Hábitos de vida y cáncer colorrectal: Un estudio de casos y controles en una población de ingresos medios y bajos / Lifestyle and colorectal cancer: A case-control study in a population of middle and low income

Introducción: En Pasto Colombia, el cáncer colorrectal es una de las principales causas de morbi-mortalidad por cáncer. Para contribuir a la prevención primaria de esta enfermedad es necesario realizar estudios que permitan identificar la población a riesgo y los factores que influyen en su desarrollo. Objetivo: Analizar los hábitos de vida que predisponen al desarrollo de CCR en la población de Pasto para contribuir a la toma de decisiones dirigidas a la prevención y el control de esta enfermedad. Materiales y metodos: Se realizó un estudio observacional analítico con una muestra de 55 casos (CCR+) seleccionados aleatoriamente de la base de datos de Registro Poblacional de Cáncer del Municipio de Pasto y pareados con 55 controles (CCR-). Mediante una regresión logística multivariada se identificó la relación y fuerza de asociación entre los hábitos de vida (actividad física, consumo de alcohol y tabaco) y el desarrollo de CCR, ajustando el modelo por covariables demográficas, socioeconómicas y clínicas. Resultados: En el análisis multivariado se identificó que el consumo diario de alcohol y el consumo diario de cigarrillo presentaron una asociación estadísticamente significativa con el desarrollo de CCR. Las personas con un consumo alto de alcohol (OR ajustado=5,8 IC95% 1,3-26,7) y un consumo de cigarrillo severo (OR ajustado=9,1 IC95% 1,7-70) tienen mayor probabilidad de desarrollar CCR que los individuos que no beben o fuman respectivamente. Conclusiones: Los hallazgos sugieren que necesario promover campañas de sensibilización que permitan dar a conocer, en la población del municipio de Pasto el riesgo a desarrollar CCR causado por inadecuados hábitos de vida como el consumo de alcohol y tabaco.

Introduction: In Pasto Colombia, the colorectal cancer is one of the major causes of morbidity and mortality from cancer. To contribute to the primary prevention of this disease, it is necessary to do studies which help to identify the population at risk and the factors that influence its development. Objective: To analyze people's lifestyles that predispose to the development of colorectal cancer (CRC) in Pasto and so contributing to decision-making for the prevention and control of this disease. Materials and methods: An analytical observational study was conducted with a sample of 55 cases (CRC +) who were randomly selected from the database of Cancer Registry of the Municipality of Pasto and matched with 55 controls (CRC -). The relationship and strength of association between lifestyle (physical activity, alcohol and snuff) and development of CRC was identified by using a multivariate logistic regression and adjusting the model for demographic, socioeconomic and clinical covariates. Results: In the multivariate analysis, it was identified that the daily consumption of alcohol and daily cigarette smoking was a statistically significant association with the development of CRC. People with a high intake of alcohol (adjusted OR = 5.8 95% CI 1.3 to 26.7) and severe cigarette consumption (adjusted OR = 9.1 95% CI 1.7 to 70) are more likely to develop CRC than the individuals who do not drink or smoke respectively. Conclusions: The findings suggest a need to promote awareness campaigns that show the risk of developing CRC caused by improper lifestyle habits such as alcohol and snuff to the population of the municipality of Pasto.

Effect of Helicobacter pylori infection on growth velocity of school-age Andean children.

BACKGROUND: Helicobacter pylori infection affects about half of the world's population and is usually acquired in childhood. The infection has been associated with chronic gastritis, peptic ulcer, and stomach cancer in adulthood. Little is known, however, about its consequences on child health. We examined the effect of H. pylori infection on growth among school-age children in the Colombian Andes by comparing growth velocity in the presence and absence of H. pylori infection. METHODS: Children who were 4-8 years old in 2004 were followed up in a community where infected children received anti-H. pylori treatment (n = 165) and a comparison community (n = 161) for a mean of 2.5 years. Anthropometry measurements were made every 3 months and H. pylori status ascertained by urea breath test every 6 months. Growth velocities (cm/month) were compared across person-time with and without infection, using mixed models for repeated measures. RESULTS: In the untreated community, 83% were H. pylori-positive at baseline and 89% were -positive at study end. The corresponding prevalences were 74% and 46%, respectively, in the treated community. Growth velocity in the pretreatment interval was 0.44 (standard deviation [SD] = 0.13) cm/month. Models that adjusted for age, sex, and height estimated that H. pylori-positive children grew on average 0.022 cm/month (95% confidence interval = 0.008 to 0.035) slower than H. pylori-negative children, a result that was not appreciably altered by adjustment for socioenvironmental covariates. CONCLUSIONS: This study suggests that chronic H. pylori infection is accompanied by slowed growth in school-age Andean children.

Effect of smoking on failure of H. pylori therapy and gastric histology in a high gastric cancer risk area of Colombia.

