Hepatitis B or C viral infection and risk of pancreatic cancer: A meta-analysis of observational studies

AIM: To investigate if there is an association between hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and the risk of pancreatic cancer. METHODS: All relevant studies published before 11 October, 2012 were identified by a systematic search of MEDLINE, EMBASE, BIOSIS Previews and the Cochrane Library databases and with cross-referencing. The observational studies that reported RR or OR estimates with 95%CIs for the association between HBV or HCV and pancreatic cancer were included. A random-effects model was used to summarize meta-analytic estimates. The Newcastle-Ottawa quality assessment scale was applied to assess the quality of the methodology in the included studies. RESULTS: A total of 8 eligible studies were selected for meta-analysis. Overall, chronic hepatitis B and inactive hepatitis B surface antigen (HBsAg) carrier state (HBsAg positive) had a significantly increased risk of pancreatic cancer with OR of 1.20 (95%CI: 1.01-1.39), especially in the Chinese population (OR = 1.30, 95%CI: 1.05-1.56). Past exposure to HBV (possible occult HBV infection) had an increased OR of pancreatic cancer risk (OR = 1.24, 95%CI: 1.05-1.42), especially among those patients without natural immunity [anti hepatitis B core (HBc) positive/hepatitis B surface antibody (anti HBs) negative], with OR of 1.67 (95%CI: 1.13-2.22). However, past exposure to HBV with natural immunity (anti-HBc positive/anti-HBs positive) had no association with pancreatic cancer development, with OR 0.98 (95%CI: 0.80-1.16), nor did the HBV active replication (hepatitis B e antigen positive status), with OR 0.98 (95%CI: 0.27-1.68). The risk of pancreatic cancer among anti-HBs positive patients was significantly lower than among anti-HBs negative patients (OR = 0.54, 95%CI: 0.46-0.62). Past exposure to HCV also resulted in an increased risk of pancreatic cancer (OR = 1.26, 95%CI: 1.03-1.50). Significant between-study heterogeneity was observed. Evidence of publication bias for HBV/HCV infection-pancreatic cancer association was not found.     

Hepatitis C Virus Infection and Risk of Venous Thromboembolism: A Systematic Review and Meta-Analysis

Background/ObjectivesHepatitis C virus (HCV) infection is one of the leading causes of cirrhosis. As a result of chronic in-flammatory response to the virus, HCV-infected patients may be at a higher risk of venous thromboembolism (VTE). However, the data on this association is unclear. This systematic review and meta-analysis was conducted with the aims to summarize all available evidence.Material and methodsA literature search was performed using MEDLINE and EMBASE from inception to April 2016. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of VTE among HCV-infected patients vs. subjects without HCV infection were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.ResultsThree studies met our eligibility criteria and were included in analysis. The pooled RR of VTE in HCV-infected patients vs. subjects without HCV infection was 1.38 (95% CI, 1.08-1.77, I² = 40%). Subgroup analysis showed that risk was increased for both pulmonary embolism (PE) and deep venous thrombosis (DVT) even though without adequate power to demonstrate statistical significance (Pooled RR of 1.34, 95% CI, 0.67-2.66 for PE and pooled RR 1.45, 95% CI, 0.93-2.77 for DVT)ConclusionOur study demonstrated a significantly increased risk of VTE among HCV-infected patients. Further studies are required to clarify how this risk should be addressed in clinical practice.     

Risk of venous thromboembolism among patients with vasculitis: a systematic review and meta-analysis

