Gastroenterology News

Impact of diet on long-term decline in gastric cancer incidence in Poland
To examine the relationship between the trends in food consumption and gastric cancer morbidity in Poland. METHODS: The study was based on gastric cancer incidence rates and consumption of vegetables, fruit, vitamin C and salt in Poland between 1960 and 2006. Food consumption data were derived from the national food balance sheets or household budget surveys. Spearman correlation coefficients were used to estimate the relationship between the variables.

Serum ferritin is an independent predictor of histologic severity and advanced fibrosis in patients with nonalcoholic fatty liver disease
Serum ferritin (SF) levels are commonly elevated in patients with nonalcoholic fatty liver disease (NAFLD) because of systemic inflammation, increased iron stores, or both. The aim of this study was to examine the relationship between elevated SF and NAFLD severity. Overall it was shown that an SF >1.5 × ULN is associated with hepatic iron deposition, a diagnosis of NASH, and worsened histologic activity and is an independent predictor of advanced hepatic fibrosis among patients with NAFLD. Furthermore, elevated SF is independently associated with higher NAS, even among patients without hepatic iron deposition. We conclude that SF is useful to identify NAFLD patients at risk for NASH and advanced fibrosis.

Albumin infusion in patients undergoing large-volume paracentesis
Albumin infusion reduces the incidence of post-paracentesis circulatory dysfunction among patients with cirrhosis and tense ascites, as compared with no treatment. Treatment alternatives to albumin such as artificial colloids and vasoconstrictors have been widely investigated. The aim of this meta-analysis was to determine whether morbidity and mortality differ between patients receiving albumin vs. alternative treatments. Overall this meta-analysis provides evidence that albumin reduces morbidity and mortality among patients with tense ascites undergoing large-volume paracentesis, as compared with alternative treatments investigated thus far. (Hepatology 2011.

Low-Dose Interleukin-2 in HCV-Induced Vasculitis
Patients with vasculitis induced by the hepatitis C virus (HCV) have reduced levels of regulatory T cells (Tregs). Resolution of HCV infection correlates with cure of vasculitis and the recovery of Treg levels. The authors of this article reasoned that interleukin-2, a cytokine that promotes Treg survival and function, could be beneficial for patients with vasculitis that is resistant to HCV therapy. The treatment did not induce effector T-cell activation, vasculitis flare, or increased HCV viremia. The authors observed a reduction in cryoglobulinemia in 9 of 10 patients and improvement of vasculitis in 8 of 10. The trial showed that low-dose interleukin-2 was not associated with adverse effects and led to Treg recovery and concomitant clinical improvement in patients with HCV-induced vasculitis, an autoimmune condition.

Fatty Liver May Benefit from Mediterranean Diet
The so-called Mediterranean diet may be a way to treat non-alcoholic hepatic steatosis or fatty liver disease, a researcher said here. In a small, randomized crossover trial, patients on the Mediterranean diet reduced hepatic fat and increased insulin sensitivity, according to Marno Ryan, MD, of St. Vincent's Hospital in Melbourne, Australia. In contrast, those on a standard low-fat diet that was rich in carbohydrates saw neither effect, Ryan said at the annual meeting of the American Association for the Study of Liver Diseases. The findings were independent of weight loss and have "significant implications for patient care," Ryan said. "We can now offer patients evidence-based dietary advice that will reduce their risk of diabetes and liver disease even without weight loss."

Alcoholic Hepatitis Survival No Better With N-acetylcysteine
Adding N-acetylcysteine to prednisolone therapy failed to significantly improve 6-month survival in patients who had severe acute alcoholic hepatitis, according to a report in the Nov. 10 New England Journal of Medicine. The combination therapy did improve 1-month survival compared with standard prednisolone treatment alone, but that benefit did not persist, said Dr. Eric Nguyen-Khac of Amiens (France) University Hospital, and his associates.

Outcome predictors in acute surgical admissions for lower gastrointestinal bleeding
The BLEED criterion is a triaging model for lower gastrointestinal bleeding (LGIB) which was developed and validated in the United States. The authors assessed the BLEED criteria in a UK population and aimed to elucidate factors which can be implemented for early risk stratification.  The commonest aetiologies were diverticular disease, haemorrhoids and malignancy. Four prognosticators of adverse outcome were identified, these being: creatinine >150μmol, age >60years, abnormal haemodynamic parameters on presentation and continued bleeding within first 24-hours.  The BLEED criterion was not shown to have any predictive value in this patient cohort. Our study has determined an independent set of prognostic factors which could be incorporated into initial triaging of patients presenting with LGIB. This may facilitate early identification of patients requiring more aggressive resuscitation, admission to monitored bed and consideration for early radiological or surgical intervention.

