Risk Assessment for Gastrointestinal Diseases via Clinical Dimension and Genome-Wide Polygenic Risk Scores of Type 2 Diabetes: A Population-Based Cohort Study.

OBJECTIVE: We aimed to evaluate whether individuals with type 2 diabetes (T2D) were at higher risk of developing a wide range of gastrointestinal diseases based on a population-based cohort study. RESEARCH DESIGN AND METHODS: This study included 374,125 participants free of gastrointestinal disorders at baseline; of them, 19,719 (5.27%) with T2D were followed-up by linking to multiple medical records to record gastrointestinal disease diagnoses. Multivariable Cox models were used to estimate the hazard ratios (HRs) and CIs. Logistic models were used to examine the associations between polygenic risk scores (PRS) and clinical gastrointestinal phenotypes. RESULTS: During a median follow-up of 12.0 years, we observed the new onset of 15 gastrointestinal diseases. Compared with nondiabetes, participants with T2D had an increased risk of gastritis and duodenitis (HR 1.58, 95% CI 1.51-1.65), peptic ulcer (HR 1.56, 95% CI 1.43-1.71), diverticular disease (HR 1.19, 95% CI 1.14-1.24), pancreatitis (HR 1.45, 95% CI 1.24-1.71), nonalcoholic fatty liver disease (HR 2.46, 95% CI 2.25-2.69), liver cirrhosis (HR 2.92, 95% CI 2.58-3.30), biliary disease (HR 1.18, 95% CI 1.10-1.26), gastrointestinal tract cancers (HR 1.28, 95% CI 1.17-1.40), and hepatobiliary and pancreatic cancer (HR 2.32, 95% CI 2.01-2.67). Positive associations of PRS of T2D with gastritis, duodenitis, and nonalcoholic fatty liver disease were also observed. CONCLUSIONS: In this large cohort study, we found that T2D was associated with increased risks of a wide range of gastrointestinal outcomes. We suggest the importance of early detection and prevention of gastrointestinal disorders among patients with T2D.

[Assessment of ten-year dynamics of cases of hospitalizations of patients with peptic ulcer disease, chronic gastritis and chronic duodenitis].

AIM: To assess of the ten-year dynamics of cases of hospitalizations of patients with peptic ulcer disease (PUD), chronic gastritis and chronic duodenitis relative to the total number of people treated in the gastroenterological departments of the hospital in 20102019. MATERIALS AND METHODS: Data of the annual reports of the work of the hospital departments were studied retrospectively. RESULTS: The relative number of persons hospitalized for chronic duodenitis decreased 2.8 times (p0.001), but the proportion of patients with chronic gastritis did not tend to decrease. This is most likely due to diagnostic errors. The cases of hospitalization of persons with uncomplicated PUD decreased by 3.1 times (p0.001), the proportion of men with duodenal ulcer decreased by 6.3 times (p0.001), with gastric ulcer decreased 1.9 times (p0.01). The proportion of women hospitalized with duodenal ulcer decreased 2.3 times (p0.01). The number of hospitalized men with duodenal ulcer is 3.8 times more than females (p0.001). It can be explained by a decrease in social stressful influences and active anti-Helicobacter pylori therapy. CONCLUSION: Over the period of follow-up, the cases of hospitalization of patients with uncomplicated PUD decreased, primarily due to a decrease in the proportion of persons with ulcer of the duodenum and duodenitis, while the number of patients with chronic gastritis not undergoing modern examination did not have significant dynamics.

[Substantiation of the model of clinical and economic efficiency evaluation of prevention, treatment, and dispenserization of the patients with comorbidity. The example of patients with arterial hypertension and duodenitis].

OBJECTIVE: Introduction: Evidence based medicine requires reliant estimators of medical programs efficiency both in clinical and economical dimensions. It necessitates the substantiation of evaluation of assessment tools on the ground of clinical and economic theory. Developed model has advantage of direct link with classical economic analyses such as costutility, cost-efficiency, and cost-benefit. The aim was to substantiate the model of clinical and economic efficiency evaluation of medical program with allowance for comorbidity. PATIENTS AND METHODS: Materials and methods: Model developed on the premises of Zweifel & Breyer [1, 2], theoretical foundation based upon classical theory of moral hazard and consumer utility. Model describes equilibrium of patient's decision on the volume of medical services to consume. RESULTS: Results: We delivered the model development and equilibrium examination. Transformation of equilibrium model to cost-utility, cost-efficiency, and cost-benefit models displayed. There was also demonstrated the allowance for comorbidity with example of patients with duodenitis and arterial hypertension. CONCLUSION: Conclusions: Proffered model based on theoretical ground of moral hazard and consumer utility. There is a direct linkage with cost-utility, cost-efficiency, and cost-benefit models. For the purpose of better cognition of practical applicability we introduced model in the context of dispenserization of the patients with duodenitis and arterial hypertension.