To investigate the possible association between systemic vasculitis and risk of venous thromboembolism (VTE), two investigators independently searched published studies indexed in MEDLINE, EMBASE, and the Cochrane database from inception to April 2016 using the terms for each type of vasculitis in conjunction with the terms for venous thromboembolism. The inclusion criteria were as follows: (1) observational studies published as original studies to evaluate the association between vasculitis and VTE, (2) odds ratios, relative risk or hazard ratio or standardized incidence ratio with 95 % confidence intervals (CI) were provided, and (3) participants without vasculitis were used as comparators for cohort studies and cross-sectional studies while participants without VTE were used as comparators for case-control studies. RevMan 5.3 software was used for the data analysis. Point estimates and standard errors were extracted from individual studies and were combined by the generic inverse variance method of DerSimonian and Laird. Seven studies investigating the risk of VTE among patients with systemic vasculitis were identified. At least one study was available for three specific forms of vasculitis (polyarteritis nodosa [PAN], granulomatosis with polyangiitis [GPA], and giant cell arteritis [GCA]). An increased risk of VTE was seen in all three vasculitides (GPA, pooled RR 3.94, 95 % CI 1.11–14.01; PAN, pooled RR 3.00, 95 % CI 2.20–4.09; GCA, pooled RR 2.26, 95 % CI 1.38–3.71). This meta-analysis demonstrates that patients with systemic vasculitis may have a significantly increased risk of VTE.     

Association of cholesterol with risk of pancreatic cancer:A meta-analysis

AIM: To evaluate the effect of dietary cholesterol and serum total cholesterol(TC) on the risk of pancreatic cancer. METHODS: A literature search was performed up to June 2014 in Pub Med, EMBASE, China National Knowledge Infrastructure and China Biology Medicalliterature database for relevant articles published in English or Chinese. Pooled relative risks(RRs) with 95% confidence intervals(CIs) were calculated with a random-effects model. RESULTS: We included 14 published articles with 439355 participants for dietary cholesterol, and 6 published articles with 1805697 participants for serum TC. For the highest vs lowest category of dietary cholesterol, the pooled RR(95%CI) of pancreatic cancer was 1.308(1.097-1.559). After excluding two studies(RR > 3.0), the pooled RR(95%CI) was 1.204(1.050-1.380). In subgroup analysis stratified by study design, the pooled RRs(95%CIs) were 1.523(1.226-1.893) for case-control studies and 1.023(0.871-1.200) for cohort studies. The association of dietary cholesterol with the risk of pancreatic cancer was significant for studies conducted in North America [1.275(1.058-1.537)] and others [2.495(1.565-3.977)], but not in Europe [1.149(0.863-1.531)]. No significant association [1.003(0.859-1.171)] was found between the risk of pancreatic cancer and serum TC. CONCLUSION: Dietary cholesterol may be associated with an increased risk of pancreatic cancer in worldwide populations, except for Europeans. The results need to be confirmed further.     

Is the incidence of malignancy increased in patients with sarcoidosis? A systematic review and meta‐analysis

A possible causal relationship between sarcoidosis and malignancy has been the subject of debates for decades. To better understand this association, we conducted a systematic review and meta‐analysis of cohort studies that reported relative risk, hazard ratio or standardized incidence ratio with 95% confidence interval (CI) comparing the incidence of malignancy in patients with sarcoidosis versus non‐sarcoidosis participants. Pooled risk ratios (RR) and 95% CI were calculated using a random‐effect, generic inverse variance methodology. Five studies were identified and included in our data analyses. The pooled RR of malignancy in patients with sarcoidosis was 1.21 (95% CI: 1.04–1.40). However, when we performed a sensitivity analysis that included only studies that compared the incidence of malignancy after the first year of the diagnosis of sarcoidosis with the incidence of malignancy after the first year of index date for non‐sarcoidosis controls, the pooled risk ratio decreased and did not reach statistical significance (RR 1.13, 95% CI: 0.97–1.32). Furthermore, analysis for publication bias has suggested that publication bias in favour of positive studies may be present. In conclusion, after accounting for possible detection bias and publication bias, there does not appear be a significant association between sarcoidosis and malignancy.     

