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Ito T, Ramos-Alvarez I, Jensen RT. Long-Term Proton Pump Inhibitor-Acid Suppressive Treatment Can Cause Vitamin B 12 Deficiency in Zollinger-Ellison Syndrome (ZES) Patients. Int J Mol Sci 2024; 25:7286. [PMID: 39000391 PMCID: PMC11242121 DOI: 10.3390/ijms25137286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
Whether the long-term treatment of patients with proton pump inhibitors (PPIs) with different diseases [GERD, Zollinger-Ellison syndrome (ZES), etc.] can result in vitamin B12 (VB12) deficiency is controversial. In this study, in 175 patients undergoing long-term ZES treatment with anti-acid therapies, drug-induced control acid secretory rates were correlated with the presence/absence of VB12 deficiency, determined by assessing serum VB12 levels, measurements of VB12 body stores (blood methylmalonic acid (MMA) and total homocysteine[tHYC]), and other features of ZES. After a mean of 10.2 yrs. of any acid treatment (5.6 yrs. with PPIs), 21% had VB12 deficiency with significantly lower serum and body VB12 levels (p < 0.0001). The presence of VB12 deficiency did not correlate with any feature of ZES but was associated with a 12-fold lower acid control rate, a 2-fold higher acid control pH (6.4 vs. 3.7), and acid control secretory rates below those required for the activation of pepsin (pH > 3.5). Over a 5-yr period, the patients with VB12 deficiency had a higher rate of achlorhydria (73% vs. 24%) and a lower rate of normal acid secretion (0% vs. 49%). In conclusion, in ZES patients, chronic long-term PPI treatment results in marked acid hyposecretion, resulting in decreased serum VB12 levels and decreased VB12-body stores, which can result in VB12 deficiency.
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Affiliation(s)
- Tetsuhide Ito
- Neuroendocrine Tumor Centra, Fukuoka Sanno Hospital, International University of Health and Welfare, 3-6-45 Momochihama, Sawara-Ku, Fukuoka 814-0001, Japan
| | | | - Robert T Jensen
- Digestive Diseases Branch, NIDDK, NIH, Bethesda, MD 20892-1804, USA
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Pereira ML, Caramelli P, Sá VMD, Rocha PHM, Oliveira JPGD, Amorim RPD, Silva EVD, Delboni VS, Barbosa MT, Miranda LFJRD, de Souza LC. Memory complaint in a middle-income country: a four-year longitudinal study in a cohort with low-education. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-9. [PMID: 38849124 DOI: 10.1055/s-0044-1787138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Memory complaints are frequent in older adults and are associated with higher risk of cognitive decline. OBJECTIVE To investigate the functional outcome of individuals with memory complaints followed up at primary care centers. METHODS Data were collected between 2016 e 2020 in primary health care centers in Brazil. Patients underwent the Brief Cognitive Screening Battery, and the Functional Activities Questionnaire. RESULTS The initial sample (2016) comprised 91 individuals classified into those with subjective cognitive decline (SCD, n = 15), mild cognitive impairment (MCI, n = 45), or dementia (n = 31). During follow-up, 8 individuals (8.8% of the initial sample) died and 26 (28.5% of the initial sample) were not found. Fifty-seven participants underwent clinical reassessment. Of 15 individuals with SCD, 7 were not found (46.7%), 4 (26.7%) progressed to MCI, and 4 (26.7%) remained stable. Of 45 individuals with MCI, 11 were not found (24.4%), 2 (4.4%) died, 6 (13.4%) progressed to dementia, 12 (26.7%) regressed to SCD, and 14 (31.1%) remained stable. Of 31 individuals with dementia, 8 were not found (25.8%), 6 (19.4%) died, 2 (6.5%) regressed to SCD, 7 (22.6%) regressed to MCI, and 8 remained stable (25.8%). Clinical improvement was due to the treatment of reversible causes, such as B12 hypovitaminosis and mood disorders. Older age, lower Mini-Mental State Examination, and higher scores of memory complaint, but not the use of benzodiazepines and of proton pump inhibitors, were predictors of functional status. CONCLUSION Despite their limits (short sample size, missing data), these results support the idea that adequate screening, follow-up, and treatment of reversible causes of dementia in primary care are essential.
