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Cost-effectiveness of screening with polymerase chain reaction for Helicobacter pylori to prevent gastric cancer and peptic ulcers

Oh, Aaron; Truong, Han; Kim, Judith; Rustgi, Sheila D; Abrams, Julian A; Hur, Chin
BACKGROUND/UNASSIGNED: METHODS/UNASSIGNED:therapy in gastric cancer prevention is not certain, we broadly varied the benefit 30-100% in sensitivity analysis. RESULTS/UNASSIGNED:C-UBT strategy with an ICER of $2,373.43 per QALY. When compared to no screening, PCR population screening reduced cumulative gastric cancer incidence from 0.84% to 0.74% and reduced PUD risk from 14.8% to 6.0%. The cost-effectiveness of PCR screening was robust to most parameters in the model. CONCLUSIONS/UNASSIGNED:eradication such as antibiotic resistance could change the balance of benefits of population screening.
PMID: 36388653
ISSN: 2078-6891
CID: 5384872

Prevalence of Extensive and Limited Gastric Intestinal Metaplasia and Progression to Dysplasia and Gastric Cancer

Laszkowska, Monika; Truong, Han; Faye, Adam S; Kim, Judith; Tan, Sarah Xinhui; Lim, Francesca; Abrams, Julian A; Hur, Chin
BACKGROUND AND AIMS/OBJECTIVE:Guidelines cite extensive gastric intestinal metaplasia (GIM) as a bigger risk factor for gastric cancer (GC) than limited GIM and an indication for endoscopic surveillance. Data on progression of extensive GIM to GC in the USA are limited. This study aimed to estimate the prevalence and progression rates of extensive GIM in a US cohort. METHODS:This retrospective study assessed the prevalence of extensive GIM between 1/1/1990 and 8/1/2019 at a large academic medical center. Multivariable regression was used to identify predictors of extensive GIM. Incidence of GC on follow-up was calculated as number of new diagnoses divided by person-years of follow-up. Presence of GIM on subsequent follow-up endoscopy was assessed. RESULTS:Of 1256 individuals with GIM, 352 (28%) had extensive GIM and 904 (72%) had limited GIM. On multivariable analysis, older age (OR 1.01, 95% CI 1.00-1.02) and Hispanic ethnicity (OR 1.55, 95% CI 1.11-2.16) were predictive of extensive GIM. The annual incidence of GC for GIM overall was 0.09%. There was no difference in progression to GC between extensive or limited GIM (IRR 0, 95% CI 0-2.6), or to advanced lesions overall (IRR 0.37, 95% CI 0.04-1.62). 70% of individuals had persistent GIM on follow-up biopsy, and 22% with limited GIM had extensive GIM on follow-up biopsy. CONCLUSIONS:28% of individuals with GIM have the extensive subtype, and are more likely to be older and of Hispanic ethnicity. There was no difference in progression to GC between extensive and limited GIM. Further research is needed to better assess risk of GIM in the US context.
PMID: 34657192
ISSN: 1573-2568
CID: 5043042

Prevalence of Clostridioides difficile and Other Gastrointestinal Pathogens in Patients with COVID-19

Laszkowska, Monika; Kim, Judith; Faye, Adam S; Joelson, Andrew M; Ingram, Myles; Truong, Han; Silver, Elisabeth R; May, Benjamin; Greendyke, William G; Zucker, Jason; Lebwohl, Benjamin; Hur, Chin; Freedberg, Daniel E
BACKGROUND:Gastrointestinal symptoms are common in patients with COVID-19, but prevalence of co-infection with enteric pathogens is unknown. AIMS/OBJECTIVE:This study assessed the prevalence of enteric infections among hospitalized patients with COVID-19. METHODS:We evaluated 4973 hospitalized patients ≥ 18 years of age tested for COVID-19 from March 11 through April 28, 2020, at two academic hospitals. The primary exposure was a positive COVID-19 test. The primary outcome was detection of a gastrointestinal pathogen by PCR stool testing. RESULTS:Among 4973 hospitalized individuals, 311 were tested for gastrointestinal infections (204 COVID-19 positive, 107 COVID-19 negative). Patients with COVID-19 were less likely to test positive compared to patients without COVID-19 (10% vs 22%, p < 0.01). This trend was driven by lower rates of non-C.difficile infections (11% vs 22% in COVID-19 positive vs. negative, respectively, p = 0.04), but not C. difficile infection (5.1% vs. 8.2%, p = 0.33). On multivariable analysis, infection with COVID-19 remained significantly associated with lower odds of concurrent GI infection (aOR 0.49, 95% CI 0.24-0.97), again driven by reduced non-C.difficile infection. Testing for both C.difficile and non-C.difficile enteric infection decreased dramatically during the pandemic. CONCLUSIONS:Pathogens aside from C.difficile do not appear to be a significant contributor to diarrhea in COVID-19 positive patients.
PMID: 33479861
ISSN: 1573-2568
CID: 4959532

