Patients Who Receive Steroids for IBD At Heightened Risk for Diabetes

Patients Who Receive Steroids for IBD At Heightened Risk for Diabetes
by GEN Staff

Mining data from electronic health records (EHRs), researchers at Columbia University in New York City looked for a link between the use of steroids and blood sugar problems in 1,719 patients with inflammatory bowel disease (IBD). Of those patients, 698 had received glucocorticoid drugs.
Among the steroid users, 140 (20%) developed steroid-induced diabetes compared with 21 patients (5.8%) who did not receive the drugs (odds ratio [OR], 7.42). More than one-fourth (27.5%) of patients with IBD who received steroids developed prediabetes compared with 67 of those (18.5%) who did not take the drugs (OR, 2.25).
In addition to use of steroids, the researchers found that increasing age and intake of parenteral nutrition products raised the risk for diabetes, and that being male and using parenteral nutrition were risk factors for developing prediabetes.
“To our knowledge, this is the first study to determine the prevalence and risk factors for [steroid-induced diabetes and prediabetes] in patients with IBD,” the researchers reported. “Gastroenterologists should be aware of the high prevalence” of these conditions in this population, “and should screen those treated with glucocorticoids for hyperglycemia. Using the EHR for automated detection of high-risk patients is possible and could result in earlier diagnosis, timelier treatment and possibly improved outcomes.”
The researchers presented their findings at the 2014 annual meeting of the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (abstract 369).

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Nutrition Deprivation Common in Hospitalized IBD Patients

Nutrition Deprivation Common in Hospitalized IBD Patients

by Lynne Peeples

Many patients hospitalized with inflammatory bowel disease may be deprived of protein and calories critical to their health and recovery, researchers have found.

Malnutrition in these patients can cause functional impairment and jeopardize tissue repair. It may also result in increased morbidity and mortality, decreased quality of life, higher health care costs, and longer and more frequent trips to the hospital.

The new study shows that more than half of patients hospitalized with IBD for at least five days became malnourished during their stay—despite the understanding among specialists that the need for adequate nutrition is critical during a bowel flare.

“During a flare is when they need nutrition the most,” said Kimberly Kolkhorst, DO, a gastroenterologist at the University of South Florida, in Tampa, who led the study. Dr. Kolkhorst and her colleagues presented their findings at the 2014 Advances in Inflammatory Bowel Diseases annual conference (abstract P-54).

Patients with Crohn’s disease or ulcerative colitis already face the risk for malnutrition. Dr. Kolkhorst said that health care providers should avoid making the situation worse. Up to an estimated 85% of hospitalized patients with IBD may suffer from protein-calorie malnutrition, she added.

The consequences of such untimely reductions in calories can include increased morbidity, mortality, hospital stays and health care costs.

After noticing how frequently their hospital’s primary care teams would order patients with abdominal pain and nausea to discontinue consumption of any food or drink via mouth (NPO), Dr. Kolkhorst and her colleagues decided to investigate the rate of iatrogenic malnutrition in patients hospitalized with IBD.

The team reviewed all inpatient gastroenterology consults to Tampa’s James A. Haley VA Hospital, between Jan. 1, 2013, and July 31, 2014, including records from hospital days 1 through 7 for patients with IBD. They defined iatrogenic malnutrition as patients with orders for NPO or a clear liquid diet for three or more days when hospitalized for at least five days.

Of 71 patients with IBD, 34 (48%) were hospitalized for at least five days. The researchers found iatrogenic malnutrition in 18 of these patients (53%).

“We thought it was going to be high but we didn’t think it would be that high,” Dr. Kolkhorst said, adding that her team is continually adding patients to increase the power of their study. “Clearly this is an issue that needs more attention.”

Only four of the 18 patients should have been NPO because they required surgery, she said.

“Optimal nutrition status should become part of the strategic quality care measures for hospitalized IBD patients,” Dr. Kolkhorst said. “Efforts need to be made to prevent overzealous NPO orders, lack of attention to diet orders, delayed endoscopies and delayed GI [gastroenterology] consults.”

