Colorectal Cancer Alarm: Rates Rising in Young Adults

“Please don’t be scared. Let’s get you checked and keep you safe. ”

— Dr. Dale

http://www.medscape.com/viewarticle/833733
Pam Harrison

PHILADELPHIA — Colonoscopy reduces cancer risk and mortality in patients with inflammatory bowel disease, according to the largest study of its kind, presented here at the American College of Gastroenterology (ACG) 2014 Annual Scientific Meeting.

"Initially, when colonoscopy was adopted and approved, there were no clear data that it reduced incidence or mortality from colorectal cancer, either in the general population or in those with inflammatory bowel disease," said Ashwin Ananthakrishnan, MD, from Harvard Medical School in Boston.

However, "a lot of patients are diagnosed in their 20s, and if they are getting a colonoscopy every 2 to 3 years, as recommended, that's a lot of colonoscopies over a lifetime," he told Medscape Medical News.

Current guidelines recommend that patients with inflammatory bowel disease undergo colonoscopy 8 to 10 years after their initial diagnosis, and every 2 to 3 years after the initial exam.

For their study, Dr Ananthakrishnan and colleagues identified 24,000 patients with ulcerative colitis or Crohn's disease from a multi-institutional electronic medical record cohort. Of these patients, 6823 had a validated diagnosis of inflammatory bowel disease.

Investigators classified these patients into two groups: 2764 had a recent colonoscopy — in the 36 months before the diagnosis of colorectal cancer or before the end of the 8-year follow-up period; and 4059 did not.

During the follow-up period, 154 patients developed colorectal cancer. Patients diagnosed with colorectal cancer were older, more likely to be male, and more likely to have a diagnosis of ulcerative colitis or primary sclerosing cholangitis.

However, there was a clear association between colonoscopy and colorectal cancer. During the follow-up period, the incidence of colorectal cancer was significantly lower in those who had a recent colonoscopy than in those who had not (1.6% vs 2.7%; P < .001), Dr Ananthakrishnan reported.

Guidelines Confirmed

In an unadjusted model, a recent colonoscopy reduced the risk of developing cancer by 44%, compared with no recent colonoscopy (odds ratio [OR], 0.56); in a fully adjusted model, recent colonoscopy reduced the risk by 35% (OR, 0.65).

For patients who developed colorectal cancer, the mortality rate was lower in those who had a recent colonoscopy than in those who had not (14% vs 34%; P=.012). The difference was "pretty striking," Dr Ananthakrishnan noted.

Unfortunately, the investigators were not able to confirm that this reduction in mortality was related to the fact that lesions identified during the procedure were early stage and more amenable to treatment. "We could not look at this directly," he pointed out, "but I think there are enough data to support this possibility."

It is also noteworthy that colorectal cancer rates are coming down, not only in the general population in the United States, but also in individuals with inflammatory bowel disease.

"If you look at data from the 1970s and 1980s, you would expect about a 20% colon cancer rate 30 years after diagnosis," Dr Ananthakrishnan explained. However, "right now, we think the rate is about half that. So what might have been a cost-effective and beneficial procedure back in the 70s and 80s may no longer be cost-effective and beneficial. That was another reason to do this study — to see if current data still support the recommendations."

It is well known that certain populations are at higher risk for colorectal cancer, although this risk depends on the longevity and the extent of disease involved, explained Paresh Mehta, MD, from Gastroenterology Consultants of San Antonio.

"I think this is an important study because it confirms that we should continue to practice according to the guidelines," he told Medscape Medical News. "I will continue to follow the ACG recommendations for colorectal cancer surveillance of patients with colitis, which are based on the length of time they've had the disease and the total amount of their colon that has been affected."

Dr Ananthakrishnan and Dr Mehta have disclosed no relevant financial relationships.

American College of Gastroenterology (ACG) 2014 Annual Scientific Meeting: Abstract 9. Presented October 20, 2014.

Meal Planning for Hepatitis C

“This is great! Thank you Gina Garippo!”

— Dr. Dale

http://inhealth.cnn.com/advances-in-treating-hepatitis-c/meal-planning-for-hepatitis-c?did=t1_rss1&hpt=he_bn9
By Gina Garippo

If you’re undergoing treatment for hepatitis C, you’re probably experiencing your fair share of side effects. These may include nausea, fever and chills, and changes in bathroom habits. But you can minimize many treatment side effects and improve your quality of life. How? By rethinking how you eat. Take a look at these meal-planning tips and tricks that can do more than just fill your stomach.

Drink Up

If you have hepatitis C, it may be time to rethink your drink. Put down your coffee or cola and opt for decaffeinated drinks, particularly water. Try to down six to eight cups a day.

Drinking water is a powerful way to counteract many side effects of treatment. It can reduce flulike symptoms and diarrhea. It can help calm a cough, ease fatigue, and prevent dry mouth. Plus, avoiding caffeinated beverages can help you sleep better.

Eat Mini-Meals

Not hungry? Poor appetite is a common side effect of hepatitis C treatment. But don’t force yourself to stay on your old eating schedule. Instead, try eating smaller, more frequent meals (think four to six) throughout the day.

