Effect of Helicobacter pylori infection and its eradication on gastric regenerating atypia in 22 133 subjects.

BACKGROUND AND AIM: The aim of this study was to identify factors affecting persistent gastric regenerating atypia and determine the effect of Helicobacter pylori eradication on the course of this lesion. METHODS: In cross-sectional setting, comprehensive health check-up subjects who underwent both endoscopy and H. pylori test from 2001 to 2009 were included. The association between H. pylori and gastric regenerating atypia was evaluated. In cohort setting, patients with regenerating atypia who underwent H. pylori test from 2001 to 2013 were included. Factors affecting positive pathology (persistent regenerating atypia or new development of neoplasm) in patients with regenerating atypia at baseline were investigated. RESULTS: In cross-sectional setting, regenerating atypia was observed in 1.1% (241/22 133). H. pylori infection was associated with gastric regenerating atypia (adjusted odds ratio, 1.47; 95% confidence interval [CI], 1.12-1.91). In cohort setting, 310 patients with regenerating atypia were finally eligible. Positive pathology rate during follow up was 16.1% (15/93) in the persistent infection group, 2.8% (3/106) in successful eradication group, and 4.5% (5/111) in baseline H. pylori-negative group. Persistent H. pylori infection increased the risk of positive pathology (adjusted risk ratio [RR], 7.18; 95% CI, 1.95-26.48) compared to H. pylori eradication group. Persistent H. pylori infection increased the risk of regenerative atypia (adjusted RR, 5.70; 95% CI, 1.46-22.17) and new neoplasm (adjusted RR, 10.74; 95% CI, 1.10-105.17) compared to baseline negative H. pylori. CONCLUSIONS: H. pylori infection is an independent risk factor for gastric regenerating atypia. Eradication of H. pylori seems helpful for regression of regenerating atypia.

Helicobacter pylori infection is an independent risk factor for colonic adenomatous neoplasms.

PURPOSE: Helicobacter pylori infection is considered to have a positive association with colorectal neoplasms. In this study, we evaluated the association between H. pylori infection and colorectal adenomas, based on the characteristics of these adenomas in Korea, where the prevalence of H. pylori infection is high and the incidence of colorectal cancer continues to increase. METHODS: The study cohort consisted of 4,466 subjects who underwent colonoscopy and esophagogastroduodenoscopy during screening (1,245 colorectal adenomas vs. 3,221 polyp-free controls). We compared the rate of H. pylori infection between patients with adenoma and polyp-free control cases, using multivariable logistic regression analysis. RESULTS: The overall rate of positive H. pylori infection was higher in adenoma cases than in polyp-free control cases (55.0 vs. 48.5%, p < 0.001). The odds ratio (OR) of positive H. pylori infection in patients with adenoma compared to polyp-free controls was 1.28 (95% CI 1.11-1.47). The positive association of H. pylori infection with colorectal adenomas was more prominent in advanced adenomas (OR 1.84, 95% CI 1.25-2.70) and multiple adenomas (OR 1.72, 95% CI 1.26-2.35). Based on the location of these adenomas, the OR was significant only in patients with colonic adenomas (OR 1.31, 95% CI 1.13-1.52) and not in those with rectal adenoma (OR 0.85, 95% CI 0.58-1.24). CONCLUSION: Helicobacter pylori infection is an independent risk factor for colonic adenomas, especially in cases of advanced or multiple adenomas, but not for rectal adenomas.

Visceral Adipose Tissue Volume and the Occurrence of Colorectal Adenoma in Follow-up Colonoscopy for Screening and Surveillance.

