Comparison of COX-2 Selective and Traditional NSAIDs on Experimental Gastric Ulcer Healing in Humans

Background: Nonsteroidal anti-inflammatory drugs impair gastrointestinal ulcers healing. This study evaluated the role of cyclooxygenase isozymes COX- 1 and COX-2 in the healing of acute gastric ulcers in humans. Methods: This was an open-label, endoscopist-blind, parallel-group study, age and sex matched at baseline in normal volunteers. At endoscopy, we took four large jumbo forceps gastric mucosal biopsies (2 from each of the antrum and corpus). Subjects received celecoxib 200mg bid), naproxen 500mg bid), nabumetone 1000mg bid or placebo until end of study. Endoscopies were performed after 5 days and every 3 days until complete re-epithelialization of all lesions or 30 days. Survival analysis was used to compare time-to-healing defined as the day with complete re-epithelialization of all ulcers. Results: Fifty-two subjects completed the study, each received four biopsyinduced gastric ulcers (204 total ulcers; the majority included the muscularis mucosa). The mean time-to-healing was 9.4 ± 0.4 days with placebo, 10.5 ± 0.4 with celecoxib, 11.1 ± 0.6 with naproxen, and 12.3 ± 0.9 with nabumetone. The time to healing of each ulcer or all ulcers was significantly delayed compared to placebo with naproxen (p=0.01) and nabumetone (p=0.002) but not with celecoxib (p=0.07). Conclusion: The COX-1 preferential inhibitor naproxen and the balanced COX-1/COX-2 inhibitor nabumetone significantly delayed the healing of ulcers. With the COX-2 specific inhibitor celecoxib, healing was delayed but not significantly. Synthesis of COX-1 derived prostaglandins appears to be important in the healing of gastric ulcers in humans.

Prevalence of Clinical Factors before Inflammatory Bowel Disease Diagnosis among 380,000 Girls Scheduled for Papillomavirus Vaccination: A Cohort Study

Background: As potentially auto-immune, human papillomavirus vaccination safety surveillance includes Inflammatory Bowel Disease (IBD). We aimed to assess other risk factors among girls scheduled to vaccinate during 2007-2016 Methods: Cohort study including girls aged 9-18 years using the Spanish Primary Care Database for Pharmacoepidemiological Research (BIFAP). Adjusted Hazard ratios (HR; reported in brackets) of IBD associated with (gastroenterological and others) clinical factors were estimated. Results: Out of 388,669 girls, 185 IBD cases occurred (43.78% Crohn’s disease, 37.84% Ulcerative colitis, 18.38% undetermined). IBD increased with age, IBD family history (HR: 10.64), thyroiditis (5.07), herpesvirus infection (4.96), asthenia (1.74), while decreased with inhaled budesonide (0.38) or meningococcus B-C vaccination (0.33). Abnormal bowel movement (25.26), lower gastrointestinal bleeding (8.74), dyspepsia (7.69), abdominal pain (1.49) and spasmolytic (3.89) or antisecretory drugs (2.43) were more recorded among cases. Contraceptives (3.07), fever (2.57), infectious gastroenteritis (2.48), growth problems (2.12), chronic diarrhoea (5.37) and coeliac disease (2.07) showed almost statistical increased risk while depression or allergy showed no risk. Conclusions: The relationship between potential immune diseases and IBD varied, being high for thyroiditis, just suggested for celiac disease and lacking for allergy. The important prevalence of family history, gastrointestinal or growth conditions on IBD was confirmed.

Complications due to Biliary Stent Deviation

We often encounter complications from biliary stents used as a treatment for obstructive jaundice and acute cholangitis. Early complications after stent placement include pancreatitis, bleeding, and duodenal perforation [1]. Stent deviation is also a complication. This is particularly prominent for plastic stents, where stent deviation is observed in 6-18.7 % of cases [2]. Stent deviation is more common among patients who have undergone endoscopic sphincterotomy (Figure 1). Most deviated biliary plastic stents are excreted in stool or collected endoscopically, but, very rarely, complications causing gastrointestinal perforation have been reported. We have described deviated biliary plastic stents causing sigmoid colon diverticulum perforation and even uterine appendage penetration (Figure 2). Diagnosis can be made from clinical symptoms and abdominal computed tomography. Treatment is basically surgery. Biliary stent-related complications are inevitable, and sometimes become serious. On suspicion of such complications, the most important issue is to accurately and rapidly diagnose complications and conduct appropriate management.

Chronic Hepatitis C as a Risk Factor for Colonic Neoplasia in a Community Setting

An estimated 3.5 million people have Chronic Hepatitis C (CHC) in the United States [1]. With the current opioid epidemic, the number of people who are injecting drugs in the US. Has substantially increased the incidence of CHC virus [2]. With an apparent second wave of CHC, it will be important to manage the sequelae of these chronically infected patients and recognize associated comorbidities. CHC has been shown to increase the risk of hepatocellular carcinoma and has been linked to such malignancies as Non-Hodgkin lymphoma, cholangiocarcinoma, breast, pancreatic, renal, skin/oral, thyroid, and colon cancer [3-6]. Colon cancer is the second leading cause of cancer-related death in men in developed countries and the third most prevalent cause of death from cancer for women [7]. Colorectal Cancer (CRC) screening has been shown to reduce the risk for the development of CRC and prevent the development of more advanced disease [8,9]. The risks for developing colorectal cancer are associated with increasing age, family history, history of adenomas or Inflammatory Bowel Diseases (IBD) and ethnicity. Other possible risk factors include a high fat, low-fiber diet, obesity, smoking, and excessive alcohol use. A possible link between colon cancer and CHC has not been extensively studied. However, previous studies have suggested that patients with CHC have a higher risk of colonic adenomas and more advanced lesions. Thus, the goal of this study was to determine if patients with CHC undergoing screening or surveillance colonoscopies in a community setting have an increased risk of colonic neoplasia.