Biomarkers for the diagnosis of the gastrointestinal (GI) cancers

Lower GI cancers are among the top three most frequent cancers in the United States and many western countries while upper GI cancers rank as the most prevalent type in many Asian countries, especially in central and eastern Asia. GI cancers are usually diagnosed in more advanced stages and in the absence of effective early diagnostic tools and therapeutic modalities, the survival rates are generally disappointingly low. Then the era of biomarkers came to solve the issue of the GI Cancer diagnosis.

Biomarker refers to a measurable indicator of some biological state or condition. This is also referring to a substance whose detection indicates the existence of a living organism. This is also used to evaluate or to examine normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.

Currently, serum biomarkers, which are sufficiently sensitive and specific for early detection and risk classification of gastric cancers. In future Three-dimensional combined biomarkers assay could improve diagnostic accuracy for gastric cancer. For cancer research MicroRNAs (miRNAs) have become the center of focus. However, there have been inconsistencies in the literature regarding the suitability of circulating miRNAs for early detection of gastrointestinal cancers.

Last few years major advances have been made to understand the role of epigenetic alterations in carcinogenesis, particularly for DNA methylation, histone modifications and non-coding RNAs. Aberrant hypermethylation of DNA at CpG islands is a well-established phenomenon that mediates transcriptional silencing of tumor suppressor genes, and it is an early event integral to gastrointestinal cancer development.

As such, detection of aberrant DNA methylation is being developed as biomarkers for prognostic and diagnostic purposes in gastrointestinal cancers. Diverse tissue types are suitable for the analyses of methylated DNA, such as tumor tissues, blood, plasma, and stool, and some of these markers are already utilized in the clinical setting.

Recent advances in the genome-wide epigenomic approaches are enabling the comprehensive mapping of the cancer methylome, thus providing new avenues for mining novel biomarkers for disease prognosis and diagnosis.

The biomarkers in GI cancers are useful not only for screening, diagnosis, and prognosis but also for prediction of the response to mechanism-based interventions, such as chemoprevention. On-going assessment of these diagnostic and predictive factors will probably lead to a change in the current staging of many GI cancers.

Telemedicine and Mobile Health Technology: Effective Management of Digestive Diseases

Telemedicine can be defined as the use of telecommunication and information technology to provide health care from an extent. It has been used to overcome distance barriers and to improve access to medical services that would often not be consistently available in distant rural communities. It has been used to save lives in critical and emergency situations.

Telemedicine is use to effectively manage disease activity, help monitor symptoms, improve compliance to the treatment protocol, increase patient satisfaction, and enhance the patient-to-provider communication.

EBSCO, PubMed, and Web of Science databases are used in Medical Subject Headings and other keywords to identify studies that utilized telemedicine in patients with digestive disease. 

Distance management intervention is defined as any remote management method in which there is a patient self-management component whereby the patient interacts remotely via a self-guided management program, electronic interface, or self-directs open access to clinic follow up.

Now a day’s inflammatory bowel disease (IBD) is biggest issue of the treatment as it is a group of chronic intestinal diseases that adversely affects quality of life and societal interaction and functioning. They are associated with significant morbidity and mortality, so telemedicine has helped in a great way.

Clinicians have focused on techniques to improve the out-patient management of IBD patients. Strategies to improve patient education alone increase IBD-related knowledge, but do not consistently improve clinical outcomes or decrease health care resource use. Focusing on improving self-management behaviour, however, may be effective. A previous systematic review on patient education and self-management reported that self-management strategies demonstrated improved outcomes of symptoms, psychological well-being, and health-care resource use.

Distance management of gastrointestinal diseases can be an important part of the management of patients, but may require tailoring of these approaches to select patient populations. A combined web-based and patient directed open access clinic distance management program, whereby patients interact with an electronic web-based management program and are able to initiate self-treatment strategies and self-referral to clinic assessments, may be a solution.

Telemedicine and mobile health technology may be effective in managing disease activity and improving quality of life in digestive diseases. Future studies should explore both gastrointestinal and gastroesophageal diseases using these types of interventions.