Whether obesity accelerates adenoma recurrence is not yet clear; therefore, we analyzed the risk factors for adenoma occurrence at follow-up colonoscopy, with a focus on visceral adiposity. In total, 1516 subjects underwent index colonoscopy, computed tomography, and questionnaire assessment from February to May 2008; 539 subjects underwent follow-up colonoscopy at the National Cancer Center at least 6 mo after the index colonoscopy. The relationships between the presence of adenoma at follow-up colonoscopy and anthropometric obesity measurements, including body mass index (BMI), waist circumference (WC), visceral adipose tissue (VAT) volume, and subcutaneous adipose tissue (SAT) volume, were analyzed. 188 (34.9%) had adenomatous polyps at follow-up colonoscopy. Multivariate analysis revealed that VAT volume ≥ 1000 cm3 and BMI ≥ 30 kg/m2 were related to the presence of adenoma at follow-up colonoscopy (VAT volume 1000-1500 cm3: odds ratio [OR] = 2.13(95% confidence interval, CI = 1.06-4.26), P = 0.034; VAT volume ≥ 1000 cm3: OR = 2.24(95% CI = 1.03-4.88), P = 0.043; BMI ≥ 30 kg/m2: OR = 4.22(95% CI = 1.12-15.93), P = 0.034). In contrast, BMI 25-29.9 kg/m2, SAT volume, and WC were not associated with the presence of adenoma at follow-up colonoscopy. In conclusion, excess VAT can contribute to the development and growth of new colorectal adenomas, and is a better predictor of colorectal adenoma occurrence at follow-up colonoscopy than BMI, WC, and SAT volume.

Effects of Helicobacter pylori infection and its eradication on lipid profiles and cardiovascular diseases.

BACKGROUND: We aimed to examine the relationship of current Helicobacter pylori infection with lipid profile and cardiovascular disease and its eradication effect. METHODS: Healthy subjects, who underwent routine checkup between October 2003 and December 2007, were followed up until June 2009. Helicobacter pylori and lipid profiles were measured both baseline and follow-up. Multiple logistic regression models for odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the effects of H. pylori infection and its eradication, on lipids and cardiovascular disease. RESULTS: Current infection with H. pylori with 50.5% (6759/13383) at baseline increased low-density lipoprotein (LDL) and decreased high-density lipoprotein (HDL) than H. pylori-negative group. Successful eradication of H. pylori decreased the risk of high LDL compared with the persistent infection (OR 0.76, 95% CI 0.59-96), which was comparable to that of the persistent negative group (OR 0.82, 95% CI 0.70-0.97), and decreased the risk of low HDL (OR 0.68, 95% CI 0.49-0.96). Current infection of H. pylori increased the risk of cardiovascular disease (OR 3.27, 95% CI 1.31-8.14) at baseline, but its eradication failed to decrease the risk at a 2-year follow-up. However, persistent negative infection decreased the risk (OR 0.57, 95% CI 0.35-0.94) comparing to persistent positive infection at follow-up. CONCLUSIONS: Current infection with H. pylori had a positive association with high LDL, low HDL, and cardiovascular disease. Successful H. pylori eradication decreased the risk of high LDL and low HDL, but did not reduce the risk of cardiovascular disease.

Healthcare Professionals' Learning Needs and Perspectives on Essential Information in Genetic Cancer Care: A Systematic Review.

BACKGROUND: The increased demand for genetic testing and counseling necessitates healthcare professionals (HCPs) to improve their genetic competency through training programs. This systematic review identified HCPs' learning needs and their perspectives on essential information for families with hereditary cancer. METHODS: This review covered studies published from 2013 to 2024 across five databases. Data were analyzed using a content analysis. RESULTS: Thirteen studies involving 332 HCPs were analyzed. Most studies focused on the learning needs of physicians caring for families affected by Hereditary Breast and Ovarian Cancer in North America and Europe. HCPs required training emphasizing practical counseling skills over the basics of genetics. Learning needs varied by profession: physicians needed training in assessing cancer risk and supporting decision-making in risk management; nurses required information on resources and the genetic care system; genetic counselors sought guidance on family communication and planning. Essential information identified for families included risk-reducing strategies, personalized cancer risk assessment, family implications, psychological issues, (cascade) genetic testing, and social concerns. CONCLUSIONS: The findings have implications for the development of training programs for HCPs, emphasizing the need for tailored training based on professions. Future research should explore the needs of HCPs caring for families with diverse hereditary cancers and cultural backgrounds.

