Introduction

Currently, gastric cancer screening is only cost-effective in countries with high incidence. Colorectal cancer screening is an effective method for the reduction of CRC incidence and receives high attendance rates. Integrated screening, where gastroscopy is performed in conjunction with colonoscopy, could help reduce the gastric cancer screening procedure burden in countries with low or intermediate incidence. However, there is a lack of population-based studies providing data on groups at high risk for mortality from gastric malignancies that might benefit from this approach.

Aims & Methods

In this retrospective analysis of a colorectal cancer screening program database, we used Cox proportional hazards model to identify an association of high-risk and low-risk finding (polyps ≥ 10mm or with high-grade dysplasia vs <10 mm and no high-grade dysplasia or advanced adenoma vs non-advanced adenoma) with time to death from
upper gastrointestinal (esophageal and gastric) cancer. To quantify the burden of deaths from upper GI cancer in screening participants with high-risk or low-risk polyps in relation to the general population, we calculated standardized mortality ratios.

Results

We included 331,284 CRC high-quality screening colonoscopies in our study. The median follow-up time was 5.04 years (95% CI 5.03-5.07). 4.4% of participants had polyps ≥10 mm or with HGD and 7.7% had advanced adenomas. At the end of the study period, 296 deaths of upper GI cancer had occurred, corresponding to a rate of 10.29 deaths per 100,000 person years in women and 26.61 deaths per 100,000 person years in men. In participants with non-advanced adenomas, hazards for upper GI cancer death were similar compared to participants with advanced adenomas (HR 1.37, 95% CI 1.01-1.72 and HR 1.35, 95% CI 0.94-1.95) when taking participants with a negative colonoscopy as the reference. However, in participants with polyps ≥10 mm or HGD, hazards for upper GI cancer death were higher (HR 1.70, 95% CI 1.07-1.66). Participants with polyps <10 mm and no HGD experienced significantly fewer deaths from upper GI cancer than the general population (SMR 0.71, 95% CI 0.61-0.83, p<0.001), however, participants with high-risk polyps had an upper GI cancer mortality which was similar to that of the population (SMR 0.90, 95% CI 0.60-1.29, p = 0.6).

Conclusion

CRC screening participants with polyps <10 mm and no HGD have a lower risk for mortality from upper gastrointestinal cancers compared to participants with polyps >10 mm and HGD or the general population. In these participants, additional upper GI screening efforts might not be useful. However, future studies will demonstrate whether integrated screening with additional gastroscopy is effective in CRC screening participants with large or highly dysplastic polyps.

Introduction

Alternate day oral iron therapy is better than daily oral iron therapy in Iron deficiency anemia (IDA) as it increases the fractional absorption of iron. In Ulcerative colitis (UC) with IDA increased fractional absorption of iron with alternate day iron may not only be better in improvement of anemia but also results in reduced unabsorbed iron delivery to distal bowel and may hence reduce adverse effects.

Aims & Methods

In a randomized, open label trial, from February 2023 to December 2024 patients of UC in remission (Mayo ≤2 OR partial Mayo ≤1 with fecal calprotectin <150mcg/gm for last 3 months) with IDA (ferritin <30mcg/l, transferrin saturation <20%, Hb 8-12 gm/dl) were randomized to every other day 132mg (EOD group) or daily 66mg (OD group) elemental oral iron given as ferrous fumarate for 8 weeks. Primary outcome was the difference in mean change in Hemoglobin (Hb) at 8 weeks. Secondary outcomes were the difference in mean change in RBC indices, iron indices and adverse events at 8 weeks.

