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1.
J Antimicrob Chemother ; 79(9): 2263-2272, 2024 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-38973619

RESUMEN

BACKGROUND: With the increasing prevalence of antibiotic resistance, real-world data on the optimal empirical second-line therapy for Helicobacter pylori are still limited. OBJECTIVES: To evaluate the real-world efficacy of various second-line therapies for H. pylori. PATIENTS AND METHODS: This was a retrospective population-based cohort study of all H. pylori-infected patients who had received the second-line treatment after the failure of primary clarithromycin triple therapy in Hong Kong between 2003 and 2018. The retreatment success rates of different second-line therapies were evaluated. RESULTS: A total of 7591 patients who received second-line treatment were included. Notably, the most commonly prescribed regimen was still clarithromycin triple therapy, but the frequency of use had decreased from 59.5% in 2003-06 to 28.7% in 2015-18. Concomitant non-bismuth quadruple therapy had emerged as the commonest regimen (from 3.3% to 43.9%). In a validation analysis, the sensitivity and specificity of retreatment-inferred second-line treatment failure were 88.3% and 97.1%, respectively. The overall success rate of second-line therapies was 73.6%. Bismuth quadruple therapy had the highest success rate of 85.6%, while clarithromycin triple therapy had the lowest success rate of 63.5%. Specifically, bismuth/metronidazole/tetracycline quadruple, metronidazole/tetracycline triple, levofloxacin/metronidazole/tetracycline quadruple, rifabutin/amoxicillin triple and amoxicillin/levofloxacin triple therapies had relatively higher success rates over 80%. Age, treatment duration, baseline conditions and first-line treatment used were associated with success rate. CONCLUSIONS: Bismuth quadruple therapy was the most effective second-line regimen for H. pylori in this real-world study. Despite a very low success rate, clarithromycin-containing triple therapies were still commonly used as second-line regimens.


Asunto(s)
Antibacterianos , Claritromicina , Quimioterapia Combinada , Infecciones por Helicobacter , Helicobacter pylori , Humanos , Infecciones por Helicobacter/tratamiento farmacológico , Estudios Retrospectivos , Femenino , Masculino , Helicobacter pylori/efectos de los fármacos , Antibacterianos/uso terapéutico , Persona de Mediana Edad , Claritromicina/uso terapéutico , Hong Kong , Adulto , Anciano , Resultado del Tratamiento , Metronidazol/uso terapéutico , Retratamiento , Amoxicilina/uso terapéutico , Insuficiencia del Tratamiento , Inhibidores de la Bomba de Protones/uso terapéutico , Inhibidores de la Bomba de Protones/administración & dosificación , Levofloxacino/uso terapéutico
2.
Ecotoxicol Environ Saf ; 270: 115829, 2024 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-38103521

RESUMEN

Impact of air pollution on incident chronic kidney disease (CKD) in diabetic patients is insufficiently studied. We aimed to examine exposure-response associations of PM2.5, PM10, PM2.5-10, NO2, and NOX with incident CKD in diabetic patients in the UK. We also widened exposure level of PM2.5 and examined PM2.5-CKD association in diabetic patients across the entire range of global concentration. Based on data from UK biobank cohort, we applied Cox proportional hazards models and the shape constrained health impact function to investigate the associations between air pollutants and incident CKD in diabetic patients. Global exposure mortality model was applied to combine the PM2.5-CKD association in diabetic patients in the UK with all other published associations. Multiple air pollutants were positively associated with incident CKD in diabetic patients in the UK, with hazard ratios (HRs) of 1.034 (95 %CI: 1.015-1.053) and 1.021 (95 %CI: 1.007-1.036) for every 1 µg/m3 increase in PM2.5 and PM10 concentration, and 1.113 (95 %CI: 1.053-1.177) and 1.058 (95 %CI: 1.027-1.091) for every 10 µg/m3 increase in NO2 and NOX concentration, respectively. For PM2.5-10, associations with CKD in diabetic patients did not reach the statistical significance. Exposure-response associations with CKD in diabetic patients showed a near-linear trend for PM2.5, PM10, NO2, and NOX in the UK, whereas PM2.5-DKD associations in the globe exhibited a non-linear increasing trend. This study supports that air pollution could significantly increase the risk of CKD onset in diabetic patients.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Diabetes Mellitus , Insuficiencia Renal Crónica , Humanos , Material Particulado/toxicidad , Dióxido de Nitrógeno/análisis , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/análisis , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Contaminantes Atmosféricos/análisis , Diabetes Mellitus/epidemiología , Diabetes Mellitus/inducido químicamente , Insuficiencia Renal Crónica/epidemiología
3.
Clin Gastroenterol Hepatol ; 21(12): 3051-3059.e4, 2023 11.
Artículo en Inglés | MEDLINE | ID: mdl-36167228