Factors Associated with Upper Gastrointestinal Cancer Occurrence After Endoscopy that Did Not Diagnose Cancer.

BACKGROUND AND AIMS: Up to 14 % of upper gastrointestinal cancer (UGIC) subjects underwent esophago-gastro-duodenoscopy (EGD) in the preceding 3 years, which did not detect UGIC. The frequency of such events and associated risk factors was evaluated. METHODS: UGIC subjects were identified from a UK primary care database. Post-EGD upper gastrointestinal cancers (PEUGIC) cases were subjects undergoing EGD 12-36 months prior to UGIC diagnosis. Controls had not undergone EGD during the same period. Logistic regression analysis examined associations with PEUGIC. RESULTS: 4249 gastric cancer (GC) subjects (44.8 %) and 5238 esophageal cancer (EC) subjects (55.2 %) were analyzed. There were 633 (6.7 %) PEUGIC subjects [279 EC and 354 GC]. Multivariate analysis revealed that younger age [OR 1.02, (95 % CI 1.01-1.03), p < 0.0001], female gender [1.39 (1.17-1.64), p < 0.0001], increasing comorbidity [1.35 (1.13-1.61), p < 0.0001], and greater deprivation [1.31 (1.09-1.59), p = 0.005] were associated with PEUGIC. Alarm symptoms on presentation [0.32 (0.26-0.40), p < 0.0001] were less likely to be associated with PEUGIC. GC was more likely to be associated with PEUGIC than EC [1.33 (1.13-1.58), p = 0.001]. PEUGIC EGDs reported findings associated with UGIC (stricture or ulceration) in 8.3 % of cases, and only 60.9 % had a follow-up EGD within 90 days. PEUGIC rate declined from 7.9 to 2.7 % for EC and 9.0-6.5 % for GC during the study period. CONCLUSIONS: PEUGIC occurs in 6.7 % of UGIC. PEUGIC was associated with GC, younger age, female gender, increasing comorbidity and deprivation, and a lack of alarm symptoms.

[Clinical and immunological assessment of Polyoxidonium and Tantum Verde efficiency by catarrhal gingivitis treatment in children with chronic gastroduodenitis].

The article presents findings allowing estimating effect of local application of polioxidonium and yantum verde in 101 children aged 12-17 with chronic catarrhal gingivitis and chronic gastroduodenitis. Statistically significant PMA indeх decrease (40.1±2.3% till 1.4±0.6% (р<0,001)) proved the above mentioned therapy scheme to be highly effective for treatment of chronic catarrhal gingivitis in children with chronic gastroduodenitis.

Additional value of upper GI tract endoscopy in the diagnostic assessment of childhood IBD.

OBJECTIVES: For the choice of treatment in children with inflammatory bowel disease (IBD), it is important to make a distinction between Crohn disease (CD) and ulcerative colitis (UC). To look for pathognomonic features of CD, upper gastrointestinal tract (UGT) endoscopy has become part of the routine evaluation of children with suspected IBD; however, pathological changes can also be found in the UGT in patients with UC. The aims of the present study were to establish the role of UGT involvement in the diagnostic assessment of suspected IBD in children and to detect histopathological changes in the UGT mucosa, which can distinguish CD from non-CD (UC and non-IBD). METHODS: Biopsies (colon, ileum, duodenum, stomach, esophagus) from children suspected of having IBD who underwent endoscopy between 2003 and 2008 were reassessed by a blinded, expert pathologist. The histological findings of the UGT were compared with the diagnosis based on ileocolonic biopsies and the final diagnosis. RESULTS: In 11% of the children with CD, the diagnosis was based solely on the finding of granulomatous inflammation in the UGT. Focal cryptitis of the duodenum and focally enhanced gastritis were found significantly more frequently in children with CD compared with children with UC and non-IBD, with a specificity and positive predictive value of 99% and 93% and 87.1% and 78.6%, respectively. CONCLUSIONS: Histology on ileocolonic biopsies alone is insufficient for a correct diagnosis of CD or UC in children. UGT endoscopy should, therefore, be performed in the diagnostic assessment of all children suspected of having IBD.

Excess comorbidity prevalence and cost associated with functional dyspepsia in an employed population.