Prevalence and Risk Factors of Germline Pathogenic Variants in Pancreatic Ductal Adenocarcinoma.

PURPOSE: The genetic attribution for pancreatic ductal adenocarcinoma (PDAC) has been reported as 5%-10%. However, the incidence of germline pathogenic variants (PVs) in Korean PDAC patients has not been thoroughly investigated. Therefore, we studied to identify the risk factors and prevalence of PV for future treatment strategies in PDAC. MATERIALS AND METHODS: Total of 300 (155 male) patients with a median age of 65 years (range, 33 to 90 years) were enrolled in National Cancer Center in Korea. Cancer predisposition genes, clinicopathologic characteristics, and family history of cancer were analyzed. RESULTS: PVs were detected in 20 patients (6.7%, median age 65) in ATM (n=7, 31.8%), BRCA1 (n=3, 13.6%), BRCA2 (n=3), and RAD51D (n=3). Each one patient showed TP53, PALB2, PMS2, RAD50, MSH3, and SPINK1 PV. Among them, two likely PVs were in ATM and RAD51D, respectively. Family history of various types of cancer including pancreatic cancer (n=4) were found in 12 patients. Three patients with ATM PVs and a patient with three germline PVs (BRCA2, MSH3, and RAD51D) had first-degree relatives with pancreatic cancer. Familial pancreatic cancer history and PVs detection had a significant association (4/20, 20% vs. 16/264, 5.7%; p=0.035). CONCLUSION: Our study demonstrated that germline PVs in ATM, BRCA1, BRCA2, and RAD51D are most frequent in Korean PDAC patients and it is comparable to those of different ethnic groups. Although this study did not show guidelines for germline predisposition gene testing in patients with PDAC in Korea, it would be emphasized the need for germline testing for all PDAC patients.

Association of colorectal adenoma with components of metabolic syndrome.

PURPOSE: Recently, some studies have shown that diabetes mellitus and metabolic syndrome increase the risk of colorectal neoplasms. Although the mechanism is not known, those have been proposed to contribute to this phenomenon, including insulin resistance, oxidative stress, and adipokine production. The objective of this study was to assess the association between metabolic risk factors and colorectal neoplasm. METHODS: Study participants visited the National Cancer Center, Korea, for screening (2007-2009). A total of 1,771 diagnosed adenoma patients and 4,667 polyp-free controls were included. The association between risk factors and colorectal neoplasm was evaluated using logistic regression models. RESULTS: High waist circumference, blood pressure, and serum triglyceride levels were associated with an increased risk of colorectal adenoma. Metabolic syndrome (MS) was associated with an increased risk of adenoma (OR = 1.44, 95 % CI = 1.23-1.70). The association between MS and colorectal adenoma was observed regardless of advanced/low-risk adenoma, and multiplicity. MS affected right colon adenomas (OR = 1.50, 95 % CI = 1.22-1.85), left colon adenomas (OR = 1.36, 95 % CI = 1.05-1.76), and adenomas in multiple anatomical locations (OR = 1.59, 95 % CI = 1.19-2.12), but was not associated with rectum. CONCLUSION: Central obesity, triglyceride level, and MS are risk factors for colorectal adenoma including advanced adenoma and multiplicity.

Differences in Willingness to Undergo BRCA1/2 Testing and Risk Reducing Surgery among the General Public, Cancer Patients, and Healthcare Professionals: A Large Population-Based Survey.

