Showing papers in "European Journal of Gastroenterology & Hepatology in 2010"

Prevalence and factors associated with the presence of nonalcoholic fatty liver disease in an adult population in Spain.

Abstract: Background/aimsThe prevalence of nonalcoholic fatty liver disease (NAFLD) is unknown in Spain. The purpose of detecting NAFLD patients is to determine the associated factors and prevent its evolution to more severe forms. The aim of this study is to determine the prevalence and factors associated wi

Dietary n-3 polyunsaturated fatty acids and the aetiology of ulcerative colitis: a UK prospective cohort study.

Abstract: The aetiology of ulcerative colitis (UC) is largely unknown, although it is plausible that dietary n-3 polyunsaturated fatty acids (PUFAs) may be protective. Metabolites derived from n-3 PUFAs are less proinflammatory than those from n-6 PUFAs. Earlier, no prospective cohort studies have investigated this hypothesis, using dietary information collected from food diaries. The aim of this study was to investigate the total dietary intake of n-3 PUFAs and the specific n-3 PUFAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on the risk of developing incident UC.

Acoustic radiation force impulse: a new ultrasonographic technology for the widespread noninvasive diagnosis of liver fibrosis

Abstract: Background/aimsAs a module of a standard ultrasound imaging device, acoustic radiation force impulse (ARFI) is a new technology for liver stiffness evaluation (LSE). We aimed to evaluate accuracy, feasibility, reproducibility, and training effect of ARFI for liver fibrosis evaluation.MethodsOne hund

Quality of life in cirrhosis is related to potentially treatable factors.

Abstract: ObjectiveImprovement of prognosis and availability of diverse therapeutic options for complications of advanced liver disease highlight the importance of health-related quality of life (HRQOL) in cirrhosis. The aim of this study was to identify factors that influence HRQOL and may be potentially tre

Optimizing assessment and treatment for hepatitis C virus infection in illicit drug users: a novel model incorporating multidisciplinary care and peer support.

Abstract: Results Two hundred and four HCV antibody-positive illicit drug users accepted referral to a weekly HCV peer-support group. Assessment for HCV occurred in 53% of patients (n=109), with 13% (n=14) having initiated or completed treatment for HCV infection before attending the support group, evaluation ongoing in 10% (n=11) and treatment deferred/not indicated in 25% (n=27). The major reasons for HCV treatment deferral included early disease (30%), drug dependence (37%), other medical (11%) or psychiatric comorbidities (4%). Sixty-eight percent of those deferred for reasons other than early liver disease showed multiple reasons for treatment deferral. The first 4 weeks of support group attendance predicted successful HCV assessment (odds ratio: 6.03, 95% confidence interval: 3.27–11.12, P<0.001). Overall, 28% (n=57) received treatment. Among individuals having completed pegylatedinterferon and ribavirin therapy with appropriate follow-up (n=19), the rate of sustained virologic response was 63% (12/19), despite illicit drug use in 53%.

Efficacy of insulin-sensitizing agents in nonalcoholic fatty liver disease.

Abstract: AIM To investigate the efficacy of insulin-sensitizing agents in nonalcoholic fatty liver disease (NAFLD) patients. METHODS This is an open-label, randomized, a single-center study. Sixty-four patients, with impaired glucose metabolism and elevated alanine aminotransferase for at least 6 months before enrollment and NAFLD activity score at least 5 in liver biopsy, were randomized as group 1 and received metformin 1700 mg/day, group 2 received rosiglitazone 4 mg/day, and group 3 received a combination of metformin 1700 mg/day and rosiglitazone 4 mg/day for 12 months. RESULTS Baseline demographic and laboratory findings were similar in all the three groups, except baseline insulin level that was significantly higher in group 1 and group 3 versus group 2 (P<0.05). Serum transaminase levels showed a significant decrease after treatment in both group 2 and group 3. Serum gamma-glutamyl transpeptidase levels decreased significantly only in the group 3. However, there was no significant change in liver tests of group 1. Postprandial glucose levels showed significant decrease in all of the three groups. Homeostasis model assessment-insulin resistance was reduced significantly in only group 2. NAFLD score was significantly decreased on follow-up biopsy of the patients in group 2 and group 3. Fibrosis did not change significantly after the treatment. CONCLUSION Rosiglitazone therapy seems to be more effective in metabolic control and histological improvement in NAFLD patients with impaired glucose metabolism.

