Purpose Autoimmunity is an alternative etiology of gastric inflammation, the initiating event in the gastric carcinogenic cascade. This mechanism may be an increasingly important cause of gastric cancer with the waning prevalence of its primary etiologic factor, chronic Helicobacter pylori infection. Materials and Methods PubMed and EMBASE were searched up to September 2018. Autoimmunity and 96 specific manifestations were considered for associations with gastric cancer risk. Random effects analysis was used to calculate pooled relative risk estimates (RR) and 95% confidence intervals (CI). Results We found a total of 52 observational studies representing 30 different autoimmune diseases. Overall, the presence of an autoimmune condition was associated with a gastric cancer pooled RR of 1.37 (95% CI, 1.24 to 1.52). Among the 24 autoimmune conditions with two or more independent reports, nine were significantly associated with increased gastric cancer risk: dermatomyositis (RR, 3.69; 95% CI, 1.74 to 7.79), pernicious anemia (RR, 2.84; 95% CI, 2.30 to 3.50), Addison disease (RR, 2.11; 95% CI, 1.26 to 3.53), dermatitis herpetiformis (RR, 1.74; 95% CI, 1.02 to 2.97; n=3), IgG4-related disease (RR, 1.69; 95% CI, 1.00 to 2.87), primary biliary cirrhosis (RR, 1.64; 95% CI, 1.13 to 2.37), diabetes mellitus type 1 (RR, 1.41; 95% CI, 1.20 to 1.67), systemic lupus erythematosus (RR, 1.37; 95% CI, 1.01 to 1.84), and Graves disease (RR, 1.27; 95% CI, 1.06 to 1.52). Conclusion Our analysis documents the wide range of autoimmune diseases associated with gastric cancer. These associations may reflect unreported links between these conditions and autoimmune gastritis. Further studies are warranted to investigate potential causal mechanisms.
OBJECTIVE Thyroid dysfunction and obesity during pregnancy have been associated with negative neonatal and obstetric outcomes. Thyroid hormone reference ranges have not been established for the pregnant Hispanic population. This study defines thyroid hormone reference ranges during early pregnancy in Chilean women and evaluates associations of BMI with thyroid function. DESIGN, PATIENTS, MEASUREMENTS This is a prospective observational study of 720 healthy Chilean women attending their first prenatal consultation at an outpatient clinic. Thyroid function (TSH, Free T4, Total T4, and TPOAb) and BMI were assessed at 8.8 ± 2.4 weeks of gestational age. RESULTS Median, 2.5th percentile (p2.5), and 97.5th percentile (p97.5) TSH values were higher, while median, p2.5, and p97.5 free T4 values were lower in obese patients compared with normal weight patients. Obesity was associated with a median TSH 16% higher (p=0.035) and a median free T4 6.5% lower (p<0.01) than values from patients with normal weight. BMI had a small, but statistically significant effect on TSH (p=0.04) and free T4 (p<0.01) when adjusted by maternal age, TPO antibodies, parity, sex of the newborn, gestational age, and smoking. In all TPOAb (-) patients, median (p2.5–p.97.5) TSH was: 1.96 mIU/L (0.11 – 5.96 mIU/L) and median (p2.5–p.97.5) free T4 was: 14.54 pmol/L (11.1 – 19.02 pmol/L). Applying these reference limits, we found a prevalence of overt and subclinical hypothyroidism of 0.9% and 3.05%, respectively. CONCLUSIONS TSH distributes at higher values and free T4 at lower values in obese pregnant women compared to normal weight pregnant women. Thyroid hormone reference ranges derived from Chilean patients with negative TPOAb are different from the fixed internationally proposed reference ranges and may be used in the Hispanic population.
Background and Study Aims: Lactase non-persistence (LNP), or primary hypolactasia, is a genetic condition that mediates lactose malabsorption and can cause lactose intolerance. Here we report the prevalence of lactose intolerance in a double-blind placebo study. Methods: The LCT C>T-13910 variant was genotyped by RT-PCR in 121 volunteers and lactose malabsorption was assessed using the hydrogen breath test (HBT) after consuming 25 g of lactose. Lactose intolerance was assessed by scoring symptoms (SS) using a standardized questionnaire following challenge with a lactose solution or saccharose placebo. Results: The LNP genotype was observed in 57% of the volunteers, among whom 87% were HBT(+). In the HBT(+) group the median SS was 9 and in the HBT(-) group the median SS was 3 (p < 0.001). No difference was observed in the SS when both groups were challenged with the placebo. The most common symptoms included audible bowel sounds, abdominal pain and meteorism. In the ROC curve analysis, an SS ≥6 demonstrated 72% sensitivity and 81% specificity for predicting a positive HBT. To estimate prevalence, lactose intolerance was defined as the presence of an SS ≥6 points after subtracting the placebo effect and 34% of the study population met this definition. Conclusions: The LNP genotype was present in more than half of subjects evaluated and the observed prevalence of lactose intolerance was 34%.
Background: Feedback is one of the most important tools to improve teaching in medical education (Rev Med Chile 2015; 143: 1005-1014
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