Tag Archives: Digestive Disease Week

The U.S. Obesity Epidemic and Surging Liver Cancer

If there is one truism that trumps everything else these days about U.S. health, it’s that America is a chubby country that keeps getting fatter.

The consequences seep into every corner of the nation’s medical state, including the surprising fact that obesity and the type 2 diabetes it causes are likely pushing up the incidence of liver cancer—hepatocellular carcinoma—to unprecedented heights.

courtesy Wikimedia Commons

When I covered Digestive Disease Week in San Diego recently, one of the biggest stories I heard was that U.S. liver-cancer rates tripled from 1975-2007, and that the numbers continued to rise from the mid to the late 2000s. (My full report on this is here).

Granted, factors other than just obesity play into the liver cancer surge, notably the sizable number of Americans infected with either hepatitis B or C virus, and the fact that as they age their risk for developing hepatocellular carcinoma rises.

But new U.S. infections by hepatitis B and C are largely under control these days (although people infected elsewhere continue to emigrate to the United States). The part of the booming liver-cancer story that is by no means under control is the obesity part.

Every time I see a new CDC map for U.S. obesity prevalence, the colors on it keep getting redder and darker (the CDC’s code for higher prevalence rates).

courtesy CDC

courtesy CDC

Earlier this year, the CDC reported a 36% obesity prevalence rate for the entire U.S. population–and still on the rise–and just a few weeks ago we heard that obesity among children and adolescents had hit a new high of 17%. With obesity seemingly on an unchanging upward trajectory, one can only wonder what rates of liver cancer it might produce in the future. Obesity carries a special relationship with the liver, and it’s not pretty. Just consider any goose headed to a foie-gras future.

Until now, the evidence linking obesity and liver cancer, and type 2 diabetes and liver cancer has been epidemiologic. Compelling, but just an association. At DDW, a new study provided more observational data on the diabetes-liver cancer link, and while still circumstantial it further supports the notion and also carries an intriguing punchline.

The study, done in Taiwan, examined 97,000 hepatocellular carcinoma patients and 195,000 matched controls. The analysis showed that people with diabetes had a two-fold increased risk for liver cancer compared with those without diabetes. Even more striking, the analysis also showed that people with diabetes treated with the oral hypoglycemic drug metformin had their risk for liver cancer cut in half compared with those not on metformin, and those with diabetes treated with a glitazone drug (such as pioglitazone–Actos) had their risk cut nearly in half.

The best solution would be if people avoided obesity and type 2 diabetes all together. Both conditions cause a lot of medical problems, and this new evidence indicates more strongly than ever before that liver cancer is one of them.

—Mitchel Zoler (on Twitter @mitchelzoler)

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Filed under Endocrinology, Diabetes, and Metabolism, Epidemiology, Gastroenterology, IMNG, Internal Medicine, Internal Medicine News, Oncology

A New View on Colonoscopy?

From the annual Digestive Disease Week, Chicago:

Tired of traditional colonoscopy? How’s this for a new view: Use a capsule that goes in the “back end” to take pictures of the colon.  A team of Japanese researchers has developed a self-propelling capsule endoscope that is designed to start in the rectum and then swim up the colon, taking pictures as it goes.

courtesy of flickr user AZAdam

Dr. Takanori Kuramoto of Osaka Medical College in Osaka, Japan, and his team developed the capsule, tested it in a dog model, and presented results of the first human test at the annual Digestive Disease Week in Chicago.

The capsule camera moved smoothly through the colon, showed clear images, and was easily and safely removed from the anus, according to a press release. The (lucky?) human volunteer was awake during the process, which involved injecting 500 ml of water and inserting the 12 mm x 65 mm-capsule into the anus. The capsule was “driven” through the colon by doctors using remote control—the capsule features a small magnetic fin– and it was propelled using a magnetic field.

Sounds like something out of science fiction, but this is real science, and it is probably headed in your direction (or the reverse direction).

“I think capsule endoscopy is going to be big in the future,” said Dr. Jerome Waye of Mount Sinai School of Medicine, New York, who moderated the press conference at which the study was presented. In general, capsule technology is becoming more accepted, Dr. Waye said. Capsules that deliver medications, as well as those that take pictures, will one day become commonplace, he said. 

Stay tuned. Remember when those communicators on Star Trek looked futuristic? I bet you have one in your purse or pocket right now.