Hepatic steatosis in hepatitis B virus infected patients: meta-analysis of risk factors and comparison with hepatitis C infected patients

Background and Aims: Although hepatic steatosis (HS) has an association with hepatitis C virus (HCV) infection, an association with hepatitis B virus (HBV) is controversial. We performed a meta‐analysis to evaluate HS prevalence and risk factors, in HBV infection. Methods: Standard guidelines for performance of meta‐analyses were followed. Studies with HS assessed by histology were included. Pooled odd ratios (OR) and standardized mean differences (SMD) were obtained with the random‐effects model and DerSimonian‐Laid method. Results: Seventeen out of 21 studies were included, comprising 4100 HBV infected patients. Overall HS prevalence was 29.6%. Eight studies also included 945 HCV infected patients, showing decreased risk of HS in HBV versus HCV patients (OR 0.55, 95%CI [0.45–0.67], P < 0.001). In HBV, HS positively associated with male gender (OR 1.74, 95%CI [1.28–2.38], P < 0.001), body mass index (SMD 2.17, 95%CI [1.23, 3.11], P < 0.001), obesity (OR 6.59, 95%CI [3.51–12.257], P = 0.003), diabetes (OR 2.62, 95%CI [1.37–4.00], P = 0.004), glycemia (SMD 0.84, 95%CI [0.00, 1.67], P = 0.049), triglycerides (SMD 1.18, 95%CI [0.48, 1.89], P = 0.001), cholesterol (SMD 0.88, 95%CI [0.31, 1.45], P = 0.003), moderate alcohol consumption (OR 1.54, 95%CI [1.10–2.15], P = 0.011) and negatively with HBV DNA (SMD ?74.12, 95%CI [?82.93, ?65.31], P < 0.001). HS had no association with aminotransferases, HBeAg, genotype or hepatic histology, necroinflammation or fibrosis. Conclusion: HS in HBV seems to be as frequent as in the general population, and lower than in HCV infected patients, relating to metabolic factors but not with hepatic histology severity. A puzzling strong negative association between viral load and HS, may even suggest a protective effect of the virus on HS.     

Smoking,alcohol consumption,and the risk of extrahepatic cholangiocarcinoma:A meta-analysis

AIM:To assess the association between smoking and alcohol consumption and extrahepatic cholangiocarcinoma(ECC)through a meta-analysis of clinical observational studies.METHODS:A literature search was conducted using Embase and MEDLINE databases from inception to 31May 2013 without language limitations,and by manually searching the references of retrieved articles.Casecontrol and cohort studies that investigated the association between smoking or alcohol consumption and ECC were included.The quality of these studies was assessed using the Newcastle-Ottawa quality assessment scale.Summary relative risks and corresponding95%CI were calculated using a random-effects model.Publication bias was assessed by Begg’s funnel plot and Egger’s test.RESULTS:A total of 12 eligible articles(11 case-control studies and one cohort study)were included in this meta-analysis.Eleven studies reported the association between smoking and ECC.Pooled analysis indicated that smokers had an increased risk of ECC development as compared with non-smokers(summary RR=1.23;95%CI:1.01-1.50).This correlation was present in population-based studies(n=5;summary RR=1.47;95%CI:1.06-2.05)but not in hospital-based studies(n=6;summary RR=1.10;95%CI:0.88-1.37)and in non-Asian regions(n=7;summary RR=1.39;95%CI:1.03-1.87)but not in Asia(n=4;summary RR=1.08;95%CI:0.85-1.38).Seven studies reported an association between consuming alcohol and ECC.Pooled analysis indicated that alcohol drinkers had a similar risk of ECC development as did individuals who did not drink alcohol(summary RR=1.09;95%CI:0.87-1.37).There was moderate heterogeneity among the studies and no evidence of publication bias.CONCLUSION:Smoking is associated with an increased risk of ECC,but alcohol consumption is not.Further population-based studies,particularly cohort studies,are warranted to enable definitive conclusions.     

Associations of Proton-Pump Inhibitors and H2 Receptor Antagonists with Chronic Kidney Disease: A Meta-Analysis

Background/Aims

The aim of this meta-analysis was to assess the risks of chronic kidney disease (CKD) and/or end-stage kidney disease (ESRD) in patients who are taking proton-pump inhibitors (PPIs) and/or H2 receptor antagonists (H2RAs).

Methods

Comprehensive literature review was conducted utilizing MEDLINE and EMBASE databases through April 2017 to identify all studies that investigated the risks of CKD or ESRD in patients taking PPIs/H2RAs versus those without PPIs/H2RAs. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this study is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017067252).

