Issue Highlights

Abstract

Coffee Reduces Risk for Hepatocellular Carcinoma: An Updated Meta-analysis Intake of Coffee, Decaffeinated Coffee, or Tea Does Not Affect Risk for Pancreatic Cancer: Results From the EPIC StudyCoffee contains several bioactive compounds with potential favorable health consequences, including a possible inhibitory effect on carcinogenesis. Insights into how coffee intake may affect the risk of hepatocellular carcinoma (HCC) and pancreatic cancer are provided in 2 articles published in this month’s issue of Clinical Gastroenterology and Hepatology.Liver cancer is the sixth most common cancer in the world, and HCC rates in North America and Northern Europe have been increasing over the last few decades. A meta-analysis of 10 case–control and cohort studies published in 2007 found that the relative risk (RR) of HCC for coffee drinkers compared to nondrinkers was 0.59 (95% confidence interval [CI], 0.49–0.72). Since then, 4 prospective and 2 case-control studies examining this association have been published. Therefore, Bravi et al performed an updated meta-analysis on how coffee intake affects the risk of HCC. They found a summary RR for any coffee consumption vs no consumption of 0.60 (95% CI, 0.50–0.71). The protective effect of coffee was consistent regardless of gender alcohol intake, or history of hepatitis or liver disease. However, causality is difficult to establish based upon observational studies, and the inverse relationship between coffee intake and HCC could be partly attributed to the fact that patients with digestive tract conditions, including liver disease, may reduce their coffee intake. Importantly, and as the authors point out, while there may be a role for coffee in liver cancer prevention, we must not lose sight of what can be achieved in this arena by hepatitis B vaccination, control of hepatitis C transmission, and reduction of alcohol drinking.In contrast to HCC, few modifiable risk factors (smoking, obesity, diabetes) have been implicated in the etiology of pancreatic cancer, a highly lethal malignancy. Basic research studies suggest that coffee and tea constituents, including flavonoids and caffeine, may inhibit tumor growth. Conversely, caffeine may decrease insulin sensitivity and hyperglycemia, both of which have been associated with an increased risk of pancreatic cancer. Two meta-analyses published in 2012 found no association between coffee intake and pancreatic cancer, but the majority of the included studies only assessed total coffee intake. Thus, it is conceivable that different types of coffee may have diverse effects on pancreatic cancer risk due to differences in their constituents. In order to explore this issue, Bhoo-Pathy et al investigated the association of total coffee, caffeinated coffee, decaffeinated coffee, and tea consumption with the risk of pancreatic cancer. Using data from the EPIC study, a large prospective European cohort of 477,312 subjects with 865 incident pancreatic cancers over a mean follow-up of 11.6 years, they found that total coffee, decaffeinated coffee, and tea consumption are not related to the risk of pancreatic cancer.See pages 1413 and 1486.High In-hospital Mortality After Percutaneous Endoscopic Gastrostomy: Results of a Nationwide Population-based Study Mortality Among Patients Who Receive or Defer GastrostomiesPercutaneous endoscopic gastrostomy (PEG) is a frequently performed invasive endoscopic procedure used to provide enteral nutrition to patients who cannot meet their nutritional requirements due to inadequate oral intake. Despite wide adoption into clinical practice, PEG has significant associated morbidity and short-term mortality. Therefore, improving our ability to select those patients who may benefit from this procedure is highly desirable. Two studies published in this issue of Clinical Gastroenterology and Hepatology address some of these important questions regarding the use, benefits, and complications of PEG.Short-term mortality after PEG may be as high as 25%, suggesting that many patients may not survive long enough to realize the benefit from the procedure. However, population-based studies examining this issue are lacking. Arora et al used the US Nationwide Inpatient Sample (NIS), a national database, to conduct a nested, case–control, retrospective study examining the incidence of and factors associated with in-hospital mortality following PEG. Among 181,196 patients who underwent PEG in 2006, in-hospital mortality was 10.8%. The odds of death increased with age, congestive heart failure, renal failure, chronic pulmonary disease, coagulopathy, pulmonary circulation disorders, metastatic cancer, and liver disease. Although the reasons for inappropriate patient selection for PEG are undoubtedly complex, the factors associated with in-hospital mortality identified by Arora et al should be taken into account.While it is important to identify risk factors for mortality following PEG, it is noteworthy that, up until now, there has been little information on outcomes of individuals who were referred for PEG