非酒精性脂肪性肝病及其肝纤维化程度与结直肠腺瘤性息肉的关系

目的:探讨非酒精性脂肪性肝病(NAFLD)及其肝纤维化严重程度与结直肠腺瘤性息肉之间的关系.方法:选择2018年4月-2021年4月在安徽医科大学第三附属医院消化内科住院的符合条件的结直肠腺瘤息肉患者538例为腺瘤性息肉组,其中165例为高危腺瘤.选择同期就诊的结肠镜检查正常的495例患者为对照组,比较腺瘤性息肉组及高...     

Relationship of non‐alcoholic fatty liver disease to colorectal adenomatous polyps

Background and Aims: Metabolic syndrome and insulin resistance are associated with a higher risk of colon cancer. Non‐alcoholic fatty liver disease (NAFLD) is regarded as a manifestation of metabolic syndrome in the liver. This investigation was initiated to determine whether NAFLD has a relationship to colorectal adenomatous polyps. Methods: We examined the 2917 participants who underwent a routine colonoscopy at Kangbuk Samsung Hospital in 2007. We divided the 2917 subjects into the adenomatous polyp group (n = 556) and the normal group (n = 2361). Anthropometric measurements, biochemical tests for liver and metabolic function, and abdominal ultrasonographs were assessed. Results: The prevalence of NAFLD was 41.5% in the adenomatous polyp group and 30.2% in the control group. By multiple logistic regression analysis, NAFLD was found to be associated with an increased risk of colorectal adenomatous polyps (odds ratio, 1.28; 95% confidence interval, 1.03–1.60). An increased risk for NAFLD was more evident in patients with a greater number of adenomatous polyps. Conclusion: NAFLD was associated with colorectal adenomatous polyps. Further studies are needed to confirm whether NAFLD is a predictor for the development of colorectal adenomatous polyps and cancer.     

排便习惯改变人群结直肠息肉患病率临床分析

背景:结直肠癌的发生与结直肠息肉,尤其是腺瘤性息肉密切相关。结直肠息肉患者常有排便习惯改变的表现。目的:分析排便习惯改变人群的结直肠息肉患病率及其临床病理特点,以期指导此类个体的干预和治疗。方法:收集2009~2012年因排便习惯改变至上海瑞金医院卢湾分院行结肠镜检查的患者,对其息肉检出率、病理类型和分布情况进行回顾性分析。结果:共6 204例患者入选,结直肠息肉检出率为32.2%(1 997例),男性检出率显著高于女性(38.8%对26.2%,P0.01)。有病理记录的息肉共3 041枚,其中腺瘤性息肉1 798枚(59.1%),增生性息肉592枚(19.5%),炎性息肉554枚(18.2%),腺癌83枚(2.7%),227枚(12.6%)腺瘤性息肉伴有低级别或高级别上皮内瘤变。息肉、腺瘤、腺癌分布于肝曲远端者均在80%以上。结论:排便习惯改变人群的结直肠息肉患病率较高且以腺瘤性息肉为主,病变多位于肝曲远端。对此类患者应尽早行全结肠镜检查/治疗,从而有效预防结直肠癌的发生。     

Is proliferative colonic disease presentation changing?

AIM: To compare the site, age and gender of cases of colorectal cancer (CRC) and polyps in a single referral center in Rome, Italy, during two periods.METHODS: CRC data were collected from surgery/pathology registers, and polyp data from colonoscopy reports. Patients who met the criteria for familial adenomatous polyposis, hereditary non-polyposis colorectal cancer syndrome or inflammatory bowel disease were excluded from the study. Overlap of patients between the two groups (cancers and polyps) was carefully avoided. The χ² statistical test and a regression analysis were performed.RESULTS: Data from a total of 768 patients (352 and 416 patients, respectively, in periods A and B) who underwent surgery for cancer were collected. During the same time periods, a total of 1693 polyps were analyzed from 978 patients with complete colonoscopies (428 polyps from 273 patients during period A and 1265 polyps from 705 patients during period B). A proximal shift in cancer occurred during the latter years for both sexes, but particularly in males. Proximal cancer increased > 3-fold in period B compared to period A in males [odds ratio (OR) 3.31, 95%CI: 2.00-5.47; P < 0.0001). A similar proximal shift was observed for polyps, particularly in males (OR 1.87, 95%CI: 1.23-2.87; P < 0.0038), but also in females (OR 1.62, 95%CI: 0.96-2.73; P < 0.07).CONCLUSION: The prevalence of proximal proliferative colonic lesions seems to have increased over the last decade, particularly in males.     

