Risk of colorectal polyps in patients with sporadic gastric polyps:A case-control study

AIM:To assess the risk of colonic polyps,adenomas and advanced neoplastic lesions(ANL) in patients with sporadic gastric polyps,especially those with fundic gland polyps(FGP).METHODS:Clinical records of patients who had performed an upper and a lower digestive endoscopy between September 2007 and August 2008 were retrospectively analyzed.A case-control study was carried out,calling patients with gastric polyps as 'cases' and patients without gastric polyps as 'controls'.The risk of colonic polyps,adenomas and ANL(villous component ≥ 25%,size ≥ 10 mm,or high grade dysplasia) was assessed [odds ratio(OR) and its corresponding 95%CI].RESULTS:Two hundred and forty seven patients were analyzed:78 with gastric polyps(cases) and 169 without gastric polyps(controls).Among the cases,the majority of gastric polyps were FGP(80%,CI:69-88) and hyperplastic(20%,CI:12-31);25% had colonic polyps(25% hyperplastic and 68% adenomas,from which 45% were ANL).Among the controls,20% had colonic polyps(31% hyperplastic and 63% adenomas,from which 41% were ANL).The patients with sporadic FGP had an OR of 1.56(CI:0.80-3.04) for colonic polyps,an OR of 1.78(CI:0.82-3.84) for colonic adenomas,and an OR of 0.80(CI:0.21-2.98) for ANL.Similar results were found in patients with gastric polyps in general.CONCLUSION:The results of this study did not show more risk of colorectal adenomas or ANL neither in patients with sporadic gastric polyps nor in those with FGP.

Colonic preparation before colonoscopy in constipated and non-constipated patients:A randomized study

AIM: To compare the efficacy of different doses of sodium phosphate(NaP) and polyethylenglicol(PEG) alone or with bisacodyl for colonic cleansing in constipated and non-constipated patients.METHODS: Three hundred and forty-nine patients,older than 18 years old,with low risk for renal damage and who were scheduled for outpatient colonoscopy were randomized to receive one of the following preparations(prep): 90 mL of NaP(prep 1);45 mL of NaP + 20 mg of bisacodyl(prep 2);4 L of PEG(prep 3) or 2 L of PEG + 20 mg of bisacodyl(prep 4).Randomization was stratified by constipation.Patients,endoscopists,endoscopists' assistants and data analysts were blinded.A blinding challenge was performed to endoscopist in order to reassure blinding.The primary outcome was the efficacy of colonic cleansing using a previous reported scale.Secondary outcomes were tolerability,compliance,side effects,endoscopist perception about the necessity to repeat the study due to an inadequate colonic preparation and patient overall perceptions.RESULTS: Information about the primary outcome was obtained from 324 patients(93%).There were no significant differences regarding the preparation quality among different groups in the overall analysis.Compliance was higher in the NaP preparations being even higher in half-dose with bisacodyl: 94%(prep 1),100%(prep 2),81%(prep 3) and 87%(prep 4)(2 vs 1,3 and 4,P < 0.01;1 vs 3,4,P < 0.05).The combination of bisacodyl with NaP was associated with insomnia(P = 0.04).In non-constipated patients the preparation quality was also similar between different groups,but endoscopist appraisal about the need to repeat the study was more frequent in the half-dose PEG plus bisacodyl than in whole dose NaP preparation: 11%(prep 4) vs 2%(prep 1)(P < 0.05).Compliance in this group was also higher with the NaP preparations: 95%(prep 1),100%(prep2) vs 80%(prep 3)(P < 0.05).Bisacodyl was associated with abdominal pain: 13%(prep 1),31%(prep 2),21%(prep 3) and 29%(prep 4),(2,4 vs 1,2,P < 0.05).In constipated patients the combination of NaP plus bisacodyl presented higher rates of satisfactory colonic cleansing than whole those PEG: 95%(prep 2) vs 66%(prep 3)(P = 0.03).Preparations containing bisacodyl were not associated with adverse effects in constipated patients.CONCLUSION: In non-constipated patients,compliance is higher with NaP preparations,and bisacodyl is related to adverse effects.In constipated patients NaP plus bisacodyl is the most effective preparation.

Risk of fracture in celiac disease:Gender,dietary compliance,or both?

AIM:To determine the incidence of peripheral fractures in patients with celiac disease (CD) and the effect of treatment on fracture risk.METHODS:We compared the incidence and risk of peripheral fractures before and after diagnosis between a cohort of 265 patients who had been diagnosed with CD at least 5 years before study entry and a cohort of 530 age-and sex-matched controls who had been diagnosed with functional gastrointestinal disorders.Data were collected through in-person interviews with an investigator.The overall assessment window for patients was 9843 patient-years (2815 patient-years after diagnosis).RESULTS:Compared with the control group,the CD cohort showed significantly higher incidence rate and risk of first peripheral fracture before diagnosis [adjusted hazard ratio (HR):1.78,95% CI:1.23-2.56,P < 0.002] and in men (HR:2.67,95% CI:1.37-5.22,P < 0.004).Fracture risk was significantly associated with the classic CD presentation with gastrointestinal symptoms (P < 0.003).In the time period after diagnosis,the risk of fractures was comparable between the CD cohort and controls in both sexes (HR:1.08,95% CI:0.55-2.10 for women;HR:1.57,95% CI:0.57-4.26 for men).CONCLUSION:CD patients have higher prevalence of fractures in the peripheral skeleton before diagnosis.This is associated with male sex and classic clinical presentation.The fracture risk was reduced after the treatment.