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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1162-1165, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683406

RESUMO

This study analyzed the distribution of high-risk population, the compliance and detected lesions of colorectal cancer screening from the Cancer Screening Program in urban areas of Kunming,Yunnan Province from 2014 to 2017. A total of 127 960 residents were included,of which 14 791 (11.70%) cases were diagnosed with high risk of colorectal cancer by the National Cancer Center High Risk Population Assessment System. A total of 3 484 cases completed colonoscopy clinical screening and the rate of participation was 23.55%. The screening results showed that 592 positive cases were detected, and the positive rate was 17.17%. The detection rates of polyps,adenomas,advanced adenomas,precancerous lesions and colorectal cancer were 16.27%,13.12%,7.18%,7.63% and 0.26%, with 567, 457, 250, 266 and 9 cases, respectively.


Assuntos
Adenoma/diagnóstico , Pólipos do Colo/epidemiologia , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Lesões Pré-Cancerosas/diagnóstico , Adenoma/epidemiologia , Adenoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Pólipos do Colo/etiologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/patologia , Fatores de Risco , Adulto Jovem
2.
Dig Endosc ; 31 Suppl 1: 36-42, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30994234

RESUMO

BACKGROUND AND AIM: The aim of this investigation was to evaluate the efficacy of Japanese magnifying colonoscopic classifications for ulcerative colitis-associated neoplasia (UCAN). METHODS: We reviewed the colonoscopy records from 2011 to 2018 at our institutions and identified cases of endoscopically or surgically resected UCAN observed by magnifying narrow-band imaging (NBI) endoscopy and magnifying chromoendoscopy. Association between magnifying endoscopic classification and histopathological findings was investigated retrospectively. Japan NBI expert team (JNET) classification and pit pattern classification were applied. RESULTS: There were 17 patients who had a diagnosis of UCAN. Tumors of types 2A, 2B and 3 by JNET classification correlated with the histopathological findings of low-grade dysplasia (LGD)/high-grade dysplasia (HGD), HGD, and massively submucosal invasive (mSM) carcinoma, respectively. Tumors of types III/IV, VI low irregularity, and VI high irregularity/VN by pit pattern classification were correlated with the histopathological findings of LGD/HGD, HGD, and mSM carcinoma, respectively. CONCLUSIONS: Japan NBI expert team classification and pit pattern classification may be predictive of the histological diagnosis and invasion depth of UCAN. This needs to be investigated prospectively in a large cohort or in a randomized clinical trial.


Assuntos
Colite Ulcerativa/complicações , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Imagem de Banda Estreita/métodos , Adulto , Idoso , Pólipos do Colo/classificação , Pólipos do Colo/etiologia , Pólipos do Colo/patologia , Pólipos do Colo/terapia , Neoplasias Colorretais/classificação , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Óptica/métodos , Estudos Retrospectivos
3.
Clin J Gastroenterol ; 12(5): 398-402, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30895472

RESUMO

We present an asymptomatic case of a 79-year-old Japanese man who had a 6 mm colonic inflammatory polyp with numerous immunoglobulin G4 (IgG4)-positive plasma cells. No symptoms or abnormal laboratory data, such as changes in serum IgG4 levels, were found at the time of diagnosis or during the 1 year of follow-up thereafter. Additionally, no diffuse/localized swelling or masses were found in organs, except for colonic polyps, by abdominal computed tomography 1 year prior to the polypectomy. Inflammatory myofibroblastic tumor was unlikely from the lack of spindle cell proliferation and ALK immunoreactivity. This is the first case of this colonic polyp in an asymptomatic person. This polyp could be probable for single organ manifestation of IgG4-related disease (IgG4-RD), according to the comprehensive diagnostic criteria for IgG4-RD published in 2012; however, colonic manifestation of IgG4-RD has not been clarified owing to its rarity, and colon-specific criteria for IgG4-RD have not been proposed. Thus, we could not definitively establish the colonic polyp as IgG4-RD. Therefore, careful clinicopathological evaluation is needed to reveal whether this colonic polyp represents a nonspecific inflammatory response or an early manifestation of IgG4-RD.