Association of nonalcoholic fatty liver disease and liver cancer

AIM:To investigate the association between nonalcoholic fatty liver disease(NAFLD) and liver cancer,and NAFLD prevalence in different liver tumors.METHODS:This is a retrospective study of the clinical,laboratory and histological data of 120 patients diagnosed with primary or secondary hepatic neoplasms and treated at a tertiary center where they underwent hepatic resection and/or liver transplantation,with subsequent evaluation of the explant or liver biopsy.The following criteria were used to exclude patients from the study:a history of alcohol abuse,hepatitis B or C infection,no tumor detected in the liver tissue examined by histological analysis,and the presence of chronic autoimmune hepatitis,hemochromatosis,Wilson’s disease,or hepatoblastoma.The occurrence of NAFLD and the association with its known risk factors were studied.The risk factors considered were diabetes mellitus,impaired glucose tolerance,impaired fasting glucose,body mass index,dyslipidemia,and arterial hypertension.Presence of reticulin fibers in the hepatic neoplasms was assessed by histological analysis using slide-mounted specimens stained with either hematoxylin and eosin or Masson’s trichrome and silver impregnation.Analysis of tumor-free liver parenchyma was carried out to determine the association between NAFLD and its histological grade.RESULTS:No difference was found in the association of NAFLD with the general population(34.2% and 30.0% respectively,95%CI:25.8-43.4).Evaluation by cancer type showed that NAFLD was more prevalent in patients with liver metastasis of colorectal cancer than in patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma(OR = 3.99,95%CI:1.78-8.94,P < 0.001 vs OR = 0.60,95%CI:0.18-2.01,P = 0.406 and OR = 0.70,95%CI:0.18-2.80,P = 0.613,respectively).There was a higher prevalence of liver fibrosis in patients with hepatocellular carcinoma(OR = 3.50,95%CI:1.06-11.57,P = 0.032).Evaluation of the relationship between the presence of NAFLD,nonalcoholic steatohepatitis,and liver fibrosis,and their risk factors,showed no significant statistical association for any of the tumors studied.CONCLUSION:NAFLD is more common in patients with liver metastases caused by colorectal cancer.     

Withdrawal time in excellent or very poor bowel preparation qualities

AIM: To evaluate association(s) between withdrawal time and polyp detection in various bowel preparation qualities. METHODS: Retrospective cohort analysis of screening colonoscopies performed between January 2005 and June 2011 for patients with average risk of colorectal cancer. Exclusion criteria included patients with a personal history of adenomatous polyps or colon cancer, prior colonic resection, significant family history of colorectal cancer, screening colonoscopy after other abnormal screening tests such as flexible sigmoidoscopy or barium enema, and screening colonoscopies during in-patient care. All procedures were performed or directly supervised by gastroenterologists. Main measurements were number of colonic segments with polyps and total number of colonic polyps.RESULTS: Multivariate analysis of 8331 colonosco-pies showed longer withdrawal time was associated with more colonic segments with polyps in good(adjusted OR = 1.16; 95%CI: 1.13-1.19), fair(OR = 1.13; 95%CI: 1.10-1.17), and poor(OR = 1.18; 95%CI: 1.11-1.26) bowel preparation qualities. A higher number of total polyps was associated with longer withdrawal time in good(OR = 1.15; 95%CI: 1.13-1.18), fair(OR = 1.13; 95%CI: 1.10-1.16), and poor(OR = 1.20; 95%CI: 1.13-1.29) bowel preparation qualities. Longer withdrawal time was not associated with more colonic segments with polyps or greater number of colonic polyps in bowel preparations with excellent(OR = 1.07, 95%CI: 0.99-1.26; OR = 1.11, 95%CI: 0.99-1.24, respectively) and very poor(OR = 1.02, 95%CI: 0.99-1.12; OR = 1.05, 95%CI: 0.99-1.10, respectively) qualities.CONCLUSION: Longer withdrawal time is not associated with higher polyp number detected in colonoscopies with excellent or very poor bowel preparation quality.     

