Meta‐analysis: non‐steroidal anti‐inflammatory drug use and the risk of esophageal squamous cell carcinoma

The relationship between non‐steroidal anti‐inflammatory drug (NSAID) use and esophageal squamous cell carcinoma (ESCC) has remained unclear. To evaluate the relationship between NSAID use and risk of ESCC, we searched the MEDLINE, Biosis, Web of Science and ISI proceedings databases up to September 2010, together with a manual search of reference lists of relevant articles. Studies evaluating the association between exposure to NSAIDs and risk of ESCC were included. The analyses used random‐effect or fixed‐effect model based on homogeneity analysis. Seven studies (six case‐control studies and one nested case‐control study) were included in this meta‐analysis. NSAID use was associated with a reduced risk of ESCC (odds ratio = 0.58, 95% confidence interval = 0.47 to 0.72). Specific analysis for aspirin and non‐aspirin NSAIDs yielded similar results. There was a protective association between NSAIDs and ESCC. This finding warrants more prospective studies evaluating the relationship between NSAIDs and ESCC.     

NSAIDs are a significant risk factor for colonic diverticular hemorrhage in elder patients: evaluation by a case-control study

Background and Aim: Diverticular bleeding is a common cause of lower gastrointestinal hemorrhage. Several factors, including use of non‐steroidal anti‐inflammatory drugs (NSAIDs), antithrombotic agents and arteriosclerosis, could be risk factors. The aim of this study is to identify these risk factors. Methods: Between January 2000 and December 2008, 51 patients among 178 acute lower gastrointestinal hemorrhages who visited Saga Medical School were diagnosed as colonic diverticular hemorrhage, established by emergency endoscopy and diagnostic criteria. Gender and age matched control cases were selected from patients of other diseases hospitalized during the same period. We evaluated by using logistic regression analysis the influences of comorbidities such as cerebrovascular disease, ischemic heart disease, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, and osteoporosis, medications including NSAIDs and antithrombotic agents, and habits of smoking, alcohol, and chronic constipation. Results: Fifty one patients out of 178 acute lower gastrointestinal bleeding (28.7%) were diagnosed as diverticular hemorrhage, which was the most common cause of lower gastrointestinal hemorrhage. Sex ratio of men versus women for colonic diverticular hemorrhage was 35:16. NSAIDs were a significant risk factor for colonic diverticular hemorrhage in elder patients (odds ratio [OR] = 7.492, 95% CI: 1.516–37.024, P = 0.0135). Hypertension and hyperlipidemia had significant association with diverticular hemorrhage among patients younger than 65 years old. This study also indicated that use of NSAIDs was a risk factor for re‐bleeding (OR = 5.4, 95% CI: 1.01–28.78, P = 0.048). Conclusion: This case‐control study revealed that the use of NSAIDs was a significant risk factor for colonic diverticular hemorrhage in elder patients. In addition, use of NSAIDs is a risk factor for re‐bleeding from colonic diverticula.     

NSAID‐induced gastrointestinal damage: Current clinical management and recommendations for prevention

Gastrointestinal toxicity is a common adverse effect of traditional non‐steroidal anti‐inflammatory drugs (NSAIDs) and patients at risk should receive prevention therapies. Selective cyclooxygenase‐2 (COX‐2) inhibitors (coxibs) are safer to the gastrointestinal tract than traditional NSAIDs. Current prevention strategies in patients who need NSAIDs should also take into account the presence of cardiovascular risk factors, as coxibs and probably most traditional NSAIDs increase the incidence of serious cardiovascular events. Patients without risk factors should be treated with traditional NSAIDs, whereas patients at risk may receive cotherapy with a proton pump inhibitor (PPI) or misoprostol, or a coxib alone. However, patients with a previous bleeding ulcer should receive the combination of a coxib plus a PPI, and Helicobacter pylori should be tested for and treated if present. Coxib and NSAID therapy should be prescribed with caution in patients with increased cardiovascular risk and should be prescribed at the lowest possible dose and for the shortest period of time. These patients will probably be treated with low‐dose aspirin or other antiplatelet agents, which puts them at increased risk of upper gastrointestinal complications. The risk of gastrointestinal toxicity with combined therapy of aspirin and coxib may be lower than that with traditional NSAIDs plus aspirin, but all these patients may benefit from PPI cotherapy. When the lower gastrointestinal tract is of concern, coxib instead of NSAID therapy should be considered. Coxib therapy has better gastrointestinal tolerance than traditional NSAIDs and PPI therapy is effective both in the treatment and prevention of NSAID‐induced dyspepsia and should be considered in patients who develop dyspepsia during NSAID or coxib therapy.     