It has been proposed that eradication of Helicobacter pylori infection is a sound strategy for gastric cancer prevention. Several factors including smoking have been associated to treatment failure rates. This study aimed to evaluate the smoking effect on the efficacy of H. pylori therapy, as well as on the histological parameters in the gastric mucosa from subjects from a high gastric cancer risk area. Two-hundred-sixty-four Colombian subjects with gastric precancerous lesions who participated in a chemoprevention trial, received anti-H. pylori treatment at baseline and had data recorded on cigarette use, were included in this study. A detailed histopathological assessment of the gastric mucosa was performed in biopsies taken before any intervention. H. pylori eradication was assessed in gastric biopsies at 36 months post-treatment. The overall eradication rate was 52.3%; rates of 41.3% and 57.1% were observed for active-smokers and non-smokers, respectively. Multivariate logistic regression analysis showed that smokers had a 2-fold higher probability of failure in Helicobacter pylori eradication than non-smokers (OR: 2.0; 95% CI: 1.01-3.95). At baseline, active-smokers had a higher score of intestinal metaplasia compared to non-smokers. In the corpus mucosa, active-smokers showed lower scores of H. pylori density, total inflammation, neutrophil infiltration, and mucus depletion than non-smokers. In the antrum, no significant differences were observed between active-smokers and non-smokers. In summary, in patients who smoked, H. pylori treatment was less effective. Smoking cessation may benefit H. pylori eradication rates.

Effect of smoking on failure of H. pylori therapy and gastric histology in a high gastric cancer risk area of Colombia / Efecto del tabaquismo en la falla al tratamiento anti-H. pylori y en la histología gástrica en una zona de alto riesgo de cáncer gástrico en Colombia

It has been proposed that eradication of Helicobacter pylori infection is a sound strategy for gastric cancer prevention. Several factors including smoking have been associated to treatment failure rates. This study aimed to evaluate the smoking effect on the efficacy of H. pylori therapy, as well as on the histological parameters in the gastric mucosa from subjects from a high gastric cancer risk area. Two-hundred-sixty-four Colombian subjects with gastric precancerous lesions who participated in a chemoprevention trial, received anti- H. pylori treatment at baseline and had data recorded on cigarette use, were included in this study. A detailed histopathological assessment of the gastric mucosa was performed in biopsies taken before any intervention. H. pylori eradication was assessed in gastric biopsies at 36 months post-treatment. The overall eradication rate was 52.3%; rates of 41.3% and 57.1% were observed for active-smokers and non-smokers, respectively. Multivariate logistic regression analysis showed that smokers had a 2-fold higher probability of failure in Helicobacter pylori eradication than non-smokers (OR: 2.0; 95% CI: 1.01-3.95). At baseline, activesmokers had a higher score of intestinal metaplasia compared to non-smokers. In the corpus mucosa, active-smokers showed lower scores of H. pylori density, total inflammation, neutrophil infiltration, and mucus depletion than non-smokers. In the antrum, no significant differences were observed between active-smokers and non-smokers. In summary, in patients who smoked, H. pylori treatment was less effective. Smoking cessation may benefit H. pylori eradication rates.

La erradicación del Helicobacter pylori ha sido propuesta como medida promisoria en la prevención del cáncer gástrico. Varios factores, incluyendo el tabaquismo, se asocian con la falla del tratamiento. El objetivo de este estudio fue evaluar el efecto del tabaquismo en la eficacia del tratamiento anti-H. pylori y en la histología gástrica en residentes de una zona de alto riesgo de cáncer gástrico. Este estudio incluyó 264 sujetos colombianos con lesiones gástricas preneoplásicas que participaron en un estudio de quimioprevención, recibieron tratamiento anti-H. pylori al ingreso, y proveyeron información sobre tabaquismo. Se realizó un detallado análisis histopatológico en las biopsias colectadas al ingreso. La erradicación de la infección fue evaluada en las biopsias gástricas a los 36 meses post-tratamiento. El porcentaje general de erradicación fue de 52.3%, con proporciones de 41.3% y 57.1% en fumadores activos y no fumadores, respectivamente. El análisis de regresión logística múltiple mostró que el riesgo de presentar falla al tratamiento fue doble en fumadores en comparación con los no fumadores (OR: 2.0; 95% CI: 1.01-3.95). Los fumadores presentaron un mayor índice de metaplasia intestinal comparado con los no fumadores. En la mucosa del cuerpo gástrico los fumadores mostraron menores índices de colonización por H. pylori, inflamación total, infiltración de neutrófilos y depleción de moco que los no fumadores. En el antro no se observaron diferencias significacomtivas entre ambos grupos. En conclusión, el tratamiento anti-H. pylori fue menos efectivo en sujetos fumadores. La cesación del consumo de tabaco puede beneficiar las tasas de erradicación del H. pylori.

Age at acquisition of Helicobacter pylori infection: comparison of two areas with contrasting risk of gastric cancer.

BACKGROUND: Helicobacter pylori infection is usually acquired during childhood and is a known risk factor for the development of gastric malignancies in adulthood. It has been reported that early age at first infection may determine a neoplastic outcome in adults. The purpose of this study was to determine the prevalence of Helicobacter pylori infection in children residing in areas with high (Pasto) and low risk (Tumaco) of gastric cancer in Colombia to evaluate whether differences in the age of acquisition of H. pylori infection were present in the two populations. MATERIALS AND METHODS: The study sample was based on a census taken in 1999. Using the (13)C-urea breath test, we compared the prevalence of H. pylori infection among children aged 1-6 years. RESULTS: Among 345 children in Pasto, 206 (59.7%) were H. pylori-positive, compared with 188 (58.6%) among 321 children in Tumaco. The two populations share a common pattern of very early age at infection and marked increase in prevalence during the first 4 years of life. No differences in any one year were observed when comparing the two groups. CONCLUSIONS: The prevalence of infection was similarly high and increased with age in both populations. In these populations the age of acquisition of H. pylori after 1 year of age does not appear to be a primary factor responsible for the differences in the rates of gastric cancer incidence in adults. Previous findings in adults showed lower prevalence of the most virulent genotypes in Tumaco compared to Pasto, and bacterial virulence may play a key role in determining cancer outcome.