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Collatuzzo G, Alicandro G, Bertuccio P, Pelucchi C, Bonzi R, Palli D, Ferraroni M, Ye W, Plymoth A, Zaridze D, Maximovich D, Aragones N, Castaño-Vinyals G, Vioque J, Garcia de la Hera M, Zhang ZF, Hu J, Lopez-Carrillo L, López-Cervantes M, Dalmartello M, Mu L, Ward MH, Rabkin C, Yu GP, Camargo MC, Curado MP, Lunet N, Negri E, La Vecchia C, Boffetta P. Peptic ulcer as mediator of the association between risk of gastric cancer and socioeconomic status, tobacco smoking, alcohol drinking and salt intake. J Epidemiol Community Health 2022; 76:jech-2022-219074. [PMID: 35831132 DOI: 10.1136/jech-2022-219074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/25/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Peptic ulcer disease (PUD) and gastric cancer (GC) are more prevalent in individuals with low socioeconomic status (SES) and share several risk factors. The aim of this study was to investigate the mediating role of PUD in the association between established risk factors and GC. METHODS We conducted a pooled analysis of 12 studies from the Stomach Cancer Pooling Project Consortium, including a total of 4877 GC cases and 11 808 controls. We explored the mediating role of PUD in the association between SES, tobacco smoking, heavy alcohol drinking and salt intake, and GC. Also, we assessed the ORs and 95% CIs of the risk factors and both PUD and GC. RESULTS PUD mediated 36% of the smoking effect mainly among men. Other risk factors were only slightly mediated by PUD (SES, 5.3%; heavy alcohol drinking, 3.3%; and salt intake, 2.5%). No significant difference was found when excluding PUD diagnosed within 2 years from GC. CONCLUSIONS Our study provides innovative information on the mechanism of stomach mucosal damage leading to PUD and GC, with respect to the effect of tobacco smoking in particular.
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Affiliation(s)
- Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
- Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Bertuccio
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Rossella Bonzi
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, ISPRO, Florence, Italy
| | - Monica Ferraroni
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Zaridze
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Dmitry Maximovich
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Nuria Aragones
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Cancer Epidemiology Section, Public Health Division, Department of Health of Madrid, Madrid, Spain
| | - Gemma Castaño-Vinyals
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Barcelona Institute for Global Health-ISGlobal, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Jesus Vioque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernandez (ISABIAL-UMH), Alicante, Spain
| | - Manoli Garcia de la Hera
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernandez (ISABIAL-UMH), Alicante, Spain
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Jinfu Hu
- Harbin Medical University, Harbin, People's Republic of China
| | | | | | - Michela Dalmartello
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Mary H Ward
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Charles Rabkin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Guo-Pei Yu
- Medical Informatics Center, Peking University, Peking, People's Republic of China
| | - M Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Maria Paula Curado
- Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
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Shin CM, Kim N, Cho SI, Sung J, Lee HJ. Validation of Alcohol Flushing Questionnaires in Determining Inactive Aldehyde Dehydrogenase-2 and Its Clinical Implication in Alcohol-Related Diseases. Alcohol Clin Exp Res 2018; 42:387-396. [PMID: 29205834 DOI: 10.1111/acer.13569] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/28/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Our aim was to validate alcohol flushing questionnaires in detecting inactive ALDH2 (ALDH2*1/*2 or ALDH2*2/*2). METHODS Two study sets were established; in study set 1, 210 healthy male subjects (age 22 to 59 years) were enrolled; in study set 2, 756 subjects were enrolled who received esophagogastroduodenoscopy to evaluate their dyspeptic symptoms or as part of a gastric cancer screening program. Subjects in study sets 1 and 2 completed the modified alcohol flushing questionnaires of Yokoyama and colleagues (, ). Polymerase chain reaction-restriction fragment length polymorphism method was used to determine ALDH2 genotype. RESULTS In study set 1, 29.0% (61 of 210) had inactive ALDH2. The sensitivity and specificity of the modified alcohol flushing questionnaire for detecting inactive ALDH2 were 95.1 and 76.5%, respectively. Drinking problems negatively correlated with positive alcohol flushing response and inactive ALDH2 (all p-values < 0.05). In study set 2, the sensitivity and specificity of the alcohol flushing questionnaire for detecting inactive ALDH2 were 78.9 and 82.1%, respectively. Interestingly, drinking ≥7 units/wk in men or ≥3.5 units/wk in women significantly increased the risk of benign gastric ulcer (BGU) among positive alcohol flushers (odds ratio, 8.97; 95% confidence interval, 1.38 to 58.30), but not among negative alcohol flushers. CONCLUSIONS Simple flushing questionnaires may be administered to the Korean population as a screening tool in detecting individuals who carry inactive ALDH2. Alcohol flushing response negatively correlates with drinking problems and can modify the risk for BGU by alcohol intake.