Results

Five studies with 536,902 participants were patients were identified and included in the data analysis. When compared with non-PPIs users, the pooled risk ratio (RR) of CKD or ESRD in patients with PPI use was 1.33 (95% CI 1.18–1.51). Pre-specified subgroup analysis (stratified by CKD or ESRD status) demonstrated pooled RRs of 1.22 (95% CI 1.14–1.30) for association between PPI use and CKD and 1.88 (95% CI 1.71–2.06) for association between PPI use and ESRD, respectively. However, there was no association between the use of H2RAs and CKD with a pooled RR of 1.02 (95% CI 0.83–1.25). When compared with the use of H2RAs, the pooled RR of CKD in patients with PPI use was 1.29 (95% CI 1.22–1.36).

Conclusions

Our study demonstrates statistically significant 1.3-fold increased risks of CKD and ESRD in patients using PPIs, but not in patients using H2RAs.

     

10天序贯疗法与标准三联疗法治疗幽门螺杆菌感染荟萃分析

目的系统地评价10天序贯疗法能否获得比标准三联疗法更高的H．pylori根除率，以及两种方案之间发生副反应的差异。方法利用中英文检索词检索相关电子数据库，根据纳入标准入选了比较10天序贯疗法与标准三联疗法的幽门螺杆菌根除率的随机临床试验。提取患者基本资料、研究质量、H．pylori根除率和副作用的发生率等相关数据。针对于10天序贯疗法和7天或10天标准三联疗法的H．pylori根除率和副作用的发生率，计算相应的RR和95％可信区间。运用漏斗图评价出版偏倚。结果Meta分析纳入了10项随机对照研究，共2855例患者。10天序贯疗法明显优于7天或10天标准三联疗法，总的H．pylori根除率分别为93．5％、75．9％和79．4％，RR为1．23（95％CI=1．19—1．28）和1．16（95％CI：1．10—1．23）。无论是溃疡性消化不良患者还是非溃疡性消化不良患者，10天序贯疗法都能获得更高的H．pylori根除率，RR分别为1．16（95％CI=1．10—1．23）和1．26（95％CI=1．19—1．33）；针对克拉霉素耐药患者，10天序贯疗法的有效H．pylori根除率也高于标准三联疗法（75．9％vs32．7％），RR为2．18（95％CI=1．43—3．34）。然而两种方案副作用的发生率无明显差别（RR=1．00，95％CI=0．97—1．03）。结论10天序贯疗法明显优于7天或10天标准三联疗法,副作用无明显增加。     

Association of type 2 diabetes mellitus and the risk of colorectal cancer: A meta-analysis and systematic review

AIM: To provide a quantitative assessment of the association between type 2 diabetes mellitus(T2DM)and the risk of colorectal cancer(CRC).METHODS: Systematic review was conducted thorough MEDLINE, EMBASE, Cochrane Library, andISI Web of knowledge databases till 31 st January 2014.This meta-analysis included the cohort studies that illustrated relative risk(RR) or odds ratio estimates with 95%CI for the predictive risk of CRC by T2 DM.Summary relative risks with 95%CI were analyzed by using an effects summary ratio model. Heterogeneity among studies was assessed by the Cochran's Q and I 2statistics.RESULTS: The meta analysis of 8 finally selected studies showed a positive correlation of T2 DM with the risk of CRC as depicted by effects summary RR of 1.21(95%CI: 1.02-1.42). Diabetic women showed greater risk of developing CRC as their effect summary RR of 1.22(95%CI: 1.01-49) with significant overall Z test at 5% level of significance was higher than the effect summary RR of 1.17(95%CI: 1.00-1.37) of men showing insignificant Z test. The effect summary RR of 1.19 with 95%CI of 1.07-1.33 indicate a positive relationship between DM and increased risk of CRC with significant heterogeneity(I 2 = 92% and P-value 0.05).CONCLUSION: Results from this systematic review and meta-analysis report that diabetic people have an increased risk of CRC as compared to non-diabetics.     

