microbial-host interactions, intracellular
signalling, modulation of inflammation, mucosal atrophic
metaplasia, and microbial resistance, to name just a few. The
issues addressed in this book are grouped according to their
leading theme. Topics include: the new Helicobacters, strain
differences of H. pylori and their consequence on microbial-host
interactions and the effects of H. pylori infection on the gastric
mucosa. The role of H. pylori is explained in relation to: gastric
carcinogenesis; gastroesophageal reflux disease; dyspepsia and
long-term acid suppression. Eradication therapies are reviewed with
respect to their global consequences and problems. The last two
sections are devoted to a global update on therapeutic indications
and finally on priorities for further research.
These proceedings accurately reflect the state-of-the-art
presentations delivered by world experts. This latest volume will
further enrich this top-class series on H. pylori infection.
The fifth meeting in the successful series Helicobacter pylori:
Basic Mechanisms to Clinical Cure took place in Maui, Hawaii,
November 2002. The meeting focused on all current aspects of H.
pylori research. Internationally acclaimed basic and clinical
researchers explored, in depth, the novel information across the
spectrum of H. pylori infection, the characteristics of the
organism, the inflammatory and tissue modifying consequences, the
overall impact of this infection on a global scale, and new
therapeutic possibilities.
H. pylori infection, both in man and in the laboratory animal, has
become a standard model to investigate fundamental problems in
biology, such as microbial-host interactions, intracellular
signalling, modulation of inflammation, mucosal atrophic
metaplasia, and microbial resistance, to name just a few. The
issues addressed in this book are grouped according to their
leading theme. Topics include: the new Helicobacters, strain
differences of H. pylori and their consequence on microbial-host
interactions and the effects of H. pylori infection on the gastric
mucosa. The role of H. pylori is explained in relation to: gastric
carcinogenesis; gastroesophageal reflux disease; dyspepsia and
long-term acid suppression. Eradication therapies are reviewed with
respect to their global consequences and problems. The last two
sections are devoted to a global update on therapeutic indications
and finally on priorities for further research.
These proceedings accurately reflect the state-of-the-art
presentations delivered by world experts. This latest volume will
further enrich this top-class series on H. pylori infection.
Ulcerative colitis and Crohn's disease remain a great therapeutic
challenge to the medical community. In recent years knowledge about
the pathogenesis of these diseases has progressed rapidly but the
cause of the diseases remains completely unknown. It has become
clear that dysregulation of the mucosal immune system is the basis
for the chronic evolution of the diseases in a genetically
susceptible population. Exciting new therapeutic approaches have
been attempted in the last couple of years and cytokine and
anti-cytokine treatments in particular seem very promising,
especially in intractable disease. The format of the Falk Symposium
106 on Advances in Inflammatory Bowel Diseases', held in Brussels,
Belgium, June 18-20, 1998, was somewhat innovative as each session
attempted to link the new insights into pathogenetic mechanisms
with new therapeutic approaches, resulting in optimal information
transfer. The classic therapeutic schemes were updated with a
special focus on step-wise build-up of therapy.
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."
The impact of Helicobacter pylori on basic science and the clinical
management of patients with the complications of this infection is
bewildering. The explosion of new information both in the
laboratory and at the bedside has progressed at an unprecedented
rate. Our main objective in furthering this progress has been to
integrate this new information and organize a series of top quality
presentations and discussions between investigators and clinicians
on all aspects of H. pylori research and to review the current
position and future research directions. To that end, the second
meeting Helicobacter pylori: Basic Mechanisms to Clinical Cure was
organized in June 1996 in Ottawa, Canada, following the successful
format of the first such meeting held in Amelia Island, Florida, in
1993. The meeting again focused on all timely aspects of H. pylori
research. Internationally renowned basic and clinical scientists,
all experts in their respective fields, explored in depth the
spectrum of H. pylori infection and the related complications of
gastritis, peptic ulcer, gastric cancer and lymphoma. The
presentations covered: the genetic heterogeneity of the organism,
including the expression of virulence factors determined by the
genetic pathogenicity island; the intricate cascade of chemokines
and cytokines leading to mucosal inflammation; the complexities of
the mucosal immune response, favoring a slight Th1 over Th2
lymphocyte imbalance; the fundamental issue of the apparent paradox
of the induction of both apoptosis and epithelial
hyperproliferation; the pathophysiological consequences of gastric
mucosal inflammation with respect to the elevation of gastrin and
the acid secretory response; themechanisms leading to peptic ulcer
disease, gastric carcinoma and gastric mucosa-associated lymphoid
tissue (MALT) lymphoma; the established and novel therapeutic
approaches to eradication and finally the prospects for successful
therapeutic and preventative vaccination. The comprehensive
manuscripts in this book of the proceedings of the meeting reflect
the most up-to-date information and state of the art approaches to
research and management of H. pylori infection and will provide an
invaluable reference source.
There is currently an explosive growth of basic and clinical
research in inflammatory bowel diseases. The extensive interest of
the medical community in these diseases is largely explained by the
devastating impact the illnesses have on the quality of life, their
high prevalence in the community, and the fact that so many medical
disciplines are involved in tackling the immensely complex studies
on pathogenesis, clinical expression and treatment possibilities.
The Falk Symposium No. 85 held in The Hague, the Netherlands, 29
June-1 July 1995 brought together over 80 speakers and 1000
participants from all over the world. Plenary sessions and
workshops allowed the discussion of basic and clinical research,
enabling appropriate choices to be made. Topics reflected areas of
high current basic research interest, clinical importance, and
actual or future treatment potential. Audience: An important work
for all disciplines involved in research and therapy of
inflammatory bowel diseases.