Assuntos
Pólipos do Colo/etiologia , Doença Relacionada a Imunoglobulina G4/complicações , Imunoglobulina G/análise , Plasmócitos/imunologia , Adenoma/etiologia , Adenoma/imunologia , Adenoma/patologia , Idoso , Pólipos do Colo/imunologia , Pólipos do Colo/patologia , Colonoscopia , Humanos , Doença Relacionada a Imunoglobulina G4/imunologia , Masculino , Plasmócitos/patologia
6.
Am J Gastroenterol ; 113(12): 1828-1835, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30385834

RESUMO

BACKGROUND AND AIMS: Serrated polyps (SPs) and conventional high-risk adenomas (HRAs) derive from two distinct biological pathways but can also occur synchronously. Adults with synchronous SPs and adenomas have been shown to be a high-risk group and may have a unique risk factor profile that differs from adults with conventional HRAs alone. We used the population-based New Hampshire Colonoscopy Registry (NHCR) to examine the risk profile of individuals with synchronous conventional HRAs and SPs. METHODS: Our study population included 20,281 first time screening colonoscopies from asymptomatic NHCR participants 40 years or older between 2004-15. Exams were categorized by findings: (1) normal, (2) HRA only (adenomas ≥ 1 cm, villous, high grade dysplasia, multiple adenomas ( > 2) and adenocarcinoma), (3) clinically significant SP (CSSP) only (any hyperplastic polyp ≥ 1 cm, sessile serrated adenomas/polyps or traditional serrated adenomas), and (4) synchronous HRA + CSSP. Risk factors examined included exposure of interest, smoking (never, past, and current/pack years), as well as age, sex, alcohol, education, and family history of colorectal cancer (CRC). Multivariable unconditional logistic regression tested the relation of risk factors with having synchronous HRA + CSSP versus having a normal exam or HRA alone. RESULTS: Among NHCR participants with 18,354 screening colonoscopies (with complete smoking, sex, bowel preparation data, and adequate preparation) there were 16,495 normal; 1309 HRA alone; 461 CSSP alone, and 89 synchronous HRA + CSSP. Current smoking was associated with an almost threefold increased risk for HRA or CSSP, and an eightfold risk for synchronous HRA + CSSP (aOR = 8.66; 95% CI: 4.73-15.86) compared to normal exams. Adults with synchronous HRA + CSSP were threefold more likely to be current smokers than those with HRA alone (aOR = 3.27; 95% CI:1.74-6.16). CONCLUSIONS: Our data suggest that current smokers may be at a higher risk for synchronous CSSP + HRA even when compared to having HRA alone.


Assuntos
Adenoma/epidemiologia , Pólipos do Colo/epidemiologia , Neoplasias Colorretais/epidemiologia , Neoplasias Primárias Múltiplas/epidemiologia , Fumar/epidemiologia , Adenoma/diagnóstico por imagem , Adenoma/etiologia , Adenoma/patologia , Idoso , Estudos de Coortes , Colo/diagnóstico por imagem , Colo/patologia , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/etiologia , Pólipos do Colo/patologia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/patologia , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/etiologia , Neoplasias Primárias Múltiplas/patologia , New Hampshire/epidemiologia , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Fumar/efeitos adversos
8.
J Crohns Colitis ; 12(12): 1438-1447, 2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30202856

