Gastrointestinal Risk Research Articles

Abstract 4137535: Gastrointestinal Bleeding Risk: Diltiazem versus Metoprolol in Patients on Rivaroxaban, Apixaban, or Dabigatran.

Introduction: A recent JAMA study by Ray et al., reported severe bleeding risk among older adults with atrial fibrillation (Afib) receiving apixaban or rivaroxaban along with diltiazem compared to metoprolol. Our investigation extended to evaluating the gastrointestinal (GI) bleeding risk associated with various Xa inhibitors and dabigatran when combined with either diltiazem, or metoprolol among all adults ages 18 and older. Method: We conducted a comparative retrospective cohort study using de-identified patient data obtained from the global network of the TriNetX platform, a comprehensive electronic health records system comprising 120 healthcare systems and more than 147 million patients worldwide. The cohorts were divided into patients treated with diltiazem vs. metoprolol while receiving apixaban or rivaroxaban (Cohort A), patients receiving metoprolol with apixaban vs. rivaroxaban treatment (Cohort B), patients treated with diltiazem with apixaban vs rivaroxaban (Cohort C), and patients treated with diltiazem vs metoprolol who received dabigatran (Cohort D). The risk of gastrointestinal hemorrhage among the cohorts was evaluated. Propensity score matching was employed to balance baseline characteristics between the cohorts, including age, sex, ethnicity, and comorbidities. Results: The risk of GI bleed in patients taking diltiazem with either apixaban or rivaroxaban was 6.3%, while the risk in patients taking metoprolol with either of these Xa inhibitors was 5.7 % (p< 0.0001, 95%CI (1.074,1.111), RR 1.09. In patients taking metoprolol with apixaban, GI bleed risk was 5.4%, compared to 6.4% in those taking metoprolol with rivaroxaban (p< 0.0001, 95% CI (0.838, 0.868), RR 0.85. For patients taking diltiazem with rivaroxaban, GI bleed risk was 7.3%, whereas it was 5.8% in those taking diltiazem with apixaban (p< 0.0001, 95% CI (1.194, 1.265), RR 1.23. Risk of GI bleed in patients taking diltiazem with dabigatran was 7.4%% while it was 6.71% for patients treated with metoprolol and dabigatran (p< 0.0011, CI 95% (1.038,1.16), RR 1.097) Discussion: Global patients’ data in this study suggested similar findings reported by Ray et al. Additionally, among all ages adults with Afib, treatment with metoprolol and apixaban was associated with the lower risk of GI bleed when compared with metoprolol and rivaroxaban. While the highest risk of GI bleed was associated with concurrent diltiazem and dabigatran use.

Post-colonoscopy upper gastrointestinal malignancies in positive immunochemical fecal occult blood test patients: An Australian data linkage study.

In immunochemical fecal occult blood test (iFOBT) positive subjects, colonoscopy screening can detect colorectal cancers and advanced adenomas, yet most iFOBT-positive subjects find no relevant lower gastrointestinal lesions. Limited data are available on upper gastrointestinal (UGI) cancer risk in iFOBT-positive patients. This study investigated the incidence of UGI malignancies diagnosed within 3years post-colonoscopy after a positive iFOBT. Retrospective analysis of iFOBT-positive patients aged 50-75years who underwent a colonoscopy at a single institution. All patients with a diagnosis of UGI cancer within 3years post-colonoscopy were identified by linking with the Queensland Cancer Register. This was used to compare to the geographical population aged 50-74years based on the Australian Bureau of Statistics and Queensland Cancer Council data. From 1748 eligible participants, 0.23% (95% confidence interval [CI] 0.06-0.58) were diagnosed with UGI cancer within 3years post-colonoscopy. This indicates an esophageal cancers rate of 114.42 per 100000 (95% CI 100.56-298.28) and gastric cancer rate of 57.21 per 100000 (95% CI 55.76-261.12). Of the patients with a UGI cancer, 75% would have had an unexplained iFOBT. Annual incidence for the same geographic region, ages, and period for the combined esophageal and gastric cancer was 36.08 per 100000 (95% CI 32.87-39.52). Among individuals with a positive iFOBT in a bowel cancer screening program, the rates of gastric and esophageal cancers were 2.7 and 7.5 times higher than the general population. Adding gastroscopy to a colonoscopy for iFOBT-positive patients in cancer surveillance programs may be justifiable.

