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Objective: Whether diabetes mellitus (DM) increases risk of gastric cancer (GC) remains controversial because of inadequate adjustments for important risk factors, including Helicobacter pylori (HP) infection status, concomitant medication use, and cancer site. We investigated whether type 2 DM increased risk of GC in patients after they received treatment for HP infection.Research Design and Methods: This was a territory-wide cohort study of patients aged ≥45 years who had received clarithromycin-based triple therapy for HP infection between 2003 and 2012 in Hong Kong. Data were retrieved from a public electronic health database. Observation started from receipt of therapy for HP infection to GC diagnosis, death, or the end of the study (December 2015). Exclusion criteria included type 1 DM, GC diagnosed within the 1st year of HP therapy, prior GC or gastrectomy, and retreatment for HP infection. The adjusted hazard ratio (aHR) of GC with type 2 DM was calculated by using a Cox model that adjusted for 20 covariates (age, sex, comorbidities, and medications) through propensity score regression.Results: During a median follow-up of 7.1 years (interquartile range 4.8-9.3 years), 153 of 46,460 patients (0.33%) developed GC at a median age of 72.4 years. Type 2 DM was associated with an increased risk of GC (aHR 1.73 [95% CI 1.08-2.79]). Stratified analysis showed an increase in risk for cardia cancer only (aHR 3.40 [95% CI 1.45-7.97]) and in those with suboptimal DM control (time-weighted mean HbA1c ≥6.0% [42 mmol/mol]; aHR 1.68 [95% CI 1.07-2.63]).Conclusions: Type 2 DM is associated with an increased risk of GC among patients in whom HP was eradicated, in particular gastric cardia cancer and in those with suboptimal DM control. [ABSTRACT FROM AUTHOR]

Background: Although prior studies showed metformin could reduce gastric cancer (GC) risk in patients with diabetes mellitus, they failed to adjust for Helicobacter pylori infection and glycemic control. We aimed to investigate whether metformin reduced GC risk in H. pylori-eradicated diabetic patients and its association with glycemic control.Methods: This was a territory-wide cohort study using hospital registry database, recruiting all diabetic patients who were prescribed clarithromycin-based triple therapy for H. pylori infection from 2003 to 2012. Subjects were observed from H. pylori therapy prescription until GC diagnosis, death, or end of study (December 2015). Exclusion criteria included GC diagnosed within first year of H. pylori therapy, prior history of GC or gastrectomy, and failure of H. pylori eradication. The hazard ratio (HR) of GC with metformin (defined as at least 180-day use) was estimated by Cox model with propensity score adjustment for covariates (age, sex, comorbidities, medications [including insulin], and time-weighted average hemoglobin A1c [HbA1c]). All statistical tests were two-sided.Results: During a median follow-up of 7.1 years (IQR = 4.7-9.8), 37 (0.51%) of 7266 diabetic patients developed GC at a median age of 76.4 years (IQR = 64.8-81.5 years). Metformin use was associated with a reduced GC risk (adjusted HR = 0.49, 95% CI = 0.24 to 0.98). There was a trend towards a lower GC risk with increasing duration (Ptrend = .01) and dose of metformin (Ptrend = .02). HbA1c level was not an independent risk factor for GC.Conclusions: Metformin use was associated with a lower GC risk among H. pylori-eradicated diabetic patients in a duration- and dose-response manner, which was independent of HbA1c level. [ABSTRACT FROM AUTHOR]