非酒精性脂肪性肝病与代谢综合征指标变化的相关性分析

目的探讨中老年人群中非酒精性脂肪性肝病(NAFLD)与代谢综合征相关指标变化的关系。方法收集2010—2011年暨南大学附属第一医院40岁以上体检人群腹部B超检查的数据,用多因素Logistic回归分析体重指数(BMI)、空腹血糖(FBG)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)、丙氨酸转氨酶(ALT)、血尿酸(UA)的变化值与NAFLD变化的关系。结果 2年内男性组和女性组NAFLD检出率都在增加,男性新增NAFLD总检出率为13.7%,明显高于女性新增NAFLD检出率7.5%(P<0.05);男性和女性的NAFLD消减率都是5.5%,且峰值都在60岁年龄组;BMI变化值与新增NAFLD密切正相关,BMI变化值的OR=1.474(95%CI 1.184～1.811),而TG和FBG的变化值与新增NAFLD无相关性;TG和BMI的变化值与NAFLD的消减呈负相关,TG变化值的OR=0.653(95%CI 0.508～0.838),BMI变化值的OR=0.628(95%CI 0.460～0.857),而FBG变化值未发现与NAFLD消减有相关性。结论 BMI变化值与NAFLD发生有密切相关性,TG和BMI的变化值与NAFLD的消减呈负相关,是影响NAFLD变化的重要因素之一。     

不同性别高血红蛋白水平对非酒精性脂肪性肝病发生风险的影响

目的探讨不同性别Hb浓度和非酒精性脂肪性肝病（NAFLD）发生风险之间的关系。方法以2012年1月至2012年12月上海市仁济医院健康保健中心年龄≥18岁的体检人群为研究对象,依据男女Hb的不同进行分组,评估各组NAFLD的患病率。结果入组的61 646人中,平均年龄（44±14）岁,男性34 961人,女性26 685人。超声诊断为NAFLD者20 401人,占33.09%。不论在男性组还是女性组,NAFLD患病率随着Hb水平的升高而升高（P〈0.001）,男性NAFLD的患病率高于女性（44.7%比17.9%,χ2=4 900,P〈0.001）,在Logistic回归分析中,NAFLD患病率和Hb水平呈现正相关的关系,在男性组,作多变量分析时,第1组作为参照,第2组、第3组、第4组的OR值分别为1.31（95%CI：1.18-1.45）、1.38（95%CI：1.24-1.53）、1.29（95%CI：1.05-1.58）,均P〈0.05。在女性组,多变量分析时,OR值分别为1.08（95%CI：0.95-1.22）、1.26（95%CI：1.09-1.45）、1.59（95%CI：1.06-2.38）,除第2组外,另两组均P〈0.05。男性患NAFLD的风险较女性高（OR为3.7,95%CI：3.57-3.85,P〈0.001）。结论 Hb水平和NAFLD呈正相关关系,高Hb水平是独立于肥胖和代谢综合征的NAFLD的又一风险因素。男性NAFLD发生风险是女性的3.7倍。     

Prevalence and incidence of hyperplastic polyps and adenomas in familial colorectal cancer: correlation between the two types of colon polyps