Nonsteroidal anti‐inflammatory drugs and esophageal inflammation – Barrett's esophagus – adenocarcinoma sequence: a meta‐analysis

The incidence of esophageal adenocarcinoma has markedly increased in the last few decades and Barrett's esophagus is regarded as the precursor lesion of this cancer. The aim of the study was to quantify the adenocarcinoma risk associated with nonsteroidal anti‐inflammatory drug use and to determine at which stage chemoprevention with this drug is the most effective in esophageal inflammation – Barrett's esophagus – adenocarcinoma sequence. A literature search was performed to identify studies published between 1998 and 2009 for relevant risk estimates. Fixed and random effect meta‐analytical techniques were conducted for aspirin, nonaspirin nonsteroidal anti‐inflammatory drugs, and all nonsteroidal anti‐inflammatory drugs. Four cohort and 10 case‐control studies were included. Use of aspirin and nonaspirin nonsteroidal anti‐inflammatory drugs in normal population was associated with a reduced risk of adenocarcinoma (odds ratio [OR]: 0.73, 95% confidence interval [CI]: 0.65–0.83; OR: 0.84, 95% CI: 0.72–0.98, respectively). The use of all nonsteroidal anti‐inflammatory drugs was associated with a reduced risk of adenocarcinoma (relative risk [RR]: 0.64, 95% CI: 0.42–0.96) in Barrett's esophagus patients. However, no obvious dose‐effect relationships were found. In addition, we discovered a reverse association between drugs use and adenocarcinoma risk in people without a history of upper gastrointestinal tract disorders (OR: 0.57, 95% CI: 0.43–0.77, P= 0.12). Our meta‐analyses suggest a protective effect of nonsteroidal anti‐inflammatory drugs on the risk of adenocarcinoma. Our results also suggest that the drugs might act after the formation of Barrett's epithelium in the esophageal inflammation – Barrett's esophagus – adenocarcinoma sequence.     

Should we eradicate Helicobacter pylori infection in patients receiving nonsteroidal anti‐inflammatory drugs or low‐dose aspirin?

Whether Helicobacter pylori infection alters the risk of ulcer disease in patients receiving nonsteroidal anti‐inflammatory drugs (NSAIDs) or low‐dose aspirin is one of the most controversial topics in peptic ulcer research. This is an important management issue, particularly in countries where peptic ulcer disease is common and the prevalence of H. pylori infection is high. Current evidence shows that H. pylori infection increases the ulcer risk associated with NSAIDs or low‐dose aspirin. Eradication of H. pylori reduces the subsequent risk of endoscopic and complicated ulcers in patients who are about to start long‐term NSAIDs. Among patients with H. pylori infection and a history of ulcer bleeding who continue to use low‐dose aspirin, 1 week of eradication therapy prevents recurrent ulcer bleeding. Failure of eradication and concomitant use of NSAIDs, however, account for most cases of recurrent bleeding with low‐dose aspirin. The apparent protective effect of H. pylori in long‐term NSAIDs users reported in some studies was actually the weeding out of susceptible patients who were intolerant to NSAIDs. There is no convincing evidence that eradication of H. pylori has any clinically important adverse effect on the healing and prevention of ulcers in NSAIDs users.     

