Coffee, tea and decaffeinated coffee in relation to hepatocellular carcinoma in a European population: multicentre, prospective cohort study

Inverse associations of coffee and/or tea in relation to hepatocellular carcinoma (HCC) risk have been consistently identified in studies conducted mostly in Asia where consumption patterns of such beverages differ from Europe. In the European Prospective Investigation into Cancer and nutrition (EPIC), we identified 201 HCC cases among 486,799 men/women, after a median follow-up of 11 years. We calculated adjusted hazard ratios (HR) for HCC incidence in relation to quintiles/categories of coffee/tea intakes. We found that increased coffee and tea intakes were consistently associated with lower HCC risk. The inverse associations were substantial, monotonic and statistically significant. Coffee consumers in the highest compared to the lowest quintile had lower HCC risk by 72% (HR: 0.28; 95% confidence intervals (CI): 0.16 to 0.50, P-trend <0.001). The corresponding association of tea with HCC risk was 0.41 (95% CI: 0.22 to 0.78, P-trend=0.003). There was no compelling evidence of heterogeneity of these associations across strata of important HCC risk factors, including hepatitis B or hepatitis C status (available in a nested case-control study). The inverse, monotonic associations of coffee intake with HCC were apparent for caffeinated (P-trend=0.009), but not decaffeinated (P-trend=0.45) coffee for which, however, data were available for a fraction of subjects. Results from this multi-centre, European cohort study strengthen the existing evidence regarding the inverse association between coffee/tea and HCC risk. Given the apparent lack of heterogeneity of these associations by HCC risk factors and that coffee/tea are universal exposures, our results could have important implications for high HCC risk subjects

Diagnostic value of radiological staging and surveillance for T1 colorectal carcinomas: a multicenter cohort study

Background: The role of radiological staging and surveillance imaging is under debate for T1 colorectal cancer (CRC) as the risk of distant metastases is low and imaging may lead to the detection of incidental findings. Objective: The aim of this study was to evaluate the yield of radiological staging and surveillance imaging for T1 CRC. Methods: In this retrospective multicenter cohort study, all patients of 10 Dutch hospitals with histologically proven T1 CRC who underwent radiological staging in the period 2000-2014 were included. Clinical characteristics, pathological, endoscopic, surgical and imaging reports at baseline and during follow-up were recorded and analyzed. Patients were classified as high-risk T1 CRC if at least one of the histological risk factors (lymphovascular invasion, poor tumor differentiation, deep submucosal invasion or positive resection margins) was present and as low-risk when all risk factors were absent. Results: Of the 628 included patients, 3 (0.5%) had synchronous distant metastases, 13 (2.1%) malignant incidental findings and 129 (20.5%) benign incidental findings at baseline staging. Radiological surveillance was performed among 336 (53.5%) patients. The 5-year cumulative incidence of distant recurrence, malignant and benign incidental findings were 2.4% (95% confidence interval (CI): 1.1%-5.4%), 2.5% (95% CI: 0.6%-10.4%) and 18.3% (95% CI: 13.4%-24.7%), respectively. No distant metastatic events occurred among low-risk T1 CRC patients. Conclusion: The risk of synchronous distant metastases and distant recurrence in T1 CRC is low, while there is a substantial risk of detecting incidental findings. Radiological staging seems unnecessary prior to local excision of suspected T1 CRC and after local excision of low-risk T1 CRC. Radiological surveillance should not be performed in patients with low-risk T1 CRC.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Prevention of colorectal cancer development and mortality: from epidemiology to endoscopy