Do shift-working nurses’ work-life quality relate to their physical health and diet quality?

Abstract Background Shift work negatively affects work-related quality of life and this situation causes significant labour force losses and decreased productivity in the society, especially health problems in nurses. This study was conducted to determine the relationship between work-related quality of life, physical health level and nutritional behaviours of nurses working in shifts. Methods This descriptive and relationship-seeking study was conducted with 312 nurses selected by quota sampling in Istanbul. Data were collected between December 2022 to July 2023 using the The Professional Quality of Life Scale (ProQOL), Physical Health Questionnaire and Food Consumption Frequency Questionnaire. Descriptive statistics and Pearson correlation tests were conducted on IBM SPSS 25.0. BeBIS 7.1 software were used for calculation diet index. Results Compassion Satisfaction (CS), Burnout (B) and Compassion Fatigue (CF) scores of nurses was examined, a relationship was found between CS score and B score (r=-0.39 p < 0.05) and between B score and CF score (r = 0.58 p < 0.05). CS score correlated with Cardiovascular Risk Level score (r=-0.15 p < 0.05) and diet index score (r = 0.15 p < 0.05). B score correlated with Gastrointestinal Risk Level score (r = 0.27 p < 0.05) and Cardiovascular Risk Level score (r = 0.38 p < 0.05). There was a correlation between the score of CF and Gastrointestinal Risk Level score (r = 0.25 p < 0.05) and Cardiovascular Risk Level score (r = 0.31 p < 0.05). Daily energy, fibre, vitamin B1 and C, folate, calcium and magnesium intakes of nurses were lower than the recommended. Conclusions Research results support that the gastrointestinal and cardiovascular systems have a direct relationship with stress and emotional states. In the policies to be developed within the scope of occupational health nursing practices, it is recommended to carry out studies to improve the physical health and nutritional behaviours of nurses in order to improve their work-related quality of life. Key messages • Nurses are a risky occupational group in terms of burnout. Protection studies should be prioritised to prevent burnout. • Gastrointestinal and cardiovascular system complaints of nurses should be paid special attention during recruitment and periodic examinations.

Glucagon-like peptide-1 receptor agonists before upper gastrointestinal endoscopy and risk of pulmonary aspiration or discontinuation of procedure: cohort study

ObjectiveTo assess whether use of glucagon-like peptide-1 (GLP-1) receptor agonists before upper gastrointestinal endoscopy is associated with increased risk of pulmonary aspiration or discontinuation of the procedure compared with sodium-glucose...

Prediction of gastrointestinal bleeding hospitalization risk in hemodialysis using machine learning

BackgroundGastrointestinal bleeding (GIB) is a clinical challenge in kidney failure. INSPIRE group assessed if machine learning could determine a hemodialysis (HD) patient’s 180-day GIB hospitalization risk.MethodsAn eXtreme Gradient Boosting (XGBoost) and logistic regression model were developed using an HD dataset in United States (2017–2020). Patient data was randomly split (50% training, 30% validation, and 20% testing). HD treatments ≤ 180 days before GIB hospitalization were classified as positive observations; others were negative. Models considered 1,303 exposures/covariates. Performance was measured using unseen testing data.ResultsIncidence of 180-day GIB hospitalization was 1.18% in HD population (n = 451,579), and 1.12% in testing dataset (n = 38,853). XGBoost showed area under the receiver operating curve (AUROC) = 0.74 (95% confidence interval (CI) 0.72, 0.76) versus logistic regression showed AUROC = 0.68 (95% CI 0.66, 0.71). Sensitivity and specificity were 65.3% (60.9, 69.7) and 68.0% (67.6, 68.5) for XGBoost versus 68.9% (64.7, 73.0) and 57.0% (56.5, 57.5) for logistic regression, respectively. Associations in exposures were consistent for many factors. Both models showed GIB hospitalization risk was associated with older age, disturbances in anemia/iron indices, recent all-cause hospitalizations, and bone mineral metabolism markers. XGBoost showed high importance on outcome prediction for serum 25 hydroxy (25OH) vitamin D levels, while logistic regression showed high importance for parathyroid hormone (PTH) levels.ConclusionsMachine learning can be considered for early detection of GIB event risk in HD. XGBoost outperforms logistic regression, yet both appear suitable. External and prospective validation of these models is needed. Association between bone mineral metabolism markers and GIB events was unexpected and warrants investigation.Trial registrationThis retrospective analysis of real-world data was not a prospective clinical trial and registration is not applicable.Graphical

