No Significant Effects of Smoking or Alcohol Consumption on Risk of Barrett’s Esophagus

Background

Smoking, but not higher alcohol consumption, is associated with increased risk of esophageal adenocarcinoma (EAC) and progression from Barrett’s esophagus (BE) to EAC. However, it is still unclear whether smoking or alcohol is implicated in the development of BE.

Aim

To evaluate the associations between smoking, alcohol and the risk of BE.

Methods

The study included eligible patients scheduled for elective esophagogastroduodenoscopy (EGD) and a sample of patients eligible for screening colonoscopy recruited from primary care clinics. We compared 258 patients with definitive BE with two separate control groups: 453 patients from the primary care group (“colonoscopy controls”) and 1,145 patients from the elective EGD group (“endoscopy controls”) with no endoscopic or histopathologic BE. We calculated odds ratios (OR) and 95 % confidence intervals (95 % CI) using multivariable logistic regression models.

Results

Seventy-seven percent of BE cases, 75 % of colonoscopy controls and 72 % of endoscopy controls were ever smokers. Of these, approximately 45 % were current smokers. Overall, 91 % of study participants were ex or current alcohol drinkers, with the majority drinking beer. We found no association between various measure of smoking exposure (status, intensity, age at initiation, duration, pack-years and cessation) and risk of BE. Alcohol consumption was not associated with increased risk of BE. Conversely, moderate intake was associated with lower risk (14 to <28 drinks/week, OR 0.39, 95 % CI 0.15–1.00).

Conclusion

Smoking and alcohol were not strong or consistent risk factors for BE. The likely role of smoking in increasing risk of EAC is through promoting progression from BE to cancer.     

The physical characteristics of resin composite–calcium silicate interface as part of a layered/laminate adhesive restoration

Objectives

To compare in-vitro micro-shear bond strengths (μSBS) of resin composite to calcium silicate cement (Biodentine™) vs. glass ionomer cement vs. resin modified glass ionomer cement (RM-GIC) using an adhesive in self-etch (SE)/total etch (TE) mode after aging three substrates and bond and characterizing their failure modes.

Methods

Resin composite was SE/TE bonded to 920 standardized disks of Biodentine™, GIC & RM-GIC. Dividing samples into two groups, the first underwent early (t = 0 min, 5 min, 20 min, 24 h) or delayed (t = 2 wk, 1 month, 3 months, 6 months) substrate aging before bonding and μSBS (t = 24 h) testing. In the second, adhesive was applied after either early (t = 5 min) or delayed (t = 2 wk) substrate aging and then tested after bond aging (t = 2 wk, 1 month, 3 months, 6 months). The failure modes were identified using stereomicroscope. SEM images of selected samples were analyzed.

Results

No significant differences were observed between (SE)/(TE) bonding modes (P = 0.42). With substrate aging, a significant reduction in μSBS occurred between early and delayed time intervals for Biodentine™ (P = 0.001), but none for the GIC/RM-GIC (P = 0.465, P = 0.512 respectively). With bond aging, there was no significant difference between time intervals for all groups, except at 6 months for the GIC (P < 0.05). Modes of failure were primarily cohesive within all the substrates (68.82%) followed by adhesive failure at the resin–substrate interface (21.71%).

Significance

Biodentine™ is a weak restorative material in its early setting phase. Placing the overlying resin composite as part of the laminate/layered definitive restoration is best delayed for >2 wk to allow sufficient intrinsic maturation to withstand contraction forces from the resin composite. A total-etch or self-etch adhesive may be used.     

Multidisciplinary management of congenitally missing lateral incisors: A minimally invasive approach

The following case report demonstrates how a multidisciplinary team approach can be utilized successfully for the minimally invasive esthetic treatment of congenitally missing maxillary lateral incisors through space closure and canine re‐anatomization.     

Balloon-occluded antegrade transvenous obliteration of rectal varices: A case report

Patients with liver cirrhosis frequently experience rectal variceal bleeding subsequent to portal hypertension. Unlike gastroesophageal variceal bleeding, a well-established guideline does not exist in terms of management of bleeding rectal varices. A 75-year-old male with non-alcoholic-steatohepatitis induced cirrhosis presented with a 3-day history of severe rectorrhagia. Considering patient''s clinical history, TIPS was not performed and thus, a novel endovascular technique termed balloon-occluded antegrade transvenous obliteration was considered. Under conscious sedation, an occlusion was made through balloon catheter by sclerotic agents including air/sodium tetradecyl sulfate/Lipiodol. After the procedure, and in the 6 months follow up period the patient''s hemodynamic status was stable and he recovered without any serious complications. Balloon-occluded antegrade transvenous obliteration is a feasible and safe modality for treating rectal varices bleeding and could be used as an alternative approach in patients with contraindications to traditional treatments.