BACKGROUND: Limited published data exist on the associated comorbid conditions with functional dyspepsia (FD). AIMS: This study aimed to assess the prevalence, services, and costs related to comorbid conditions associated with FD and the risk of having FD for each comorbid condition. METHODS: A retrospective database analysis was undertaken using payroll data and adjudicated claims from January 1, 2001, through December 31, 2004 among >300,000 employees. Employees with FD were compared to propensity-score-matched employees without FD (controls). Outcome measures included the prevalence, costs, and utilization of health services for comorbid conditions as defined by the Agency for Healthcare Research and Quality (AHRQ) and the odds ratios of having FD from a multivariate model. RESULTS: FD employees (N = 1,669) and a 50:1 matched control cohort (N = 83,450) were compared. Compared to matched controls, FD employees were more likely to have all major diagnostic categories. Moreover, 199/261 of the AHRQ's specific categories were more common in the FD cohort. Annual medical costs for the FD cohort were greater than for controls in 155/261 (59%) specific categories and significantly greater (P ≤ 0.05) in 76 categories (29%). Similarly, services were greater for 179/261 (69%) specific categories and significantly greater (P ≤ 0.05) in 110 categories (42%). In a multivariate model, esophageal disorders, gastritis and duodenitis, and abdominal pain were the most associated with having FD (odds ratios 3.8, 3.7, and 3.6, respectively). Only hypertension complications and disorders of the teeth and jaw were significantly negatively associated with FD. CONCLUSION: There is unexplained excess comorbidity associated with FD which may be a major determining factor for excess healthcare services and costs.

Gastroduodenitis and Helicobacter pylori in Nigerians: histopathological assessment of endoscopic biopsies.

OBJECTIVE: Morphologic changes seen in the endoscopic biopsies are dynamic and could be predictive of more important sequelae of chronic H. pylori gastritis such as gastric carcinoma and lymphoma. The objective of the study was to review the biopsy appearances of endoscopic gastroduodenal biopsies using the updated Sydney System of classification in order to throw some light on the biology of gastroduodenitis. METHODS: A retrospective review of all endoscopic gastroduodenal biopsies received in the department of Morbid Anatomy of Obafemi Awolowo University Teaching Hospitals Complex between 1994 and 2003 was undertaken. Grading of the chronicity, activity, atrophy, H. pylori density and metaplasia were done using the updated Sydney System of classification and grading. RESULTS: A total of 1047 gastric and 47 duodenal biopsies from 1047 patients were reviewed. There was evidence of significant chronic gastritis in 98.1% of the gastric biopsies and in 78.0% of these, H. pylori was the main identifiable aetiological agent. Marked atrophic changes and intestinal metaplasia that are known to predispose to gastric malignances were seen in 4.9% and 9.3% of our cases respectively. Chronic duodenitis was seen in 83% of the duodenal biopsies and in 29.6%, H. pylori was seen on a background of gastric metaplasia. CONCLUSION: The prevalence of H. pylori was high and it was the single most important aetiological factor responsible for the biopsy changes associated with chronic gastroduodenitis.

Faecal elastase 1 concentration is a marker of duodenal enteropathy.

BACKGROUND: Measurement of faecal elastase (FE1) is used widely to screen for pancreatic exocrine insufficiency (PI). FE1 does not allow differentiation of primary from secondary PI. AIMS: To investigate the relation between duodenal morphology and FE1 in children with secondary PI resulting from primary gastrointestinal diseases. METHODS: A group of 51 children underwent small intestinal biopsy and FE1 measurement. Villus to crypt ratio (VCR) and inflammation within the lamina propria of duodenal mucosal biopsy specimens were scored and compared with FE1 values. RESULTS: In 51 children from nine diagnostic categories, a highly significant correlation between FE1 and both duodenal morphology and inflammation was found. CONCLUSION: Small bowel enteropathy is associated with low FE1 concentrations, indicative of secondary exocrine pancreatic insufficiency.

[The assessment of the degree of the colonization of the gastric mucosa by Helicobacter pylori and of the gastritis and duodenitis activity in duodenal peptic ulcer in different age groups]. / Otsinka stupenia obsimeninnia slyzovoï obolonky shlunka Helicobacter pylori ta aktyvnosti hastrytu i duodenitu pry vyrazkovii khvorobi dvanadtsiatipaloï kyshky v riznykh vikovykh hrupakh.

The article contains intriguing data on the difference in H. pylori extents of growth in the gastric antrum mucosa of patients at various ages with duodenal ulcer (DU). A comparative evaluation was done of extents of growth, average antibody titre, and activity of gastritis of the body of antral gastritis and duodenitis in different age groups in DU. The author has come to the conclusion that in the given population, H. pylori extents of growth and activity of antral gastritis and duodenitis in DU young subjects are not lower but even higher than in those at later ages.

