Association of Helicobacter pylori infection with gastric carcinoma: a meta-analysis

OBJECTIVE

As conflicting studies have recently been published, we aimed to determine if Helicobacter pylori (H. pylori) infection is associated with gastric adenocarcinoma.

METHODS

This was a meta-analysis of observational epidemiological studies.

RESULTS

A total of 42 studies met the selection criteria and were categorized by the type of study design: eight cohort and 34 case-control studies. The pooled odds ratio for H. pylori in relation to gastric carcinoma was 2.04 (95% CI: 1.69-2.45). Both patient age (OR 0.77, 95% CI: 0.68-0.89) and intestinal type cancers (OR 1.14, 95% CI: 1.05-1.25) were independent effect modifiers. Analysis of other effect modifiers showed no relationship with female gender (OR 0.76, 95% CI: 0.64-0.89), stage of cancer (advanced %) (OR 1.12, 95% CI: 0.88-1.43), anatomical location (cardia %) (OR 1.54, 95% CI: 0.32-7.39) or cohort (nested case-control) studies (OR 1.72, 95% CI: 0.32-9.17). There was significant heterogeneity among the studies (tau2 = 149; p < 0.001). The quality of the studies varied considerably, with the majority of excellent studies producing positive results and the very poor to moderate studies producing mixed results.

CONCLUSIONS

H. pylori infection is associated with a 2-fold increased risk of developing gastric adenocarcinoma.

Benefits of fish oil supplementation in hyperlipidemia: a systematic review and meta-analysis

BACKGROUND

Fish oils have been widely reported as a useful supplement to reduce fasting blood triglyceride levels in individuals with hyperlipidemia. We performed an updated meta-analysis to quantitatively evaluate all the randomized trials of fish oils in hyperlipidemic subjects.

METHODS

We conducted a systematic literature search using several electronic databases supplemented by manual searches of published reference lists, review articles and conference abstracts. We included all placebo-controlled randomized trials of parallel design that evaluated any of the main blood lipid outcomes: total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol or triglycerides (TG). Data were pooled using DerSimonian-Laird's random effects model.

RESULTS

The final analysis comprised of 47 studies in otherwise untreated subjects showed that taking fish oils (weighted average daily intake of 3.25 g of EPA and/or DHA) produced a clinically significant reduction of TG (-0.34 mmol/L, 95% CI: -0.41 to -0.27), no change in total cholesterol (-0.01 mmol/L, 95% CI: -0.03 to 0.01) and very slight increases in HDL (0.01 mmol/L, 95% CI: 0.00 to 0.02) and LDL cholesterol (0.06 mmol/L, 95% CI: 0.03 to 0.09). The reduction of TG correlated with both EPA+DHA intake and initial TG level.

CONCLUSION

Fish oil supplementation produces a clinically significant dose-dependent reduction of fasting blood TG but not total, HDL or LDL cholesterol in hyperlipidemic subjects.

Dysphagia: epidemiology, risk factors and impact on quality of life--a population-based study

BACKGROUND

Data on the population epidemiology of dysphagia are scarce. Little is known about the prevalence, risk factors and impact on quality of life of dysphagia in the general community.

AIM

To determine the magnitude and impact of dysphagia in the general community.

METHODS

A random sample of 1000 individuals of Sydney, Australia, were mailed a validated self-report questionnaire to assess dysphagia. Measured were dysphagia symptoms, potential mechanisms, risk factors, psychological disorders, quality of life and demographics.

RESULTS

The response rate of included subjects (n = 926) was 73% (n = 672). Dysphagia ever was reported by 16% (n = 110). Multiple logistic regression analysis found that odynophagia was independently associated with gastro-oesophageal reflux disease (GERD) (OR = 3.41, 95% CI: 1.16-10.04). Intermittent dysphagia was independently associated with GERD (OR = 2.96, 95% CI: 1.76-4.98) and anxiety (OR = 1.09, 95% CI: 1.01-1.19). The presence of progressive dysphagia was independently associated with depression (OR = 1.34, 95% CI: 1.07-1.67). Progressive dysphagia was independently associated with reduced 'general health' (OR = 0.95, 95% CI: 0.90-0.99), while intermittent dysphagia was associated with a reduction in the 'role physical' subscale (OR = 0.98, 95% CI: 0.97-0.99).

CONCLUSIONS

Dysphagia is remarkably common in the general population. GERD is a risk factor for dysphagia as well as odynophagia. Intermittent dysphagia was associated with anxiety, while progressive dysphagia was associated with depression.

