The epidemiology and pathogenesis of neoplasia in the small intestine.
The epidemiology and pathogenesis of neoplasia in the small intestine.
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DOI：
10.1016/j.annepidem.2008.10.004
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发表时间：
2009-01
影响因子：
5.6
通讯作者：
Vigneau FD
中科院分区：
文献类型：
--
作者：
Schottenfeld D;Beebe-Dimmer JL;Vigneau FD
小肠粘膜约占消化系统腔表面积的90%，但仅占美国每年胃肠道癌症总发病率的2%。从肿瘤的细胞类型、人口学特征和分子特征方面，回顾了小肠和大肠在年龄标准化癌症发病率方面的显著差异。特别值得注意的是，结肠腺癌占大多数，按细胞类型计算，它占总发病率的98%以上，而小肠的发病率为30%至40%，导致年龄标准化比率超过50倍。腺瘤和癌的发病率在十二指肠和空肠近端最为突出。全球小肠和大肠肿瘤的发病率与第二原发腺癌风险的相对增加呈正相关，这表明存在共同的环境风险因素。克罗恩炎症性肠病的病理生理学和腺癌风险的增加证明了粘膜屏障的完整性受损和对管腔、本土和潜在致病微生物的异常免疫反应的重要性。在提出小肠和大肠粘膜敏感性差异的可能机制方面，强调了在不同的分类、厌氧微生物的浓度和代谢活性、肠道转运速度、pH变化以及胆汁酸的肠-肝循环和代谢方面的实质性差异。引用的实验和流行病学研究表明，微生态的变化，特别是在结肠中，与摄取和内源性形成的致癌底物的代谢激活增强有关。
The mucosa of the small intestine encompasses about 90% of the luminal surface area of the digestive system, but only 2% of the total annual gastrointestinal cancer incidence in the United States. The remarkable contrast in age-standardized cancer incidence between the small and large intestine has been reviewed with respect to the cell type patterns, demographic features, and molecular characteristics of neoplasms. Particularly noteworthy is the predominance of adenocarcinoma in the colon, which exceeds 98% of the total incidence by cell type, in contrast to that of 30% to 40% in the small intestine, resulting in an age-standardized ratio of rates exceeding 50-fold. The prevalence of adenomas and carcinomas is most prominent in the duodenum and proximal jejunum. The positive correlation in global incidence rates of small and large intestinal neoplasms and the reciprocal increases in risk of second primary adenocarcinomas suggest that there are common environmental risk factors. The pathophysiology of Crohn inflammatory bowel disease and the elevated risk of adenocarcinoma demonstrate the significance of the impaired integrity of the mucosal barrier and of aberrant immune responses to luminal indigenous and potentially pathogenic microorganisms. In advancing a putative mechanism for the contrasting mucosal susceptibilities of the small and large intestine, substantial differences are underscored in the diverse taxonomy, concentration and metabolic activity of anaerobic organisms, rate of intestinal transit, changing pH, and the enterohepatic recycling and metabolism of bile acids. Experimental and epidemiologic studies are cited that suggest that the changing microecology, particularly in the colon, is associated with enhanced metabolic activation of ingested and endogenously formed procarcinogenic substrates.
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影响因子：
120.7
作者：
Catassi, C;Fabiani, E;Corazza, GR
通讯作者：
Corazza, GR
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3.3
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6.2
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8.8
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--
影响因子：
8
作者：
Bl채ker, H;von Herbay, A;Otto, HF
通讯作者：
Otto, HF