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Dietary Total Antioxidant Capacity and Risk of Gastrointestinal Cancers: A Systematic Review and Meta-analysis of Observational Studies.
Zamani, B, Daneshzad, E, Azadbakht, L
Archives of Iranian medicine. 2019;(6):328-335
Abstract
BACKGROUND Gastrointestinal (GI) cancers are common types of cancers. Among different factors that affect the etiology of GI cancers, diet has an important contribution. Dietary antioxidants decrease oxidative stress which plays a pivotal role in carcinogenesis. Several studies assessed the relation between dietary total antioxidant capacity (TAC) and risk of GI cancers. Dietary TAC was measured by three indices including FRAP (ferric ion reducing antioxidant power), TRAP (total radical-trapping antioxidant parameter), and TEAC (trolox equivalent antioxidant capacity). We performed a systematic review and meta-analysis of published studies to determine the association between dietary TAC and GI cancers risk. METHODS Eligible studies were selected from PubMed, ISI Web of Science and Scopus databases from inception until May 2018. Case-control and cohort studies that reported GI cancer risk estimates for dietary TAC were included. We ignored the distinction between case-control and cohort studies. We applied random-effects to estimate pooled relative risks. Subgroup analysis was done based on study design. RESULTS Among the seven observational studies that were included, four were cohort studies and three were case-control studies. Dietary FRAP, TRAP, and TEAC reduced GI cancer risk: FRAP; 0.71; 95% CI: 0.58-0.85, TRAP; 0.65; 95% CI: 0.57-0.75, TEAC; 0.70; 95% CI: 0.59-0.83, respectively. CONCLUSION This study indicated that dietary TAC significantly decreased the risk of GI cancers. Nevertheless, further prospective studies are required to clarify the association between dietary TAC and risk of GI cancers.
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Advances in the Antagonism of Epigallocatechin-3-gallate in the Treatment of Digestive Tract Tumors.
Liu, C, Li, P, Qu, Z, Xiong, W, Liu, A, Zhang, S
Molecules (Basel, Switzerland). 2019;(9)
Abstract
Due to changes in the dietary structure of individuals, the incidence of digestive tract tumors has increased significantly in recent years, causing a serious threat to the life and health of patients. This has in turn led to an increase in cancer prevention research. Many studies have shown that epigallocatechin-3-gallate (EGCG), an active ingredient in green tea, is in direct contact with the digestive tract upon ingestion, which allows it to elicit a significant antagonizing effect on digestive tract tumors. The main results of EGCG treatment include the prevention of tumor development in the digestive tract and the induction of cell cycle arrest and apoptosis. EGCG can be orally administered, is safe, and combats other resistances. The synergistic use of cancer drugs can promote the efficacy and reduce the anti-allergic properties of drugs, and is thus, favored in medical research. EGCG, however, currently possesses several shortcomings such as poor stability and low bioavailability, and its clinical application prospects need further development. In this paper, we have systematically summarized the research progress on the ability of EGCG to antagonize the activity and mechanism of action of digestive tract tumors, to achieve prevention, alleviation, delay, and even treat human gastrointestinal tract tumors via exogenous dietary EGCG supplementation or the development of new drugs containing EGCG.
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EUS-guided fiducial placement for GI malignancies: a systematic review and meta-analysis.
Coronel, E, Cazacu, IM, Sakuraba, A, Luzuriaga Chavez, AA, Uberoi, A, Geng, Y, Tomizawa, Y, Saftoiu, A, Shin, EJ, Taniguchi, CM, et al
Gastrointestinal endoscopy. 2019;(4):659-670.e18
Abstract
BACKGROUND AND AIMS Image-guided radiotherapy (IGRT) allows the delivery of radiation with high precision to a target lesion while minimizing toxicity to surrounding tissues. EUS provides excellent visualization of GI tumors and consequently is being used for fiducial placement with increased frequency. Our goal was to perform a systematic review and meta-analysis of studies evaluating the technical aspects, safety, and efficacy of EUS fiducial placement for IGRT in GI malignancies. METHODS A systematic literature search was carried out in the following databases: Medline, PubMed, Embase, Web of Science, and Cochrane Library, using Medical Subject Headings terms combined with text words. A random effects model was used to determine pooled proportions of technical success, migration, and adverse event rates. Heterogeneity was assessed using the I2 statistic. Publication bias was assessed visually using a funnel plot and by the Begg and Egger tests. RESULTS Nine full articles and 5 abstracts reporting on 1155 patients, 49% from a single study by Dhadham et al, were included in the meta-analysis. The pooled rate of technical success was 98% (95% confidence interval [CI], 96-99). Moderate heterogeneity (I2 = 34.18) was present, which appeared to be due to variable sample sizes. Publication bias was present, suggesting that studies with less-substantial outcomes may have not been reported (Begg test, P = .87; Egger test, P < .01). Pooled rates for fiducial migration and adverse events were 3% (95% CI, 1.0-8.0) and 4% (95% CI, 3-7), respectively. CONCLUSIONS Our meta-analysis showed that EUS-guided insertion of gold fiducials for IGRT is technically feasible and safe. Further controlled studies assessing its long-term effectiveness in GI malignancies are needed.
