Risk of cancer in patients with bile acid diarrhoea: a Danish nationwide matched cohort study
Objective Bile acid diarrhoea is a common cause of chronic diarrhoea. Increased levels of potentially carcinogenic bile acids in faeces, theoretically, may increase the risk of colorectal cancer in particular, but the long-term disease course is unknown. We aimed to investigate the overall and site-...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-04-01
|
| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/11/1/e001340.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1825206969654312960 |
|---|---|
| author | Tine Jess Nynne Nyboe Andersen Gry Poulsen Signe Wildt Lars Kristian Munck Aske Thorn Iversen Christian Borup |
| author_facet | Tine Jess Nynne Nyboe Andersen Gry Poulsen Signe Wildt Lars Kristian Munck Aske Thorn Iversen Christian Borup |
| author_sort | Tine Jess |
| collection | DOAJ |
| description | Objective Bile acid diarrhoea is a common cause of chronic diarrhoea. Increased levels of potentially carcinogenic bile acids in faeces, theoretically, may increase the risk of colorectal cancer in particular, but the long-term disease course is unknown. We aimed to investigate the overall and site-specific cancer risk in bile acid diarrhoea.Design Adult patients with bile acid diarrhoea were identified using nationwide Danish registries from 2003 to 2020 by a diagnostic gold-standard 75-selenium tauroselcholic acid procedure followed within 6 months by sequestrant prescription. The risk of overall and site-specific cancers in cases with bile acid diarrhoea was compared with sex, age and comorbidity-adjusted matched controls. A competing risk model estimated cumulative incidence functions and cause-specific HRs.Results We identified 2260 patients with bile acid diarrhoea with a mean follow-up of 5.5 years (SD 4.2). The overall cancer risk was increased by an HR of 1.32 (95% CI 1.12 to 1.54). The risk of site-specific cancer was increased in 3 of 10 cancer groups: haematological, HR 2.41 (1.36 to 4.02); skin, HR 1.33 (1.01 to 1.71); and male genital cancers, HR 1.85 (1.11 to 2.92). No increased risk of colorectal cancer was detected in patients with bile acid diarrhoea, HR 0.73 (0.34 to 1.63).Conclusions Bile acid diarrhoea was associated with an increased overall risk of cancer, especially haematological cancers, but the risk of colorectal cancer was not increased. The lack of a diagnostic code for bile acid diarrhoea and potential residual confounding are limitations, and the findings should be replicated in other cohorts. |
| format | Article |
| id | doaj-art-a6388eec66014d268a9876c8a2f0174c |
| institution | Kabale University |
| issn | 2054-4774 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-a6388eec66014d268a9876c8a2f0174c2025-02-07T01:00:11ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742024-04-0111110.1136/bmjgast-2023-001340Risk of cancer in patients with bile acid diarrhoea: a Danish nationwide matched cohort studyTine Jess0Nynne Nyboe Andersen1Gry Poulsen2Signe Wildt3Lars Kristian Munck4Aske Thorn Iversen5Christian Borup6Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, DenmarkDepartment of Gastroenterology, Zealand University Hospital Koge, Koge, DenmarkDepartment of Clinical Medicine, Aalborg University, Copenhagen, DenmarkDepartment of Gastroenterology and Hepatology, Hvidovre Hospital, Hvidovre, DenmarkDepartment of Gastroenterology, Zealand University Hospital Koge, Koge, DenmarkCenter for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Copenhagen, DenmarkDepartment of Gastroenterology, Zealand University Hospital Koge, Koge, DenmarkObjective Bile acid diarrhoea is a common cause of chronic diarrhoea. Increased levels of potentially carcinogenic bile acids in faeces, theoretically, may increase the risk of colorectal cancer in particular, but the long-term disease course is unknown. We aimed to investigate the overall and site-specific cancer risk in bile acid diarrhoea.Design Adult patients with bile acid diarrhoea were identified using nationwide Danish registries from 2003 to 2020 by a diagnostic gold-standard 75-selenium tauroselcholic acid procedure followed within 6 months by sequestrant prescription. The risk of overall and site-specific cancers in cases with bile acid diarrhoea was compared with sex, age and comorbidity-adjusted matched controls. A competing risk model estimated cumulative incidence functions and cause-specific HRs.Results We identified 2260 patients with bile acid diarrhoea with a mean follow-up of 5.5 years (SD 4.2). The overall cancer risk was increased by an HR of 1.32 (95% CI 1.12 to 1.54). The risk of site-specific cancer was increased in 3 of 10 cancer groups: haematological, HR 2.41 (1.36 to 4.02); skin, HR 1.33 (1.01 to 1.71); and male genital cancers, HR 1.85 (1.11 to 2.92). No increased risk of colorectal cancer was detected in patients with bile acid diarrhoea, HR 0.73 (0.34 to 1.63).Conclusions Bile acid diarrhoea was associated with an increased overall risk of cancer, especially haematological cancers, but the risk of colorectal cancer was not increased. The lack of a diagnostic code for bile acid diarrhoea and potential residual confounding are limitations, and the findings should be replicated in other cohorts.https://bmjopengastro.bmj.com/content/11/1/e001340.full |
| spellingShingle | Tine Jess Nynne Nyboe Andersen Gry Poulsen Signe Wildt Lars Kristian Munck Aske Thorn Iversen Christian Borup Risk of cancer in patients with bile acid diarrhoea: a Danish nationwide matched cohort study BMJ Open Gastroenterology |
| title | Risk of cancer in patients with bile acid diarrhoea: a Danish nationwide matched cohort study |
| title_full | Risk of cancer in patients with bile acid diarrhoea: a Danish nationwide matched cohort study |
| title_fullStr | Risk of cancer in patients with bile acid diarrhoea: a Danish nationwide matched cohort study |
| title_full_unstemmed | Risk of cancer in patients with bile acid diarrhoea: a Danish nationwide matched cohort study |
| title_short | Risk of cancer in patients with bile acid diarrhoea: a Danish nationwide matched cohort study |
| title_sort | risk of cancer in patients with bile acid diarrhoea a danish nationwide matched cohort study |
| url | https://bmjopengastro.bmj.com/content/11/1/e001340.full |
| work_keys_str_mv | AT tinejess riskofcancerinpatientswithbileaciddiarrhoeaadanishnationwidematchedcohortstudy AT nynnenyboeandersen riskofcancerinpatientswithbileaciddiarrhoeaadanishnationwidematchedcohortstudy AT grypoulsen riskofcancerinpatientswithbileaciddiarrhoeaadanishnationwidematchedcohortstudy AT signewildt riskofcancerinpatientswithbileaciddiarrhoeaadanishnationwidematchedcohortstudy AT larskristianmunck riskofcancerinpatientswithbileaciddiarrhoeaadanishnationwidematchedcohortstudy AT askethorniversen riskofcancerinpatientswithbileaciddiarrhoeaadanishnationwidematchedcohortstudy AT christianborup riskofcancerinpatientswithbileaciddiarrhoeaadanishnationwidematchedcohortstudy |