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Affiliation(s)
- Marcos Leandro Pereira
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
- Khronus Saúde e Educação Ltda, Instituto Khronus de Desenvolvimento Humano, Patos de Minas MG, Brazil
- Centro Universitário de Patos de Minas, Curso de Medicina, Patos de Minas MG, Brazil
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
| | - Vannessa Marinara de Sá
- Khronus Saúde e Educação Ltda, Instituto Khronus de Desenvolvimento Humano, Patos de Minas MG, Brazil
| | | | | | | | - Elvis Vieira da Silva
- Centro Universitário de Patos de Minas, Curso de Medicina, Patos de Minas MG, Brazil
| | | | - Maira Tonidandel Barbosa
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
| | | | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
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Simomura VL, Miorando D, de Oliveira BMM, Mânica A, Bohnen LC, Buzatto MV, Kunst FM, Ansolin LD, Somensi LB, Vidal Gutiérrez M, Venzon L, de Queiroz E Silva TF, Mota da Silva L, Roman Junior WA. Aqueous extract of the bark of Uncaria tomentosa, an amazonian medicinal plant, promotes gastroprotection and accelerates gastric healing in rats. JOURNAL OF ETHNOPHARMACOLOGY 2024; 321:117542. [PMID: 38056537 DOI: 10.1016/j.jep.2023.117542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
ETHNOPHARMACOLOGICAL IMPORTANCE Uncaria tomentosa Willd. DC., is used in the Amazonian region of South America, wherein ethnic groups use the plant to treat diseases, including gastric disorders. However, despite its widespread popular use, this species has yet to be assessed for its anti-ulcer effects. AIM OF THE STUDY In this study, we aimed to evaluate the in vivo gastroprotective and gastric healing activities of an aqueous extract of the bark of Uncaria tomentosa (AEUt) and sought to gain an understanding of the pharmacological mechanisms underlying these biological effects. MATERIALS AND METHODS To verify the gastroprotective properties rats were treated with AEUt (30, 60, or 120 mg/kg) prior to inducing gastric ulceration with ethanol or piroxicam. Additionally, the involvement of nitric oxide, non-protein sulfhydryl compounds (NP-SH), α-2 adrenergic receptors, and prostaglandins was investigated. Furthermore, a pylorus ligature model was employed to investigate the antisecretory activity of AEUt. The gastric healing effects of AEUt (60 mg/kg) were examined in rats in which ulceration had been induced with 80% acetic acid, whereas the quality of healing was evaluated in mice with interleukin-induced recurrent ulcers. We also evaluated the in vivo thickness of the gastric wall using ultrasonography. Moreover, the levels of reduced glutathione (GSH) and malondialdehyde (MDA) were evaluated in ulcerated mucosa, and we determined the activities of the enzymes myeloperoxidase (MPO), N-acetyl-β-D-glycosaminidase, superoxide dismutase, catalase, and glutathione S-transferase. In addition, we assessed the effects of AEUt on cell viability and subjected the AEUt to phytochemical analyses. RESULTS Administration of the AEUt (60 or 120 mg/kg) prevented ethanol- and piroxicam-induced ulceration, which was also confirmed histologically. Moreover, we observed that pre-treatment with NEM and indomethacin abolished the gastroprotective effects of AEUt, thereby indicating the involvement of NP-SH and prostaglandins in these protective effects. In addition, we found that the administration of AEUt had no appreciable effects on the volume, acidity, or peptic activity of gastric juice. Furthermore, the AEUt (60 mg/kg) accelerated the gastric healing of acetic acid-induced ulcers by 46.2% and ultrasonographic findings revealed a reduction in the gastric wall thickness in this group. The gastric healing effect of AEUt was also accompanied by a reduction in MPO activity. The AEUt (60 mg/kg) also minimized ulcer recurrence in mice exposed to IL-1β and was associated with the maintenance of GSH levels and a reduction in MDA contents. We deduce that the biological effects of AEUt could be associated with the activities of polyphenols and the alkaloids isomitraphylline and mitraphylline, identified as predominant constituents of the AEUt. Furthermore, we found no evidence to indicate that AEUt would have any cytotoxic effects. CONCLUSION Collectively, our findings provide compelling evidence indicating the therapeutic efficacy of U. tomentosa. Our data indicate that compounds in AEUt confer gastroprotection and that this preventive effect of AEUt was accompanied by gastric healing and a reduction in gastric ulcer recurrence. Moreover, we provide evidence to indicate that the gastroprotective and gastric healing effects involve the antioxidant system and anti-inflammatory responses that contribute to preserving the gastric mucosa.