Long-Term Aspirin Lowers Hereditary Cancer Risk By Over 60%
Patients with a family history of cancer who take daily aspirin for a number of years have a 63% lower chance of developing the disease, scientists from the Universities of Newcastle and Leeds, England, reported in the medical journal The Lancet. The researchers emphasized that it takes some years of daily aspirin therapy for the benefits to kick in. The authors explained that over the last two decades there has been growing evidence of a cancer-protecting quality in aspirin. However, this is the first proper randomized controlled study to look at aspirin's effect on cancer risk.

Uncovering the truth about covered stents: is there a difference between covered versus uncovered stents with transjugular intrahepatic portosystemic shunts?
Polytetrafluoroethylene (PTFE)-covered transjugular intrahepatic portosystemic shunt (TIPS) stents purportedly provide superior patency. This study was undertaken to determine whether covered stents provide better long-term patency and outcomes after TIPSs. Patients with portal hypertension undergoing TIPS at a large teaching hospital from 2001 to 2010 were studied and it was found that Covered stents may improve patency but do not mitigate postshunt hepatic dysfunction and do not improve survival.

New Drug Allows Shorter Hepatitis Therapy for Some
Response-guided therapy with the protease inhibitor telaprevir (Incivek) can cut the treatment period for hepatitis C (HCV) in half, researchers reported. In an open-label randomized trial, 24 and 48 weeks of standard therapy – each combined with telaprevir for the first 12 weeks – had equivalent efficacy among patients who responded early and strongly, according to Kenneth Sherman, MD, PhD, of the University of Cincinnati College of Medicine, and colleagues.

Acid Suppressants Reduce Risk of Gastrointestinal Bleeding in Patients on Antithrombotic or Anti-Inflammatory Therapy
This article  investigated the effect of different prevention strategies against upper gastrointestinal bleeding (UGIB) in the general population and in patients on antithrombotic or anti-inflammatory treatments. A population-based, nested, case-control study using The Health Improvement Network UK primary care database. From 2000 to 2007, we identified 2049 cases of UGIB and 20,000 controls. The relative risk (RR) of UGIB associated with various gastroprotective agents was estimated by comparing current use (defined as use within 30 days of the index date) with nonuse in the previous year, using multivariate logistic regression. Overall PPI use was associated with a lower risk of UGIB in the general population and in patients on antithrombotic or anti-inflammatory therapy compared with nonuse of PPIs. The reduction in risks of UGIB was smaller in H2RA than in PPI users.

Telaprevir for Previously Untreated Chronic Hepatitis C Virus Infection
In phase 2 trials, telaprevir, a hepatitis C virus (HCV) genotype 1 protease inhibitor, in combination with peginterferon–ribavirin, as compared with peginterferon–ribavirin alone, has shown improved efficacy, with potential for shortening the duration of treatment in a majority of patients. This was a  this international, phase 3, randomized, double-blind, placebo-controlled trial, we assigned 1088 patients with HCV genotype 1 infection who had not received previous treatment for the infection. The results show that Telaprevir with peginterferon–ribavirin, as compared with peginterferon–ribavirin alone, was associated with significantly improved rates of sustained virologic response in patients with HCV genotype 1 infection who had not received previous treatment, with only 24 weeks of therapy administered in the majority of patients. 

The natural history of nonalcoholic fatty liver disease with advanced fibrosis or cirrhosis
Information on the long-term prognosis of nonalcoholic fatty liver disease (NAFLD) is limited. We sought to describe the long-term morbidity and mortality of patients with NAFLD with advanced fibrosis or cirrhosis. The authors conducted this prospective cohort study including 247 patients with NAFLD and 264 patients with HCV infection that were either naïve or non-responders to treatment. Both cohorts were Child-Pugh class A and had advanced (stage 3) fibrosis or cirrhosis (stage 4) confirmed by liver biopsy at enrolment. Overall Patients with NAFLD with advanced fibrosis or cirrhosis have lower rates of liver-related complications and hepatocellular cancer than corresponding patients with HCV infection, but similar overall mortality. Some clinical and laboratory features predict outcomes in patients with NAFLD.