RESUMEN

BACKGROUND& AIMS: Although antithrombotic agents could increase the risk of postpolypectomy bleeding, interruption of these agents also increases the risk of thromboembolism (TE). We assessed the risks of postcolonoscopy TE events and their association with the interruption of antithrombotic agents. METHODS: This was a retrospective cohort study including consecutive patients undergoing colonoscopy between January 2016 and March 2021. We determined the rates of postcolonoscopy TE events in patients taking various antithrombotic agents (with or without interruption), and in different patient groups according to indications for colonoscopy, underlying TE, and bleeding risks. RESULTS: Of the 6220 patients, 1755 (28.2%) were on antithrombotics. Overall, 20 patients (0.32%) developed TE events, and 25 (0.80%) of 3134 patients with polypectomy experienced major episodes of bleeding. Among all patients on antithrombotic agents, the highest rates of TE events were observed in patients on dual-antiplatelet therapy (4.65%; adjusted odds ratio [aOR], 28.0; 95% CI, 3.77-142.1) and clopidogrel (2.78%; aOR, 12.2; 95% CI, 2.10-57.0), compared with 0.11% among those not on antithrombotics. In patients interrupting anti-thrombotic agents, the risk of TE was increased compared to those on no agent as follows: stopping 2 or more antithrombotic agents (4.55%; aOR, 22.5; 95% CI, 1.09-158.0), monotherapy with clopidogrel (3.06%; aOR, 15.5; 95% CI, 2.86-69.6), warfarin (1.33%; aOR, 6.96; 95% CI, 1.14-33.5), or direct-acting oral anticoagulants (0.87%; aOR, 6.23; 95% CI, 1.22-26.8). Having an underlying high TE risk (aOR, 16.8; 95% CI, 6.33-46.6) was associated with higher postcolonoscopy TE events. CONCLUSIONS: The risk of post-colonoscopy thromboembolic events is low. However, the temporary interruption of antithrombotic agents, particularly stopping 2 or more agents, clopidogrel, warfarin, or direct-acting oral anticoagulants was associated with higher postcolonoscopy TE events, particularly in high-risk patients.


Asunto(s)
Colonoscopía , Tromboembolia , Warfarina , Humanos , Anticoagulantes/efectos adversos , Clopidogrel , Estudios de Cohortes , Inhibidores del Factor Xa , Fibrinolíticos/efectos adversos , Hemorragia/inducido químicamente , Inhibidores de Agregación Plaquetaria/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Tromboembolia/epidemiología , Tromboembolia/etiología , Colonoscopía/efectos adversos
4.
Gastroenterology ; 163(6): 1522-1530.e5, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-35970241

RESUMEN

BACKGROUND & AIMS: Interval colorectal cancers (CRCs), cancers diagnosed after a screening/surveillance examination in which no cancer is detected, and before the date of next recommended examination, reflect an unprecedented challenge in CRC detection and prevention. To better understand this poorly characterized CRC variant, we examined the clinical and mutational characteristics of interval CRCs in comparison with screen detected CRCs. METHODS: We included 1175 CRCs documented in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial and 3661 CRCs in the Nurses' Health Study (NHS) and Health Professionals Follow-up Study (HPFS). Multivariable Cox models were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of death risk. Whole exome sequencing was conducted in 147 PLCO cases and 796 NHS/HPFS cases. RESULTS: A total of 619 deaths (312 CRC-specific) and 2404 deaths (1904 CRC-specific) were confirmed during follow-up of PLCO and NHS/HPFS, respectively. Compared with screen detected CRCs, interval CRCs had a multivariate-adjusted HR (95% CI) of 1.47 (1.21-1.78) for CRC-specific mortality and 1.27 (1.09-1.47) for overall mortality (meta-analysis combining all 3 cohorts). However, we did not observe significant differences in mutational features between interval and screen detected CRCs (false discovery rate adjusted P > .05). CONCLUSION: Interval CRCs had a significantly increased risk of death compared with screen detected CRCs that were not explained by established clinical prognostic factors, including stage at diagnosis. The survival disadvantage of interval CRCs did not appear to be explained by differences in the genomic landscape of tumors characterized by whole exome sequencing.