Disease Course and Outcomes of COVID-19 Among Hospitalized Patients With Gastrointestinal Manifestations

Laszkowska, Monika; Faye, Adam S; Kim, Judith; Truong, Han; Silver, Elisabeth R; Ingram, Myles; May, Benjamin; Ascherman, Benjamin; Bartram, Logan; Zucker, Jason; Sobieszczyk, Magdalena E; Abrams, Julian A; Lebwohl, Benjamin; Freedberg, Daniel E; Hur, Chin
BACKGROUND & AIMS:Our understanding of outcomes and disease time course of COVID-19 in patients with gastrointestinal (GI) symptoms remains limited. In this study we characterize the disease course and severity of COVID-19 among hospitalized patients with gastrointestinal manifestations in a large, diverse cohort from the Unites States. METHODS:This retrospective study evaluated hospitalized individuals with COVID-19 between March 11 and April 28, 2020 at two affiliated hospitals in New York City. We evaluated the association between GI symptoms and death, and also explored disease duration, from symptom onset to death or discharge. RESULTS:Of 2804 patients hospitalized with COVID-19, the 1,084 (38.7%) patients with GI symptoms were younger (aOR for age ≥75, 0.59; 95% CI, 0.45-0.77) and had more co-morbidities (aOR for modified Charlson comorbidity score ≥2, 1.22; 95% CI, 1.01-1.48) compared to those without GI symptoms. Individuals with GI symptoms had better outcomes, with a lower likelihood of intubation (aHR, 0.66; 95% CI, 0.55-0.79) and death (aHR, 0.71; 95% CI, 0.59-0.87), after adjusting for clinical factors. These patients had a longer median disease course from symptom onset to discharge (13.8 vs 10.8 days, log-rank p = .048; among 769 survivors with available symptom onset time), which was driven by longer time from symptom onset to hospitalization (7.4 vs 5.4 days, log-rank P < .01). CONCLUSION:Hospitalized patients with GI manifestations of COVID-19 have a reduced risk of intubation and death, but may have a longer overall disease course driven by duration of symptoms prior to hospitalization.
PMID: 33007514
ISSN: 1542-7714
CID: 4959482

Helicobacter pylori and Gastric Cancer

Kim, Judith; Wang, Timothy Cragin
Helicobacter pylori is present in approximately one-half of the world's population. There are significant differences in prevalence based on region, age, race/ethnicity, and socioeconomic status. H pylori is the most common cause of infection-related cancers. Studies have demonstrated the relationship between H pylori infection and gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. H pylori has features and enzymatic properties allowing it to survive in the acidic stomach environment, and has specific virulence factors that promote an increased risk of gastric pathology. Eradication of H pylori is first-line therapy for mucosa-associated lymphoid tissue lymphoma and decreases the risk of gastric adenocarcinoma.
PMID: 34053633
ISSN: 1558-1950
CID: 4961922

Heavy Alcohol Use Is Associated With Gastric Cancer: Analysis of the National Health and Nutrition Examination Survey From 1999 to 2010

Laszkowska, Monika; Rodriguez, Steven; Kim, Judith; Hur, Chin
INTRODUCTION:Evidence regarding the association between alcohol use and gastric cancer (GC) has been inconsistent. METHODS:Adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010 were included. Multivariable regression was used to assess the association between GC and heavy alcohol use (≥5 alcoholic drinks daily). RESULTS:Of 470,168 individuals surveyed, 342 had a history of GC. Heavy alcohol use was associated with GC (odds ratio 3.13, 95% confidence interval 1.15-8.64) on multivariable analysis. DISCUSSION:This is the largest study to our knowledge to demonstrate an association between heavy alcohol use and GC in the United States.
PMID: 33625123
ISSN: 1572-0241
CID: 4961912

Reply [Letter]

Kim, Judith; Doyle, John B; Lebwohl, Benjamin
PMID: 33453225
ISSN: 1528-0012
CID: 4961902

Risk of Adverse Outcomes in Hospitalized Patients With Autoimmune Disease and COVID-19: A Matched Cohort Study From New York City

