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Harm-to-Benefit Ratio of Fecal Immunochemical Test-Based Screening for Colorectal Cancer Given Prior Fecal Hemoglobin Concentrations. 粪便免疫化学检验法筛查结直肠癌的危害效益比(考虑到之前的粪便血红蛋白浓度)。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-11 DOI: 10.1016/j.cgh.2024.08.041
Esther Toes-Zoutendijk, Hilliene J van de Schootbrugge-Vandermeer, Maria A Katsara, Lucie de Jonge, Manon C W Spaander, Anneke J van Vuuren, Folkert J van Kemenade, Evelien Dekker, Iris D Nagtegaal, Monique E van Leerdam, Iris Lansdorp-Vogelaar, Reinier G S Meester

Background and aims: This study aimed to provide evidence on the harm-to-benefit ratio of fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening by previous fecal hemoglobin (f-Hb) concentrations, as reflected in the number needed to screen (NNS) and number needed to scope (NNSc).

Methods: Participants in up to 4 FIT screening rounds of the Dutch CRC screening program were included. The main outcomes of this study were the NNS and NNSc to detect 1 CRC and/or advanced neoplasia (AN) in screening rounds 2, 3, or 4, conditional on previous f-Hb concentrations. Outcomes were compared between participants using chi-square tests and logistic regression.

Results: In total, 2,428,883 study participants completed at least 2 consecutive FITs, 1,308,684 completed 3 FITs, and 150,958 completed 4 FITs. There were 31,400, 16,060, and 2007 ANs detected by round, respectively. The NNS for individuals with vs without a history of detectable f-Hb differed significantly irrespective of screening round. Individuals without detectable f-Hb in previous negative FITs had almost 9 times the NNS to detect 1 AN compared with those with detectable f-Hb (odds ratio, 8.71; 95% confidence interval, 8.51-8.92). A similar directional pattern was observed for NNSc, although the differences were smaller (odds ratio, 2.7; 95% confidence interval, 2.7-2.8).

Conclusions: The harm-to-benefit ratio of FIT-based screening is substantially greater in individuals without vs with prior detectable f-Hb. Less intensive screening should be considered for this lower-risk group.

背景和目的:本研究旨在为基于粪便免疫化学检验(FIT)的结直肠癌(CRC)筛查提供证据,以筛查所需人数(NNS)和范围所需人数(NNSc)来反映之前粪便血红蛋白(f-Hb)的浓度:方法:研究对象包括参加荷兰 CRC 筛查计划最多四轮 FIT 筛查的参与者。本研究的主要结果是根据先前的 f-Hb 浓度,在第二、三或四轮筛查中检测出一个 CRC 和/或 AN 的 NNS 和 NNSc。采用卡方检验和逻辑回归对不同参与者的结果进行比较:共有 2,428,883 名研究参与者完成了至少两次连续的 FIT,1,308,684 人完成了三次 FIT,150,958 人完成了四次 FIT。按轮检测的 AN 分别为 31,400 例、16,060 例和 2,007 例。无论哪一轮筛查,有检测到 f-Hb 病史与没有检测到 f-Hb 病史的个体的 NNS 都有显著差异。与可检测到 f-Hb 的人相比,既往 FIT 阴性结果中未检测到 f-Hb 的人检测到一个 AN 的 NNS 几乎是可检测到 f-Hb 的人的 9 倍(OR 8.71,95%CI 8.51-8.92)。NNSc也观察到类似的方向性模式,尽管差异较小(OR 2.7,95%CI 2.7-2.8):结论:基于 FIT 的筛查对未检测到 f-Hb 的个体与之前检测到 f-Hb 的个体的危害效益比要大得多。对于这类低风险人群,应考虑降低筛查强度。
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引用次数: 0
Low Prevalence of Submucosal Cancer in Large Right Colon Large Superficial Lesions: Matter of Case Selection! 右大肠 LSL 黏膜下癌发病率低:病例选择问题!
IF 3.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-09 DOI: 10.1016/j.cgh.2024.08.042
Jeremie Jacques, Mathieu Pioche, Yutaka Saito
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引用次数: 0
The Critical Role of Accurate Diagnosis and Risk-stratification in Safe and Precise Endoscopic Ultrasound-guided Pancreatic Cyst Ablation. 准确诊断和风险分级在安全精确的 EUS 引导下胰腺囊肿消融中的关键作用。
IF 3.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-09 DOI: 10.1016/j.cgh.2024.08.039
Matthew Yoder, Somashekar G Krishna
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引用次数: 0
Prediction of Hepatocellular Carcinoma and Liver-related Events in Anti-hepatitis D Virus-positive Individuals. 预测抗-高密度脂蛋白血症病毒阳性者的肝细胞癌和肝脏相关事件。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-09 DOI: 10.1016/j.cgh.2024.08.036
Lesley A Patmore, Michelle Spaan, Kosh Agarwal, Özgür M Koc, Hans Blokzijl, Samantha Brouwer, Hanneke van Soest, Astrid G W van Hulzen, Harry L A Janssen, A J Jolanda Lammers, Louis Jansen, Mark Claassen, Robert A de Man, R Bart Takkenberg, Remco van Dijk, Dirk Posthouwer, Jurriën G P Reijnders, Ivana Carey, Milan J Sonneveld