Diabetes mellitus and risk of endometrial cancer: a meta-analysis

Aims/hypothesis Diabetes has been associated with a statistically significantly increased risk of endometrial cancer in most, but not all studies. To provide a quantitative assessment of the association between diabetes and risk of endometrial cancer, we conducted a meta-analysis of case-control studies and cohort studies. Subjects and methods We identified studies by a literature search of PubMed and Embase through to January 2007 and by searching the reference lists of relevant articles. Summary relative risks (RRs) with 95% CIs were calculated using random-effects model. Results The analysis of diabetes (largely type 2) and endometrial cancer is based on 16 studies (three cohort and 13 case-control studies), including 96,003 participants and 7,596 cases of endometrial cancer. Twelve of the studies showed a statistically significantly increased risk and four a non-significant increased risk of endometrial cancer. In our meta-analysis we found that diabetes was statistically significantly associated with an increased risk of endometrial cancer (summary RR 2.10, 95% CI 1.75–2.53). The risk estimates were somewhat stronger among case-control (RR 2.22, 95% CI 1.80–2.74) than among cohort studies (RR 1.62, 95% CI 1.21–2.16), stronger among studies adjusting only for age (RR 2.74, 95% CI 1.87–4.00) compared with multivariate adjustment (RR 1.92, 95% CI 1.58–2.33) and slightly lower in studies performed in the USA than in those performed Europe. The analysis of type 1 diabetes and endometrial cancer was based on three studies and found a statistically significant positive association (summary RR 3.15, 95%CI 1.07–9.29). Conclusions/interpretation Results from the meta-analysis support a relationship between diabetes and increased risk of endometrial cancer.     

Hypertension, antihypertensives and mutations in the Von Hippel-Lindau gene in renal cell carcinoma: results from the Netherlands Cohort Study

OBJECTIVES: Hypertension and/or antihypertensive medication are reported to be risk factors of renal cell carcinoma (RCC). We investigated whether these risk factors are associated with von Hippel-Lindau gene (VHL) mutations in RCC. METHODS: The Netherlands Cohort Study on Diet and Cancer (NLCS) started in 1986 (n = 120 852 men and women) and uses the case-cohort methodology. After 11.3 years of follow-up, 337 RCC cases and 4774 subcohort members were available for analysis. DNA was isolated from paraffin-embedded tumour tissue for VHL analysis. RESULTS: Cohort members who reported hypertension or use of antihypertensive medication had a slightly (non-significant) increased risk of RCC: rate ratios (RR) 1.22 [95% confidence interval (CI), 0.94-1.58] and 1.14 (95% CI, 0.85-1.52), respectively. RRs were adjusted for sex, age, body mass index (BMI) and cigarette smoking. Of the 235 patients for whom tumour tissue specimens were collected, 187 had a clear-cell RCC, of whom 114 had a VHL mutation. History of hypertension was associated with a non-significantly increased risk of clear-cell RCC with VHL mutations: RR = 1.34 (95% CI, 0.87-2.07), and was not associated with the risk of clear-cell RCC without VHL mutations; RR = 0.88 (95% CI, 0.51-1.53). Use of diuretics was associated with clear-cell RCC without VHL mutations; RR = 2.11 (95% CI, 1.16-3.83). CONCLUSIONS: In this study non-significantly increased risks for history of hypertension and use of antihypertensive medication with RCC were observed. The association with hypertension was stronger in RCC patients with VHL mutations, while there was a positive association of diuretics use and risk of RCC without VHL mutations.     

MiR-146a rs2910164 polymorphism increases risk of gastric cancer: A meta-analysis