Asunto(s)
Neoplasias Colorrectales , Genómica , Humanos , Masculino , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/genética , Estudios de Seguimiento , Estudios Prospectivos
5.
Gastrointest Endosc ; 98(5): 813-821.e3, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37307902

RESUMEN

BACKGROUND AND AIMS: Blue-light imaging (BLI) is a new image-enhanced endoscopy with a wavelength filter similar to narrow-band imaging (NBI). We compared the 2 with white-light imaging (WLI) on proximal colonic lesion detection and miss rates. METHODS: In this 3-arm prospective randomized study with tandem examination of the proximal colon, we enrolled patients aged ≥40 years. Eligible patients were randomized in 1:1:1 ratio to receive BLI, NBI, or WLI during the first withdrawal from the proximal colon. The second withdrawal was performed using WLI in all patients. Primary outcomes were proximal polyp (pPDRs) and adenoma (pADRs) detection rates. Secondary outcomes were miss rates of proximal lesions found on tandem examination. RESULTS: Of 901 patients included (mean age, 64.7 years; 52.9% men), 48.1% underwent colonoscopy for screening or surveillance. The corresponding pPDRs of the BLI, NBI, and WLI groups were 45.8%, 41.6, and 36.6%, whereas the corresponding pADRs were 36.6%, 33.8%, and 28.3%. There was a significant difference in pPDR and pADR between BLI and WLI groups (difference, 9.2% [95% confidence interval {CI}, 3.3-16.9] and 8.3% [95% CI, 2.7-15.9]) and between NBI and WLI groups (difference, 5.0% [95% CI, 1.4-12.9] and 5.6% [95% CI, 2.1-13.3]). Proximal adenoma miss rates were significantly lower with BLI (19.4%) than with WLI (27.4%; difference, -8.0%; 95% CI, -15.8 to -.1) but not between NBI (27.2%) and WLI. CONCLUSIONS: Both BLI and NBI were superior to WLI on detecting proximal colonic lesions, but only BLI had lower proximal adenoma miss rates than WLI. (Clinical trial registration number: NCT03696992.).

6.
Helicobacter ; 28(4): e12990, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37246782

RESUMEN

BACKGROUND: To investigate risks of hospitalization for upper gastrointestinal bleeding (UGIB) in H. pylori-eradicated patients newly started on warfarin or direct oral anti-coagulants (DOACs). METHODS: We identified all patients who had previously received H. pylori eradication therapy or were found to have no H. pylori on endoscopy and were then newly started on warfarin or DOACs from a population-based electronic healthcare database. Primary analysis was the risk of UGIB between warfarin and DOACs users in H. pylori-eradicated patients. Secondary analysis included the UGIB risk between H. pylori-eradicated and H. pylori-negative patients who were newly started on warfarin or DOACs. The hazard ratio (HR) of UGIB was approximated by pooled logistic regression model incorporating the inverse propensity of treatment weightings with time-varying covariables. RESULTS: Among H. pylori-eradicated patients, DOACs had a significantly lower risk of UGIB (HR: 0.26, 95% CI 0.09-0.71) compared with warfarin. In particular, lower UGIB risks with DOACs were observed among older (≥65 years) patients, female, those without a history of UGIB or peptic ulcer, or ischemic heart disease, and non-users of acid-suppressive agents or aspirin. Secondary analysis showed no significant difference in UGIB risk between H. pylori-eradicated and H. pylori-negative patients newly started on warfarin (HR: 0.63,95% CI 0.33-1.19) or DOACs (HR: 1.37, 95% CI 0.45-4.22). CONCLUSIONS: In H. pylori-eradicated patients, new users of DOACs had a significantly lower risk of UGIB than new warfarin users. Furthermore, the risk of UGIB in new warfarin or DOACs users was comparable between H. pylori-eradicated and H. pylori-negative patients.


Asunto(s)
Infecciones por Helicobacter , Helicobacter pylori , Humanos , Femenino , Warfarina/efectos adversos , Estudios de Cohortes , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Hemorragia Gastrointestinal/inducido químicamente , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/complicaciones , Anticoagulantes/efectos adversos , Hospitalización , Administración Oral , Estudios Retrospectivos
7.
J Antimicrob Chemother ; 77(2): 517-523, 2022 02 02.
Artículo en Inglés | MEDLINE | ID: mdl-34791274