Sunanda Kane, MD, a gastroenterologist and professor of medicine at Mayo Clinic, in Rochester, Minn., said the new study provides a “good teachable moment. Many clinicians assume that a patient hospitalized with IBD needs to be NPO or on restricted caloric intake.”

However, she pointed out an important limitation to the study: Patients with ulcerative colitis and Crohn’s disease were lumped together. “A patient with an obstruction certainly should not be fed but a patient with an abscess or just active ulcerative colitis can be,” Dr. Kane said.

Maria Abreu, MD, a gastroenterologist at the University of Miami’s Miller School of Medicine, in Florida, said the findings point to the need to use electronic health records “to encourage doctors to reassess a patient’s ability to eat solid food or at least nutritional drinks.“Most of us doctors don’t realize how awful it is to not eat,” she said.

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Biliary Tract Cancers Show Tumor-Specific Gene Features

Biliary Tract Cancers Show Tumor-Specific Gene Features

by Chase Doyle

San Francisco—Two-thirds of biliary tract cancer patients harbored genomic alterations that could soon guide the selection of approved targeted therapies or access to novel therapies available in clinical trials, according to findings presented at the 2015 Gastrointestinal Cancers Symposium.

“Given the limited treatment options and poor prognosis of patients with biliary tract cancers, and the diversity of clinically relevant alterations that have been identified in this study … comprehensive genomic profiling [has] significant potential to maximize the identification of new treatment paradigms and meet an unmet clinical need for this devastating disease,” said investigator Jeffrey Ross, MD, medical director of Foundation Medicine and chair of the Department of Pathology and Laboratory Medicine at Albany Medical College, in New York.

According to Dr. Ross, biliary tract cancers—including intrahepatic cholangiocarcinoma (IHCCA), extrahepatic cholangiocarcinoma (EHCCA) and gallbladder carcinomas (GBCA)—typically present at an advanced stage and are refractory to conventional cytotoxic chemotherapy. The study’s goal was to determine whether comprehensive genomic profiling of IHCCA, EHCCA and GBCA would reveal distinctive patterns of genomic alterations and identify clinically relevant alterations that could lead to targeted therapies.

The study used a hybrid capture-based next-generation sequencing assay that evaluated the coding exons of 315 cancer-related genes and 47 introns in genes commonly rearranged in cancer. DNA was extracted from 554 biliary tract carcinomas, including 412 cases of IHCCA, 57 cases of EHCCA and 85 cases of GBCA.

The overall number of genomic alterations per patient was similar among the various types of biliary tract carcinomas (Table). The clinically relevant alterations—the so-called “actionable alterations” per patient—also were the same: two for all three tumor types.

Table. Genomic Alterations in Biliary Tract Cancers
Genomic Profiling Findings EHCCA GBCA IHCCA
Overall genomic alterations per patient 4.4 4 3.6
Clinically relevant genomic alterations per patient 2.1 2 2
ERBB2 amplification, % 11 16 4
BRAF substitutions, % 3 1 5
KRAS substitutions, % 42 11 22
PI3KCA substitutions, % 7 14 5
FGFR1-3 fusions and amplifications, % 0 3 11
CDKN2A/B loss, % 17 19 27
IDH1/2 substitutions, % 0 0 20
ARID1A alterations, % 12 13 18
MET amplification, % 0 1 2
EHCCA, extrahepatic cholangiocarcinoma; GBCA, gallbladder carcinoma; IHCCA, intrahepatic cholangiocarcinoma

For patients with IHCCA, “There was a wide diversity in the type of alterations,” Dr. Ross said.TP53 was the most commonly altered gene, followed by P16KRAS and others. For the GBCA group, TP53 also was the most commonly altered gene. KRAS was the most commonly altered gene for EHCCA, followed by TP53 and P16.