but deferred this intervention. Kurien et al assessed 30-day and 1-year mortalities of patients who underwent gastrostomy compared to those in whom the intervention was deferred. Among 1327 patients referred to 2 UK hospitals for gastrostomies, 304 (23%) did not undergo the procedure because a multidisciplinary team review concluded that the intervention was futile, or the patient declined the intervention after considering the risks and benefits. Mortality for those who deferred vs those who underwent PEG was 35.5% vs 11.2% at 30 days, and 74.3% vs 41.1% at 1 year. In an additional analysis, there was acceptable agreement between actual and predicted mortality for both groups of patients using the validated Sheffield Gastrostomy Scoring System, an assessment tool used to predict mortality following gastrostomy. Although it appears that using a multidisciplinary team review while accounting for the patient’s wishes frequently enabled appropriate selection of patients who would benefit from PEG, the findings indicate that the Sheffield Gastrostomy Scoring System may provide objective support to clinicians involved in this decision-making process.See pages 1437 and 1445. Coffee Reduces Risk for Hepatocellular Carcinoma: An Updated Meta-analysis Intake of Coffee, Decaffeinated Coffee, or Tea Does Not Affect Risk for Pancreatic Cancer: Results From the EPIC StudyCoffee contains several bioactive compounds with potential favorable health consequences, including a possible inhibitory effect on carcinogenesis. Insights into how coffee intake may affect the risk of hepatocellular carcinoma (HCC) and pancreatic cancer are provided in 2 articles published in this month’s issue of Clinical Gastroenterology and Hepatology.Liver cancer is the sixth most common cancer in the world, and HCC rates in North America and Northern Europe have been increasing over the last few decades. A meta-analysis of 10 case–control and cohort studies published in 2007 found that the relative risk (RR) of HCC for coffee drinkers compared to nondrinkers was 0.59 (95% confidence interval [CI], 0.49–0.72). Since then, 4 prospective and 2 case-control studies examining this association have been published. Therefore, Bravi et al performed an updated meta-analysis on how coffee intake affects the risk of HCC. They found a summary RR for any coffee consumption vs no consumption of 0.60 (95% CI, 0.50–0.71). The protective effect of coffee was consistent regardless of gender alcohol intake, or history of hepatitis or liver disease. However, causality is difficult to establish based upon observational studies, and the inverse relationship between coffee intake and HCC could be partly attributed to the fact that patients with digestive tract conditions, including liver disease, may reduce their coffee intake. Importantly, and as the authors point out, while there may be a role for coffee in liver cancer prevention, we must not lose sight of what can be achieved in this arena by hepatitis B vaccination, control of hepatitis C transmission, and reduction of alcohol drinking.In contrast to HCC, few modifiable risk factors (smoking, obesity, diabetes) have been implicated in the etiology of pancreatic cancer, a highly lethal malignancy. Basic research studies suggest that coffee and tea constituents, including flavonoids and caffeine, may inhibit tumor growth. Conversely, caffeine may decrease insulin sensitivity and hyperglycemia, both of which have been associated with an increased risk of pancreatic cancer. Two meta-analyses published in 2012 found no association between coffee intake and pancreatic cancer, but the majority of the included studies only assessed total coffee intake. Thus, it is conceivable that different types of coffee may have diverse effects on pancreatic cancer risk due to differences in their constituents. In order to explore this issue, Bhoo-Pathy et al investigated the association of total coffee, caffeinated coffee, decaffeinated coffee, and tea consumption with the risk of pancreatic cancer. Using data from the EPIC study, a large prospective European cohort of 477,312 subjects with 865 incident pancreatic cancers over a mean follow-up of 11.6 years, they found that total coffee, decaffeinated coffee, and tea consumption are not related to the risk of pancreatic cancer.See pages 1413 and 1486. Coffee contains several bioactive compounds with potential favorable health consequences, including a possible inhibitory effect on carcinogenesis. Insights into how coffee intake may affect the risk of hepatocellular carcinoma (HCC) and pancreatic cancer are provided in 2 articles published in this month’s issue of Clinical Gastroenterology and Hepatology. Liver cancer is the sixth most common cancer in the world, and HCC rates in North America and Northern Europe have been increasing over the last few decades. A meta-analysis of 10 case–control and cohort studies published in 2007 found that the relative risk (RR) of HCC for coffee drinkers compared to nondrinkers was 0.59 (95% confidence interval [CI], 0.49–0.72). Since then, 4 prospective and 2 