title: Chronic hepatitis C as a risk factor for colorectal adenoma.
abstract: BACKGROUND
  Over the last decade, epidemiologic studies have determined a relationship between chronic hepatitis C (CHC) and malignancies other than hepatocellular carcinoma (HCC), particularly in gastrointestinal malignancies. This study aims to evaluate the incidence of colorectal adenomas and advanced neoplasia in CHC patients compared to the general population and to evaluate whether CHC infection is an independent risk factor for colorectal adenomas and advanced neoplasia.
  
  
  METHODS
  This is a retrospective, case-control study. CHC patients who underwent screening colonoscopy between September 2006 and September 2010 were compared to randomly selected non-hepatitis C controls undergoing screening colonoscopy during the same period. Multivariate analysis was performed taking into account the known risk factors for colorectal adenoma.
  
  
  RESULTS
  Two hundred thirty-three CHC patients and 466 controls that underwent screening colonoscopy were included in the study. CHC patients were younger and more likely to be male, smoker and have HIV infection compared to the control group (p < 0.05). CHC group had a significantly higher number of patients with adenomas (adenoma detection rate of 37.8 vs. 30.3 %; p = 0.04) and hyperplastic polyps (p = 0.01) detected on screening colonoscopy. The total number of adenomas detected was also higher in the CHC group; however, this was not statistically significant (0.69 vs. 0.58 per patient; p > 0.05). CHC patients were twice more likely to have advanced neoplasia detected compared to non-hepatitis C patients (odds ratio 2.04, 95 % confidence interval = 1.20-3.49; p = 0.03). CHC group was also more likely to have adenomas of ≥6 mm (p = 0.005) and macroadenomas of ≥1 cm (p = 0.02).
  
  
  CONCLUSIONS
  Limitations include the single-center, retrospective design of the study.
  
  
  CONCLUSIONS
  Our study is the first to demonstrate a significantly higher rate of adenomas, advanced neoplasia, and hyperplastic polyps in CHC patients compared to the general population. On multivariate analysis, CHC infection was found to be an independent risk factor for colorectal adenoma, particularly advanced neoplasia. Larger prospective studies are needed to strengthen our findings which may have implications for colorectal cancer screening.
authors: Section of Digestive Diseases, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA, tarun.rustagi@yale.edu.
authors: Tarun
authors: T
authors: Rustagi
authors: Emily Idel
authors: EI
authors: Zarookian
authors: Omesh
authors: O
authors: Qasba
authors: Luis F
authors: LF
authors: Diez
mesh_terms: D000236:Adenoma / Q000453:epidemiology* / Q000209:etiology*; D000328:Adult; D016022:Case-Control Studies; D003111:Colonic Polyps / Q000175:diagnosis / Q000453:epidemiology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D055088:Early Detection of Cancer; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
references: Hepatology. 2004 Apr;39(4):999-1007
references: 15057904
references: Oncogene. 2006 Jun 26;25(27):3834-47
references: 16799625
references: Clin Gastroenterol Hepatol. 2011 Feb;9(2):168-74
references: 21029788
references: J Clin Gastroenterol. 2007 Mar;41(3):229-30
references: 17426458
references: Gastroenterology. 2004 Nov;127(5 Suppl 1):S35-50
references: 15508101
references: Cancer Res. 1997 Nov 1;57(21):4787-94
references: 9354440
references: Br J Cancer. 2009 Jun 2;100(11):1765-70
references: 19436294
references: Am J Epidemiol. 2009 Oct 1;170(7):863-72
references: 19723749
references: Hepatology. 1993 Dec;18(6):1293-9
references: 8244252
references: Cancer Sci. 2004 Jul;95(7):592-5
references: 15245596
references: Cancer Epidemiol Biomarkers Prev. 2009 Apr;18(4):1239-42
references: 19336553
references: Am J Gastroenterol. 2002 Nov;97(11):2886-95
references: 12425564
references: Ann Intern Med. 2000 Feb 15;132(4):296-305
references: 10681285
references: Arch Intern Med. 2006 Aug 14-28;166(15):1626-31
references: 16908796
references: Ann Intern Med. 1992 Jan 15;116(2):97-102
references: 1309286
references: Clin Exp Rheumatol. 2003 Nov-Dec;21(6 Suppl 32):S78-84
references: 14740431
references: Am J Gastroenterol. 2005 Mar;100(3):515-23; discussion 514
references: 15743345
references: Ann Intern Med. 1995 Oct 15;123(8):615-20
references: 7677303
references: Br J Cancer. 2010 Jun 29;103(1):120-6
references: 20531412
references: Nat Med. 1998 Sep;4(9):1065-7
references: 9734402
references: Am J Gastroenterol. 2009 Mar;104(3):739-50
references: 19240699
references: Am J Hematol. 2001 Jul;67(3):168-71
references: 11391713
references: Br J Haematol. 1994 Oct;88(2):392-4
references: 7803287
references: Am J Gastroenterol. 1994 Feb;89(2):254-6
references: 8304313
references: CA Cancer J Clin. 2010 Sep-Oct;60(5):277-300
references: 20610543
references: Ann Intern Med. 2008 May 20;148(10):728-36
references: 18490686
references: Clin Gastroenterol Hepatol. 2008 Apr;6(4):451-8
references: 18387498
references: Eur J Cancer. 2010 Jul;46(10):1866-72
references: 20395126
references: Ann Intern Med. 2006 May 16;144(10):705-14
references: 16702586
references: J Virol. 1997 Jan;71(1):479-86
references: 8985374
references: Gastroenterology. 2008 Feb;134(2):388-95
references: 18242207
references: Hepatology. 2009 Jan;49(1):116-23
references: 19085911
references: Gut. 2009 Aug;58(8):1129-34
references: 19293177