RESUMO

Background: During surveillance colonoscopy of patients with long-standing ulcerative colitis [UC], a variety of dysplastic and non-dysplastic lesions are detected. The aim of this study was to address the diagnostic accuracy of endoscopic characterization of endoscopic trimodal imaging [ETMI] and chromoendoscopy [CE]. ETMI includes the combination of autofluorescence imaging [AFI], narrow band imaging [NBI] and white light endoscopy [WLE]. Methods: This is a pre-specified additional analysis of a multi-centre, randomized controlled trial that compared AFI with CE for dysplasia detection in 210 patients with long-standing UC [FIND-UC trial]. In the AFI arm, endoscopists used the ETMI system to record AFI colour, Kudo pit pattern using NBI and WLE for lesion characterization. For AFI, purple colour and ambiguous colour combined with pit pattern type III-V on NBI was considered dysplastic. Kudo pit pattern was described in the CE arm. For pit pattern description using NBI and CE, type III-V was considered dysplastic. Histology was the reference standard. Results: In total, 52 dysplastic and 255 non-dysplastic lesions were detected. Overall sensitivity for real-time prediction of dysplasia was 76.9% (95% confidence interval [CI] 46.2-95.0) for ETMI, and 81.6% [95% CI 65.7-92.3] for CE. Overall negative predictive value [NPV] for ETMI was 96.9% [95% CI 92.0-98.8] and 94.7% [90.2-97.2] for CE. Conclusions: Sensitivity for endoscopic differentiation of dysplastic lesions detected during surveillance of patients with long-standing UC seems limited using ETMI and CE. Future research is warranted as the high NPV indicates that these techniques are valuable for the exclusion of dysplastic lesions [NTR4062].


Assuntos
Colite Ulcerativa , Pólipos do Colo/diagnóstico por imagem , Neoplasias Colorretais/diagnóstico por imagem , Endoscopia do Sistema Digestório/métodos , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Pólipos do Colo/etiologia , Neoplasias Colorretais/etiologia , Diagnóstico Diferencial , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Valor Preditivo dos Testes , Sensibilidade e Especificidade
10.
Indian J Gastroenterol ; 37(3): 235-242, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29876742

RESUMO

BACKGROUND: Sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA) are recognized precursors of colorectal cancer, but their risk factors are not well established. We investigated the association between Helicobacter pylori infection (HPI) and the development of SSA and TSA. METHODS: Retrospective data were collected on patients aged ≥ 18 years that underwent colonoscopy with biopsy between 2006 and 2016. Based on histology, patients were classified into three groups: those with SSA and/or TSA, (serrated neoplasia group, SN); conventional adenomas only (CA); and with no polyps (NP). Gastric HPI status, demographic, and clinical risk factors were compared between groups using bivariate and multivariable analysis. RESULTS: HPI was significantly associated with increased risk of SN (SN vs. NP: OR 1.71 [95% CI 1.29-2.27]; SN vs. CA: 1.49 [1.14-1.96]). Additional factors associated with increased risk of SN included the following: age 50-75 years, compared to younger age (SN vs. NP: 2.83 [1.69-4.74]), female gender (SN vs. CA: 1.28 [0.99-1.64]), White race, compared to Blacks (SN vs. CA: 1.52 [1.07-2.15)], overweight and obese body mass index [SN vs. NP: p < 0.001) and current smoking status (SN vs. CA: 2.09 [1.55-2.82)]. Among SN, higher HPI prevalence was associated with dysplasia (p = 0.05) and proximal location (p = 0.01). CONCLUSIONS: Our data suggest that gastric HPI is associated with increased risk of SN and CA, with a stronger association with SN as compared to CA. Age 50-75 years, female gender, White race, obesity, and smoking were also predictors of SN. A positive correlation of HPI with proximal and dysplastic SN suggests a possible role in serrated pathway carcinogenesis. Prospective studies with large patient population are needed to further investigate this association.