We aimed to understand the decision-making process related to the willingness to undergo BRCA1/2 genetic testing, risk-reducing salpingo-oophorectomy (RRSO), or risk-reducing mastectomy (RRM) among the general public, cancer patients, and healthcare professionals in South Korea. In total, 3444 individuals (1496 from the general public, 1500 cancer patients, 108 clinicians, and 340 researchers) completed a survey addressing genetic testing and related risk management options in a hypothetical scenario. Differences in intent and associated factors for undergoing the above procedures or sharing test results were analyzed. Overall, 67% of participants were willing to undergo BRCA1/2 testing, with proportions of the general public (58%), cancer patients (70%), clinicians (88%), and researchers (90%). The willingness to undergo RRSO was highest among clinicians (58%), followed by among patients (38%), the general public (33%), and researchers (32%) (p < 0.001). Gender, age, education level, and household income were associated with willingness to undergo genetic testing, RRM, and RRSO (p < 0.05). The intent for undergo genetic testing, RRM, and RRSO were affected by many factors. Finally, 69% of the general public intended to share information with family, while this percentage was 92%, 91%, and 94% for patients, clinicians, and researchers, respectively (p < 0.05). These results highlight the requirement for developing targeted educational materials and counseling strategies for facilitating informed decision making.

Osteoporosis Is Associated with an Increased Risk of Colorectal Adenoma and High-Risk Adenoma: A Retrospective, Multicenter, Cross-Sectional, Case-Control Study.

Background/Aims: The protective effects of vitamin D and calcium on colorectal neoplasms are known. Bone mineral density (BMD) may be a reliable biomarker that reflects the long-term anticancer effect of vitamin D and calcium. This study aimed to evaluate the association between BMD and colorectal adenomas including high-risk adenoma. Methods: A multicenter, cross-sectional, case-control study was conducted among participants with average risk of colorectal cancer who underwent BMD and screening colonoscopy between 2015 and 2019. The main outcome was the detection of colorectal neoplasms. The variable under consideration was low BMD (osteopenia/osteoporosis). The logistic regression model included baseline demographics, components of metabolic syndrome, fatty liver disease status, and aspirin and multivitamin use. Results: A total of 2,109 subjects were enrolled. The mean age was 52.1±10.8 years and 42.6% were male. The adenoma detection rate was 43%. Colorectal adenoma and high-risk adenoma were both more prevalent in subjects with low BMD than those with normal BMD (48.2% vs 38.8% and 12.1% vs 9.1%). In the univariate analysis, old age, male sex, smoking, metabolic components, fatty liver, and osteoporosis were significantly associated with the risk of adenoma and high-risk adenoma. In the multivariate analysis, osteoporosis was independently associated with risk of colorectal adenoma (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.11 to 2.46; p=0.014) and high-risk adenoma (OR, 1.94; 95% CI, 1.14 to 3.29; p=0.014). Conclusions: Osteoporosis is an independent risk factor of colorectal adenoma and high-risk adenoma.

Abdominal visceral adipose tissue volume is associated with increased risk of erosive esophagitis in men and women.

BACKGROUND & AIMS: Data on the association between erosive esophagitis and obesity are inconsistent because of variations in study populations and methods used to determine obesity. METHODS: Participants in a prospective health-screening cohort underwent esophagogastroduodenoscopy and computed tomography. The association between erosive esophagitis and obesity (measured by body mass index [BMI], waist circumference, and abdominal visceral adipose tissue volume) was estimated with odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for confounding factors. We also analyzed the association between obesity and erosive esophagitis by sex. RESULTS: The prevalence of erosive esophagitis was 9.3% (495/5329). The OR for erosive esophagitis correlated with obesity measured by BMI, waist circumference, and abdominal visceral adipose tissue volume (P < .001 for each factor). The multivariate OR for erosive esophagitis was 1.97 (95% CI: 1.34-2.90) for a visceral adipose tissue volume of 500-999 cm(3), 2.27 (95% CI: 1.51-3.39) for 1000-1499 cm(3), and 2.94 (95% CI: 1.87-4.62) for ≥1500 cm(3), compared with participants who had visceral adipose tissue volumes less than 500 cm(3). When measures of obesity were analyzed simultaneously, abdominal visceral adipose tissue volume, but not BMI or waist circumference, was associated with erosive esophagitis. The 3 measures of obesity were significantly associated with erosive esophagitis in males, but only visceral adipose tissue volume was associated with erosive esophagitis in females (P = .002). CONCLUSIONS: In contrast to BMI or waist circumference, abdominal visceral adipose tissue volume is associated with an increased risk of erosive esophagitis in males and females.