IHCCA, EHCCA and GBCA all were noted to have frequent genomic alterations associated with cell cycle regulation (CDKN2B) and chromatin remodeling (ARID1A). IHCCA was further characterized by FGFR fusions, IDH1/2 substitutions, BRAF substitutions and MET amplification, with a low KRAS mutation frequency. IHCCA and GBCA had frequent ERBB2 amplifications and PI3KCA/MTOR pathway alterations. KRAS mutation frequency was high in EHCCA and low in GBCA.

Dr. Ross noted that amplification of the ERBB2 gene—potentially the same as in breast and upper gastroesophageal carcinomas—was found in 16% of patients with GBCA. The ERBB2amplification rate was lower in patients with EHCCA (11%) and even lower in patients with IHCCA (4%).

Dr. Ross highlighted several cases in which patients responded to targeted therapies in each of the three tumor types. For example, one patient with an EGFR-amplification GBCA responded to neoadjuvant erlotinib (Tarceva, Genentech) therapy when it was combined with systemic chemotherapy. In another case, a GBCA patient with FGFR3 fusion demonstrated disease stability after four months of the investigational agent dovitinib. “This suggests, that targeting the FGFR fusion has clinical efficacy for this tumor type,” Dr. Ross said.

Dr. Ross stressed that the findings were preliminary and were meant to identify potential therapeutic targets. “We did not use this study as a prognostic test; it was only done to search for therapy targets,” he said. “We do not have the kind of outcomes data for the entire cohort to be able to put prognostic results into the study at this point, but we’re hoping to get that kind of follow-up.”

Clinical Trials Needed

Laura A. Dawson, MD, a researcher for the Cancer Clinical Research Unit at the Princess Margaret Cancer Centre, in Toronto, Canada, said, “I think moving forward, we need to change the way we make treatment decisions, and I think this is the way of the future—to look at not only pathological or anatomical histology but profiling as well. [These] results validate some others that have looked at the biliary tract, so it’s very exciting—there’s huge promise here. However, we still need to do this in a clinical trial, because a mutation does not necessarily mean it will benefit with an agent that hits the mutation. So, I strongly believe we need to incorporate profiling into trials.”

Although Dr. Dawson said she would use profiling with her patients, she cautioned that it would be unethical to do so without the proper mechanism to treat the patient, such as a clinical trial.

“And for trials that aren’t using profiling,” she concluded, “I strongly recommend the archiving of tissue—or to look for serum and circulating DNA—so we can learn in a prospective setting whether targeting actual mutations should differ from standard care.”

Payment also is a problem, Dr. Meropol argued. Increasingly, payors are scrutinizing off-label use of expensive targeted agents, resulting in costs falling on patients. “Recommending cancer drugs with high copays may not be ethical without strong evidence that they are going to help that individual patient,” he said. Given the potential for confusion over interpretation, Dr. Meropol stressed the importance of knowing who is interpreting the data and making recommendations. He concluded his talk with a focus on the patients. “We don’t want to give our patients false hope,” he said. “We don’t want to subject them to the risks of needless biopsies, and we don’t want to subject them to the financial burden of therapies and procedures that are not destined to help.”

After both speakers completed their presentations, the audience response shifted somewhat. After the presentations, fewer participants stated that they would routinely order genomic tests than had indicated they would in a baseline survey before the debate. Nevertheless, 60% of the audience polled still said they would recommend an assay for a patient with metastatic colon cancer refractory to treatment if the gene-sequencing panel was covered by insurance.

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Study Supports Living-Donor Liver Transplants