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Affiliation(s)
- Viviane Lazari Simomura
- Postgraduate Program in Health Sciences, Community University of Chapecó Region, CEP 89809-900, Chapecó, SC, Brazil.
| | - Daniela Miorando
- Postgraduate Program in Health Sciences, Community University of Chapecó Region, CEP 89809-900, Chapecó, SC, Brazil.
| | | | - Aline Mânica
- Postgraduate Program in Health Sciences, Community University of Chapecó Region, CEP 89809-900, Chapecó, SC, Brazil.
| | - Lilian Caroline Bohnen
- Postgraduate Program in Health Sciences, Community University of Chapecó Region, CEP 89809-900, Chapecó, SC, Brazil.
| | - Maike Valentin Buzatto
- Laboratory of Pharmacognosy, Community University of the Chapecó Region, CEP 89809-900, Chapecó, SC, Brazil.
| | - Francine Mantelli Kunst
- Laboratory of Pharmacognosy, Community University of the Chapecó Region, CEP 89809-900, Chapecó, SC, Brazil.
| | - Lucas Damo Ansolin
- Laboratory of Pharmacognosy, Community University of the Chapecó Region, CEP 89809-900, Chapecó, SC, Brazil.
| | - Lincon Bordignon Somensi
- Postgraduate Program in Development and Society, Alto Vale do Rio do Peixe University, CEP 89500-199, Caçador, SC, Brazil.
| | - Max Vidal Gutiérrez
- Department of Chemistry, Biology and Agricultural Sciences, Universidad de Sonora, Navojoa Sonora, Mexico.
| | - Larissa Venzon
- Postgraduate Program in Pharmaceutical Sciences, University of Vale do Itajaí, CEP 88302-202, Itajaí, SC, Brazil.
| | | | - Luisa Mota da Silva
- Postgraduate Program in Pharmaceutical Sciences, University of Vale do Itajaí, CEP 88302-202, Itajaí, SC, Brazil; TGI Pharmacology and its interactions Laboratory, Department of Pharmacology, UFSC, SC, Brazil.
| | - Walter Antônio Roman Junior
- Postgraduate Program in Health Sciences, Community University of Chapecó Region, CEP 89809-900, Chapecó, SC, Brazil; Laboratory of Pharmacognosy, Community University of the Chapecó Region, CEP 89809-900, Chapecó, SC, Brazil.
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Tortorella MEC, Alves I, Gromicho M, Santos MO, de Carvalho M. Proton pump inhibitors and amyotrophic lateral sclerosis: A case-control study. J Neurol Sci 2024; 457:122895. [PMID: 38267282 DOI: 10.1016/j.jns.2024.122895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/26/2023] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Affiliation(s)
| | - Inês Alves
- Faculdade de Medicina, Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Marta Gromicho
- Faculdade de Medicina, Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel Oliveira Santos
- Faculdade de Medicina, Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal; Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisboa, Portugal
| | - Mamede de Carvalho
- Faculdade de Medicina, Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal; Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisboa, Portugal.
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Bhatnagar MS, Choudhari S, Pawar D, Sharma A. Long-Term Use of Proton-Pump Inhibitors: Unravelling the Safety Puzzle. Cureus 2024; 16:e52773. [PMID: 38389608 PMCID: PMC10882567 DOI: 10.7759/cureus.52773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
Globally, over 25% of the population suffers from acid-related disorders such as dyspepsia or gastroesophageal reflux disease (GERD), and around 7.6% of Indians report having GERD symptoms on a frequent enough basis to warrant a diagnosis. Over the past three decades, proton-pump inhibitors (PPIs) have been the mainstay of medical therapy for acid-peptic diseases like GERD, etc. Additionally, they are frequently prescribed for prophylactic purposes and in conjunction with non-steroidal anti-inflammatory drugs. PPIs are generally prescribed for four to eight weeks. However, it may be prescribed for patients with comorbidities and multiple medications for a longer period of time. While this remains true in terms of effectiveness, concerns have been raised about the safety of long-term PPI use and the serious adverse effects that may result. Some of the observational and population-based cohort studies have shown an association between long-term use of PPIs and an increased risk of pneumonia, major cardiovascular events, dementia, vitamin B12 deficiency, bone fractures, gastric cancer, and kidney injury, among others. This review analyzes the clinical data supporting the long-term use of PPIs and takes a deep dive into whether these several emerging long-term concerns apply to the currently available PPIs in India. We have summarized a vast array of studies, including randomized trials, cohort studies, and meta-analyses, that report low or high incidences of major health risks linked with PPIs and have assessed their appropriateness over a given period.