Non-cardiac chest pain: prevalence, risk factors, impact and consulting--a population-based study

BACKGROUND

Little is known about the prevalence and importance of non-cardiac chest pain in the general population.

AIM

To evaluate the magnitude and impact of this condition.

METHODS

A validated self-report questionnaire was mailed to a sample of 1000 residents of Penrith, selected randomly from the electoral rolls. Symptoms, risk factors, psychological distress, quality of life and demographics were measured.

RESULTS

The response rate was 73% (n = 672; mean age, 46 years; 52% female). Chest pain ever was reported by 39% of the population; 7% reported a history of myocardial infarction and 8% a history of angina. Two hundred and nineteen (33%) cases were classified as non-cardiac chest pain; only 23% had consulted a physician about chest pain in the previous year. The only independent risk factor for non-cardiac chest pain was the frequency of heartburn (odds ratio, 1.74; 95% confidence interval, 1.08-2.79; P = 0.02). None of the gastrointestinal (heartburn, dysphagia, acid regurgitation) or psychological (anxiety, depression, neuroticism) risk factors were significantly associated with consulting for non-cardiac chest pain.

CONCLUSIONS

Non-cardiac chest pain is remarkably common in the general population and negatively impacts on the quality of life. Gastro-oesophageal reflux disease is a key risk factor for non-cardiac chest pain in the community. Health care seeking for non-cardiac chest pain remains unexplained.

Epidemiology of esophageal cancer

The epidemiology of esophageal cancer has radically changed in the last fifty-years in the Western world. Changes in the predominant type of squamous cell carcinoma to adenocarcinoma, disparities between different ethnicities, and the exponential increase in incidence rates of adenocarcinoma have established esophageal cancer as a major public health problem requiring urgent attention.

Gastrointestinal symptoms and obesity: a meta-analysis

Weight loss is a recognized alarm symptom for organic gastrointestinal (GI) disease, yet the association between obesity and specific GI symptoms remains poorly described. A meta-analysis was conducted to determine which GI symptoms predominate among obese individuals. A search of the literature using the databases MEDLINE, EMBASE PubMed and Current Contents (1950 - November 2011) was conducted. All studies assessing GI symptoms and increasing body mass index (BMI)/obesity were included. English and non-English articles were searched. A random effect model of the studies was undertaken. Overall, significant associations between GI symptoms and increasing BMI were found for upper abdominal pain (odds ratio [OR] = 2.65, 95% confidence interval [CI]: 1.23-5.72), gastroesophageal reflux (OR = 1.89, 95% CI: 1.70-2.09), diarrhoea (OR = 1.45, 95% CI: 1.26-1.64), chest pain/heartburn (OR = 1.74, 95% CI: 1.49-2.04), vomiting (OR = 1.76, 95% CI: 1.28-2.41), retching (OR = 1.33, 95% CI: 1.01-1.74) and incomplete evacuation (OR = 1.32, 95% CI: 1.03-1.71). However, no significant associations were found for all abdominal pain, lower abdominal pain, bloating, constipation/hard stools, fecal incontinence, nausea and anal blockage. Several key GI symptoms are associated with increasing BMI and obesity. In addition, there were a number of other GI symptoms that had no relationship with obesity. A greater knowledge of the GI symptoms associated with obesity along with the physiology will be important in the clinical management of these patients.

Review article: the burden of illness of non-cardiac chest pain

BACKGROUND

Non-cardiac chest pain is a common condition affecting approximately one-quarter of the population during their lifetime, but the long-term economic costs of non-cardiac chest pain are poorly defined.

METHODS

A MEDLINE and Current Contents search was performed from 1991 to 2002 using specific keywords. All major articles on the subject of non-cardiac chest pain in this period were reviewed and their reference lists searched.

RESULTS

Limited studies suggest that the majority of those with non-cardiac chest pain do not consult a doctor regarding their symptoms; the drivers of health care seeking are not known. The impact on the quality of life in consulters can be severe, with as many as 36% reporting much lower quality of life levels. The diagnosis of non-cardiac chest pain can be difficult due to the heterogeneous nature of the condition, with significant overlap of gastro-oesophageal reflux disease, chest wall syndromes and psychiatric disease, which may drive up the costs of management. The prognosis appears to be good, but there are conflicting results in long-term studies.