–Heidi Splete

(on Twitter @hsplete)

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Filed under Drug And Device Safety, Family Medicine, Gastroenterology, IMNG, Internal Medicine

Video of the Week: Digestive Disease Week Recap

Digestive Disease Week is billed as the “world’s largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy, and gastrointestinal surgery.” Our reporter Heidi Splete has been covering the big stories from the meeting. Here’s her wrap-up of some of yesterday’s important studies: obesity interventions work for preschool-aged children; bariatric surgery is no riskier for older adults.

For more great medical news videos, visit our YouTube page; for in-depth stories and commentary on the latest medical news, visit Internal Medicine News or Family Practice News.

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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Gastroenterology, IMNG, Internal Medicine, Internal Medicine News, Pediatrics, Primary care, Surgery, Video

Star Power and Digestive Disease

From Digestive Disease Week in New Orleans, LA: 

courtesy of flickr user Crafting with Cat Hair

Never underestimate the power of celebrity. Today at Digestive Disease Week, I heard a presentation that reported on the first year of activity for a Web site called sedationfacts.org. The Web site’s goal is to educate clinicians and the public by providing the latest evidence-based data on endoscopic sedation. The site is a joint effort of several organizations: American Society for Gastrointestinal Endoscopy, American Gastrointestinal Association Institute, American College of Gastroenterology, and Society of Gastroenterology Nurses and Associates, Inc. 

Basically, the news is great. The site is averaging 5,000 visits per month. But Dr. Jenifer Lightdale of Children’s Hospital Boston, who presented the findings, noted that visitors to the site also include individuals who want to know about the sedation medications themselves. In particular, the Web site traffic report showed a huge spike in July 2009, the month after Michael Jackson’s death, when even my mom learned how to pronounce propofol

Obviously, some of those visitors weren’t googling “propofol” because they were interested in endoscopic sedation, but Dr. Lightdale’s data showed that visitors to the Web site were clicking on an average of 3.3 pages per visit. So, thanks to star power, some of these chance visitors might end up learning something before they click away.

If a dramatic celebrity death ends up teaching someone something about endoscopic sedation, maybe that will make the difference between that person going for a screening colonoscopy that might identify cancer, vs. skipping the appointment because he or she is afraid of the procedure or its side effects. I heard several doctors, in presentations and in comments, note that fear remains one of the key barriers to getting patients to come in for screening colonoscopies. 

Alternatively, perhaps we are due for another celebrity colonoscopy. It has been quite a while since Katie Couric showed off her colon on national TV. Harry Smith did his personal sequel to Katie’s Colon earlier this year, but maybe the public would pay more attention to someone with more sex appeal. Brad Pitt, are you listening? 

 –Heidi Splete (on twitter @hsplete)

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Filed under Anesthesia and Analgesia, Drug And Device Safety, Family Medicine, Gastroenterology, IMNG, Internal Medicine, Primary care, Uncategorized

The Electric Kandy-Colored Metamucil Test

From Digestive Disease Week, Chicago.

So this meeting is, theoretically, a 10-year-old boy’s dream..approximately 16,000 gastroenterologists and hepatologists discussing what goes on from the mouth out through the rear end. I’ve yet to hear anyone say “poop,” “fart,” or “burp,” but I did enounter a “Dr. Butt.”  All kidding aside, there’s plenty of fiber to go around — lots of studies of substance on hepatitis, obesity, Crohn’s disease, liver cancer, Barrett’s esophagus.

The Offending Product/Photo by A. Ault

The Offending Product/Photo by A. Ault

And apparently, there’s no lack of roughage in the exhibit hall, either.  As I strolled through yesterday, I was accosted by a young woman at the Procter & Gamble booth who thrust a tray of “pink lemonade smoothies” in my general direction and asked if I’d like one.  It looked marginally inviting, so I said, “sure.”

I sucked down a big gulp, instantly regretting it.  My regret turned to dismay when she announced that it was the newest Metmucil flavor.  Yep, Pink Lemonade.

Let’s just say that artificially-sweetened bubble-gum-ish psyllium was not on the list of culinary attractions I hoped to hit while in Chicago.  Nor did I fancy examining my own digestive functions close-up and personal later on in my hotel room.

The offending product was dispensed with forthwith.

— Alicia Ault (on Twitter @aliciaault)

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Filed under Endocrinology, Diabetes, and Metabolism, Gastroenterology, Internal Medicine