Background & aims: Chronic hepatitis D (CHD) is the most severe form of chronic viral hepatitis, with a high risk of developing hepatocellular carcinoma (HCC) and liver-related mortality. Risk stratification is needed to guide HCC surveillance strategies and to prioritize treatment with antiviral agents.

Methods: We conducted a multicenter retrospective cohort of anti-hepatitis D virus (HDV)-positive individuals managed at sites in the Netherlands and the United Kingdom. We studied the 5-year cumulative incidences of HCC and liver-related events (first of HCC, liver transplantation, and liver-related mortality), in the overall cohort and among relevant subgroups.

Results: We analyzed 269 anti-HDV-positive individuals with a median follow-up of 4.3 years in which 47 first events occurred. The 5-year cumulative incidences of HCC and liver-related events were 3.8% and 15.6% in the overall cohort. The 5-year cumulative incidence of HCC and liver-related events for individuals without cirrhosis was 0% and 0.9% compared with 12% and 41.3% for individuals with cirrhosis (P < .001). The 5-year cumulative incidence of HCC and liver-related events was 0% and 2.1% among individuals with low PAGE-B scores, compared to 3.2% and 21.1% with intermediate and 25.4% and 45.5% with high-risk scores (P < .001). We found comparable results for the Fibrosis-4 score. Findings were consistent regardless of cirrhosis or detectable HDV RNA (P < .001).

Conclusion: Anti-HDV-positive individuals are at high risk of adverse liver-related outcomes. The incidence of HCC was negligible among individuals without cirrhosis and among individuals with low baseline PAGE-B and/or Fibrosis-4 scores. Therefore, these scores can be used to guide HCC surveillance strategies and potentially also for treatment prioritization.

背景和目的:慢性丁型肝炎(CHD)是慢性病毒性肝炎中最严重的一种,罹患肝细胞癌(HCC)和肝脏相关死亡的风险很高。需要进行风险分层,以指导 HCC 监控策略并确定抗病毒药物治疗的优先次序:我们对在荷兰和英国的医疗机构接受治疗的抗-HDV 阳性患者进行了多中心回顾性队列研究。我们研究了整个队列和相关亚组中 HCC 和肝脏相关事件(首次 HCC、肝移植和肝脏相关死亡率)的 5 年累积发病率:我们对 269 例抗-HDV 阳性患者进行了分析,中位随访时间为 4.3 年,其中有 47 例首次发病。在整个队列中,HCC 和肝脏相关事件的 5 年累计发病率分别为 3.8% 和 15.6%。无肝硬化患者的 HCC 和肝脏相关事件的 5 年累计发病率分别为 0% 和 0.9%,而肝硬化患者的 HCC 和肝脏相关事件的 5 年累计发病率分别为 12% 和 41.3%(p 结论:抗-HDV 阳性患者的肝癌风险较高:抗-HDV 阳性者发生肝脏相关不良后果的风险很高。无肝硬化者和基线 PAGE-B 和/或 FIB-4 评分较低者的 HCC 发生率可忽略不计。因此,这些评分可用于指导 HCC 监控策略,也可用于确定治疗的优先次序。
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引用次数: 0
How to Incorporate Subcutaneous Infliximab and Vedolizumab in Your Practice. 如何将皮下注射英夫利西单抗和维多珠单抗纳入临床实践?
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-08 DOI: 10.1016/j.cgh.2024.07.042
Sara N Horst, Melissa Kirkpatrick, Elizabeth Scoville, Anthony Buisson
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引用次数: 0
Neoplastic Progression Risk in Females With Barrett's Esophagus: A Systematic Review and Meta-Analysis of Individual Patient Data. 女性巴雷特食管癌患者的肿瘤进展风险:对患者个体数据的系统回顾和荟萃分析。
IF 3.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-05 DOI: 10.1016/j.cgh.2024.06.053
Pauline A Zellenrath, Laurelle van Tilburg, Roos E Pouw, Rena Yadlapati, Yonne Peters, Michael B Ujiki, Prashanthi N Thota, Norihisa Ishimura, Stephen J Meltzer, Noam Peleg, Won-Tak Choi, John V Reynolds, Alexandros D Polydorides, Arjun D Koch, Judith Honing, Manon C W Spaander