Fecal calprotectin is a predictive marker of relapse in Crohn's disease involving the colon: a prospective study.

Abstract: ObjectivesFecal calprotectin seems to have a diagnostic precision in predicting relapse in quiescent ulcerative colitis patients. However, the data remain controversial in Crohn's disease. The aim of this study was to prospectively evaluate the role of fecal calprotectin as a predictive marker for 1

Infusion of autologous bone marrow mononuclear cells through hepatic artery results in a short-term improvement of liver function in patients with chronic liver disease: a pilot randomized controlled study.

Abstract: AIM: This randomized controlled study evaluated the effect of autologous infusion of bone marrow cells (BMC) in patients with hepatic cirrhosis. METHODS: Thirty patients on the liver transplant waiting list were randomly assigned to receive BMC therapy or no treatment. They were followed up for 1 year. The study was nonblinded. Autologous mononuclear-enriched BMC were infused into the hepatic artery; liver function scores/tests were chosen as endpoints to assess efficacy. Statistical analysis calculated mean relative changes (RC) from baseline and fitted a random-effects model. RESULTS: Mean age, baseline model for end-stage liver disease, and Child-Pugh score were similar in both groups. Child-Pugh score improved in the first 90 days in the cell therapy group compared with controls (P = 0.017, BMC group RC = -8%, controls RC = +5%). The model for end-stage liver disease score remained stable in the treated patients (RC -2 to +6%), whereas it increased during follow-up in the control group (RC +6 to +18%). Albumin levels improved in the treatment arm, whereas they remained stable among controls in the first 90 days (P = 0.034; BMC group RC = +16%, control group RC = +2%). Bilirubin levels increased among controls, whereas they decreased in the therapy arm during the first 60 days; INR RC differences between groups reached up to 10%. The changes observed did not persist beyond 90 days. CONCLUSION: Transplantation of autologous BMC into the hepatic artery improved liver function in patients with advanced cirrhosis in the first 90 days. However, larger studies are necessary to define the role of BMC therapy in cirrhotic patients. Repeated autologous BMC infusions or combination therapy with granulocyte-colony-stimulating factor might improve or sustain the treatment response.

Feasibility and long-term evolution of TIPS in cirrhotic patients with portal thrombosis.

Abstract: Aim Many researchers consider portal thrombosis (PT) as a contraindication to transjugular intrahepatic portosystemic shunt (TIPS). The aim of this retrospective study was to compare the feasibility and long-term prognosis of TIPS in cirrhotic patients, with and without, complete PT. Patients and methods Four hundred and thirty-six consecutive cirrhotic patients with portal hypertension were referred for TIPS, between 1990 and 2004. These patients were divided into two groups according to their portal patency. PT +: 34 patients with complete PT with cavernoma (19) or without (15) cavernoma versus PT-: 402 patients with normal portal patency (308) and partial PT (94). Epidemiological data were compared using the χ 2 and Student's t-tests, and comparative evolution was made from actuarial data using the log-rank test. Results PT + patients were more frequently women with viral hepatitis, and TIPS was performed more often for bleeding indications. The TIPS success rate was significantly lower in the PT + group (79%) than in the PT- group (99.5%) (P<10 -4 ). Presence of a cavernoma decreased the success rate to 63%. TIPS was always feasible in cases of recent PT and portal cavernoma with an accessible intrahepatic patent portal branch. Early and late outcome and complications were not significantly different between the two groups. Conclusion Complete PTdoes not modify TIPS' long-term outcome. Rather than a contraindication, PT should be considered as an indication for TIPS in cirrhotic patients with accessible intrahepatic portal vein. Further randomized studies should be planned in cirrhotic patients with recent PT to better qualify TIPS and anticoagulation indications, respectively.

