Ungprasert, Patompong

Background/ObjectivesStudies have suggested that smokers may have a lower risk of primary sclerosing cholangitis (PSC) although the results have been inconsistent. This systematic review and meta‐analysis was conducted to summarize all available data to better characterize this association.MethodsA comprehensive literature review was conducted using Medline and Embase databases through January 2018 to identify all studies that compared the risk of PSC among current/former smokers versus nonsmokers. Effect estimates from each study were extracted and combined using the random‐effect, generic inverse variance method of DerSimonian and Laird.ResultsSeven case‐control studies with 2,307,393 participants met the eligibility criteria and were included in the meta‐analysis. The risk of PSC among current smokers and former smokers was significantly lower than nonsmokers with the pooled odds ratio of 0.31 (95% CI, 0.18–0.53) and 0.52 (95% CI, 0.44–0.61), respectively. The risk remained significantly lower among current smokers and former smokers compared with nonsmokers even when only patients with PSC without inflammatory bowel disease were included.ConclusionsA significantly decreased risk of PSC among current and former smokers was demonstrated in this study.

Abstract Background/objectives Hepatitis C virus (HCV) infection is one of the most common causes of chronic liver disease. Several epidemiologic studies have suggested that patients with HCV infection might have a higher risk of osteoporotic fracture. However, the data are inconclusive. This systematic review and meta‐analysis was conducted with the aims to summarize all available evidence. Methods A literature search was performed using MEDLINE and EMBASE database from inception to June 2016. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of osteoporotic fracture among HCV‐infected patients versus subjects without HCV infection were included. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random‐effect, generic inverse variance method. Results Three studies with 362,285 participants met our eligibility criteria and were included in analysis. We found a significantly higher risk of osteoporotic fracture among patients with HCV infection with RR of 1.53 (95% CI 1.09 to 2.14). Conclusions Our study demonstrated an increased risk of osteoporotic fracture among HCV‐infected patients. Further studies are required to clarify how this risk should be addressed in clinical practice.

Background/objective Recent epidemiologic studies have suggested that patients with celiac disease might be at an increased risk of schizophrenia. However, the data on this risk remain inconclusive. This meta-analysis was conducted with the aim to summarize all available evidence. Methods A literature search was carried out using MEDLINE and Embase database from inception to June 2017. Studies that compared the risk of schizophrenia among patients with celiac disease versus individuals without celiac disease were included. Pooled odds ratio and 95% confidence interval were calculated using a random-effect, generic inverse-variance method. Results Of the 284 retrieved studies, four met our eligibility criteria and were included in the analysis. We found a higher risk of schizophrenia among patients with celiac disease compared with individuals without celiac disease with the pooled odds ratio of 2.03 (95% confidence interval: 1.45–2.86). The statistical heterogeneity of this study was insignificant (I 2=0%). Conclusion This systematic review and meta-analysis found a significantly higher risk of schizophrenia among patients with celiac disease.

Background/Aims Studies have shown that nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of chronic kidney disease (CKD). However, it is unknown whether severe liver fibrosis is associated with a higher prevalence of CKD among NAFLD. We examined the diagnostic performance of noninvasive fibrosis markers in identifying prevalent CKD among NAFLD. Methods This study represents an analysis of the National Health and Nutrition Examination Survey conducted in the USA between 1988 and 1994. NAFLD was defined by ultrasonographic evidence of hepatic steatosis without other liver diseases. CKD was defined by estimated glomerular filtration rate less than 60 ml/min/1.73 m2. The presence and severity of hepatic fibrosis were determined by the NAFLD fibrosis score (NFS), FIB-4 score, APRI score, and BARD score. Multiple logistic regression was performed to generate odds ratios (ORs) and receiver operating characteristic curves were used to assess the predictive values of each marker. Results A total of 4142 individuals with NAFLD were included; 200 (4.8%) had CKD. The area under the receiver operating characteristic curves was 0.77, 0.75, 0.62, and 0.51 for the multivariable equation with FIB-4, NFS, BARD, and APRI score, respectively. Compared with patients with a low probability of developing advanced liver fibrosis, individuals with a high probability of developing fibrosis showed significantly increased odds of CKD as estimated by NFS (adjusted OR: 4.92, 95% confidence interval: 2.96–8.15) and FIB-4 (adjusted OR: 2.27, 95% confidence interval: 1.05–4.52). Conclusion Advanced liver fibrosis, defined by NFS and FIB-4 scores, is associated independently with CKD among individuals with NAFLD. FIB-4 is the best predictor of an increased risk of prevalent CKD.