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The Rationale and Efficacy of Primary and Secondary Prevention in Adenocarcinomas of the Upper Gastrointestinal Tract.
Bornschein, J, Bird-Lieberman, EL, Malfertheiner, P
Digestive diseases (Basel, Switzerland). 2019;(5):381-393
Abstract
While the primary risk factor for oesophageal adenocarcinoma (OAC) and its precursor lesion Barrett's oesophagus (BO) is gastro-oesophageal reflux, the infection with Helicobacter pylori (H. pylori) is the dominant risk factor for gastric cancer. Reduction of reflux by dietary measures and proton pump inhibitors has some merits in OAC prevention, and the chemopreventive effect of Aspirin and statins is being widely investigated; however, improved outcome in OAC occurs primarily as the result of secondary prevention. Early detection of neoplastic lesions in Barrett's metaplasia can be achieved by surveillance endoscopies. Novel endoscopic imaging modalities carry similar importance as the endoscopic treatment techniques as without detection of early lesions, therapy cannot be applied. Minimally invasive approaches are currently being investigated to identify patients with BO who are at particular risk of neoplastic progression. While dietary factors also play an important role in the prevention of gastric cancer and chemoprevention seems to be promising, the most beneficial effect has been shown for the eradication of H. pylori infection, which results in at least a one third reduction of gastric cancer risk. This effect can be further improved if the eradication takes place prior to the development of pre-neoplastic gastric conditions such as mucosal atrophy or intestinal metaplasia (IM). The definition of the "point of no return", after which eradication is less effective, is of high importance, although H. pylori eradication can still be beneficial even at more advance stages of mucosal changes. For this reason, patients with advanced atrophy and IM should undergo endoscopic surveillance in the same way as patients with BO. There is also need for development of non-invasive tests to identify patients at high risk of progression to gastric cancer to improve outcome of these surveillance approaches.
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CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis.
Su, H, Ruan, J, Chen, T, Lin, E, Shi, L
Cancer imaging : the official publication of the International Cancer Imaging Society. 2019;(1):82
Abstract
BACKGROUND The impact of sarcopenia on the outcome of gastrointestinal (GI) oncological patients is still controversial. We aim to discuss the prevalence of sarcopenia and its relation to the oncological outcome. METHODS Embase, Medline, PubMed, and the Cochrane library were systematically searched for related keywords. Studies using CT to assess sarcopenia and evaluate its relationship with the outcome of GI oncological patients were included. Long-term outcomes, including overall survival and disease-free survival, were compared by hazard ratios (HRs) with 95% confidence intervals (CIs). Short-term outcomes, including total complications and major complications (Clavien-Dindo ≥IIIa) after curable surgery, were compared by the risk ratio (RR) and 95% CI. RESULTS A total of 70 studies including 21,875 patients were included in our study. The median incidence of sarcopenia was 34.7% (range from 2.1 to 83.3%). A total of 88.4% of studies used skeletal muscle index (SMI) in the third lumbar level on CT to define sarcopenia, and a total of 19 cut-offs were used to define sarcopenia. An increasing trend was found in the prevalence of sarcopenia when the cut-off of SMI increased (β = 0.22, 95% CI = 0.12-0.33, p < 0.001). The preoperative incidence of sarcopenia was associated both with an increased risk of overall mortality (HR = 1.602, 95% CI = 1.369-1.873, P < 0.001) and with disease-free mortality (HR = 1.461, 95% CI = 1.297-1.646, P < 0.001). Moreover, preoperative sarcopenia was a risk factor for both total complications (RR = 1.188, 95% CI = 1.083-1.303, P < 0.001) and major complications (RR = 1.228, 95% CI = 1.042-1.448, P = 0.014). CONCLUSION The prevalence of sarcopenia depends mostly on the diagnostic cut-off points of different criteria. Preoperative sarcopenia is a risk factor for both long-term and short-term outcomes.