International researchers summarize the current understanding of
peptic disease and trace the development of a novel new drug for
peptic disease therapy-sucralfate. Contributors present laboratory
research along side data from clinical trials as well as from the
practice of medicine. Articles discuss the history of sucralfate's
development, mechanisms of action, clinical efficacy, and future
directions for research. This volume will be of interest to
scientists and clinicians working in gastroenterology and
gastrointestinal physiology.
IS CROHN'S DISEASE A MYCOBACTERIAL DISEASE'! The fact that the
differential diagnosis of inflammatory bowel disease includes
intestinal infections has been a source of much interest and
clinical concern for many years. Since the recognition of
ulcerative colitis and Crohn's disease as clinical entities,
numerous attempts have been made to identify a specific organism
resulting in the clinical and pathologic picture of Inflammatory
Bowel Disease. The first suggestion about a connection between
Johne's disease, a chronic mycobacterial enteritis in cattle, and
Crohn' s disease occurred in 1913, when Dalziel described enteritis
in humans which, although resembling intestinal tuberculosis, he
believed to be a new disorder. Since the work of Crohn in the
thirties a few investigators attempted to look for mycobacteria in
Crohn's disease. Until now the work of Van Patter, Burnham and
others did not receive widespread recognition. In 1984 the
isolation of M. paratuberculosis was reported by Chiodini et al.
This report initiated the current interest and controversy about a
mycobacterial etiology in Crohn's disease. The hypothesis "Crohn's
disease is Johne's disease" did not receive widespread recognition,
but has lead to the first muIticentered efforts to determine
whether or not mycobacteria are associated with Crohn's disease.
International researchers summarize the current understanding of
peptic disease and trace the development of a novel new drug for
peptic disease therapy-sucralfate. Contributors present laboratory
research along side data from clinical trials as well as from the
practice of medicine. Articles discuss the history of sucralfate's
development, mechanisms of action, clinical efficacy, and future
directions for research. This volume will be of interest to
scientists and clinicians working in gastroenterology and
gastrointestinal physiology.
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.
John Libbey Eurotext continues to publish the proceedings of the
gastroenterology seminars taught by leading European specialists
and organised by the European Association for Gastroenterology and
Endoscopy (EAGE). The aim of the book is to describe major clinical
and therapeutic progress observed during 2003.
The fourth meeting in the very successful series Helicobacter
pylori: Basic Mechanisms to Clinical Cure was held on the island of
Bermuda in late March 2000. This was only some two years after the
third meeting in San Diego and it seemed hardly possible that there
would be so much new information. However, as the contributions in
this volume testify, there was plenty of exciting new information
with important implications for both understanding this infection
and for clinical management. Some of this information was of a
fundamental nature, such as the role of the acid sensitive urel
channel in regulating the influx of urea and the formation of
ammonia transported back in the microbial periplasmic space to
neutralize acid; the observation of genetic polymorphism of the
IL-1 gene as an explanation of achlorhydria and gastric cancer risk
in the first-degree relatives of gastric cancer patients; and the
peculiar biochemical and physio logical consequences of the genome
of the microorganisms. The format of the meeting, with short
fifteen-minute state-of-the-art pre sentations by world experts
closely involved in Helicobacter research fol lowed by ample time
for panel discussions, was again followed this year. Traditional
aspects included detailed study of the microbial characteristics,
the novel Helicobacters, the interaction with the human host, the
peculiarities of the inflammatory immune response, the short and
long-term mucosal consequences, the effects on acid secretion, the
problem of gastric malignancy and the therapeutic possibilities."
The fourth meeting in the very successful series Helicobacter
pylori: Basic Mechanisms to Clinical Cure was held on the island of
Bermuda in late March 2000 and was sponsored by Axcan Pharma. This
was only some two years after the third meeting in San Diego, and
it seemed hardly possible that there would be so much new
information. However, as the contributions in this volume testify,
there was plenty of exciting new information with important
implications for both understanding this infection and for clinical
management. Some of this information was of a fundamental nature,
such as the role of the acid sensitive ureI channel in regulating
the influx of urea and the formation of transported ammonia back in
the microbial perisplasmic space to neutralize acid; the
observation of genetic polymorphism of the IL-1beta gene as an
explanation of achlorhydria and gastric cancer risk in the
first-degree relatives of gastric cancer patients; and the peculiar
biochemical and physiological consequences of the genome of the
microorganisms. The format of the meeting, with short
fifteen-minute state-of-the-art presentations by world experts
closely involved in Helicobacter research followed by ample time
for panel discussions, was again followed this year. Traditional
aspects included detailed study of the microbial characteristics,
the novel Helicobacters, the interaction with the human host, the
peculiarities of the inflammatory immune response, the short and
long-term mucosal consequences, the effects on acid secretion, the
problem of gastric malignancy, and the therapeutic possibilities.
However, a series of short debates was introduced to highlight
controversial issues, such as the pathogenic orcommensal role of
the organism, the role of virulence factors, the characteristics of
the inflammatory immune response, the reversibility of mucosal
atrophy and metaplasia, and the primary or secondary role of
quadruple therapy, to name just a few. This provocative approach
was very successful and provided fuel for further in-depth
discussions. These debates have been included in this book in the
form of conventional manuscripts in order to maintain the shortest
possible production time for the publication of the proceedings.
Helicobacter pylori has come a long way since the first meeting in
Amelia Island, in 1993, and the science of this organism and the
understanding of the consequences of the infection have advanced
our knowledge fundamentally and revolutionized our thinking about
gastrointestinal disease. We now recognize the existence of more
than thirty Helicobacter species, some of which may play a
significant role in human disease. The experience gained through
our investigation of H. pylori promises to make a significant
contribution to the future exploration of the possible role of
Helicobacter species in hepatic, biliary, and intestinal diseases.
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