Cost-utility analysis of duloxetine in osteoarthritis: from Chinese healthcare perspective

ABSTRACT Objectives To estimate the cost-utility of duloxetine compared with that of a placebo, common traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors for the treatment of osteoarthritis (OA) from a Chinese healthcare perspective. Methods A Markov model was constructed. The costs and utility inputs were obtained from the database and published literature. Incremental cost-effectiveness ratio (ICER) was the main model outputs. Subgroup analyses were also conducted for patients at high risk of gastrointestinal (GI) or cardiovascular (CV) AEs. Deterministic and probabilistic sensitivity analyses were performed. Results The model estimated an ICER of $3409.21/QALY for duloxetine compared with etoricoxib, with duloxetine dominating other active treatment strategies in patients at a low risk of GI and CV AEs. The ICER for duloxetine over etoricoxib was $322.21/QALY in patients at high risk of GI and CV AEs. These results were consistent with the sensitivity analyses; 53.64% and 53.93% of the patients were willing to use duloxetine comparing with etoricoxib, for which the thresholds were 1.0 and 3.0 per capita gross domestic product (GDP), respectively. Conclusions Duloxetine is a valuable option for patients with OA; however, uncertainties exist in the model, and these suggestions can be adopted with caution.

Prediction of Gastrointestinal Bleeding Hospitalization Risk in Hemodialysis: Machine Learning vs. Logistic Regression

Prediction of Gastrointestinal Bleeding Hospitalization Risk in Hemodialysis: Machine Learning vs. Logistic Regression

Nonvitamin K Anticoagulants: Risk of Bleeding When Interacting With Other Medications: A Cohort Study From Medicare.

Patients on nonvitamin K antagonist (NVKA) are usually taking other drugs. Potential interaction may increase the gastrointestinal (GI) bleeding risk associated with NVKA. Observational cohort study using Medicare data from 2017 to 2020. Participants receiving a NVKA were included. A concomitant overlapping period while on NVKA was assessed for nonsteroidal anti-inflammatory drugs (NSAIDS), selective serotonin reuptake inhibitors (SSRI), antiplatelets, glucocorticoids, aspirin and proton pump inhibitors (PPI). A logistic regression predicting either any bleeding or GI bleeding was conducted estimating the odds ratio (OR) and 95% confidence interval (CI). A total of 102 531 people on NVKA with mean age 77 years (SD = 9.8) and 55% females (N = 56 671) were included. Previous history of GI bleeding occurred in 2 908 (2.8%) participants, concomitant exposure to PPI occurred in 38 713 (38%), SSRI in 16 487 (16%), clopidogrel in 15 795 (15.4%), NSAIDs in 13 715 (13.4%) and glucocorticoids in 13 715 (13.4%). Risk for any bleeding was shown for clopidogrel (OR: 1.37, 95% CI: 1.30, 1.44), prasugrel/ticagrelor (OR: 1.36, 95% CI: 1.18, 1.58), glucocorticoids (OR: 1.26, 95% CI: 1.19, 1.34), and SSRIs (OR: 1.13, 95% CI: 1.07, 1.19). GI bleeding risk was shown for clopidogrel (OR: 1.44, 95% CI: 1.34, 1.55), prasugrel/ticagrelor (OR: 1.47, 95% CI: 1.20, 1.79), SSRIs (OR: 1.09, 95% CI: 1.01, 1.17) and glucocorticoids (OR: 1.33, 95% CI: 1.23, 1.44). PPI use was correlated with both NSAID (r = 0.07, p ≤ 0.0001) and SSRI use (r = 0.09, p ≤ 0.0001). NVKA concomitantly taken with antiplatelets, glucocorticoids, and SSRIs showed an increased risk for any bleeding and GI bleeding.