The risk of gastrointestinal hemorrhage with non-vitamin K antagonist oral anticoagulants: A network meta-analysis.

BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) have been widely used for stroke prevention in atrial fibrillation (AF) and the treatment and prevention of venous thromboembolism. There is an issue with safety, especially in clinically relevant bleeding. We performed a network meta-analysis to evaluate the risk of major gastrointestinal (GI) bleeding associated with NOACs. METHODS: Interventions were warfarin, enoxaparin, apixaban, dabigatran, edoxaban, and rivaroxaban. The primary outcome was the incidence of major GI bleeding. A subgroup analysis was performed according to the following indications: AF, deep venous thrombosis/pulmonary embolism, and postsurgical prophylaxis. RESULTS: A total of 29 randomized controlled trials (RCTs) and 4 large observation population studies were included. Compared with warfarin, apixaban showed a decreased the risk of major GI bleeding (relative risk [RR] 0.54, 95% confidence interval [CI] 0.25-0.76), and rivaroxaban tended to increase this risk (RR 1.40, 95% CI 1.06-1.85). Dabigatran (RR 1.25, 95% CI 0.98-1.60), edoxaban (RR 1.07, 95% CI 0.69-1.65), and enoxaparin (RR 1.24, 95% CI 0.63-2.43) did not significantly increase the risk of GI bleeding than did warfarin. In the subgroup analysis, according to indications, apixaban showed a decreased risk of major GI bleeding (RR 0.50, 95% CI 0.34-0.74) than did warfarin in AF studies. Dabigatran (RR 2.36, 95% CI 1.55-3.60, and rivaroxaban (RR 1.75, 95% CI 1.10-6.41) increased the risk of major GI bleeding than did apixaban. An analysis of studies on venous thromboembolism or pulmonary embolism showed that no individual NOAC or enoxaparin was associated with an increased risk of major GI bleeding compared to warfarin. CONCLUSION: Individual NOACs had varying profiles of GI bleeding risk. Results of analyses including only RCTs and those including both RCTs and population studies showed similar trends, but also showed several differences.

Abdominal visceral adipose tissue predicts risk of colorectal adenoma in both sexes.

BACKGROUND & AIMS: Small studies have shown inconsistent results regarding the association between abdominal visceral adipose tissue and colorectal adenomas. We evaluated the effects of visceral adipose tissue volume on the development and growth of colorectal adenomas. METHODS: A total of 3922 participants underwent colonoscopy and computed tomography from February to November 2008. The associations between waist circumference, visceral adipose tissue volume, and colorectal adenomas were estimated with adjusted odds ratios and 95% confidence intervals (CIs). In addition, the association between characteristics of colorectal adenomas and visceral adipose tissue volume was evaluated. RESULTS: Compared with participants who had visceral adipose tissue volume of less than 500 cm(3), the odds ratio for colorectal adenoma was 1.09 (95% CI, 0.87-1.36) for a volume of 500 to 999 cm(3), 1.33 (95% CI, 1.04-1.69) for a volume of 1000 to 1499 cm(3), and 1.43 (95% CI, 1.06-1.94) for a volume of 1500 cm(3) or greater. The risk of colorectal adenomas increased with increasing visceral adipose tissue volume in both sexes (P trend = .004 in men and .009 in women). Waist circumference was associated with colorectal adenomas in men (P trend = .02), but not in women. High volume of visceral adipose tissue (>or=1000 cm(3)) had a positive association with larger adenomas (>or=10 mm) and multiple adenomas. CONCLUSIONS: Abdominal visceral adipose tissue volume can contribute to the development and growth of colorectal adenomas, and it was a better predictor for risk of colorectal adenomas than body mass index or waist circumference in both sexes.

Effect of Helicobacter pylori infection and its eradication on reflux esophagitis and reflux symptoms.