Assuntos
Adenoma/etiologia , Pólipos do Colo/etiologia , Gastrite/complicações , Gastrite/microbiologia , Infecções por Helicobacter , Helicobacter pylori , Adenoma/epidemiologia , Fatores Etários , Idoso , Análise de Variância , Índice de Massa Corporal , Pólipos do Colo/epidemiologia , Neoplasias Colorretais/etiologia , Grupos de Populações Continentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Fumar
11.
J Dig Dis ; 19(7): 386-394, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29869371

RESUMO

Colon capsule endoscopy (CCE) is designed for direct visualization of the colonic mucosa through passive propulsion. The role of CCE in the detection of colonic polyps has been extensively evaluated. As mucosal healing has emerged as a pivotal target for treatment of inflammatory bowel disease (IBD), there is increasing data to suggest that CCE can also be used in the monitoring of mucosal inflammation in patients with active IBD, particularly in ulcerative colitis (UC) and Crohn's disease (CD). Despite advantages such as its non-invasive nature, patient's comfort, safety, and access to anatomical regions not easily reached by conventional endoscopy, CE has limitations including the lack of ability to obtain biopsies or therapeutic capabilities and no control over movement. In this review, the role and diagnostic value of CCE on diagnosis and monitoring of UC and CD patients, its safety and limitations are discussed.


Assuntos
Endoscopia por Cápsula/métodos , Colite Ulcerativa/diagnóstico por imagem , Pólipos do Colo/diagnóstico por imagem , Colonoscopia/métodos , Doença de Crohn/diagnóstico por imagem , Adulto , Colite Ulcerativa/complicações , Colo/diagnóstico por imagem , Pólipos do Colo/etiologia , Doença de Crohn/complicações , Feminino , Humanos , Mucosa Intestinal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
12.
Gastroenterology ; 155(2): 355-373.e18, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29702117

RESUMO

BACKGROUND & AIMS: Serrated polyps (SPs) and conventional adenomas are precursor lesions for colorectal cancer (CRC), but they are believed to arise via distinct pathways. We characterized risk factor profiles for SPs and conventional adenomas in a post hoc analysis of data from 3 large prospective studies. METHODS: We collected data from the Nurses' Health Study, the Nurses' Health Study 2, and the Health Professionals Follow-up Study on subjects who developed SPs or conventional adenomas. Our analysis comprised 141,143 participants who had undergone lower gastrointestinal endoscopy, provided updated diet and lifestyle data every 2-4 years, and were followed until diagnosis of a first polyp. We assessed 13 risk factors for CRC in patients with SPs or conventional adenomas and examined the associations according to histopathology features. RESULTS: We documented 7945 SPs, 9212 conventional adenomas, and 2382 synchronous SPs and conventional adenomas during 18-20 years of follow-up. Smoking, body mass index, alcohol intake, family history of CRC, and height were associated with higher risk of SPs and conventional adenomas, whereas higher intake of vitamin D and marine omega-3 fatty acid were associated with lower risk. The associations tended to be stronger for synchronous SPs and conventional adenomas. Smoking, body mass index, and alcohol intake were more strongly associated with SPs than conventional adenomas (P for heterogeneity <.05), whereas physical activity and intake of total folate and calcium were inversely associated with conventional adenomas but not SPs. For SPs and conventional adenomas, the associations tended to be stronger for polyps in the distal colon and rectum, of 10 mm or larger or with advanced histology. CONCLUSIONS: In an analysis of data from 3 large prospective studies, we found that although SPs and conventional adenomas share many risk factors, some factors are more strongly associated with one type of lesion than the other. These findings provide support for the etiologic heterogeneity of colorectal neoplasia.


Assuntos
Adenoma/epidemiologia , Pólipos do Colo/epidemiologia , Neoplasias Colorretais/epidemiologia , Adenoma/diagnóstico por imagem , Adenoma/etiologia , Adenoma/patologia , Idoso , Colo/diagnóstico por imagem , Colo/patologia , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/etiologia , Pólipos do Colo/patologia , Colonoscopia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/patologia , Feminino , Seguimentos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reto/diagnóstico por imagem , Reto/patologia , Fatores de Risco
13.
Balkan Med J ; 35(5): 400-401, 2018 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-29687785