Multicenter retrospective cohort study demonstrates superior safety profile of indobufen over aspirin for Post-CABG antiplatelet therapy.

Coronary artery bypass grafting (CABG) is essential for treating coronary artery disease, with postoperative aspirin crucial to prevent graft restenosis. However, its gastrointestinal side effects may limit tolerability in some patients. Indobufen presents a potential alternative, but its safety and efficacy need further validation. This study aimed to compare the efficacy and safety of indobufen versus aspirin in patients' post-CABG. This retrospective observational study included 39 patients who underwent CABG at two centers from January to December 2023. Patients were retrospectively assigned to two groups based on the antiplatelet therapy they received: the indobufen group (n = 19) and the aspirin group (n = 20). The primary endpoint was a composite of non-fatal myocardial infarction, stroke, and revascularization due to acute coronary syndrome in the intention-to-treat population. Postoperative data on platelet count, hemoglobin, D-dimer, activated partial thromboplastin time (APTT), and hospital stay length were collected. Transfusion rate, bleeding, thrombotic events, and gastrointestinal adverse reactions were compared between the two groups. Over the 8-to-18-month follow-up period, 5 patients (25%) in the aspirin group reached the primary endpoint, while none in the indobufen group did, a difference that was statistically significant (p = 0.02). Although the rates of non-fatal myocardial infarction, revascularization, stroke, and thrombotic events were higher in the aspirin group, these differences did not reach statistical significance. Importantly, the total bleeding events were markedly lower in the indobufen group (15.79% vs. 55%, p = 0.011), with major bleeding events also significantly reduced in the indobufen group (0% vs. 20%, p = 0.04). Both groups showed no significant differences were observed in postoperative hospital stay, hemoglobin, and D-dimer levels between the groups. However, the indobufen group demonstrated significantly lower platelet count and APTT. The average daily cost of indobufen was 27.8 times higher than that of aspirin. Indobufen demonstrates a comparable antiplatelet effect to aspirin and offers significant advantages in reducing gastrointestinal adverse reactions and bleeding risk. It can be considered a preferable alternative for patients who cannot tolerate or have contraindications to aspirin. Further large-scale clinical trials are needed to confirm its potential as the first-choice antiplatelet therapy post-CABG.

Prescribing practices for Proton pump inhibitors among primary care physicians in England.

Proton pump inhibitors (PPIs) the most frequently prescribed drug class globally, are often overused. To assess PPI prescribing practice in England. Electronic medical record (EMR) evaluation from 62 primary care GP practices. Adult patients on continuous PPI treatment (repeat prescription or≥4 acute prescriptions 6 months before data extraction) were included (August 2021-June 2022) to compare PPI prescribing practices vs National Institute for Health and Care Excellence (GORD and dyspepsia management) and Medicines and Healthcare products Regulatory Agency (clopidogrel-PPI interaction) guidelines. We identified 77,356 patients on continuous PPI treatment. The most common (68%) diagnosis recorded in patients' EMRs and indicated for PPI use was gastroprotection, although 62% had no recorded indication. Of these 62% patients, 40% had no medication review in the preceding year. Among those with diagnoses indicated for≤3 months of PPI therapy (34%), 99% received their first PPI prescription≥3 months previously. Of patients with diagnoses indicated for long-term treatment (4%), 41% had no medication review in the preceding year. Furthermore, 18% of patients using omeprazole or esomeprazole were also prescribed clopidogrel, and 19% of those prescribed treatments associated with gastrointestinal risk (N=14,826) were not prescribed PPIs. This study shows that PPI prescribing in England is not in alignment with existing clinical guidelines and highlights the need for appropriate measures to increase awareness of overuse and support deprescribing where appropriate.

Dihydropyrimidine Dehydrogenase Polymorphism c.2194G>A Screening Is a Useful Tool for Decreasing Gastrointestinal and Hematological Adverse Drug Reaction Risk in Fluoropyrimidine-Treated Patients.

