Gastrointestinal

IBS – Diet or Medication?

/ SupremeCmdr / 3 Comments

What are the new findings?

  • In a controlled trial enrolling 470 newly diagnosed primary care IBS patients, a self-management FODMAP-lowering smartphone application was superior to standard medical therapy in alleviating IBS symptoms.
  • The superiority of the diet app was already present at 4 weeks and persisted at 8 and 16 weeks.
  • The diet app had a high acceptability and adherence rate.
Diet or medication in primary care patients with IBS: the DOMINO study – a randomised trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute — https://gut.bmj.com/content/71/11/2226?rss=1

Microbial Link Between Western-style Diet and Colon Cancer Risk

/ SupremeCmdr / 1 Comment

Investigators from Brigham and Women’s Hospital with collaborators looked at data from more than 134,000 participants from two U.S.-wide prospective cohort studies. The team analyzed dietary patterns as well as DNA from Escherichia coli strains found in more than 1,000 colorectal tumors. The team looked for bacterial strains carrying a distinct genetic island known as polyketide synthase (pks). Pks encodes an enzyme that has been shown to cause mutations in human cells. Overall, the team found that Western diet was associated with colorectal tumors containing high amounts of pks+ E. coli but not with tumors containing little to no amount of pks+ E. coli.

Brigham and Women’s Hospital. “Microbial link between Western-style diet and incidence of colorectal cancer uncovered.” ScienceDaily. ScienceDaily, 27 June 2022. www.sciencedaily.com/releases/2022/06/220627124937.htm.

Dead at Just 49 Years Old

/ SupremeCmdr / 1 Comment
Get tested.

Because the birth-cohort effect in cancer suggests that exposures early in life, during childhood or young adulthood, may be crucial, some have begun looking closely at changes to the microbiome. “We know that diet and lifestyle significantly shape our microbiome. They also significantly shape our immune system, which we need to fight off the development of cancer. And so we are hypothesizing that it’s a complex interplay among the microbiome, diet, lifestyle and your immune system,” Ng says.

The Colon Cancer Conundrum — https://www.nature.com/articles/d41586-021-03405-6

My cousin died from metastatic colon cancer at age 49.

Get tested.

Colonoscopy – Just Do It (an almost forgotten post)

/ SupremeCmdr / 8 Comments

I came across this post in my collection of unpublished drafts. I thought I posted this but obviously I didn’t. This article link was intended to be posted before Colorectal Cancer Rates Rising in Ages 50-54. Better late than never, I guess.

More than one quarter of colonoscopies carried out in Americans aged 30 to 49 years reveal some type of neoplasm, and slightly over 6% of these patients have advanced cancer, results of a nationally representative endoscopic registry show.

One Quarter of 30–49-Year-Olds Have Abnormal Colonoscopy Results – Medscape – Jun 07, 2021. — https://www.medscape.com/viewarticle/952536?src=rss#vp_1
APL = Advanced Premalignant Lesions. CRC = Colorectal cancer.

Also see Study Finds Sharp Rise in Colon Cancer and Rectal Cancer Rates Among Young Adults and Diet and Colon Cancer Risk – CBS News.

Colorectal Cancer Rates Rising in Ages 50-54

/ SupremeCmdr / Leave a comment

During the period 1992–2018, there were a total of 101,609 cases of CRC among adults aged 45–59 years. Further analysis showed that the CRC incidence rates rose from 23.4 to 34.0 per 100,000 among people aged 45–49 years and from 46.4 to 63.8 per 100,000 among those aged 50–54 years. Conversely, incidence rates decreased among individuals aged 55–59 years, from 81.7 to 63.7 per 100,000 persons.

Colorectal Cancer Rates Rising in People Aged 50 to 54 Years – Medscape – Nov 11, 2021 – https://www.medscape.com/viewarticle/962769?src=rss#vp_2

I am posting a link to this article as I enjoy the effects of 238 grams of Miralax mixed with a gallon of sports beverage and/or water. It certainly takes your mind off of not eating all day.

Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort

/ SupremeCmdr / Leave a comment

Conclusion All NAFLD histological stages were associated with significantly increased overall mortality, and this risk increased progressively with worsening NAFLD histology. Most of this excess mortality was from extrahepatic cancer and cirrhosis, while in contrast, the contributions of cardiovascular disease and HCC were modest.

Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort — https://gut.bmj.com/content/70/7/1375?rss=1

Also see previous posts:

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?

NAFLD

NAFLD and Obesity: What Is the Mortality Risk? | Medpage Today

NAFLD = Higher Mortality Rate

PPI’s and Gastric Cancer Risk

/ SupremeCmdr / 5 Comments

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

/ SupremeCmdr / 9 Comments

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.

NAFLD: not a benign disease

/ SupremeCmdr / 3 Comments

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide, affecting at least a quarter of the global adult population. It is rapidly becoming one of the most common indications for liver transplantation in Western countries. NAFLD is widely considered as the hepatic manifestation of the metabolic syndrome. It is particularly common among patients with type 2 diabetes and obesity. Nonetheless, emerging data suggest that NAFLD is present in a significant proportion of lean individuals. In a systematic review and meta-analysis of 93 studies (involving over 10 million individuals), Ye et al found that 19.2% and 40.8% of patients with NAFLD were lean and non-obese, respectively, according to ethnic-specific body mass index (BMI) cut-offs.1 However, over 80% of the studies included in this systematic review were from Asia, raising the suspicion that NAFLD in lean individuals is a unique phenomenon among Asians, especially as Asians are known to have more central fat deposition and develop NAFLD and metabolic complications at a lower BMI.2

NAFLD in lean individuals: not a benign disease — https://gut.bmj.com/content/early/2021/03/11/gutjnl-2021-324162?rss=1

80% of the studies reviewed were from Asia which helps to explain why NAFLD was found in lean and non-obese people. I wonder how their diets have changed from traditional cuisines to cause this incidence level? Western style fast food?

Also see previous posts:

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?

NAFLD

NAFLD and Obesity: What Is the Mortality Risk? | Medpage Today

NAFLD = Higher Mortality Rate

Alkaline phosphatase 59 U/L, AST 28. ALT 10 as of September 2020. GGTP 36 as of December 2015. Sharing these numbers for all of my friends from the past who thought I would never live long enough to boast about these numbers.