CONCLUSIONS

The costs of non-cardiac chest pain to the health care system are likely to be large and represent a significant proportion of each Western country's health care budget. Further studies are required to determine methods of reducing health care costs.

Non-cardiac chest pain: predictors of health care seeking, the types of health care professional consulted, work absenteeism and interruption of daily activities

AIMS

To determine the predictors of health care seeking, assess the types of health care professional consulted and to calculate the work absenteeism rates and interruptions to daily activities among non-cardiac chest pain patients.

METHODS

A total of 212 patients who presented to a Tertiary Hospital Emergency Department over a 1-year period with acute chest pain were assessed according to a standard diagnostic protocol and completed the Chest Pain Questionnaire (CPQ).

RESULTS

In the previous 12 months prior to presentation to the Emergency Department, 78% of patients had seen a health care professional for chest pain. The main health care professionals seen were general practitioners (85%), cardiologists (74%) and gastroenterologists (30%). Work absenteeism rates because of non-cardiac chest pain were high (29%) as were interruptions to daily activities (63%). Multiple logistic regression found that acid regurgitation was the only independent predictive symptom associated with consulting for non-cardiac chest pain (OR = 3.97, 95% CI: 1.25-12.63).

CONCLUSIONS

Consulting for chest pain is common is this group of patients. The type of health care professional seen appears to be moderated by the frequency and severity of reflux symptoms among these chest pain patients. Work absenteeism and interruptions to daily activities is high among chest pain sufferers.

Noncardiac chest pain: evaluation and treatment

Noncardiac chest pain is a heterogeneous condition for which diagnosis and treatment are challenging. Research is needed to streamline evaluation to minimize unnecessary invasive testing and costs. Chest pain clinics to assess chest pain patients are popular in the United States and may be of value in reassuring patients and reducing presentation to hospital; however, recently this has been contended [111]. Options for the effective treatment of NCCP are dependent on the risk of an adverse outcome and the cost-effectiveness of the management algorithm that is followed. Most (64%) of those presenting to the emergency department with chest pain are classified as having NCCP [112,113]. GERD is probably the most important cause and application of a test of acid suppression with a high-dose PPI for 1 to 2 weeks seems to be a useful diagnostic tool. In those patients with GERD-related NCCP, short-term and potentially long-term therapy with a PPI (commonly higher than standard dose) is required to alleviate symptoms. Esophageal dysmotility is relatively uncommon in patients with NCCP and evaluation by esophageal manometry might be limited to rule out achalasia. Chest wall syndromes are common but probably often missed. Many patients with NCCP have psychologic or psychiatric abnormalities, as either the cause or an effect of the chest pain, but diagnosis here depends on techniques not applied easily in the acute situation. Pain modulators seem to offer significant improvement in chest pain symptoms for non-GERD-related NCCP. Finally, trials of management strategies to deal with this problem are required urgently, because the earlier discharge of patients with NCCP may exacerbate the problem. Fig. 2 provides a flow chart for diagnosis and treatment of NCCP.

Noncardiac chest pain: epidemiology, natural history, health care seeking, and quality of life

The epidemiology of NCCP is poorly described, and the available data are conflicting. Population-based studies on the prevalence of NCCP are rare; most studies have been hospital based. According to the limited studies available, the annual prevalence of NCCP is approximately 25%. Despite this significant burden, the impact and natural history of NCCP in the community has not been adequately explored. NCCP is presumed to bea heterogeneous condition. Hospital-based studies have suggested that GERD, esophageal spasm, psychiatric disease (including panic attacks), and musculoskeletal pain explain many cases of NCCP. However, unrecognized coronary artery disease and microvascular angina (cardiac syndrome X)also explain an unknown proportion of cases in the general population.Current studies suggest that NCCP is common in the general population and significantly affects QOL, yet only a minority seeks medical attention.The epidemiology of NCCP requires further study in the general population and in those attending the Emergency Department.

