Korean Journal of Family Medicine

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Original Article

Use of Proton Pump Inhibitor and Risk of Colorectal Cancer: A Meta-analysis of Observational Studies: Jeong Soo Ahn, Sang Min Park, Chun Sick Eom, Sarah Kim, Seung-Kwon Myung; Korean J Fam Med 2012;33(5):272-279. Published online September 27, 2012; DOI: https://doi.org/10.4082/kjfm.2012.33.5.272

Abstract
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Background

Previous case-control studies have reported inconsistent findings regarding the association between proton pump inhibitor (PPI) use and colorectal cancer (CRC) risk. We investigated these associations using meta-analysis.

Methods

We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library in April 2011. Two evaluators independently reviewed and selected articles, based on pre-determined selection criteria.

Results

Out of 737 articles meeting our initial criteria, 5 case-control studies, which involved 120,091 participants (9,514 cases and 110,577 controls), were included in the final analyses. The overall use of PPI (used vs. never or rarely used) was not significantly associated with the risk of CRC in a fixed-effects model meta-analysis of all 5 case-control studies (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.96 to 1.20; I² = 3.5%). Also, in sensitivity meta-analysis by cumulative duration of PPI use, there was no association between PPI use of 1 year or longer and the risk of colorectal cancer in a fixed-effects meta-analysis (OR, 1.09; 95% CI, 0.98 to 1.22; I² = 0%).

Conclusion

Although hypergastrinemia could be an important factor in the pathogenesis of some colorectal cancers, our study suggests that this does not lead to significant clinical risk for most PPI users. Further prospective studies or randomized controlled trials related to PPI use and colorectal cancer risk are needed to investigate this association.

Citations

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Knowledge, Attitudes, and Practices of Community Pharmacists Regarding Proton Pump Inhibitor (PPI) Use: A Cross-Sectional Study
Hebatallah Ahmed Mohamed Moustafa, Ahmad Z. Al Meslamani, Hazem Mohamed Metwaly Elsayed Ahmed, Salma Ahmed Farouk Ahmed, Nada Ehab Shahin Sallam, Ghadah H. Alshehri, Nawal Alsubaie, Amira B. Kassem
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Proton Pump Inhibitors and Likelihood of Colorectal Cancer in the Korean Population: Insights from a Nested Case–Control Study Using National Health Insurance Data
Mi Jung Kwon, Kyeong Min Han, Joo-Hee Kim, Ji Hee Kim, Min-Jeong Kim, Nan Young Kim, Hyo Geun Choi, Ho Suk Kang
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PLOS ONE.2018; 13(9): e0203918. CrossRef
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Brief Communication

Changes in Skin Color after Smoking Cessation: Young Hye Cho, Dong Wook Jeong, Sang Hee Seo, Sang Yeoup Lee, Eun Jung Choi, Yun Jin Kim, Jeong Gyu Lee, Yu-Hyun Lee, Mi Jin Bae, Hyun Woo Chin; Korean J Fam Med 2012;33(2):105-109. Published online March 30, 2012; DOI: https://doi.org/10.4082/kjfm.2012.33.2.105

Abstract
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This study was performed to assess changes in skin color over 1 month after smoking cessation. The study population consisted of 49 men who participated in a smoking cessation program from March 2010 to June 2010 at a public health centre in Yangsan, South Korea. Thirty-four men who stop smoking completely were included in our study. Instrumental evaluations of skin color were performed using Mexameter (MX 18; Courage and Khazaka Electronic GmbH) at the beginning of the study and at 1-week and 4-week follow-up visits. Skin color was evaluated by measurement of 2 main color bases-melanin and haemoglobin-with the results expressed as melanin index (MI) and erythema index (EI). Both MI and EI were significantly reduced at the 4-week follow-up visit on all 7 sites measured. We anticipate that desirable effects on skin color after smoking cessation will play a positive role in maintaining smoking abstinence in routine clinical practice.