case-control studies examining this association have been published. Therefore, Bravi et al performed an updated meta-analysis on how coffee intake affects the risk of HCC. They found a summary RR for any coffee consumption vs no consumption of 0.60 (95% CI, 0.50–0.71). The protective effect of coffee was consistent regardless of gender alcohol intake, or history of hepatitis or liver disease. However, causality is difficult to establish based upon observational studies, and the inverse relationship between coffee intake and HCC could be partly attributed to the fact that patients with digestive tract conditions, including liver disease, may reduce their coffee intake. Importantly, and as the authors point out, while there may be a role for coffee in liver cancer prevention, we must not lose sight of what can be achieved in this arena by hepatitis B vaccination, control of hepatitis C transmission, and reduction of alcohol drinking. In contrast to HCC, few modifiable risk factors (smoking, obesity, diabetes) have been implicated in the etiology of pancreatic cancer, a highly lethal malignancy. Basic research studies suggest that coffee and tea constituents, including flavonoids and caffeine, may inhibit tumor growth. Conversely, caffeine may decrease insulin sensitivity and hyperglycemia, both of which have been associated with an increased risk of pancreatic cancer. Two meta-analyses published in 2012 found no association between coffee intake and pancreatic cancer, but the majority of the included studies only assessed total coffee intake. Thus, it is conceivable that different types of coffee may have diverse effects on pancreatic cancer risk due to differences in their constituents. In order to explore this issue, Bhoo-Pathy et al investigated the association of total coffee, caffeinated coffee, decaffeinated coffee, and tea consumption with the risk of pancreatic cancer. Using data from the EPIC study, a large prospective European cohort of 477,312 subjects with 865 incident pancreatic cancers over a mean follow-up of 11.6 years, they found that total coffee, decaffeinated coffee, and tea consumption are not related to the risk of pancreatic cancer. See pages 1413 and 1486. High In-hospital Mortality After Percutaneous Endoscopic Gastrostomy: Results of a Nationwide Population-based Study Mortality Among Patients Who Receive or Defer GastrostomiesPercutaneous endoscopic gastrostomy (PEG) is a frequently performed invasive endoscopic procedure used to provide enteral nutrition to patients who cannot meet their nutritional requirements due to inadequate oral intake. Despite wide adoption into clinical practice, PEG has significant associated morbidity and short-term mortality. Therefore, improving our ability to select those patients who may benefit from this procedure is highly desirable. Two studies published in this issue of Clinical Gastroenterology and Hepatology address some of these important questions regarding the use, benefits, and complications of PEG.Short-term mortality after PEG may be as high as 25%, suggesting that many patients may not survive long enough to realize the benefit from the procedure. However, population-based studies examining this issue are lacking. Arora et al used the US Nationwide Inpatient Sample (NIS), a national database, to conduct a nested, case–control, retrospective study examining the incidence of and factors associated with in-hospital mortality following PEG. Among 181,196 patients who underwent PEG in 2006, in-hospital mortality was 10.8%. The odds of death increased with age, congestive heart failure, renal failure, chronic pulmonary disease, coagulopathy, pulmonary circulation disorders, metastatic cancer, and liver disease. Although the reasons for inappropriate patient selection for PEG are undoubtedly complex, the factors associated with in-hospital mortality identified by Arora et al should be taken into account.While it is important to identify risk factors for mortality following PEG, it is noteworthy that, up until now, there has been little information on outcomes of individuals who were referred for PEG but deferred this intervention. Kurien et al assessed 30-day and 1-year mortalities of patients who underwent gastrostomy compared to those in whom the intervention was deferred. Among 1327 patients referred to 2 UK hospitals for gastrostomies, 304 (23%) did not undergo the procedure because a multidisciplinary team review concluded that the intervention was futile, or the patient declined the intervention after considering the risks and benefits. Mortality for those who deferred vs those who underwent PEG was 35.5% vs 11.2% at 30 days, and 74.3% vs 41.1% at 1 year. In an additional analysis, there was acceptable agreement between actual and predicted mortality for both groups of patients using the validated Sheffield Gastrostomy Scoring System, an assessment tool used to predict mortality following gastrostomy. Although it appears that using a multidisciplinary team review while accounting for the patient’s wishes frequently enabled appropriate selection of patients