Is the length of newly diagnosed Barrett's esophagus decreasing? The experience of a VA Health Care System.

Background & Aims: Secular trends in the length of newly diagnosed Barrett's esophagus (BE) are unknown. We have anecdotally noticed less frequent new diagnoses of long segments of BE.

Methods: This is a retrospective analysis of prospectively collected information on a well-characterized large cohort of patients with documented BE that was diagnosed between 1981 and 2000 at Southern Arizona Department of Veterans Affairs Health Care System.

Is fibrolamellar carcinoma different from hepatocellular carcinoma? A US population-based study.

There have been no population-based studies of the epidemiology and prognosis of patients with fibrolamellar carcinoma (FLC). We conducted a retrospective cohort study using information collected by population-based registries of the Surveillance, Epidemiology, and End Results (SEER) program. The demographic features, stage at diagnosis, and type of therapy, as well as age-adjusted incidence rates and observed and relative survival rates were compared between persons with FLC and those with hepatocellular carcinoma (HCC) diagnosed between 1986 and 1999.

Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma.

Background & Aims: An association between diabetes and chronic liver disease has been reported. However, the temporal relationship between these conditions remains unknown.

Methods: We identified all patients with a hospital discharge diagnosis of diabetes between 1985 and 1990 using the computerized records of the Department of Veterans Affairs.

The risk of end stage liver disease and hepatocellular carcinoma among persons infected with hepatitis C virus: publication bias?

Objectives: In persons infected with hepatitis C virus (HCV), the incidence of cirrhosis and hepatocellular carcinoma (HCC) can be estimated by examining over time entire cohorts with known onset of HCV infection. We performed a systematic review of the literature to identify and to analyze studies that examine such cohorts.

Methods: A search of all articles from 1980 to 2001 was performed.

The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update.

Background: The incidence of hepatocellular carcinoma was reported to be increasing in the United States. However, alternate explanations were diagnostic or reclassification bias and changes in the demographic features of the general population.

Objective: To examine the temporal trends in the incidence of hepatocellular carcinoma.

Temporal trends (1973-1997) in survival of patients with esophageal adenocarcinoma in the United States: a glimmer of hope?

Objective: The incidence and mortality related to esophageal adenocarcinoma (EAC) has been rising in the United States. Meanwhile, the number of diagnostic and therapeutic procedures has increased in number and improved technologically. However, the impact of these advances on the survival of EAC in clinical practice remains unknown.

Is there a true "shift" to the right colon in the incidence of colorectal cancer?

Objective: Previous studies have reported a migration in the occurrence of colorectal cancer (CRC) toward a proximal colonic location. To assess the potential impact of this, we evaluated recent temporal trends in the United States.

Methods: Using the nine population-based cancer registries that constitute the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, we identified primary CRCs diagnosed between 1978 and 1998.

Geographic variation within the United States in the incidence of hepatocellular carcinoma.

Geographic variation in hepatocellular carcinoma (HCC) has not been previously studied in the United States. Using data collected by the Surveillance, Epidemiology, and End Results registries (SEER) and the 1990 Behavioral Risk Factor Surveillance System (BRFSS), we analyzed incidence and risk factors for HCC in nine geographic regions in the United States. We identified all individuals with HCC during 1975-1998 in five states (Connecticut, Iowa, Utah, New Mexico, and Hawaii) and four metropolitan areas (Detroit-Metropolitan, San Francisco-Oakland, Seattle-Puget Sound, and Atlanta-Metropolitan).

Survival of colorectal cancer patients hospitalized in the Veterans Affairs Health Care System.

Objectives: A recent analysis based on data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute indicates that no survival benefit occurred, for white or for black individuals, in colorectal cancer diagnosed during 1986-1997, and that blacks fared worse than whites. The objective of this research was to evaluate recent temporal trends in the survival of patients with colorectal cancer admitted to hospitals in the Veterans Affairs (VA) system, which offers equal access to care and facilitates systemwide implementation of prevention and treatment services.

Methods: This research was a cohort study of patients admitted to all VA hospitals with a new diagnosis of colorectal cancer between October, 1987, and September, 1998, and followed through September, 2001.

Impact of irritable bowel syndrome: prevalence and effect on health-related quality of life.

The prevalence of a disease and its effect on health-related quality of life (HRQOL) are important measures of its burden on society. The prevalence of irritable bowel syndrome (IBS) symptoms in the U.S.

Serum ferritin level predicts advanced hepatic fibrosis among U.S. patients with phenotypic hemochromatosis.

Background: DNA-based HFE gene testing can confirm hereditary hemochromatosis in most people of Northern European descent. However, liver biopsy is important to detect cirrhosis.

Objective: To develop noninvasive criteria to predict the presence or absence of advanced hepatic fibrosis or cirrhosis in Americans with hemochromatosis.