Bifidobacterium combined with fructo-oligosaccharide versus lactulose in the treatment of patients with hepatic encephalopathy.

Abstract: BackgroundHepatic encephalopathy (HE) is a reversible neuropsychiatric syndrome in patients with liver disease. It was suggested that Bifidobacterium+fructo-oligosaccharides (FOS) may decrease blood and brain ammonia levels.AimThe study was conducted to compare the efficacy of Bifidobacterium+FOS an

Northwestern China: a place to learn more on oesophageal cancer. Part one: behavioural and environmental risk factors.

Abstract: Oesophageal squamous cell carcinoma (OSCC) remains a public health problem in many countries, especially in emerging and developing countries. Epidemiology of OSCC is characterized by marked differences in prevalence between countries/regions/ethnical groups. The highest incidence in the world is reached by populations living in specific areas of northwestern Xinjiang, China where age-adjusted mortality may reach 150 of 100 000. In fact, there are also marked differences among the various geographical areas and the various ethnic groups within the region, which suggests specific risk factors. Behavioural factors include those factors which are common to all 'high-risk populations', such as tobacco smoking and alcohol drinking. However, the very unusual sex ratio (1.2 : 1.0) and young age range of OSCC occurrence suggests the involvement of additional early risk factors shared by males and females, and which are different from those studied in other 'high-risk' areas of the world, including China, such as LinXian area. These include drinking very hot and salted tea, boiled with milk; a diet rich in meat, especially salted, dry and/or smoked meat, and dairy products; and a diet poor in fresh fruit and vegetables. The combination of hot drinks (such as milk, tea and soups) and high-degree spirit drinks, and hard food (bread, meat and cheese), together with poor oral hygiene and tooth loss, is likely to add mechanical injury of the oesophagus to other factors linked to climate characteristics of the area (drought) and dietary habits, which promote a sodium and nitrosamine-rich diet. Association of early and severe hypertension in the same populations at high risk of OSCC might likely raise more attention. Human papilloma virus (HPV) infection, and especially HPV 16/18 E6/E7, with gene mutations and association with p53 overexpression, may contribute to the extremely high incidence of OSCC observed in Xinjiang, and could be accessible to prevention. Infection may especially be a crucial additional factor in the Uygur population in which not only HPV infection but also infection with other oncogenic viruses, such as HHV8, are highly prevalent. Genetic polymorphism might interact with viruses and/or viral products to promote carcinogenesis. These observations in northwestern China suggest that usually neglected factors, such as sodium excess and viral infection, could be taken into more account when studying OSCC risk factors in other parts of the world, especially Europe.

Helicobacter pylori infection and gastric histology in first-degree relatives of gastric cancer patients: a meta-analysis.

Abstract: ObjectivesHelicobacter pylori (H. pylori) is believed to predispose to gastric cancer by inducing the precancerous changes, that is, atrophy and intestinal metaplasia (IM). First-degree relatives of patients with gastric cancer might be at an increased risk of developing gastric cancer. However, thi

Protective effect of N-acetylcysteine on antituberculosis drug-induced hepatotoxicity.

Abstract: IntroductionIsoniazid, rifampicin, and pyrazinamide, the first-line antituberculosis (anti-TB) drugs, are associated with hepatotoxicity.Aims and objectivesTo study the hepatoprotective effect of N-acetylcysteine (NAC) on liver injury induced by anti-TB drugs.MethodsA randomized clinical trial was c

Small bowel capsule endoscopy in clinical practice: a multicenter 7-year survey.