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Affiliation(s)
- Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi-do, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Il Cho
- School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Joohon Sung
- School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Hee-Jung Lee
- Incheon Research Institute of Public Health and Environment , Incheon, Korea
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Time trends in epidemiology of peptic ulcer disease in India over two decades. Indian J Gastroenterol 2012; 31:111-5. [PMID: 22766645 DOI: 10.1007/s12664-012-0201-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/25/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Epidemiology of peptic ulcer disease (PUD) in India differs from that in the West. It may have undergone a change with recent improvement in hygiene and availability of potent antisecretory and ulcerogenic drugs. We therefore tried to assess time-trends in the frequency of PUD over the past two decades. METHODS Records of patients with uninvestigated dyspepsia and no alarm symptoms who had undergone upper gastrointestinal endoscopy at our institution during the years 1988 (n = 2,358), 1992 (n = 2,240), 1996 (n = 5,261), 2000 (n = 7,051), 2004 (n = 5,767) and 2008 (n = 7,539) were retrospectively reviewed. The frequencies of duodenal and gastric ulcer disease in these groups were compared. RESULTS Of the 30,216 patients (age:41.7±12.7 years, 34 % females) during the six study periods, 2,360 (7.8 %) had PUD. The frequencies of both duodenal ulcer and gastric ulcer showed a decline from 1988 to 2008, i.e. from 12 % to 2.9 % and 4.5 % to 2.7 %, respectively (p-value <0.001 for trend for each). The decline was more marked for duodenal ulcer, and the ratio of duodenal to gastric ulcer declined from 2.7 in 1988 to 1.1 in 2008. CONCLUSIONS The epidemiology of PUD in India may have changed in the past two decades with the incidence of duodenal ulcer declining more rapidly than that of gastric ulcer.
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Wang FW, Tu MS, Mar GY, Chuang HY, Yu HC, Cheng LC, Hsu PI. Prevalence and risk factors of asymptomatic peptic ulcer disease in Taiwan. World J Gastroenterol 2011; 17:1199-203. [PMID: 21448426 PMCID: PMC3063914 DOI: 10.3748/wjg.v17.i9.1199] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/26/2010] [Accepted: 11/02/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence and risk factors of asymptomatic peptic ulcer disease (PUD) in a general Taiwanese population.
METHODS: From January to August 2008, consecutive asymptomatic subjects undergoing a routine health check-up were evaluated by upper gastrointestinal endoscopy. Gastroduodenal mucosal breaks were carefully assessed, and a complete medical history and demographic data were obtained from each patient. Logistic regression analysis was conducted to identify independent risk factors for asymptomatic PUD.
RESULTS: Of the 572 asymptomatic subjects, 54 (9.4%) were diagnosed as having PUD. The prevalence of gastric ulcer, duodenal ulcer and both gastric and duodenal ulcers were 4.7%, 3.9%, and 0.9%, respectively. Multivariate analysis revealed that prior history of PUD [odds ratio (OR), 2.0, 95% CI: 1.3-2.9], high body mass index [body mass index (BMI) 25-30: OR, 1.5, 95% CI: 1.0-2.2; BMI > 30 kg/m2: OR, 3.6, 95% CI: 1.5-8.7] and current smoker (OR, 2.6, 95% CI: 1.6-4.4) were independent predictors of asymptomatic PUD. In contrast, high education level was a negative predictor of PUD (years of education 10-12: OR, 0.5, 95% CI: 0.3-0.8; years of education > 12: OR, 0.6, 95% CI: 0.3-0.9).
CONCLUSION: The prevalence of PUD in asymptomatic subjects is 9.4% in Taiwan. Prior history of PUD, low education level, a high BMI and current smoker are independent risk factors for developing asymptomatic PUD.
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Nkuize M, De Wit S, Muls V, Arvanitakis M, Buset M. Upper gastrointestinal endoscopic findings in the era of highly active antiretroviral therapy. HIV Med 2010; 11:412-7. [PMID: 20146733 DOI: 10.1111/j.1468-1293.2009.00807.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The current literature suggests that there has been a decrease in opportunistic diseases among HIV-infected patients since the widespread introduction of highly active antiretroviral therapy (HAART) in 1995. OBJECTIVES The aim of the study was to investigate the impact of HAART and CD4 lymphocyte count on diseases of the upper gastrointestinal (UGI) tract, digestive symptoms, and endoscopic and histological observations. METHODS A review of 706 HIV-infected patients who underwent GI endoscopy was undertaken. The cohort was divided into three groups: group 1 (G1), pre-HAART, consisting of 239 patients who underwent endoscopy between January 1991 and December 1994; group 2 (G2), early HAART, consisting of 238 patients who underwent endoscopy between January 1999 and December 2002; and group 3 (G3), recent HAART, consisting of 229 patients who underwent endoscopy between January 2005 and December 2008. Parameters studied included age, gender, opportunistic chemoprophylaxis, antiretroviral therapies, CD4 cell counts, symptoms, observations at the first UGI endoscopy and histology. RESULTS When G1, G2 and G3 were compared, significant increases were seen over time in the following parameters: the percentage of women, the mean CD4 cell count, and the frequencies of reflux symptoms, gastroesophageal reflux disease (GERD), inflammatory gastropathy, gastric ulcer and Helicobacter pylori (HP) infection. Significant decreases were seen in the frequencies of the administration of anti-opportunistic infection prophylaxis, odynophagia/dysphagia, acute/chronic diarrhoea, candida oesophagitis, nonspecific oesophageal ulcer and Kaposi sarcoma. No significant change was observed in the other parameters, i.e. digestive bleeding, duodenal ulcer and inflammatory duodenopathy. CONCLUSION These results suggest a correlation between the improvement of immunity as a result of more efficient antiviral therapy and the decrease in the frequency of digestive diseases in AIDS, mainly opportunistic pathologies. However, HP infection, reflux symptoms and GERD have increased in the HAART era.
