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Gut 2004;53:251-255. doi: 10.1136/gut.2003.026799 Background: Inflammatory bowel disease (IBD) is known to be associated with reduced bone density but the extent to which this results in an increased risk of [...]

Gut 2004;53:246-250. doi: 10.1136/gut.2003.025239 Background: Few environmental determinants of Crohn's disease are well established. Some observational data exist to implicate antibiotic use as a risk factor but these are derived [...]

Objective: To examine the seroprevalence, correlates, and characteristics of undetected coeliac disease in a large adult population sample in Cambridge, UK. Methods: The Cambridge General Practice Health Study invited individuals [...]

Background: While coeliac disease is now recognised as being associated with both osteoporosis and osteomalacia, the size of any increase in the risk of fracture in patients with coeliac disease [...]

J. West [1] B.P. Palmer [1] G.K.T. Holmes [2] R.F.A. Logan[1] (1.) Division of Public Health and Epidemiology, University of Nottingham, Nottingham, NG7 2UH; (2.) Dept of Medicine, Derbyshire Royal [...]

J. West [1] C.A. Lloyd [2] R Reader [3] P.G. Hill [2] G.K.T. Holmes [4] K.T. Khaw [3] R.F.A. Logan [1] (1.) Division of Public Health and Epidemiology, University of [...]

M.W. James [1] S. Mian [2] R.F.A. Logan [3] R.G. Long [1] (1.) Nottingham City Hospital, Nottingham; (2.) British Society of Gastroenterology Research Unit; (3.) University Hospital, Nottingham, UK Neuroendocrine [...]

Division of Public Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK Background: In the US and several other western countries the incidence of oesophageal adenocarcinoma (AC) [...]

Velazquez RF, Rodriguez M, Navascues CA, et al. Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis. Hepatology 2003;37:520-7. Hepatocellular cancer (HCC) meets several of the [...]

Prenatal or perinatal environmental exposures have been postulated to change the risk of inflammatory bowel disease (IBD) later in life. (1) One manifestation of this, perhaps because of early and [...]

Introduction: People with coeliac disease may be at increased risk of gastrointestinal malignancy, lymphoma, and mortality, but at decreased risk of other cancers. We performed a population based cohort study [...]

Background: We have recently shown that there may be as much as a fourfold increase in risk of death in young adults with Crohn's disease, (1) but that in absolute [...]

Ioannou GN, Rockey DC, Bryson CL, et al. Iron deficiency and gastrointestinal malignancy: a population-based cohort study. Am J Med 2002;113:276-80. Iron deficiency anaemia (IDA) is common; population surveys have [...]

A Fujita N, Maguchi H, Komatsu Y, et al. Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: a prospective randomised controlled multicenter trial. Gastrointest Endosc 2003;57:151-5. Endoscopic [...]

A Ghosh, S, Goldin E, Gordon FH, et al. Natalizumab for active Crohn's disease. N Engl J Med 2003;348:24-32. Natalizumab, an [α.sub.4] integrin-inhibitor of lymphocyte trafficking, is effective for active [...]

Background & Aims: Previous studies have raised concern about reduced fertility and increased adverse pregnancy-related events in women with celiac disease, but none has estimated overall fertility compared with the general female population. Methods: We compared computerized primary care data for 1521 women with celiac disease with data for 7732 age- and practice-matched women without celiac disease. We estimated population-based rates of fertility and adverse pregnancy outcomes. Results: Crude fertility rates were 48.2 and 47.7 live births per 1000 person-years for women with and without celiac disease, respectively (rate ratio, 1.01; 95% confidence interval, 0.90–1.14). Age-specific fertility rates showed that women with celiac disease had lower fertility when younger but higher fertility when older compared with women without celiac disease. This increase in relative fertility with increasing age held whether women had treated or untreated celiac disease. Risks of cesarean section (odds ratio, 1.33; 95% confidence interval, 1.03–1.70) and miscarriage (rate ratio, 1.31; 95% confidence interval, 1.06–1.61) were moderately higher in women with celiac disease, but risks of assisted birth, breech birth, preeclampsia, postpartum hemorrhage, ectopic pregnancy, stillbirth, and termination were similar. Conclusions: Overall, women with celiac disease have fertility similar to that of the general female population, but they have their babies at an older age. Although our findings may reflect a disease effect, the age shift in fertility rates and the increase in cesarean section risk is consistent with socioeconomic or educational advantages of women with celiac disease. [Copyright &y& Elsevier]

Presents a study assessing effect of risk standardization on variation in outcome after acute upper gastrointestinal hemorrhage. Limitations of mortality as outcome measure; Range of gastrointestinal hemorrhage severity; Characteristics of deaths from the disorder.

Presents letters related to medicine to the editors of the 'British Medical Journal' in Great Britain. List of problems facing medical research; Statistics on the number of suicide in young adults; Decline in the incidence of gastric cancer.

Presents a study for the determination of the effects of varying efficacy and cost of two antibiotic regimens for the eradication of Helicobacter pylori, on the overall cost effectiveness of H pylori eradication in duodenal ulcer disease. Information on the two decision analysis models used in the study; Results of the study; Discussion based on the results. INSETS: Model 1;Key messages.