Background and aims: Females with Barrett's esophagus (BE) have a lower risk of neoplastic progression than males, but sufficiently powered risk analyses are lacking. This systematic review and meta-analysis of individual patient data (IPD) aimed to provide more robust evidence on neoplastic progression risk in females.

Methods: We conducted a systematic literature search of 3 electronic databases (Medline, Embase, Google Scholar) from inception until August 2023. Eligible studies (1) reported original data on progression from nondysplastic BE, indefinite for dysplasia, or low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma; and (2) included female and male patients. IPD were quality controlled by 2 independent reviewers. The primary outcome was the association between sex and neoplastic progression risk, adjusted for risk factors using multivariable Cox regression analysis. Secondary outcomes were sex differences in time to progression and annual progression rate.

Results: IPD were obtained from 11 of 66 eligible studies, including 2196 (31%) females. Neoplastic progression risk was lower in females (hazard ratio for males vs females, 1.44; 95% confidence interval, 1.13-1.82) after adjusting for age, smoking, medication use, hiatal hernia, BE length, and baseline pathology. The annual progression rate was 0.88% in females vs 1.29% in males. Time to progression was similar in both sexes: 3.7 years (interquartile range, 2.1-7.7 years) in females and 4.2 years (interquartile range, 2.0-8.1 years) in males.

Conclusion: Although females had a lower neoplastic progression risk, sex differences were smaller than previously reported, and time to progression was similar for both sexes. Future research should focus on other factors than sex to identify low- and high-risk BE patients.

背景和目的:女性巴雷特食管(Barrett's esophagus,BE)患者的肿瘤进展风险低于男性,但目前缺乏足够的风险分析。本研究对患者个体数据(IPD)进行系统回顾和荟萃分析,旨在为女性肿瘤进展风险提供更有力的证据:对三个电子数据库(Medline、Embase、Google Scholar)进行系统文献检索,检索时间从开始到 2023 年 8 月。符合条件的研究(1)报告了从非增生异常BE(NDBE)、增生异常不定期(IND)或低度增生异常(LGD)到高级别增生异常(HGD)或食管腺癌(EAC)进展的原始数据,(2)纳入了女性和男性患者。IPD由两名独立审稿人进行质量控制。主要结果是性别与肿瘤进展风险之间的关系,使用多变量考克斯回归分析对风险因素进行调整。次要结果是进展时间和年进展率的性别差异:从11/66项符合条件的研究中获得了IPD,其中包括2 196名女性(31%)。在对年龄、吸烟、用药、食道裂孔疝、BE长度和基线病理学进行调整后,女性的肿瘤进展风险较低(男性与女性的HR为1.44,95%CI为1.13-1.82)。女性的年进展率为 0.88%,男性为 1.29%。男女肿瘤进展时间相似:女性为3.7年(IQR 2.1-7.7),男性为4.2年(IQR 2.0-8.1):结论:虽然女性肿瘤恶化的风险较低,但性别差异小于之前的报道,而且男女肿瘤恶化的时间相似。未来的研究应关注性别以外的其他因素,以识别低风险和高风险的 BE 患者。
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引用次数: 0
Environmental Risk Factors for Gallbladder Cancer: Field-Wide Systematic Review and Meta-Analysis. 胆囊癌的环境风险因素:全领域系统回顾和荟萃分析。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-05 DOI: 10.1016/j.cgh.2024.07.046
Daniele Piovani, Georgios K Nikolopoulos, Alessio Aghemo, Ana Lleo, Saleh A Alqahtani, Cesare Hassan, Alessandro Repici, Stefanos Bonovas

Background & aims: Cholelithiasis is the most well-recognized risk factor for gallbladder cancer (GBC), the predominant biliary-tract malignancy; however, credibility on other modifiable exposures remains uncertain. We performed a field-wide systematic review and meta-analysis on environmental factors associated with GBC.