RESUMEN

BACKGROUND: The success rate of conventional Helicobacter pylori eradication therapy is declining, due to rising antibiotic resistance. OBJECTIVES: To determine the temporal effects of prior antibiotic exposure on eradication outcome. PATIENTS AND METHODS: This is a retrospective cohort study including all H. pylori-infected patients who received their first course of clarithromycin-containing triple therapy in 2003-18. Prior antibiotic exposures before H. pylori eradication therapy (up to 180 days, 1 year or 3 years) were retrieved. A logistic regression model was used to evaluate the association between different timings of previous antibiotic exposure, recent (within 30/60 days) or distant period, and the need for retreatment for H. pylori. RESULTS: A total of 120 787 H. pylori-infected patients were included. Prior exposure to any antibiotics within 180 days was associated with a higher risk of retreatment (OR 1.18, 95% CI 1.13-1.24) and the risk progressively increased with longer duration of antibiotic use. The results were consistent for prior exposure up to 1 year (OR 1.26, 95% CI 1.20-1.31) or 3 years (OR 1.30, 95% CI 1.25-1.35). However, when compared with those without prior antibiotic exposure, recent exposure (within 30 days) did not increase the risk of retreatment, which was consistent for analysis with prior antibiotic exposure up to 3 years. Notably, recent use of cephalosporins within 30/60 days and nitroimidazole within 30 days had significantly lower risks of retreatment. CONCLUSIONS: Any prior antibiotic exposure increased the risk of treatment failure of clarithromycin-containing triple therapy. Recent exposures to some classes of antibiotics may paradoxically increase treatment success.


Asunto(s)
Infecciones por Helicobacter , Helicobacter pylori , Antibacterianos/farmacología , Quimioterapia Combinada , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Estudios Retrospectivos
8.
PLoS Pathog ; 16(11): e1009079, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33253277

RESUMEN

RNA viruses are a leading cause of human infectious diseases and the prediction of where new RNA viruses are likely to be discovered is a significant public health concern. Here, we geocoded the first peer-reviewed reports of 223 human RNA viruses. Using a boosted regression tree model, we matched these virus data with 33 explanatory factors related to natural virus distribution and research effort to predict the probability of virus discovery across the globe in 2010-2019. Stratified analyses by virus transmissibility and transmission mode were also performed. The historical discovery of human RNA viruses has been concentrated in eastern North America, Europe, central Africa, eastern Australia, and north-eastern South America. The virus discovery can be predicted by a combination of socio-economic, land use, climate, and biodiversity variables. Remarkably, vector-borne viruses and strictly zoonotic viruses are more associated with climate and biodiversity whereas non-vector-borne viruses and human transmissible viruses are more associated with GDP and urbanization. The areas with the highest predicted probability for 2010-2019 include three new regions including East and Southeast Asia, India, and Central America, which likely reflect both increasing surveillance and diversity of their virome. Our findings can inform priority regions for investment in surveillance systems for new human RNA viruses.


Asunto(s)
Infecciones por Virus ARN/virología , Virus ARN/aislamiento & purificación , Biodiversidad , Clima , Humanos , Salud Pública , Análisis Espacio-Temporal
9.
Helicobacter ; 27(3): e12893, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35411663

RESUMEN

BACKGROUND: Failure rates of clarithromycin-containing triple therapy for H. pylori are rising. To determine the trend of failure rates of clarithromycin-containing triple therapy in different age groups in Hong Kong over the past 15 years. MATERIALS AND METHODS: This is a population-based retrospective age-period-cohort study involving all adult H. pylori-infected patients who had received the first course of clarithromycin-containing triple therapy in 2003-2017. Failed eradication was identified by the need of retreatment within 2 years of eradication. Logistic regression model was used to characterize the risk of retreatment. RESULTS: 113,526 H. pylori-infected patients were included. The overall failure rate increased from 4.83% in 2003 to 10.2% in 2016 (p for linear trend <0.001). When stratified by age of eradication, patients 75 years or above had the lowest retreatment rate of 5.11%, which progressively increased in younger patients (60-74 years: OR 1.26, 95% CI 1.15-1.38; 45-59 years: OR 1.36, 95% CI 1.24-1.48; 18-44 years: OR 1.55, 95% CI 1.41-1.69). The results remained consistent when stratified by year of birth, and period of eradication. Other risk factors for retreatment included female (OR 1.24, 95% CI 1.18-1.30), triple therapy containing metronidazole (OR 2.30, 95% CI 2.12-2.50), and shorter duration of therapy (10 days: OR 0.88, 95% CI 0.79-0.97; 14 days: OR 0.67, 95% CI 0.58-0.77 vs 7 days). CONCLUSIONS: While failure rates of clarithromycin-containing triple therapy progressively increased over the past 15 years, the failure rate was particularly high among younger patients, which could undermine the potential benefits of early H. pylori eradication.