Colorectal cancer is a major cause of cancer related morbidity and mortality in the Western world. The development of colorectal cancer from precursor lesions, i.e. adenomas, takes approximately 10 years. This relatively slow transition allows for screening, detecting and removing adenomas before they become malignant. Colonoscopy is the most sensitive method for detecting colorectal adenomas but is not perfect as approximately 25% of adenomas are missed. In the first part of this thesis new modalities that specifically may help to increase adenoma detection and thereby improve quality of colonoscopy in general. A prediction score was developed to identify subjects at risk for inadequate bowel preparation. The discriminative ability of the prediction score was well (AUC 0.63) and may specifically be suitable to identify subjects that could benefit from intensified bowel preparation. We further investigated two novel technologies that are designed to improve visualization at the proximal sides of folds and inner curves of flexures: Full Spectrum Endoscopy (Fuse) colonoscopy and EndoRings colonoscopy. Both Fuse colonoscopy (7% vs. 41%) and EndoRings colonoscopy (10% vs. 48%) had significantly lower adenoma miss rates when compared to standard colonoscopy. Finally, in a pilot study we investigated the feasibility of eye tracking technology to measure viewing behavior of endoscopists during real-time and self-performed colonoscopies. Gaze patterns were successfully measured in 90% of the procedures and it appeared that gaze patterns across the endoscopy monitor may serve as a good measure for colon inspection. In the second part of this thesis four epidemiological studies are described in which factors that might be associated with colorectal cancer development and survival were studied. In one of these studies the use of antibiotics appeared to be associated with an increased risk of developing colorectal cancer. The results of study in a prospective cohort including more than 500.000 subjects (EPIC cohort) showed no significant associations between the consumption of coffee and tea and the risk of developing colorectal cancer. In the same cohort we found that the consumption of dairy is neither associated with disease-specific nor with all-cause death in patients with colorectal cancer. In another cohort study we observed that in colon cancer patients high socioeconomic status is associated with a lower risk of undergoing open or converted laparoscopic surgery, anastomotic leakage or abscess formation, and a lower 30 days mortality risk following surgical resection of the primary tumor compared to low socioeconomic status

Missed adenomas with behind-folds visualizing colonoscopy technologies compared with standard colonoscopy: a pooled analysis of 3 randomized back-to-back tandem colonoscopy studies

Item does not contain fulltextBACKGROUND AND AIMS: The Third Eye Retroscope, Full Spectrum Endoscope (FUSE), and EndoRings devices have been shown to reduce overall adenoma miss rates. We evaluated the characteristics of adenomas and patient subgroups for which these behind-folds visualizing technologies mostly reduce adenoma miss rates. METHODS: Data of 3 multicenter randomized trials (NCT01044732, NCT01549535, NCT01955122) were combined. Patients underwent same-day, back-to-back tandem examinations with standard colonoscopy and Third Eye Retroscope, FUSE, or EndoRings colonoscopy, respectively. Adenoma miss rates were stratified by adenoma characteristics and patient subgroups. RESULTS: A total of 650 patients (60% male, mean age 57.5 years, standard deviation 9.7 years) were included; 330 patients underwent behind-folds visualizing colonoscopy first, and 320 patients underwent standard colonoscopy first. Regarding adenoma characteristics, adenoma miss rates were significantly (P &lt; .001) lower with behind-folds visualizing technologies compared with standard colonoscopy for proximal (14% vs 38%) and distal (15% vs 35%), &lt;/=5 mm (17% vs 38%), 6 to 9 mm (8% vs 44%), sessile (16% vs 37%), flat (9% vs 52%; P = .014), and tubular (15% vs 38%) adenomas and sessile serrated polyps (7% vs 50%; P = .039) but were not statistically significantly (P &gt; .05) different for &gt;/=10 mm, pedunculated, (tubulo-)villous, and advanced adenomas. Regarding patient subgroups, adenoma miss rates were significantly (P &lt;/= .020) lower with behind-folds visualizing technologies for patients &gt;/=50 years, both sexes, and all indications. CONCLUSIONS: Behind-folds visualizing colonoscopy reduces miss rates for 1 to 9 mm adenomas in the entire colon, whereas no advantage was found for &gt;/=10 mm and advanced adenomas. Whether increased detection and removal of &lt;10 mm adenomas also reduces colorectal cancer incidence and mortality remains to be determined. Future research is needed to determine which colonoscopy technology would be most beneficial for which patient or endoscopist

Measuring gaze patterns during colonoscopy: a useful tool to evaluate colon inspection?