Methods: We systematically searched Medline/PubMed and Embase up to May 8, 2023, to identify randomized and nonrandomized studies examining environmental factors for GBC. We conducted random-effects meta-analyses focusing on longitudinal studies. Evidence from case-control studies was considered complementary. Evidence credibility was graded by prespecified criteria including the random-effects estimate, 95% confidence interval (CI), P value, statistical heterogeneity, small-study effects, and robustness to unmeasured confounding.

Results: We identified 215 eligible primary studies and performed 350 meta-analyses across 7 domains: lifestyle, reproductive, metabolic, dietary, infections, interventions, and contaminants and occupational exposures. Based on longitudinal evidence, body mass index (relative risk [RR] per 5-unit increase, 1.27; 95% CI, 1.21‒1.33), hip circumference (RR per 5-cm increase, 1.16; 95% CI, 1.11‒1.22), infection of bile ducts (RR, 31.7; 95% CI, 24.8-40.6), high parity (RR, 1.48; 95% CI, 1.30‒1.68), obesity (RR, 1.70; 95% CI, 1.44‒2.01), overweight (RR, 1.28; 95% CI, 1.14‒1.43), waist circumference (RR per 5-cm increase, 1.14; 95% CI, 1.10‒1.18), and waist-to-height ratio (RR per 0.1 increase, 1.49; 95% CI, 1.36‒1.64) were robustly associated with increased GBC risk, whereas high education (RR, 0.63; 95% CI, 0.49‒0.82) was associated with reduced risk (moderate-to-high credibility). Another 39 significant associations showed lower credibility, including different exposure scenarios of tobacco smoking, alcohol consumption, and insufficient physical activity.

Conclusions: This study offers a detailed appraisal and mapping of the evidence on modifiable factors for GBC. Further high-quality prospective studies are essential to validate emerging associations and inform preventive strategies in high-incidence areas. (Systematic review registration: CRD42023434673.).

背景和目的:胆石症是胆囊癌(GBC)--主要的胆道恶性肿瘤--最公认的风险因素;然而,其他可改变的暴露因素的可信度仍不确定。我们对与胆囊癌相关的环境因素进行了全领域的系统回顾和荟萃分析:我们系统地检索了 Medline/PubMed 和 Embase(截至 2023 年 5 月 8 日),以确定研究 GBC 环境因素的随机和非随机研究。我们对纵向研究进行了随机效应荟萃分析。病例对照研究的证据被视为补充。证据可信度按照预先规定的标准进行分级,包括随机效应估计值、95% 置信区间、P 值、统计异质性、小型研究效应以及对未测量混杂因素的稳健性:我们确定了 215 项符合条件的主要研究,并在生活方式、生殖、代谢、饮食、感染、干预、污染物和职业暴露等七个领域进行了 350 项元分析。根据纵向证据,体重指数(RR 每增加 5 个单位为 1.27;95% CI,1.21-1.33)、臀围(RR 每增加 5 厘米为 1.16;1.11-1.22)、胆管感染(RR 31.7;24.8-40.6)、高妊娠率(RR 1.48;1.30-1.68)、肥胖(RR 1.70;1.44-2.01)、超重(RR 1.28;1.14-1.43)、腰围(每增加 5 厘米,RR 为 1.14;1.10-1.18)和腰围身高比(每增加 0.1 厘米,RR 为 1.49;1.36-1.64)与 GBC 风险增加密切相关,而高学历(RR 为 0.63;0.49-0.82)则与风险降低相关(可信度为中高水平)。另外 39 项重要关联的可信度较低,包括吸烟、饮酒和体育锻炼不足的不同暴露情景:本研究详细评估并绘制了有关可改变 GBC 的因素的证据图谱。进一步开展高质量的前瞻性研究对于验证新出现的关联并为高发地区的预防策略提供信息至关重要。
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引用次数: 0
Preparing the Next Generation of Gastroenterologists to Tackle Climate Change. 培养下一代消化内科医生应对气候变化。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-04 DOI: 10.1016/j.cgh.2024.07.043
Amisha Ahuja, Nitin K Ahuja
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引用次数: 0
The Impact of Immigration Status on Gastric Cancer Risk in a Community Hospital in New York City. 移民身份对纽约市一家社区医院胃癌风险的影响。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-04 DOI: 10.1016/j.cgh.2024.08.038
Meredith E Pittman, Avleen Kaur, Thin Phyu Phyu Aung, Linda A Lee, Yasutoshi Shiratori
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引用次数: 0
Oral Antibiotic Use in Adulthood and Risk of Early-Onset Colorectal Cancer: A Case-Control Study. 成年后口服抗生素与早发结直肠癌的风险:病例对照研究
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-03 DOI: 10.1016/j.cgh.2024.09.002
Kevin J Kane, Christopher D Jensen, Jingrong Yang, Huyun Dong, Sophie A Merchant, Pradeep Koripella, Xiaoran Li, Jeffrey M Hendel, Douglas A Corley, Jeffrey K Lee

