Clinicopathological features of laterally spreading colorectal tumors and their association with advanced histology and invasiveness: An experience from Honam province of South Korea: A Honam Association for the Study of Intestinal Diseases (HASID)

<div><p>Background and aims</p><p>Laterally spreading colorectal tumors (LSTs) are divided into four subtypes, including homogenous (HG), nodular mixed (NM), flat elevated (FE), and pseudo-depressed (PD), based on their different endoscopic morphologies. The aim of this study was to investigate the clinicopathological significance of LST subtypes and their association with advanced histology.</p><p>Methods</p><p>We investigated the medical records of consecutive patients with LST who initially underwent endoscopic resection at five university hospitals in Honam province of South Korea between January 2012 and December 2013. A total of 566LST lesions removed via endoscopic procedures were collected retrospectively for data analysis.</p><p>Results</p><p>The PD, FE, and NM subtypes were more common in the distal colon and the HG subtype in the proximal colon. The PD subtype had the biggest tumor size, followed by the NM subtype. The frequency of adenomatous pit pattern was significantly higher in the HG, NM, and FE subtypes than in the PD subtype. In contrast, the frequency of cancerous pit pattern was significantly higher in the PD subtype than in the other three subtypes. The rate of advanced histology (high-grade dysplasia or carcinoma) among the LSTs was 36.0%. The risk of advanced histology increased in the distal colon compared with the proximal colon. The PD subtype had the highest incidence of villous component, advanced histology,submucosal invasion, and postprocedure perforation among the four subtypes. The distal colon as tumor site, larger tumor size, PD subtype, and villous component were associated with a statistically significant increased risk of advanced histology.</p><p>Conclusion</p><p>Our results indicate that the location, size, endoscopic subtype, and histologic component of the LSTs are associated with an increased risk of advanced histology. Therefore, these clinicopathological parameters may be useful in selecting therapeutic strategies in the clinical setting.</p></div

Comparison of clinicopathological parameters of the LST according to histology.

<p>Comparison of clinicopathological parameters of the LST according to histology.</p

Clinicopathological parameters of the patients with colorectal laterally spreading tumors.

<p>Clinicopathological parameters of the patients with colorectal laterally spreading tumors.</p

Clinicopathological parameters of the patients with colorectal laterally spreading tumors.

<p>Clinicopathological parameters of the patients with colorectal laterally spreading tumors.</p

Risk of advanced histology according to clinicopathological parameters in colorectal laterally spreading tumors.

<p>Risk of advanced histology according to clinicopathological parameters in colorectal laterally spreading tumors.</p

High Dietary Sodium Intake Assessed by Estimated 24-h Urinary Sodium Excretion Is Associated with NAFLD and Hepatic Fibrosis

<div><p>Background</p><p>Although high sodium intake is associated with obesity and hypertension, few studies have investigated the relationship between sodium intake and non-alcoholic fatty liver disease (NAFLD). We evaluated the association between sodium intake assessed by estimated 24-h urinary sodium excretion and NAFLD in healthy Koreans.</p><p>Methods</p><p>We analyzed data from 27,433 participants in the Korea National Health and Nutrition Examination Surveys (2008–2010). The total amount of sodium excretion in 24-h urine was estimated using Tanaka’s equations from spot urine specimens. Subjects were defined as having NAFLD when they had high scores in previously validated NAFLD prediction models such as the hepatic steatosis index (HSI) and fatty liver index (FLI). BARD scores and FIB-4 were used to define advanced fibrosis in subjects with NAFLD.</p><p>Results</p><p>The participants were classified into three groups according to estimated 24-h urinary excretion tertiles. The prevalence of NAFLD as assessed by both FLI and HSI was significantly higher in the highest estimated 24-h urinary sodium excretion tertile group. Even after adjustment for confounding factors including body fat and hypertension, the association between higher estimated 24-h urinary sodium excretion and NAFLD remained significant (Odds ratios (OR) 1.39, 95% confidence interval (CI) 1.26–1.55, in HSI; OR 1.75, CI 1.39–2.20, in FLI, both <i>P</i> < 0.001). Further, subjects with hepatic fibrosis as assessed by BARD score and FIB-4 in NAFLD patients had higher estimated 24-h urinary sodium values.</p><p>Conclusions</p><p>High sodium intake was independently associated with an increased risk of NAFLD and advanced liver fibrosis.</p></div

Differences in estimated 24-h urinary sodium excretion levels among groups with and without hepatic fibrosis defined by BARD score (A) and FIB-4 (B) in subjects with NAFLD.

<p>** Data presented as mean + standard deviation.</p

Association of estimated 24-h sodium excretion with prevalence of NAFLD assessed by FLI and elevated serum ALT levels.

<p>Elevated ALT levels were defined as >33 IU/L for males and >25 IU/L for females. * P-value < 0.05.</p

Characteristics of the study population according to tertiles of estimated 24-h sodium excretion.

<p>Data presented as mean ± standard deviation or n (%) for categorical variables</p><p>^§: The difference between 1^st and 2^nd: p <0.05 after ANOVA followed by Scheffé post hoc comparison</p><p>^†: The difference between 1^st and 3^rd: p <0.05 after ANOVA followed by Scheffé post hoc comparison</p><p>^‡ The difference between 2^nd and 3^rd: p <0.05 after ANOVA followed by Scheffé post hoc comparison</p><p>E24UNA, Estimated 24-hour urine sodium excretion; BMI, body mass index; ASM, appendicular skeletal mass; SBP, systolic blood pressure; DBP, diastolic blood pressure; LDL, low-density lipoprotein; HDL, high-density lipoprotein; AST, aspartate aminotransaminase; ALT, alanine aminotransferase; GGT, gamma-glutamyl transferase; HTN, hypertension; FLI, fatty liver; HSI, hepatic steatosis index</p><p>Characteristics of the study population according to tertiles of estimated 24-h sodium excretion.</p