OBJECTIVES: We evaluated the association between current Helicobacter pylori infection and reflux esophagitis and the effect of H. pylori eradication on reflux esophagitis in a healthy screening population. METHODS: A total of 10,102 subjects in a comprehensive screening cohort were enrolled, and 4,007 subjects had follow-up after a median of 2 years. Effects of H. pylori infection on reflux esophagitis were estimated with odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression analysis. We evaluated the change in prevalence of reflux esophagitis and reflux symptoms after H. pylori eradication vs. persistence. RESULTS: The prevalence of reflux esophagitis (as classified by the Los Angeles system) was 4.9% (490/10,102). Whereas the prevalence of reflux esophagitis was 6.4% (319/4,971) in subjects without H. pylori infection, it was 3.3% (171/5,131) in subjects with infection (P<0.001). H. pylori infection had a strong negative association with reflux esophagitis in multivariate analysis (OR 0.42; 95% CI, 0.34-0.51). Compared with the prevalence of reflux esophagitis in the persistent infection group, the prevalence of reflux esophagitis increased after successful H. pylori eradication (OR 2.34; 95% CI, 1.45-3.76; P<0.001), which was comparable to that of the H. pylori-negative group (OR 2.42; 95% CI, 1.73-3.36; P<0.001). However, reflux symptoms had no association with H. pylori infection or eradication. CONCLUSIONS: In a healthy screening population, H. pylori infection had a strong negative association with reflux esophagitis, but H. pylori eradication increased the prevalence of erosive esophagitis to the level of H. pylori-negative individuals. Long-term clinical significance of newly developed erosive esophagitis after H. pylori eradication should be evaluated prospectively.

Risk factors associated with gastric cancer in patients with a duodenal ulcer.

BACKGROUND: Although gastric cancer (GC) and duodenal ulcer (DU) are both strongly associated with Helicobacter pylori infection, a DU is negatively associated with the risk of GC. The aim of the study is to evaluate histologic risk factors for GC among patients with a DU. MATERIALS AND METHODS: A total of 541 consecutive patients with GC were prospectively evaluated for the presence of a DU. Control patients with only a DU (n = 89) were recruited from health screening population. Histologic grading was assessed using the updated Sydney system for six gastric biopsies from three regions. GC risk among patients with a DU was evaluated using logistic regression analysis. RESULTS: Among patients with GC, 7.6% (41/541) had a concomitant DU or an ulcer scar. Corpus-predominant/pangastritis were more frequently found in concomitant GC patients with a DU (90%) than in patients with a DU alone (62%) (p = .001). In patients with a DU, moderate-severe chronic inflammation at the lesser and greater curvatures of corpus was associated with GC risk (OR, 3.70; 95% CI, 1.46-9.36, and OR, 7.72; 95% CI, 3.18-18.7, respectively). Additionally, moderate-severe intestinal metaplasia (IM) at the antrum and corpus lesser curvature was associated with GC risk (OR, 7.52; 95% CI, 3.06-18.5, and OR, 9.25, 95% CI, 2.39-35.8, respectively). CONCLUSIONS: A DU is not rare in patients with GC in a high-risk region of GC. Patients with a DU with chronic corpus gastritis and IM have an increased risk of GC, thus those patients should be followed up for GC development.

The prevalence and clinical characteristics of reflux esophagitis in koreans and its possible relation to metabolic syndrome.

The prevalence of reflux esophagitis is increasing in Korea. To estimate the prevalence and clinical characteristics of reflux esophagitis in healthy subjects, we retrospectively examined the medical records of healthy subjects undergoing a routine check-up from October 2004 to September 2005. A total of 6,082 (3,590 men, mean age 44+/-10 yr) subjects were enrolled in this study. The prevalence of reflux esophagitis in healthy subjects was 10.5%. According to the univariate analysis, male sex (odds ratio [OR] 3.49, 95% confidence interval [CI] 2.84-4.30), smoking history (OR 1.91, 95% CI 1.60-2.28), body mass index (BMI) >30 kg/m(2) (OR 2.13, 95% CI 1.37-3.33), total cholesterol >250 mg/dL (OR 1.50, 95% CI 1.05-2.14), low-density lipoprotein (LDL) cholesterol >/=160 mg/dL (OR 1.52, 95% CI 1.08-2.14), triglyceride >/=150 mg/dL (OR 1.92, 95% CI 1.61-2.30), high blood pressure (BP) (OR 1.46, 95% CI 1.20-1.76), and fasting glucose >/=110 mg/dL (OR 1.45, 95% CI 1.13-1.86) were significantly associated with reflux esophagitis (all p<0.05). However, age, alcohol drinking and Helicobacter pylori infection were not associated with reflux esophagitis. In conclusion, significant relationships of reflux esophagitis with obesity, low high-density lipoprotein (HDL) cholesterol, high triglyceride, high BP, and elevated fasting glucose suggested that reflux esophagitis might represent the disease spectrum of the metabolic syndrome.