BACKGROUND AND AIMS: Colorectal adenomas are recognised as precursors of colorectal carcinomas. The significance of hyperplastic (metaplastic) colorectal polyps is unknown. The relationship between hyperplastic polyps and adenomas, and the prevalence and incidence of these lesions were evaluated in individuals predisposed to familial colorectal cancer. METHODS: A total of 299 individuals participating in our surveillance programme during 1990-2000 were retrospectively evaluated. Subjects were classified into three groups: hereditary non-polyposis syndrome (HNPCC) (n=108), hereditary colorectal cancer (HCRC) (n=127), and individuals with empirical risk estimates-two close relatives (TCR) (n=64). Findings from 780 colonoscopies were evaluated regarding prevalence and incidence of hyperplastic polyps and adenomas. Correlations between hyperplastic polyps and adenomas were calculated by Pearson correlation. RESULTS: In total, 292 hyperplastic polyps and 186 adenomas were observed in 98 and 90 individuals, respectively. A positive correlation was found between the numbers of hyperplastic polyps and adenomas (r=0.40; p<0.001). Correlations between adenomas and hyperplastic polyps were similar in the three groups. The risk of detecting new hyperplastic polyps (odds ratio 5.41) or adenomas (OR 2.56) increased significantly when there was a positive finding at first colonoscopy. CONCLUSION: Hyperplastic polyps as well as adenomas may identify individuals with a high risk of colorectal cancer. This information is important when these individuals are selected and included in tailored surveillance programmes.     

Hyperplastic Colonic Polyps as a Marker for Adenomatous Colonic Polyps

Hyperplastic colonic polyps are generally regarded as being of little or no clinical consequence. Recently, however, hyperplastic polyps have been found to share numerous functional similarities with colorectal carcinoma. To determine whether the presence of an isolated left-sided colonic hyperplastic (metaplastic) polyp could serve as a marker for more proximal synchronous adenomatous colonic polyps, we retrospectively analyzed all consecutive colonoscopic polypectomies performed over an 18-month period at two medical centers. It is the policy at both institutions to remove or biopsy all polyps, regardless of size. Indications for colonoscopy included known or previous colonic polyps or carcinoma, hemoccult positive stool, lower gastrointestinal bleeding, iron deficiency anemia, abnormal barium enema, inflammatory bowel disease, abdominal pain, and family history of colon cancer. The location of adenomatous polyps and hyperplastic polyps was recorded and compared. One hundred sixty-three of 845 consecutive patients (19.3%) had at least one colonic polyp. The prevalence of adenomatous polyps alone was 10.3%, hyperplastic polyps 9%, and both types 1.9%. The prevalence rate for an adenomatous polyp in patients without a hyperplastic polyp was 15%. In contrast, among patients with a hyperplastic polyp, 49% had a synchronous adenomatous polyp. Only 3.4% of patients had an adenomatous polyp proximal to the splenic flexure when no polyps were present in the left colon. Conversely, among the 29 patients in whom an isolated hyperplastic polyp was found in the left colon, there was a 32.5% prevalence of adenomatous polyps in the proximal colon (p less than 0.01). The results of this study suggest that left-sided hyperplastic colonic polyps (generally within the reach of a screening sigmoidoscopy) serve as a marker for neoplastic polyps.     

Total Colonoscopy in Patients with Polyps in the Proctosigmoid Region

Abstract: We conducted a prospective study of the general population in Taiwan to determine how many patients with polyps in the proctosigmoid region would have synchronous polyps in the proximal colon. The pathology and the number of proctosigmoid polyps as well as the benefits of subsequent colonoscopy were taken into account. Proctosigmoid polyps were identified in 261 of 2746 asymptomatic patients by 60 cm sigmoidoscopy, yeilding a 9.5% (male: 11.0%; female: 5.0%) prevalence rate. Subsequent total colonoscopy combined with polypectomy was completed in 205 patients (152 males; 53 females) eligible for analysis. In all, 353 polyps were removed for pathological verification at colonoscopy. The mean size of adenomatous polyps was 6.2 mm and that of hyperplastic polyps 3.2mm (p<0.05). Five mucosal cancers as well as one submucosal cancer were identified, and one of the mucosal cancers was beyond the range of the prior 60 cm sigmoidoscopy. Of these 205 patients, 63 (31%) were found to have at least one proximal polyp. The prevalences of synchronous proximal colon polyps were 23%, 42% and 77% for the 1-polyp, 2-polyp and β2-polyp groups in the proctosigmoid region, respectively. When the pathology of the proctosigmoid polyps was taken into account, it was found that 42% of patients with adenomatous polyps in the proctosigmoid region had proximal polyps, compared with 10% of those with distal hyperplastic polyps and 8% of those with other findings (p<0.05). The present study suggests that all polyps, of all sizes, found at sigmoidoscopy merit pathological verification. Furthermore, colonoscopy should be reserved for patients proved to have adenomatous or multiple polyps in the proctosigmoid region.     