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Northuis CA, Bell EJ, Lutsey PL, George KM, Gottesman RF, Mosley TH, Whitsel EA, Lakshminarayan K. Cumulative Use of Proton Pump Inhibitors and Risk of Dementia: The Atherosclerosis Risk in Communities Study. Neurology 2023; 101:e1771-e1778. [PMID: 37558503 PMCID: PMC10634644 DOI: 10.1212/wnl.0000000000207747] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/20/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies on the association between proton pump inhibitor (PPI) use and dementia report mixed results and do not examine the impact of cumulative PPI use. We evaluated the associations between current and cumulative PPI use and risk of incident dementia in the Atherosclerosis Risk in Communities (ARIC) Study. METHODS These analyses used participants from a community-based cohort (ARIC) from the time of enrollment (1987-1989) through 2017. PPI use was assessed through visual medication inventory at clinic visits 1 (1987-1989) to 5 (2011-2013) and reported annually in study phone calls (2006-2011). This study uses ARIC visit 5 as baseline because this was the first visit in which PPI use was common. PPI use was examined 2 ways: current use at visit 5 and duration of use before visit 5 (from visit 1 to 2011, exposure categories: 0 day, 1 day-2.8 years, 2.8-4.4 years, >4.4 years). The outcome was incident dementia after visit 5. Cox proportional hazard models were used, adjusted for demographics, comorbid conditions, and other medication use. RESULTS A total of 5,712 dementia-free participants at visit 5 (mean age 75.4 ± 5.1 years; 22% Black race; 58% female) were included in our analysis. The median follow-up was 5.5 years. The minimum cumulative PPI use was 112 days, and the maximum use was 20.3 years. There were 585 cases of incident dementia identified during follow-up. Participants using PPIs at visit 5 were not at a significantly higher risk of developing dementia during subsequent follow-up than those not using PPIs (hazard ratio (HR): 1.1 [95% confidence interval (CI) 0.9-1.3]). Those who used PPIs for >4.4 cumulative years before visit 5 were at 33% higher risk of developing dementia during follow-up (HR: 1.3 [95% CI 1.0-1.8]) than those reporting no use. Associations were not significant for lesser durations of PPI use. DISCUSSION Future studies are needed to understand possible pathways between cumulative PPI use and the development of dementia. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that the use of prescribed PPIs for >4.4 years by individuals aged 45 years and older is associated with a higher incidence of newly diagnosed dementia.
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Affiliation(s)
- Carin A Northuis
- From the University of Minnesota (C.A.N., P.L.L., K.L.), Minneapolis; Optum (E.J.B.), Minneapolis, MN; University of California, Davis (K.M.G.); National Institute of Neurological Disorders and Stroke (R.F.G.), Washington, DC; University of Mississippi Medical Center (T.H.M.), Jackson; and University of North Carolina (E.A.W.), Chapel Hill
| | - Elizabeth J Bell
- From the University of Minnesota (C.A.N., P.L.L., K.L.), Minneapolis; Optum (E.J.B.), Minneapolis, MN; University of California, Davis (K.M.G.); National Institute of Neurological Disorders and Stroke (R.F.G.), Washington, DC; University of Mississippi Medical Center (T.H.M.), Jackson; and University of North Carolina (E.A.W.), Chapel Hill
| | - Pamela L Lutsey
- From the University of Minnesota (C.A.N., P.L.L., K.L.), Minneapolis; Optum (E.J.B.), Minneapolis, MN; University of California, Davis (K.M.G.); National Institute of Neurological Disorders and Stroke (R.F.G.), Washington, DC; University of Mississippi Medical Center (T.H.M.), Jackson; and University of North Carolina (E.A.W.), Chapel Hill
| | - Kristen M George
- From the University of Minnesota (C.A.N., P.L.L., K.L.), Minneapolis; Optum (E.J.B.), Minneapolis, MN; University of California, Davis (K.M.G.); National Institute of Neurological Disorders and Stroke (R.F.G.), Washington, DC; University of Mississippi Medical Center (T.H.M.), Jackson; and University of North Carolina (E.A.W.), Chapel Hill
| | - Rebecca F Gottesman
- From the University of Minnesota (C.A.N., P.L.L., K.L.), Minneapolis; Optum (E.J.B.), Minneapolis, MN; University of California, Davis (K.M.G.); National Institute of Neurological Disorders and Stroke (R.F.G.), Washington, DC; University of Mississippi Medical Center (T.H.M.), Jackson; and University of North Carolina (E.A.W.), Chapel Hill
| | - Tom H Mosley
- From the University of Minnesota (C.A.N., P.L.L., K.L.), Minneapolis; Optum (E.J.B.), Minneapolis, MN; University of California, Davis (K.M.G.); National Institute of Neurological Disorders and Stroke (R.F.G.), Washington, DC; University of Mississippi Medical Center (T.H.M.), Jackson; and University of North Carolina (E.A.W.), Chapel Hill
| | - Eric A Whitsel
- From the University of Minnesota (C.A.N., P.L.L., K.L.), Minneapolis; Optum (E.J.B.), Minneapolis, MN; University of California, Davis (K.M.G.); National Institute of Neurological Disorders and Stroke (R.F.G.), Washington, DC; University of Mississippi Medical Center (T.H.M.), Jackson; and University of North Carolina (E.A.W.), Chapel Hill
| | - Kamakshi Lakshminarayan
- From the University of Minnesota (C.A.N., P.L.L., K.L.), Minneapolis; Optum (E.J.B.), Minneapolis, MN; University of California, Davis (K.M.G.); National Institute of Neurological Disorders and Stroke (R.F.G.), Washington, DC; University of Mississippi Medical Center (T.H.M.), Jackson; and University of North Carolina (E.A.W.), Chapel Hill.