Study Supports Living-Donor Liver Transplants
by Kate O’Rourke

Boston—Patients who receive a liver transplant from a living donor experience outcomes as good as—if not better than—those of individuals who receive an organ from a deceased donor, researchers have found.
The findings mark a shift from studies in the 1990s and early 2000s, when three-year survival rates for live-donor liver grafts were not much above 60%. Now they are over 80% and appear to be climbing, according to the researchers, who presented their findings at the 2014 Liver Meeting of the American Association for the Study of Liver Diseases (AASLD; abstract 3). Experts said the results indicate that live-donor livers can help ease shortage of the organs available for transplant.
“As a community, we should consider increased use of living-donor liver transplantation to help bridge the organ-supply demand gap, as long as it can be done without compromising donor safety,” said David Goldberg, MD, medical director for living-donor liver transplantation at the Hospital of the University of Pennsylvania, in Philadelphia, who led the study. “Recent AASLD guidelines for transplantation suggest that living-donor transplantation is controversial. These data suggest that the issue, at least from the recipient side, is less controversial.”
In the new study, researchers examined national transplant data from the Organ Procurement and Transplant Network/United Network for Organ Sharing between 1999 and 2012, to compare outcomes of liver transplant recipients when living versus deceased donors were used. Patients receiving a second liver and recipients of multiple organs were excluded from the analysis.
The three-year unadjusted graft survival from living-donor liver transplants steadily rose over time, from 63.4% in 1999 to 82.2% in 2008. By 2008, outcomes were similar in terms of patient survival and graft survival whether a deceased or living donor was used.
Center experience was clearly associated with transplant outcomes. Patients with autoimmune hepatitis or cholestatic liver disease were more likely to survive a live-donor transplant if they received care at an experienced center, defined as one that had performed at least 15 adult living-donor procedures.
Novel Risk Assessment
The researchers calculated a living-donor risk index score to identify donor–recipient combinations to achieve the best outcomes. The formula included factors such as recipient age, weight, diagnosis and serum albumin, as well as donor age, weight and graft type.
The researchers said they were surprised that the Model for End-Stage Liver Disease (MELD) score was not significantly associated with outcomes among living-donor recipients, but that may reflect the fact that there was a narrow range of MELD scores and few living-donor recipients with a score greater than 25 at transplantation. At one, three and five years, the risk index score was moderately accurate at predicting graft survival.
“This score, when validated in a separate cohort, which we are currently doing, may help to identify donor–recipient combinations to achieve best living-donor transplant outcomes. This could potentially work under several different scenarios,” Dr. Goldberg said.
First, he said, when a recipient has several potential donors, the score might help to objectively measure the best donor for that given recipient. Currently, there is no quantitative way to do that. Second, the score could be used in the future if paired liver exchanges become a reality. Finally, by having data on predicted graft outcomes, clinicians may be able to counsel patients on predicted outcomes. Dr. Goldberg cautioned that the score was not yet ready to use for clinical purposes and requires further validation.

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Appendicitis Rates Linked to Industrialization

Appendicitis Rates Linked to Industrialization
by David Wild
Cases of appendicitis appear to surge as countries become more industrialized, and then taper as economies mature, Canadian researchers have found.
What accounts for the correlation is unclear, but experts have suggested everything from poor air quality to improved access to health care as possible explanations.
Pedro Teixeira, MD, a surgeon at the University of Southern California, in Los Angeles, who has researched appendicitis, applauded the study for providing important epidemiologic data. “It could be that the better sanitation and water treatment that accompanies industrialization decreases exposure to intestinal pathogens and consequently alters immune response to infections, increasing the risk for appendicitis,” said Dr. Teixeira, who was not involved in the latest work.
Gilaad Kaplan, MD, MPH, associate professor of medicine at the University of Calgary, Alberta, and his colleagues used Canadian and U.S. administrative databases to document the annual incidence of appendicitis between 2004 and 2008. They also analyzed data from 92 population-based studies from the two countries as well as several other countries.
Dr. Kaplan, who presented the findings at Canadian Digestive Diseases Week 2015 (abstract 70), said his team found that the incidence of appendicitis peaked in the middle of the 20th century, with 383 cases per 100,000 people in North America. In contrast, the average incidence of appendicitis between 2004 and 2008 was 85.8 and 98.1 cases per 100,000 people in Canada and the United States, respectively, he said.
Rates of appendicitis in Europe mirrored North American trends, peaking in the mid-20th century at 601 cases per 100,000 people, Dr. Kaplan’s group reported.
Buttressing the link between industrialization and appendicitis was another of the researchers’ findings, which showed appendicitis rates have been more recently steadily increasing in the Middle East and Asia. Industrialization began later there and is now intensifying.
Dr. Kaplan said air pollution may also have contributed to rising appendicitis rates—a link that has some support.
“My own prior research has found that more air pollution can trigger or exacerbate appendicitis and other autoimmune illnesses, including inflammatory bowel disease,” he said (Environ Health Perspect 2013;121:939-943). “Conversely, as we learned to better manage air pollution over time, in Canada, for example, we saw a coinciding decrease or stabilization of appendicitis rates.”
Yet another explanation for the decreases in appendicitis rates that occurred in the later 20th century and early 21st century is a greater accuracy in the diagnosis of appendicitis, Dr. Teixeira added.
“One plausible explanation is that with improved access to medical care there were possibly higher rates of negative appendectomies, which could have artificially inflated the incidence of appendicitis,” he said. Subsequent improvements in diagnosis would have reduced rates of appendicitis, he said.
A separate but related study presented by Dr. Kaplan’s team at Canadian Digestive Diseases Week (abstract 73) provides an important caveat to the above findings. Namely, his group found that using administrative databases could overestimate incidence rates by up to 15%.

