Lee, Gyeongsil

(1) Background: The association between proton pump inhibitor (PPI) use and hepatocellular carcinoma (HCC) has been controversial, especially in the general population. We aimed to determine the impact of PPI on HCC risk in participants without liver cirrhosis or chronic hepatitis virus infection. (2) Methods: We assessed 406,057 participants from the Korean National Health Insurance Service database who underwent health screening from 2003 to 2006. We evaluated exposure to PPI before the index date using a standardized daily defined dose (DDD) system. The association of proton pump inhibitor use with the risk of HCC was evaluated using multivariable-adjusted Cox proportional hazards regression. (3) Results: Compared with non-users, PPI use was not associated with the HCC risk in low (<30 DDDs; aHR, 1.07; 95% CI, 0.91–1.27), intermediate (30 ≤ PPI < 60 DDDs; aHR, 0.96; 95% CI, 0.73–1.26), and high (≥60 DDDs; aHR, 0.86; 95% CI, 0.63–1.17) PPI groups in the final adjustment model. In addition, risks of cirrhosis-associated HCC and non-cirrhosis-associated HCC were not significantly associated with PPI use. The results remained consistent after excluding events that occurred within 1, 2, and 3 years to exclude pre-existing conditions that may be associated with the development of HCC. We also found no PPI-associated increase in HCC risk among the selected population, such as those with obesity, older age, and chronic liver diseases. (4) Conclusions: PPI use may not be associated with HCC risk regardless of the amount. We call for future studies conducted in other regions to generalize our findings.

Abstract Background : Studies have proposed an inverse association between allergic diseases and cancer risk, but few studies to date have specifically investigated the risk of primary liver cancer (hepatocellular carcinoma, HCC; intrahepatic cholangiocarcinoma, ICC) in patients with or without allergic diseases. Objective : The aim of this study was to evaluate the association between allergic diseases and risk of developing liver cancer.Methods: A retrospective cohort study of the Korean National Health Insurance Service database was performed to study 405,512 South Korean adults ages 40 and above who underwent routine health screening after January 1st, 2005. All participants were followed for liver cancer diagnosis or death until December 31st, 2013. Those who died before the index date, had pre-diagnosed cancer, or did not undergo health screening were excluded. Cox proportional hazards regression was performed to determine the adjusted hazard ratios(aHRs) and 95% confidence intervals (CIs) for risk of developing liver cancer according presence or absence of atopic dermatitis, asthma and allergic rhinitis.Results: The aHR (95% CI) for overall liver cancer among allergic patients was 0.72 (0.64-0.81). Allergic patients had significantly reduced risk of HCC (aHR: 0.70, 95% CI: 0.61-0.81) but not ICC (aHR: 0.99, 95% CI: 0.71-1.08). Presence of allergic diseases was associated with significantly lower risk of liver cancer in both patients with (aHR: 0.61, 95% CI: 0.47-0.8) or without (aHR: 0.74, 95% CI: 0.65-0.85) chronic Hepatitis B/C infections. Presence of allergic diseases was associated with significantly lower risk of liver cancer in patients without cirrhosis (aHR: 0.72, 95% CI 0.63-0.82), but not in those with cirrhosis (aHR: 0.98, 95% CI 0.68-1.41). Patients with multiple allergies had even lower risk of liver cancer compared to patients with single allergy. Conclusion: Patients with allergic diseases have significantly lower risk of developing liver cancer compared to those without allergic diseases, which supports the rationale for immunotherapy as an effective treatment of liver cancer.

Introduction Despite extensive studies on the relationship between diabetes mellitus (DM) and depression, the associations of depressive symptom severity with prevalence, awareness, treatment, and control of diabetes remain unclear. We aimed to investigate changes in these outcomes of diabetes as depressive symptoms aggravate. Research design and methods We conducted a cross-sectional analysis of 14 328 participants in the 2011–2016 National Health and Nutrition Examination Survey. Participants were classified into depressive symptom groups of none, mild, moderate, moderately severe, and severe depending on their Patient Health Questionnaire-9 scores. Multivariate logistic regression analyses were conducted in three models adjusted for expanding confounders to evaluate the associations between severity of depressive symptoms and prevalence, awareness, treatment, and control of DM. Results As depressive symptom severity worsened, both prevalence and awareness of DM increased regardless of models (p value for trend <0.01 in all models for prevalence and awareness; adjusted OR (aOR) 2.14, 95% CI 1.29 to 3.56 for prevalence in the severe group, model 1; aOR 2.43, 95% CI 1.27 to 4.64 for awareness in the moderately severe group, model 1). Notwithstanding higher awareness of diabetes in the moderately severe and severe groups (84.5% and 86.2%, respectively, vs 71.3% in the none group), these groups were treated less (aOR 0.25, 95% CI 0.11 to 0.55 in the severe group, model 3) or inadequately controlled (aOR 0.51, 95% CI 0.27 to 0.98 in the moderately severe group, model 3). Conclusions The gap between patients’ higher awareness and lower treatment rate or control of diabetes among individuals with severe depressive symptoms highlights the unmet needs for postdiagnostic multidisciplinary care for patients with comorbid depression and DM.