Although the risk of fluoropyrimidine toxicity may be decreased by identifying poor metabolizers with a preemptive dihydropyrimidine dehydrogenase (DPYD) test, following international standards, many patients with wild-type (WT) genotypes for classic variations may still exhibit adverse drug reactions (ADRs). Therefore, the safety of fluoropyrimidine therapy could be improved by identifying new DPYD polymorphisms associated with ADRs. This study was carried out to assess whether testing for the underestimated c.2194G>A (DPYD*6 polymorphism, rs1801160) is useful, in addition to other well-known variants, in reducing the risk of ADRs in patients undergoing chemotherapy treatment. This retrospective study included 132 patients treated with fluoropyrimidine-containing regimens who experienced ADRs such as gastrointestinal, dermatological, hematological, and neurological. All subjects were screened for DPYD variants DPYD2A (IVS14+1G>A, c.1905+1G>A, rs3918290), DPYD13 (c.1679T>G, rs55886062), c.2846A>T (rs67376798), c.1236G>A (rs56038477), and c.2194G>A by real-time polymerase chain reaction (RT-PCR). In this cohort, the heterozygous c.2194G>A variant was present in 26 patients, while 106 individuals were WT; both subgroups were compared for the incidence of ADRs. This assessment revealed a high incidence of gastrointestinal and hematological ADRs in DPYD6 carriers compared to WT. Moreover, we have shown a higher prevalence of ADRs in females compared to males when stratifying c.2194G>A carrier individuals. Considering that c.2194G>A was linked to clinically relevant ADRs, we suggest that this variant should also be assessed preventively to reduce the risk of fluoropyrimidine-related ADRs.

O72 ASSOCIATION BETWEEN CUMULATIVE BLOOD PRESSURE AND RISK OF GASTEROINTESTINAL CANCER

Objective: We aimed to examine the association between cumulative blood pressure (cumBP) and risk of gastrointestinal cancer. Methods: The Kailuan study is a prospective cohort study based on community. CumBP (mmHg year) was calculated as follows: cumBP = [(BP1 + BP2)/2 time1-2] + [(BP2 + BP3)/2 time2-3]. All participants were into four groups according to the quartiles of cumBP. The association between quartiles of cumBP or duration of hypertension and gastrointestinal cancer was assessed by the Cox proportional hazards models (hazard ratios [HRs], 95%confidence intervals [CI]). Results: During the median follow-up time of 11 years, a total of 624 (0.95%) participants gastrointestinal cancer occurred among 65,734 participants. The Kaplan-Meier curves showed that higher quartiles on cumulative systolic blood pressure (cumSBP), cumulative diastolic blood pressure (cumDBP) and cumulative pulse pressure (cumPP) or duration of hypertension are strongly associated with an increased risk of gastrointestinal cancer. After adjusting for covariables, compared with the lowest quartile of cumSBP, cumDBP and cumPP, the HRs (95%CI) of gastrointestinal cancer in highest quartiles were 1.96 (1.44-2.67), 1.29 (0.98-1.71), and 2.18 (1.62-2.92), respectively. Furthermore, compared to those with hypertension unexposed, participants with a 6 years exposure duration of hypertension had 1.37-fold higher risk of gastrointestinal cancer. Conclusions: The higher exposure of cumSBP, cumPP and duration of hypertension are associated with an increased risk of gastrointestinal cancer. Striving to control long-term SBP, PP and hypertension across the life course, and avoiding to develop hypertension by keeping good pathways such as health lifestyles could be of enormous benefit for gastrointestinal cancer risk reduction.

CYP2D6, CYP2E1 Gene Polymorphisms and Gastrointestinal Cancer Risk in Rural Maharashtra: A Hospital Based Case-Control Study.

