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They identified 7,625 patients who had a follow-up biopsy between 6 months and 5 years after having had an initial diagnostic biopsy. Almost two-thirds were women, and the median age at the time of diagnosis was 25. A total of 43% had evidence of ongoing villous atrophy on the second biopsy. During a median follow-up time of 9 years after the second biopsy, 53 patients (0.7%) were diagnosed with a lymphoproliferative malignancy. The incidence in the overall group was 67.9 per 100,000 patient-years. In contrast, the incidence in those with ongoing villous atrophy was 102.4 per 100,000, the researchers reported. Multivariate analysis adjusting for age, sex, education, and duration of disease found a hazard ratio for lymphoproliferative malignancy of 2.26 (95% CI 1.18-4.34) among those with ongoing mucosal disease compared with those who had healing of the intestinal mucosa. Among these patients with persistent villous atrophy, the higher risk was most prominent during the first 12 months after the follow-up biopsy, with a hazard ratio of 3.67 (95% CI 0.80-16.86), decreasing to 1.99 (95% CI 0.79-4.97) after 5 years. “In some patients, persistent villous atrophy may reflect a gradual healing process, and a future biopsy may show mucosal healing,” the researchers explained. Specific subtypes of disease that were associated with higher risk when villous atrophy persisted were non-Hodgkin’s lymphoma (HR 2.82, 95% CI 1.29-6.17, P=0.009) and unspecified non-Hodgkin’s lymphoma (HR 4.31, 95% CI 1.27-14.61, P=0.019). There also was an increase in risk, although nonsignificant, for T-cell lymphoma (HR 3.51, 95% CI 0.75-16.34, P=0.110).
“Inflammation, Autophagy and Obesity Common Features in the Pathogenesis of Pancreatitis and Pancreatic Cancer” by Ilya Gukovsky, Ning Li, Jelena Todoric, Anna Gukovskaya and Michael Karin. “A Starring Role for Stellate Cells in the Pancreatic Cancer Microenvironment” by Minoti Apte, Jeremy Wilson, Aurelia Lugea and Stephen Pandol. “Roles for KRAS in Pancreatic Tumor Development and Progression” by Marina Pasca di Magliano and Craig Logsdon. “Role of Immune Cells and Immune-Based Therapies in Pancreatitis and Pancreatic Ductal Adenocarcinoma” by Lei Zheng, Jing Xue, Elizabeth Jaffee and Aida Habtezion. “Biology and Clinical Applications of Pancreatic Cancer Stem Cells” by Ethan Abel and Diane Simeone. B. Disease and Therapy of Pancreatic Disorder “A Historical Perspective on Clinical Advances in Pancreatic Diseases” by Anil Rustgi. Listen to related podcast “The Epidemiology of Pancreatitis and Pancreatic Cancer” by Dhiraj Yadav and Albert Lowenfels. “Technologies for Imaging the Normal and Diseased Pancreas” by Greg Cote, Jeffrey Smith, Stuart Sherman and Kimberly Kelly. “Clinical Management of Patients with Acute Pancreatitis” by Bechien Wu and Peter Banks “Management of Chronic Pancreatitis” by Chris Forsmark. “Genetic Risk Factors for Pancreatic Disorders” by David Whitcomb. “Pancreatic Cystic Neoplasms: Management and Unanswered Questions” by James Farrell and Carlos Fernandez del-Castillo. “Therapeutic Advances in Pancreatic Cancer” by Andrew Scott Paulson, Hop Tran Cao, Margaret Tempero and Andrew Lowy. “We believe that this 13th issue will inspire our readers not only by knowledge transfer, but also in ways that lead to new discoveries and therapies to improve the lives of patients afflicted with pancreatic disorders,” stated Dr. Pandol from Cedars-Sinai Medical Center and the Department of Veterans Affairs in Los Angeles, CA.