Search PubMed⌕ Search

Biomedical subjects

W Fischbach

Publications and source records attributed to W Fischbach.

At least 19 recordsLinked to original sources
PubMed2001

Complete remission of primary high-grade B-cell gastric lymphoma after cure of Helicobacter pylori infection.

PURPOSE: Treatment of low-grade gastric mucosa-associated lymphoid tissue lymphoma by eradication of Helicobacter pylori is reported to result in complete lymphoma remission in approximately 75% of cases. The effect that cure of the infection has on the course of a primary high-grade gastric lymphoma is largely uncertain. The aim of this study was to report the effect of cure of H pylori infection exerted in patients with high-grade B-cell gastric lymphoma. PATIENTS AND METHODS: Eight patients (4 males and 4 females; age range, 26 to 85 years) with H pylori infection and high-grade lymphoma received eradication therapy before planned treatment. The effect of H pylori eradication on the course of high-grade lymphoma was assessed by analysis of surgical specimens (n = 2) or endoscopic biopsies (n = 6). RESULTS: H pylori eradication was successful in all patients and led to complete remission of the lymphoma in seven patients. One patient has experienced partial remission. Two patients were referred to surgery, one of whom (stage II(1E)) had lymph node involvement, and the histologic work-up of the resected stomach revealed residual infiltrates of a low-grade lymphoma, which prompted consolidation chemotherapy. In one patient (initially stage I(1E)), abdominal lymphoma developed 6 months after eradication therapy, which regressed completely after chemotherapy. In four patients, no further treatment was given. Six patients continue in complete remission (range, 6 to 66 months). CONCLUSION: Primary high-grade B-cell gastric lymphoma in stages I(E) through II(E1) associated with H pylori may regress completely after successful cure of the infection. Prospective trials are needed to investigate this treatment in larger numbers of patients.

Adult↗
PubMed2000

Gastrointestinal lymphomas: the Würzburg study experience.

Appropriate management of primary gastric lymphomas is still controversial. We, therefore, conducted a prospective multicenter study to identify its clinical features, evaluate the accuracy of diagnostic and staging procedures, and assess a treatment strategy based on tumor stage and malignancy. Of 266 patients recruited within three years, 107 had low-grade (40%) and 159 high-grade (60%) lymphoma. A total of 237 patients (89%) presented with localized disease (stages EI/II). Based on the rapid urease test and/or histology the overall Helicobacter pylori positivity was 59% (76%, 51%, 38% in low-grade, high-grade, and secondary high-grade lymphoma, respectively). In 27% of the cases, patients could not be precisely classified and graded on the basis of endoscopic biopsies. In 78 patients, pre-operative endoscopic ultrasound correctly predicted the depth of tumor infiltration in 78% and lymph-node involvement in 75%. Treatment was stratified according to the grade of malignancy and stage: H. pylori eradication in low-grade lymphoma of stage EI, surgical resection in stages EI/II of low- and high-grade lymphoma and, depending on the pathohistological stage and post-operative residual tumor mass radiation and chemotherapy/combined radiochemotherapy in low-grade and high-grade lymphoma, respectively.

Adult↗
PubMed2000

Primary gastric non-Hodgkin's lymphoma: requirements for diagnosis and staging.

Tumor stage and histological grading (low grade vs. high grade) determine the prognostic outcome of primary gastric mucosa-associated lymphoid tissue (MALT)-type non-Hodgkin's lymphoma (NHL). Any diagnostic uncertainty of clinical staging may have potentially important therapeutic implications, especially if a non-surgical approach is favored. Diagnostic procedures for evaluation of gastric lymphoma include gastrointestinal endoscopy, endoscopic ultrasound of the upper gastrointestinal tract, conventional abdominal and cervical ultrasound, thoracic and abdominal computed tomography (CT) scans and bone marrow biopsy. In the present overview, the value of clinical diagnostic procedures is discussed with respect to clinical and endoscopic criteria which may be helpful for evaluation of gastric NHL. Furthermore, clinical staging methods such as endoscopic ultrasound are assessed which may allow pre-operative determination of tumor and lymph-node stage. These novel approaches are compared with the gold standard of pathohistological analysis. In conclusion, the diagnostic procedures presented appear to be helpful for establishing an early diagnosis, however, innovative methods such as endoscopic-bioptic mapping of the stomach and ultrasound-guided fine-needle biopsy techniques may improve pre-therapeutical work-up.

Gastroscopy↗
PubMed2000

Helicobacter pylori in the upper gastrointestinal tract: medical or surgical treatment of gastric lymphoma?