Natural history and predictors of outcome for non-cardiac chest pain: a prospective 4-year cohort study

The natural history of non-cardiac chest pain (NCCP) is poorly understood. We aimed to assess the 2- and 4-year outcomes of patients with chest pain, and determine whether baseline characteristics could predict outcomes (mortality, continued chest pain and quality of life). This was a prospective cohort study in a tertiary teaching hospital (Nepean Hospital), Sydney, Australia. All subjects who presented with acute chest pain to the emergency department were recruited at baseline (n = 197). Mortality data were obtained from death certificates on the entire cohort at 4 years; 129 (65%) patients responded to a 2 year follow-up and 92 (47%) to a 4-year follow-up questionnaire. At baseline, there were 126 (60%) NCCP patients and 71 cardiac patients. Chest pain continued to be reported in the majority of individuals (>65%) at follow-up. Over the 2-year period, NCCP disappeared among 10% (n = 9/88), but remained present in the remaining 90% (n = 79). In comparison, 69% (n = 28/41) of the cardiac chest pain (CCP) patients continued to have chest pain at the 2-year follow-up (NCCP vs CCP: P < 0.001). At the 4-year follow-up, 71% (n = 45/64) and 81% (23/27) continued to have NCCP and CCP respectively. The mortality rate among the entire cohort over the 4-year study was 9% (17/197). The cardiac mortality rate for patients initially diagnosed with CCP was 11% (8/71); compared with 5.5% (7/126) (P = 0.16) among patients initially diagnosed with NCCP who subsequently died from a cardiac cause. Outcomes in terms of mortality did not significantly differ between cardiac and NCCP patients. Both groups experienced continued chest pain during the follow-up period. Non-cardiac chest pain does not always confer an excellent long-term prognosis.

Gastroesophageal reflux disease (GERD): risk factors, and impact on quality of life-a population-based study

BACKGROUND

We aimed to determine the prevalence of gastroesophageal reflux disease (GERD) and associated risk factors, and assess quality of life (QoL) in relation to the frequency and severity of reflux symptoms.

METHODS

A random sample of 1000 residents of Western Sydney were mailed a validated self-report questionnaire. GERD symptoms, risk factors, psychologic distress, QoL, and demographics were measured.

RESULTS

The response rate was 73% (n=672; mean age, 46 y; 52% female). A total of 78 [12%, 95% confidence interval (CI): 9-14] had GERD (at least weekly heartburn and/or acid regurgitation). Independent risk factors for GERD were high cholesterol [odds ratio (OR) =3.28, 95% CI: 1.42-7.57, P=0.005] and current smoker (OR=2.47, 95% CI: 1.07-5.70, P=0.03). Anxiety, depression, and neuroticism were not risk factors. Worse physical functioning was the only QoL domain associated with GERD (OR=0.98, 95% CI: 0.97-0.99, P=0.006). QoL was significantly impaired regardless of the severity of GERD for the QoL domains physical function, body pain, vitality, and social function. The frequency of heartburn and acid regurgitation were not associated with significantly reduced QoL domain scores.

CONCLUSIONS

Cardiac risk factors (high cholesterol and smoking) were independently associated with GERD. Increasing GERD symptom severity is associated with worse QoL scores, whereas GERD symptom frequency did not impact the QoL scores.

Epidemiology of gallbladder cancer

Gallbladder cancer is the most common biliary tract cancer. The highest incidence rates occur in Chile, which also has the highest mortality rates. This lethal gastrointestinal cancer has a predilection among adult women and older subjects of both sexes, and also among populations throughout central and Eastern Europe and certain racial groups, such as Native American Indians. Unfortunately, prospects are poor for preventing this form of cancer.

Helicobacter pylori infection causes gastric cancer? A review of the epidemiological, meta-analytic, and experimental evidence

Since the discovery of Campylobacter-like organisms Helicobacter pylori (H pylori) more than two decades ago the possibility of a relationship with gastric cancer has been postulated, tested and supposedly proven. There have been numerous human studies of various designs from many countries around the world. Several meta-analyses have been published and more recently a small number of experimental animal studies were reported looking at the association between H pylori infection and gastric cancer. Over the years, the human epidemiological studies have produced conflicting results; the meta-analyses have as one would expect produced similar pooled estimates; while the early experimental animal studies require replication. The exact mechanisms by which H pylori might cause gastric cancer are still under investigation and remain to be elucidated.

Foetal intrauterine growth restrictions with Helicobacter pylori infection

BACKGROUND

Helicobacter pylori infection has been associated with growth restriction in young children.

AIM

To determine whether there is an association between H. pylori infection and intrauterine growth restriction.

METHODS

Four hundred and forty-eight consecutive pregnant women (aged 15-44 years), attending for routine examinations in the third trimester, were enrolled. Clinical, demographic and previous obstetric data, as well as smoking history, were collected. At delivery, the weight, height, gender and status of the neonate were recorded; intrauterine growth restriction was defined if the birth weight was below the 10th percentile according to the gestational age for infants born in Australia.