Cytochrome P450 (CYP) is a family phase I metabolizing enzymes important in xenobiotics metabolism. Genetic polymorphisms of CYPs have been comprehensively studied for their association with a range of diseases including cancer risk. In this study we assessed single nucleotide polymorphism (SNP) CYP2D6 and CYP2E1 genes and their role in gastrointestinal (GI) cancer susceptibility in the rural population of Maharashtra. Genotyping of CYP2D6*4, CYP2E1*5B, CYP2E1*6, CYP2E1*7B genes among 200 GI cancer cases and equal number of controls was studied by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The Odds ratio (OR) with 95% confidence interval and p-value were evaluated to get the level of association of polymorphisms with risk of GI cancer, where p ≤0.005 was considered as statistically significant. After the analysis of CYP2D6 and CYP2E1 gene polymorphisms, we noticed that CYP2D6*4 (rs3892097) with heterozygous genotype (G/C) showed negative association with GI cancer risk (OR=0.43, 95% CI: 0.25-0.74; p=0.002) and CYP2E1*6 (rs6413432) variant genotype showed positive association (OR=2.85, 95% CI: 1.40-5.81; p=0.003) showed positive association with GI cancer risk in studied population. The findings obtained from this study concluded that the polymorphic CYP2D6 was negatively associated; however CYP2E1*6 polymorphism was significantly associated with GI cancer risk in studied population.

Nonsteroidal anti-inflammatory drug use by patients: Impact of modular educational training on pharmacists' questioning, counselling and risk assessments

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs)-related morbidity and mortality can be reduced through medication counselling and risk reduction. ObjectivesThis study evaluated the impact of short online modular NSAID training on the type and quality of questions asked, risk factors assessed, and counselling offered by community pharmacists to NSAID users. MethodsA cross-sectional questionnaire-guided survey conducted in Ibadan, Nigeria, among 87 pharmacists evaluated the frequency of counselling, NSAID risk factor assessment and barriers to risk assessment. Additionally, a before-and-after RCT was used to evaluate the impact of short online modular NSAID training for the intervention group (IG) on the type and quality of the questions asked, counselling provided, and risk assessed by the pharmacists. Eight standardised patients, aged 25–43 years, four at pre- and postintervention, presented four standardised scenarios at community pharmacies [IG, n = 22, control group (CG, n = 30)] to assess these outcomes. The quality of each outcome (questions asked, counselling offered and risk assessed) was classified as poor (0–≤20%), fair (>20–≤40%), moderate (>40 – ≤60%), or optimal (>60–100%). The data are presented with descriptive statistics. ResultsThe community pharmacists reported counselling patients on NSAID precautions (80–86%) and dosages (51–69%). Gastrointestinal bleeding risk was assessed by 61–89% of the pharmacists, and time constraints (39–42%) and patient impatience (47–75%) were some barriers to risk assessment. Online modular educational intervention significantly improved the types and quality of questions asked by pharmacists (CG: poor to fair, 16%–21%; IG: poor to moderate, 14%–45%), NSAID risk factors assessed (CG: poor to poor, 10%–9%; IG: poor to fair, 11%–27%) and counselling offered (CG: poor to poor, 6%–7%; IG: poor to fair, 6%–22%). ConclusionsShort online modular educational training on NSAIDs improved the types and quality of the questions asked, NSAID risk factors assessed, and counselling provided by community pharmacists to patients during consultations.

The effects of air and transportation noise pollution-related altered blood gene expression, DNA methylation, and protein abundance levels on gastrointestinal diseases risk

IntroductionAir pollution and transportation noise pollution has been linked to gastrointestinal (GI) diseases, but their relationship remains unclear. MethodsWe extracted the significantly modulated genes and CpG sites related to air pollution (PM2.5, PM10, and NOx) and transportation noise pollution (aircraft, railway, and traffic road noise) from previous published studies. Genome-wide methylation analysis and colocalization analysis with these CpG sites and GWAS data of GI diseases were performed to disentangle the relationship between pollution-related blood DNA methylation (DNAm) alterations and GI diseases risk. Summary-based Mendelian randomization (SMR) analysis assessed the impact of pollution-related genes on GI diseases risk across methylation, gene expression, and protein levels. Enrichment analysis investigated the implicated biological pathways and immune cell types. ResultsDNAm at cg00227781 [CD300A] (modulated by NOx exposure) and cg19215199 [ZMIZ1] (modulated by PM2.5 exposure) was significantly linked to increased noninfective enteritis and colitis risk, while cg08500171 [BAT2] (modulated by NOx exposure) is significantly associated with an increased gastroesophageal reflux disease (GERD) risk. Colocalization analysis provides strong evidence supporting a shared causal variant between these associations. Multi-omics levels SMR analysis revealed that pollution-modulated lower DNAm at 5 specific CpG sites were associated with increased expression of 4 genes (IL21R, EVPL, SYNGR1, and WDR46), subsequently increasing the risk of GERD, ulcerative colitis, and gastric ulcer. 7 circulating proteins coded by pollution-modulated genes were observed to be associated with 6 GI diseases risk. Enrichment analysis implicates immune and inflammatory responses, MAPK signaling, and telomere maintenance in these pollution-induced effects. ConclusionWe identified potential links between air and transportation noise pollution-related gene methylation, expression, and protein abundance with GI diseases risk, possibly revealing new therapeutic targets.

