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Alcohol intake and oesophageal cancer
Oesophageal squamous cell cancer (OSCC), oesophageal adenocarcinoma (OA) and oesophago-gastric junction adenocarcinoma (OGJA) are leading causes of death worldwide. While alcohol is an established cause of OSCC, its relationship to the other two subtypes is still unclear. In this landmark multi-national study, Freedman et al provide definitive answers. Pooling data from nine case control studies and two cohort studies of the Barrett's Oesophagus and Oesophageal Adenocarcinoma Consortium (BEACON), they were able to examine 1016 OSCC, 1821 OA, 1837 OGJA cases and 10 854 controls. Heavy alcohol consumption (seven or more drinks per day) was not associated with increased risk of OA or OGJA. Modest alcohol consumption appeared to be associated with reduced risk for both types of cancer. In contrast, alcohol intake was strongly associated with increased risk of OSCC (OR for ≥7 drinks per day 9.62, 95% CI 4.26 to 21.71). The findings highlight the difference in aetiology between the subtypes of oesophageal cancer and will aid clinicians in offering appropriate advice about the causes of cancer to their patients (see page 1029).
Targeting MAdCAM in ulcerative colitis
Biological therapy has transformed management of IBD but more strategies are still needed. Homing of leucocytes to the gut mucosa is a promising target for therapeutic intervention in IBD shown by studies with the α4-integrin antibody natalizumab. However, natalizumab has a risk of progressive multifocal leucoencephalopathy. To avoid this, more selective strategies targeting the α4β7/MAdCAM pathway in the gut would retain the efficacy of natalizumab but offer a better safety profile. In …
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