Associations between drugs and small‐bowel mucosal bleeding: Multicenter capsule‐endoscopy study

Background and Aim

Although several drugs may induce small‐bowel mucosal injuries, it is unclear whether these injuries contribute to overt small‐bowel bleeding. This study was designed to evaluate the associations between drug use and small‐bowel mucosal injury and between these mucosal injuries and overt bleeding in a disease‐relevant population.

Methods

We retrospectively studied patients with suspected small‐bowel diseases who underwent capsule endoscopy between 2010 and 2013. Drug exposure, Charlson Comorbidity Index, smoking, and alcohol consumption were assessed before capsule endoscopy. Adjusted odds ratios (AOR) and confidence intervals (CI) were estimated for small‐bowel mucosal injury and small‐bowel overt bleeding.

Results

In total, 850 patients were analyzed during the study period. Median age was 64 years, and 544 patients (64.0%) were men. Among the patients with small‐bowel mucosal injury (n = 60) and without mucosal injury (n = 705), use of non‐steroidal anti‐inflammatory drugs (NSAIDs) (AOR 1.8, 95% CI 1.01–3.31) was significantly associated with an increased risk of small‐bowel mucosal injury compared with non‐use. Patients with small‐bowel mucosal injury with overt bleeding (n = 85) and without overt bleeding (n = 60) were compared, and no significant difference between the groups in the usage rates for NSAIDs, thienopyridine, other antiplatelets, anticoagulants, acetaminophen, tramadol hydrochloride, or steroids was revealed, even after adjusting for confounders.

Conclusion

Although the use of NSAIDs was significantly associated with an increased risk of small‐bowel mucosal injury, no significant associations were observed between the use of such drugs and small‐bowel overt bleeding.     

The +252A/G polymorphism in the Lymphotoxin‐α gene increases the risk of asthma: A meta‐analysis

Background and Objective: A number of studies have shown that the +252A/G polymorphism (rs909253) in the lymphotoxin‐α (LT‐α) gene is implicated in susceptibility to asthma. However, the findings have been inconclusive. The aim of this study was to investigate the association between the +252A/G polymorphism in the LT‐α gene and the risk of asthma by performing a meta‐analysis. Methods: The Pubmed and Embase databases were searched for all studies relating to this polymorphism and the risk of asthma. Statistical analyses were performed using the Revman4.2 and STATA 10.0 software. Results: Thirteen case‐control studies that included a total of 2220 cases and 6428 controls were included in the meta‐analysis. There was no significant association between this polymorphism and the risk of asthma in the all‐combined analysis (odds ratio (OR) 1.14, 95% confidence interval (CI): 0.89–1.45 for GG+GA vs AA). In a subgroup analysis by ethnicity, no significant association with asthma risk was identified in Asians (OR 1.31, 95% CI: 0.97–1.77) or Europeans (OR 1.08, 95% CI: 0.77–1.53). In a subgroup analysis by age, a significantly increased risk was identified among adults (OR 1.25, 95% CI: 1.03–1.50) but not children (OR 1.04, 95% CI: 0.28–3.89). In a subgroup analysis by atopic status, a significantly elevated risk was identified among atopic (OR 1.55, 95% CI: 1.28–1.87) but not non‐atopic individuals (OR 0.94, 95% CI: 0.53–1.68). Conclusions: This meta‐analysis suggested that the +252A/G polymorphism in the LT‐α gene is a risk factor for asthma in adults and atopic populations.     

Significant association between asthma risk and the GSTM1 and GSTT1 deletion polymorphisms: An updated meta‐analysis of case–control studies