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Affiliation(s)
- M Nkuize
- Clinic of Hepato-gastroenterology, CHU Saint Pierre, Brussels, Belgium
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Preventing the gastrointestinal adverse effects of nonsteroidal anti-inflammatory drugs: from risk factor identification to risk factor intervention. Joint Bone Spine 2009; 77:6-12. [PMID: 20022539 DOI: 10.1016/j.jbspin.2009.11.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2009] [Indexed: 12/16/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) have huge prescription volumes, for two main reasons: the aging of the population is increasing the prevalence of diseases that respond to NSAIDs, such as osteoarthritis; and NSAIDs are highly effective drugs that contribute crucially to the management of many diseases. In France, the number of physician orders that include an NSAID is estimated at 25 to 30 million per year. Nevertheless, the use of NSAIDs is limited by adverse effects. The gastrointestinal tract is the main target of NSAID toxicity, and NSAID therapy is among the leading causes of bleeding from upper gastrointestinal ulcers. Adverse events targeting the lower gastrointestinal tract are also of concern, although they receive less attention. To effectively prevent NSAID toxicity, it must be recognized that the risk of adverse events can be diminished but not eliminated. Therefore, the risk/benefit ratio must be carefully evaluated at each prescription. A number of risk factors should be emphasized. Thus, the risk increases with age, and there is a sharp risk increase at 60 years of age. Other risk factors include a history of ulcers (most notably with bleeding), the use of high NSAID dosages, Helicobacter pylori infection, and the concomitant use of antiplatelet agents. Minimizing NSAID-related gastrointestinal toxicity requires a careful risk factor evaluation; selection of the most appropriate NSAID and NSAID dosage; and, in some patients, prophylactic gastroprotective therapy, for instance with a proton pump inhibitor. Gastrointestinal symptoms either have no value for predicting gastrointestinal events or occur too late to serve as alarm signals. The toxicity advantages of cyclooxygenase-2 inhibitors seem modest and do not eliminate the need for this rational prescription strategy.
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The natural course of Helicobacter pylori infection on endoscopic findings in a population during 17 years of follow-up: the Sørreisa gastrointestinal disorder study. Eur J Epidemiol 2009; 24:649-58. [PMID: 19629722 DOI: 10.1007/s10654-009-9371-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 07/07/2009] [Indexed: 12/23/2022]
Abstract
The natural course of Helicobacter pylori (H. pylori) is poorly understood, as most research in the field has been on patient populations. We studied the natural course of H. pylori and its associations to morphological changes of the gastric mucosa, peptic ulcer, and reflux oesophagitis in a prospective cohort study of subjects with and without dyspepsia. A total of 361 adults (201 men/160 women, mean age 41/42 years) in Sørreisa municipality, Norway who in 1987 were subjected to upper endoscopy and assessed for gastrointestinal symptoms and H. pylori status were followed up in 2004. H. pylori was strongly associated with neutrophilic (odds ratio [OR] 23.79; 95% confidence interval [CI] 11.64:48.61) and mononuclear infiltration (OR 9.43; CI 5.12:17.36), moderately with atrophy of the antrum (OR 1.98; CI 1.17:3.34), but not with atrophy of the gastric body or intestinal metaplasia. Elimination of H. pylori was associated with regression of gastric inflammation and atrophy, whereas intestinal metaplasia progressed. H. pylori was positively associated with peptic ulcer (OR 2.69; CI 1.2:6.02) but not significantly negatively associated with oesophagitis (OR 0.62; CI 0.35:1.09). This is the first prospective study including endoscopic findings of subjects without dyspepsia, to show that the impact of H. pylori on gastric atrophy is only modest, and that eliminating H. pylori does not cause regression of intestinal metaplasia. However, inflammation of the gastric mucosa regresses after H. pylori elimination. H. pylori is only a moderate risk factor for peptic ulcer, and other explanatory factors deserve more attention.
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