AIM: To systematically evaluate the association between the miR-146a rs2910164 polymorphism and susceptibility to gastric cancer.METHODS: A comprehensive electronic search was conducted for articles published up until January 27, 2014 in Medline (PubMed), Excerpta Medica Database (Embase), the Cochrane Library and Google Scholar. Only case-control studies published in English that evaluated the association between the miR-146a rs2910164 polymorphism and susceptibility to gastric cancer were included. Furthermore, only studies with sufficient data allowing for calculation of odds ratio (OR) and corresponding 95% confidence interval (CI) were included. These values were used in the quantitative synthesis to assess the strength of the association between the miR-146a rs2910164 polymorphism and risk of gastric cancer.RESULTS: The database search identified 1002 eligible studies, of which seven (comprising 4112 cases and 5811 controls) were included for the meta-analysis. The results indicate that miR-146a rs2910164 polymorphism is more likely to be associated with gastric cancer risk. In the overall analysis, a significantly increased cancer risk was found in the heterozygote (GG vs GC) comparison (OR = 1.14, 95%CI: 1.03-1.27; P = 0.01 for pooled OR). In the ethnicity subgroup analysis, a similar result was found among Caucasians (OR = 1.36, 95%CI: 1.01-1.85; P = 0.04 for pooled OR). In the stratified analysis by quality of studies, a significantly increased cancer risk was found in the heterozygote comparison among high quality studies (OR = 1.12, 95%CI: 1.01-1.26; P = 0.04 for pooled OR). When stratified on the basis of sample size, a significantly increased cancer risk was found among small sample size subgroups for the allelic (G vs C: OR = 1.16, 95%CI: 1.03-1.30; P = 0.01), homozygote (GG vs CC: OR = 1.33, 95%CI: 1.03-1.73; P = 0.03) and recessive model (GG vs GC + CC: OR = 0.05, 95%CI: 0.00-0.10; P = 0.03) comparisons.CONCLUSION: The miR-146a rs2910164 polymorphism is associated with increased gastric cancer risk, particularly evident in high quality studies with small sample sized Caucasian populations.     

Sugar sweetened beverages consumption and risk of coronary heart disease: A meta-analysis of prospective studies

Objective

To summarize the evidence with respect to sugar sweetened beverages (SSBs) consumption and risk of coronary heart disease (CHD) and to recommend field standards for future analysis on this topic.

Methods

We searched for articles published up to February 2013 through PubMed, EMbase, and Cochrane Library Database and reviewed reference list of the retrieved articles. Prospective studies with reported relative risks (RRs) with 95% confidence intervals (CIs) of CHD for different categories of SSBs consumption were included. Random-effects models were used to evaluate the associations by comparing the highest and lowest categories of SSBs consumption in relation to risk of CHD.

Results

Four prospective studies with 7396 CHD cases among 173,753 participants were included in the meta-analysis. The pooled RR (95% CI) for CHD in the highest category of SSBs consumption in comparison with the lowest category of SSBs was 1.17 (1.07–1.28). Stratified analyses indicated a significant association for men but not for women, with pooled RRs (95%CI) of 1.17 (1.05–1.29) and 1.19 (0.94–1.50), respectively. For studies carried out in America, the pooled RR for CHD was 1.18 (1.07–1.30). Additionally, a one-severing per day increase in SSBs consumption was associated with a 16% increased risk of CHD (RR: 1.16, 95%CI: 1.10–1.23).

Conclusion

Our meta-analysis of four studies suggests that consumption of SSBs may increase risk of CHD, especially among men and American populations. However, this finding was based on limited studies; further studies are warranted to critically evaluate the relationship.     

Sugar and artificially sweetened soda consumption linked to hypertension: A systematic review and meta-analysis

Abstract

Background/objectives: The risk of hypertension (HTN) in patients who regularly drink soda is controversial. The objective of this meta-analysis was to assess the associations between consumption of sugar and artificially sweetened soda and HTN. Methods: A literature search was performed using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews from inception through January 2015. Studies that reported relative risks, odd ratios or hazard ratios comparing the risk of HTN in patients consuming a significant amount of either sugar or artificially sweetened soda versus those who did not consume soda were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Eight studies were included in our analysis to assess the association between consumption of sugar-sweetened soda and HTN. The pooled RR of HTN in patients consuming sugar-sweetened soda was 1.12 (95% CI, 1.03–1.23). Four studies were selected to assess the association between consumption of artificially sweetened soda and HTN. The pooled RR of HTN in patients consuming artificially sweetened soda was 1.15 (95% CI, 1.11–1.19). Conclusions: Our study demonstrates statistically significant associations between both sugar and artificially sweetened soda consumption and HTN. This finding may impact clinical management and primary prevention of HTN.     