Background and aims: Prior antibiotic use may be a factor in the rising incidence of colorectal cancer seen in those under 50 years of age (early-onset colorectal cancer [EOCRC]); however, the few studies to examine this link have reported conflicting results. Therefore, we evaluated the association between oral antibiotic use in adulthood and EOCRC in a large integrated healthcare system in the United States.

Methods: A population-based nested case-control study was conducted among Kaiser Permanente Northern California patients 18-49 years of age diagnosed with EOCRC (adenocarcinoma of the colon or rectum) in 1998-2020 who had ≥2 years of continuous pharmacy benefit prior to diagnosis. Cases were matched 4:1 to healthy controls on birth year, sex, race and ethnicity, medical facility, and duration of pharmacy benefit. Antibiotic exposure >1 year before the diagnosis/index date was assessed using prescribing records. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. A sensitivity analysis was performed among those with ≥10 years of continuous prescribing records.

Results: A total of 1359 EOCRC cases were matched to 4711 healthy controls. Antibiotic use in adulthood was not significantly associated with EOCRC in unadjusted or adjusted analyses (adjusted odds ratio, 1.04; 95% confidence interval, 0.94-1.26). No associations were seen for cumulative number of oral antibiotic dispensations or for any prior period of antibiotic exposure.

Conclusions: In a large U.S. healthcare setting, there was no conclusive evidence of an association between oral antibiotic use in adulthood and risk of EOCRC.

背景与目的:50 岁以下人群的结直肠癌(早发结直肠癌 [EOCRC])发病率不断上升,之前使用抗生素可能是其中的一个因素;然而,对这一联系进行研究的少数几项研究报告了相互矛盾的结果。因此,我们在美国的一个大型综合医疗系统中评估了成年后口服抗生素与 EOCRC 之间的关联:方法:我们对 1998-2020 年间被诊断为 EOCRC(结肠或直肠腺癌)的 18-49 岁北加州凯泽医疗集团患者进行了一项基于人群的巢式病例对照研究,这些患者在确诊前有≥2 年的连续药房福利。病例与健康对照组在出生年份、性别、种族和民族、医疗机构和药房福利持续时间方面的匹配比例为 4:1。根据处方记录对诊断/指标日期前一年以上的抗生素接触情况进行评估。条件逻辑回归用于估计几率比(OR)和 95% 置信区间(CI)。对连续处方记录≥10年的患者进行了敏感性分析:1359 例 EOCRC 病例与 4711 例健康对照组进行了配对。在未调整或调整后的分析中,成年期使用抗生素与 EOCRC 的关系不大(调整后 OR:1.04;95% CI:0.94-1.26)。口服抗生素的累计配药次数或之前接触抗生素的任何时期均与此无关联:在美国的大型医疗机构中,没有确凿证据表明成年后口服抗生素与罹患 EOCRC 的风险有关。
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引用次数: 0
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Clinical Gastroenterology and Hepatology
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