Polymorphisms in GSTM1 and GSTT1 may be associated with asthma risk, yet several studies and meta‐analyses have reported inconclusive results. Therefore, an updated meta‐analysis was conducted. Literature searches were performed using the Pubmed, Embase and Web of Science databases until October 2012. Variant ‘null’ genotype was compared with wild‐type ‘present’ in the pooled data. All statistical analyses were performed using STATA 11.0. A total of 26 case–control studies were suitable for inclusion in the meta‐analysis. In the overall population, a significant association was found for both the GSTM1 (odds ratio (OR) = 1.452; 95% confidence interval (CI): 1.192–1.770) and GSTT1 polymorphism (OR = 1.792; 95% CI:1.293–2.483). For subgroup analysis by age, GSTM1 significantly increased risk for both children (OR = 1.368; 95% CI: 1.051–1.781) and adults (OR = 1.859; 95% CI: 1.183–2.921). For GSTT1, a significant association was only found in the adult population (OR = 2.312; 95%CI: 1.204–4.439). Based on subgroup analysis by ethnicity, a significant association for GSTM1 was found in Europe (OR = 1.303; 95% CI: 1.018–1.667), Africa (OR = 2.175; 95%CI: 1.560–3.031) and Latin America (OR = 2.265; 95%CI: 1.375–3.729). For GSTT1, significantly increased risk was found only for Asian (OR = 2.105; 95% CI: 1.101–4.025) and Russian (OR = 2.747; 95% CI: 1.071–7.046) populations. This meta‐analysis provides evidence that GSTM1 and GSTT1 polymorphisms may be risk factors for asthma.     

Risk of hospitalization for upper gastrointestinal tract complications associated with non‐selective non‐steroidal anti‐inflammatory drugs in Malaysia: a retrospective case control study

Aims: To assess the association between non‐steroidal anti‐inflammatory drug (NSAID) use and upper gastrointestinal (GI) tract‐related hospitalizations and to evaluate inpatient healthcare resource utilization associated with these complications in Malaysia. Methods: A retrospective case control study was performed using medical records of patients admitted to two Malaysian hospitals during 1999 and 2000. Cases were identified based on mode of presentation at hospital admission. One control was identified for each case, matched by age, sex and admission date. NSAID exposure was determined by drug use during one year prior to admission. Conditional logistic regression analysis was used to determine the association between NSAID use and upper GI complications, adjusting for predictors. Results: The 273 cases were significantly more likely to have used NSAIDs in the year prior to hospitalization than controls (27.8%vs. 6.2% of patients; P < 0.0001). Conditional logistic regression analysis adjusting for other predictors showed that the odds of being hospitalized for upper GI tract complications were 4.1 times higher among NSAID users than non‐users (95% CI = 1.88–9.12). Other risk factors for GI‐related hospitalizations were a history of upper GI tract complications (OR = 5.8, 95% CI = 1.28–26.53), use of gastroprotective agents (OR = 5.3, 95% CI = 1.67–16.79), and use of antacids (OR = 5.0, 95% CI = 2.10–11.91) in the previous year. Conclusion: This study demonstrated that NSAID exposure was significantly higher among patients hospitalized for GI‐related complications than for other reasons, indicating that NSAID use is an independent risk factor for upper GI tract complications in this Malaysian sample.     

Factors associated with the presence of multiple Lugol‐voiding lesions in patients with esophageal squamous‐cell carcinoma

Multicentric squamous dysplasia of the esophagus is characterized by multiple Lugol‐voiding lesions (LVLs) on Lugol chromoendoscopy. Multiple LVLs are associated with a very high risk of multiple cancers arising in the esophagus as well as the head and neck. To gain insight into the pathogenesis of multiple LVLs of the esophageal mucosa, we studied risk factors for the development of such lesions in 76 patients who had a current or previous diagnosis of esophageal squamous cell carcinoma. All patients underwent Lugol chromoendoscopy of the esophageal mucosa. The history of tobacco and alcohol use was documented. Polymorphisms of the aldehyde dehydrogenase type 2 (ALDH2) gene were identified by polymerase chain reaction using sequence‐specific primers. Clinical factors related to multiple LVLs were analyzed. All patients with multiple LVLs were drinkers. On univariate analysis, male sex (odds ratio [OR] 15, 95% confidence interval [CI] 1.84–122.45: P = 0.011), presence of the ALDH2‐2 allele (OR 4.5, 95% CI 1.55–13.24: P = 0.006), and smoking index ≥1000 (OR 2.6, 95% CI 1.02–6.6: P = 0.045) were associated with multiple LVLs. On multivariate analysis, male sex (OR 10.02, 95% CI 1.13–88.44: P = 0.038) and presence of the ALDH2‐2 allele (OR 4.56, 95% CI 1.4–14.82: P = 0.012) were associated with multiple LVLs. Among drinkers, a daily alcohol intake of ≥100 g pure ethanol with the ALDH2‐2 allele (OR 17.5, 95% CI 1.97–155.59: P = 0.01) and a daily alcohol intake of <100 g pure ethanol with the ALDH2‐2 allele (OR 8.85, 95% CI 1.68–46.69: P = 0.01) more strongly correlated with multiple LVLs than did a daily alcohol intake of <100 g pure ethanol without the ALDH2‐2 allele, whereas a daily alcohol intake of ≥100 g pure ethanol without the ALDH2‐2 allele (OR 4.0, 95% CI 0.54–29.81: P = 0.18) did not. In conclusion, male sex and the ALDH2‐2 allele are associated with an increased risk for multiple LVLs of the esophageal mucosa in patients with esophageal squamous cell carcinoma. Among drinkers with the ALDH2‐2 allele, the risk of multiple LVLs increased in parallel to the daily alcohol intake.     