Abstract: Background and aim Data about small bowel capsule endoscopy (SBCE) come from studies involving small and highly selected populations. The study aim was to describe extent of use, indications, results, complications, and practical issues of SBCE in clinical practice in a Northern Italian Region (Lombardia). Materials and methods Twenty-three out of 29 invited centers fulfilled a specific questionnaire. Results Between 2001 and 2008, 2921 procedures were performed and both the number of centers performing SBCE (from 5 to 29) and the number of SBCE (from 7.2 to 69.2 per month) increased steadily. The main indications for SBCE were: obscure gastrointestinal bleeding (OGIB) (43.4%), unexplained anemia (23.9%), suspected Crohn's disease (7.8%) and abdominal pain (5.3%). Overall, SBCE was positive in 50% of cases, negative in 36% and undefined in 14%. The highest diagnostic yields were observed in patients with OGIB (62.5%), polypoid syndromes (74.1%), known (54.8%) or suspected (47.3%) inflammatory bowel disease, while the yields were low in patients examined for chronic diarrhea (27.4%) and abdominal pain (14.9%), 61 patients (2.1%) experienced capsule retention. Thirty-two of them eventually excreted the capsule naturally while endoscopic or surgical retrieval was necessary in 29 (1%) (in two because of obstruction). Conclusion Over a period of 7 years the use of SBCE in Lombardia increased steadily confirming, in clinical practice, a high diagnostic yield and an acceptable safety profile.

Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer.

Abstract: ObjectivesEndoscopic submucosal dissection (ESD) has advantages over conventional endoscopic mucosa resection. The number of elderly patients (more than 75 years old) with early gastric cancer (EGC) has been steadily increasing. We sought to assess clinical outcomes of ESD for EGC in elderly.Methods

Hepatocellular carcinoma in two patients with cardiac cirrhosis.

Abstract: Hepatocellular carcinoma has been commonly associated with multiple etiologic factors including hepatitis B and C, alcoholic liver disease, and more rarely congenital metabolic liver diseases. 'Cardiac cirrhosis' is the cirrhosis resulting from prolonged passive liver venous congestion secondary to right-sided congestive heart failure; hepatocellular carcinoma is a rarely reported outcome. In this study we present two female patients with congenital heart defects treated with the Fontan procedure who survived into their third decade, and developed hepatocellular carcinoma in the setting of cardiac cirrhosis. The Fontan procedure diverts blood from the inferior vena cava and superior vena cava to the pulmonary arteries, thereby increasing survival in infants born with a single effective ventricle. As such patients live longer, however elevated pulmonary and right-sided heart pressures cause chronic passive liver congestion and eventual cardiac cirrhosis. The two patients in this study had no risk factors for hepatocellular carcinoma other than cardiac cirrhosis secondary to their prolonged survival after their Fontan procedure. In conclusion, we suggest that cardiac cirrhosis may be a risk factor for developing hepatocellular carcinoma and recommend close follow-up and hepatocellular carcinoma screening for patients with known right heart failure and passive hepatic congestion.

Structured patient education is superior to written information in the management of patients with irritable bowel syndrome: a randomized controlled study.

Abstract: Objective Education and reassurance are proposed to be of great importance in the management of patients with irritable bowel syndrome (IBS), but few trials supporting this are available. Our aim was to compare the effects of a structured patient group education (IBS school) versus receiving written information in the form of an IBS guidebook, on knowledge, symptoms, and quality of life in IBS patients. Methods Patients with IBS according to the Rome II criteria were randomized to participate in the group education or to receive the guidebook. The effects were evaluated by self-administered questionnaires at 3 and 6 months after baseline. Results One hundred and forty-three patients – 71 in the guidebook group and 72 in the IBS school group – completed the study. Compared with the guidebook group, the patients in the education group showed greater reduction in IBS symptom severity and gastrointestinal (GI)-specific anxiety, as well as greater improvement in perceived knowledge of IBS. Several aspects of health-related quality of life were significantly improved after the group education, but not in the group who received the written information. Conclusion A structured patient group education is superior to written information to enhance knowledge of IBS, and improve GI symptoms and GI-specific anxiety in IBS patients.

