Nicholas Talley study

Saw a press brief sort of thing talking about a study by a Nicholas Talley called “Risk of Developing Colorectal Cancer and Benign Neoplasm in Patients with Chronic Constipation.”

Based on the results this interests me some, but I don't want to believe it without checking things out. Anyone actually seen this study published? PubMed doesn't have it indexed, the University of Newcastle doesn't list it on Talley's papers. The release comes from "The American College of Gastroenterology" from 2012. Anyone seen it in the flesh? There are some flags for "might not be quality" but there are other indications to where I would be interested in seeing it.

Here you go!

[Talley is the last author]

https://onlinelibrary.wiley.com/doi/abs/10.1111/apt.12789

Risk of developing colorectal cancer and benign colorectal neoplasm in patients with chronic constipation

A Guérin, R Mody, B Fok, KL Lasch… - Alimentary …, 2014 - Wiley Online Library

Background Chronic constipation (CC) is a highly prevalent health problem, potentially associated with increased risk of colorectal cancer (CRCancer). Aim To investigate the association between CC, its severity, and CRC ancer by estimating the relative risk of developing CRC ancer and benign colorectal neoplasm (BCN) among severity‐stratified patients with and without CC. Methods Chronic constipation patients from a large retrospective US claims database were matched 1: 3 with CC‐free controls by demographic …

https://www.ncbi.nlm.nih.gov/pubmed/24832002

Aliment Pharmacol Ther. 2014 Jul;40(1):83-92. doi: 10.1111/apt.12789. Epub 2014 May 15.

Risk of developing colorectal cancer and benign colorectal neoplasm in patients with chronic constipation.

Guérin A1, Mody R, Fok B, Lasch KL, Zhou Z, Wu EQ, Zhou W, Talley NJ.

Author information

1

Analysis Group, Inc., Boston, MA, USA.

Abstract

BACKGROUND:

Chronic constipation (CC) is a highly prevalent health problem, potentially associated with increased risk of colorectal cancer (CRCancer).

AIM:

To investigate the association between CC, its severity, and CRCancer by estimating the relative risk of developing CRCancer and benign colorectal neoplasm (BCN) among severity-stratified patients with and without CC.

METHODS:

Chronic constipation patients from a large retrospective US claims database were matched 1:3 with CC-free controls by demographic characteristics. CRCancer and BCN prevalence were measured over 1 year. In pre-index CRCancer- and BCN-free patients, incidence rate ratios (IRRs) of new CRCancer and BCN were calculated. Multivariate regression models adjusted for comorbidities and family history. CC patients' disease severity was rated based on CC-related resource use. IRRs for new CRCancer and BCN were estimated for CC severity groups and controls.

RESULTS:

Chronic constipation (N = 28,854) and CC-free (N = 86,562) patients had mean age 61.9 years; 66.7% were female. One-year CRCancer prevalence was 2.7% and 1.7%, and BCN prevalence was 24.8% and 11.9% for CC and CC-free patients, respectively. Adjusted IRRs between CC and CC-free patients were 1.59 [95% confidence interval (CI): 1.43-1.78] and 2.60 [95% CI: 1.51-2.70] for CRCancer and BCN, respectively. Patients with severe and very severe CC had significantly greater incidence of CRCancer and BCN. At ≥ 2 and ≥ 5 years of observation, CRCancer and BCN incidence remained consistently and significantly higher for CC patients.

CONCLUSIONS:

Patients with chronic constipation are associated with significantly higher prevalence and incidence of colorectal cancer and benign colorectal neoplasm than matched chronic constipation-free patients. These risks increase with the severity of chronic constipation.

Thanks, Susie! I'll run that down, though I have to say my BS detector edged up a bit higher... press releases going out two years before publication, quotes and interview from someone who was not a primary author... did find it posted on Talley's list of published works though.

I'll have to give my librarian a meaningful look for not finding it.

It could have been submitted two years before it was accepted for publication and maybe he was in a race with another group to see who could get it out first--even though it may only have been submitted for publication.

A lot of what is published is wrong or bullshit, so I would look for similar articles to confirm or refute those results.

If it IS a good study, and I agree that studies are only as good as the efficacy of the research behind them, then I think it adds some scientific backing to the practice of keeping our colons clean, and enemas do a great job of cleaning out a dirty colon. I like to keep mine squeaky clean!

If it IS a good study, and I agree that studies are only as good as the efficacy of the research behind them, then I think it adds some scientific backing to the practice of keeping our colons clean, and enemas do a great job of cleaning out a dirty colon. I like to keep mine squeaky clean!

That is a logical fallacy.

It does NOT necessarily follow that a constipated colon or one with a slow transport is more likely to cause cancer.

Besides, how clean is a "clean" colon? Also, the cells on the colon wall are new every three days.

Yeah, and its conclusions are noticeably different than accepted norms, and the posited mechanism (increased exposure to bile salts) is a bit iffy because bile is introduced and materials move through the colon on a somewhat consistent basis, so there are bile salts in contact with the mucosa whether or not you are constipated. Based on the article's hypothesis minimizing production of bile would seem to be a better goal then minimizing constipation.

Still haven't read it in its entirety yet. I will have to be aware of a bit of bias on my part to look for things that say "I don't have to worry," but I imagine that I will emerge from reading it not worrying too much. At least I hope so.

Susie - you were looking at the bright side. I saw the two year delay and immediately wondered if they had to shop it around to find a journal willing to print it.

Susie - you were looking at the bright side. I saw the two year delay and immediately wondered if they had to shop it around to find a journal willing to print it.

That's also a possibility but most medical journals require you submit an article ONLY to them because they don't want to go through reviewing it, making recommendations for changes and then have you decide to have another journal publish it.

Also, it costs the writers a lot of money (sometimes thousands of dollars) when an article is submitted for publication.

Depends on the magazine, but I fully agree that they're a scam.

Really, 1.78x the risk for colorectal cancer and 2.7x the risk for benign neoplasms seems a bit excessive. If that's the true number I'd be looking for confounding variables or examining how they got the sample.

Well... the numbers are not happy numbers, but it is a retrospective analysis and there is the likelihood of things such as, hmm, maybe a chunk of the subjects being constipated because they like to eat things such as cheeseburgers, milkshakes and fries.

More of a preliminary study really.

I still don't consider this study absolute proof, but upon reflection the logic of his hypothesis does come through. The predominance of polyps and cancers is in the sigmoid, where the stool backs up and would be "stronger" because it is dewatered. My error was looking at it as a constant exposure system.

Still don't necessarily want it to be true (if it is it's another mark in favor of "you're screwed"), but...

You will find this interesting

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412677/

Interesting, even though I've only read the abstract/intro and discussion. I wonder about their hormone hypothesis vs something such as women in our culture being pressured to look a certain way might tend to watch what they eat and exercise more than men. Have zero supporting evidence for that possibility, though - similar to the possibility that Talley's sample was constipated because of poor diet.

It's a likely yes on the hormone hypothesis. Several good studies, including one on hormone replacement therapy, show a reduced risk of CRC and delayed onset. Good news for the ladies out there.

Most guys have to stick with diet and exercise