The treatment of primary gastric lymphoma is controversial. The role of surgery has come to be questioned with increasing knowledge about the pathogenesis of gastric lymphoma and with new therapeutic approaches such as eradication of Helicobacter pylori. We review published clinical trials of primary gastric lymphoma, including preliminary results of our own prospective multicenter trial. The results of 7 trials of H. pylori eradication and 12 prospective therapeutic trials trial are discussed. On basis of these data it is concluded that surgery with intention of R0 resection is the treatment of choice in stages EI2 and EII1 of low-grade lymphoma. In high-grade lymphomas it is still unclear whether surgery or its primary combination with radio- or chemotherapy should be preferred. The eradication of H. pylori is a promising therapeutic approach for localized low-grade mucosa-associated lymphoid tissue lymphoma. A randomized trial is needed to clarify whether medical or surgical management of localized gastric lymphoma or a combination of two is the best treatment modality.

Clinical Trials as Topic↗
PubMed2000

Primary gastric B-cell lymphoma: results of a prospective multicenter study. The German-Austrian Gastrointestinal Lymphoma Study Group.

BACKGROUND & AIMS: Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopic biopsy diagnosis and clinical staging procedures and assess a treatment strategy based on Helicobacter pylori status and tumor stage and grade. METHODS: Of 266 patients with primary gastric B-cell lymphoma, 236 with stages EI (n = 151) or EII (n = 85) were included in an intention-to-treat analysis. Patients with H. pylori-positive stage EI low-grade lymphoma underwent eradication therapy. Nonresponders and patients with stage EII low-grade lymphoma underwent gastric surgery. Depending on the residual tumor status and predefined risk factors, patients received either radiotherapy or no further treatment. Patients with high-grade lymphoma underwent surgery and chemotherapy at stages EI/EII, complemented by radiation in case of incomplete resection. RESULTS: Endoscopic-bioptic typing and grading and clinical staging were accurate to 73% and 70%, respectively, based on the histopathology of resected specimens. The overall 2-year survival rates for low-grade lymphoma did not differ in the risk-adjusted treatment groups, ranging from 89% to 96%. In high-grade lymphoma, patients with complete resection or microscopic tumor residuals had significantly better survival rates (88% for EI and 83% for EII) than those with macroscopic tumor residues (53%; P < 0.001). CONCLUSIONS: There is a considerable need for improvement in clinical diagnostic and staging procedures, especially with a view toward nonsurgical treatment. With the exception of eradication therapy in H. pylori-positive low-grade lymphoma of stage EI and the subgroup of locally advanced high-grade lymphoma, resection remains the treatment of choice. However, because there is an increasing trend toward stomach-conserving therapy, a randomized trial comparing cure of disease and quality of life with surgical and conservative treatment is needed.

Adult↗
PubMed2000

Comparative analysis of the Helicobacter pylori status in patients with gastric MALT-type lymphoma and their respective spouses.

UNLABELLED: Helicobacter pylori is of major importance for the development and progression of gastric MALT-type lymphoma. In case of localized low grade lymphoma successfully treated by Helicobacter pylori eradication reinfection by the bacterium may involve the risk of lymphoma reoccurrence. AIMS: To assess the frequency and type of Helicobacter pylori infection among patients with gastric MALT-type lymphoma and their respective spouses as potential sources of person to person spread of the infection. SUBJECTS: 35 patients with gastric MALT-type lymphoma and their cohabiting spouses. METHODS: We investigated serum IgG titers in response to the infection by Helicobacter pylori and to its virulence factors CagA and VacA by enzyme linked immunosorbent assay (ELISA) and by Western blot. RESULTS: Seropositivity of Helicobacter pylori, Cag A and Vac A was found to be 100/89/69% and 97/86/66% in patients and respective partners, respectively. The seroprevalence rates of the latter group by far exceed those of the German population. CONCLUSION: These data provide evidence for a high Helicobacter pylori infection rate in both patients with gastric MALT-type lymphoma and their respective spouses. Considering the latter as a potential source of reinfection with the risk of lymphoma reoccurrence for the successfully treated patient with gastric MALT-type lymphoma careful follow-up seems highly reasonable to decide on the necessity of a future test-and-treat strategy of this population.

Adult↗
PubMed2000

Primary gastric lymphoma of MALT: considerations of pathogenesis, diagnosis and therapy.

Primary gastric lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct entity with its own histological classification. Epidemiological, histomorphological, molecular biological and experimental data clearly underline that infection of the gastric mucosa by Helicobacter pylori plays an important role in both the development and progression of MALT lymphoma. Considering the histological grade of malignancy and dissemination (stage) of the disease as decisive prognostic factors, and therapeutic determinants, endoscopic bioptical diagnosis and endoscopic ultrasound are of particular importance. In cases of localized (stage 1), low grade lymphoma, eradication of H pylori offers a promising and fascinating therapeutic option. Surgical resection, radiotherapy or chemotherapy, and their combination, have proven to be effective treatment modalities. There is a need to clarify whether operative or conservative therapeutic strategies should be favoured in the future.