Asunto(s)
Infecciones por Helicobacter , Helicobacter pylori , Adolescente , Adulto , Anciano , Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Estudios de Cohortes , Quimioterapia Combinada , Femenino , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Metronidazol/uso terapéutico , Estudios Retrospectivos
10.
Oncologist ; 26(1)2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32845538

RESUMEN

Individuals with cancer may be at high risk for coronavirus disease 2019 (COVID-19) and adverse outcomes. However, evidence from large population-based studies examining whether cancer and cancer-related therapy exacerbates the risk of COVID-19 infection is still limited. Data were collected from the COVID Symptom Study smartphone application since March 29 through May 8, 2020. Among 23,266 participants with cancer and 1,784,293 without cancer, we documented 10,404 reports of a positive COVID-19 test. Compared with participants without cancer, those living with cancer had a 60% increased risk of a positive COVID-19 test. Among patients with cancer, current treatment with chemotherapy or immunotherapy was associated with a 2.2-fold increased risk of a positive test. The association between cancer and COVID-19 infection was stronger among participants >65 years and males. Future studies are needed to identify subgroups by tumor types and treatment regimens who are particularly at risk for COVID-19 infection and adverse outcomes.


Asunto(s)
Antineoplásicos/efectos adversos , Prueba de COVID-19/estadística & datos numéricos , COVID-19/epidemiología , Neoplasias/epidemiología , SARS-CoV-2/aislamiento & purificación , Adulto , Factores de Edad , Anciano , COVID-19/diagnóstico , COVID-19/inmunología , COVID-19/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Neoplasias/inmunología , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2/inmunología , Factores Sexuales , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto Joven
11.
Clin Gastroenterol Hepatol ; 19(2): 314-322.e2, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-32289532

RESUMEN

BACKGROUND & AIMS: Little is known about risk of upper gastrointestinal bleeding (UGIB) in patients failed by Helicobacter pylori eradication therapy. We investigated the effects of different time until retreatment, after failure of initial H pylori eradication therapy, on subsequent risk of UGIB. METHODS: We performed a territory-wide retrospective cohort study of 70,518 patients with H pylori infection who had received their first course of clarithromycin-based triple therapy from January 2003 through December 2012 in Hong Kong. Patients who required retreatment after failed initial therapy (n = 8330, 11.8%) were categorized based on time between initial and final H pylori eradication (3 months or less, 3-12 months, and more than 12 months). We collected clinical data from 30 days after prescription of the last course of H pylori therapy until hospitalization for non-variceal UGIB, death, or the end of the study (30 Jun 2016; median follow-up time, 7.65 years). The primary outcome was difference in development UGIB (determined from ICD-9 codes) between patients who required retreatment and those who did not (reference group). RESULTS: Compared with the reference group, patients who required retreatment had an overall higher risk of UGIB, even after last eradication therapy (adjusted hazard ratio (HR), 1.50, 95% CI, 1.34-1.69). There was a progressive increase in risk of UGIB with longer time from initial until final eradication therapy: hazard ratio for time less than 3 months, 1.16; 95% CI, 0.88-1.54, hazard ratio for time 3-12 months, 1.35; 95% CI, 1.07-1.69, and hazard ratio for time more than 12 months, 1.68; 95% CI, 1.46-1.94 (P for trend = .038). CONCLUSION: In a retrospective study of patients in Hong Kong, we found that those failed by initial H pylori eradication have an increased risk of UGIB, compared to patients who responded to the initial therapy. Risk increased progressively with longer time until retreatment. Early retreatment within 3 months should be considered to minimize subsequent UGIB risk.


Asunto(s)
Infecciones por Helicobacter , Helicobacter pylori , Antibacterianos/efectos adversos , Quimioterapia Combinada , Hemorragia Gastrointestinal , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Retratamiento , Estudios Retrospectivos
12.
J Gastroenterol Hepatol ; 36(12): 3354-3362, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34289518