Risk factors associated with allergic and non‐allergic asthma in adolescents

Introduction: Risk factors for asthma have been investigated in a large number of studies in adults and children, with little progress in the primary and secondary prevention of asthma. The aim of this investigation was to investigate risk factors associated with allergic and non‐allergic asthma in adolescents. Methods: In this study, 959 schoolchildren (13–14 years old) answered a questionnaire and performed exhaled nitric oxide (NO) measurements. All children (n = 238) with reported asthma, asthma‐related symptoms and/or increased NO levels were invited to a clinical follow‐up which included a physician evaluation and skin‐prick testing. Results: Asthma was diagnosed in 96 adolescents, whereof half had allergic and half non‐allergic asthma. Children with both allergic and non‐allergic asthma had a significantly higher body mass index (BMI) (20.8 and 20.7 vs. 19.8 kg/m²) (p < 0.05) and a higher prevalence of parental asthma (30% and 32% vs. 16%) (p < 0.05). Early‐life infection (otitis and croup) [adjusted odds ratio (OR) (95% confidence interval (CI)): 1.99 (1.02–3.88) and 2.80 (1.44–5.42), respectively], pets during the first year of life [2.17 (1.16–4.04)], window pane condensation [2.45 (1.11–5.40)] and unsatisfactory school cleaning [(2.50 (1.28–4.89)] was associated with non‐allergic but not with allergic asthma. Conclusion: This study indicates the importance of distinguishing between subtypes of asthma when assessing the effect of different risk factors. While the risk of both allergic and non‐allergic asthma increased with increasing BMI, associations between early‐life and current environmental exposure were primarily found in relation to non‐allergic asthma. Please cite this paper as: Janson C, Kalm‐Stephens P, Foucard T, Alving, K and Nordvall SL. Risk factors associated with allergic and non‐allergic asthma in adolescents. The Clinical Respiratory Journal 2007;1:16–22.     

Choosing and using non‐steroidal anti‐inflammatory drugs in haemophilia

The management of pain and inflammation in haemophilic arthropathy is challenging due to the lack of anti‐inflammatory analgesic agents perfectly suitable for this population. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are widely used in the management of arthritis due to their analgesic and anti‐inflammatory effects. Their use in persons with haemophilia (PWH), however, is limited due to increased risk of bleeding mainly from the upper gastrointestinal (UGI) tract. Cyclooxygenase‐2 (COX‐2) selective NSAIDs which have comparable analgesic effect to traditional NSAIDs (tNSAIDs) but with less UGI bleeding have been considered to be a suitable option for treatment of haemophilic arthropathy. COX‐2 inhibitors, however, have an increased in the risk of cardiovascular (CV) disease. Although the atherosclerotic burden in PWH is similar to that in the general population, the risk of CV‐related deaths is lower. PWH have a higher risk of GI bleeding and lower risk of thrombotic disease compared to general population. Therefore, when PWH require anti‐inflammatory/analgesic agents, it seems reasonable to use lowest dose of COX‐2 inhibitors for the shortest period together with a proton pump inhibitor. Helicobacter pylori infection should be tested for and eradicated prior to starting NSAID treatment in PWH. Furthermore, regular blood pressure and renal function test monitoring is required during COX‐2 inhibitor treatment.     

