Gastroenterology News
Colorectal cancer screening test more accurate in winter than summer
Study results show that the immunochemical fecal occult blood test (iFOBT) for detecting colorectal cancer is approximately 13% less accurate in the summer than in the winter. In this study, Grazia Grazzini (Cancer Prevention and Research Institute, Florence, Italy) and colleagues analyzed 199,654 iFOBT results taken as part of the Florence regional colorectal cancer screening program. Overall, the researchers found that there was a 13% lower probability of detecting a cancer or an advanced adenoma with iFOBT in the summer than the winter. Writing in the journal Gut, the investigators warn: "These results will have important implications for the organization of iFOBT-based screening programs, particularly in countries with high ambient temperatures."
Lactulose versus Polyethylene Glycol for Chronic Constipation
Constipation is a common clinical problem. Lactulose and Polyethylene Glycol (PEG) are both commonly used osmotic laxatives that have been shown to be effective and safe treatments for chronic constipation. However, there is no definitive data as to which provides the best treatment. This Cochrane Review reviewed all relevant data in order to determine whether Lactulose or Polyethylene Glycol is more effective at treating chronic constipation and faecal impaction. In the present meta-analysis the findings of our work indicate that Polyethylene glycol is better than lactulose in outcomes of stool frequency per week, form of stool, relief of abdominal pain and the need for additional products.
Computed tomographic colonography in the diagnosis of colorectal cancer
This study aimed to determine the sensitivity of computed tomographic colonography (CTC) in diagnosing colorectal cancer and to explore the reasons why these cancers are missed on CTC. Patients who underwent CTC in the 56-month period from 1 January 2004 to 1 September 2008, and all cases of colorectal cancer recorded in the National Cancer Registry database from 1 January 2004 to 1 December 2008, were identified. Overall the sensitivity of 95 per cent for CTC in the diagnosis of colorectal cancer compares favourably with that of double-contrast barium enema (92 per cent) and colonoscopy (94 per cent).
A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease
Nonalcoholic fatty liver disease (NAFLD) encompasses a histological spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). NAFLD carries a higher risk of cardio-metabolic and liver-related complications, the latter being confined to NASH and demanding specific treatment. This article assessed the efficacy of proposed treatments for NAFLD/NASH by reviewing reports of randomized controlled trials (RCTs) on online databases and national and international meeting abstracts through January 2010.
Most RCTs were small and did not exceed 1-year duration. Weight loss, thiazolidinediones (especially pioglitazone), and antioxidants were most extensively evaluated. Of them none of them yielded significant results suggesting that well-designed RCTs of adequate size and duration, with histological endpoints, are needed to assess long-term safety and efficacy of proposed treatments on patient-oriented clinical outcomes.
Donor Race Does Not Predict Graft Failure After Liver Transplantation
Donor race has been proposed to predict graft failure after liver transplantation. This article evaluated the extent to which the center where the transplantation surgery was performed and other potential confounding factors might account for the observed association between donor race and graft failure.
Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease
The rising incidence of obesity and diabetes coincides with a marked increase in fructose consumption. Fructose consumption is higher in individuals with nonalcoholic fatty liver disease (NAFLD) than in age-matched and body mass index (BMI)-matched controls. Because fructose elicits metabolic perturbations that may be hepatotoxic, this article investigated the relationship between fructose consumption and disease severity in NAFLD.
After controlling for age, sex, BMI, and total calorie intake, daily fructose consumption was associated with lower steatosis grade and higher fibrosis stage (P < 0.05 for each). In older adults (age 48 years), daily fructose consumption was associated with increased hepatic inflammation (P < 0.05) and hepatocyte ballooning (P = 0.05). In patients with NAFLD, daily fructose ingestion is associated with reduced hepatic steatosis but increased fibrosis. These results identify a readily modifiable environmental risk factor that may ameliorate disease progression in patients with NAFLD.