Summary: Background: Ticagrelor and prasugrel are third‐generation oral P2Y12 receptor antagonists with rapid onset and pronounced platelet inhibition. However, higher overall bleeding rates have been reported for these agents when compared with clopidogrel. Aim: To compare the risk of gastrointestinal bleeding (GIB) among users of third‐generation P2Y12 inhibitors with clopidogrel. Methods: We systematically searched for published randomised controlled trials of ticagrelor or prasugrel versus clopidogrel until September 2018. The primary outcome was the risk of GIB among users of third‐generation P2Y12 inhibitors when compared to clopidogrel, expressed as risk ratio (RR) and 95% confidence interval (CI). The rates of non‐coronary artery bypass graft (CABG) major bleeding, life‐threatening bleeding, fatal bleeding, and intracranial bleeding were analysed as secondary outcomes. Results: Forty‐one studies were included in the analysis of non‐CABG major bleeding, of which 12 were included in the analysis of GIB including 58 678 patients. Third‐generation P2Y12 inhibitors were associated with higher risk of GIB as compared with clopidogrel (RR 1.28, 95% CI 1.13‐1.46). The findings were consistent for upper (RR 1.32, 95% CI 1.05‐1.67) and unspecified GIB (RR 1.25, 95% CI 1.01‐1.53), but not lower GIB (RR 1.25, 95% CI 0.95‐1.65). Subgroup analysis showed higher GIB risk in prasugrel studies (RR 1.40, 95% CI 1.10‐1.77) than in ticagrelor studies (RR 1.15, 95% CI 0.94‐1.39). Third‐generation P2Y12 inhibitors also increased the risk of non‐CABG major bleeding (RR 1.18, 95% CI 1.08‐1.28). Conclusion: Third‐generation P2Y12 inhibitors were associated with increased risk of GIB and non‐CABG major bleeding when compared with clopidogrel. [ABSTRACT FROM AUTHOR]

Background/Aims: We determined the rates of metachronous colorectal neoplasm in colorectal cancer (CRC) patients after resection for right (R)-sided or left (L)-sided cancer. Methods: Consecutive CRC patients who had undergone surgical resection for curative intent in our hospital between 2001 and 2004 were identified. R-sided colonic cancers refer to cancer proximal to splenic flexure whereas L-sided cancers include rectal cancers. Patients were included only if they had a clearing colonoscopy performed either before or within 6 months after the operation. Findings of surveillance colonoscopy performed up to 5 years after colonic resection were included in the analysis. Results: Eight hundred and sixty-three CRC patients underwent curative surgical resection during the study period. Three hundred and twenty-seven patients (107 R-sided and 220 L-sided) fulfilled the inclusion criteria and had at least 1 postoperative surveillance colonoscopy performed. The proportion of patients who had polyp and adenoma on surveillance colonoscopy was significantly higher among patients with L-sided than R-sided cancers (polyps: 30.9% vs. 19.6%, P =0.03; adenomas: 25.5% vs. 13.1%, P =0.01). The mean number of adenoma per patient on surveillance colonoscopy was also higher for patients with L-sided than R-sided tumors (0.52; 95% confidence interval [CI], 0.37-0.68 vs. 0.22; 95% CI, 0.08-0.35; P <0.01). Multivariate analysis showed that L-sided cancers, age, male gender and longer follow-up were independent predictors of adenoma detection on surveillance colonoscopy. Conclusions: Patients with Lsided cancer had a higher rate of metachronous polyps and adenoma than those with R-sided cancer on surveillance colonoscopy. [ABSTRACT FROM AUTHOR]

Background: Despite successful H. pylori (HP) eradication, some individuals remain at risk of developing gastric cancer (GC). Previous studies showed that aspirin was associated with a reduced GC risk. However, whether aspirin can reduce GC risk in HP-eradicated subjects remains unknown. We aimed to determine the chemopreventive effect of aspirin in HP-eradicated subjects.Methods: We identified subjects who had received a prescription of clarithromycin-based triple therapy for HP between 2003 and 2012 from a territory-wide health care database. The observation period started from commencement of HP therapy (index date), and the follow-up was censored at the end of the study (December 2015), death, or GC diagnosis. Aspirin use was defined as use once or more often weekly. Subjects who failed HP eradication or were diagnosed with GC within 12 months of HP therapy were excluded. The hazard ratio (HR) of GC with aspirin use was calculated by Cox model with Propensity Score adjustment for age, sex, comorbidities, and concurrent medications. All statistical tests were two-sided.Results: The median follow-up was 7.6 years (interquartile range [IQR] = 5.1-10.3 years), and 169 (0.27%) out of 63 605 patients developed GC. The incidence rate of GC was 3.5 per 10 000 person-years. Aspirin use was associated with a reduced GC risk (HR = 0.30, 95% confidence interval [CI] = 0.15 to 0.61). The risk of GC decreased with increasing frequency, duration, and dose of aspirin (all Ptrend < .001).Conclusions: Aspirin use was associated with a frequency-, dose-, and duration-dependent reduction in GC risk after HP eradication. The effect was most prominent in those who used aspirin daily or for five or more years. [ABSTRACT FROM AUTHOR]

To the Editor: We read with great interest the article on human norovirus (hNoV) by Straub et al. (1). By using 3-dimensional aggregates of a highly differentiated intestinal epithelial cell [...]