Enteral nutrition for the maintenance of remission in Crohn's disease: a systematic review.

Abstract: ObjectiveThis review study was designed to evaluate the efficacy of enteral nutrition (EN) for the maintenance of remission in patients with Crohn's disease (CD) who achieved medically or surgically induced remission.MethodsThe Medline, Embase, Ovid, and Cochrane database search of literature was ca

The PreventCD Study design: towards new strategies for the prevention of coeliac disease.

Abstract: PreventCD is expected to elucidate some of the genetic and immunological mechanisms involved in the process of immune intolerance.

The relationship between symptoms, body mass index, gastrointestinal transit and stool frequency in patients with irritable bowel syndrome.

Abstract: Background and aimsMotility disturbances are involved in the pathophysiology of the irritable bowel syndrome (IBS). Population-based studies have shown an association between increasing body mass index (BMI) and different gastrointestinal (GI) symptoms. The aim of this prospective study was to chara

Unfolded protein response activation contributes to chemoresistance in hepatocellular carcinoma.

Abstract: ObjectiveHepatocellular carcinoma (HCC) has an annual worldwide incidence of 626 000 cases and causes 550 000 deaths per year. Although the mainstay of treatment is surgical resection, for inoperable or metastatic disease, chemotherapy may be offered. The primary agent used is doxorubicin, but respo

Tolerance and outcome of patients with unresectable hepatocellular carcinoma treated with sorafenib.

Abstract: Background Sorafenib is the standard treatment for patients with an advanced stage of hepatocellular carcinoma (HCC). The aims of this study were (i) to evaluate the tolerance and survival of sorafenib-treated patients, in a nonselected population, especially in Child-Pugh B patients; and (ii) to identify potential prognostic factors of survival. Patients and methods From April 2007 to December 2008, 50 patients received sorafenib for advanced HCC. Seventeen (34%) were Child-Pugh B patients. We recorded adverse events and the duration of treatment and survival. For 34 patients with histopathologically proven HCC, immunophenotypical analysis was carried out using antibodies against cluster differentiation 34, vascular endothelial growth factor, phosphorylated ERK, cytokeratin 19, and phosphorylated stat3. Results Patients with Child-Pugh B cirrhosis had a more advanced stage of the disease compared with Child-Pugh A patients. The occurrence of adverse events was similar in Child-Pugh A and Child-Pugh B patients. Duration of treatment until discontinuation for bad tolerance was lower in Child-Pugh B patients (1.8 vs. 5 months, P=0.02). Survival of Child-Pugh A patients was higher compared with Child-Pugh B patients (8.9 vs. 2 months, P=0.004). Barcelona Clinic Liver Cancer stage, Eastern Cooperative Oncology Group Performance Status, portal vein impairment, extra-hepatic spread, and alpha-foetoprotein were also prognostic factors. In multivariate analysis, the sole factor associated with survival was the Barcelona Clinic Liver Cancer stage. None of the immunohistological markers used was associated with tolerance and survival. Conclusion Occurrence of adverse events is similar in Child-Pugh A and Child-Pugh B patients. Nevertheless, the survival of Child-Pugh B patients is very low. Whether liver function or tumor spread is responsible for mortality is unclear. Opportunity of treatment for Child-Pugh B patients is questionable. The immunophenotype of tumoral tissue was not predictive of survival.

Effects of a single terlipressin administration on cardiac function and perfusion in cirrhosis.

Abstract: BackgroundThe vasoconstrictor terlipressin is widely used in the treatment of the hepatorenal syndrome and variceal bleeding. However, terlipressin may compromise cardiac function and induce ischemia.AimTherefore, we aimed to assess the effects of terlipressin on cardiac function and perfusion.Metho

Benefits of breath hydrogen testing after lactulose administration in analysing carbohydrate malabsorption.