Prevalence of Helicobacter pylori infection in duodenal ulcer and gastro‐duodenal ulcer diseases in Taiwan

Background and Aim: The prevalence of Helicobacter pylori‐negative duodenal ulcer (DU) is increasing in Western countries but is rare in Japan. We aimed to examine the prevalence of H. pylori infection and the characteristics in DU and gastro‐duodenal ulcer (GDU) diseases in Taiwan. Study: All patients with an endoscopic diagnosis of DU or GDU from September 2003 to May 2004 at Taipei Veterans General Hospital were included. Rapid urease test was done for all patients, while urea breath test was carried out on those with negative rapid urease tests. A patient was considered infected if either test was positive. Results: The prevalence of H. pylori was 88.7% (555/626) in DU and 90.5% (95/105) in GDU patients. There was no difference in sex and prevalence of H. pylori between the two groups but age was higher in the GDU patients (60.1 ± 15.5 vs. 55.4 ± 15.5, P = 0.005). Of H. pylori‐negative DU patients, 28.2% (20/71) reported using non‐steroidal anti‐inflammatory drugs (NSAIDs)/aspirin, which were used by all 10 H. pylori‐negative GDU patients (100%) (P < 0.001). There was no difference in sex and age between H. pylori‐positive and negative DU patients. The prevalence rate of H. pylori in DU was not statistically different among outpatients, inpatients, and physical check‐up subjects (86.8% vs. 93.3% vs. 90.7%, P = 0.163). Conclusion: The prevalence of H. pylori infection in DU appears to be decreasing in Taiwan. Thus, eradication therapy without confirming the presence of H. pylori in DU patients cannot be recommended. NSAIDs/aspirin is the major risk factor for H. pylori‐negative DU patients, especially those with co‐morbid gastric ulcer.     

Clinical outcomes associated with per‐operative discontinuation of aspirin in patients with coronary artery disease: A systematic review and meta‐analysis

Background: Postoperative state is characterized by increased thrombotic risk by virtue of platelet activation. Whether aspirin ameliorates this risk in patients with established coronary artery disease undergoing cardiac or noncardiac surgery is unknown. We conducted a systematic review and meta‐analysis to compare the risk of major adverse cardiac events (MACE) and the risk of bleeding in patients with early (3–5 or more days before surgery) vs. late discontinuation(<3–5 days)/no discontinuation of aspirin. Methods: Multiple databases were searched from inception of these databases until March 2015 to identify studies that reported discontinuation of aspirin in patients undergoing surgery. The outcomes measured were all cause mortality, nonfatal myocardial infarction and other relevant thrombotic events (MACE) which also may include, fatal and nonfatal MI, stent thrombosis and restenosis, stroke, perioperative cardiovascular complications (heart failure, MI, VTE, acute stroke) and perioperative bleeding during the perioperative period to up to 30 days after surgery. Results: A total of 1,018 titles were screened, after which six observational studies met the inclusion criteria. Our analysis suggests that there is no difference in MACE with planned discontinuation of aspirin (OR = 1.17, 95% CI = 0.76–1.81; P = 0.05; I² = 55%). Early discontinuation of aspirin showed a decreased risk of peri‐operative bleeding (OR 0.82, 95% CI = 0.67–0.99; P = 0.04; I² = 42%). Conclusion: Our analysis suggests that planned short‐term discontinuation in the appropriate clinical setting appears to be safe in the correct clinical setting with no increased risk of thrombotic events and with a decreased risk of bleeding. © 2016 Wiley Periodicals, Inc.     