云南省布朗族成人非酒精性脂肪性肝病流行特点研究

目的 调查云南省勐海县布朗族成人非酒精性脂肪性肝病(NAFLD)的流行特点及其它代谢性疾病的患病情况.方法 2017年2～3月对布朗族聚集且交通便利的5个行政村、18岁及以上3365名居民进行普查,纳入研究3258名.采用问卷调查、体格检查、实验室检测和超声检查.以2010年第六次全国人口普查的人口构成为标准人口构成,...     

The association of fasting insulin concentrations and colonic neoplasms in acromegaly: a colonoscopy-based study in 210 patients

CONTEXT: Hyperinsulinemia is associated with colon carcinoma in the general population. Patients with acromegaly are considered to be at risk for developing colonic lesions and typically have hyperinsulinemia. OBJECTIVE: Our objective was to evaluate the role of fasting insulin levels on the prevalence of colonic adenomatous polyps or adenocarcinoma in acromegaly. DESIGN: This is an analytical, observational, prospective study. Patients: A total of 210 patients (111 women, 99 men, age 20-82 yr) undergoing complete colonoscopy at diagnosis of acromegaly were included in this study. RESULTS: Colonic lesions were found in 81 patients (38.6%), and consisted of hyperplastic polyps in 33 (15.7%), adenomatous polyps in 42 (20.0%), and adenocarcinoma in six patients (2.8%). Polyps were single in 22 cases (27.1%). Fasting insulin levels were significantly lower in patients without lesions (16.0 +/- 7.5 mU/liter) than in patients with hyperplastic polyps (22.4 +/- 8.8 mU/liter; P < 0.01), adenomatous polyps (38.0 +/- 15.9 mU/liter; P < 0.0001), and adenocarcinoma (59.0 +/- 30.6 mU/liter; P < 0.0001). Fasting insulin levels were also lower in patients with hyperplastic polyps than in those with adenomatous polyps (P < 0.01). The odds ratio for harboring colonic adenomas was 14.8 (95% confidence interval 4.4-51.2; P < 0.0001) and 8.6 times higher (95% confidence interval 2.8-29.0; P < 0.0001) in patients with fasting insulin levels in the upper tertile [>/=27.1 mIU/liter (n = 28)] compared with the lower [12.1 to <27.1 mIU/liter (n = 74)], respectively. CONCLUSION: An increase in fasting insulin levels is associated with an 8.6- to 14.8-fold increased risk of presenting with colonic adenomas in acromegaly.     

High Prevalence of Hyperplastic Colonic Polyps in Acromegalic Subjects

We evaluated the prevalence and features of colonic polyps in a population of acromegalic subjects, compared to a control group of patients with irritable bowel syndrome (IBS). Colonic polyps were found in 30 acromegalic subjects (40%) and in 10 controls (13%) (P < 0.0001). Among the acromegalic patients, polyps were of the hyperplastic type in 27 subjects (90%) and adenomatous in 3 (10%). In the control group, polyps were hyperplastic in nine subjects (90%) and adenomatous in one (10%). We also observed a significant association (P < 0.0001) between the presence of hyperplastic polyps and the older age in both the acromegalic and the control groups. There were no differences between the two groups regarding sex, site, size, or macroscopic and histological types of polyps. Acromegalic patients have a higher prevalence of colonic hyperplastic polyps than IBS subjects, while the prevalence of adenomatous polyps is similar in the two groups.     

