Background: Lactose intolerance (LI) appears usually in later ages when the lactase enzyme becomes deficient or absent in the small intestine. Conflicting results have been reported in the literature about the association of lactose intolerance with various gastrointestinal malignancies. Hence, our aim was to study the association between LI, colon cancer (CCa), and gastric cancer (GC) using a large database. Methods: A cross-sectional study was performed using the National Inpatient Sample (NIS) database between 2004 and 2014. We identified adult patients (18-90 years) who were diagnosed with LI (study group) using appropriate International Classification of Diseases, Ninth Revision (ICD-9) codes. The control group comprised patients who did not have a diagnosis of LI. We identified the diagnosis of CCa and GC in both study and control groups using the ICD-9 codes. Univariable and multivariable logistic regression analyses were performed to assess the association between LI, CCa, and GC. Results: The total population comprised 71,360,501 patients, of which 57,909 (0.08%) were diagnosed with LI. LI patients were older (62 vs 51 years) with more females (61.5% vs 60.1%) and less African American patients (11.8% vs 14.3%) (p <0.0001 for all). In addition, LI patients had more smoking (12.4% vs 12%) and obesity (15% vs 8.9%). On the other hand, patients in the LI group had less alcohol use (3.8% vs 4.2%) (p <0.0001). After adjusting for the age, gender, race, smoking, alcohol, obesity, and inflammatory bowel disease, the LI group had a slightly lower rate of CCa (OR 0 .974, 95%CI 0.906-1.048, p = 0.486) and a lower rate of GC (OR: 0.993, 95%CI 0.924-1.068, p =0.853); however, the results were not statistically significant. Conclusion: Patients with lactose intolerance may have a lower risk of colon and gastric cancer. However, these findings were not statistically significant. Further studies are needed to understand this association.

Esophageal epidermoid metaplasia is a rare premalignant condition characterized histologically by a well-developed granular layer with hyperorthokeratosis and is associated with an increased risk of esophageal squamous cell carcinoma. We present a case of a 56-year-old woman with progressive dysphagia and weight loss who was diagnosed with epidermoid metaplasia that demonstrated histologic resolution during surveillance, despite persistent endoscopic abnormalities. This case highlights the uncertainty surrounding disease progression and emphasizes the need for ongoing endoscopic surveillance even in the setting of apparent histologic regression.

Introduction: This study aims to evaluate and compare the clinical manifestations and disease progression of CD in African Americans (AA) and Caucasians {CA}. Methods: We conducted a single-center cross-sectional study of all patients with CD, both hospitalized and seen as outpatient, treated from 2019 to 2024. Chart reviews were used to identify disease location, and perianal disease, strictures, penetrating natures, endoscopy and surgical history, extra intestinal manifestation, demographics, treatment and medication use. Patients with ulcerative colitis or indeterminant colitis were excluded. Results: A total of 167 patients were identified, comprising 43% AA and 56% Ca. Mean age of diagnosis was 43±14.56 for AA and 47±15.71 for Ca. The average measured BMI was higher in AA (28.55±8.07) than Ca (26.01±5.93) (p<0.01; Table 1). Although there was no significant gender difference in the overall diagnosis of CD, a higher prevalence was observed among females in AA (F/M ratio: 43/27 in AAs vs. 50/45 in Ca). CDs related surgeries occurred in 71% of AA and 56% of Ca. Time from diagnosis to surgery was 17 years for AA and 15 years for Ca with a wide range of standard deviation. No significance differences noted in extraintestinal manifestations, undergoing surgeries, treatment modalities, insurances and perianal disease. AA were more likely to have penetrating phenotype (B3) and less likely to have inflammatory (B1) and stricturing phenotypes (B2) as compared to Caucasians (p<0.005; Table 1). Multivariate logistic regression analysis revealed that the odds of having a B3 phenotype compared to a B1 phenotype were approximately 2.43 times higher for AA compared to Ca (CI: 1.26-4.69) after adjusting for age, sex and BMI. In a subgroup analysis of those with the B3 phenotype, AA were less likely to use steroids compared to Ca (32% Vs 53%, p < 0.05). Discussion: This study showed that AA were more likely to develop complicated CD over time compared to Ca. Higher BMI was noted among AA, however not correlated with complicated CD. AA were diagnosed younger, had a female predominance, longer time from diagnosis to surgery and underwent more surgeries. These findings suggest that CD may manifest differently in AA, though socioeconomic status, healthcare access, and awareness of the disease process may also play a role.