RESULTS

Eighty-nine (20%) women were seropositive for H. pylori. The prevalence of H. pylori was significantly lower in Caucasians (17%) vs. non-Caucasians (42%, P < 0.0001). There were 34 (7.5%) cases of intrauterine growth restriction (7% Caucasians, 16% Asians, 12% Aborigines and 0% Pacific Islanders). Intrauterine growth restriction was more common in H. pylori-seropositive women than in H. pylori-seronegative women [13.5% vs. 6%; odds ratio (OR) = 2.41; 95% confidence interval (CI), 1.14-5.08; P = 0.018]. A multiple logistic regression model revealed that smoking (OR = 3.55; 95% CI, 1.62-7.79; P = 0.002), maternal height (OR = 0.48; 95% CI, 0.28-0.80; P = 0.005) and H. pylori seropositivity (OR = 2.59; 95% CI, 1.12-5.95; P = 0.025) were all independent risk factors for intrauterine growth restriction.

CONCLUSIONS

H. pylori infection in pregnant women may affect foetal intrauterine growth.

Usefulness of chest pain character and location as diagnostic indicators of an acute coronary syndrome

This study assessed chest pain locations/symptoms among patients who presented with acute chest pain and how these compare with a clinical diagnosis of cardiac or noncardiac chest pain. A cluster analysis was undertaken to determine any pattern in the chest pain locations described by patients. Cluster analysis identified 4 distinct chest pain locations (upper chest, central retrosternal, central chest, and left chest and left arm). There was considerable location/symptom overlap between patients who had cardiac chest pain and those who had noncardiac chest pain.

Diagnosis and treatment of noncardiac chest pain

Chest pain is common: one in four of the population have an episode annually. Of those who present to hospital, nearly two-thirds have noncardiac chest pain. More than half of these cases might have gastroesophageal reflux disease. Opinion differs over what is the most appropriate application of current investigatory methods. Evidence suggests that, once cardiac disease is ruled unlikely, empiric use of a proton pump inhibitor is an option; if acid suppression fails, detailed investigations as clinically indicated can be considered. A range of esophageal investigations is available, including 24-hour or 48-hour esophageal pH testing and esophageal manometry, as well as provocative tests, but there is no consensus as to which methods are the most useful. Psychiatric evaluation is not routine, but psychiatric or psychological disorders are common. Musculoskeletal disorders are also common, but are frequently overlooked. It is possible to subject patients to a comprehensive set of investigations before empiric therapy, but recent studies have failed to demonstrate an improved outcome using this exhaustive approach. A new tactic is required, with less attention spent on absolute diagnostic accuracy and more emphasis on optimizing the long-term clinical outcome in patients with noncardiac chest pain. It is possible that the targeted use of multiple drug trials in a policy of 'therapy as investigation' might be a superior methodology.

Empirically derived symptom sub-groups correspond poorly with diagnostic criteria for functional dyspepsia and irritable bowel syndrome. A factor and cluster analysis of a patient sample

AIM

To determine how clusters (groups) of patients with respect to symptoms compare with a clinical diagnosis in patients with irritable bowel syndrome and non-ulcer dyspepsia.

METHODS

All patients who attended a gastroenterology practice at Nepean Hospital were included in the study. All patients received the previously validated Bowel Disease Questionnaire, and were independently assessed by the gastroenterologist. Factor analysis and a k-means cluster analysis were completed.

RESULTS

The study population comprised 897 patients [320 males (36%) and 577 females (64%)]. Factor analysis identified nine symptom factors: (1) diarrhoea; (2) constipation; (3) dysmotility; (4) dyspepsia/reflux; (5) nausea/vomiting; (6) bowel; (7) meal-related pain; (8) weight loss; and (9) abdominal pain. A k-means cluster analysis identified seven distinct subject groups, which included an undifferentiated group: (1) diarrhoea; (2) meal-related pain; (3) abdominal pain; (4) faecal indicators; (5) nausea/vomiting/weight loss; and (6) constipation. The majority of irritable bowel syndrome patients fitted into two cluster groups [diarrhoea (25%) and constipation (20%)], whereas those with non-ulcer dyspepsia predominantly fitted into the undifferentiated cluster (34%) and the nausea/vomiting cluster (18%).

CONCLUSION

This study supports the concept of symptom subgroups, including the subdivision of patients into diarrhoea- and constipation-predominant irritable bowel syndrome.

