Introduction

Rosacea is a common inflammatory skin disease with multiple etiologies. Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RA) are acid suppressive drugs widely used for gastrointestinal diseases, and long-term use has been reported to be associated with dysbiosis which is a potential risk for development of Rosacea. This study aimed to study association between rosacea and acid suppressants in Korean national cohort.

Aims & Methods

We used Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) data of 749,166 patients with upper gastrointestinal (GI) diseases between 2001 and 2013. Duration of acid suppressants were compared between patients with and without rosacea together with other sociodemographic characteristics and hazard ratios were estimated.

Results

Longer use of acid suppressants was significantly associated with increased risk of Rosacea. After adjustment for possible confounders, increased cumulative defined daily dose (cDDD) was significantly associated with risk of rosacea (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.20-2.00, P = 0.001). Other factors significantly associated with risk of rosacea include residing at rural area (OR, 2.58; 95% CI, 2.18-3.06, P < 0.001), greater Charlson Comorbidity Index (CCI) score (OR, 1.45; 95% CI, 1.15-1.83, P = 0.002), and comorbidities (malignancy, thyroid disease, and depression).

Conclusion

Results from our study indicate that H2RA or PPI is associated with the occurrence of rosacea among patients with GI diseases in Korean population. The risk was increased in dose-response trend, even after adjusting for confounding variables. Clinicians should be aware of risks associated with prolonged use of acid suppressive drugs.

Introduction

Recent research from the Netherlands, the United States, and Korea suggests that individuals who receive a positive result on the fecal immunochemical test (FIT) may be at a higher risk of developing gastroesophageal cancer (GEC) within the following 36 months. However, the associations reported in these studies may be biased due to differences in age and sex between the FIT-positive and FIT-negative groups and other confounding factors.

Aims & Methods

We aimed to evaluate the association between FIT results and the risk of GEC in a matched cohort by age and sex. Additionally, we assessed the cost-effectiveness of a one-time Esophago-Gastro-Duodenoscopy (EGD) for individuals with positive FIT results.. We created a matched cohort of individuals aged 50 to 75 who underwent FIT testing at Clalit Health in Israel between June 2016 and June 2019. For each FIT-positive individual, we matched three FIT-negative individuals based on age, sex, and H. pylori status. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were utilized to evaluate the association between a positive FIT result and the risk of GEC within 36 months. We calculated the incremental cost-effectiveness ratio (ICER) for a one-time EGD at $400 in individuals who tested positive for FIT. Screening is considered cost-effective if the ICER is below $50,000.

Results

The primary cohort included 483,710 individuals, while the matched cohort comprised 151,500 individuals (47.6% female, median age 62.5 years). During the follow-up period, 202 cases of GEC occurred: 0.2% (64/38,575) among FIT-positive individuals and 0.1% (138/112,925) among FIT-negative individuals, adjusted HR 1.39 (95% CI 1.03-1.87). Age, male sex, H. pylori exposure, country of birth, proton-pump inhibitor usage, smoking status, and anemia were all significantly associated with an increased risk of gastric cancer. A one-time EGD has been determined to be a cost-effective option in a range of ages and rates of localized disease at the time of EGD.

Conclusion

This matched cohort study suggests that individuals with a positive FIT may have an increased risk of GEC, which occurs at an overall rate of 0.2% within 36 months. A one-time EGD priced at $400 can be cost-effective in many scenarios.

Disclosure

NONE

Introduction

Esophageal cancer (EC) exhibits a disproportionate burden in low- and middle-income regions. Magnesium, a critical regulator of metabolic and inflammatory pathways, has been implicated in chronic diseases such as diabetes and cardiovascular disorders. Preclinical studies suggest that magnesium deficiency promotes oxidative stress and systemic inflammation, processes central to cancer progression. However, evidence directly linking magnesium metabolism disorders with esophageal cancer risk remains limited. The Magnesium Depletion Score (MDS), a validated tool integrating diuretic use, proton pump inhibitors, renal dysfunction, and heavy alcohol consumption, offers a novel approach to evaluate magnesium status. The study aims to elucidate the potential mechanisms by which magnesium metabolism may influence the development of esophageal cancer and to provide a scientific basis for future preventive and intervention strategies.

