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The percentage of adenocarcinoma prevalence increased from 3. In Western countries, adenocarcinoma has become the dominant histological type of esophageal cancer. Data collected between and in the USA by the Centers for Disease Control and Prevention showed that the incidence of esophageal adenocarcinoma increased by 2. Gastroesophageal reflux disease GERD , obesity, and decreasing prevalence of Helicobacter pylori infection are factors related to the development of adenocarcinoma of the esophagus [9].

When classified according to the location of tumors, adenocarcinoma of the esophagus occurs in the distal third of the esophagus, whereas squamous cell carcinoma can occur in any part of the esophagus, although most tumors occur in the distal third of the esophagus [11]. There has been a downward trend in the incidence of gastric cancer. The prevalence of gastric cancer increased significantly throughout the 19 th century, but the number of cases has decreased abruptly over the past five decades in most parts of the world [ 2 , 12 ].

The decreasing number of H. The rate of diffuse type gastric carcinoma increased from 0. An increase in the incidence of diffuse type gastric cancer and a decrease in intestinal-type gastric cancer was reported for males and females, African-Americans and whites [16]. The most common stomach cancer location in the world is non-cardia gastric cancer, although its incidence has been declining in developed regions.

By contrast, the incidence of adenocarcinoma of the cardia, which is triggered by reflux disease, has been rising in Europe and North America over the past two decades [3]. Small intestine cancer is a rare type of tumor that accounts for [17].

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A study from Sweden reported that, from to , the incidence of small intestine cancer increased from The incidence of duodenal cancer increased more than threefold from 1. Malignant tumors of the small bowel with unspecified anatomical locations increased slightly from 7. Global Cancer Statistics - stated that colorectal cancer is the third most common cancer in males and second most common in females [ 19 , 20 ]. Several studies have reported that the incidence of colorectal cancer has been increasing in Asian countries [ 5 , 21 ].

By contrast, the incidence of colorectal cancer has remained stable in most developed countries and has shown decreased trends in the USA [ 4 , 22 ]. Some studies have shown that colorectal cancer affects a younger population in some regions in Asia, Canada, Australia, North America, and some European countries.

ipdwew0030atl2.public.registeredsite.com/94238-tracker-where.php By contrast, some studies have claimed that this was not a consistent trend or was a temporary trend only in particular areas. In China, the proportion of colorectal cancer patients aged 60 years diagnosed with colorectal cancer increased over time. A shift in the typical location of colorectal cancers has also occurred. In China, from year to the proportion of patients with sigmoid colon cancer increased from By contrast, Gomez et al. Similar data were also reported by Effendi et al. The aim of this study was to identify the latest trends in the demography, histopathology, and location of gastrointestinal malignancies in patients admitted to Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.

This cross-sectional retrospective study was based on medical records collected consecutively from January 1, , to December 31, The subjects were patients diagnosed with esophageal cancer, gastric cancer, duodenal cancer, and colorectal cancer based on endoscopy reports from the Gastrointestinal Endoscopy Center, Cipto Mangunkusumo National General Hospital. The variables analyzed in this study were age, gender, histopathology, and location of the cancers.

The data were analyzed using analysis of variance, independent t test, chi-square test, or Fisher—Kolmogorov—Smirnov test using SPSS There were and gastrointestinal cancer patients data analysed during — and —, respectively Table 1 and Among all, The most prevalent gastrointestinal cancers throughout the decade were colorectal cancer Esophageal cancer Demography of esophageal cancer: There was no statistically significant change in the demography of esophageal cancer between the two periods Table 3.

However the prevalence was higher in males as compared to females during both periods. Histopathology of esophageal cancer: There was a shift in the pattern of the histopathology of esophageal cancer Table 4. The percentage of squamous cell carcinoma cases were decreased from — to — Location of esophageal cancer: Overall, there were no changes in the location of esophageal cancers upper esophagus, lower esophagus, middle esophagus, and diffuse between the periods Table 5.

Gastric cancer Demography of gastric cancer: The mean age at diagnosis of gastric cancer was This shift in age was also apparent in the different age groups: the percentage of patients aged 30—60 years increased from More patients were male in both periods. Histopathology of gastric cancer: Adenocarcinoma comprises intestinal, diffuse, and indeterminate types.

In this study, the intestinal type comprised tubular, papillary, and mucinous adenocarcinoma. The diffuse type comprises signet ring cell carcinoma, and the indeterminate type comprises adenosquamous carcinoma [15]. Nonepithelial tumors comprise gastrointestinal stromal tumor GIST , composite glandular endocrine tumor, mucosa-associated lymphoid tissue lymphoma, lymphoma, leiomyosarcoma, and mesenchymal tumor.