Risk of gastrointestinal bleeding in Asian patients receiving oral anticoagulants for stroke prevention in atrial fibrillation.

Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used for stroke prevention in atrial fibrillation. At the Asia Pacific Advancing Patient care with EdoXaban 2023 meeting, experts shared insights on gastrointestinal bleeding with NOACs for stroke prevention in atrial fibrillation in Asian clinical practice, where NOACs have gained widespread acceptance due to their favourable profiles. Gastrointestinal bleeding risk varies amongst NOACs, emphasizing the importance of diligent patient assessment, dosage selection and vigilant monitoring. Edoxaban emerged as a viable option with a low gastrointestinal bleeding risk profile in Asian compared with non-Asian patients, supporting its continued clinical utilization for appropriate patients.

Food biodiversity and gastrointestinal cancer risk in nine European countries: Analysis within a prospective cohort study

BackgroundFood biodiversity in human diets has potential co-benefits for both public health and sustainable food systems. However, current evidence on the potential relationship between food biodiversity and cancer risk, and particularly gastrointestinal cancers typically related to diet, remains limited. This study evaluated how dietary species richness (DSR) was associated with gastrointestinal cancer risk in a pan-European population. MethodsAssociations between DSR and subsequent gastrointestinal cancer risk were examined among 450,111 adults enrolled in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC, initiated in 1992), free of cancer at baseline. Usual dietary intakes were assessed at recruitment with country-specific dietary questionnaires. DSR of an individual’s yearly diet was calculated based on the absolute number of unique biological species in each food and drink item. Associations between DSR and cancer risk were assessed by multivariable Cox proportional hazards regression models. FindingsDuring a median follow-up time of 14.1 years (SD=3.9), 10,705 participants were diagnosed with gastrointestinal cancer. Hazard ratios (HRs) and 95 % confidence intervals (CIs) comparing overall gastrointestinal cancer risk in the highest versus lowest quintiles of DSR indicated inverse associations in multivariable-adjusted models [HR (95 % CI): 0.77 (0.69–0.87); P-value < 0·0001] (Table 2). Specifically, inverse associations were observed between DSR and oesophageal squamous cell carcinoma, proximal colon, colorectal, and liver cancer risk (p-trend<0.05 for all cancer types). InterpretationGreater food biodiversity in the diet may lower the risk of certain gastrointestinal cancers. Further research is needed to replicate these novel findings and to understand potential mechanisms.

Intestinal microbiota composition is predictive of radiotherapy-induced acute gastrointestinal toxicity in prostate cancer patients