Sectional Analysis of Learning on the KAIST-Ewha Colonoscopy Simulation II.

The goal of this study is to validate the KAIST-Ewha Colonoscopy Simulation II as a training tool by examining the sectional learning curve of the trainees' performance on the simulation. Nine subjects including three fellows and six residents in the internal medicine participated in this study. All the subjects practiced the colonoscopy on the simulation until their performance surpasses the criteria preset by colonoscopy experts. Performance of the subjects during all the trials was measured in terms of eight performance indices and analyzed according to the colon segments. The results show that the trainees' skills significantly improved through training on the KAIST-Ewha Colonoscopy Simulation II. Particularly, most of the improvement appeared in the sigmoid and descending colon. On the other hand, there was little improvement in the ascending colon.

Gender-specific Effect of Micronutrient on Non-erosive Reflux Disease and Erosive Esophagitis.

BACKGROUND/AIMS: The effect of dietary micronutrients on non-erosive reflux disease (NERD) and reflux esophagitis is unclear. We aim to evaluate the gender-specific effect of micronutrient on erosive esophagitis and NERD. METHODS: A total of 11 690 participants underwent endoscopy and completed 3-day recordings for dietary intake and questionnaires for reflux symptoms from 2004 to 2008. To evaluate the effect of dietary micronutrients on NERD or erosive esophagitis, adjusted regression analysis with odds ratio (OR) and 95% confidence interval (CI) was used. In addition, we performed gender-specific analysis. RESULTS: Prevalence of NERD and erosive esophagitis was 6.8% and 11.2% in men and 9.1% and 2.4% in women. In adjusted analysis, high intake of vitamin A (OR, 0.78; 95% CI, 0.64-0.96), retinol (OR, 0.73; 95% CI, 0.59-0.90), vitamin B2 (OR, 0.68; 95% CI, 0.54-0.87), vitamin B6 (OR, 0.75; 95% CI, 0.58-0.96), folic acid (OR, 0.77; 95% CI, 0.62-0.96), calcium (OR, 0.66; 95% CI, 0.53-0.82), and iron (OR, 0.68; 95% CI, 0.53-0.87) had an inverse association with NERD. However, erosive esophagitis has no relationship with micronutrients except vitamin C (OR, 0.78; 95% CI, 0.62-0.98). High dietary intake of calcium reduced the risk of NERD in men and high dietary intake of many micronutrients reduced NERD in women. CONCLUSIONS: While many dietary micronutrients reduced NERD, they had no effect on erosive esophagitis. The effect of micronutrient on NERD was more prominent in women than men.

Association of current Helicobacter pylori infection and metabolic factors with gastric cancer in 35,519 subjects: A cross-sectional study.