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Development of quality measures for the care of patients with gastro esophageal reflux disease

Development of quality measures for the care of patients with gastro esophageal reflux disease
Clinical Gastroenterology and Hepatology, 11/21/2014 Clinical Article

Yadlapati R, et al. – The objective of this study was to use a well–described, formal methodology to develop valid, physician–led, quality measures for all aspects of care for patients with gastroesophageal reflux disease (GERD). The authors used RAND/University of California, Los Angeles Appropriateness Methodology (RAM) to develop quality measures for GERD care. By examining performance on these valid, formally developed quality measures, clinical practices and individual providers can assess their adherence with them and direct quality improvement efforts accordingly.

Methods

  • Quality measures were identified from the literature, consensus guidelines, and GERD experts.
  • Eight clinical experts ranked potential measures for validity on the basis of the RAND/University of California, Los Angeles Appropriateness Methodology (RAM).

Results

  • Of the 52 proposed quality measures, 24 were rated as valid and 1 new measure was developed.
  • These valid measures were related to initial diagnosis and management (9), monitoring (3), further diagnostic testing (4), proton pump inhibitor refractory symptoms (2), symptoms of chest pain (1), erosive esophagitis (3), esophageal stricture or ring (1), and surgical therapy (2).
  • Fifteen of these measures were ranked with the highest validity.
  • Twenty-seven measures were determined to be equivocal; 89% of these were extracted from guidelines based on low or moderate level evidence.

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New Treatments for Diabetic Gastroparesis Offer Promise

New Treatments for Diabetic Gastroparesis Offer Promise

by Caroline Helwick

New treatments for diabetic gastroparesis appeared encouraging in two recent Phase II studies. One agent is still under development; the other is a novel formulation of the only FDA-approved product on the market for the condition, symptoms of which may, at some point, affect as many as half of patients with types 1 and 2 diabetes.

At the late-breaking abstract session at the 2014 Digestive Disease Week (DDW), investigators reported that a 10-mcg twice-daily subcutaneous dose of RM-131 significantly accelerated gastric emptying (GE) and led to clinically meaningful reductions in vomiting.

RM-131, also known as relamorelin (Rhythm Pharmaceuticals), is a selective ghrelin pentapeptide agonist under fast-track review by the FDA. RM-131 increases GE in patients with diabetes and is believed to be 15 to 130 times more potent than ghrelin, a gastric hormone that stimulates gastrointestinal activity.

“RM-131 met the study’s primary end point for gastric emptying, as well as key secondary end points,” said Anthony Lembo, MD, of Beth Israel Deaconess Medical Center, in Boston, who reported the findings.

Emptying improved by an average of 23 minutes from baseline after four weeks of twice-daily subcutaneous injections at the 10-mcg dose, Dr. Lembo reported.