Abstract: Background and aimsBreath hydrogen testing after lactulose administration may yield findings of clinical value, but whether it should be a routine part of breath testing has not been evaluated. We examined the contribution of breath testing after lactulose administration to the conduct and interpret

Noncirrhotic human nonalcoholic fatty liver disease induces portal hypertension in relation to the histological degree of steatosis.

Abstract: Introduction We earlier showed in an animal model that steatosis, in the absence of fibrosis or inflammation, induces a significant rise in portal pressure. The relevance of these findings for human pathology is unknown till date. Aims To study portal pressure in nonalcoholic fatty liver disease patients and to identify factors possibly related to steatosis-induced changes in liver haemodynamics. Materials and methods Patients presenting with a problem of overweight and with noninvasive signs of liver involvement were proposed for transjugular liver biopsy. The biopsy was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network scoring system. Results Fifty consecutive patients were studied. Mean age was 47.9±13.6 years; 31 (62%) of them were female. Hepatic venous pressure gradient (HVPG) was normal in 27 patients (54%), borderline (5 mmHg) in nine (18%) and elevated in 14 patients (28%). For further analysis those with a HVPG of 5 mmHg were considered normal (group 1). HVPG was 8.8±2.6 mmHg in those with an elevated HVPG (group 2) versus 3.4 ± 1.2 mmHg in group 1 (P< 0.0001). In both the groups, only one patient had cirrhosis; 26 of 36 (group 1) and nine of 14 patients (group 2) had fibrosis score 0. Fibrosis score was not significantly different (P= 0 . 530 ). Perisinusoidal fibrosis score was not significantly different (P=0. 1 86). Steatosis was the only histological feature that significantly differed between the groups (P= 0 . 016 ). The degree of steatosis (P= 0 . 010 ) was the only independent predictor of the presence of portal hypertension. Conclusion Human nonalcoholic fatty liver disease can, even in the absence of significant fibrosis, induce portal hypertension, correlated with the severity of the steatosis.

Early azathioprine/biological therapy is associated with decreased risk for first surgery and delays time to surgery but not reoperation in both smokers and nonsmokers with Crohn's disease, while smoking decreases the risk of colectomy in ulcerative colitis.

Abstract: BACKGROUND/AIMS Smoking may alter the natural course of Crohn's disease (CD). Smokers are more likely to develop complications, relapses and have a greater risk for surgery. In contrast, in ulcerative colitis (UC), smoking might improve the disease course. Our aim was to assess the combined effect of disease phenotype, smoking, and immunomodulator [azathioprine (AZA), AZA/biological] treatment on the risk of intestinal resection/reoperation in CD and colectomy in UC. PATIENTS/METHODS Six hundred and eighty-one inflammatory bowel disease patients were analyzed (CD: 340, male/female: 155/185, duration: 9.4+/-7.5 years; UC: 341, male/female: 174/164, duration: 11.5+/-9.7 years). Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. Medical records were retrospectively analyzed. RESULTS Smoking was present in 45.5% in CD and 15.8% in UC. CD patients who underwent at least one bowel resection comprised 46.5%. In an univariate analysis, disease location, behavior, AZA, or AZA/biological use before surgery [odds ratio (OR): 0.26 and 0.22, P<0.001] and smoking (OR: 1.61, P = 0.03) were associated with risk for first surgery. Smoking, AZA, or AZA/biological (P<0.001) use before first surgery and disease behavior were independently associated with risk for surgery in a proportional Cox-regression analysis. Perianal disease (OR: 3.2, P = 0.001) and frequent relapses (OR: 4.8, P<0.001) but not smoking, AZA, or AZA/biological use after first surgery were predictive for reoperation. In UC, the rate of colectomy was 5.6%. Disease location (P = 0.001) and smoking status (P = 0.02) were independently associated with risk for colectomy in a proportional Cox-regression analysis. CONCLUSION Our data suggest that early AZA/biological therapy reduces the risk for first operation but not reoperation in CD, in both smokers and nonsmokers. In contrast, smoking was associated with a decreased need for colectomy in UC.