Multicenter randomised controlled trial comparing the high definition white light endoscopy and the bright narrow band imaging for colon polyps

AIM To compare high definition white light endoscopy and bright narrow band imaging for colon polyps' detection rates. METHODS Patients were randomised to high definition white light endoscopy(HD-WLE) or the bright narrow band imaging(b NBI) during withdrawal of the colonoscope. Polyps identified in either mode were characterised using b NBI with dual focus(b NBI-DF) according to the Sano's classification. The primary outcome was to compare adenoma detection rates(ADRs) between the two arms. The secondary outcome was to assess the negative predictive value(NPV) in differentiating adenomas from hyperplastic polyps for diminutive rectosigmoid lesions.RESULTS A total of 1006 patients were randomised to HD-WLE(n = 511) or b NBI(n = 495). The mean of adenoma per patient was 1.62 and 1.84, respectively. The ADRs in b NBI and HD-WLE group were 37.4% and 39.3%, respectively. When adjusted for withdrawal time(OR = 1.19, 95%CI: 1.15-1.24, P 0.001), the use of b NBI was associated with a reduced ADR(OR = 0.69, 95%CI: 0.52-0.92). Nine hundred and thirty three polyps(86%) in both arms were predicted with high confidence. The sensitivity(Sn), specificity(Sp), positive predictive value and NPV in differentiating adenomatous from non-adenomatous polyps of all sizes were 95.9%, 87.2%, 94.0% and 91.1% respectively. The NPV in differentiating an adenoma from hyperplastic polyp using b NBI-DF for diminutive rectal polyps was 91.0%.CONCLUSION ADRs did not differ between b NBI and HD-WLE, however HD-WLE had higher ADR after adjustment of withdrawal time. b NBI surpassed the PIVI threshold for diminutive polyps.     

835枚结直肠进展期腺瘤的病例资料特点及漏诊原因分析

目的分析结直肠进展期腺瘤(advanced colorectal adenoma,ACA)在不同年龄患者中的特点,探讨影响其漏诊及再发的因素。方法收集2012年1月至2017年12月在上海交通大学医学院附属瑞金医院北部院区接受肠镜检查的患者,共纳入符合条件的ACA 835枚,分析这些患者的年龄、性别、检出ACA基数、大小、形态、位置、肠道准备情况,初步了解中青年(≤60岁)及老年(>60岁)患者的ACA特点,探讨其漏诊及再发的相关因素。结果在漏诊的中青年ACA中,性别、肠道准备情况组间比较,差异有统计学意义(P<0.05),男性及肠道准备欠佳者易出现漏诊情况(P=0.001、P=0.000),而肠镜ACA基数、大小、位置组间比较,差异无统计学意义(P>0.05)。在再发的中青年ACA中,性别组间比较差异有统计学意义(P=0.005)。在漏诊的老年ACA中,男性、多发ACA、扁平或宽蒂的结直肠ACA、肠道准备欠佳者易出现漏诊情况(P=0.002、P=0.023、P=0.001、P=0.000),而ACA大小、位置组间比较,差异无统计学意义(P>0.05)。在再发的老年ACA中,同中青年ACA,性别组间比较差异有统计学意义(P=0.040),而肠镜ACA基数、大小、形态、位置、肠道准备情况差异无统计学意义(P>0.05)。对ACA的漏诊及再发相关因素进行Logistic回归分析发现,患者的年龄(OR=0.608,P=0.007)、性别(OR=2.553,P=0.000)、Boston评分(OR=0.464,P=0.000)是影响ACA漏诊的独立危险因素,而患者的性别(OR=1.589,P=0.018)是影响ACA再发的独立危险因素。结论年龄越大、男性、肠道准备差会导致ACA的漏诊,而男性ACA的再发风险更高。     

A community-based epidemiological study of elevated serum alanine aminotransferase levels in Kinmen, Taiwan