The randomized, double-blind, placebo-controlled 28-day study (abstract 929a) involved 204 patients with a mean body mass index (BMI) of 33 kg/m2 , a Gastroparesis Cardinal Symptom Index (GCSI) of at least 2.6, and a history of nausea and/or vomiting at least once a week. Approximately 12% of patients had type 1 diabetes.

The screening GE breath test was performed at baseline and day 28 of the study. Symptoms were recorded daily, and the researchers analyzed a composite of nausea, abdominal pain, bloating and early satiety.

After a one-week run-in phase, patients were randomized to placebo before breakfast and before the evening meal; placebo before breakfast and RM-131 before the evening meal (i.e., RM-131 10-mcg once daily) or RM-131 before both meals (i.e., RM-131 10-mcg twice daily).

Changes in the placebo arm were significantly less than those observed in the active treatment group. The primary end point was change from baseline in GE breath test half-emptying time, which indirectly measures GE by determining concentrations of 13C-octanoid acid. In the modified intention-to-treat population (who received at least one dose), the change from baseline was –22.9 minutes with 10 mcg twice daily (P<0.001) and –7.5 with placebo, an absolute difference between the arms of 15.4 minutes.

In the 10-mcg once-daily group, the change from baseline was much less, –5.9 minutes, an insignificant difference over baseline measurement.

Twice-daily treatment also reduced weekly vomiting episodes by 63% (P=0.033) and vomiting severity by 58% (P=0.005) compared with placebo.

A strong placebo effect was present for symptoms of nausea, abdominal pain, bloating and early satiety, and in the composite end point. “The effects of RM-131 were numerically greater, but not significantly different from placebo,” Dr. Lembo said.

Most Benefit Seen in Vomiting Subgroup

Approximately 60% of the study population reported vomiting at baseline, with a mean of five to six episodes per week. RM-131 had a significant effect in this subgroup of 119 patients, reducing mean GE breath test by 30.6 minutes over baseline, and vomiting episodes by 63%.

“We did this subgroup [post hoc] analysis because vomiting is the most bothersome symptom and often brings the patient in for treatment,” Dr. Lembo said. In contrast to the overall population, for the four subjective patient-reported symptoms, “a clear separation from placebo was demonstrated,” Dr. Lembo reported.

The composite score separated from placebo within one week, and was statistically significant at weeks 2, 3 and 4 of the study. Overall, there were no safety concerns with the drug, which had no effect on weight, Dr. Lembo said. Adverse events were reported by 43% of the placebo group, 48% of the once-daily treatment arm and 37% of the twice-daily group.

Pankaj Jay Pasricha, MD, professor of medicine at Johns Hopkins University and director of the Johns Hopkins Center for Motility Disorders and Digestive Diseases, in Baltimore, said, “There are few drugs with positive results in diabetic gastroparesis, and I hope this one moves forward.”

Metoclopramide Nasal Spray

Metoclopramide is the only FDA-approved drug for treating symptoms of gastroparesis. A nasal spray formulation (EVK-110) is being developed to provide reliable systemic absorption, even when patients are experiencing a disease flare. Systemic concentrations are about 85% of the orally administered dose.

“A prior head-to-head study suggested the nasal spray has advantages over an orally administered tablet, including better symptom control in diabetic patients with gastroparesis,” said Henry P. Parkman, MD, director of the GI Motility Laboratory at Temple University School of Medicine, in Philadelphia, who presented Phase IIb results at DDW (abstract 71).

“This Phase IIb study was the largest clinical study in diabetic gastroparesis with metoclopramide. The results were encouraging and quite unexpected,” Dr. Parkman said. “Metoclopramide nasal spray provided a significant clinical benefit in reducing the symptoms of diabetic gastroparesis in women, whereas in men it did not.”

More than 80% of patients with diabetic gastroparesis are women, Dr. Parkman noted, so the latest findings are “important new information. Metoclopramide nasal spray has the potential to address an unmet need for patients.”