Computerized virtual chromoendoscopy versus indigo carmine chromoendoscopy combined with magnification for diagnosis of small colorectal lesions: a randomized and prospective study.

Abstract: Background and study aimsMagnifying colonoscopy with indigo carmine dye and the analysis of the capillary and the pit patterns by computed virtual chromoendoscopy (Fujinon Intelligent Color Enhancement, FICE) with magnification are effective for the differential diagnosis of neoplastic and non-neopl

Appropriate diagnosis of biliary cystic tumors: comparison with atypical hepatic simple cysts

Abstract: BackgroundBiliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are often confused with other intrahepatic cystic diseases.AimsThe aims of this study were to investigate predictive factors of biliary cystic tumor (BCT) and clinical characteristic of BCAC.MethodsWe retrospectively reviewed

Consensus on the current use of sorafenib for the treatment of hepatocellular carcinoma

Abstract: An expert panel was convened to reach a consensus on the current use of sorafenib in the treatment of hepatocellular carcinoma (HCC). A multinational, multidisciplinary group of experts objectively reviewed clinical data of sorafenib and considered clinical experience to develop statements summarizing our consensus on the current use of sorafenib. Sorafenib is the standard of care for Child-Pugh (CP) A patients with advanced HCC (i.e. not amenable to surgery or locoregional treatment). There is currently insufficient evidence to support the routine clinical use of sorafenib in CP B patients, but sorafenib can be offered as an option for those with compensated liver cirrhosis. Patients with stable performance status who have progressive disease during sorafenib treatment can be maintained on sorafenib, although there are no clear data supporting the continuation of sorafenib in these patients. The effectiveness of the adjuvant use of sorafenib in preventing recurrence after resection or local ablation, or in combination with transarterial chemoembolization, are being evaluated in clinical studies. In conclusion, sorafenib has extended treatment options for patients with HCC, and is now established as the standard of care for CP A patients with HCC not amenable to surgery or locoregional treatment. Based on its multikinase-inhibitor activity and proven efficacy in prolonging survival in HCC, broader use - including a subgroup of patients with CP B (clinically compensated cirrhosis) and earlier disease stages - might be expected dependent on the results of ongoing studies of safety and clinically relevant benefit in these patients.

Exposure to colorectal examinations before a colorectal cancer diagnosis: a case-control study.

Abstract: OBJECTIVES: To assess the prior exposure to colorectal examinations between colorectal cancer (CRC) patients and matched control participants to estimate the effect of these examinations on the development of CRC and to obtain insight into the background incidence of colorectal examinations. METHODS: A population-based case-control study was conducted within the Dutch Integrated Primary Care Information database over the period 1996-2005. All incident CRC cases were matched with up to 18 controls (n=7,790) for age, sex, index date (date of CRC diagnosis) and follow-up before diagnosis. All colorectal examinations performed in symptomatic participants in the period 0.5-5 years before index date were considered in the analyses. RESULTS: Within the source population of 457 024 persons, we identified 594 incident cases of CRC. In the period 0.5-5 years before index date 2.9% (17 of 594) of the CRC cases had undergone colorectal examinations, compared with 4.4% (346 of 7790) in the control population [odds ratio (ORadj): 0.56, 95% confidence interval (CI): 0.33-0.94]. For left-sided CRC, significantly more controls than cases had undergone a colorectal examination (4.7 vs. 2.0%, respectively, ORadj: 0.36, 95% CI: 0.17-0.76), which was not seen for right-sided CRCs (3.3 vs. 3.9%, respectively, ORadj: 0.98, 95% CI: 0.42-2.25). CONCLUSION: Patients diagnosed with CRC were less likely than controls to have had a colorectal examination in previous years, being more pronounced in patients diagnosed with left-sided CRCs. If diagnostic examinations have a similar protective effect as screening examinations, this finding supports the concept that colorectal examination can have a major impact on the reduction of CRC risk.