Aims & Methods

This prospective cohort study included 450,700 UK Biobank participants. The Magnesium Depletion Score (MDS) incorporated diuretic use, proton pump inhibitors, renal function (eGFR-based), and heavy alcohol consumption, categorized as low (0–1), moderate (2), or high (3–5). Multivariable Cox proportional hazards models, adjusted for demographics, socioeconomic factors, BMI, smoking, and alcohol use, assessed associations between MDS and esophageal cancer (EC) incidence (ICD-10: C15) and subtypes. Sensitivity analyses excluded participants with <1–3 years of follow-up. Mediation analyses evaluated inflammatory/metabolic biomarkers (e.g., CRP, HbA1c). Subgroup analyses explored effect modification by age, sex, and lifestyle factors, while restricted cubic splines tested nonlinear relationships. Analyses adhered to STROBE guidelines and utilized R v4.2.3.

Results

Among 450,700 participants (54% female, mean age 56.6 years), 1,572 developed esophageal cancer (EC: 645 adenocarcinomas [EAC], 275 squamous cell carcinomas [ESCC], 905 lower EC). EC cases were predominantly male, older (mean +4.8 years vs. non-EC), and exhibited higher Magnesium Depletion Score (MDS), BMI, smoking rates, and socioeconomic deprivation. EAC patients were more likely overweight/obese (BMI >25), while ESCC patients had higher smoking rates and normal BMI.
Higher MDS was significantly associated with increased EC risk (continuous MDS: HR=1.186, 95% CI:1.102–1.277, P<0.001). Compared to low MDS (0–1), moderate (2) and high MDS (3–5) groups showed 29.6% (HR=1.296, P=0.001) and 63.5% (HR=1.635, P<0.001) higher EC risk, respectively. Similar trends were observed for EAC (HR=1.277, P<0.001) and lower EC (HR=1.158, P=0.003). Sensitivity analyses excluding early-diagnosis cases (1–3 years) confirmed robustness. Associations persisted after adjusting for diabetes, hypertension, and H. pylori.
Stratified analyses revealed stronger MDS-EC associations in males, smokers, alcohol consumers, and overweight/obese individuals (BMI>25). MDS did not correlate with all-cause mortality in EC patients (HR=0.963, P=0.370). Mediation analyses identified inflammatory (C-reactive protein: 1.40%, P=0.013; neutrophils: 4.50%, P=0.003) and metabolic biomarkers (HbA1c: 0.91%, P=0.033; glucose: 0.38%, P=0.047) as partial mediators.

Conclusion

In summary, this study demonstrates a significant positive association between MDS and the risk of esophageal cancer, with an especially pronounced impact observed among overweight or obese individuals, males, and alcohol consumers. The findings support the hypothesis that magnesium metabolism may influence esophageal cancer through multiple mechanisms, including inflammation, metabolic abnormalities, and immune dysfunction.

Introduction

Psoriasis is a common inflammatory skin disorder following non-specific triggers such as scratching, piercing, sunburn, and chemical irritants. Involvement of immune system is widely accepted for pathogenesis studies have demonstrated importance of gut microbiota in pathogenesis of inflammatory skin diseases. Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RA) are acid suppressing drugs widely used for gastrointestinal diseases, and long-term use has been reported to be associated with altered gut microbiota. This study aimed to investigate association between psoriasis and acid suppressing drugs in Korean population.

Aims & Methods

We used Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) data of 746,816 patients with upper gastrointestinal (GI) diseases between 2002 and 2013. Duration of acid suppressing drug exposure and other socio-demographic characteristics were compared between patients with and without psoriasis, and hazard ratios were estimated.

Results

Significantly larger number of patients with exposure to acid suppressing drugs had developed psoriasis compared to control cohort (46.3% vs. 33.7% respectively, P < 0.001). In the multivariate analysis, longer use of acid suppressing drugs and greater Charlson comorbidity index score were significantly associated with increased risk of psoriasis with an adjusted odds ratio, 1.89 (95% confidence interval, 1.66-2.17, P < 0.001) and 1.33 (1.17-1.51, P = <0.001), respectively.

Conclusion

Results from our study indicate that prolonged use of H2RA or PPI is associated with the risk of psoriasis among patients with GI diseases in Korean population. The risk was increased in dose-response trend, even after adjusting for confounding variables. Clinicians should be aware of risks associated with prolonged use of acid suppressing drugs.

References

1. Buhas MC, Gavrilas LI, Candrea R, Catinean A, Mocan A, Miere D, et al. Gut Microbiota in Psoriasis. Nutrients 2022;14(14).
2. Schon MP, Boehncke WH. Psoriasis. N Engl J Med 2005;352(18):1899-912.
3. Boehncke WH, Schon MP. Psoriasis. Lancet 2015;386(9997):983-94.
4. Nickoloff BJ, Qin JZ, Nestle FO. Immunopathogenesis of psoriasis. Clin Rev Allergy Immunol 2007;33(1-2):45-56.
5. Sabat R, Philipp S, Hoflich C, Kreutzer S, Wallace E, Asadullah K, et al. Immunopathogenesis of psoriasis. Exp Dermatol 2007;16(10):779-98.