The multicenter, double-blind, placebo-controlled trial compared two doses (10 and 14 mg) of metoclopramide nasal spray in 287 patients with symptomatic diabetic gastroparesis (mean age 51; 71% women). The primary end point was change from baseline to week 4 in the modified daily dietary version of the GCSI total score (nausea, early satiety, bloating and upper abdominal pain).

“Overall, the primary efficacy end point was not statistically significant,” Dr. Parkman said (Table). “This appeared to be due to the high placebo response, primarily in male patients. Females, but not males, had statistically significant improvement in symptoms for both doses of intranasal metoclopramide.”

toclopramide.”

Table. Change in mGCSI-DD Total Score From Baseline to Week 4 (Intention-to-Treat)
Population Placebo 10 mg EVK-001 P Value 14 mg EVK-001 P Value
All patients (N=287) –1.0 –1.2 0.1504 –1.2 0.3005
Women (n=203) –0.8 –1.2 0.0247 –1.3 0.0215
Men (n=84) –1.4 –1.2 0.4497 –0.9 0.2174
mGCSI-DD, modified daily dietary version of the Gastroparesis Cardinal Symptom Index

For the primary end point, an interaction test between treatment and sex was statistically significant (P=0.038), suggesting the effect of the drug differs between men and women, he said. “The observed differences in efficacy by gender were not related to severity of baseline disease or other demographic characteristics,” he added.

Dr. Parkman said the patients tolerated the nasal spray well at both doses. “There were no dose-limiting toxicities and fewer than 10% of patients dropped out, including 5% due to adverse events,” he said.

The majority of adverse events were mild or moderate, and there were no deaths or reports of tardive dyskinesia, he added.

“These two studies offer potentially very exciting new options for the treatment of a very common problem for a large number of diabetic patients,” said David A. Johnson, MD, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School, in Norfolk. He said the lack of tardive dyskinesia and tremor with the metoclopramide nasal spray is notable.

“Improving gastric emptying in these patients is important for both symptom relief as well as glycemic control,” Dr. Johnson said. “At present, we have very limited effective options for these patients, and these data address a huge unmet therapeutic need.”

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Weight loss surgery can slash diabetes risk by 80%, reveals new study

Monday, 3 November 2014 – 4:56pm IST | Place: London | Agency: ANI

A new study has revealed that weight loss surgery can help beat diabetes, by slashing the risk of developing Type 2 diabetes by a massive 80% in people who are obese.

Martin Gulliford, professor of public health at King’s College London, said that their results suggest that bariatric surgery may be a highly effective method of preventing the onset of new diabetes in men and women with severe obesity, the Daily Express reported. Gulliford added that people need to understand how weight loss surgery can be used, together with interventions to increase physical activity and promote healthy eating, as part of an overall diabetes prevention strategy.

The new research used electronic health records to assess the effect of contemporary surgical weight loss procedures on the development of diabetes and identified 2,167 obese adults without diabetes who underwent one of three surgical procedures – a gastric band, sleeve or bypass – for weight loss from 2002 onwards.

They were compared with 2,167 controls matched for age, sex, BMI, and blood glucose control who did not have surgery or other obesity treatments and then were followed up for a maximum of seven years, during which time, 38 who had weight loss surgery were newly diagnosed with diabetes, compared with 177 in the control group.

Compared with controls, diabetes incidence was reduced by about 80% in those having surgery, even after controlling for other important factors including smoking, high blood pressure and high cholesterol.

The study was published in The Lancet Diabetes & Endocrinology journal.

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Half of premature colorectal cancer deaths due to socioeconomic inequality

November 10, 2014,

Source: – American Cancer Society

Half of all premature deaths from colorectal cancer (described as deaths in people ages 25 to 64) in the United States are linked to ethnic, socioeconomic, and geographic inequalities, and therefore could be prevented according to a new study by American Cancer Society researchers. The report, which appears in the Journal of Clinical Oncology, found more preventable deaths occur in southern states than in northern and western states, but that in virtually all states those with the least education had significantly higher colorectal cancer death rates.