Citations

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Melanin levels in relation to vitamin D among first-generation immigrants from different ethnic groups and origins: A comparative national Canadian cross-sectional study
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Frontiers in Medicine.2023;[Epub] CrossRef
Promoting New Approach Methodologies (NAMs) for research on skin color changes in response to environmental stress factors: tobacco and air pollution
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Frontiers in Toxicology.2023;[Epub] CrossRef
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Original Articles

Dietary Intake of Calcium and Distal Colorectal Adenomatous Polyps in Korean Adults.: Ji Young Son, Siwon Hur, Jong Jin Kim, Hyuk Tae Kwon, Be Long Cho; Korean J Fam Med 2009;30(2):106-111. Published online February 10, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.2.106

Abstract
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Background
Colorectal cancer has the fourth prevalence of carcinoma and the fourth cause of death from malignant neoplasm, which has been increasing in Korea. In this study, we tried to investigate the association of dietary intake of calcium anddistal colorectal adenomatous polyps known as precursors of colorectal cancer. Methods: 2,456subjects who visited Health Promotion Center in one university Hospital in Seoul Korea from June 2003 to June 2006 got sigmoidoscopy and completed 24-hour dietary recall. Results: Among the selected 2,408 subjects, the prevalence of distal colorectal adenoma found in sigmoidoscopy was 12.54%. After adjusting for age, and total serum cholesterol by multiple logistic regression, the odds ratio of the male subjects who have the highest quintile of dietary intake of calcium was 0.512 (95% CI: 0.305-0.859 P = 0.011) compared with the lowest. Conclusion: In male subjects, highest quintile of dietary calcium density was associated with the low risk of distal colorectal adenomatous polyps.

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The Association between Distal Colon Adenoma and the Metabolic Syndrome and Lifestyle Factors in Male Examinees in a University Hospital.: Moon Chan Kim, Chang Sup Kim, Deuk Kee Lee, Tae Heum Jeong; J Korean Acad Fam Med 2008;29(3):195-200. Published online March 10, 2008

Abstract
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Background
According to previous epidemiologic studies, the metabolic syndrome, dietary and lifestyle factors were associated with colon polyps. The aim of this cross-sectional study was to assess the relationship between the risk of the colorectal adenoma incidence and the individual components of the metabolic syndrome with lifestyle factors such as drinking, cigarette smoking and physical activity. Methods: Sigmoidoscopic examination for colon cancer screening was performed from January 2002 to December 2003 at the Health Promotion Center of Ulsan University Hospital in Ulsan, Korea. A total of 1,565 subjects underwent satisfactory sigmoidoscopy. The subjects with a history of colon cancer or polyps or inflammatory bowel disease were excluded from the study. Alcohol consumption, cigarette smoking and other confounding factors were included as covariates in the models. Results: After adjusting for age, physical activity, smoking and alcohol intake, the subjects of metabolic syndrome (≥3 vs. 0 components) combined with cigarette smoking had a positive association with colorectal adenoma incidence (OR 3.63, 95% CI 1.49∼8.89). Physical activity was negatively associated the risk of the colorectal adenoma incidence (OR 0.60 95% CI 0.44∼0.81). Conclusion: These results suggest that clustering of components of the metabolic syndrome combined with cigarette smoking significantly increased the colorectal adenoma risk, but physical activity reduced the risk of colorectal adenoma incidence in Korean adult males after multivariate adjustment. (J Korean Acad Fam Med 2008; 29:195-200)

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Relationship between the Metabolic Syndrome and Colorectal Polyps.: Jae Hun Ju, Tae Kyun Lim, Kyung Kyun Shin, Ki Heon Park, Kyung Chae Park, Moon Jong Kim, Young Jin Lee; J Korean Acad Fam Med 2007;28(2):134-140. Published online February 10, 2007

Abstract
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Background
With increased prevalence of colorectal cancer, it is important to establish the risk factors of colorectal cancer. The prevalence of the metabolic syndrome (MS) is also increasing. Insulin resistance may play an important role in the pathogenesis of MS and colorectal polyps. The aim of this study was to assess the relationship between MS and colorectal polyps. Methods: A total 558 subjects underwent colonoscopic examination from April 2004 to July 2005 at the health promotion center of Bundang CHA Hospital. According to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III definition of MS, the waist circumference, blood pressure (BP), fasting blood glucose (FBG), triglyceride (TG) and HDL cholesterol were measured. Alcohol consumption, smoking and other confounding factors were assessed by a self-administered questionnaire. Results: The incidence of MS and colorectal polyps was 16.3% and 33.0%, respectively. In subjects with polyps, the number of men, smokers and drinkers were higher than in subjects without polyps. In subjects with polyps, BP, FBG and TG were also higher than in subjects without polyps. After adjustment for possible confounding factors, MS was associated with increased risk of colorectal polyps (odds ratio, 1.74; 95% confidence interval, 0.94∼3.22). MS strongly increased the risk of colorectal polyps in men (odds ratio 2.19; 95% confidence interval, 1.07∼4.45), but not in women. Conclusion: We concluded that MS is a risk factor for colorectal polyps in asymptomatic Korean adults and this suggests that insulin resistance may play an important role in the development of colorectal polyps. (J Korean Acad Fam Med 2007;28:134-140)