Introduction

Helicobacter pylori (H. pylori) infection is the primary risk factor for gastric cancer (GC), and although the risk decreases after H. pylori eradication (HPE), it remains elevated. Understanding the impact of lifestyle factors on post-HPE GC risk is crucial for prevention strategies.

Aims & Methods

The aim of this study is to clarify the effect of lifestyle on GC risk after HPE.
Using the Korean National Health Insurance Services (NHIS) database, adult individuals who claimed HPE between 2010 and 2016 were analyzed. The adjusted hazard ratios (aHR) for GC were analyzed according to the lifestyle status including smoking (never; light [<10PY]; moderate [10-20PY]; heavy [≥20PY]), drinking (non; mild [<30g/day]; heavy [≥30g/day]), and abdominal obesity (yes; no) were evaluated by using Cox proportional hazard model under control with potentially related factors.

Results

During a median follow-up of 6.7 years, 9,754 individuals were diagnosed with GC. Moderate (aHR 1.12, 95% confidence interval [CI] 1.04–1.20) and heavy smokers (aHR 1.34, 95% CI 1.27–1.42) had a greater risk of GC, with a dose-response relationship. Heavy drinkers had an increased risk (aHR 1.23, 95% CI 1.15–1.32), and those with abdominal obesity had a slightly elevated risk (aHR 1.11, 95% CI 1.06–1.15). Subgroup analyses showed that individuals aged ≥ 55 years were more affected by unhealthy lifestyles, and males had a stronger association between smoking and GC risk compared to females (p-for-interaction 0.02).

Conclusion

Unhealthy lifestyle factors, such as smoking, alcohol consumption, and abdominal obesity, are major risk factors for post-HPE GC. These findings underscore the importance of addressing lifestyle factors during the post-eradication period to reduce GC risk.

Disclosure

The authors disclose that they have nothing to disclose.

Introduction

Direct oral anticoagulants (DOACs), particularly rivaroxaban and apixaban, are increasingly utilized to manage thromboembolic conditions due to their favorable efficacy and safety profiles. However, gastrointestinal bleeding (GIB) remains a significant concern associated with these medications, particularly considering pharmacogenetic variations among populations. This study aims to evaluate the frequency and identify risk factors associated with GIB in patients using rivaroxaban and apixaban in a Mexican healthcare setting.

Aims & Methods

This retrospective observational study analyzed data from January 2018 to December 2023 at the Centro Médico Nacional 20 de Noviembre, Mexico City. The cohort consisted of 278 patients: 136 on DOAC therapy (rivaroxaban or apixaban) and 142 controls without anticoagulation. Clinical data, demographic characteristics, comorbidities, and concomitant medications were systematically reviewed. Statistical methods employed included chi-square tests, Student's t-tests, and logistic regression analysis to assess the risk factors and association between anticoagulant type and incidence of GIB.

Results

The study population had a mean age of 67.36 ± 15.05 years, with an equal gender distribution (52.9% male). Rivaroxaban was significantly linked to increased GIB-related hospitalizations compared to controls (OR 1.29, 95% CI: 1.10–1.52, p < 0.001), while apixaban showed no statistically significant increase. NSAID co-administration dramatically raised the risk of GIB in rivaroxaban users (OR 16.1, 95% CI: 1.22–212.6, p = 0.03). Patients treated with DOACs experienced more hospitalizations (average 0.49 ± 0.80) and longer hospital stays (2.19 ± 3.54 days) compared to controls (0.30 ± 0.62 hospitalizations, 0.99 ± 2.68 days, respectively). Mortality rates were not significantly different between groups.

Conclusion

Rivaroxaban and apixaban present similar overall risks of gastrointestinal bleeding, although rivaroxaban is associated with higher hospitalization rates. Concomitant NSAID use substantially elevates the risk in patients on rivaroxaban. This underscores the necessity of individualized anticoagulant management strategies, especially in populations with distinct genetic and clinical characteristics, such as the Mexican demographic.

References

1. Lopes RD, Guimarães PO, Kolls BJ, et al. Gastrointestinal bleeding with novel oral anticoagulants: A systematic review and meta-analysis. BMJ. 2015;350:h1857.
2. Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955-962.
3. Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-992.