Proton Pump Inhibitors Increase Risk for Recurrent Clostridium difficile Infection
Proton pump inhibitors (PPIs) are widely used gastric acid suppressants, but they are often prescribed without clear indications and may increase risk of Clostridium difficile infection (CDI). An article in the Archives of Internal Medicine sought to determine the association between PPI use and the risk of recurrent CDI. Recurrent CDI was more common in those exposed to PPIs than in those not exposed (25.2% vs 18.5%) and treatment was associated with a 42% increased risk of recurrence.
Antireflux surgery does not prevent esophageal adenocarcinoma
Antireflux surgery does not prevent development of esophageal or cardia adenocarcinoma in patients with reflux, show study results. To investigate the suggestion that antireflux surgery may have a preventive effect on these cancers in people with reflux, which is a known risk factor, Jesper Lagergren (Karolinska Institutet, Stockholm, Sweden) and colleagues carried out a population based cohort study of 14,102 people with gastroesophageal reflux disease (GERD) who had antireflux surgery from 1965 to 2006. “This large and population-based cohort study with long and complete follow-up evaluation indicates that antireflux surgery does not prevent the development of esophageal or cardia adenocarcinoma among persons with reflux,” conclude the authors in the journal Gastroenterology.
Inflammatory Bowel Disease Confers a Lower Risk of Colorectal Cancer to Females Than to Males
Reported differences in cancer risk between male and female animals after chronic inflammation suggest that estrogen has inflammation-modifying properties. Little is known about these effects in human beings. Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC). An article in this months Journal of Gastroenterology studied differences in inflammation-associated CRC between men and women patients with IBD by using a large population-based cohort (n = 7607) of individuals diagnosed with IBD from 1954 to 1989, we assessed the sex-specific incidence of CRC from 1960 to 2004. During 171,000 person-years of follow-up evaluation, 196 new cases of CRC were observed (123 in males, 73 in females). Males with IBD had a 60% higher risk of CRC than females (cumulative incidence 40 years after IBD diagnosis, 8.3% vs 3.5%). Compared with the rate of CRC among the general population, in males with IBD the RR was 2.6 and the 95% CI was 2.2–3.1, whereas in females the RR was 1.9 and the 95% CI was 1.5–2.4.
Once-Daily Dosing of Delayed-Release Oral Mesalamine (400-mg Tablet) Is as Effective as Twice-Daily Dosing for Maintenance of Remission of Ulcerative Colitis
The practice of dosing mesalamines in divided doses for the treatment of ulcerative colitis (UC) began with sulfasalazine and was driven by sulfapyridine toxicity. This convention and the assumption that dosing multiple times a day is necessary to treat UC had not been challenged until recently. This study was conducted to determine the efficacy and safety of once-daily dosing of delayed-release mesalamine (Asacol 400-mg tablets) compared with twice-daily dosing for maintaining remission in UC patients. A total of 1023 patients were randomized and dosed. The primary objective of noninferiority was met. At month 6, 90.5% of patients receiving once-daily dosing had maintained clinical remission, compared with 91.8% of patients receiving twice-daily dosing (95% confidence interval for twice daily - once daily, -2.3 to 4.9). At month 12, 85.4% of patients receiving once-daily dosing had maintained clinical remission, compared with 85.4% of patients receiving twice-daily dosing (95% confidence interval for twice daily - once daily, -4.6 to 4.7). Both regimens had low rates of withdrawals as a result of adverse events and serious adverse events.
Omega-3 May Safely Treat Precancerous Bowel Polyps
Treatment with a specific type of omega-3 fatty acid can shrink the number and size of precancerous polyps in people at high genetic risk of developing bowel cancer, British researchers say. The study authors reported that the new treatment appears to work as well as a drug called celecoxib (Celebrex), which is prescribed for patients with bowel polyps linked to their genetic risk, but it doesn't cause heart-related side effects.