Continuous proton pump inhibitor treatment decreases upper gastrointestinal bleeding and related death in rural area in Japan

Background and Aims: Proton pump inhibitors (PPI) have been rarely used for prevention of upper gastrointestinal bleeding (UGIB) induced by non‐steroidal anti‐inflammatory drugs (NSAIDs) and/or aspirin in Japan. The increased incidence of UGIB in the aged society is becoming a serious problem. The aim of this study was to retrospectively evaluate whether PPI can prevent UGIB. Methods: We examined records of 2367 patients (aged 67.9 ± 15.1 years, male 1271) attending the only hospital serving the rural area, with little population movement. We investigated the correlation between the frequency of usage of medicine (PPI, histamine 2 receptor antagonists [H2RA], NSAIDs, aspirin) and incidence of UGIB over 12 years. UGIB was defined as cases with hematemesis and/or melena and definite bleeding at upper gastrointestinal endoscopy. The annual incidence of UGIB of inhabitants (16 065 ± 375.3 persons/year) was evaluated. The frequency of usage of medicine was compared with the total number of patients prescribed any medication (1080 ± 33.2 persons/year). Results: The frequency of PPI usage has increased significantly 4.6%→30.8% (P < 0.05). NSAIDs and aspirin usage increased significantly in the latter half of the survey period (P < 0.05). The annual incidence of UGIB significantly decreased 160.8 →23.6/100 000 inhabitants per annum (P ≤ 0.05) due to widespread use of PPI. No patients died due to UGIB after 2006. The incidence of UGIB and the prevalence of PPI usage were found to have a negative correlation (r = ?0.804, P = 0.0016). Conclusions: By widespread use of PPI, UGIB and related death has declined significantly. This survey showed that continuous PPI treatment decreases UGIB and related death in community medicine.     

Association of interleukin‐13 C‐1112T and G+2044A polymorphisms with asthma: A meta‐analysis

Background and objective: Polymorphisms in the IL13 gene have been reported to be associated with susceptibility to asthma. However, a number of studies have shown inconsistent results. A meta‐analysis was performed to investigate whether polymorphisms in the IL13 gene were associated with the risk of asthma. Methods: Searches were performed of the Medline and Chinese National Knowledge Infrastructure (CNKI) databases, covering all papers published up to 31 August 2010. A recently proposed logistic regression‐based method for meta‐analysis of case–control genetic association studies was used to analyse pooled data. All statistical analyses were performed using stata version 10.0 software. Results: The IL13 C‐1112T and G+2044A polymorphisms were investigated in 10 and 14 studies, respectively. The summary estimates suggested that both these polymorphisms were associated with susceptibility to asthma. Carriers of the IL13 ?1112T allele had a 38.9% increased risk of asthma compared with homozygotes (?1112CC) (odds ratio (OR) 1.389, 95% confidence interval (CI): 1.103–1.749). Carriers of the IL13+2044A allele had a 40.0% increased risk of asthma compared with homozygotes (+2044GG) (OR 1.400, 95% CI: 1.137–1.724). In a subgroup analysis by ethnicity, the IL13 ?1112T allele was associated with an increased risk of asthma among Caucasians (OR 1.629, 95% CI: 1.255–2.113) but not among Asians, and the IL13+2044A allele was associated with an increased risk of asthma among Asians (OR 1.436, 95% CI: 1.101–1.873) but not among Caucasians. Conclusions: This meta‐analysis indicated that the IL13 C‐1112T and G+2044A polymorphisms predispose to asthma. Further studies, including pooling of individual data to facilitate evaluation of gene–gene and gene–environment interactions between these IL13 gene polymorphisms and asthma susceptibility, are recommended.     