Gastric metastasis in renal cell carcinoma: a case report and systematic review

BACKGROUND

Published report of cases of gastric metastases arising from renal cell carcinoma is a rare event and treatment of such patients can be difficult. Gastrectomy may be a surgical alternative; however, the prognosis for the majority of patients is very poor.

METHODS

We report a rare case of a patient with a metastatic renal cell carcinoma that metastasized to the stomach. In addition, we conducted a systematic review of the literature to assess the prevalence of reports and to gain a greater understanding of this particular metastatic cancer spread from the kidney to the stomach.

RESULTS

Published reports of metastases from the kidney to the stomach are not as rare as previously thought with three times of the number of reports found to what most authors thought actually existed. The majority of reports occurred among males (77%). The mean age of presentation was 65 years for males and 68 years for females (range, 40-84 years). Average time from nephrectomy to presentation of gastric metastases was 7 years for both males and females (range, 0-24 years).

CONCLUSION

Females with gastric metastases from the kidney are slightly older than males, and no difference exists between males and females in terms of the time interval between nephrectomy and subsequent metastasis or select patients treatment options.

Atypical pityriasis rosea or psoriasis guttata? Early examination is the key to a correct diagnosis

Pityriasis rosea is a self-limited, mild, inflammatory skin disease characterized by scaly lesions, possibly due to an unidentified infectious agent. It may occur at any age, but is seen most frequently in young adults. This paper reports a patient who presented with a skin condition which was initially diagnosed as pityriasis rosea; however, due to the persistence and change in appearance of the lesions, the diagnosis was later altered to psoriasis guttata. Changes in pityriasis rosea lesions over the course of the disease may make a correct diagnosis difficult, unless the patient is seen during the early stages of lesion formation. The final diagnosis in this case was of the rare variant known as pityriasis rosea irritata. This case highlights the importance of an excellent patient history in order to correctly diagnose the disease.

Rectal bleeding: epidemiology, associated risk factors, and health care seeking behaviour: a population-based study

PURPOSE

Rectal bleeding is considered an important sign of colonic disease, particularly colorectal cancer. The epidemiology of rectal bleeding in the community is poorly understood. Moreover, there is little information as to whether individuals seek health care for this problem. This study aimed to determine the prevalence of rectal bleeding and levels of healthcare seeking amongst an Australian population.

METHOD

A community sample of adults aged above 18 years of Penrith (a Sydney suburb representative of the Australian population) selected randomly from the electoral roll. The survey consisted of a self-administered questionnaire sent out to 440 residents stratified for equal numbers of men and women.

RESULTS

The response rate was 77% (n = 338; mean age 46 years; SD: 16; range: 18-90; 55% women). Blood in the stools in the previous 12 months was reported by 18% (95% CI: 14-23). Colour of the blood in bowel movements was reported as bright (72%), dark (7%), bright and dark (10%), 11% did not know. Only 31% (n = 21/68) of respondents with rectal bleeding had visited a physician primarily about the presence of blood in the bowel movement within the previous 12 months. The majority (90%) who consulted about the presence of blood were aged between 30 and 60 years. Blood in the stools was independently associated with younger age (OR = 0.97, 95% CI: 0.95-0.99, P = 0.01), feelings of incomplete rectal evacuation (OR = 3.42, 95% CI: 1.66-7.08, P = 0.001), self-reported injury or tear (OR = 3.45, 95% CI: 1.53-7.69, P = 0.002), and surgery (OR = 2.70, 95% CI: 1.03-7.14, P = 0.04) to the perianal region.

CONCLUSIONS

Rectal bleeding is common in the general population. Only one-third of those with rectal bleeding consults a physician about their condition. Rectal bleeding occurs in younger individuals, those who suffer from incomplete evacuation and among individuals who have had an injury, tear or surgery to the anus.

Circulating interleukin-18 concentrations and a loss-of-function P2X7 polymorphism in heart failure

We examined if a loss-of-function polymorphism in the P2X(7) receptor (1513C) corresponded with circulating interleukin(IL)-18 concentrations in heart failure (HF) patients. IL-18 values were significantly elevated in HF subjects compared to healthy control subjects. No association was seen between the polymorphism and IL-18 concentrations in HF patients. In HF patients, IL-18 values had an inverse relationship with ejection fraction, mean arterial pressure and body mass index, while high IL-18 concentrations were associated with increased mortality.