Proton-Pump Inhibitor Use Is Not Associated With Osteoporosis or Accelerated Bone Mineral Density Loss
Recent studies have shown an association between proton-pump inhibitor use (PPI) and hip fracture. The mechanism by which PPI use promotes the development of hip fracture is uncharacterized. A study out of Gastroenterology sought to determine whether PPI use is associated with osteoporosis or accelerated bone mineral density (BMD) loss. PPI use was not associated with having osteoporosis at either the hip (OR, 0.84; 95% CI, 0.55–1.34) or the lumbar spine (OR, 0.79; 95% CI, 0.59–1.06) for PPI use >1500 doses over the previous 5 years. In the longitudinal study no significant decrease was observed in BMD at either site attributable to PPI use.
Leflunomide: Is a New Oral Agent in Treatment of Acute Pancreatitis?
Nuclear factor-κB (NF-κB) is a potent mediator in several steps of acute pancreatitis. Leflunomide is a novel immunomodulating drug that is also a potent inhibitor of NF-κB activation. The aim of this study was to investigate the effects of leflunomide pretreatment in severe necrotizing pancreatitis. Leflunomide pretreatment significantly ameliorated pancreatic hemorrhage, edema, and neutrophil infiltration and decreased histopathological score compared with the untreated severe necrotizing pancreatitis group. Leflunomide is a beneficial agent in the severe form of acute pancreatitis in rats and should be considered as a potential agent for treatment of acute pancreatitis.
Efficacy of Ceftriaxone or Meropenem as Initial Therapies in Whipple's Disease
Whipple's disease is a chronic infection caused by the actinomycete Tropheryma whipplei. An article from the Journal of Gastroenterology presented a randomized controlled trial of the efficacy of antimicrobials that are able to cross the blood-brain barrier and to which T whipplei is susceptible. Patients from central Europe with previously untreated Whipple's disease (n = 40) were assigned randomly to groups given daily infusions of either ceftriaxone (1 × 2 g, 20 patients) or meropenem (3 × 1 g, 20 patients) for 14 days, followed by oral trimethoprim–sulfamethoxazole for 12 months. The primary outcome measured was maintenance of remission for 3 year. All achieved clinical and laboratory remission. Remission was maintained in all patients during the time of observation, except for 2 who died from unrelated causes.
Treatment with Monoclonal Antibodies against Clostridium difficile Toxins
New therapies are needed to manage the increasing incidence, severity, and high rate of recurrence of Clostridium difficile infection. A study out of the New England Journal showed that among the 200 patients who were enrolled (101 in the antibody group and 99 in the placebo group), the rate of recurrence of C. difficile infection was lower among patients treated with monoclonal antibodies (7% vs. 25%). The addition of monoclonal antibodies against C. difficile toxins to antibiotic agents significantly reduced the recurrence of C. difficile infection.
Blood Test Detects Colorectal Cancer
A novel blood test that measures CD24 protein levels may detect early colorectal cancer and precancerous adenomas, researchers found. The investigational assay had 78.4%% sensitivity and 86.8% specificity for distinguishing patients with colorectal adenoma or cancer from healthy controls in a study led by Sarah Kraus, PhD, of Tel Aviv Souraski Medical Center in Israel.
Continuation of Low-Dose Aspirin Therapy in Peptic Ulcer Bleeding
It is uncertain whether aspirin therapy should be continued after endoscopic hemostatic therapy in patients who develop peptic ulcer bleeding while receiving low-dose aspirin. In a parallel randomized, placebo-controlled noninferiority trial, in which both patients and clinicians were blinded to treatment assignment. It was shown that among low-dose aspirin recipients who had peptic ulcer bleeding, continuous aspirin therapy may increase the risk for recurrent bleeding but potentially reduces mortality rates. Larger trials are needed to confirm these findings.
Statins don't curb colorectal cancer risk
Taking a cholesterol-lowering statin will lower your cholesterol but it won't cut your risk of developing colorectal cancer, according to study of more than 400,000 Canadians.