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Home parenteral nutrition increases fat free mass in patients with incurable gastrointestinal cancer. Results of a randomized controlled trial.
Obling, SR, Wilson, BV, Pfeiffer, P, Kjeldsen, J
Clinical nutrition (Edinburgh, Scotland). 2019;(1):182-190
Abstract
OBJECTIVE Preventing loss of muscle mass and function is an enduring challenge in malnourished patients with incurable cancer. The benefit of supplemental home parenteral nutrition has not been firmly established. Our aim was to evaluate the effects of supplemental home parenteral nutrition, the primary endpoint being fat free mass (FFM) and secondary: muscle function, quality of life and overall survival. DESIGN AND METHODS In a single centre open-label randomised controlled trial, patients with incurable gastrointestinal cancer, nutritionally at risk, were randomly assigned to either; a) best practice nutritional care and dietetic counselling (non-sHPN) or b) dietetic counselling and supplemental home parenteral nutrition (sHPN group). Treatment duration was 24 weeks with visits every six weeks for five scheduled visits. Main outcome was gain in bioelectrical impedance analyses (BIA) estimated FFM. Secondary outcomes were muscle strength, quality of life and survival. RESULTS Eligible for inclusion were 234 patients, 47 of these accepted enrolment; 25 were randomized to non-sHPN and 22 to sHPN according to performance status, age and diagnoses. Median age was 66.9 (41.5-88.2), BMI 21.3 (14.8-35.7) and (91%) were receiving palliative chemotherapy. Median FFM and fat free mass index increased in the sHPN group. At 12 weeks a significant difference (p < 0.01) was found between the groups; in the sHPN group 69% of the patients (versus 40%) increased their FFM. Handgrip strength increased in both groups but without significance between the two. Quality of life at 12 weeks was significantly better (p < 0.05) in the sHPN group. No difference was noticed in survival, median 169 (CI 88-295) days versus 168 (CI 80-268) days. Study completion was accomplished by 36%; 60% died before end of study. CONCLUSIONS Providing supplemental home parenteral nutrition may prevent loss of FFM, and it is even possible to increase FFM in patients with incurable gastrointestinal cancer. Supplementation with parenteral nutrition might have a temporarily positive impact on quality of life. TRIAL REGISTRATION (NCT02066363) www.clinicaltrials.gov.
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Obesity and the Risk of Gastrointestinal Cancers.
Karczewski, J, Begier-Krasińska, B, Staszewski, R, Popławska, E, Gulczynska-Elhadi, K, Dobrowolska, A
Digestive diseases and sciences. 2019;(10):2740-2749
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Abstract
Obesity is a risk factor for all major gastrointestinal cancers. With the rapid increase in the prevalence of obesity worldwide, this link could lead to an elevated burden of cancers of the digestive system. Currently, three main mechanisms explaining the link between excess adiposity and gastrointestinal cancer risk are being considered, including altered insulin signaling, obesity-associated chronic low-grade inflammation, and altered sex hormone metabolism, although new potential mechanisms emerge. This review is aimed to present our current knowledge on biological mechanisms involved in adiposity-related gastrointestinal carcinogenesis supported by results collected in epidemiological studies.
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The Use of a Stylet in Endoscopic Ultrasound With Fine-Needle Aspiration: A Systematic Review and Meta-Analysis.