Colorectal cancer (CRC) is the third leading cause of cancer death for both men and women in the U.S. Historically, death rates were higher in those with higher socioeconomic status, in whites, and in northern states. Over the past few decades, though, that switched, with death rates now highest in persons with the lowest socioeconomic status, in blacks, and in southern states. That shift is likely the result of access to better early detection and treatment.

To better understand the extent to which these racial/ethnic and socioeconomic disparities vary within each state and contribute to premature death as a result of colorectal cancer, American Cancer Society researchers led by Ahmedin Jemal, Ph.D., looked at CRC death rates in people between ages 25 and 64 by state, race/ethnicity, and educational attainment (as a marker of socioeconomic status), using data from the National Vital Statistics System of the National Center for Health Statistics (part of the Centers for Disease Control and Prevention). The age range of 25 to 64 was chosen because in this age group, a greater number of life-years are lost and because cancer disparities are larger in this age group than in age 65 and above, in part due to differences in the availability of universal healthcare coverage.

The researchers found that among people ages 25 to 64, those with the least education had significantly higher CRC death rates in virtually all states for each racial/ethnic group. In the most dramatic example, in New Mexico those non-Hispanic whites with the lowest educational attainment were at more than three times the risk of CRC death as non-Hispanic whites with the highest educational attainment. The researchers conclude that half of all CRC deaths in those ages 25 to 64 that occurred nationwide from 2008 through 2010 would have been avoided if everyone had experienced the lowest death rates of the most educated whites, or 7,690 CRC deaths every year.

The authors say more premature deaths were avertable in southern states (60% to 70%) than in northern and western states (30% to 40%). When the analysis was restricted to those ages 50 to 64, for whom CRC screening is recommended, the disparities by educational attainment within state or cross states were remarkably similar.

The authors note that the factors that contribute to CRC disparities are complex and multifactorial. Differences in income, education, insurance status, and geographic residence between sociodemographic groups result in inequalities in the prevalence of CRC risk factors as well as in access to screening and treatment services. The prevalence of behavioral risk factors for CRC varies geographically and is generally inversely associated with SES. Obesity, cigarette smoking, and red meat consumption increase CRC risk, whereas physical activity and anti-inflammatory drug use decrease risk.

Story Source:                

The above story is based on materials provided by American Cancer Society. Note: Materials may be edited for content and length.

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E-cigarettes may have unknown health risks: Study

New York: E-smokers beware! There is not enough evidence to prove the claim that e-cigarettes are an healthy alternative to smoking.

“Despite the apparent optimism surrounding e-cigarettes and their purported therapeutic role in smoking cessation, there just simply is not enough evidence to suggest that consumers should use e-cigarettes for this purpose,” explained allergist Andrew Nickels from Mayo Clinic’s division of allergy and immunology.

Another cause for concern is that when people use e-cigarettes in public and still smoke regular cigarettes at home, “they continue to expose children and asthma sufferers in the household to dangerous second-hand smoke”, researchers warn.

Dual use of both e-cigarettes and regular cigarettes carries the risk of second-hand smoke exposure, causing worsening respiratory effects on children and asthma sufferers.

“It also promotes ongoing nicotine dependence,” said Chitra Dinakar, a professor of pediatrics at Children’s Mercy Hospitals.Because e-cigarettes are fairly new, there could be other long-term health complications that are yet to be discovered.Due to the lack of production oversight, most consumers do not know what is in the e-cigarettes they buy.

“Nicotine delivered by any mechanism represents a drug exposure,” said the American College of Allergy, Asthma and Immunology (ACAAI) statement.

Inhaling irritants such as smoke and vapours has an impact on the lungs, whether it is mild or severe.And irritants can cause asthma attacks in some individuals, said the study published in the journal Annals of Allergy, Asthma & Immunology.

ANI
First Published: Tuesday, May 27, 2014, 14:21

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