Autoimmune Gastritis May Be Underdiagnosed by as Much as Half
Autoimmune gastritis may be twice as common as indicated in the current literature, according to a poster presented here at the American Society for Clinical Pathology (ASCP) 2009 Annual Meeting.
While the commonly estimated prevalence of the disease is only 0.1% to 0.2%, those estimates are based primarily on clinical features, not histological examination, the authors reported. When the biopsies were examined under a microscope, 13 cases of the autoimmune gastritis were found that had been missed by the pathologist on clinical examination, bringing the sample prevalence up to 4%.
Antibiotics Top Cause of Drug-Induced Liver Failure
Antimicrobial agents are the most common cause of drug-induced liver failure, with most cases ending in death or transplant, a researcher said here. A prospective analysis of some 1,200 cases of acute liver failure found that half of those caused by drugs were associated with antituberculosis, antifungal, sulfa drugs, and other antibiotics, according to Adrian Reuben, MBBS, of the Medical University of South Carolina in Charleston.
Use of Over-the-Counter Analgesics Is Not Associated With Acute Decompensation in Patients With Cirrhosis
Only 32 (35%) of the cirrhotic patients used over-the-counter analgesics (19% acetaminophen, 16% nonsteroidal anti-inflammatory drugs), compared with 80 of the cirrhotic controls (52%; 25% acetaminophen, 31% nonsteroidal anti-inflammatory drugs), and 62 (70%) of the noncirrhotic controls. Acetaminophen use did not differ between groups, even for those with recent alcohol use.
Proton Pump Inhibitors Do Not Counteract Benefits Of Antiplatelet Drugs Clopidogrel Or Prasugrel In Patients After An Acute Coronary Syndrome
An article published Online First and in a future edition of The Lancet reports that proton pump inhibitors (PPIs) do not interfere with the clinical benefit of the anticlotting drugs clopidogrel or prasugrel (thienopyridines) in patients after an acute coronary syndrome such as heart attack or unstable angina.
EGD can be diagnostic for children’s abdominal pain
MedWire News: US study findings suggest that esophagogastroduodenoscopy (EGD) may be diagnostic in more than a third of children who experience chronic abdominal pain.Their study showed that EGD had diagnostic yield, in contrast with most alarm symptoms and routine laboratory tests evaluated.EGD is not generally recommended for the evaluation of chronic abdominal pain, say K Thakkar (Baylor College of Medicine, Houston, Texas) and colleagues.
MRI touted as endoscopic alternative for Crohn’s disease
Positive study findings have led Spanish researchers to propose that magnetic resonance (MR) could be used as an alternative to endoscopy to assess the activity and severity of ileocolonic Crohn’s disease (CD). Quantitative MR changes such as wall thickening, contrast signal intensity, and relative contrast enhancement closely paralleled the severity of endoscopic lesions, say J Panes (Hospital Clinic of Barcelona) and colleagues.
High Intake Of Linoleic Acid Associated To A Third Of Ulcerative Colitis Cases
A research published ahead of print in Gut (International Journal of Gastroenterology and Hepatology) reports that high intakes of linoleic acid might be associated to a third of ulcerative colitis cases. Linoleic acid is a common dietary polyunsaturated fatty acid (N-6 PUFA).
Colonoscopy Beats 'Camera Pill' at Catching Colon Cancer
Researchers had high hopes for a minimally invasive cancer-screening technique known as capsule endoscopy, but the "camera pill" appears to be less effective than standard colonoscopy at identifying precancerous polyps and cancer, new research from Belgium suggests
A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome
Irritable Bowel Syndrome (IBS) is a common chronic gastrointestinal disorder and the evidence for efficacy of most drug therapies in the treatment of IBS is weak. A popular alternative is probiotics, which have been used in several conditions. including IBS. Probiotics are live microbial food supplements.
