Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A variety of questions regarding Helicobacter pylori need to be addressed by future research. Further investigations are needed on the relationship between H. pylori and gastric cancer. In particular, the mechanism of the interaction between H. pylori infection and host genetic factors and dietary factors that lead to the cancer need to be unraveled. Also, the reversibility of cancer-associated abnormalities (e.g., hypochlorhydria, atrophy, and intestinal metaplasia) by eradication of H. pylori needs to be determined. Noninvasive means of identifying H. pylori-positive subjects at high risk of developing gastric cancer are required for such subjects to be targeted for eradication therapy. Further studies are also required on the interactions between H. pylori and proton pump inhibitor therapy that might predispose to cancer. There is considerable interest in the possibility of noninvasive H. pylori testing replacing endoscopy in determining management of nonelderly patients with uncomplicated dyspepsia unassociated with nonsteroidal anti-inflammatory drugs (NSAIDs). Randomized studies comparing endoscopy vs. noninvasive H. pylori testing in this situation are required with comprehensive outcome measures. Improvement in eradication therapy is required and will depend on the development of more effective and specific antibiotics and therapeutic vaccines. Wide-scale elimination of the infection will depend on preventing its spread from person to person. Achieving this will require further knowledge of its mode of transmission, particularly in childhood, and the development of prophylactic vaccines. Further studies are required to define the role of H. pylori infection in other diseases, including predisposition to enteric infection in the developing world as a result of H. pylori-induced chronic hypochlorhydria, nonulcer dyspepsia, pernicious anemia, atherosclerosis, and NSAID-related ulcer disease. Finally, we need to know whether H. pylori infection may be beneficial in certain circumstances and whether eradicating the infection may be disadvantageous to some subjects.
 ...
PMID:What remaining questions regarding Helicobacter pylori and associated diseases should be addressed by future research? View from Europe. 939 79

In 18 patients with pernicious anaemia (PA) the authors assessed the blood glucose level, C-peptide level and immunoreactive insulin (IRI) during the oral glucose tolerance test (o-GTT). They calculated the body mass index (BMI), assessed the level of the thyroid-stimulating hormone (s-TSH), free thyroxine (fT4), triiodothyronine (T3) and took repeatedly blood pressure readings. In one female patient they confirmed the diagnosis of insulin dependent diabetes mellitus (IDDM), in another six subjects they detected non-insulin dependent diabetes mellitus (NIDDM), incl. two persons where it was detected newly. In four patients impaired glucose tolerance was revealed. In the remaining seven patients non-classifiable glucose tolerance was found, none of the patients had a quite normal o-GTT. In five patients, hitherto not diagnosed latent hypothyroidism was detected. Eleven subjects were obese, four patients suffered from hypertension, another six from systolic hypertension, in eight patients a significantly elevated C-peptide level on fasting was found, in the majority of patients an elevated, or protracted response of C-peptide and insulin to orally administered glucose was found. Patients with pernicious anaemia must be considered subjects with cumulation of risk factors for atherosclerosis; these risk factors must be actively sought and treated.
 ...
PMID:[Occurrence of diabetes, hyperinsulinism and other risk factors for atherosclerosis in patients with pernicious anemia]. 982 Jan 7

Vitamin B12 (cobalamin) deficiency is a common cause of macrocytic anemia and has been implicated in a spectrum of neuropsychiatric disorders. The role of B12 deficiency in hyperhomocysteinemia and the promotion of atherosclerosis is only now being explored. Diagnosis of vitamin B12 deficiency is typically based on measurement of serum vitamin B12 levels; however, about 50 percent of patients with subclinical disease have normal B12 levels. A more sensitive method of screening for vitamin B12 deficiency is measurement of serum methylmalonic acid and homocysteine levels, which are increased early in vitamin B12 deficiency. Use of the Schilling test for detection of pernicious anemia has been supplanted for the most part by serologic testing for parietal cell and intrinsic factor antibodies. Contrary to prevailing medical practice, studies show that supplementation with oral vitamin B12 is a safe and effective treatment for the B12 deficiency state. Even when intrinsic factor is not present to aid in the absorption of vitamin B12 (pernicious anemia) or in other diseases that affect the usual absorption sites in the terminal ileum, oral therapy remains effective.
 ...
PMID:Vitamin B12 deficiency. 1476 65

Evidence exists that well-planned vegetarian diets provide numerous health benefits and are appropriate for all stages of the life cycle. It is also known that animal foods provide micronutrients that are nonexistent or available only in limited amounts in plant foods. Restriction or exclusion of all animal foods may therefore result in low intake of certain micronutrients such as vitamin B-12, thereby affecting vitamin B-12 status and elevating plasma homocysteine concentrations. Overall, the studies we reviewed showed reduced mean vitamin B-12 status and elevated mean homocysteine concentrations in vegetarians, particularly among vegans. Low vitamin B-12 intake may lead to decreased bioavailability and functional deficiency of cobalamin. Although early noticeable symptoms of vitamin B-12 deficiency are nonspecific (unusual fatigue, digestion problems, frequent upper respiratory infections), the best-known clinical manifestations of cobalamin malabsorption are hematologic (pernicious anemia) and neurologic symptoms. Hyperhomocysteinemia is associated with an increased risk of atherosclerosis and cardiovascular disease. Given these health concerns, vegetarians, particularly vegans, must be advised to carefully plan their diets, to monitor their plasma vitamin B-12 on a regular basis to facilitate early detection of low cobalamin status, and to use vitamin B-12-fortified foods or take vitamin B-12 supplements if necessary.
 ...
PMID:Vitamin B-12 and homocysteine status among vegetarians: a global perspective. 1935 23

A 27 year-old man who presented to the hospital with progressive lower extremity weakness, developed an acute ST elevation myocardial infarction on his second hospital day. Primary angioplasty to the left anterior descending coronary artery was performed. Due to persistent dyspnea, the patient underwent a diagnostic chest computed tomography which confirmed multiple small pulmonary emboli. Laboratory analysis revealed a megaloblastic anemia with a reduced vitamin B12 level and positive titers for antibodies against intrinsic factor, establishing a diagnosis of pernicious anemia. Screening for hypercoaguable markers documented an isolated severely elevated homocysteine levels (105 mumol/l). No other significant risk factors for coronary artery disease including a family history of premature atherosclerosis were identified. This case illustrates the importance of testing for hyperhomocysteinemia as part of a workup for atherothrombotic disease, especially in patients without other significant risk factors. The severity of hyperhomocysteinemia found in our patient is unusual for patients with vitamin B12 malabsorption and raises the question of whether the widely practiced folic acid fortification in the United States may mask or even worsen vitamin B12 deficiency over time, leading to more severe cases of vitamin B12 deficiency and hyperhomocysteinemia than seen in the past.
 ...
PMID:Acute myocardial infarction and pulmonary embolism in a young man with pernicious anemia-induced severe hyperhomocysteinemia. 1943 95