[Comparative assessment of antacid agents with intragastric ph-metry]. / Sravnitel'naia otsenka éffektivnosti antatsidnykh preparatov s pomoshch'iu vnutrizheludochnoi ph-metrii.

Alkalizing effects of maalox, renni and tams were compared in 63 patients (27 males and 36 females) aged 19-56 with endoscopically confirmed superficial gastroduodenitis using intragastric pH-metry. Liquid antacids (maalox) began their action quicker (1.3-1.7 times) than tablets (renni and tams) but the tablets had longer alkalizing effects. Maximal and minimal alkalizing effects were achieved with maalox and renni, respectively. It is inferred that rapid intragastric pH-metry can be used for comparative assessment of different antacid drugs. Of the drugs studied the highest antiacid effect was exhibited by maalox.

Helicobacter pylori eradication--comparison of three drug regimens and symptomatic assessment in duodenitis and antral gastritis.

Helicobacter pylori (Hp) eradication in peptic ulcer disease is associated with a greatly reduced recurrence rate. The optimal drug regimen for HP eradication remains uncertain. It is also unclear if eradication of Hp in duodenitis and antral gastritis improves symptoms. The aims of this study were to compare the efficacy of three drug regimens in the eradication of Hp and to assess if Hp eradication improved symptoms in patients with duodenitis and antral gastritis. Patients (n = 79) found to have duodenal ulcer, duodenitis and/or antral gastritis with a positive urease test (CLO) at endoscopy were allocated to one of the three regimens: A. omeprazole 20 mg b.d. and clarithromycin 500 mg t.d.s. for two weeks (n = 27), B. De-Nol 240 mg b.d. for four weeks, metronidazole 400 mg t.d.s. and amoxicillin 500 mg t.d.s. for one week (n = 26), and C. omeprazole 20 mg b.d. and amoxicillin 500 mg t.d.s. for two weeks (n = 26). In conclusion, traditional 'triple' therapy with bismuth and two antibiotics achieved the highest Hp eradication rate and was best tolerated. Recolonisation with Hp was uncommon after eradication. Dyspeptic symptoms improved with Hp eradication in duodenitis and antral gastritis.

[The assessment of the mental health of children with psychosomatic diseases]. / Otsenka psikhicheskogo zdorov'ia detei s psikhosomaticheskimi zabolevaniiami.

The mental health of children and adolescents who suffered from gastrointestinal diseases due to psychosomatic causes (duodenal ulcer, chronic gastroduodenitis) was examined. Those with the diseases are a group at risk for nervous and mental disorders, and impaired psychophysical adaptation.

Gastroduodenal mucosa in peptic ulcer: endoscopic and histological assessment.

This study aimed to assess the prevalence of endoscopic and histological gastroduodenitis as well as helicobacter-like organisms in patients with peptic ulcer. After diagnostic endoscopy, gastroduodenal biopsy specimens were taken from thirty patients (n = 30) with clinical and endoscopic diagnosis of peptic ulcer (duodenal ulcer = 25, gastric ulcer = 5). Endoscopic gastroduodenitis occurred in 18 patients (60%). Histological gastritis was detected in the gastric body or antrum in 25 (83%) and duodenitis in 17 (57%) patients. There was significant correlation between endoscopic and histological gastritis (p < 0.05). Helicobacter-like organisms occurred in 73% of the patients with peptic ulcer and in 88% of the antral biopsy specimens showing antral gastritis. Presence of helicobacter-like organisms was in particular associated with acute on chronic gastritis compared to chronic gastritis (p < 0.01). Moreover the patients with gastritis were found to belong to the older age group and 81.8% had blood group O +ve (p < 0.01 and p < 0.05 respectively). We conclude that presence of helicobacter-like organisms in patients with peptic ulcer is significantly associated with acute on chronic gastritis.

Time trends in peptic ulcer disease and in gastritis and duodenitis. Mortality, utilization, and disability in the United States.