BACKGROUND AND OBJECTIVE: Considerable variation in adenoma detection has been shown between endoscopists, which may be explained by differences in colon inspection. Eye-tracking technology is an objective tool that detects differences in viewing patterns. We investigated the feasibility of eye-tracking technology during real-time, self-performed colonoscopies. METHODS: In this pilot study, 10 endoscopists performed two colonoscopies each. A mobile eye-tracking system to register the right eye position was used to determine the gaze across four areas of interest of the endoscopy monitor (upper, lower, left, and right quadrant). The measured gaze across the endoscopy monitor was correlated with the gaze across the endoscopically visualized colonic surface. RESULTS: Gaze patterns were measured successfully in 18 of 20 procedures. Significant differences in the time spent per area of interest were observed between endoscopists. The measured total gaze time per area of interest correlated strongly with the time spent on the corresponding area of the colonic surface (Pearson correlation coefficients ranging between 0.91 and 0.97). Endoscopists with more years of colonoscopy experience showed significantly higher percentages of overlap between the measured gaze position in the different areas of interest and the actual inspected area of the colonic surface (r=0.65, P=0.02). More experienced endoscopists had nonsignificantly longer mean gaze times per area of interest (r=0.52, P=0.06). CONCLUSION: Eye-tracking technology to measure gaze patterns of endoscopists during real-time, self-performed colonoscopies is feasible and may be used to evaluate and compare viewing behavior across the colonic surface of experienced endoscopists

Increase in bone mineral density in strictly treated Crohn's disease patients with concomitant calcium and vitamin D supplementation

Background and aims: Decreased bone mineral density (BMD) is common in Crohn's disease (CD) patients. This paper reports on the prevalence of decreased BMD in a referral cohort study of CD-patients next to the change of BMD over time in relation with CD-associated clinical characteristics. Methods: 205 CD patients of a referral hospital were enrolled between januari 1998-January 2010 when measurement of BMD by dual X-ray absorptiometry (DXA) was available. Follow-up DXA scan was performed in subjects with known risk factors besides Crohn indicative for low BMD. Treatment of CD patients was according to a protocol which is comparable to the current (inter)national guidelines. In osteopenic patients, supplemental vitamin D (800. IU) and Calcium (500-1000. mg) were prescribed. Results: Mean BMD at baseline was 0.97±0.16gram/c

Coffee and tea consumption, genotype-based CYP1A2 and NAT2 activity and colorectal cancer risk—Results from the EPIC cohort study

Coffee and tea contain numerous antimutagenic and antioxidant components and high levels of caffeine that may protect against colorectal cancer (CRC). We investigated the association between coffee and tea consumption and CRC risk and studied potential effect modification by CYP1A2 and NAT2 genotypes, enzymes involved in the metabolization of caffeine. Data from 477,071 participants (70.2% female) of the European Investigation into Cancer and Nutrition (EPIC) cohort study were analyzed. At baseline (1992–2000) habitual (total, caffeinated and decaffeinated) coffee and tea consumption was assessed with dietary questionnaires. Cox proportional hazards models were used to estimate adjusted hazard ratio's (HR) and 95% confidence intervals (95% CI). Potential effect modification by genotype-based CYP1A2 and NAT2 activity was studied in a nested case–control set of 1,252 cases and 2,175 controls. After a median follow-up of 11.6 years, 4,234 participants developed CRC (mean age 64.7¿±¿8.3 years). Total coffee consumption (high vs. non/low) was not associated with CRC risk (HR 1.06, 95% CI 0.95–1.18) or subsite cancers, and no significant associations were found for caffeinated (HR 1.10, 95% CI 0.97–1.26) and decaffeinated coffee (HR 0.96, 95% CI 0.84–1.11) and tea (HR 0.97, 95% CI 0.86–1.09). High coffee and tea consuming subjects with slow CYP1A2 or NAT2 activity had a similar CRC risk compared to non/low coffee and tea consuming subjects with a fast CYP1A2 or NAT2 activity, which suggests that caffeine metabolism does not affect the link between coffee and tea consumption and CRC risk. This study shows that coffee and tea consumption is not likely to be associated with overall CRC