Examines the risk of patients who are admitted to hospitals for acute upper gastrointestinal hemorrhage. Use of a risk scoring system to identify low-risk patients; Relation between risk score and length of hospital stay; Effect of time between admission and endoscopy on the length of hospital stay.

Introduction: The relationship between Barrett's oesophagus and extra-oesophageal malignancies (EOM) has been a matter of controversy. Some researchers have pointed out that the incidence of colon cancer is higher in Barrett patients while others have found no such association. The current study explores the relationship between Barrett's oesophagus and EOM in general and colon cancer in particular in 27 813 subjects in General Practice Research Database (GPRD). Methods: The mean follow-up experience was about 6 years and the study subjects constitute four groups: Barrett's oesophagus group (1677), oesophagitis group (6392), simple reflux group (6328), and normal group (13 416). Respectively the last three groups were 4/1, 4/1, and 8/1 matched to the Barrett group according to their GP practice, date of birth and sex. All malignancies occurring before or in the first year after the diagnosis of Barrett's, oesophagitis, or reflux were regarded as prevalent and excluded from the analysis. Risk of occurrence of an unrelated condition such as cataract was also explored for comparison. Number of visits to the GP was defined as a date on which there are both medical and drug records available and its confounding effects were control[ed. Hazard ratios were calculated using Cox-proportional hazard regression analysis. Results: A total of 2167 EOM, 260 colorectal cancer, and 1918 cataract diagnoses were identified in study subjects of which 1119, 113, and 853 cases were excluded respectively as being prevalent. The hazard ratios have been presented in the table after adjusting for age, sex, and number of visits to the GP. Conclusion: The risk of colorectal cancer was not specifically higher in any of these groups. There were small increases in risk of EOM in the Barrett's oesophagus, oesophagitis and reflux groups in comparison to the general population. The explanation for these increases is unclear but they may be mediated by smoking if smoking rates are increased in... [ABSTRACT FROM AUTHOR]

Presents abstracts of articles published in the August 2003 issue of 'Gut' journal. 'Screening and surveillance for Barrett's esophagus in high-risk groups: A cost-utility analysis'; 'Rapid diagnosis of spontaneous bacterial peritonitis by use of reagent strips'; 'Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases.'

Background: Only a small number of trials have directly addressed the management of patients with "uninvestigated" dyspepsia. The design of trials to determine cost effectiveness is more complex than efficacy trials, and can be enhanced by pre-trial modelling. Methods: A simulation model of 72 alternative management strategies for a dyspeptic patient was constructed. The model simulated the flow of individual patients with potential upper Gl disorders through potential investigations and therapies, including endoscopy, non-invasive testing for H pylori, acid suppression therapy, and H pylori eradication. Epidemiological data and meta-analyses were used to specify parameters within the model. The model was used to establish the important comparisons for future research and to establish likely effect sizes in terms of cost and efficacy. Sensitivity analysis explored potential effect modifiers and the MRC-CUBE study was designed and powered on the basis of the model. Results: Recent trials have supported some of the model's findings, in that only empiric acid suppression with either an antacid or a PPI, or H pylori "test and treat", followed by acid suppression were cost effective. Test and treat was more effective, but more costly than empiric acid suppression alone. Based on the model, the minimum effect size would be 7%, assuming a maximum willingness to pay For a patient free of dyspepsia for a year of 100, and a control event rate of 70%. 1940 patients would be required for an α of 0.05 and β 0.1. Conclusions: The MRC-CUBE trial is about to start recruitment in 60 practices, a large, multi-centre trial being justified on the basis of the model. As well as informing the selection of appropriate comparisons, pre-trial modelling enables cost effectiveness trials to be powered for cost as well as effectiveness outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Barrett's oesophagus is recognised to be a pre-malignant condition and the incidence of oesophogeal adenocarcinoma (OAC) in people with Barrett's is much higher than general population. Nevertheless, it has been suggested that gastro-oesophageal reflux per se is a more important determinant of risk. The current study was set up to explore the risk of oesophageal cancer (OC) and specifically OAC in Borrett's using a total of 166 228 person-years follow-up experience from General Practice Research Database (GPRD). Methods: The 27 813 study subjects constitute four groups: Barrett's oesophagus group (1677), oesophagitis group (6392), simple reflux group (6328), and normal group (13 416). The last three groups were 4/1, 4/1, and 8/1 matched to the Barrett group according to their GP practice, date of birth, and sex, respectively. All prevalent cases of OC, including those diagnosed before or in the first year after the diagnosis of their condition, were excluded from the analysis. Hazard ratios were calculated using Cox-proportional hazard regression analysis. Using the England and Wales cancer registry data, the incidence of non-AC cancer of oesophagus and subsequently the estimated number of observed AC were worked out in study groups and the relative rate were calculated by standardised incidence ratio method. Results: A total of 137 oesophageal cancer cases were identified in study subjects of which 80 cases were excluded as being prevalent. 57 were entered into the analysis. The results have been presented in the table. Conclusion: Barrett's oesophagus increases oesophageal cancer risk about 20 times and oesophageal adenocarcinoma about 50 times in comparison to general population. There is only a modest increase in risk of oesophageal cancer in patients with reflux but no record of Barrett's. Given that the person-years follow-up in Barrett's group is about twice the largest previous study lower relative risk estimates further emphasises the... [ABSTRACT FROM AUTHOR]