AIM: To explore any gender-related differences in prevalence of and condition-associated factors related to an elevated serum alanine aminotransferase (ALT) level amongst residents of Kinmen, Taiwan. METHODS: A total of 11 898 of a potential 20 112 regional residents aged 30 years or more completed a related questionnaire that was carried out by the Yang-Ming Crusade between 1991 and 1994 inclusively, with blood samples being collected by public nurses. The overall questionnaire response rate was 59.3% (52.4% for males and 66.0% for females). RESULTS: The prevalence of an elevated serum ALT level for this sub-population was found to be 7.2%, the prevalence revealing a statistically significant decrease with increasing population age (P<0.0001). Males exhibited a greater prevalence of elevated serum ALT level than did females (9.4% vs 5.3%, P<0.0001). Using multiple logistic regression analysis, in addition to male gender, a younger age, greater waist circumference, presence of type-2 diabetes and hyperuricemia were the significant factors associated with an elevated serum ALT level for both males and females. Gender-related differences as regards associated factors were also revealed. For males, obesity was significantly related to an elevated serum ALT level (OR = 1.28, 95%CI: 1.00-1.66) but this was not so for females (OR = 1.09, 95%CI: 0.84-1.42). Hypertriglyceridemia (OR = 1.80, 95%CI: 1.36-2.39) and hyperuricemia (OR = 1.61, 95%CI: 1.03-2.52) were significantly related to elevated serum ALT levels only for females. CONCLUSION: Several gender-related differences were noted pertaining to the prevalence of and relationship between obesity, hypertriglyceridemia and hyperuricemia and elevated serum ALT level in the present study.     

Gastric polyps: Association with Helicobacter pylori status and the pathology of the surrounding mucosa,a cross sectional study

aim:To assess the endoscopic characteristics of gastric polyps and their association with Helicobacter pylori(H.pylori)status in a predominantly Hispanic population.m ETHODS:We conducted a retrospective study of all esophagogastroduodenoscopies performed at our institution.Demographic,endoscopic and histopathological data were reviewed.Categorization of patients into Hispanic and Non-Hispanic was based on selfidentification.Patients without resection/biopsy were not included in the analysis.Identification of polyps type was based on histological examination.One way analysis of variance was used to compare continuousvariables among different polyp types and Fisher’s exact test was used compare categorical variables among polyp types.Unadjusted and adjusted comparisons of demographic and clinical characteristics were performed according to the H.pylori status and polyp type using logistic regressions.RESULTS:Of 7090 patients who had upper endoscopy,335 patients had gastric polyps(4.7%).Resection or biopsy of gastric polyps was performed in 296 patients(88.4%)with a total of 442 polyps removed or biopsied.Of 296 patients,87(29%)had hyperplastic polyps,82(28%)had fundic gland polyps and 5(1.7%)had adenomatous polyps.Hyperplastic polyps were significantly associated with positive H.pylori status compared with fundic gland polyps(OR=4.621;95%CI:1.92-11.13,P=0.001).Hyperplastic polyps were also found to be significantly associated with portal hypertensive gastropathy compared with fundic gland polyps(OR=6.903;95%CI:1.41-33.93,P=0.0174).Out of 296 patients,30(10.1%)had a followup endoscopy with a mean duration of 26±16.3 mo.Interval development of cancer was not noted in any of the patients during follow up period.CONCLUSi ON:Gastric hyperplastic polyps were significantly associated with positive H.pylori status and portal hypertensive gastropathy as compared with fundic gland polyps.     

Prevalence and etiology of elevated serum alanine aminotransferase level in an adult population in Taiwan