Cancer Risk With Barrett's Esophagus May Be Lower Than Thought
The risk of cancer associated with the condition known as Barrett's esophagus may be lower than previously thought, according to a new long-term study. People diagnosed with the premalignant condition are advised to undergo routine endoscopies to screen for esophageal adenocarcinoma, a common form of esophageal cancer. Endoscopy involves insertion of a long, thin tube with a camera at the end into the esophagus, enabling doctors to check for abnormalities. In conducting the study, published online June 16 in theJournal of the National Cancer Institute, researchers in Northern Ireland followed more than 8,500 patients diagnosed with Barrett's esophagus.

Colorectal cancer risk in IBD stable for past 30-years
The risk for colorectal cancer in patients with inflammatory bowel disease (IBD) has not increased in recent years, and has not worsened with the use of immunomodulators and biologic drugs, suggest study findings.During a presentation at Digestive Disease Week in Chicago, Illinois, USA, Michael Kappelman (University of North Carolina, Chapel Hill, USA) reported that the standardized incidence ratio (SIR) for any invasive cancer among patients with Crohn's disease or ulcerative colitis (UC) remained stable at 1.2 for both 1978-1993 and 1994-2008. The findings are of importance, as the widespread use of immune-modifying drugs has been thought to increase the risk for extra-intestinal malignancies in IBD patients, said Kappelman.

Use of Aspirin or Nonsteroidal Anti-inflammatory Drugs Increases Risk for Diverticulitis and Diverticular Bleeding
Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, have been implicated in diverticular complications. We examined the influence of aspirin and NSAID use on risk of diverticulitis and diverticular bleeding in a large prospective cohort. The authors studied 47,210 US men in the Health Professionals Follow-up Study cohort who were 40–75 years old at baseline in 1986. We assessed use of aspirin, nonaspirin NSAIDs, and other risk factors biennially. We identified men with diverticulitis or diverticular rbleeding based on responses to biennial and supplementary questionnaires. The results showed that Regular use of aspirin or NSAIDs is associated with an increased risk of diverticulitis and diverticular bleeding. Patients at risk of diverticular complications should carefully consider the potential risks and benefits of using these medications.

Zinc Monotherapy Is Not as Effective as Chelating Agents in Treatment of Wilson Disease
Wilson disease is a genetic disorder that affects copper storage, leading to liver failure and neurologic deterioration. Patients are treated with copper chelators and zinc salts, but it is not clear what approach is optimal because there have been few studies of large cohorts. We assessed long-term outcomes of different treatments. Patients in tertiary care centers were retrospectively analyzed (n = 288; median follow-up time, 17.1 years) for adherence to therapy, survival, treatment failure, and adverse events from different treatment regimens (chelators, zinc, or a combination). Hepatic treatment failure was defined as an increase in activity of liver enzymes (aspartate aminotransferase, alanine aminotransferase, and γ-glutamyltransferase) >2-fold the upper limit of normal or >100% of baseline with an increase in urinary copper excretion. Overall Treatments with chelating agents or zinc salt are effective in most patients with Wilson disease; chelating agents are better at preventing hepatic deterioration. It is important to identify patients who do not respond to zinc therapy and have increased activities of liver enzymes, indicating that a chelating agent should be added to the therapeutic regimen.

Endoscopic band ligation versus pharmacological therapy for variceal bleeding in cirrhosis: A meta-analysis
Due to the high mortality risk associated with esophageal variceal bleeding in patients with cirrhosis, improvements in primary and secondary prophylaxis would be highly beneficial. Although drug therapy using nonselective beta-blockers has been shown to be effective in reducing portal pressures and, thus, reducing or preventing variceal bleeding, many patients have contraindications or experience severe complications, thereby making it necessary to suspend or discontinue therapy. Endoscopic band ligation, however, is a purely mechanical method of eradicating varices that precludes the undesirable side effects of other procedures such as sclerotherapy. This meta-analysis was prompted by the controversial and partly inconclusive results of several previous studies comparing endoscopic band ligation with pharmacological therapy for primary and secondary prophylaxis of variceal hemorrhage.