RESUMEN

BACKGROUND: Previous studies have demonstrated the seasonal variations of non-variceal upper gastrointestinal bleeding (UGIB), but there is scanty data on lower gastrointestinal bleeding (LGIB) and the association with other meteorological parameters. METHODS: We included all patients hospitalized for UGIB and LGIB between 2009 and 2018 in Hong Kong. The monthly age-standardized and sex-standardized GIB incidences were fitted to meteorological data including average temperature (AT), maximum temperature (MaxT), minimum temperature (MinT), temperature range (TR), average precipitation, average atmospheric pressure (AtomP), and average relative humidity after adjusting for prescriptions of aspirin, proton pump inhibitors, and Helicobacter pylori eradication therapy using the autoregressive integrated moving average model. RESULTS: Despite a gradual decline in UGIB incidences, the incidences of UGIB were still higher in winter months. The incidence and fluctuation of both UGIB and LGIB were higher in the older age groups, especially those ≥80 years. The seasonality was only identified in those ≥60 years for UGIB, and only in those ≥80 years for LGIB. UGIB incidence was inversely associated with AT, MaxT, and MinT, but positively associated with TR and AtomP. LGIB was also significantly associated with AT, MaxT, MinT, and AtomP. CONCLUSION: Despite the changes in GIB incidences, the seasonal patterns of GIB were still marked in the elderly. With the aging population, the impacts of seasonal variations on GIB incidences could be considerable.


Asunto(s)
Hemorragia Gastrointestinal , Conceptos Meteorológicos , Estaciones del Año , Anciano , Anciano de 80 o más Años , Hemorragia Gastrointestinal/epidemiología , Hong Kong/epidemiología , Humanos , Incidencia , Persona de Mediana Edad
13.
Gut ; 69(3): 445-452, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31101690

RESUMEN

OBJECTIVE: The risk of GI bleeding (GIB) in aspirin users after Helicobacter pylori (HP) eradication remains poorly defined. We characterised the incidences and temporal trends of hospitalisations for all GIB in aspirin users after HP eradication therapy. DESIGN: Based on a territory-wide health database, we identified all patients who had received the first course of clarithromycin-based triple therapy between 2003 and 2012. Patients were divided into three cohorts according to aspirin use: new users (commenced after HP eradication), chronic users (commenced before and resumed after HP eradication) and non-users. The primary outcome was to determine the risk of hospitalisation for GIB. RESULTS: We included 6985 new aspirin users, 5545 chronic users and 48 908 non-users. The age-adjusted and sex-adjusted incidence of hospitalisation for all GIB in new, chronic and non-users was 10.4, 7.2 and 4.6 per 1000 person-years, respectively. Upper and lower GIB accounted for 34.7% and 45.3% of all bleeding, respectively. Compared with chronic users, new users had a higher risk of GIB (HR with propensity score matching: 1.89; 95% CI 1.29 to 2.70). Landmark analysis showed that the increased risk in new aspirin users was only observed in the first 6 months for all GIB (HR 2.10, 95% CI 1.41 to 3.13) and upper GIB (HR 2.52, 95% CI 1.38 to 4.60), but not for lower GIB. CONCLUSION: New aspirin users had a higher risk of GIB than chronic aspirin users, particularly during the initial 6 months. Lower GIB is more frequent than upper GIB in aspirin users who had HP eradicated.


Asunto(s)
Aspirina/efectos adversos , Hemorragia Gastrointestinal/epidemiología , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Hospitalización/tendencias , Inhibidores de Agregación Plaquetaria/efectos adversos , Adulto , Anciano , Aspirina/administración & dosificación , Femenino , Hemorragia Gastrointestinal/inducido químicamente , Hemorragia Gastrointestinal/mortalidad , Hong Kong/epidemiología , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/administración & dosificación , Factores Protectores , Factores de Riesgo
14.
Gastrointest Endosc ; 92(1): 11-22.e6, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32119938

RESUMEN

BACKGROUND AND AIMS: We performed a meta-analysis of all published studies to determine the diagnostic accuracy of artificial intelligence (AI) on histology prediction and detection of colorectal polyps. METHOD: We searched Embase, PubMed, Medline, Web of Science, and Cochrane library databases to identify studies using AI for colorectal polyp histology prediction and detection. The quality of included studies was measured by the Quality Assessment of Diagnostic Accuracy Studies tool. We used a bivariate meta-analysis following a random-effects model to summarize the data and plotted hierarchical summary receiver operating characteristic curves. The area under the hierarchical summary receiver operating characteristic curve (AUC) served as an indicator of the diagnostic accuracy and during head-to-head comparisons. RESULTS: A total of 7680 images of colorectal polyps from 18 studies were included in the analysis of histology prediction. The accuracy of the AI (AUC) was .96 (95% confidence interval [CI], .95-.98), with a corresponding pooled sensitivity of 92.3% (95% CI, 88.8%-94.9%) and specificity of 89.8% (95% CI, 85.3%-93.0%). The AUC of AI using narrow-band imaging (NBI) was significantly higher than the AUC using non-NBI (.98 vs .84, P < .01). The performance of AI was superior to nonexpert endoscopists (.97 vs .90, P < .01). For characterization of diminutive polyps using a deep learning model with nonmagnifying NBI, the pooled negative predictive value was 95.1% (95% CI, 87.7%-98.1%). For polyp detection, the pooled AUC was .90 (95% CI, .67-1.00) with a sensitivity of 95.0% (95% CI, 91.0%-97.0%) and a specificity of 88.0% (95% CI, 58.0%-99.0%). CONCLUSIONS: AI was accurate in histology prediction and detection of colorectal polyps, including diminutive polyps. The performance of AI was better under NBI and was superior to nonexpert endoscopists. Despite the difference in AI models and study designs, AI performances are rather consistent, which could serve as a reference for future AI studies.