Five‐year survival predictive factors in patients with excessive alcohol intake and cirrhosis. Effect of alcoholic hepatitis,smoking and abstinence

Abstract: Aim: To evaluate 5‐year survival predictive factors in hospitalised patients with excessive alcohol intake and cirrhosis, including in a multivariate analysis the severity of the liver disease, gastrointestinal bleeding, concomitant viral B or C infection, smoking status, presence of alcoholic hepatitis at inclusion and abstinence from alcohol during follow‐up. Methods: In a non‐concurrent cohort study, 122 patients with excessive alcohol intake and cirrhosis were followed up at least five years or till death. Two patients were lost to follow‐up. Results: The 5‐year survival rates were 43% in the 122 patients and 66%, 50% and 25% in Child–Pugh class A, B and C patients, respectively. In multivariate analysis, age (P = 0.01), Child–Pugh score (P = 0.0001), gastrointestinal bleeding (P = 0.01), presence of HBs Ag and/or anti‐HCV (P = 0.03), smoking (P = 0.01), absence of histologically proven alcoholic hepatitis (P = 0.05) and persistent alcohol intake (P = 0.002) were associated with significantly increased risk ratios of death. Conclusions: In hospitalised patients with excessive alcohol intake and cirrhosis: (1) age, liver failure, gastrointestinal bleeding, concomitant viral B or C infection and persistent alcohol intake are independent poor prognostic markers, (2) smoking may contribute to the aggravation of cirrhosis, and (3) alcoholic hepatitis, being a potentially reversible cause of liver failure, has a favourable prognostic significance.     

Respiratory Sensitization of a Food Manufacturing Worker to Konjac Glucomannan

Intake of paracetamol has been associated with development of asthma. The aim of this study was to address a possible association between intake of paracetamol and risk of adult-onset asthma. Using a multidisciplinary postal questionnaire survey concerning health and lifestyle we prospectively studied 19,349 adult twins enrolled in the nationwide Danish Twin Registry. There was a higher prevalence of new-onset asthma in subjects who reported frequent intake of paracetamol at baseline compared with subjects without this determinant (12.0% vs. 4.3%), OR = 3.03 (1.51–6.11), p = 0.005. The result remained significant after adjusting for sex, age, smoking, BMI, hay fever, eczema, and intake of medications other than paracetamol, OR = 2.16 (1.03–4.53), p = 0.041. Frequent intake of paracetamol is an independent risk factor for adult-onset asthma.     

Polymorphisms in the transforming growth factor‐β1 gene and the risk of asthma: A meta‐analysis

Background and objective: Polymorphisms in the transforming growth factor‐β1 (TGF‐β1) gene have been implicated in susceptibility to asthma, but a large number of studies have reported inconclusive results. A meta‐analysis was performed to investigate the association between polymorphisms in the TGF‐β1 gene and asthma susceptibility. Methods: Searches were performed of Medline (Ovid), PubMed, the Chinese Biological Medicine Database (CBM), the Chinese Journals Full‐text Database (CNKI), the Cochrane Library Database and the Web of Science, covering all papers published up to 30 April 2009. Statistical analysis was performed using Revman4.2.8 and STATA10.0 software. Results: Two polymorphisms (?509C/T and 915G/C(G25C)) were investigated in 14 studies, involving 2979 asthma patients and 4941 control subjects. The results showed that individuals carrying the ?509T allele (TT+TC) had a 36% increased risk of asthma, when compared with homozygotes (?509CC) (OR 1.36, 95% CI: 1.12–1.65). However, there was no significant association with risk of asthma in carriers of the 915C allele (GC+CC) compared with 915GG homozygotes (OR 1.05, 95% CI: 0.65–1.70). In a subgroup analysis by ethnicity, the risk of asthma associated with the ?509T allele was significantly elevated among Asians (OR 1.50, 95% CI: 1.04–2.17) but not Caucasians (OR 1.16, 95% CI: 1.00–1.36). In a subgroup analysis by age, the ?509T allele was associated with a significantly elevated risk of asthma among adults (OR 1.45, 95% CI: 1.09–1.92) but not children (OR 1.19, 95% CI: 0.96–1.46). Conclusions: This meta‐analysis suggested that the ?509C/T polymorphism in the TGF‐β1 gene may be a risk factor for asthma. To further evaluate gene–gene and gene–environment interactions between polymorphisms in the TGF‐β1 gene and asthma susceptibility, more studies involving thousands of patients are required.