Factors associated with hepatitis C prevalence differ by the stage of liver fibrosis: A cross-sectional study in the general population in Poland, 2012-2016.

BACKGROUND & AIMS: There is a considerable burden of hepatitis C in Europe related to the lack of prompt diagnosis. We aimed to estimate the prevalence and related risk factors of HCV infections by the stages of liver fibrosis, using non-invasive methods, to understand testing needs in Poland. METHODS: A cross-sectional study was conducted in 2012-2016 adopting a stratified random sampling of primary health care units followed by systematic sampling of patients within each unit. Study participants filled a questionnaire and donated blood for laboratory HCV testing. Additionally, the results of liver function tests and platelet count were collected to calculate APRI and FIB-4 scores. Cases were classified according to the level of fibrosis: 'significant fibrosis' (APRI≥0.7 or FIB4≥1.45) and 'no significant fibrosis' (APRI<0.7 and FIB4<1.45). RESULTS: Of 21 875 study participants, 102 were HCV-RNA positive. Prevalence of HCV infections and significant fibrosis was estimated at 0.47% (95% CI 0.38% - 0.57%) and 0.12% (0.08% - 0.17%), respectively. Cases with significant fibrosis accounted for 51.6% (33.4%-69.9%) in men and 34.4% (17.3%-51.4%) in women. There was no correlation between the HCV prevalence and age. Blood transfusion prior to 1992 strongly predicted significant fibrosis as did the history of injecting drug use (IDU) and ever having an HCV-infected sexual partner in men and caesarean sections in women. Factors associated with HCV infection without significant fibrosis were tattooing in men and younger age in women. We acknowledge limited possibility to study the associations between IDU and ever having HCV-infected sexual partner, given small sample sizes for these exposures. CONCLUSIONS: As no clear birth cohort affected by HCV could be identified, risk factor-based screening in the general population should be considered, taking into account the association between the increased risk of liver fibrosis and the history of transfusion prior to 1992 and caesarean sections.

The effect of primary care physician counseling on participation rate and use of sedation in colonoscopy-based colorectal cancer screening program--a randomized controlled study.

OBJECTIVES: Physician recommendation is a strong predictor of colorectal cancer (CRC) screening adherence, but there are no sufficient data specific to primary colonoscopy screening programs. The primary objective was to compare the effect of primary care physician's (PCP) counseling with information leaflet about CRC screening on participation rate in opportunistic primary colonoscopy screening program. Secondary objective was to determine the impact of this counseling on a decision to choose unsedated colonoscopy. MATERIAL AND METHODS: Six hundred consecutive subjects 50-65 years of age visiting PCP group practice for routine medical consultation were randomly assigned in a 1:1 ratio either to discuss CRC screening with PCP or to receive an information leaflet on CRC screening only. The outcome measures were the participation rate and the proportion of unsedated colonoscopies assessed on subjects' self-reports collected six months after the intervention. Multivariate logistic regression model with backward selection was used to investigate the association between independent covariates and binary endpoints. RESULTS: Participation rate was 47.0% (141 subjects) in the counseling group and 13.7% (41 patients) in the information leaflet group. The rates of unsedated colonoscopies were 77.0% and 39.0%, respectively. In a multivariate analyses, PCP's counseling was associated with higher participation in CRC screening (adjusted odds ratio [OR] 5.33, 95% confidence intervals [95% CI] 3.55-8.00) and higher rate of unsedated colonoscopies (OR 7.75, 95% CI 2.94-20.45). CONCLUSION: In opportunistic primary colonoscopy screening, PCP's counseling significantly increases participation rate and decreases demand for sedation compared to recruitment with information materials only. NCT01688817.

Gastroesophageal reflux in alcohol-abusing patients.