The intestinal type of adenocarcinoma was the most frequent type of gastric cancer in both periods Table 7. The histopathology pattern of gastric cancer showed that the percentage of the diffuse type of adenocarcinoma decreased from Location of gastric cancer: The percentage of cases with an unclassified location or where the tumor extended more than one location increased from 2.

Duodenal cancer Demography of duodenal cancer: There was a significant fold increase in the incidence of duodenal cancer from — to — Table 9. There were no significant demographic changes in duodenal cancer over this interval, and most patients were aged 30—60 years at both times. Histology of duodenal carcinoma: There were no changes in the pattern of the histology of duodenal carcinoma from to Table Adenocarcinoma was the most prevalent duodenal carcinoma at both periods.

Location of duodenal cancers: Similarly, No change was observed in the location of duodenal cancers in both periods Table Colorectal cancer Demography of colorectal cancer: The percentage of patients with colorectal cancer aged Histopathology of colorectal cancer: There was no change in the histopathology of colorectal cancer Table 13 when compared between periods. Carcinoma was the most frequent colorectal cancer in both periods.

Location of colorectal cancers: There was no change in the location of colorectal cancers Table Cancer is the leading cause of death in economically developed countries and the second leading cause of death in developing countries [19]. Gastrointestinal malignancy is one of the most common malignancies in the world, and its incidence remains high, particularly in Asia [4].

The number of cases of gastrointestinal malignancy in Cipto Mangunkusumo National General Hospital was higher in — compared with — and , respectively. Most patients were male: The incidence of gastrointestinal cancer in our hospital is similar to that reported in other countries. In general, we did not find any changing trends in the demography of gastrointestinal malignancy [19].

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Demography of esophageal cancer Esophageal carcinoma is likely to occur in older people and is more frequent in males. A study from the Czech Republic found that the highest incidence of esophageal carcinoma occurred in people aged 50—70 years, with male-to-female ratio of 3.

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In our study, the highest incidence of esophageal cancer occurred in people aged 50—60 years, but the male-to-female ratio was Even though the increase in the percentage of female patients did not change significantly between the two periods Worldwide, both in high-and low-incidence areas for esophageal cancer, the percentage of the population younger than 30 years with esophageal cancer are 0.

Data from our hospital is in line with global incidence of esophageal cancer in the younger population aged [26]. This difference between studies may reflect genetic or environmental differences such as socioeconomic status, diet, use of traditional medicine or foods, and the presence of communicable diseases [22]. Histopathology of esophageal cancer During the decade of this study, the number of adenocarcinoma cases increased and that of squamous cell carcinomas decreased. These results are similar to those of a study by Rozen et al. Adenocarcinoma of the esophagus is associated with chronic GERD.

A recent meta-analysis based on five studies showed that GERD patients without reflux symptoms or at least weekly symptoms had a nearly fivefold increased risk of adenocarcinoma of the esophagus odds ratio OR , 4. In addition to GERD, many studies have shown that obesity is also a risk factor for adenocarcinoma of the esophagus, particularly in men. Several authors have hypothesized that this is because a heavier abdomen tends to increase the pressure on the stomach, causing acid reflux into the esophagus [9].

The increased BMI has strong association with development of adenocarcinoma of esophagus.

A recent meta-analysis based on 22 observational studies found that the risk ratio of adenocarcinoma of the esophagus was 2. The changing histological pattern of esophageal cancer in Indonesia is similar to that in other countries. The increased prevalence of GERD and obesity has become important factors in the development of adenocarcinoma of the esophagus. Syam et al. In addition to the increased prevalence of GERD, the high prevalence of overweight has also become an important factor underlying the changing histological pattern of esophageal cancer both worldwide and in Indonesia.

Worldwide, the prevalence of overweight and obesity combined rose by A study by Stevens et al reported that during to , there was an increase prevalence of overweight from We predict that, in the future, adenocarcinoma of the esophagus will occur more often compare with squamous cell carcinoma because of the increase in the prevalence of GERD and obesity in Indonesia. These related factors seemed to be increasing because of dietary changes, especially fast food consumption, in our population. Quigley, M.

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Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract Watch a video presentation of this article. Evidence for a Disturbed Microbiome in Chronic Liver Disease Small Intestinal Bacterial Overgowth By virtue of changes in gut motility and transit, on the one hand, and intestinal permeability, on the other, subjects with chronic liver disease are predisposed to intestinal stasis and bacterial translocation from the gut lumen to portal circulation.

Therapeutic Impact of Modulating the Microbiota A role for the microbiota in chronic liver disease and its complications or progression can also be inferred from the impact of therapeutic interventions that modify the microbiota. Antibiotics Antibiotic therapy, in liver disease, may remove organisms involved in the generation of endodoxin and thereby ameliorate the hyperdynamic circulation thought to contribute to the maintenance of portal hypertension; the ability of antibiotics to not only prevent related infections but also reduce rebleeding rates in variceal hemorrhage may be based on this mechanism.