This study compared the results of two analytic methods testing the effects of histamine H2 receptor antagonists on acid-related conditions. We examined the rates of peptic ulcer disease-related and of gastritis- and duodenitis-related mortality, hospitalizations, surgery, physician visits, work-loss, and disability retirements in the United States from 1970 to 1986. First, we performed a nonparametric epidemiologic analysis. For mortality, hospitalizations, and surgeries, age-specific rates continued their historic decline; there was an additional large one-time decline of operations in 1978. Trends were stronger for peptic ulcer than for gastritis and duodenitis. From pooled annual data, rates of physician visits and physician referral declined for peptic ulcer and for gastritis and duodenitis in the post-1977 period (p = 0.0001). Work-loss and other restrictions on normal daily activities also declined for persons with peptic ulcer and with gastritis and duodenitis (p = 0.0001). Second, we fit a parametric model by maximum likelihood to test specific population effects of H2 blockers. The model indicated that people > or = 65 years old had increasing peptic ulcer mortality rates after 1977 (p < 0.001), while people < 65 years old had a deceleration in rates of decline (p < 0.01). Hospitalization rates for peptic ulcer and for gastritis and duodenitis increased in the elderly after 1977 (p < 0.01) and decreased among those < 65 years old. Both age groups experienced similar declining trends of operations for peptic ulcer; these were not significantly different when pre- and post-1977 periods were compared. The rate of disability retirement declined sharply for workers > or = 50 years old (p < 0.01) and for those < 50 years of age (p < 0.001). The inconclusive results of the parametric analysis, plus only partial congruence between parametric and nonparametric analyses, emphasize the difficulty of relating diverse effects over time to a single, new, more effective treatment.

[Tubeless methods of the assessment of functional state of digestive organs in hormonal disorders]. / Bezzondovye metody otsenki funktsional'nogo sostoianiia organov pishchevareniia pri gormonal'nykh narusheniiakh.

The function of the stomach, pancreas, and intestine was studied in patients with chronic duodenitis without resorting to intubation. Disordered relationships between the hormones participating in the functioning of the hypophyseo-antral and entero-thyroid axis, resulting in trophic disorders in the gastroduodenal zone, are associated with characteristic shifts shown by methods of investigation other than intubation: drastically increased acid production in the presence of unchanged activity of urinary amylase before and after nutrient stimulation, combined with amylasorrhea. Diagnostic methods without intubation can earlier detect gastroduodenal diseases of dyshormonal etiology, particularly in children. Such methods may be used for initial screening, preceding more profound studies of both the hormonal status and the function of the organs of digestion.

Coeliac disease with histological features of peptic duodenitis: value of assessment of intraepithelial lymphocytes.

AIMS: To determine if a clinically important polymorphonuclear leucocyte infiltrate and surface gastric epithelial metaplasia occur in the second part of the duodenum in coeliac disease; to evaluate the utility of these morphological criteria in the differential diagnosis of coeliac disease and peptic duodenitis. METHODS: 49 mucosal biopsy specimens of the second part of the duodenum reported as showing inflammation were reviewed. Sections were prepared with haematoxylin and eosin, periodic acid Schiff, and Warthin-Starry stains. Clinical presentation, outcome, and immunological investigations were assessed. RESULTS: Four cases confirmed as coeliac disease on clinical and immunological grounds showed acute inflammation and surface epithelial gastric metaplasia. Increased intraepithelial lymphocytes (IELs) were found in each of the four. CONCLUSIONS: Clinically important polymorphonuclear leucocyte infiltration and surface epithelial gastric metaplasia may occur in the duodenal mucosa in coeliac disease and should not be used as diagnostic features to exclude the diagnosis of coeliac disease in the absence of confirmatory clinical and immunological information.

Patterns of care and expenditures by California Medicaid for peptic ulcer and other acid-related diseases.

We examined California Medicaid (Medi-Cal) service use and expenditures for peptic ulcer and other acid-related diseases during the 10-year period fiscal year (FY) 1976-1985. Between FY 1976 and FY 1980, hospitalizations rose irregularly, operations declined by 37%, endoscopies tripled, physician visits fluctuated from year to year, antacid prescriptions increased by 36%, and anticholinergic medication use was stable. From FY 1981 to FY 1985, hospitalizations declined by 52%, operations by 91%, endoscopies by 45%, physician visits by 30%, antacid use by 12%, and anticholinergic medication use by 48%. H2 antagonists were allowed onto Medi-Cal formulary near the end of FY 1980, and use rose sharply through 1985. Similar results were found across specific gastrointestinal (GI) diagnoses. Total payments for acid-related conditions were essentially stable during FY 1976-1980 period, although, for individual services, utilization and expenditures did not always move in the same direction. For example, declining operations rates and stable expenditures were found. However, during FY 1981-85, changes in rates of service use were generally matched by similar changes in total expenses for that service. For example, the 40% reduction in rate of endoscopies was accompanied by a near 50% decline in payments. Overall expenditures for all acid-related diagnoses fell by nearly 28% between 1981 and 1985. We concluded that the introduction of H2 antagonists had important positive clinical effects on all studied acid-related GI diagnoses.