Clinical Gastroenterology and Hepatology最新文献

Background and aims: Oxidative stress is an essential factor in the pathogenesis of inflammatory bowel disease (IBD). A previous study found protective potential of some antioxidative nutrients against IBD. However, the association between total antioxidant capacity (TAC) of the diet and incident IBD is unclear.

Methods: We conducted a prospective cohort study including 186,195 IBD-free participants at baseline from the UK Biobank. We calculated dietary TAC using the oxygen radical absorbance capacity method based on repeated online 24-hour dietary recalls. Crohn's disease (CD) and ulcerative colitis (UC) were identified via inpatient register and primary care data. Genetic susceptibility for IBD was assessed by a polygenic risk score. Cox proportional hazard models were applied to estimate multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).

Results: During a median follow-up of 11.4 years, we identified 396 CD and 809 UC incident cases. Individuals with the highest quintile of dietary TAC had a lower risk of CD (27.0 vs 17.0 cases/100,000 person-years; aHR 0.66, 95% CI 0.49-0.90) but not UC (46.7 vs 35.5 cases/100,000 person-years; aHR 0.85, 95% CI 0.69-1.06) compared with the lowest group. We observed interactions between TAC and genetic susceptibility at both multiplicative (P-interaction=0.008/0.063 for CD/UC) and additive (both P values>1) scales. Additionally, a polymorphism of the endogenous antioxidant enzyme gene SOD2 (rs4880) modified the dietary TAC-UC association (P-interaction=0.039).

Conclusion: This study suggests that a diet with high TAC may help prevent the development of IBD, particularly in individuals at high genetic risk of IBD and in mutation carriers of rs4880 in SOD2.

Background and aims: Breast cancer is the most common malignancy observed in patients with inflammatory bowel diseases (IBD). The aim of our study was to evaluate incident cancer rate (recurrence or new-onset cancer) in a cohort of IBD patients with a history of breast cancer according to the subsequent IBD treatment provided.

Methods: A multicenter retrospective study included consecutive IBD patients with prior breast cancer. The inclusion date corresponded to the diagnosis of index malignancy. Follow-up lasted from cancer diagnosis until the occurrence of incident cancer.

Results: Among 207 patients included (median disease duration: 13 years [IQR 6 - 21]), first line treatment (median interval of 28 months [IQR 7 - 64]) was a conventional immunosuppressant in 19.3 % of patients, anti-TNF in 19.8 %, vedolizumab in 7.2 % and ustekinumab in 1.9 %. After a median follow-up of 71 months [IQR, 34 - 148], 42 (20%) incident cancers were observed (34 breast cancer recurrences). Adjusted incidence rates per 1000 person-years were 10.2 (95%CI 6.0- 16.4) for the untreated arm and 28.9 (95%CI 11.6-59.6) for exposed patients (p= 0.0519). There was no significant difference between treated patients and controls regarding incident-cancer free survival rates (p=0.4796). In multivariable analysis, factors associated with incident cancer were stage T4d (p=0.036), triple negative tumor (p=0.016) and follow-up of less than 71 months (p=0.005).

Conclusion: We did not find a statistically significant increase in incident breast cancer related to IBD treatment beyond the already known poor prognostic factors of breast cancer.

Background and aims: Eosinophilic esophagitis (EoE) has been continually increasing in prevalence but current estimates are lacking. We aimed to determine updated estimates of the prevalence and medical costs associated with EoE in the United States.

Methods: We used two large administrative databases, MarketScan and Medicare, and International Classification of Disease codes to calculate annual prevalence of EoE, as well as age- and sex- stratified estimates, standardized to the U.S.

Population: Health care utilization, including medications and endoscopic procedures was quantified, and annual EoE-associated costs were estimated.

Results: We identified 20,435 EoE cases in MarketScan in 2022 and 1,913 EoE cases in Medicare in 2017. This translated to prevalences of 163.08 cases/100,000 and 64.83 cases/ 100,000 in MarketScan and Medicare, respectively. There was a 5-fold increase in prevalence in both databases since 2009. In MarketScan, prevalence was higher among males (204.45/100,000 vs 122.06/100,000 among females); for both sexes, peak prevalence was from 40-44years. Standardized to the U.S. population, the prevalence of EoE was 142.5/100,000, extrapolating to 472,380 cases. Total EoE-associated healthcare costs were estimated to be $1.32 billion in 2024 dollars after accounting for inflation.

Conclusions: The prevalence of EoE continues to increase, with a rate of 1 in 617 in 2022 in those <65 years of age, and 1 in 1562 in 2017 those ≥65 years. Standardized to the U.S. population, the overall prevalence was approximately 1 in 700. EoE-associated annual costs were estimated to be $1.3 billion in 2024 dollars, representing a substantial financial burden.

Introduction: Guidelines recommend that subcentimeter nodules on ultrasound be followed with short-interval surveillance ultrasound given assumed low risk of hepatocellular carcinoma (HCC) and suboptimal diagnostic imaging performance in lesions < 1cm. We performed a systematic review to estimate HCC risk among patients with cirrhosis and subcentimeter nodules detected on ultrasound.

Methods: We systematically searched Ovid MEDLINE and EMBASE databases for relevant articles published between January 2005 and July 2024. A random-effects model was used to calculate the pooled proportion of incident HCC.

Results: We identified 9 eligible studies, of which 5 provided both lesion- and patient-level data (n=354 patients), 2 patient-level alone (n=888 patients), and 2 lesion-level alone (n=69 lesions). The pooled proportion of incident HCC was 31.9% (95%CI: 8.7-69.7%) on a lesion-level and 21.3% (95%CI: 6.0-53.6%) on a patient-level; however, pooled estimates were limited by high heterogeneity (I² >90%). Among two studies with study periods post-dating 2015, HCC developed in only ∼5% of patients during a median follow-up of 2 years. Risk factors associated with incident HCC were older age, male sex, elevated AFP levels, thrombocytopenia, and Child Pugh B cirrhosis. Limitations of studies included small sample sizes, selection bias, ascertainment bias for HCC, and failure to report factors associated with HCC.

Conclusion: Up to one-fifth of patients with subcentimeter nodules may develop HCC, although contemporary cohorts report a substantially lower risk. Older patients and those with elevated AFP levels or poorer liver function are at greatest risk of HCC, highlighting an unmet need for better risk stratification models.