The search for factors beyond the radiotherapy dose that could identify patients more at risk of developing radio-induced toxicity is essential to establish personalised treatment protocols for improving the quality-of-life of survivors. To investigate the role of the intestinal microbiota in the development of radiotherapy-induced gastrointestinal toxicity, the MicroLearner observational cohort study characterised the intestinal microbiota of 136 (discovery) and 79 (validation) consecutive prostate cancer patients at baseline radiotherapy. Gastrointestinal toxicity was assessed weekly during RT using CTCAE. An average grade >1.3 over time points was used to identify patients suffering from persistent acute toxicity (endpoint). The microbiota of patients was quantified from the baseline faecal samples using 16S rRNA gene sequencing technology and the Ion Reporter metagenomic pipeline. Statistical techniques and computational and machine learning tools were used to extract, functionally characterise, and predict core features of the bacterial communities of patients who developed acute gastrointestinal toxicity. Analysis of the core bacterial composition in the discovery cohort revealed a cluster of patients significantly enriched for toxicity, displaying a toxicity rate of 60%. Based on selected high-risk microbiota compositional features, we developed a clinical decision tree that could effectively predict the risk of toxicity based on the relative abundance of genera Faecalibacterium, Bacteroides, Parabacteroides, Alistipes, Prevotella and Phascolarctobacterium both in internal and external validation cohorts. We provide evidence showing that intestinal bacteria profiling from baseline faecal samples can be effectively used in the clinic to improve the pre-radiotherapy assessment of gastrointestinal toxicity risk in prostate cancer patients. Italian Ministry of Health (Promotion of Institutional Research INT-year 2016, 5 × 1000, Ricerca Corrente funds). Fondazione Regionale per la Ricerca Biomedica (ID 2721017). AIRC (IG 21479).

Difference in Gastrointestinal Cancer Risk and Mortality by Dietary Pattern Analysis: A Systematic Review and Meta-Analysis.

Several studies have demonstrated that dietary patterns identified by a posteriori and hybrid methods are associated with gastrointestinal (GI) cancer risk and mortality. These studies applied different methods for analyzing dietary data and reported inconsistent findings. This systematic review and meta-analysis were aimed to determine the association between dietary patterns, derived using principal component analysis (PCA) and reduced rank regression (RRR), and GI cancer risk and GI cancer-caused mortality. Articles published up to June 2023 in English were eligible for inclusion. The Medline, SCOPUS, Cochrane Library, CINHAL, PsycINFO, ProQuest, and Web of Sciences databases were used to identify prospective studies. The Preferred Reporting Item for Systematic Review and Meta-analysis Protocol 2020 was used to report results. A total of 28 studies were eligible for inclusion. Varied approaches to deriving dietary patterns were used, including PCA (n = 22), RRR (n = 2), combined PCA and RRR (n = 1), cluster analysis (CA; n = 2) and combined PCA and CA (n = 1). Two dietary patterns, "healthy" and "unhealthy," were derived using PCA and RRR. The healthy dietary pattern was characterized by a higher intake of fruits, whole grains, legumes, vegetables, milk, and other dairy products, whereas the unhealthy dietary pattern was characterized by a higher intake of red and processed meat, alcohol, and both refined and sugar-sweetened beverages. The findings indicated that the PCA-derived healthy dietary pattern was associated with an 8% reduced risk (relative risk [RR], 0.92; 95% CI, 0.87-0.98), and the unhealthy dietary pattern was associated with a 14% increased risk (RR, 1.14; 95% CI, 1.07-1.22) of GI cancers. Similarly, the RRR-derived healthy dietary pattern (RR, 0.83; 95% CI, 0.61-1.12) may be associated with reduced risk of GI cancers. In contrast, the RRR-derived unhealthy dietary pattern (RR, 0.93; 95% CI, 0.57-1.52) had no association with a reduced risk of GI cancers. Similarly, evidence suggested that PCA-derived healthy dietary patterns may reduce the risk of death from GI cancers, whereas PCA-derived unhealthy dietary patterns may increase the risk. Findings from prospective studies on the association of PCA-derived dietary patterns and the risk of GI cancers support the evidence of healthy and unhealthy dietary patterns as either protective or risk-increasing factors for GI cancers and for survivorship, respectively. The findings also suggest that the RRR-derived healthy dietary pattern reduces the risk of GI cancers (albeit with low precision), but no association was found for the RRR-derived unhealthy dietary pattern. Prospective studies are required to further clarify disparities in the association between PCA- and RRR-derived dietary patterns and the risk of GI cancers. Systematic review registration: PROSPERO registration no. CRD42022321644.

Improving Insights Into Ultra-processed Food Consumption and Gastrointestinal Cancer Risk.

Improving Insights Into Ultra-processed Food Consumption and Gastrointestinal Cancer Risk.