who would benefit from PEG, the findings indicate that the Sheffield Gastrostomy Scoring System may provide objective support to clinicians involved in this decision-making process.See pages 1437 and 1445. Percutaneous endoscopic gastrostomy (PEG) is a frequently performed invasive endoscopic procedure used to provide enteral nutrition to patients who cannot meet their nutritional requirements due to inadequate oral intake. Despite wide adoption into clinical practice, PEG has significant associated morbidity and short-term mortality. Therefore, improving our ability to select those patients who may benefit from this procedure is highly desirable. Two studies published in this issue of Clinical Gastroenterology and Hepatology address some of these important questions regarding the use, benefits, and complications of PEG. Short-term mortality after PEG may be as high as 25%, suggesting that many patients may not survive long enough to realize the benefit from the procedure. However, population-based studies examining this issue are lacking. Arora et al used the US Nationwide Inpatient Sample (NIS), a national database, to conduct a nested, case–control, retrospective study examining the incidence of and factors associated with in-hospital mortality following PEG. Among 181,196 patients who underwent PEG in 2006, in-hospital mortality was 10.8%. The odds of death increased with age, congestive heart failure, renal failure, chronic pulmonary disease, coagulopathy, pulmonary circulation disorders, metastatic cancer, and liver disease. Although the reasons for inappropriate patient selection for PEG are undoubtedly complex, the factors associated with in-hospital mortality identified by Arora et al should be taken into account. While it is important to identify risk factors for mortality following PEG, it is noteworthy that, up until now, there has been little information on outcomes of individuals who were referred for PEG but deferred this intervention. Kurien et al assessed 30-day and 1-year mortalities of patients who underwent gastrostomy compared to those in whom the intervention was deferred. Among 1327 patients referred to 2 UK hospitals for gastrostomies, 304 (23%) did not undergo the procedure because a multidisciplinary team review concluded that the intervention was futile, or the patient declined the intervention after considering the risks and benefits. Mortality for those who deferred vs those who underwent PEG was 35.5% vs 11.2% at 30 days, and 74.3% vs 41.1% at 1 year. In an additional analysis, there was acceptable agreement between actual and predicted mortality for both groups of patients using the validated Sheffield Gastrostomy Scoring System, an assessment tool used to predict mortality following gastrostomy. Although it appears that using a multidisciplinary team review while accounting for the patient’s wishes frequently enabled appropriate selection of patients who would benefit from PEG, the findings indicate that the Sheffield Gastrostomy Scoring System may provide objective support to clinicians involved in this decision-making process. See pages 1437 and 1445. Mortality Among Patients Who Receive or Defer GastrostomiesClinical Gastroenterology and HepatologyVol. 11Issue 11PreviewThere are few data on outcomes and mortality of patients who have received gastrostomies. We assessed 30-day and 1-year mortalities of patients in the United Kingdom who were referred to hospitals for gastrostomies and of patients who deferred this intervention. Full-Text PDF Intake of Coffee, Decaffeinated Coffee, or Tea Does Not Affect Risk for Pancreatic Cancer: Results From the European Prospective Investigation into Nutrition and Cancer StudyClinical Gastroenterology and HepatologyVol. 11Issue 11PreviewFew modifiable risk factors have been implicated in the etiology of pancreatic cancer. There is little evidence for the effects of caffeinated coffee, decaffeinated coffee, or tea intake on risk of pancreatic cancer. We investigated the association of total coffee, caffeinated coffee, decaffeinated coffee, and tea consumption with risk of pancreatic cancer. Full-Text PDF High In-hospital Mortality After Percutaneous Endoscopic Gastrostomy: Results of a Nationwide Population-based StudyClinical Gastroenterology and HepatologyVol. 11Issue 11PreviewIt is important to carefully select patients who undergo endoscopic procedures, to optimize health care. Percutaneous endoscopic gastrostomy (PEG) is a frequently performed invasive endoscopic procedure that has been associated with high short-term mortality. We used a national database to determine the incidence of, and factors associated with, in-hospital mortality among patients undergoing PEG. Full-Text PDF Coffee Reduces Risk for Hepatocellular Carcinoma: An Updated Meta-analysisClinical Gastroenterology and HepatologyVol. 11Issue 11PreviewCoffee consumption has been suggested to reduce the risk for hepatocellular carcinoma (HCC). We performed a meta-analysis of epidemiological studies to provide updated information on how coffee drinking affects HCC risk. Full-Text PDF