Results

54 patients were randomized between both groups. One patient in EOD and 2 in OD group withdrew before treatment initiation. Eleven patients had disease flare on oral iron therapy (5 in EOD and 6 in OD group) p= 0.62 and two patients in EOD group had intolerance requiring oral iron stoppage. Thirty-eight patients completed treatment. The mean change in Hb at 8 weeks in EOD and OD groups was 2.08±1.0gm/dl and 2.09±1.11gm/dl respectively in per protocol analysis (p=0.797). The mean change in serum ferritin, serum iron, transferrin saturation and total iron binding capacity in both the groups is not significant. Disease flare within 6 months prior to oral iron therapy correlated with increased incidence of flare on oral iron therapy. (P=0.04)

Conclusion

Alternate day oral iron is not better than daily oral iron in improving Hb levels, iron indices and with similar incidence of adverse events in patients of UC in remission. A recent flare has increased chances of disease flare with oral iron therapy

Introduction

A plethora of findings suggests the correlation between Metabolic-(Dysfunction)Associated Fatty Liver Disease (MAFLD) and long-term incorrect lifestyle behavior. The Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV2) pandemic lockdown represented a unique event forcing the entire population to suddenly change their lifestyle, favoring a drastic reduction in physical activity and an improper diet, with consequences on metabolic homeostasis never experienced before. In this study, we aimed to investigate the effects of the SARS-CoV-2 confinement and related lifestyle changes on MAFLD evolution.

Aims & Methods

A cohort of 222 MAFLD patients was followed two years before, two years during, and one year after the pandemic. At four time points [January 2018: T0; January 2020: T1; January 2022: T2; January 2023: T3], anthropometrical, biochemical, nutritional, bioelectrical impedance analysis (BIA) data, non-invasive tools for disease staging and hepatocellular carcinoma (HCC) occurrence were collected.

Results

At T2 an increase in fats and carbohydrate intake consistently with impaired weekly physical activity was demonstrated, associated with an increase in body mass index and waist-to-hip ratio (p<0.0001 for all), as well as a worsening in levels of total cholesterol, low/high-density lipoprotein, triglycerides, glucose, insulin, homeostatic model assessment for insulin resistance and transaminases (insulin: p=0.0003, glucose: p=0.0007; p<0.0001 for the others). Non-invasive tools assessments revealed a NAFLD fibrosis score, Liver Stiffness Measurement (LSM), and Controlled Attenuation Parameter impairment at T2 (p<0.0001 all). In comparison with T0 and T1, the BIA evidenced at T2 an increase in Fat Mass (FM) and a reduction of Free Fat Mass (FFM), Body Cell Mass (BCM), and Extracellular Mass (ECM). During the confinement period, the overall HCC and Milan-out staged HCC occurrence revealed HR:2.521, p=0.01, and HR:13.78, p=0.0009 respectively. Contrariwise to the modifications of the biochemical parameters, a significant association between body composition parameters modification during the study evaluations with HCC overall and HCC Milan-out criteria occurrence was highlighted (ΔFFM pre- vs during pandemic, OR: 0.704; ΔFM pre- vs during-pandemic, OR: 1.531; p <0.0001).
Receiving operator curve (ROC) analysis identified respectively -0.92 Kg (AUC:0.86) and -1.90 Kg (AUC:0.90) for FFM and +1.35 Kg (AUC:0.87) and +1.51 Kg (AUC:0.94) for FM as the best cut-off (BCO) variations (pre-pandemic vs pandemic) in the prediction of HCC overall and HCC Milan-out staged occurrence during the confinement. Time-to-time analysis revealed a higher incidence of HCC overall occurrence along the pandemic period in MAFLD patients presenting the following body modification composition “combined pattern” (BMCC) [BCO FFM decrease + BCO FM increase] in comparison to individuals presenting only one of two variations (p:0.025). At T3, compared to the pandemic period, simultaneously with improvement in physical activity as well as a decrease in fats and carbohydrate intake, the insulin levels, CAP, and FM were significantly decreased (p<0.001). Relevantly, a higher incidence of HCC overall occurrence even after the pandemic period in BMCC-MAFLD patients (p:0.048) was observed.

Conclusion

The confinement-related lifestyle changes impacted MAFLD evolution via body composition modifications, negatively influencing the HCC occurrence even after the pandemic period and the restoration of pre-existing life habits, as we are still observing the consequences of the confinement-induced "damages".