LINKED CONTENT: This article is linked to Ko et al papers. To view these articles, visit https://doi.org/10.1111/apt.16970 and https://doi.org/10.1111/apt.17044 [ABSTRACT FROM AUTHOR]

Computer-assisted detection (CADe) is a promising technologic advance that enhances adenoma detection during colonoscopy. However, the role of CADe in reducing missed colonic lesions is uncertain. The aim of this study was to determine the miss rates of proximal colonic lesions by CADe and conventional colonoscopy. This was a prospective, multicenter, randomized, tandem-colonoscopy study conducted in 3 Asian centers. Patients were randomized to receive CADe or conventional white-light colonoscopy during the first withdrawal of the proximal colon (cecum to splenic flexure), immediately followed by tandem examination of the proximal colon with white light in both groups. The primary outcome was adenoma/polyp miss rate, which was defined as any adenoma/polyp detected during the second examination. Of 223 patients (48.6% men; median age, 63 years) enrolled, 7 patients did not have tandem examination, leaving 108 patients in each group. There was no difference in the miss rate for proximal adenomas (CADe vs conventional: 20.0% vs 14.0%, P =.07) and polyps (26.7% vs 19.6%, P =.06). The CADe group, however, had significantly higher proximal polyp (58.0% vs 46.7%, P =.03) and adenoma (44.7% vs 34.6%, P =.04) detection rates than the conventional group. The mean number of proximal polyps and adenomas detected per patient during the first examination was also significantly higher in the CADe group (polyp: 1.20 vs.86, P =.03; adenoma,.91 vs.61, P =.03). Subgroup analysis showed that CADe enhanced proximal adenoma detection in patients with fair bowel preparation, shorter withdrawal time, and endoscopists with lower adenoma detection rate. This multicenter trial from Asia confirmed that CADe can further enhance proximal adenoma and polyp detection but may not be able to reduce the number of missed proximal colonic lesions. (Clinical trial registration number: NCT04294355.) [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Jiang et al papers. To view these articles, visit https://doi.org/10.1111/apt.16604 and https://doi.org/10.1111/apt.16736 [ABSTRACT FROM AUTHOR]

Background and Aim: The incidence of colorectal cancer (CRC) is rising rapidly in Chinese. We studied the anatomic distributions and characteristics of CRC in Hong Kong (HK) and Chongqing (CQ) with different CRC epidemiology. Methods: It was a retrospective study conducted in three large regional hospitals of the two cities. We identified all patients newly diagnosed with CRC between 2003 and 2012. The distribution and characteristics of CRC of the two cities were compared. Results: Of CRC, 3664 new cases were diagnosed within the study period. CRC was more common in men (>56%) in both cities. The mean age at diagnosis was significantly younger in CQ, the lower prevalence area, than in HK (62.1 vs 70.4 years; P<0.001). Rectal cancer was the predominant (61.3%) cancer in CQ, but only 18% of cancers in HK were rectal cancer (P = 0.0001). Right-sided colonic cancer, however, was more common in HK than CQ (27.2% vs 17.4%; P<0.001). Women had more right-sided colonic cancer than men in both cities (P<0.002), and there was an age-related increase in right-sided colonic cancer in HK but not in CQ. Multivariate analysis showed that older age, female, and living in HK were independent risk factors associated with right-sided colonic cancer. Conclusions: There are significant differences in the distribution of CRC between HK and CQ. The discrepancy may be partly accounted by older population and an increase in proximal colonic cancer, particularly in women, in HK. [ABSTRACT FROM AUTHOR]