BACKGROUND: The prevalence and etiologies of elevated alanine aminotransferase (ALT) have geographic variations and they are rarely reported in Taiwan. Through a population-based screening study, the prevalence and etiologies of elevated ALT in an adult population of Taiwan were assessed. METHODS: A cross-sectional community study in a rural village of Taiwan was conducted in 3260 Chinese adults (age >or=18 years) undergoing ultrasonography (US), blood tests, and interviews with a structured questionnaire. The diagnostic criteria of non-alcoholic fatty liver disease (NAFLD) included alcohol intake <20 g/week for women or <30 g/week for men, negative hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, no known etiologies of liver disease, and US consistent with fatty liver. RESULTS: The prevalence of elevated ALT was 11.4% (372/3260). The probable cause of this elevation was excess alcohol consumption in 0.8%, HBV in 28.5%, HCV in 13.2%, both HBV and HCV in 2.2%, NAFLD in 33.6%, and unexplained cause in 21.8%. The etiologic distribution of elevated ALT was similar in both genders, although elevation was more common in men compared to women (17.3%vs 6.1%, P < 0.05). The prevalence of elevated ALT in NAFLD was 18.1% (125/691), and the positive predictive value was 33.6% (125/372). The development of NAFLD was related to increasing age (age between 40 years and 64 years, odds ratio [OR] 1.59, 95% confidence interval [CI]: 1.25-2.01; age >or= 65 years, OR 1.46, 95%CI: 1.08-1.96), fasting plasma glucose (FPG) >or= 126 mg/dL (OR 1.54, 95%CI: 1.11-2.14), body mass index (BMI) >or= 25 kg/m(2) (OR 5.01, 95%CI: 4.13-6.26), triglyceridemia >or= 150 mg/dL (OR 1.96, 95%CI: 1.58-2.42), and hyperuricemia (OR 1.50, 95%CI: 1.22-1.84). Elevated ALT was related to male gender, BMI >or= 25 kg/m(2), and triglyceridemia >or= 150 mg/dL in subjects without known etiologies of liver disease (all P < 0.05). CONCLUSIONS: Non-alcoholic fatty liver disease appears to be the commonest cause of elevated ALT and presumed liver injury in Taiwan. The development of NAFLD is closely associated with many metabolic disorders. Metabolic disorders are also related to elevated ALT in subjects without known etiologies of liver disease.     

Association of non-alcoholic fatty liver disease with gallstone disease in the United States hospitalized patient population

BACKGROUND Gallstones and cholecystectomy have been proposed as risk factors for nonalcoholic fatty liver disease(NAFLD). The reason for this may be that both gallstones, as well as NAFLD share several risk factors with regards to their development. Currently, there is a lack of sufficient evidence showing an association between these clinical conditions.AIM To determine whether there is a meaningful association between gallstones and cholecystectomy with NAFLD.METHODS We queried the National Inpatient Sample database from the years 2016 and 2017 using International Classification of Diseases, 10 th revision, Clinical Modification diagnosis codes to identify hospitalizations with a diagnosis of gallstone disease(GSD)(includes calculus of gallbladder without cholecystitis without obstruction and acquired absence of gallbladder) as well as NAFLD(includes simple fatty liver and non-alcoholic steatohepatitis). Odds ratios(ORs) measuring the association between GSD(includes gallstones and cholecystectomy) and NAFLD were calculated using logistic regression after adjusting for confounding variables.RESULTS Out of 14294784 hospitalizations in 2016-2017, 159259 were found to have NAFLD. The prevalence of NAFLD was 3.3% in patients with GSD and 1% in those without. NAFLD was prevalent in 64.3% of women with GSD as compared to 35.7% of men with GSD. After controlling for various confounders associated with NAFLD and GSD, multivariate-adjusted analysis showed that there was an association between NAFLD with gallstones [OR = 6.32; 95% confidence interval(CI): 6.15-6.48] as well as cholecystectomy(OR = 1.97; 95%CI: 1.93-2.01). The association between NAFLD and gallstones was stronger in men(OR = 6.67; 95%CI: 6.42-6.93) than women(OR = 6.05; 95%CI: 5.83-6.27). The association between NAFLD and cholecystectomy was stronger in women(OR = 2.01; 95%CI: 1.96-2.06) than men(OR = 1.85; 95%CI: 1.79-1.92). P value was less than 0.001 for all comparisons.CONCLUSION NAFLD is more prevalent in women with GSD than men. The association between NAFLD and cholecystectomy/gallstones indicates that they may be risk factors for NAFLD.