Men are more fatigable than strength-matched women when performing intermittent submaximal contractions

BACKGROUND AND STUDY AIMS: Adenoma miss rate during colonoscopy has become a widely acknowledged proxy measure for post-colonoscopy colorectal cancer. Among other reasons, this can happen because of inadequate visualization of the proximal aspects of colonic folds and flexures. EndoRings (EndoAid Ltd., Caesarea, Israel) is a silicone-rubber device that is fitted onto the distal end of the colonoscope. Its flexible circular rings engage and mechanically stretch colonic folds during withdrawal. The primary aim of this study was to compare adenoma miss rates between standard colonoscopy and colonoscopy using EndoRings. METHODS: In this multicenter, randomized, tandem colonoscopy study, we performed same-day, back-to-back colonoscopies with EndoRings followed by standard colonoscopy, or vice versa. Results : After exclusion of 10 patients for protocol violations, 116 patients (38.8 % female; mean age 58.7) remained for analysis. The adenoma miss rate of EndoRings colonoscopy (7/67; 10.4 %) was significantly lower (P < 0.001) compared with standard colonoscopy (28/58; 48.3 %). Similar results were found for polyp miss rates: EndoRings (9.1 %) and standard colonoscopy (52.8 %; P < 0.001). Mean cecal intubation times (9.3 vs. 8.4 minutes; P = 0.142) and withdrawal times (7.4 vs. 7.2 minutes; P = 0.286), respectively, were not significantly different between EndoRings and standard colonoscopy. Mean total procedure time was longer with EndoRings than with standard colonoscopy (21.6 vs. 18.5 minutes, P = 0.001) as more polyps were removed. CONCLUSIONS: This study demonstrates that colonoscopy with EndoRings has lower adenoma and polyp miss rates than standard colonoscopy, which may improve the efficacy particularly of screening and surveillance colonoscopies.ClinicalTrials.gov NCT01955122

Coffee and tea consumption, genotype-based CYP1A2 and NAT2 activity and colorectal cancer risk—Results from the EPIC cohort study

Coffee and tea contain numerous antimutagenic and antioxidant components and high levels of caffeine that may protect against colorectal cancer (CRC). We investigated the association between coffee and tea consumption and CRC risk and studied potential effect modification by CYP1A2 and NAT2 genotypes, enzymes involved in the metabolization of caffeine. Data from 477,071 participants (70.2% female) of the European Investigation into Cancer and Nutrition (EPIC) cohort study were analyzed. At baseline (1992–2000) habitual (total, caffeinated and decaffeinated) coffee and tea consumption was assessed with dietary questionnaires. Cox proportional hazards models were used to estimate adjusted hazard ratio's (HR) and 95% confidence intervals (95% CI). Potential effect modification by genotype-based CYP1A2 and NAT2 activity was studied in a nested case–control set of 1,252 cases and 2,175 controls. After a median follow-up of 11.6 years, 4,234 participants developed CRC (mean age 64.7¿±¿8.3 years). Total coffee consumption (high vs. non/low) was not associated with CRC risk (HR 1.06, 95% CI 0.95–1.18) or subsite cancers, and no significant associations were found for caffeinated (HR 1.10, 95% CI 0.97–1.26) and decaffeinated coffee (HR 0.96, 95% CI 0.84–1.11) and tea (HR 0.97, 95% CI 0.86–1.09). High coffee and tea consuming subjects with slow CYP1A2 or NAT2 activity had a similar CRC risk compared to non/low coffee and tea consuming subjects with a fast CYP1A2 or NAT2 activity, which suggests that caffeine metabolism does not affect the link between coffee and tea consumption and CRC risk. This study shows that coffee and tea consumption is not likely to be associated with overall CRC