Outcomes of colorectal cancer in the United States: no change in survival (1986-1997).

Objectives: The past decade has witnessed important advances in colorectal cancer (CRC) screening and treatment. To assess the potential impact of these advances on CRC survival and incidence, we evaluated recent temporal trends in the United States.

Methods: Using the nine population-based cancer registries that constitute the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, we identified primary CRCs diagnosed between 1986 and 1997.

Association between hepatitis C infection and other infectious diseases: a case for targeted screening?

Objective: Hepatitis C virus (HCV) shares risk factors and routes of transmission with several other infectious agents. However, the prevalence of comorbid infectious disorders among HCV-infected patients remains unknown. To analyze the association between HCV and several categories of infectious disorders, we carried out a case-control study using information from 172 hospitals contained in the computerized databases of the Department of Veterans Affairs.

Extrahepatic manifestations of hepatitis C among United States male veterans.

Hepatitis C virus (HCV) has been associated with several extrahepatic conditions. To date, most studies assessing these associations involved small numbers of patients and lacked a control group. Using the computerized databases of the Department of Veterans Affairs, we carried out a hospital-based case-control study that examined all cases of HCV-infected patients hospitalized during 1992 to 1999 (n = 34,204) and randomly chosen control subjects without HCV (n = 136,816) matched with cases on the year of admission.

Hepatocellular carcinoma and hepatitis C in the United States.

Chronic infection with hepatitis C virus (HCV) is a major risk factor for development of hepatocellular carcinoma (HCC). In general, HCC develops only after 2 or more decades of HCV infection and the increased risk is restricted largely to patients with cirrhosis or advanced fibrosis. Factors that predispose to HCC among HCV-infected persons include male sex, older age, hepatitis B virus (HBV) coinfection, heavy alcohol intake, and possibly diabetes and a transfusion-related source of HCV infection.

Hepatocellular carcinoma: an epidemiologic view.

Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world and is estimated to cause approximately half a million deaths annually. Because of its high fatality rates, the incidence and mortality rates are almost equal. The major risk factors for HCC are chronic hepatitis B virus infection, chronic hepatitis C virus (HCV) infection, and alcoholic cirrhosis.

Prevention of complicated ulcer disease among chronic users of nonsteroidal anti-inflammatory drugs: the use of a nomogram in cost-effectiveness analysis.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of clinical upper gastrointestinal tract (UGI) events, namely, symptomatic ulcer, perforation, bleeding, and obstruction. Our objective in this study was to compare the cost-effectiveness of several strategies aimed at reducing the risk of clinical UGI events in NSAID users.

Methods: A decision tree model was used for patients requiring long-term treatment with NSAIDs to compare conventional NSAID therapy alone with 7 other treatment strategies to reduce the risk of NSAID-related clinical UGI events (cotherapy with proton-pump inhibitor, cotherapy with misoprostol, cyclooxygenase [COX]-2-selective NSAID therapy, or Helicobacter pylori treatment followed by each of the previous strategies, including conventional NSAID treatment, respectively).

Rising prevalence of hepatitis C virus infection among patients recently diagnosed with hepatocellular carcinoma in the United States.

Background: the aim of this study was to determine whether hepatitis C virus (HCV) is an underlying cause of the increase in the incidence of hepatocellular carcinoma (HCC) in the United States.

Study: the medical records of all patients who had received a pathologic diagnosis of HCC at the University of Texas M.D.

Psychiatric disorders among veterans with hepatitis C infection.

Background & Aims: The presence of psychiatric, drug-, and alcohol-use disorders in hepatitis C virus (HCV)-infected patients may influence their management and prognosis. The frequency and the risk for these disorders among HCV-infected patients are unknown.

Methods: We identified all HCV-infected veteran patients who were hospitalized during 1992-1999 and searched the inpatient and outpatient computerized files for predefined psychiatric, drug-, and/or alcohol-use disorders.

Endoscopic manifestations of gastroesophageal reflux disease in patients between 18 months and 25 years without neurological deficits.

Objective: The aim of this study was to determine the prevalence of erosive esophagitis and Barrett's esophagus (BE) among a large cohort of neurologically normal children with gastroesophageal reflux disease (GERD).

Methods: We identified all patients between 18 months and 25 yr of age with GERD who underwent an upper endoscopy with biopsies during 1996-2000 at Texas Children's Hospital. A manual review of the endoscopy and histopathology reports was performed.

The epidemic of esophageal adenocarcinoma.

The incidence and mortality related to esophageal adenocarcinoma (EAC) have been increasing in the United States, several European countries, and Oceania for the past 2 to 3 decades. Survival remains dismal, with little improvement during the same time period. Variations in the coding, classification, and detection of gastroesophageal malignancy may have contributed partially to the observed trends.