Background/objective Hepatitis C virus (HCV) infection is one of the most common infections worldwide. Recent epidemiologic studies have suggested that patients with HCV infection might be at an increased risk of Parkinson’s disease. However, the data on this relationship remain inconclusive. This meta-analysis was conducted with the aim to summarize all available evidence. Patients and methods A literature search was performed using MEDLINE and EMBASE database from inception to May 2017. Studies that reported relative risks, odd ratios (ORs), or hazard ratios comparing the risk of Parkinson’s disease among HCV-infected patients versus participants without HCV infection were included. Pooled OR and 95% confidence interval were calculated using a random-effect, generic inverse variance method. Results Of 468 studies, five studies with 323 974 participants met our eligibility criteria and were included in the analysis. We found a higher risk of Parkinson’s disease among patients with chronic HCV infection compared with participants without HCV infection with the pooled OR of 1.35 (95% confidence interval: 1.19–1.52). The statistical heterogeneity of this study was insignificant (I 2=3%). The main limitation of this meta-analysis was the limited accuracy of diagnosis in the primary studies as they were coding-based studies. Conclusion This study demonstrated a higher risk of Parkinson’s disease among HCV-infected patients. Further studies are required to clarify how this risk should be addressed in the clinical picture.

Background Hyperuricemia is a significant risk factor for nonalcoholic fatty liver disease (NAFLD). It may also have an impact on the histologic severity of NAFLD. However, data on this association are limited. We conducted this meta-analysis to investigate the relationship of serum uric acid with liver histologic severity as determined by NAFLD activity score (NAS) in patients with NAFLD. Patients and methods MEDLINE and EMBASE databases were searched through August 2016 for studies that investigated the association between hyperuricemia and NAS among patients with biopsy-proven NAFLD. Pooled odds ratio and 95% confidence interval were calculated using a random-effects model (generic inverse variance method). The between-study heterogeneity of effect size was quantified using the Q statistic and I 2. Results Five observational studies with 777 NAFLD patients were identified. Patients with NAFLD who had hyperuricemia had a high NAS (defined as score of ≥5) significantly more often than did those without hyperuricemia with a pooled odds ratio of 2.17 (95% confidence interval: 1.51–3.12). The statistical heterogeneity was low, with I 2 of 16% (P heterogeneity=0.31). Conclusion In patients with NAFLD, hyperuricemia is associated with a higher degree of histological liver damage. Further studies are required to establish the role of uric acid-lowering therapy among these patients.

AbstractBackgroundSodium‐glucose cotransporter 2 (SGLT2) inhibitors could potentially alter calcium and phosphate homeostasis and may increase the risk of bone fracture.MethodsThe current meta‐analysis was conducted to investigate the fracture risk among patients with type 2 diabetes mellitus treated with SGLT2 inhibitors. Randomized controlled trials that compared the efficacy of SGLT2 inhibitors to placebo were identified. The risk ratios of fracture among patients who received SGLT2 inhibitors versus placebo were extracted from each study. Pooled risk ratios and 95% confidence intervals were calculated using a random‐effect, Mantel‐Haenszel analysis.ResultsA total of 20 studies with 8286 patients treated with SGLT2 inhibitors were included. The pooled risk ratio of bone fracture in patients receiving SGLT2 inhibitors versus placebo was 0.67 (95% confidence interval, 0.42‐1.07). The pooled risk ratio for canagliflozin, dapagliflozin, and empagliflozin was 0.66 (95% confidence interval, 0.37‐1.19), 0.84 (95% confidence interval, 0.22‐3.18), and 0.57 (95% confidence interval, 0.20‐1.59), respectively.ConclusionsIncreased risk of bone fracture among patients with type 2 diabetes mellitus treated with SGLT2 inhibitors compared with placebo was not observed in this meta‐analysis. However, the results were limited by short duration of treatment/follow‐up and low incidence of the event of interest.

Background and Aim Peri‐procedural bridging ( PPB ) with heparin is recommended for patients with high thromboembolic risk who need to withhold antithrombotic therapy for colonoscopic polypectomy. However, little is known about the bleeding risk from heparin‐bridging therapy itself. Methods MEDLINE and EMBASE databases were searched through January 2017 for studies that compared the risk of PPB in patients who received heparin‐bridging therapy in lieu of antithrombotic agents for colonoscopic polypectomy and those who discontinued antithrombotic agents without receiving heparin. Pooled odds ratio ( OR ) and 95% confidence interval ( CI ) were calculated using a random‐effects model, generic inverse variance method. Between‐study heterogeneity was quantified using the Q statistic and I 2 . Results A total of five studies consisting of 2601 patients were identified. A significantly increased risk of PPB among bridged patients compared to non‐bridged patients was demonstrated with a pooled OR of 8.29 (95% CI , 4.96–13.87). Statistical heterogeneity was low with I 2 of 0%. Conclusion The present study demonstrated a significantly increased risk of PPB among patients who underwent colonoscopic polypectomy and received heparin‐bridging therapy in lieu of antithrombotic agents compared to patients who did not receive it.