RESUMO

Background: Filiform polyposis is a rare benign condition referred to as inflammatory polyposis, or pseudopolyposis that is usually found in association with Crohn's disease, ulcerative colitis or granulomatous colitis which is formed by non-specific mucosal and submucosal reactions to previous severe inflammation. It is characterized by multiple finger-like projections most commonly in the transverse and descending colon. Case Report: A 15-year-old girl with a history of ulcerative colitis was admitted to the pediatric emergency department with abdominal pain attacks for the past 2 weeks. Abdominal ultrasound and magnetic resonance enterography revealed mucosal thickening in the transverse and descending colon. Colonoscopy revealed small filiform polyps throughout the colon. Histopathological examination revealed inflammatory polyps associated with ulcerative colitis. Conclusion: Non-neoplastic filiform polyps can be detected even in children with ulcerative colitis with long-term remissions.


Assuntos
Colite Ulcerativa/complicações , Pólipos do Colo/etiologia , Polipose Intestinal/etiologia , Adolescente , Feminino , Humanos
14.
Endocrinol Diabetes Nutr ; 65(5): 297-305, 2018 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29653911

RESUMO

Acromegaly is a rare disease with many comorbidities that impair quality of life and limit survival. There are discrepancies in various clinical guidelines regarding diagnosis and postoperative control criteria, as well as screening and optimal management of comorbidities. This expert consensus was aimed at establishing specific recommendations for the Spanish healthcare system. The existing recommendations, the scientific evidence on which they are based, and the main controversies are reviewed. Unfortunately, the low prevalence and high clinical variability of acromegaly do not provide strong scientific evidences. To mitigate this disadvantage, a modified Delphi questionnaire, combining the best available scientific evidence with the collective judgment of experts, was used. The questionnaire, generated after a face-to-face debate, was completed by 17 Spanish endocrinologists expert in acromegaly. A high degree of consensus was reached (79.3%), as 65 of the total 82 statements raised were accepted. Some criteria for diagnosis and postoperative control were identified by this procedure. Regarding comorbidities, recommendations have been established or suggested for screening and management of oncological, cardiovascular, respiratory (sleep apnea), metabolic (dyslipidemia and diabetes), musculoskeletal, and hypopituitarism-related disorders. Consensus recommendations may facilitate and homogenize clinical care to patients with acromegaly in the Spanish health system.


Assuntos
Acromegalia/diagnóstico , Acromegalia/cirurgia , Adenoma/cirurgia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Absorciometria de Fóton , Acromegalia/complicações , Acromegalia/tratamento farmacológico , Adenoma/complicações , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/etiologia , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/etiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etiologia , Técnicas de Diagnóstico Cardiovascular , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/etiologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Humanos , Hipofisectomia , Polissonografia , Cuidados Pós-Operatórios , Guias de Prática Clínica como Assunto , Síndromes da Apneia do Sono/diagnóstico
16.
J Clin Gastroenterol ; 52(9): 805-811, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29210901

RESUMO

GOALS: The goal of this study is to test the association between lifetime smoking habits and colorectal polyps of different classifications. BACKGROUND: Smoking is an established risk factor for several cancers, including colorectal cancer. However, the association between lifetime smoking habits including intensity, duration, and cessation, and premalignant colorectal polyps is yet to be established. STUDY: A case-control study among 828 consecutive subjects aged 40 to 70 years, undergoing screening or diagnostic colonoscopy. Exclusion criteria were: medically treated diabetes, colectomy, and belonging to colorectal cancer high risk group. Polyps were stratified according to histology (serrated or adenomatous polyp) and location. All participants underwent anthropometric measurements and a structured medical and lifestyle interview. RESULTS: Current-smoking was more strongly associated with increased odds for distal rather than proximal polyps [odds ratio (OR), 4.00; 95% confidence interval (CI), 2.40-6.68 and OR, 2.52; 95% CI, 1.46-4.36, respectively], with serrated-polyps rather than adenomas (OR, 6.36; 95% CI, 2.77-14.57 and OR, 3.01; 1.90-4.74, respectively). All levels of smoking intensity (daily cigarettes) were associated with colorectal polyps. A dose-response association was seen between smoking duration and colorectal polyps. Smoking duration of ≥20 years was strongly associated with distal polyps (OR, 4.01; 95% CI, 1.62-9.84), independently of potential confounders, smoking intensity and years since smoking cessation. All associations were stronger for distal serrated polyps. CONCLUSIONS: Smoking duration is associated with colorectal plyps, independently of other potential confounders, smoking intensity, and cessation. The association is stronger with distal rather than proximal polyps, and with serrated polyps rather than adenomas.