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Colorectal Cancer Screening Recommendations by Primary Care Physicians' in Seoul.: Eun Jung Lee, Eun Ju Sung, Ho Cheol Shin, Yong Woo Park, Cheol Hwan Kim, Soo Youn Kim; J Korean Acad Fam Med 2007;28(1):17-23. Published online January 10, 2007

Abstract
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Background
: Regular colorectal cancer (CRC) screening is known to reduce the CRC incidence and mortality. Health care providers can play a key role in recommending screening to healthy people. However, data on providers' CRC screening knowledge, attitude, and practice are sparse in Korea. We investigated primary care physicians' perception and performance of practice guidelines for CRC screening recommendations, and their view of barriers to physicians' adherence to guidelines.

Methods : A questionnaire was administered to 760 primary care physicians of internal medicine, general surgery, and family medicine in Seoul, Korea. The data were collected from March 2 to April 30, 2004, and those of 106 respondents (response rate 14%) were analyzed.

Results : Forty seven percent of respondents reported they recommended CRC screening. The most common screening test equipment in primary care settings was the fecal occults blood test (22.6%) followed by sigmoidoscopy (16.0%), colonoscopy (16.0%), and double contrast barium enema (10.4%). However, colonoscopy was recommended the most as a CRC screening method (54%) and only 43% of respondents complied with the interval indicated on the guidelines. Awareness (64.8%) and agreement (93.2%) to CRC screening recommendation by primary care physicians in Seoul, Korea was high, but the screening delivery was suboptimal. Many primary care physicians regarded patient-related factors were more important barriers of CRC screening than environment-related factors.

Conclusion : There were many barriers to physicians' guideline adherence. It may be useful to develop and improve guidelines in considerationt these barriers to establish appropriate cancer screening.

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Prevalence and Risk Factors for Adenomatous Polyp in Koreans (A Cross-sectional Study).: Moon Chan Kim, Chang Sup Kim, Tae Heum Jeong, Young Sik Kim; J Korean Acad Fam Med 2006;27(7):549-555. Published online July 10, 2006

Abstract
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Background
: According to previous epidemiologic studies, dietary and life style factors were associated with colon polyps. Despite the high prevalence of colon polyps, little is known about its risk factors in Korean adults. The aim of this cross-sectional study was to assess the relationship between alcohol consumption, smoking, obesity, physical activity and the presence of colorectal polyps.

Methods : Sigmoidoscopic examinations for colon cancer screening were performed from January 2002 to December 2003 at the Health Promotion Center of Ulsan University Hospital. Alcohol consumption, smoking and other confounding factors were assessed by self-administered questionnaire.

Results : After adjusting for age, physical activity, obesity, total fat and total energy intake, current smokers who had smoked more than 21 pack-years were at significantly higher risk of adenomatous polyps compared to non-smokers (OR 2.56, 95% CI 1.30∼5.01). Alcohol consumption was positively associated with risk of adenomatous polyps compared to non-drinkers (OR 1.48, 95% CI 1.03∼2.13). Physical activity was negatively associated with risk of distal colon polyps.

Conclusion : These results suggest that alcohol consumption, cigarette smoking, and obesity were positively associated with risk of colorectal polyps and physical activity was negatively associated in Korean adult males.

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The Effect of Physical Activity on Colorectal Polyps.: Moon Chan Kim, Chang Sup Kim, Tae Heum Jeong; J Korean Acad Fam Med 2005;26(7):391-396. Published online July 10, 2005

Abstract
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Background
: The results of previous epidemiologic studies showed that dietary and life style factors are associated with colon polyps. Despite the high prevalence of colon polyps, little is known about its risk factors in Korean adults. The aim of this study was to assess the relationship between physical activity and the presence of colorectal polyps.

Methods : In 859 subjects, rectosigmoidoscopy was performed at Ulsan University Hospital Health Promotion Center from January 2002 to October 2002. Drinking, smoking and other confounding factors were assessed by self-administered questionnaire in 161 subjects with colon polyps and 698 controls.

