Journals Watch - Barrett's oesophagus and H1N1

Not had time to read the journals? Let Dr Sally Hope bring you up to date with the latest research.

Patients with Barrett’s oesophagus (above) had a higher risk of oesophageal adenocarcinoma (Photograph: SPL)
Patients with Barrett’s oesophagus (above) had a higher risk of oesophageal adenocarcinoma (Photograph: SPL)

Adenocarcinoma in patients with Barrett's oesophagus
N Engl J Med 2011; 365: 1375-83

This research looked at incidence of oesophageal adenocarcinoma and high-grade dysplasia in people with Barrett's oesophagus in Denmark. More than 11,000 patients were included.

Within one year there were 131 new adenocarcinomas, and 66 new adenocarcinomas in subsequent years. This is an incidence rate of only 1.2 adeno-carcinomas per 1,000 person-years.

However, the RR of patients developing adenocarcinoma who have Barrett's oesophagus was 11.3 compared with the risk of the general population, so they are indeed an 'at risk' group.

In patients with Barrett's oesophagus but without dysplasia the rate of adenocarcinoma was only one case per 1,000 patient-years. In patients with low-grade dysplasia the risk was five per 1,000 person-years, and even higher in the high-grade dysplasia group.

The authors concluded strategies for monitoring patients with Barrett's oesophagus should be improved.

Disorders after H1N1 vaccination
BMJ 2011; 343: d5956

This study looked at the risk of neurological and autoimmune disorders in people vaccinated with the H1N1 vaccine compared with non-vaccinated people. More than one million people in Stockholm were vaccinated (52.6 per cent of the study population).

This vaccine had novel adjuvants, containing squalene, to reduce the amount of antigen required and reinforce long-lasting immunological protection.

There was no change in the risk for Guillain-Barre syndrome, MS, type-1 diabetes or rheumatoid arthritis. RR was significantly increased for Bell's palsy, paraesthesia and inflammatory bowel disease after vaccination, predominantly in the early phase of the vaccination campaign.

However, high-risk patients with pre-existing neurological and autoimmune diseases were vaccinated in the early phase, so the data were skewed. People vaccinated after the first 45 days had no associations between vaccination and autoimmune and/or neurological sequelae.

Effect of wine on nitric oxide synthesis in endothelial cells
Maturitas 2011; 70: 169-75

This research looks at the non-alcoholic effects of wine polyphenolic components on endothelial cells. The researchers looked at human umbilical vein endothelial cells, and assayed different grape varieties' effects on nitric oxide synthase activity.

Nitric oxide is a powerful vasodilator and anti-inflammatory. The grapes tested induced nitric oxide activity, but pinot noir was the most powerful: equivalent doses of one to two glasses per day would work.

About 50 per cent of the activity of the polyphenols is via the estrogen receptors. The human cells responded with enhanced expression of endothelial nitric oxide synthase.

The conclusion is that a 'moderate' intake of wine might be a useful nutritional protective component in post-menopausal women.

Prevalence of chlamydial infection in backpackers
Int J STD AIDS 2011; 22(3): 160-4

A study of 432 backpackers in youth hotels in Sydney (87 per cent European, median age 23.5 years) gave a prevalence of chlamydia of 3.1 per cent in men and 3.9 per cent in women.

A new sexual partner while travelling was reported by 67 per cent, with more than half having more than one new partner. Only 40 per cent reported always using a condom, so clearly the 'safe sex' message does not always work.

Oral teriflunomide for relapsing MS
N Engl J Med 2011; 365: 1293-303

MS is one of many neurological diseases where little has happened despite all the increased immunological knowledge.

Teriflunomide is a new oral disease modifier that blocks pyrimidine synthesis thus reducing Tand B-cell proliferation with no cytotoxicity.

In a study of more than 1,000 patients over two years, people were given placebo or teriflunamide at two different doses (7mg and 14mg).

Teriflunomide reduced the relapse rate (0.54 for placebo versus 0.37 for teriflunomide at either dose), with relative risk reductions of 31.2 per cent and 31.5 per cent, respectively. This was also confirmed by MRI scanning evidence of disease. The rate of adverse serious infections was 2.5 % and side-effects included diarrhoea nausea hair thinning.

Flaxseed and breast cancer
J Clin Oncol 2011; 29: 3723-4

Dietary lignans have been identified as potentially protective against breast cancer via estrogen-dependent and independent anticarcinogenic activity. Lignans are bioactive, non-nutrient, noncaloric phenolic plant compounds that are found in large amounts in flaxseeds, sesame seeds and whole grains.

One half cup of whole wheatmeal is estimated to provide approximately 325 microgram of lignans and a half cup of flaxseed provides approximately 275,000 microgram.

Using the biomarker enterolactone, research has looked at breast cancer survivor outcomes in 1,140 postmenopausal women, and found that the highest quartile of enterolactone biomarkers are associated with a 40 per cent reduced risk of overall mortality.

In this very measured editorial the pitfalls of dietary supplements are discussed. The authors conclude that a prospective controlled trial is required before we can recommend flaxseed to our breast cancer patients.

  • Dr Hope is a GP in Woodstock, Oxfordshire, and a member of our team who regularly review the journals

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Look at the histological biopsies of all your patients with Barrett's oesophagus. If they do have dysplasia, check they are being recalled for regular endoscopies.
  • Consider doing an audit on patients with Bell's palsy and inflammatory bowel disease incidence by month and if they had a flu vaccine or not.
  • Review your protocols for travel clinics, to include advice on the perils of excess alcohol and unprotected sex.

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