Asunto(s)
Pólipos del Colon , Inteligencia Artificial , Pólipos del Colon/diagnóstico por imagen , Colonoscopía , Humanos , Imagen de Banda Estrecha
15.
Gastrointest Endosc ; 91(1): 104-112.e5, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31276672

RESUMEN

BACKGROUND AND AIMS: Linked color imaging (LCI) is a newly available image-enhanced endoscopy (IEE) system that emphasizes the red mucosal color. No study has yet compared LCI with other available IEE systems. Our aim was to investigate polyp detection rates using LCI compared with narrow-band imaging (NBI). METHODS: This is a prospective randomized tandem colonoscopy study. Eligible patients who underwent colonoscopy for symptoms or screening/surveillance were randomized in a 1:1 ratio to receive tandem colonoscopy with both colonoscope withdrawals using LCI or NBI. The primary outcome was the polyp detection rate. RESULTS: Two hundred seventy-two patients were randomized (mean age, 62 years; 48.2% male; colonoscopy for symptoms, 72.8%) with 136 in each arm. During the first colonoscopy, the polyp detection rate (71.3% vs 55.9%; P = .008), serrated lesion detection rate (34.6% vs 22.1%; P = .02), and mean number of polyps detected (2.04 vs 1.35; P = .02) were significantly higher in the NBI group than in the LCI group. There was also a trend of higher adenoma detection rate in the NBI group compared with the LCI group (51.5% vs 39.7%, respectively; P = .05). Multivariable analysis confirmed that use of NBI (adjusted odds ratio, 1.99; 95% confidence interval, 1.09-3.68) and withdrawal time >8 minutes (adjusted odds ratio, 5.11; 95% confidence interval, 2.79-9.67) were associated with polyp detection. Overall, 20.5% of polyps and 18.1% of adenomas were missed by the first colonoscopy, but there was no significant difference in the miss rates between the 2 groups. CONCLUSION: NBI was significantly better than LCI for colorectal polyp detection. However, both LCI and NBI missed 20.5% of polyps. (Clinical trial registration number: NCT03336359.).


Asunto(s)
Adenoma/diagnóstico por imagen , Neoplasias del Colon/diagnóstico por imagen , Pólipos del Colon/diagnóstico por imagen , Colonoscopía , Aumento de la Imagen , Imagen de Banda Estrecha , Adenoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Colon/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Prospectivos
17.
Endoscopy ; 49(3): 243-250, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28129661

RESUMEN

Background and study aims Interval colorectal cancers detected after screening colonoscopy are more likely to be associated with missed lesions in the proximal colon. The aim of this study was to determine whether segmental re-examination of the proximal colon could increase the proximal adenoma detection rate (ADR) and to evaluate the time-effectiveness of this approach. Patients and methods Patients undergoing colonoscopy were recruited into the prospective randomized controlled study. They were randomly assigned to the segmental re-examination group, in which the proximal colon was examined twice segmentally, and a control group in which the withdrawal time was extended (EWT). Detection rates were calculated and compared for all polyps and adenomas in both the proximal colon and the whole colon. Withdrawal times were recorded and compared. Results A total of 360 patients were included in the study (re-examination 178 vs. EWT 182). The proximal ADR in the re-examination group was higher than that in the EWT group (33.1 % vs. 23.6 %; P = 0.045). More proximal adenomas were detected per patient in the re-examination group (0.54 vs. 0.36; P = 0.048). The ADR of the whole colon was similar in the two groups. Proximal withdrawal time was also similar (re-examination 4.29 ±â€Š1.23 minutes vs. EWT 4.34 ±â€Š1.36 minutes; P = 0.74). In addition, there was no statistically significant difference in the total duration of the colonoscopy between the two groups. Conclusions Segmental re-examination of the proximal colon increased the proximal ADR and the number of proximal adenomas detected, and was accomplished easily and safely without increasing the overall examination time. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02581475).