Assuntos
Pólipos Adenomatosos/epidemiologia , Fumar Cigarros/epidemiologia , Pólipos do Colo/epidemiologia , Colonoscopia/métodos , Pólipos Adenomatosos/etiologia , Adulto , Idoso , Estudos de Casos e Controles , Fumar Cigarros/efeitos adversos , Pólipos do Colo/etiologia , Pólipos do Colo/patologia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/etiologia , Fatores de Risco , Abandono do Hábito de Fumar/estatística & dados numéricos , Fatores de Tempo
17.
J Gastroenterol Hepatol ; 33(7): 1335-1340, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29231995

RESUMO

BACKGROUND AND AIMS: The incidence and disease burden of colorectal cancer (CRC) in young adults were increasing. However, there was a dearth of advice on how to identify young population at risk for neoplastic colonic polyps (NCPs) and CRC. We aimed to identify risk factors for NCPs and CRC in young adults presenting with bloody stool. METHODS: A total of 1496 subjects younger than 40 years old who underwent colonoscopy due to bloody stool from 2005 to 2014 were enrolled in this retrospective study as the study group, and 1481 age-matched and gender-matched asymptomatic subjects who underwent colonoscopy for health checkup from 2011 to 2016 were enrolled as the control group at a tertiary center hospital. RESULTS: Multivariate analysis results showed that increasing age (odds ratio [OR] = 1.11, 95% confidence interval [CI]: 1.07-1.15, P < 0.001), higher body mass index (BMI) (OR = 1.07, 95%CI: 1.03-1.12, P = 0.001), diabetes mellitus (OR = 2.80, 95%CI: 1.06-7.42, P = 0.038), and positive family history of CRC (OR = 13.28, 95%CI: 5.70-30.97, P < 0.001) were identified as independent risk factors for NCPs in study group. The best cut-off values by receiver operating characteristic curve for age and BMI were 32 years old and 24.8 kg/m2 , respectively. More risk factors were associated with the higher risk for NCPs (OR = 2.17 every increasing one risk factor, P < 0.001). In the control group, no independent risk factors were identified. CONCLUSIONS: Adults aged ≤ 40 years with bloody stool who had increasing age (> 32 years old), higher BMI (> 24.8 kg/m2 ), diabetes mellitus, and positive family history of CRC had a higher detection rate of NCPs and CRC.


Assuntos
Pólipos do Colo/etiologia , Neoplasias Colorretais/etiologia , Melena/etiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Pólipos do Colo/diagnóstico , Colonoscopia , Neoplasias Colorretais/diagnóstico , Diabetes Mellitus , Feminino , Humanos , Masculino , Anamnese , Melena/diagnóstico , Análise Multivariada , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
18.
Obesity (Silver Spring) ; 25 Suppl 2: S72-S80, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29086511