References

1. Taheri E, Bostick RM, Hatami B, et al. Dietary and Lifestyle Inflammation Scores Are Inversely Associated with Metabolic-Associated Fatty Liver Disease among Iranian Adults: A Nested Case-Control Study. J Nutr 2022;152:559-567.
2. Dallio M, Romeo M, Gravina AG, et al. Nutrigenomics and Nutrigenetics in Metabolic- (Dysfunction) Associated Fatty Liver Disease: Novel Insights and Future Perspectives. Nutrients 2021;13.
3. Ariya M, Koohpayeh F, Ghaemi A, et al. Assessment of the association between body composition and risk of non-alcoholic fatty liver. PLoS One 2021;16:e0249223.
4. Fujii H, Nakamura N, Fukumoto S, et al. Lifestyle changes during the coronavirus disease 2019 pandemic impact metabolic dysfunction-associated fatty liver disease. Liver Int 2022;42:995-1004.

Introduction

The available evidence on the epidemiology of acute pancreatitis (AP) is primarily based on older studies conducted in other countries, limiting its applicability to local settings. This study aims to provide updated data on the clinical characteristics and outcomes of patients with AP in our region thereby improving understanding and management of the disease.

Aims & Methods

A retrospective analysis was conducted on a prospective database comprising a cohort of 526 patients with acute pancreatitis (AP), consecutively included between March 2017 and June 2019 at a tertiary care hospital. Systematic laboratory testing was performed at admission and again at 48 hours. Clinical management followed standard practice guidelines, including routine abdominal ultrasound after admission and abdominal CT scan in cases of diagnostic uncertainty, clinical deterioration, or lack of improvement. Diagnosis and classification were based on the revised 2012 Atlanta classification.

Results

The most frequent etiology of AP in our setting was biliary lithiasis (65.9%), followed by idiopathic (15.4%) and alcohol-related causes (8.4%). Severe AP accounted for 9% of cases, while 14.3% were classified as moderately severe. Up to 20.2% of patients developed local complications; however, only 4.9% presented with pancreatic necrosis. SIRS was observed in 18.7% of patients at admission, decreasing to 8.7% at 48 hours. Only 3.7% of patients required ICU admission (Table 1). Factors such as smoking, ERCP, antibiotic therapy, acute cholangitis, and SIRS showed significant differences across different etiological groups.

Conclusion

Acute pancreatitis (AP) is a common condition that imposes a significant healthcare burden. Determining the etiology of AP at admission is important not only from an epidemiological standpoint but also due to its profound implications for patient prognosis.
Contrary to what has been reported in the literature, the second most frequent cause of AP in our cohort was idiopathic, surpassing alcohol-related cases. In line with other studies, we observed significant differences between biliary and alcohol-related etiologies regarding smoking habits, development of acute cholangitis, need for ERCP, and use of antibiotic therapy. Patients with alcohol-related AP were significantly more likely to present with SIRS at admission. However, we did not find statistically significant differences in other key clinical outcomes, although patients with alcohol-related AP appeared to have a higher, but not statistically significant, risk of developing local complications, pancreatic necrosis, and SIRS at 48 hours.
This study highlights the importance of tailoring management strategies according to etiology to optimize clinical outcomes.

References

1. Wang, G. J., Gao, C. F., Wei, D., Wang, C., & Ding, S. Q. (2009). Acute pancreatitis: etiology and common pathogenesis. World journal of gastroenterology, 15(12), 1427–1430.
2. Petrov, M. S., & Yadav, D. (2019). Global epidemiology and holistic prevention of pancreatitis. Nature reviews. Gastroenterology & hepatology, 16(3), 175–184.
3. Iannuzzi, J. P., King, J. A., Leong, J. H., Quan, J., Windsor, J. W., Tanyingoh, D., Coward, S., Forbes, N., Heitman, S. J., Shaheen, A. A., Swain, M., Buie, M., Underwood, F. E., & Kaplan, G. G. (2022). Global Incidence of Acute Pancreatitis Is Increasing Over Time: A Systematic Review and Meta-Analysis. Gastroenterology, 162(1), 122–134.