Background: The incidence of colorectal cancer (CRC) in the US has declined. The decreasing trend is observed in non-Hispanic Whites, Blacks, and Hispanics. However, close analysis of the trends demonstrates that the decline among Hispanics is less than other races/ethnicities. We investigate the burden of CRC in Hispanics living near the U.S.-Mexico border, a subpopulation of Hispanics composed primarily of individuals of Mexican origin. Objectives: The objective of this study was to investigate and compare incidence rates of CRC in non-Hispanic Whites and Hispanics living in counties along the U.S.-Mexico border. Methods: Data from the National Institutes of Health National Cancer Institute and State Cancer Profiles were analyzed to obtain CRC incidence rates (per 100,000 population) for persons ≥ 50 years of age residing in counties along the U.S.-Mexico border by race (non-Hispanic White and Hispanic) and gender from 2011 to 2015. Results: Incidence rates of CRC in Hispanic men ≥ 50 years of age, living in counties along the U.S.-Mexico border, were higher than the national average for Hispanic men of similar age. In contrast, the incidence of CRC declined or remained stable in non-Hispanic Whites and women. Conclusions: Our study unveils a significant disparity in CRC incidence among Hispanics living near the U.S.-Mexico border, disproportionally affecting men ≥ 50 years of age. Socioeconomic and cultural/lifestyle factors are likely contributing to these disparities.

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INTRODUCTION: Latin America is experiencing a rise in the prevalence and incidence of inflammatory bowel disease (IBD). Environmental and dietary changes may be contributing factors. In Latin America, Crohn’s disease (CD) is less common than ulcerative colitis (UC), but the predominant phenotype of CD is not established. Also, it is unknown whether there are regional differences in phenotype across Latin America. This systematic review aims to describe the phenotype of CD in Latin Americans as compared with U.S. Hispanics. METHODS: We conducted a systematic review with meta-analysis of population-based studies to compare the phenotype of CD across Latin America with U.S. Hispanics. Phenotype was defined according to the Montreal classification. A systematic search was conducted using MEDLINE and EMBASE. Inclusion criteria: (i) studies describing the phenotype of CD in Latin America and Hispanics in the U.S. (ii) age >18. Exclusion criteria: (i) prevalence or incidence studies not describing the phenotype. A random effects model was chosen “a priori” for analysis of pooled proportions. RESULTS: A total of 4,627 studies were screened. 34 studies from Latin America and 7 studies from the U.S met inclusion criteria. 2,877 Latin Americans and 233 U.S. Hispanics had the diagnosis of CD. The predominant phenotype in Latin America was ileo-colonic disease (L3) with a pooled proportion of 0.37 (95% CI 0.32-0.41, I2 82%), and for U.S. Hispanics, 0.46 (95% CI 0.31-0.61, I2 82.5%), P = 0.88. Inflammatory behavior (B1) was predominant for Latin America and U.S. Hispanics, 0.51 (95% CI 0.41-0.60, I2 94.3%) vs. 0.64 (95% CI 0.42-0.87, I2 91.7%), P = 0.24, respectively. Perianal involvement was similar between Latin Americans and U.S Hispanics with nearly one-third of patients showing this phenotype, P = 0.82. Phenotype across Latin America was similar except in Cuba, where ileal disease was present in nearly one-half of patients. Colonic CD (L2) was less frequently seen in Cuba, 0.15 (95% CI 0.10-0.21), P = 0.002. Disease behavior and perianal involvement were similar across Latin Americans, Table 1. CONCLUSION: The phenotype of Crohn's disease was similar between Latin Americans and U.S. Hispanics. This goes in line with current knowledge that ileo-colonic disease is the predominant disease location in Caucasians. Disease behavior and perianal involvement were similar between Latin Americans and U.S. Hispanics. In Latin America, the phenotype was homogeneous, except in Cuba where ileal disease was the predominant location.

Latin America has experienced a rise in the prevalence and incidence of inflammatory bowel disease (IBD). Differences in IBD phenotype between Hispanics in Latin America and those in the USA have not been described. We conducted a systematic review with meta-analysis of population-based and cohort studies comparing the phenotype of ulcerative colitis (UC) and Crohn’s disease (CD) in Latin Americans and US Hispanics. A systematic search was conducted up to March 2019 using MEDLINE, EMBASE and Google Scholar. Inclusion criterion includes studies describing IBD phenotype in Latin Americans or in US Hispanics. Exclusion criterion includes prevalence or incidence studies not describing phenotype. A random effects model was chosen “a priori” for analysis of pooled proportions. A total of 46 studies were included from Latin America and 7 studies from the USA. The predominant IBD subtype in Latin America was UC with a more balanced UC:CD ratio noted in Puerto Rico (0.53) and Brazil (0.56). UC-related extensive colitis was more common in US Hispanics (0.64) than in Latin Americans (0.38), p<0.001. CD phenotype was similar between US Hispanics and Latin Americans. UC is the predominant IBD subtype in Latin America, with the exception of Puerto Rico and Brazil which demonstrate a more balanced UC:CD ratio. In UC, extensive colitis was more frequently seen in US Hispanics than in Latin Americans. CD phenotype was similar in both US Hispanics and Latin Americans.