Faye, Adam S; Lee, Kate E; Laszkowska, Monika; Kim, Judith; Blackett, John William; McKenney, Anna S; Krigel, Anna; Giles, Jon T; Wang, Runsheng; Bernstein, Elana J; Green, Peter H R; Krishnareddy, Suneeta; Hur, Chin; Lebwohl, Benjamin
OBJECTIVE:To examine the effect of autoimmune (AI) disease on the composite outcome of intensive care unit (ICU) admission, intubation, or death from COVID-19 in hospitalized patients. METHODS:Retrospective cohort study of 186 patients hospitalized with COVID-19 between March 1, 2020, and April 15, 2020 at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center. The cohort included 62 patients with AI disease and 124 age- and sex-matched controls. The primary outcome was a composite of ICU admission, intubation, and death, with secondary outcome as time to in-hospital death. Baseline demographics, comorbidities, medications, vital signs, and laboratory values were collected. Conditional logistic regression and Cox proportional hazards regression were used to assess the association between AI disease and clinical outcomes. RESULTS:0.73, 95% CI 0.33-1.63). CONCLUSION:Among patients hospitalized with COVID-19, individuals with AI disease did not have an increased risk of a composite outcome of ICU admission, intubation, or death.
PMID: 33132221
ISSN: 0315-162x
CID: 4959492

Increased Risk of Pancreatitis after Endoscopic Retrograde Cholangiopancreatography Following a Positive Intraoperative Cholangiogram: A Single-Center Experience

Sitaraman, Lalitha M; Knotts, Rita M; Kim, Judith; Mahadev, Srihari; Lee, David S
Background/Aims/UNASSIGNED:To determine if patients with a positive intraoperative cholangiogram (IOC) who undergo a subsequent endoscopic retrograde cholangiopancreatography (ERCP) have an increased risk of post-ERCP pancreatitis (PEP) compared to those who undergo ERCP directly for suspected common bile duct stones. Methods/UNASSIGNED:A retrospective case-control study was performed from 2010 to 2016. Cases included inpatients with a positive IOC at cholecystectomy who underwent subsequent ERCP. The control group included age-sex matched cohorts who underwent ERCP for choledocholithiasis. Multivariate logistic regression was used to assess the association between PEP and positive IOC, adjusting for matching variables and additional potential confounders. Results/UNASSIGNED:Of the 116 patients that met the inclusion criteria, there were 91 women (78%) in each group. Nine patients (7.8%) developed PEP in the IOC group, compared to 3 patients in the control group (2.6%). The use of pancreatic duct stents and rectal indomethacin was similar in both groups. After adjusting for age, sex, total bilirubin levels, and any stent placement, patients with a positive IOC had a significantly increased risk of PEP (odds ratio, 4.79; 95% confidence interval, 1.05-21.89; p<0.05). Conclusions/UNASSIGNED:In this single-center case-control study, there was a five-fold increased risk of PEP following a positive IOC compared to an age-sex matched cohort.
PMID: 32666773
ISSN: 2234-2400
CID: 4778612

Low sodium diet for gastric cancer prevention in the United States: Results of a Markov model

Kim, Judith; Oh, Aaron; Truong, Han; Laszkowska, Monika; Camargo, M Constanza; Abrams, Julian; Hur, Chin
BACKGROUND AND AIMS:High sodium consumption has been associated with an increased risk of gastric cancer. The mean daily sodium intake in the United States substantially exceeds the national recommended amount. The low sodium-DASH diet has been shown to decrease the risk of cardiovascular disease in the United States, but its impact on gastric cancer has not been well studied. We therefore aimed to model the impact and cost-effectiveness of the low sodium-DASH diet for gastric cancer prevention in the U.S. POPULATION/: METHODS:A Markov cohort state-transition model was developed to simulate the impact of the low sodium-DASH diet on gastric cancer outcomes for the average 40-year-old in the United States compared to no intervention. Primary outcomes of interest were gastric cancer incidence and incremental cost-effectiveness ratios (ICER). RESULTS:Our model found that compared to the no intervention cohort, the risk of gastric cancer decreased by 24.8% for males and 21.2% for females on the low sodium-DASH diet. 27 cases and 14 cases per 10,000 individuals were prevented for males and females, respectively, in the intervention group. The ICER for the low sodium-DASH diet strategy was $287,726 for males and $423,878 for females compared to the no intervention strategy. CONCLUSIONS:Using a Markov model of gastric cancer risk, we found that adherence to a low sodium-DASH diet could decrease the risk of gastric cancer. This intervention was not cost-effective due to the high cost of a low sodium-DASH accordant diet, but significantly improved for high-risk populations and when the cost of the diet became slightly more affordable.
PMID: 33259151
ISSN: 2045-7634
CID: 4961892