Colonoscopy screening markedly reduces the occurrence of colon carcinomas and carcinoma-related death: a closed cohort study.

BACKGROUND: Colonoscopy with a possible polypectomy is an efficient and preferred screening method to reduce the incidence of colorectal cancer (CRC). However, critics argue that, to date, a reduction of incidence and mortality from CRC has not been demonstrated in a population-based setting. OBJECTIVE: To compare the incidence of and mortality from CRC among individuals screened by colonoscopy and non-screened individuals. DESIGN: A closed cohort study. SETTING: Population-based setting in a precisely defined area with a low level of population migration. PATIENTS: This study involved 1912 screened and 20,774 control participants. INTERVENTION: CRC cases in this closed cohort study were prospectively collected during the screening period of 1 year and the follow-up period of 6 years. MAIN OUTCOME MEASUREMENTS: Follow-up data were corrected for negligible migration balance in the area. Tumor characteristics and risk or protective factors, age and sex, participation in general health screening examinations, history of CRC in a first-degree relative, smoking status, body mass index, frequency of sports activity, eating habits, and patients' professions were recorded. RESULTS: Overall cancer incidence was significantly lower in the screened group compared with the non-screened group (adjusted odds ratio [OR] 0.31; 95% confidence interval [CI], 0.16-0.59; P < .001). Colon cancer-associated mortality also was clearly lower (adjusted OR 0.12; 95% CI, 0.01-0.93; P = .04). Risk factors such as lifestyle, smoking, and body mass index as well as family history were similar in both groups. Blue-collar workers had a higher incidence of CRC compared with professionals. The risk factors for CRC were a positive family history and smoking. LIMITATIONS: Number and ethnicity of the participants, non-randomized study. CONCLUSION: Colonoscopy with polypectomy significantly reduces CRC incidence and cancer-related mortality in the general population.

Colonoscopic findings of symptomatic patients aged 50 to 80 years suggest that work-up of tumour suspicious symptoms hardly reduces cancer-induced mortality.

QUESTIONS UNDER STUDY: The risk of colorectal cancer (CRC) starts to increase at the age of 50 years in average persons without special risk factors. The significance of clinical symptoms and frequency of endoscopies done at this age are hitherto unknown. We do not know the stage of colorectal cancers nor the distribution of advanced neoplasms in symptomatic persons above 50 years. These data are of interest to validate the necessity of screening programmes, to define the target population and to interpret results of screening studies in asymptomatic people. METHODS: Endoscopies of the colon performed from 1991 to 2000 in symptomatic patients aged 50 to 80 in the well-defined area of Uri were analysed retrospectively, focusing on symptoms leading to the endoscopy and the occurrence of neoplastic lesions. RESULTS: Sixteen percent of the population at the age of 50-80 years had a colonoscopy for workup of symptoms. A CRC was found in 5.5% of all patients (83 of 1514 patients), in 12.3% of patients with tumour suspicious symptoms, but only in 0.3% of patients with unspecific pain. Stage of tumours was often advanced (82% T3/T4, 38% N1-3, 21% M1). In 2.6% of patients a colorectal cancer was found before the age of 60, mostly in men. Advanced lesions were more frequent in men, increasing with age. CONCLUSIONS: A substantial part of the population above the age of 50 had an endoscopic workup of the colon for symptoms, what has to be considered when defining the target population and the necessary manpower of screening programmes. Tumour-suspicious symptoms were significant predictors for the presence of a CRC, but tumours were often already advanced. This underlines the importance to screen persons before developing symptoms.

Epidemiology and costs of gastroesophageal reflux disease in Switzerland: a population-based study.

OBJECTIVES: Assessment of the prevalence, health care resource use and cost of gastroesophageal reflux disease in Switzerland. METHODS: A population-based telephone survey was conducted in German and French speaking Switzerland. Reflux cases were defined using a questionnaire proposed by the German Gastro League and answered additional questions on their personal characteristics and resource use. RESULTS: 1,274 out of 7,222 participants were positively screened. The prevalence of reflux disease in Swiss adults was estimated at 17.6% (95% CI: 15.6%-19.7%) or 993,000 individuals. Regular treatment with medication was reported by 38.0% of the reflux positive sample. Reflux-induced general practitioner consultations during the last year were reported by 25.9%. On average, there were 0.84 general practitioner consultations, 0.19 specialist consultations, 0.08 gastroscopies and 0.01 hospitalisations annually. Mean direct medical costs, dominated by medication costs, were CHF 185 per patient-year (95% CI: CHF 140-230) or 0.5% of Switzerland's total health care expenditures. Total costs were CHF 234 (95% CI: CHF 185-284) per patient-year. CONCLUSIONS: The prevalence of reflux disease in Switzerland is similar to that in other industrialised countries. Reflux disease causes considerable costs, in the medical system and at the societal level.

Herbal does not mean innocuous: ten cases of severe hepatotoxicity associated with dietary supplements from Herbalife products.

BACKGROUND/AIMS: Herbal agents are popular and perceived as safe because they are supposedly 'natural'. We report 10 cases of toxic hepatitis implicating Herbalife products. METHODS: To determine the prevalence and outcome of hepatotoxicity due to Herbalife products. A questionnaire was sent to all public Swiss hospitals. Reported cases were subjected to causality assessment using the CIOMS criteria. RESULTS: Twelve cases of toxic hepatitis implicating Herbalife preparations (1998-2004) were retrieved, 10 sufficiently documented to permit causality analysis. Median age of patients was 51 years (range 30-69) and latency to onset was 5 months (0.5-144). Liver biopsy (7/10) showed hepatic necrosis, marked lymphocytic/eosinophilic infiltration and cholestasis in five patients. One patient with fulminant liver failure was successfully transplanted; the explant showed giant cell hepatitis. Sinusoidal obstruction syndrome was observed in one case. Three patients without liver biopsy presented with hepatocellular (2) or mixed (1) liver injury. Causality assessment of adverse drug reaction was classified as certain in two, probable in seven and possible in one case(s), respectively. CONCLUSIONS: We present a case series of toxic hepatitis implicating Herbalife products. Liver toxicity may be severe. A more detailed declaration of components and pro-active role of regulatory agencies would be desirable.