PPI’s and Gastric Cancer Risk

Objective The association between proton pump inhibitor (PPI) use and gastric cancer related to Helicobacter pylori eradication has not been fully investigated in geographical regions with high risk of gastric cancer. We aimed to evaluate the association between PPIs and gastric cancer in Korea.

Design This study analysed the original and common data model versions of the Korean National Health Insurance Service database from 2002 to 2013. We compared the incidence rates of gastric cancer after 1-year drug exposure, between new users of PPIs and other drugs excluding PPIs, by Cox proportional hazards model. We also analysed the incidence of gastric cancer among PPI users after H. pylori eradication.

Results The analysis included 11 741 patients in matched PPI and non-PPI cohorts after large-scale propensity score matching. During a median follow-up of 4.3 years, PPI use was associated with a 2.37-fold increased incidence of gastric cancer (PPI≥30 days vs non-PPI; 118/51 813 person-years vs 40/49 729 person-years; HR 2.37, 95% CI 1.56 to 3.68, p=0.001). The incidence rates of gastric cancer showed an increasing trend parallel to the duration of PPI use. In H. pylori-eradicated subjects, the incidence of gastric cancer was significantly associated with PPI use over 180 days compared with the non-PPI group (PPI≥180 days vs non-PPI; 30/12 470 person-years vs 9/7814 person-years; HR 2.22, 95% CI 1.05 to 4.67, p=0.036).

Conclusion PPI use was associated with gastric cancer, regardless of H. pylori eradication status. Long-term PPIs should be used with caution in high-risk regions for gastric cancer.

Association between proton pump inhibitor use and gastric cancer: a population-based cohort study using two different types of nationwide databases in Korea — https://gut.bmj.com/content/early/2021/05/11/gutjnl-2020-323845?rss=1
  • Prevacid 24HR
  • Nexium 24HR
  • Prilosec OTC
  • Zegerid OTC

OTC PPIs are only intended for a 14-day course of treatment and can be used up to three times per year.

Over-The-Counter (OTC) Heartburn Treatment — https://www.fda.gov/drugs/information-consumers-and-patients-drugs/over-counter-otc-heartburn-treatment

I was thinking of a snarky comment but decided against posting any snark.

But if you routinely pop a PPI before and/or after chowing down on a meat lover’s pizza you can’t say you weren’t advised that maybe it might be a better idea to give up the pizza.

Dumb and Dumber – Noncompliance with Colonoscopy Post Positive FIT

Results Some 88 013 patients who were FIT positive complied with colonoscopy (males: 56.1%; aged 50–59 years: 49.1%) while 23 410 did not (males: 54.6%; aged 50–59 years: 44.9%).

The 10-year cumulative incidence of CRC was 44.7 per 1000 (95% CI, 43.1 to 46.3) among colonoscopy compliers and 54.3 per 1000 (95% CI, 49.9 to 58.7) in non-compliers, while the cumulative mortality for CRC was 6.8 per 1000 (95% CI, 5.9 to 7.6) and 16.0 per 1000 (95% CI, 13.1 to 18.9), respectively. The risk of dying of CRC among non-compliers was 103% higher than among compliers (adjusted HR, 2.03; 95% CI, 1.68 to 2.44).

Conclusion The excess risk of CRC death among those not completing colonoscopy after a positive faecal occult blood test should prompt screening programmes to adopt effective interventions to increase compliance in this high-risk population.

Non-compliance with colonoscopy after a positive faecal immunochemical test doubles the risk of dying from colorectal cancer — https://gut.bmj.com/content/early/2021/03/30/gutjnl-2020-322192?rss=1

Help me understand human behavior. You get a positive FOBT or Cologuard test and your doctor says you need a colonoscopy but you decide not to follow up and follow through with the scope.

SMH.

More on Vulvar Melanoma

Lesions could be angiokeratomas, petechiae, purpura, melanosis, and nevi, for example. Seborrheic keratoses can mimic melanoma. “If it looks odd, don’t be afraid to biopsy it,” said Mauskar, assistant professor of dermatology and obstetrics and gynecology at the University of Texas Southwestern Medical Center in Dallas.

Low Threshold to Biopsy Atypical Lesions May ID Vulvar Melanoma Early, Experts Say — https://www.medscape.com/viewarticle/941157?src=rss

I first became aware of melanoma down there back in June of this year. See Vulvar Melanoma Is Increasing in Older Women

So remember, if it looks odd get it biopsied.

Vulvar Melanoma Is Increasing in Older Women

Vulvar Melanoma Is Increasing in Older Women

The national incidence of vulvar melanoma is on the rise in women aged over 60 years, climbing by an average of 2.2% per year during 2000–2016, Maia K. Erickson reported in a poster at the virtual annual meeting of the American Academy of Dermatology.

These are often aggressive malignancies. The 5-year survival following diagnosis of vulvar melanoma in women aged 60 years or older was 39.7%, compared with 61.9% in younger women, according to Ms. Erickson, a visiting research fellow in the department of dermatology at Northwestern University, Chicago.

Meat Intake and Colorectal Polyps

Meat Intake and Colorectal Polyps

Research professor of medicine Martha Shrubsole, Ph.D., and colleagues at Vanderbilt University Medical Center have published the first study to evaluate intakes of meat, cooking methods and meat mutagens and risk of developing sessile serrated polyps (SSPs, also called sessile serrated lesions). Shrubsole previously reported that consuming high levels of red meat increased the risk of developing all types of polyps, but that the likelihood of developing SSPs was two times greater than the risk of developing adenomas and hyperplastic polyps (HP).

Conventional colorectal adenomas are the precursor lesions for most colorectal cancers. SSPs, however, represent an alternative pathway to carcinogenesis that may account for up to 35 percent of colorectal cancers. Because a diagnostic consensus for SSPs was not reached until 2010, few epidemiologic studies have evaluated risk factors.

 

Any Polyp Type Raises CRC Risk

A finding of any type of polyp in the colon increases the risk for colorectal cancer (CRC), according to new findings from a large Swedish study.

At 10 years, the cumulative colorectal cancer incidence was 1.6% among patients with hyperplastic polyps, 2.5% among those with sessile serrated polyps, 2.7% for tubular adenomas, 5.1% for tubulovillous adenomas, and 8.6% for villous adenomas, as compared with 2.1% for the control group.

However, a higher risk for colorectal-related death was only observed in patients with sessile serrated polyps, tubulovillous adenomas, or villous adenomas.

The study was published online March 16 in Lancet Gastroenterology & Hepatology.

Any Type of Polyp Increases the Risk for Colorectal Cancer

Boldface sections are mine.

I had my first virtual visit with my physician yesterday.  I mentioned that I was postponing my colonoscopy this year for pandemic reasons.  She said that’s fine, don’t worry about it.  I read this article today.  Now I know why I’m on a three year callback.

 

Scientists uncover how high-fat diet drives colorectal cancer growth

In mice.

The research, conducted in a mouse model, suggests how lifestyle and genetics converge. The researchers found that animals with an APC mutation, the most common genetic mutation found in humans with colorectal cancer, developed cancer faster when fed a high-fat diet.

The mice with APC mutations developed benign growths called adenomas. In humans, adenomas are common in the intestine and are routinely removed during colonoscopies. These growths normally take decades to turn into malignant adenocarcinomas. Yet the adenomas in these mice quickly turned cancerous when given high-fat diets.