INTRODUCTION: Consumption of large amounts of alcohol can promote regurgitation of hydrochloric acid into the esophagus and therefore cause symptoms of gastroesophageal reflux disease. Most individuals who experience alcohol-related health problems are not addicted to alcohol, but they usually show a hazardous pattern of alcohol consumption. OBJECTIVES: Objectives The aim of the study was to examine the gastrointestinal tract in hazardous drinkers and to establish whether such alcohol consumption pattern may be an important risk factor for developing gastroesophageal reflux. PATIENTS AND METHODS: Primary care patients (n = 2000; mean age 41.1 years) from Warsaw, Poland, responded to 2 surveys: AUDIT (Alcohol Use Disorders Identification Test) and Carlsson's questionnaire. Patients characterized as hazardous drinkers and having symptoms of reflux disease entered the second phase of the study: gastroscopy and pH-metry. The results were compared with those obtained in the control group (n = 60), which included patients with reflux symptoms but who abstained from alcohol or were moderate drinkers. RESULTS: According to the survey results, 18.75% of the study group showed a hazardous pattern of alcohol consumption, while 33% had symptoms of gastrointestinal reflux disease. A positive pH-metry result was observed in 87.5% of the hazardous drinkers. Endoscopic features of esophagitis were observed in 64% of the patient group and 28% of the control group. Hazardous alcohol consumption and male sex may be the risk factors for developing reflux-related esophagitis. CONCLUSIONS: Primary care physicians should routinely ask their patients about alcohol consumption. Hazardous alcohol drinking may be a risk factor for developing reflux disease.

[Gastroesophageal reflux disease in hazardous drinkers]. / Wystepowanie refluksu zoladkowo-przelykowego u osób naduzywajacych alkoholu.

Excess alcohol consumption has been associated with multiple pathologies of the gastrointestinal tract. The consumption of large amounts of alcohol (hazardous drinking) facilitates acid regurgitation by reducing the pressure of the lower oesophageal sphincter and slowing both oesophageal motility and gastric emptying. Regardless of the type of alcoholic beverage involved lower alcohol doses also have been shown to induce decreased pressure in lower oesophageal, decrease in oesophageal motility and enhanced risk of gastroesophageal reflux disease (GERD). GERD can be important risk factor for oesophageal adenocarcinoma. For identification of hazardous drinking patients we can use AUDIT (Alcohol Use Disorder Identification Test). AUDIT has been created by World Health Organization experts as a simple screening test looking for hazardous drinking people.

Sibutramine therapy in obese women--effects on plasma neuropeptide Y (NPY), insulin, leptin and beta-endorphin concentrations.

OBJECTIVE: Some neuropeptides and monoaminergic neurotransmitters may affect hypothalamic feeding centres, sympathetic activity and thermogenesis. Sibutramine (BTS54524; N-[1-[1(4-chloro phenyl) cyclobutyl]-3methyl N,N-dimethylamine hydrochloride monohydrate) is a new 5-HT serotonin and noradrenaline reuptake inhibitor (SNRI), antiobesity drug. The aim of this study was to evaluate the effects of the sibutramine therapy on plasma neuropeptide Y (NPY), insulin, leptin and beta-endorphin concentrations in obese patients. METHODS: Sibutramine, serotonin and noradrenaline reuptake antiobesity drug was administered for 6 months in a dose of 10 mg daily in 60 obese women (BMI 30-40 kg/m2) (mean 34 kg/m2). Plasma NPY, leptin, beta-endorphin and insulin concentrations were measured with RIA methods using commercial kits (Peninsula Lab, Linco, Peninsula Lab, Swierk respectively). The above neuropeptides levels were evaluated before and after the 6 month sibutramine therapy in 60 obese women as well as in 30 obese women on low caloric diet and in 30 of the control group. RESULTS: In 85% obese patients a decrease of body weight was found after 6 month therapy with sibutramine. A decrease in total cholesterol, LDL and triglycerides and an increase in HDL were observed after the sibutramine treatment. We have demonstrated that the sibutramine therapy leads to the decrease of plasma NPY, beta-endorphin, insulin and leptin concentrations in obese patients. After low diet therapy we have observed a decrease in plasma leptin levels, however we did not find significant changes in plasma leptin, NPY, beta-endorphin and insulin concentrations. CONCLUSIONS: We suggest that the effects on the disturbed activity of NPY, beta-endorphin, insulin and leptin may be involved in the mechanism of sibutramine action.