Role of upper gastrointestinal investigations in a screening study for colorectal neoplasia.

Thomas, W. M.; Hardcastle, J. D.

doi:10.1136/gut.31.11.1294

Cited by 36 publications

(25 citation statements)

References 15 publications

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“…For most of these subjects, the reason for the positive test result was not apparent. In an earlier study, the proportion of these subjects who had upper gastrointestinal symptoms at the time they completed-the FOB test was low, and in follow-up of 269 subjects free of these symptoms for a median period of 5 years, only five were referred for investigation of symptoms which had developed since the patients were screened, all of whom had benign upper gastrointestinal conditions (Thomas & Hardcastle, 1990). In the present study, 12 (7%) of these subjects had inflammatory bowel disease and 12 had diverticular disease.…”

Section: Discussionmentioning

confidence: 93%

Colorectal adenomas and diet: a case-control study of subjects participating in the Nottingham faecal occult blood screening programme

Little

Logan²,

Hawtin³

et al. 1993

Br J Cancer

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Summary Diets high in animal fat and protein and low in fibre and calcium are thought to be factors in the etiology of colorectal cancer. Intakes of these nutrients were determined in three groups participating in a randomised trial of faecal occult blood (FOB) screening. A diet history was obtained by interview from 147 patients with colorectal adenomas, 153 age and sex matched FOB-negative controls (a) and 176 FOB-positive controls without colorectal neoplasia (b). Unconditional logistic regression was used to estimate relative risks (RR) and 95% confidence limits (t) adjusted for age, sex and social class.After adjustment for total energy intake, no associations were found with total, saturated or monounsaturated fat, or calcium intake. For total fibre intake there were non-linear relationships with both control groups with the crude RR for highest quintiles of total fibre intake compared to the lowest being 0.6, although this pattern was no longer apparent after adjustment for energy intake with group (a). In comparison with group (b) cereal fibre intake showed a more consistent inverse relationship with adenoma prevalence with the RR for ascending quintiles of intake being 1.0, 0.7 (0.3-1.6), 0.5 (0.3-1.1), 0.7 (0.4-1.4) and 0.3 (0.1-0.6) (trend x2 = 8.80, p = 0.003). In comparison with group (a), the adjusted RR for the highest quintile of cereal fibre intake compared with the lowest was 0.6, but no clear trend was apparent. There was an unexpected positive relationship between adenomas and polyunsaturated fat intake with the RR for having an adenoma being 1.0, 2.8 (1.3-6.1), 1.6 (0.7-3.4), 3.5 (1.6-7.5) and 2.3 (1.1-5.0) for ascending quintiles of polyunsaturated fat intakes (trend x2 = 4.8, P = 0.03) in comparison with group (a) only.Our data, while providing no support for the role of dietary animal fat or protein, do support the protective role of dietary cereal fibre in the etiology of colorectal adenomas.High intakes of animal fat and protein (Wynder & Shigematsu, 1967;Drasar and Irving, 1973), and low intakes of fibre (Burkitt, 1971) and calcium (Newmark et al., 1984) have been postulated to increase the risk of colorectal cancer. However, the role of these nutrients has not been clarified in analytical epidemiological studies (Zaridze, 1983;Willett, 1989a (Paul & Southgate, 1978).In addition to the nutrients about which we had specific hypotheses, we considered total energy intake as an important potential confounder (Willett, 1989b, pp , the sources of protein and fibre, and the different types of fatty acid.We also asked subjects about the frequency of consumption of certain foods which might be markers of 'healthy Correspondence: J. Little,

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Section: Discussionmentioning

confidence: 93%

Colorectal adenomas and diet: a case-control study of subjects participating in the Nottingham faecal occult blood screening programme

Little

Logan²,

Hawtin³

et al. 1993

Br J Cancer

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“…For this group the existence of polyps could not be excluded. There might be about 10% of subjects of the higher age groups who could present with polyps [15]. Nevertheless, we think that this control group best represents the general population.…”

Section: Discussionmentioning

confidence: 99%

<i>Helicobacter pylori</i> and the Risk of Colonic Adenomas

et al. 1999

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Aims: Previous studies have found a positive association between Helicobacter pylori infection and colorectal adenomas. The aim of the present study was to examine this association while taking possible confounding factors into account. Methods: 98 serum samples were available from 182 patients with colorectal adenomas who entered a case-control study of colorectal adenomas and diet. The H. pylori status in patients was compared with a hospital control group and a population control group. Results: H. pylori IgG antibodies were more common in colorectal polyp patients compared with either control group, the prevalence being 79% in cases compared with 62% in both control groups. The corresponding RR was 1.4 (0.76–2.6) compared with hospital controls and 2.1 (1.1–3.9) compared with population controls. After adjusting for possible confounding variables the association between H. pylori status and adenoma risk was even more marked. There was an RR of 1.6 (0.80–3.4) compared with hospital controls and an RR of 2.6 (1.3–5.4) compared with population controls, the latter association being statistically significant. Conclusion: These findings suggest a statistically significant association between H. pylori infection and colorectal polyps. A possible mechanism might be increased gastrin levels in H. pylori-infected subjects which exhibit a trophic effect on colonic mucosa.

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“…10,11 Some studies showed that evaluation of the upper gastrointestinal tract helped to identify important lesions in symptomatic patients and those with iron deficiency anemia; 12,13 however, others concluded that esophagogastroduodenos copy was unjustified because important findings in the upper gastrointestinal tract were rare [14][15][16][17] and sometimes irrelevant to the results of fecal occult blood testing. [18][19][20][21] This controversy is re lated to the heterogeneity of study populations and to the limitations of the formerly used guaiac-based fecal occult blood test, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] which was not able to distinguish bleeding in the lower gastrointestinal tract from that originating in the upper tract.…”

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confidence: 99%

Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract

Chiang¹,

Lee²,

Tu³

et al. 2011

Canadian Medical Association Journal

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Role of upper gastrointestinal investigations in a screening study for colorectal neoplasia.

Cited by 36 publications

References 15 publications

Colorectal adenomas and diet: a case-control study of subjects participating in the Nottingham faecal occult blood screening programme

Colorectal adenomas and diet: a case-control study of subjects participating in the Nottingham faecal occult blood screening programme

<i>Helicobacter pylori</i> and the Risk of Colonic Adenomas

Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract

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