RESUMO

OBJECTIVE: Prevention of colorectal cancer (CRC) by colonoscopy is recommended according to age and personal/familial history. Metabolic alterations are associated with colorectal adenomas, but data are scarce regarding serrated polyps and advanced polyps. The aim of this study was to evaluate the association between metabolic alterations and colorectal polyp type and advanced polyps. METHODS: A case-control study was conducted among consecutive subjects, 40 to 70 years old, who underwent screening/diagnostic colonoscopy from 2010 to 2015. Subjects who were treated for diabetes, who had a family/personal history of CRC, and who were at high risk for CRC were excluded. Participants underwent anthropometric, laboratory, and ultrasonographic evaluations and a medical and lifestyle interview. Polyps were histologically classified as adenomatous or serrated polyps and divided into advanced and non-advanced categories. RESULTS: The study included 828 participants (58.4 ± 6.6 years, 50.4% men). Abdominal obesity (odds ratio [OR] = 1.67, 95% CI: 1.20-2.30), hypertension (OR = 1.47, 95% CI: 1.03-2.09), and a high glycosylated hemoglobin percentage (HbA1c%) (OR = 1.57, 95% CI: 1.06-2.34) were independently associated with colorectal adenomas, whereas a high triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio was independently associated with serrated polyps (OR = 2.31, 95% CI: 1.32-4.03). A combination of three metabolic alterations was strongly associated with colorectal polyps. CONCLUSIONS: Abdominal obesity, hypertension, and a high HbA1c% are independently associated with adenomas, whereas a high TG/HDL ratio is associated with serrated polyps. These parameters are easily accessible in clinical practice and may help define high-risk groups for CRC.


Assuntos
Adenoma/epidemiologia , Neoplasias Colorretais/epidemiologia , Síndrome Metabólica , Obesidade Abdominal , Adenoma/sangue , Adenoma/etiologia , Adenoma/patologia , Estudos de Casos e Controles , Colesterol/sangue , Pólipos do Colo/sangue , Pólipos do Colo/epidemiologia , Pólipos do Colo/etiologia , Pólipos do Colo/patologia , Colonoscopia , Neoplasias Colorretais/sangue , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/patologia , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Triglicerídeos/sangue
19.
PLoS One ; 12(10): e0186668, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29088250

RESUMO

BACKGROUNDS AND AIMS: The association of melanosis coli with the development of colorectal polyps remains uncertain. METHODS: From a total of 18263 patients who had received colonoscopy in our hospital, 219 with melanosis coli cases and 438 controls matched by age and sex (at 1:2 ratio) were included in this study. The association of incidence, number, location, and pathology of colorectal neoplasm with grades and distribution of melanosis coli were analyzed. RESULTS: Melanosis coli was associated with significantly more colorectal polyps than control, a higher incidence of numerous colorectal polyps (number ≥ 20) (7.3% vs 0.5%; p < 0.001), and higher number of small colorectal polyps (diameter ≤ 5 mm; p < 0.01). Patients with melanosis coli had higher incidences of low-grade adenomas (31.1% vs 23.3%, p < 0.05) and non-adenoma polyps (20.1% vs 12.8%, p < 0.05) than the controls. On multivariate analysis, melanosis coli was independently associated with increased detecting rates of low grade adenoma (OR = 1.54; 95%: 1.06-2.23; p < .05), non-adenoma polyp (OR = 1.72; 95%: 1.11-2.70; p < .05) and numerous polyps (OR = 16.2, 95%: 3.66-71.6; p < .05). There was no significant difference in the incidence of high-grade adenomas or adenocarcinomas in the two population groups, but the numbers of these lesions were insufficient to permit firm conclusions. No significant differences in incidence, number, and pathology of colorectal polyps between individuals with melanosis coli of three different grades of severity were found. Melanosis located predominantly in the right colon had an interestingly lower incidence of colonic polyps in right colon than did melanosis located predominantly in the left colon or total colon (8.9% vs. 26.3%, 24.0%, p < 0.05). Patients with melanosis coli had significantly more nonspecific distal ileal ulcers than did controls (8.0% vs 0%, p < 0.001). CONCLUSION: Melanosis coli is associated with a higher incidence and number of colonic non-adenoma polyps and low-grade adenomas, and higher incidence of distal ileal ulcers. Melanosis coli may not be a harmless pigmentation, but a sign of chronic injury of colonic and intestinal mucosa.


Assuntos
Pólipos do Colo/etiologia , Melanose/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , Colonoscopia , Feminino , Humanos , Masculino , Melanose/complicações , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
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