Cognitive impairment and 30-day rehospitalization rate in patients with acute heart failure: A systematic review and meta-analysis

Background

Heart failure (HF) is one of the world leading causes of hospitalization and rehospitalization. Cognitive impairment has been identified as a risk factor for rehospitalization in patients with heart failure. However, previous studies reported mixed results. Therefore, we conducted a systematic review and meta-analysis to assess the association between cognitive impairment and 30-day rehospitalization in patients with HF.

Association of proton pump inhibitors with risk of hepatic encephalopathy in advanced liver disease: A meta-analysis

BACKGROUND Several studies have explored the association between the use of proton pump inhibitors (PPIs) and the risk of developing hepatic encephalopathy (HE) in patients with advanced liver disease. However, the evidence-based conclusions are controversial. We hypothesized that using PPIs may increase the risk of HE in patients with advanced liver disease. If confirmed, clinicians must strictly adhere to the indications for PPI treatment in this population. AIM To evaluate the pooled risk of HE in patients with advanced liver disease who use PPIs. METHODS Three electronic databases (PubMed, EMBASE, and the Cochrane Library) were searched from the date of database inception through January 8, 2019 to identify comparative studies evaluating the association between PPI use and the risk of HE. Data from the included studies were extracted. The random-effects model was used for pooling risk estimates and the corresponding 95% confidence intervals (CIs). Subgroup and sensitivity analyses were also performed. RESULTS In total, 4342 patients from five case-control studies and 188053 patients from four cohort studies were included in this analysis. In patients with advanced liver disease, PPI use was associated with an elevated risk of developing HE, with significant heterogeneity. The pooled odds ratio for case-control studies was 2.58 (95%CI: 1.68-3.94, I2 = 72%). The pooled RR for cohort studies was 1.67 (95%CI: 1.30-2.14, I2 = 67%). The results of the subgroup analyses suggested that the heterogeneity may be the result of differences in the study designs and the definitions of PPI use. The sensitivity and subgroup analyses did not alter our findings. CONCLUSION In patients with advanced liver disease, PPI use is associated with an elevated risk of HE. Future large prospective studies are needed to confirm this association.     

Fish consumption and risk of gastrointestinal cancers: A meta-analysis of cohort studies

AIM: To assess quantitatively the relationship between fish intake and the incidence of gastrointestinal cancers in a meta-analysis of cohort studies.METHODS: We searched MEDLINE, Embase, Science Citation Index Expanded, and the bibliographies of retrieved articles. Prospective cohort studies were included if they reported relative risks (RRs) and corresponding 95% confidence intervals (CIs) of various cancers with respect to fish intake. When RRs were not available in the published article, they were computed from the exposure distributions. Two investigators extracted the data independently and discrepancies were resolved by discussion with a third investigator. We performed random-effect meta-analyses and meta-regressions of study-specific incremental estimates to determine the risk of cancer associated with a 20-g/d increment of fish consumption.RESULTS: Forty-two studies, comprising 27 independent cohorts, met our inclusion criteria. The studies included 2325040 participants and 24115 incident cases of gastrointestinal cancer, with an average follow-up of 13.6 years. Compared with individuals who did not eat, or seldom ate, fish, the pooled RR of gastrointestinal cancers was 0.93 (95%CI: 0.88-0.98) for regular fish consumers, 0.94 (0.89-0.99) for low to moderate fish consumers, and 0.91 (0.84-0.97) for high fish consumers. Overall, a 20-g increase in fish consumption per day was associated with a 2% reduced risk of gastrointestinal cancers (RR = 0.98; 95%CI: 0.96-1.01). In subgroup analyses, we noted that fish consumption was associated with reduced risk of colorectal (RR = 0.93; 95%CI: 0.87-0.99; P < 0.01), esophageal (RR = 0.91; 95%CI: 0.83-0.99; P < 0.05) and hepatocellular cancers (RR = 0.71; 95%CI: 0.48-0.95; P < 0.01).CONCLUSION: This meta-analysis suggested that fish consumption may reduce total gastrointestinal cancer incidence. Inverse relationships were also detected between fish consumption and specific types of cancers.     