Objectives: Recent data show that a Glasgow-Blatchford Bleeding Score (GBS) >2 does not identify patients with upper gastrointestinal (GI) bleeding who benefit from inpatient esophagogastroduodenoscopy (EGD). This study aimed to determine the rate of endoscopic hemostatic interventions (HI) in patients with nonvariceal acute GI bleeding (NVAUGIB) admitted with a GBS >2. Secondary aims included comparison of clinical outcomes in patients with and without HI and cost of nontherapeutic EGDs.Methods: We conducted a retrospective review of medical records of patients admitted to a referral hospital for NVAUGIB from January 2015 to December 2017. Mortality, blood transfusion rates, length of stay, length of intensive care unit stay, and cost of a nontherapeutic EGD were outcomes of interest. Patients 18 years of age and older of both sexes were included. The accuracy of the GBS >2 cutoff was determined using receiver operating characteristic curve analysis.Results: A total of 357 patients were included and only 58 (16.2%) required HI. The area under the curve for GBS >2 as a predictor of HI was 0.57. The performance of HI did not influence mortality (P = 0.33), blood transfusion rates (P = 0.51), length of stay (P = 0.2), or length of intensive care unit stay (P = 0.36). The estimated cost of performing nontherapeutic EGD was approximately $855,000 for the 299 patients who did not need HI.Conclusions: A GBS cutoff of >2 is not an accurate criterion to triage patients with NVAUGIB for inpatient emergent EGD. More clinically meaningful and cost-effective methods to triage these patients are necessary.

INTRODUCTION: Non-variceal acute upper gastrointestinal bleeding (NVAUGIB) is one of the most common causes of hospitalization worldwide. The Glasgow-Blatchford Score (GBS) was developed to identify subjects who would benefit from hemostatic endoscopic intervention (HEI), in this and other types of GIB. According to the literature, a GBS score <2 identifies with up to 99% accuracy subjects who do not need emergent HEI. Experience at our center suggests that the average GBS of our patients with NVAUGIB is consistently >2 and yet our rate of HEI is low. Therefore, the primary aim of this study was to accurately determine the rate of significant HEI in subjects with NVAUGIB with GBS >2. The secondary aim was to determine the cost of esophagogastroduodenoscopy (EGD) in patients in whom no significant HEI was performed. METHODS: Medical records of subjects admitted for NVAUGIB who underwent EGD from January 2015 – December 2017 were reviewed. NVAUGIB was defined as the presence of any of the following: hematemesis, hematochezia, coffee ground emesis, + FOBT, melena, drop in Hgb >2 g/dl and absence of varices on EGD. The GBS was calculated on the day of EGD on all subjects. Data obtained was compared using a Kolmogorov-Smirnov Test of Normality first to ensure normal distribution, then an independent T-test was used to evaluate for significance. EGD cost was obtained from the hospital administration. RESULTS: A total of 586 subjects underwent EGD for the evaluation of NVAUGIB, and their demographic characteristics are listed in Table 1. The mean GBS for subjects with ≤2 and >2 were 1 and 8.8 respectively. Of those with a GBS >2 (503/586), only 16.9% (85/503) underwent a HEI. On the other hand, only 1% (1/83) of those with GBS ≤2 (83/586), underwent HEI. Overall, subjects who received HEI (86) had higher GBS compared to those who didn't (9.29, SD 3.51) vs. (7.42, SD 4.06) (P ≤ 0.05). A total of 418 EGDs without HEI were performed in subjects with GBS >2. The cost of a diagnostic EGD at our institution is approximately $2,866.00. Therefore, the cost of these procedures was approximately $1,200,000.00. CONCLUSION: In our population, a GBS cutoff of >2 did not identify patients requiring HEI accurately as previously reported in the literature. The cost of performing non-therapeutic endoscopic evaluation in these subjects is alarming. Further research regarding the generalizability of the GBS is needed at this time.

INTRODUCTION: Liver cancer is the fifth most common cause of cancer-related death in men and the seventh most common in women, accounting for 7% and 4%, respectively, of all cancer-related deaths. In the United States, the incidence of liver cancer has more than tripled since 1980, and it continues to increase by about 3% per year in women and 4% per year in men. Mortality rates from liver cancer have also increased at a faster pace than all other cancer sites. The rising trend of liver cancer is likely attributed to an aging population with chronic hepatitis C virus infection and the increasing prevalence of diabetes, obesity, metabolic syndrome, and NAFLD; risk factors that are amenable to intervention. In this study, we investigate the burden of liver cancer in persons living near the U.S.-Mexico border. METHODS: Incidence statistics for liver cancer in counties along the U.S.-Mexico border were obtained from the NIH National Cancer Institute, State Cancer Profiles. Incidence rates (per 100,000 population) were compared by race (non-Hispanic white and Hispanic) and gender from 2011 to 2015. Variability in rates and changes in trends over the period were reported with 95% confidence intervals. Only descriptive data was reported - a statistical trend test was not used to analyze incidence rates over time. RESULTS: Incidence rates of liver cancer are higher in states that border Mexico. In general, Hispanics have higher average annual incidence rates of liver cancer than non-Hispanic whites, and this finding is even more noticeable in those living in counties along the U.S.-Mexico border, where rates of liver cancer in Hispanic men and women are higher than the state and national averages for Hispanics. Furthermore, an upward trend in liver cancer incidence was noted in Hispanic men living in El Paso County and Hispanic women living in San Diego County (Figure 1). CONCLUSION: Hispanics have the highest incidence rates of liver cancer, and this finding is more pronounced in those living near the U.S.-Mexico border; where the prevalence of known risk factors are higher. Increasing awareness and targeting preventive practices are needed to reduce the future impact imposed by liver cancer.