Mini-meals can help give you the energy you need. Plus, they can reduce nausea and vomiting. To get the most out of what you do eat, make sure to include high-protein foods in your meals, such as cheese, peanut butter, eggs, or protein drinks like Ensure.

Choose Wisely

In addition to changing  when you eat, watching  what you eat can also minimize side effects like nausea. Try to avoid spicy, greasy, sweet or acidic foods—which all have the potential to make you queasy. Instead, calm your stomach by drinking ginger ale or ginger tea. If your nausea occurs in the morning, nibbling dry crackers or toast can help you feel better.  

Counteract Metallic Taste

Many people who are treated for hepatitis C develop a metallic taste in their mouth. To help, try eating with plastic utensils and snacking on a little yogurt or dark chocolate about a half hour before meals. Drinking lemonade, water with fresh lemon, or cranberry juice or sucking on sugar-free lemon drops can also help reduce the metallic taste.

Get Regular

Does diarrhea occasionally keep you in the bathroom? Reducing spicy and acidic foods as well as eating more soluble fiber will help. When meal planning, incorporate foods from the “BRAT” diet, which includes foods high in soluble fiber like  Bananas, white  Rice,  Applesauce, and white  Toast. Also, try to avoid dairy products for a few days after your diarrhea resolves.

Remember, there are many ways you can help reduce your side effects and feel better each day. Using your diet as a tool will put you on the right track.

Key Takeaways

• Opt for decaffeinated beverages. Drinking water can help counteract many side effects of treatment.

• If your appetite is poor, swap three big meals for four to six smaller meals throughout the day.

• Try to avoid spicy, greasy, sweet or acidic foods. Calm your stomach by drinking ginger ale or eating dry crackers.

• To combat a metallic taste in your mouth, snack on yogurt or dark chocolate before meals. Lemonade or sugar-free lemon drops can also help.

Celiac Disease Showing Up in Many Forms and at All Ages

“It’s nice to see more emphasis and greater study put toward celiac research. ”

— Dr. Dale

http://www.medscape.com/viewarticle/835567
By Janice Neumann

(Reuters Health) - A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.

Instead, doctors should take other symptoms into account and consider the possibility of celiac disease, even when patients don't fit the old image of the condition, researchers say.

"It's been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children," said Dr. Peter Green, who wasn't involved in the study.

"We don't actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis," said Green, director of the Celiac Disease Center at Columbia University in New York.

Dr. Umberto Volta and his coauthors wrote November 18 online in the journal BMC Gastroenterology that just 15 years ago, celiac disease was still thought of mainly as a rare pediatric food intolerance, whose most common signs were diarrhea and intestinal damage.

Volta, a professor of medicine at the University of Bologna in Italy and vice president of the Ethical Committee at St. Orsola-Malpighi University Hospital, and colleauges looked at the celiac patients diagnosed over the course of 15 years at that hospital.

The study involved 770 patients, 599 of them female, diagnosed between 1998 and 2007. Nearly half were diagnosed during the first 10 years of the study period and the rest in the last five years, indicating a steep rise in rates of diagnosis.

Among all the patients, 610 people, or 79%, had symptoms when they were diagnosed. But most of their problems were not the typical diarrhea and weight loss, but rather "non-classical" issues like bloating, osteoporosis and anemia. Diarrhea was a symptom in just 27%.

Indeed, classical symptoms became less common over the years, decreasing from 47% of patients during the first 10 years to 13% in the last five. Meanwhile, other problems, as well as a lack of any significant related illness, increased by more than 86%.

"The most striking change in clinical presentation of celiac disease over time has been the decrease of diarrhea as the leading symptom and the progressive increase of other non-classical gastrointestinal symptoms (such as constipation, bloating and alternate bowel habits as well as gastro-esophageal reflux, nausea, vomiting and dyspepsia)," Volta said in an e-mail to Reuters Health.

"A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages," he said.

The most common illness associated with celiac was thyroid disease. Only half the patients had severe intestinal damage.

In later years, more patients were diagnosed with blood tests. That may be one factor accounting for the changing pattern of typical symptoms, Volta said, because the patients were diagnosed earlier.

"The effects of gluten weren't as severe yet," Volta said. "The story of celiac disease has been radically changed by the discovery celiac disease-related antibodies, which identify plenty of unsuspected cases."

Green agreed that testing has vastly improved diagnosis of the disease. He said that in the UK, anyone with iron deficiency or migraine is tested for celiac disease.

While most celiac specialists understand the varied symptoms, other physicians might not, he said. Green pointed out that in the United States, only 17% of people with the disease are actually diagnosed.

"Anyone can have celiac disease, it's common and underdiagnosed," said Green. "The message we want to get out is if you think you've got celiac disease, don't just go on a gluten-free diet, test for it."

Volta said he hoped the study reminded doctors about the many problems that can signal celiac disease.

"I hope doctors keep in mind that celiac disease is a very frequent food intolerance, which should be investigated not only in patients with diarrhea and overt malabsorption, but also in people (with other symptoms)," Volta said.

"The treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients including those without symptoms," he said.

SOURCE: http://bit.ly/1ATNpT3

BMC Gastroenterol 2014.