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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 [...]

Duodenal ulcer is a condition caused by an imbalance between the protective properties of the intestinal lining (mucosa) and the destructive properties of gastric acid. It is further characterized by erosions in the wall of the duodenum (the first part of the small intestine). Not all of the causal factors involved in the development of duodenal ulcer are known, but it has been reported that individuals who are physically active in their jobs are at greater risk for developing duodenal ulcer than are individuals with jobs not requiring physical labor. It is not known to what extent this reflects the different lifestyles of manual workers and office workers (the former are, on average, of a lower socioeconomic status than the latter), and to what extent it reveals physical activity as a true risk factor. To further investigate this question, a study was carried out in which the cases of 76 recently diagnosed duodenal ulcer patients and 76 healthy controls were analyzed. The risk of duodenal ulcer was greater in those patients who smoked, who were in a lower social class (as determined by a standardized grouping of occupations), and who were physically active on the job. The lower social classes tended to have jobs that required greater levels of physical activity, but even when social class was statistically controlled, more active individuals tended to be at greater risk for developing ulcer; this was true for all social classes. The mechanism by which increased activity leads to a higher incidence of ulceration is not known, but might involve activity-induced alterations in blood flow to the gastrointestinal tract, or changes in nutrient intake in more active individuals. (Consumer Summary produced by Reliance Medical Information, Inc.)

Duodenal ulcer is an inflammatory condition of the initial segment of the small intestine. Many factors contribute to the development of duodenal ulcer, including stress, smoking, and drug treatment. Food and fluid intake are thought to play important roles in the likelihood of developing an ulcer, but the exact nature of the effects of different diets is poorly understood. It has been suggested that ingestion of a diet high in fiber or low in refined sugars may be protective against duodenal ulcer, but this remains controversial. To investigate this issue, 78 patients with duodenal ulcer and a group of matched, healthy control subjects were evaluated. Statistical techniques applied to the data demonstrated that when other risk factors (e.g. smoking) were corrected for, there was no correlation between total dietary fiber intake and risk of ulcer. There was, however, a correlation between high vegetable fiber intake and low ulcer incidence; there was also a greater tendency for patients with high refined sugar intake to develop duodenal ulcers. Smoking, weight, and social class were also associated with ulcer prevalence. When these variables were statistically controlled for, the relationship between low sugar intake and low ulcer incidence remained strong, but the relationship between high vegetable fiber and low ulcer occurrence was weakened. It appears that neither total dietary fiber nor fiber subtype is strongly linked to ulcer formation, but low intake of refined sugar may play a protective role. (Consumer Summary produced by Reliance Medical Information, Inc.)

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 [...]

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.

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]