Endosonography↗
PubMed1999

Differences in endoscopic and clinicopathological features of primary and secondary gastric non-Hodgkin's lymphoma. German Gastrointestinal Lymphoma Study Group.

BACKGROUND: Lymphomatous neoplasia of the stomach is initially seen either as primary gastric B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) or as nodal non-Hodgkin s lymphoma (NHL) secondarily involving the GI tract. One hundred seventy-six patients with primary gastric NHL (low grade, n = 65; high grade, n = 111) and 29 with secondary gastric NHL (low grade, n = 19; high grade, n = 10) were studied to evaluate whether differences in pathogenesis are associated with distinct clinical and endoscopic features. METHODS: Clinical features, tumor size, localization, and growth pattern were analyzed by means of esophagogastroduodenoscopy; grading was determined with histologic examination. RESULTS: The analysis of various clinical symptoms and endoscopic findings revealed a relationship between the occurrence of abdominal pain, vomiting, and unifocal growth pattern with an affiliation to the group with primary gastric NHL (p < 0.001), whereas tumor localization in the gastric fundus was predominantly found in secondary gastric NHL (p < 0.001). An equation has been generated that may help to predict affiliation to primary or secondary gastric NHL with an accuracy of 96%. CONCLUSIONS: Our results indicate that careful pretreatment analysis of clinical and endoscopic findings may be helpful in the diagnosis of primary or secondary gastric involvement by NHL, although reliable discrimination still requires histologic verification.

Abdominal Pain↗
PubMed1999

Response

Explore the source record for details and available documents.

Journal Article↗
PubMed1999

Evaluation of Helicobacter pylori in gastric MALT-type lymphoma: differences between histologic and serologic diagnosis.

Helicobacter pylori provides the pathogenic background for the development of gastric MALT-type lymphoma. The assessment of H. pylori is limited by the accuracy of the detection method used. Especially in patients with low-grade MALT-type lymphoma, the H. pylori status is the crucial question for therapeutic management. In this study, 60 patients with gastric MALT-type lymphoma. (lowgrade, 22; high-grade, 38) were investigated for the presence of H. pylori by histologic and serologic means. In 98% of the patients with MALT-type lymphoma, H. pylori-specific IgG serum antibodies were detected. In contrast, on histologic examination, H. pylori was found only in 78% of the patients (low-grade, 77%; high-grade, 79%). In this study, a discrepancy between serologic and histologic evaluation of the H. pylori status in gastric MALT-type lymphoma was found. Therefore, a H. pylori eradication therapy in low-grade MALT-type lymphoma, which often leads to a complete tumor regression, should not be excluded as a first line therapy because of a negative H. pylori status on histologic examination.

Antibodies, Bacterial↗
PubMed1998

[Helicobacter and lymphoma].

The gastrointestinal tract represents the most common extranodal site of malignant non-Hodgkin's lymphoma. Epidemiological, histomorphological, molecular biological and experimental animal studies undoubtedly underline the important role of Helicobacter pylori for the development and progression of primary gastric lymphoma of MALT (mucosa-associated lymphoid tissue). Eradication of Helicobacter pylori is an important therapeutic option in low-grade gastric, MALT lymphoma of localized stage E I.

Cell Transformation, Neoplastic↗
PubMed1998

[Diagnostic value of stomach biopsy in comparison with surgical specimen in gastric B-cell lymphomas of the MALT type].

Diagnostic und therapeutic management of gastric lymphomas of the mucosa-associated lymphoid tissue type (MALT-type lymphomas) is often based exclusively on the evaluation of biopsy material. To evaluate the diagnostic value of gastric biopsies in gastric MALT-type lymphomas, biopsies--on average six per patient--and subsequent surgical specimens of 64 patients were compared at the Institute of Pathology, University of Würzburg. Tumor diagnosis and tumor gradind were assessed. Using biopsy specimens, primary gastric MALT-type lymphomas were correctly diagnosed by local pathologists in 69% of cases, but correctly graded as low-grade, high-grade or secondary high-grade lymphomas in only 41%. When immunohistochemistry and molecular biological techniques were applied in addition to conventional histology, diagnosis of gastric MALT-type lymphoma was achieved in biopsies in 95% of cases at the Institute of Pathology Würzburg, but correct grading in only 73%. In secondary high-grade MALT-type lymphomas, both components--the high-grade and the low-grade component--were identified in gastric biopsies in only 33% of cases. Diagnostic accuracy in gastric lymphomas based on biopsies is limited by biopsy artefacts, but improved by using immunohistochemistry and molecular biological techniques. Particularly in secondary high-grade MALT-type lymphomas the correct diagnosis is often missed when using biopsies, due to a low number of biopsy specimens.

Biomarkers, Tumor↗