Hepatitis B virus and hepatitis C virus play different prognostic roles in intrahepatic cholangiocarcinoma: A meta-analysis

AIM: To identify the prognostic value of hepatitis B virus(HBV) and hepatitis C virus(HCV) infections in patients with intrahepatic cholangiocarcinoma.METHODS: A search was performed for relevant publications in Pub Med, EMBASE and Web of Science databases. The pooled effects were calculated from the available information to identify the relationship between HBV or HCV infection and the prognosis and clinicopathological features. The χ2 and I2 tests were used to evaluate heterogeneity between studies. Pooled hazard ratios(HRs) with 95% confidence intervals(CIs) were calculated by a fixed-effects model, if no heterogeneity existed. If there was heterogeneity, a random-effects model was applied.RESULTS: In total, 14 studies involving 2842 cases were enrolled in this meta-analysis. The patients with HBV infection presented better overall and diseasefree survival, and the pooled HRs were significant at 0.76(95%CI: 0.70-0.83) and 0.78(95%CI: 0.66-0.94), respectively. Additionally, our study revealed that HCV infection was correlated with shortened overall survival in comparison with the control group(HR = 2.64, 95%CI: 1.77-3.93). We also found that HBV infection occurred more frequently in male patients [odds ratio(OR) = 1.91, 95%CI: 1.06-3.44] and was correlated with higher levels of serum aspartate transaminase(AST) and alpha-fetoprotein(AFP)(OR = 1.93, 95%CI: 1.11-3.35; OR = 3.86, 95%CI: 2.58-5.78) and a lower level of serum carbohydrate antigen 19-9(CA19-9)(OR = 0.47, 95%CI: 0.34-0.65). Moreover, HBV infection was associated with cirrhosis(OR = 6.44, 95%CI: 4.33-9.56), a higher proportion of capsule formation(OR = 6.04, 95%CI: 3.56-10.26), and a lower rate of lymph node metastasis(OR = 0.39, 95%CI: 0.25-0.58). No significant publication bias was seen in any of the enrolled studies.CONCLUSION: HBV infection may indicate a favorable prognosis in patients with intrahepatic cholangiocarcinoma, while HCV infection suggests a poor prognosis.     

Helicobacter pylori infection and esophageal cancer risk:An updated meta-analysis

AIM:To clarify the association between Helicobacter pylori(H.pylori)infection and the risk of esophageal carcinoma through a meta-analysis of published data.METHODS:Studies which reported the association between H.pylori infection and esophageal cancer published up to June 2013 were included.The odds ratios(ORs)and corresponding 95%CIs of H.pyloriinfection on esophageal cancer with respect to health control groups were evaluated.Data were extracted independently by two investigators and discrepancies were resolved by discussion with a third investigator.The statistical software,STATA(version 12.0),was applied to investigate heterogeneity among individual studies and to summarize the studies.A meta-analysis was performed using a fixed-effect or random-effect method,depending on the absence or presence of significant heterogeneity.RESULTS:No significant association between H.pylori infection and esophageal squamous cell carcinoma(ESCC)risk was found in the pooled overall population(OR=0.97,95%CI:0.76-1.24).However,significant associations between H.pylori infection and ESCC risk were found in Eastern subjects(OR=0.66,95%CI:0.43-0.89).Similarly,cytotoxin-associated gene-A(CagA)positive strains of infection may decrease the risk of ESCC in Eastern subjects(OR=0.77,95%CI:0.65-0.92),however,these associations were not statistically significant in Western subjects(OR=1.26,95%CI:0.97-1.63).For esophageal adenocarcinoma(EAC)the summary OR for H.pylori infection and CagA positive strains of infection were 0.59(95%CI:0.51-0.68)and 0.56(95%CI:0.45-0.70),respectively.CONCLUSION:H.pylori infection is associated with a decreased risk of ESCC in Eastern populations and a decreased risk of EAC in the overall population.