Lai, A, Davis-Yadley, A, Lipka, S, Lalama, M, Rabbanifard, R, Bromberg, D, Nehaul, R, Kumar, A, Kulkarni, P
Journal of clinical gastroenterology. 2019;(1):1-8
Abstract
BACKGROUND Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is the most efficacious way to collect specimens from a solid lesion adjacent to the gastrointestinal tract and is performed with an internal stylet during puncture. However, its reinsertion into the needle is time-consuming. Controversy surrounds whether quality of cytology specimen improves with stylet use. We performed a meta-analysis comparing the use of stylet versus no stylet with EUS-FNA of gastrointestinal-related masses. METHODS Multiple databases were searched from inception until April 28, 2016. Discordant findings from independent extractions were reviewed by at least 2 investigators. Methods were executed as per the standards of the Cochrane Collaboration. Primary outcomes assessed were diagnostic adequacy of individual specimen samples, accuracy, and yield. Secondary outcomes included overall diagnostic accuracy of per-malignant lesion, cellularity, contamination, and bloodiness of the sample, and adverse events. RESULTS Five randomized control trials were identified comparing stylet versus no stylet use, which enrolled 504 patients, evaluated 537 lesions, and 1914 distinct specimens. There was no difference in diagnostic adequacy [risk ratio (RR)=1.00; 95% confidence interval (CI), 0.95-1.07], accuracy (RR=0.98; 95% CI, 0.90-1.06), or yield (RR=0.96; 95% CI, 0.89-1.03). No stylet use was favored in per-lesion malignant diagnosis (RR=0.85; 95% CI, 0.76-0.96). There was no difference in representative cellularity, contamination, or bloodiness of specimens obtained with or without stylet use. CONCLUSIONS Stylet use confers no significant advantage in diagnostic adequacy, accuracy, yield, contamination, bloodiness, or cellularity over no stylet. We reinforce that no stylet use may be used preferentially in EUS-FNA as a more convenient technique and is favored with a higher per-lesion malignant diagnosis.
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TAS2R38 Bitterness Receptor Genetic Variation and Risk of Gastrointestinal Neoplasm: A Meta-Analysis.
Choi, JH, Kim, J
Nutrition and cancer. 2019;(4):585-593
Abstract
Genetic variation in TAS2R38 bitterness taste receptor could alter the efficacy of molecular sensing, hence may be associated with cancer risk. Thus, we performed a meta-analysis to verify the association between the risk of gastrointestinal (GI) neoplasm and TAS2R38 genetic variation. Studies with TAS2R38 diplotype distribution and GI neoplasm phenotypes were searched from PubMed, EMBASE and SCOPUS, and five articles including eight studies were finally selected. The association between diplotype and neoplasm risk was estimated with summarized odds ratios (ORs) and 95% confidence intervals (CIs), applying of fixed- or random-effects models. The findings suggested TAS2R38 diplotype was not associated with GI neoplasms susceptibility [AVI vs. PAV: OR = 1.03 (95%CI: 0.97-1.09), AVI/PAV vs. PAV/PAV: OR = 1.05, (95%CI: 0.94-1.17), AVI/* vs. PAV/PAV: OR = 1.04 (95%CI: 0.94-1.16)]. Because of the presence of heterogeneity under the two genetic models (AVI/AVI vs. PAV/PAV and AVI/AVI vs. PAV/*), further subgroup analyses by ethnicity and neoplasm type were performed. However, results failed to show the neoplasm risk was altered by diplotype. In conclusion, the meta-analysis indicates that TAS2R38 diplotype minimally modified the GI neoplasm risk. Given the limited study size and resources, further well-designed and larger studies are required to validate the true effect of TAS2R38 polymorphisms on neoplasm risk.
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10.
Gastrointestinal Polyposis in Pediatric Patients.
MacFarland, SP, Zelley, K, Katona, BW, Wilkins, BJ, Brodeur, GM, Mamula, P
Journal of pediatric gastroenterology and nutrition. 2019;(3):273-280
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Abstract
Gastrointestinal polyps are mucosal overgrowths that, if unchecked, can undergo malignant transformation. Although relatively uncommon in the pediatric age group, they can be the harbingers of multiorgan cancer risk and require close management and follow-up. Additionally, as many polyposis syndromes are inherited, appropriate genetic testing and management of relatives is vital for the health of the entire family. In this review, we discuss both common and uncommon childhood gastrointestinal polyposis syndromes in terms of clinical presentation, management, and surveillance. We also detail any additional malignancy risk and surveillance required in the pediatric age group (<21 years old). Through this review, we provide a framework for gastroenterologists to manage the multifaceted nature of pediatric polyposis syndromes.