The incidence of primary sclerosing cholangitis: A systematic review and meta-analysis
Incidence studies of primary sclerosing cholangitis (PSC) are important for describing disease burden and shedding light on disease etiology. The purpose of this study was to conduct a systematic review with meta-analysis of the incidence studies of PSC and to investigate the possible geographic variations and temporal trends in the incidence of disease. A systematic literature search of MEDLINE (1950-2010) and EMBASE (1980-2010) was conducted to identify studies investigating the incidence of PSC.  The incidence of PSC was summarized using an incidence rate (IR) with 95% confidence intervals (CIs).  . Sensitivity analyses excluding non-population based studies increased the overall IR to 1.00 (0.82-1.17) and eliminated the heterogeneity between studies (P=.08). The IRR for males compared to females was 1.70 (1.34-2.07) and the median age was 41 (35-47) years. All studies investigating time trends reported an overall increasing incidence. The incidence of PSC is similar in North American and European countries, and continues to increase over time. Incidence data from developing countries was lacking and limits our understanding the global incidence of PSC.

Inflammatory Markers Are Associated With Risk of Colorectal Cancer and Chemopreventive Response to Anti-Inflammatory Drugs
Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) lower the risk of colorectal cancer (CRC). We investigated whether plasma inflammatory markers were associated with risk of CRC and if use of anti-inflammatory drugs was differentially associated with risk of CRC according to levels of inflammatory markers. We measured levels of high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, and the soluble tumor necrosis factor receptor 2 (sTNFR-2) in blood samples from 32,826 women, collected from 1989 to 1990. Through 2004, we documented 280 cases of incident CRC; each case was matched for age to 2 randomly selected participants without cancer (controls). Information on anti-inflammatory drug (aspirin and NSAIDs) use was collected biennially. Plasma levels of sTNFR-2, but not CRP or IL-6, are associated with an increased risk of CRC. Anti-inflammatory drugs appear to reduce risk of CRC among women with high, but not low, baseline levels of sTNFR-2. Certain subsets of the population, defined by inflammatory markers, may obtain different benefits from anti-inflammatory drugs.

Thrombosis risk doubled in IBD patients
 Patients with inflammatory bowel disease (IBD) are twice as likely as people who have not been diagnosed with to develop venous thromboembolism (VTE), study findings indicate."The relative risks were particularly high at young ages, though the absolute risks increased with age," remark Michael Kappelman (University of North Carolina, Chapel Hill, USA) and colleagues in the journal Gut.

Statin Therapy Improves Sustained Virologic Response Among Diabetic Patients With Chronic Hepatitis C
Patients with chronic hepatitis C infection are 2- to 3-fold more likely to develop type 2 diabetes, which reduces their chances of achieving a sustained virologic response (SVR). To identify differences in predictors of SVR in patients with and without diabetes who received combination antiviral therapy, we conducted a retrospective analysis of a national Veterans Affairs administrative database. It was found that Statin use was associated with an improved SVR among both diabetic patients and nondiabetic patients receiving combination antiviral therapy. Diabetic patients who received insulin achieved lower SVR compared with those not receiving insulin. Poor diabetes control was associated with lower SVR rates.

Treatment of acute hepatitis C in human immunodeficiency virus–infected patients
Acute hepatitis C continues to be a concern in men who have sex with men (MSM), and its optimal management has yet to be established. In this study, the clinical, biological, and therapeutic data of 53 human immunodeficiency virus (HIV)-infected MSM included in a multicenter prospective study on acute hepatitis C. This study showed the low rate of spontaneous clearance and the high SVR rates argue for early HCV therapy following diagnosis of acute hepatitis C in HIV-infected MSM. Pegylated interferon and ribavirin seem to be the best option. The duration of treatment should be modulated according to RVR, with a 24-week course for patients presenting RVR and a 48-week course for those who do not, irrespectively of HCV genotype.

Open access journals: Why are we not there yet?
Although I am not aged by current criteria, in my formative years as a junior investigator, I remember long hours in the library searching for references. There was no PubMed; instead, a book called IndexMedicus was searched for topics relevant to a field of research, or an information expert in the library was asked to perform a computerized search for a fee. Once articles of interest were identified, they were copied in the library (often at a cost of $0.05/page). Copy machines were crucial for obtaining the articles. Book binding often precluded laying the book flat and interfered with accurate copying near the seam of the binding. Articles were then read, further references were identified, and this prompted additional trips to the library and repetitive use of the copying machine. Obtaining and managing references for grants and articles was costly, tiresome, and exasperating. Relevant articles were so difficult to identify and retrieve that senior investigators could often play one-upmanship by quoting pertinent publications of which others were simply unaware...... For More Gastroenterology News Visit Our Gastroenterology Archives