Results : Among the total of 859 cases the prevalence of colorectal adenomatous polyps was 18.7%. After adjusting for age, sex, physical activity, obesity, calcium and total energy intake, using multiple logistic regression, decreasing risk of colorectal polyps were observed with increasing level of physical activities. The odds ratio for 3 to 4 hours per week exercise group was 0.460 (CI=0.262∼0.809). The frequency and intensity of exercise also had an inverse association with colon polyps (4∼5 times/ week group: OR=0.428, CI=0.220∼0.832; vigorous exercise group: OR=0.454, CI=0.298∼0.693).

Conclusion : Physical activities were inversely associated with colorectal polyps in Korean adults.

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Cost-effectiveness Analysis of Colorectal Cancer Screening in Korean General Population.: Sang Min Park, Yoon Jung Chang, Young Ho Yun, Tai Woo Yoo, Bong Yul Huh, Soonman Kwon; J Korean Acad Fam Med 2004;25(4):297-306. Published online April 10, 2004

Abstract
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Background
: CRC is an ideal target for population screening because it is a prevalent disease with an identifiable precursor lesion. This study was performed for the purpose of comparing cost-effectiveness of CRC screening strategies.

Methods : The natural history of a simulated cohort of 50- year-old Koreans in the general population was modeled with and without CRC screening until age 80 years. We evaluated 16 different screening strategies with Markov model. Cases of positive screening test results were worked up with a colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Our main outcome measurements were discounted lifetime costs, life expectancy and incremental cost-effectiveness (CE) ratio, comparing 16 different CRC screening strategies.

Results : In base-case analysis, compliance was assumed to be 60% with the initial screen and 80% with follow-up or surveillance colonoscopy. The non-dominated strategies were colonoscopy every 10 years (COL10), colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). Strategies that only included sigmoidoscopy were generally not regarded as non-dominated strategies, but sigmoidoscopy every 5 years (SIG5) showed similar cost and effects as COL10 while sigmoidoscopy every 3 years (SIG3) had similar results as COL5. Other strategies recommended by the expert panel, such as sigmoidocopy plus colon study every 5 years were less cost-effective than the alternatives.

Conclusion : Colonoscopy is the most cost-effective strategy in Korea for colorectal cancer screening. Unfortunately, the number of physicians skilled enough to perform colonoscopy is not enough to meet the demands of screening for colorectal cancer in average-risk adults. Therefore, we consider alternative strategies such as SIG5 or SIG3.

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Risk Factors of Colorectal Polyps in Korean Adults.: Moon Chan Kim, Do Ha Kim, Tae Heum Jeong; J Korean Acad Fam Med 2002;23(7):890-896. Published online July 10, 2002

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The factors relates to the screening tests of colorectal cancer in men.: Yong Chul Kim, Ho Cheol Shin; J Korean Acad Fam Med 1999;20(1):34-42. Published online January 1, 1999

Abstract
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Background
: Cancer is the second leading cause of death in Korea. Colorectal cancers rank fourth in term of total cancer mortality. Colorectal cancers have been the focus of screening for early detection. Few current data are available regarding factors associated with participation in cancer screening examinations in the general population. This study investigated associations of age, income, education, marital status, smoking, drinking, sleeping, presence of a hemorrhoid, and attitudes toward cancer prevention with participation in three cancer screening tests for colorectal cancer.

Methods : To identify the factors associated with participation in cancer screening examinations, 2372 men in a certain company were surveyed in 1992. Cancer related questions were included to determine the attitudes toward cancer prevention and the history of tests performed that are used for screening for colorectal cancer.

Results : Statistically significant (P<0.05) strong predictors of ever having had a specific cancer screening test were as follow:(1) digital rectal examination: above 40 years old(OR=3.4, 95% CI 2.1-5.4), having a hemorrhoid(OR=2.9, 95% CI 1.7-5.0), and regular exercise(OR=2.1, 95% CI 1.2-3.5); (2) fecal occult blood: above 40 years old(OR=4.2, 95% CI 2.5-7.2) and (3) colonoscopy or sigmoidoscopy: above 40 years old(OR=3.5, 95% CI 2.4-5.2), married(OR=3.5, 95% CI 1.6-7.7), and heavy drinker(OR=1.8, 95% CI 1.2-2.7).

Conclusion : The largest differences among the population for participation in cancer screening examinations involved age. Education and encouragement may persuade men participate more in screening.