Background: The effect of current infection of Helicobacter pylori on gastric cancer has rarely been studied in a large population. We investigated the association of current H. pylori infection and metabolic factors with gastric cancer in a large population. Methods: Persons who made their first visit to the National Cancer Center for a health examination, including endoscopy and H. pylori testing using gastric tissue between 2003 and 2013, were included. The association of H. pylori with gastric cancer was estimated using odds ratios (ORs) and 95% confidence intervals (CIs). Results: Among 35,519 people, 113 gastric cancer and 158 gastric dysplasia cases were detected. In the adjusted analysis, gastric cancer was associated with current H. pylori infection (OR, 2.39; 95% CI, 1.53-3.74), age (OR, 1.06; 95% CI 1.04-1.08), first-degree relatives with gastric cancer (OR, 2.08; 95% CI, 1.30-3.32) and hyperglycaemia (OR, 1.66; 95% CI, 1.04-2.65), whereas it was inversely associated with high-density lipoprotein (HDL) (OR, 0.49; 95% CI, 0.22-0.94). In the subanalysis, gastric cancer was associated with first-degree relatives with gastric cancer (OR, 3.23; 95% CI, 1.39-7.50) in the absence of H. pylori, whereas it was associated with hyperglycaemia (OR, 1.98; 95% CI, 1.16-3.39) in the presence of H. pylori. Conclusions: Gastric cancer was associated with current H. pylori infection, hyperglycaemia, and low HDL levels in a large population.

Rate and predictive factors of Helicobacter pylori recurrence: Analysis of a screening cohort.

BACKGROUND/AIM: The aim of the study was to identify the recurrence rate of Helicobacter pylori after successful eradication in an endemic area and investigate baseline and clinical factors related to the recurrence. PATIENTS AND METHODS: H. pylori infected patients from a screening cohort of National Cancer Center between 2007 and 2012 were enrolled in the study. A total of 647 patients who were confirmed to be successfully eradicated were annually followed by screening endoscopy and rapid urease test. Median follow-up interval was 42 months. Annual recurrence rate of H. pylori was identified. Demographics, clinical factors, and endoscopic findings were compared between H. pylori recurrence group and persistently eradicated group (control group). RESULTS: H. pylori recurrence was observed in 21 (3.25%) patients. Its annual recurrence rate was 0.91% (1.1% in males and 0.59% in females). Mean age was higher in the recurrence group than that in the control group (55.9 vs 50.7, P = 0.006). Median follow-up was shorter in the recurrence group than that in the control group (34 vs. 42.5 months, P = 0.031). In multivariate analysis, OR for H. pylori recurrence was 1.08 per each increase in age (P = 0.012). Adjusted ORs for H. pylori recurrence were 0.20 (95% CI: 0.06-0.69) and 0.25 (95% CI: 0.08-0.76) in age groups of 50-59 years and less than 50 years, respectively, compared to the group aged 60 years or older. CONCLUSION: H. pylori recurrence rate in Korea is very low after successful eradication. Advanced age is at increased risk for H. pylori recurrence. Thus, H. pylori treatment for patients who are under 60 years of age is more effective, leading to maintenance of successful eradication status.

Effect of Abdominal Visceral Fat Change on the Regression of Erosive Esophagitis: A Prospective Cohort Study.

Background/Aims: Although abdominal visceral fat has been associated with erosive esophagitis in cross-sectional studies, there are few data on the longitudinal effect. We evaluated the effects of abdominal visceral fat change on the regression of erosive esophagitis in a prospective cohort study. Methods: A total of 163 participants with erosive esophagitis at baseline were followed up at 34 months and underwent esophagogastroduodenoscopy and computed tomography at both baseline and follow-up. The longitudinal effects of abdominal visceral fat on the regression of erosive esophagitis were evaluated using relative risk (RR) and 95% confidence intervals (CIs). Results: Regression was observed in approximately 49% of participants (n=80). The 3rd (RR, 0.13; 95% CI, 0.02 to 0.71) and 4th quartiles (RR, 0.07; 95% CI, 0.01 to 0.38) of visceral fat at follow-up were associated with decreased regression of erosive esophagitis. The highest quartile of visceral fat change reduced the probability of the regression of erosive esophagitis compared to the lowest quartile (RR, 0.10; 95% CI, 0.03 to 0.28). Each trend showed a dose-dependent pattern (p for trend <0.001). The presence of baseline Helicobacter pylori increased the regression of erosive esophagitis (RR, 2.40; 95% CI, 1.05 to 5.48). Conclusions: Higher visceral fat at follow-up and a greater increase in visceral fat reduced the regression of erosive esophagitis in a dose-dependent manner.