Asunto(s)
Adenoma/diagnóstico por imagen , Colon/diagnóstico por imagen , Neoplasias del Colon/diagnóstico por imagen , Colonoscopía/métodos , Adenoma/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colon/patología , Neoplasias del Colon/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Método Simple Ciego , Adulto Joven
19.
Therap Adv Gastroenterol ; 16: 17562848231170943, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37168403

RESUMEN

Background: There is evidence supporting the association between Helicobacter pylori infection and colorectal cancer (CRC), but whether H. pylori eradication reduces the risk of CRC is still unknown. Objectives: To compare the incidence of CRC in subjects who had received H. pylori eradication therapy with general population. Design: A population-based retrospective cohort study. Methods: This study included all H. pylori-infected subjects who had received their first course of clarithromycin-containing triple therapy in 2003-2015 in Hong Kong. We compared the observed incidences of CRC in this H. pylori eradicated cohort with the expected incidences in the age- and sex-matched general population. The standardized incidence ratio (SIR) with 95% confidence interval (CI) was computed. Results: Among 96,572 H. pylori-eradicated subjects with a median follow-up of 9.7 years, 1417 (1.5%) developed CRC. Primary analysis showed no significant difference in the observed and expected incidences of CRC (SIR: 1.03, 95% CI: 0.97-1.09). However, when stratified according to the follow-up period, higher incidence of CRC was only observed in the first 5 years after eradication (SIR: 1.47, 95% CI: 1.39-1.55), but it was lower (SIR: 0.85, 95% CI: 0.74-0.99) than general population after 11 years. When stratified by tumor location, the observed incidence was higher for colon (SIR: 1.20, 95% CI: 1.12-1.29) but lower for rectal cancer (SIR: 0.90, 95% CI: 0.81-0.999) among H. pylori-eradicated subjects. Conclusions: H. pylori-infected subjects appeared to have a higher incidence of CRC initially, which declined progressively to a level lower than general population 10 years after H. pylori eradication, particularly for rectal cancer.

20.
Elife ; 112022 06 06.
Artículo en Inglés | MEDLINE | ID: mdl-35666108

RESUMEN

Background: The variation in the pathogen type as well as the spatial heterogeneity of predictors make the generality of any associations with pathogen discovery debatable. Our previous work confirmed that the association of a group of predictors differed across different types of RNA viruses, yet there have been no previous comparisons of the specific predictors for RNA virus discovery in different regions. The aim of the current study was to close the gap by investigating whether predictors of discovery rates within three regions-the United States, China, and Africa-differ from one another and from those at the global level. Methods: Based on a comprehensive list of human-infective RNA viruses, we collated published data on first discovery of each species in each region. We used a Poisson boosted regression tree (BRT) model to examine the relationship between virus discovery and 33 predictors representing climate, socio-economics, land use, and biodiversity across each region separately. The discovery probability in three regions in 2010-2019 was mapped using the fitted models and historical predictors. Results: The numbers of human-infective virus species discovered in the United States, China, and Africa up to 2019 were 95, 80, and 107 respectively, with China lagging behind the other two regions. In each region, discoveries were clustered in hotspots. BRT modelling suggested that in all three regions RNA virus discovery was better predicted by land use and socio-economic variables than climatic variables and biodiversity, although the relative importance of these predictors varied by region. Map of virus discovery probability in 2010-2019 indicated several new hotspots outside historical high-risk areas. Most new virus species since 2010 in each region (6/6 in the United States, 19/19 in China, 12/19 in Africa) were discovered in high-risk areas as predicted by our model. Conclusions: The drivers of spatiotemporal variation in virus discovery rates vary in different regions of the world. Within regions virus discovery is driven mainly by land-use and socio-economic variables; climate and biodiversity variables are consistently less important predictors than at a global scale. Potential new discovery hotspots in 2010-2019 are identified. Results from the study could guide active surveillance for new human-infective viruses in local high-risk areas. Funding: FFZ is funded by the Darwin Trust of Edinburgh (https://darwintrust.bio.ed.ac.uk/). MEJW has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No. 874735 (VEO) (https://www.veo-europe.eu/).


Asunto(s)
Virus ARN , Virus , África , Biodiversidad , Humanos , Probabilidad , ARN , Estados Unidos
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