Pub Date : 2024-10-11DOI: 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。
{"title":"Harm-to-Benefit Ratio of Fecal Immunochemical Test-Based Screening for Colorectal Cancer Given Prior Fecal Hemoglobin Concentrations.","authors":"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","doi":"10.1016/j.cgh.2024.08.041","DOIUrl":"10.1016/j.cgh.2024.08.041","url":null,"abstract":"<p><strong>Background and aims: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.cgh.2024.08.042
Jeremie Jacques, Mathieu Pioche, Yutaka Saito
{"title":"Low Prevalence of Submucosal Cancer in Large Right Colon Large Superficial Lesions: Matter of Case Selection!","authors":"Jeremie Jacques, Mathieu Pioche, Yutaka Saito","doi":"10.1016/j.cgh.2024.08.042","DOIUrl":"10.1016/j.cgh.2024.08.042","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.cgh.2024.08.039
Matthew Yoder, Somashekar G Krishna
{"title":"The Critical Role of Accurate Diagnosis and Risk-stratification in Safe and Precise Endoscopic Ultrasound-guided Pancreatic Cyst Ablation.","authors":"Matthew Yoder, Somashekar G Krishna","doi":"10.1016/j.cgh.2024.08.039","DOIUrl":"10.1016/j.cgh.2024.08.039","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 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.
{"title":"Prediction of Hepatocellular Carcinoma and Liver-related Events in Anti-hepatitis D Virus-positive Individuals.","authors":"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","doi":"10.1016/j.cgh.2024.08.036","DOIUrl":"10.1016/j.cgh.2024.08.036","url":null,"abstract":"<p><strong>Background & aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-08DOI: 10.1016/j.cgh.2024.07.042
Sara N Horst, Melissa Kirkpatrick, Elizabeth Scoville, Anthony Buisson
{"title":"How to Incorporate Subcutaneous Infliximab and Vedolizumab in Your Practice.","authors":"Sara N Horst, Melissa Kirkpatrick, Elizabeth Scoville, Anthony Buisson","doi":"10.1016/j.cgh.2024.07.042","DOIUrl":"10.1016/j.cgh.2024.07.042","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 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.
{"title":"Neoplastic Progression Risk in Females With Barrett's Esophagus: A Systematic Review and Meta-Analysis of Individual Patient Data.","authors":"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","doi":"10.1016/j.cgh.2024.06.053","DOIUrl":"10.1016/j.cgh.2024.06.053","url":null,"abstract":"<p><strong>Background and aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 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.).
{"title":"Environmental Risk Factors for Gallbladder Cancer: Field-Wide Systematic Review and Meta-Analysis.","authors":"Daniele Piovani, Georgios K Nikolopoulos, Alessio Aghemo, Ana Lleo, Saleh A Alqahtani, Cesare Hassan, Alessandro Repici, Stefanos Bonovas","doi":"10.1016/j.cgh.2024.07.046","DOIUrl":"10.1016/j.cgh.2024.07.046","url":null,"abstract":"<p><strong>Background & aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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] <sub>per 5-unit increase</sub>, 1.27; 95% CI, 1.21‒1.33), hip circumference (RR <sub>per 5-cm increase</sub>, 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 <sub>per 5-cm increase</sub>, 1.14; 95% CI, 1.10‒1.18), and waist-to-height ratio (RR <sub>per 0.1 increase</sub>, 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.</p><p><strong>Conclusions: </strong>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.).</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-04DOI: 10.1016/j.cgh.2024.07.043
Amisha Ahuja, Nitin K Ahuja
{"title":"Preparing the Next Generation of Gastroenterologists to Tackle Climate Change.","authors":"Amisha Ahuja, Nitin K Ahuja","doi":"10.1016/j.cgh.2024.07.043","DOIUrl":"10.1016/j.cgh.2024.07.043","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-04DOI: 10.1016/j.cgh.2024.08.038
Meredith E Pittman, Avleen Kaur, Thin Phyu Phyu Aung, Linda A Lee, Yasutoshi Shiratori
{"title":"The Impact of Immigration Status on Gastric Cancer Risk in a Community Hospital in New York City.","authors":"Meredith E Pittman, Avleen Kaur, Thin Phyu Phyu Aung, Linda A Lee, Yasutoshi Shiratori","doi":"10.1016/j.cgh.2024.08.038","DOIUrl":"10.1016/j.cgh.2024.08.038","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-03DOI: 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.
{"title":"Oral Antibiotic Use in Adulthood and Risk of Early-Onset Colorectal Cancer: A Case-Control Study.","authors":"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","doi":"10.1016/j.cgh.2024.09.002","DOIUrl":"10.1016/j.cgh.2024.09.002","url":null,"abstract":"<p><strong>Background and aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}