Colorectal cancer: From prevention to personalized medicine

Colorectal cancer (CRC) is a heterogeneous disease that is caused by the interaction of genetic and environmental factors. CRC develops through a gradual accumulation of genetic and epigenetic changes, leading to the transformation of normal colonic mucosa into invasive cancer. CRC is one of the most prevalent and incident cancers worldwide, as well as one of the most deadly.

Colorectal cancer had a low incidence several decades ago. However, it has become a predominant cancer and now accounts for approximately 10% of cancer-related mortality in western countries. The rise of colorectal cancer in all over countries has been characterized  to the increasingly ageing population, unfavourable modern dietary habits and an increase in risk factors such as smoking, low physical exercise and obesity.

There are different strategies for screening and although the number of such strategies is increasing due to the potential of emerging technologies in molecular marker application, not all strategies meet the criteria required for screening tests in population programs; the three most accepted tests are the fecal occult blood test (FOBT), colonoscopy and sigmoidoscopy.

The design of genetic and epigenetic marker panels that are able to provide maximum coverage in the diagnosis of colorectal neoplasia seems a reasonable strategy. In coming years, the use of DNA, RNA and protein markers in different biological samples has been traverse as strategies for CRC diagnosis. Although there is not yet sufficient evidence to recommend the analysis of biomarkers such as DNA, RNA or proteins in the blood or stool, it is likely that given the quick advancement of technology tools in molecular biology progressively sensitive and not so expensive, these tools will gradually be employed in clinical practice and will likely be developed in mass.

Colorectal metastatic cancer treatment- Approximately half of the patients diagnosed with CRC eventually develops metastases, mainly those of metachronic presentation. The most common site for metastases occurrence is the liver.

This has made the metastatic CRC therapeutic approach more complex, with multiple treatment options that increasingly require a multidisciplinary medical team, which can combine locoregional treatment of metastases with systemic treatment to obtain disease resectability.

These treatments include- Surgery, Local liver treatments, Chemotherapy, New drugs.

Chemotherapy remains the cornerstone of systemic treatment today, but several new targeted drugs have emerged in this filed in the last decade, improving the management of metastatic disease. The recent advances in molecular biology and the genetic classification of CRC are essential to individualize these therapies and will be basic for improving the treatment in the next years.

Treatment of Obesity: Weight Loss and Bariatric Surgery

Bariatric surgery includes a kind of procedures performed on people who have obesity. Weight loss is achieved by reducing the size of the stomach with a gastric band or through taking away a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestine to a small stomach pouches (gastric bypass surgery).

The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by non-surgical means.  It even helps in the reduction of cardiovascular disease (CVD) as well as other expected benefits of this intervention. The ultimate benefit of weight reduction relates to the reduction of the co-morbidities, quality of life and all-cause mortality.

Specific criteria established by the NIH consensus panel indicated that bariatric surgery is appropriate for all patients with BMI (kg/m2) >40 and for patients with BMI 35-40 with associated comorbid conditions. These standards have held up over the long years, although specific indications for bariatric/metabolic surgical intervention have been recognized for persons with less severe obesity, such as persons with BMI 30-35 with type 2 diabetes. The indications for bariatric surgery are evolving rapidly to consider the presence or absence of comorbid conditions as well as the severity of the obesity, as reflected by BMI.

Specific Bariatric Surgical Procedures are Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy, Biliopancreatic diversion with duodenal switch, Implantation of Devices (includes Adjustable Gastric Banding, Intermittent vagal blockade, Gastrointestinal Endoscopic Devices).

Bariatric surgical community enacted a number of changes to result in this improved safety record. Included is the identification of the importance of surgeon and center experience, the establishment of pathways, care protocols, and quality initiatives and incorporation of all of these aspects of care into an accreditation of centers program. The transition to laparoscopic methodology occurred during the same time period and also contributed to the improved safety.

Weight loss following bariatric surgery has been studied and reported both short- and longer-term following all surgical procedures undertaken, as weight loss is the primary objective of bariatric surgery. Mean weight loss is uniformly reported. It is crucial to identify however, the high variability of weight loss following apparently standardized operative procedures such as RYGB or Laparoscopic Adjustable Gastric Banding (LAGB).

The ultimate benefit of weight reduction, whether medical or surgical, relates to the reduction of the co-morbidities, quality of life and all-cause mortality. Despite the importance of assessing these risks and taking steps to implement effective medical management with variable success, surgery has proven to be more effective.