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Giuliano S, Montemagno C, Domdom MA, Teisseire M, Brest P, Klionsky DJ, Hofman P, Pagès G, Mograbi B. Should evidence of an autolysosomal de-acidification defect in Alzheimer and Parkinson diseases call for caution in prescribing chronic PPI and DMARD? Autophagy 2023; 19:2800-2806. [PMID: 37482676 PMCID: PMC10472882 DOI: 10.1080/15548627.2023.2214960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 07/25/2023] Open
Abstract
Nearly fifty million older people suffer from neurodegenerative diseases, including Alzheimer (AD) and Parkinson (PD) disease, a global burden expected to triple by 2050. Such an imminent "neurological pandemic" urges the identification of environmental risk factors that are hopefully avoided to fight the disease. In 2022, strong evidence in mouse models incriminated defective lysosomal acidification and impairment of the autophagy pathway as modifiable risk factors for dementia. To date, the most prescribed lysosomotropic drugs are proton pump inhibitors (PPIs), chloroquine (CQ), and the related hydroxychloroquine (HCQ), which belong to the group of disease-modifying antirheumatic drugs (DMARDs). This commentary aims to open the discussion on the possible mechanisms connecting the long-term prescribing of these drugs to the elderly and the incidence of neurodegenerative diseases.Abbreviations: AD: Alzheimer disease; APP-βCTF: amyloid beta precursor protein-C-terminal fragment; BACE1: beta-secretase 1; BBB: brain blood barrier; CHX: Ca2+/H+ exchanger; CMI: cognitive mild impairment; CQ: chloroquine; DMARD: disease-modifying antirheumatic drugs; GBA1: glucosylceramidase beta 1; HCQ: hydroxychloroquine; HPLC: high-performance liquid chromatography; LAMP: lysosomal associated membrane protein; MAPK/JNK: mitogen-activated protein kinase; MAPT: microtubule associated protein tau; MCOLN1/TRPML1: mucolipin TRP cation channel 1; NFE2L2/NRF2: NFE2 like bZIP transcription factor 2; NRBF2: nuclear receptor binding factor 2; PANTHOS: poisonous flower; PD: Parkinson disease; PIK3C3: phosphatIdylinositol 3-kinase catalytic subunit type 3; PPI: proton pump inhibitor; PSEN1: presenilin 1, RUBCN: rubicon autophagy regulator; RUBCNL: rubicon like autophagy enhancer; SQSTM1: sequestosome 1; TMEM175: transmembrane protein 175; TPCN2: two pore segment channel 2; VATPase: vacuolar-type H+-translocating ATPase; VPS13C: vacuolar protein sorting ortholog 13 homolog C; VPS35: VPS35 retromer complex component; WDFY3: WD repeat and FYVE domain containing 3; ZFYVE1: zinc finger FYVE-type containing 1.
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Affiliation(s)
- Sandy Giuliano
- Université Nice Côte d'Azur, IRCAN, CNRS, INSERM, Centre Antoine Lacassagne, IHU RespirERA, FHU-Oncoage, Nice, France
| | | | - Marie-Angela Domdom
- Université Nice Côte d'Azur, IRCAN, CNRS, INSERM, Centre Antoine Lacassagne, IHU RespirERA, FHU-Oncoage, Nice, France
| | - Manon Teisseire
- Université Nice Côte d'Azur, IRCAN, CNRS, INSERM, Centre Antoine Lacassagne, IHU RespirERA, FHU-Oncoage, Nice, France
| | - Patrick Brest
- Université Nice Côte d'Azur, IRCAN, CNRS, INSERM, Centre Antoine Lacassagne, IHU RespirERA, FHU-Oncoage, Nice, France
| | - Daniel J. Klionsky
- Department of Molecular, Cellular, and Developmental Biology, Life Sciences Institute, University of Michigan, Ann Arbor, MI, USA
| | - Paul Hofman
- Université Nice Côte d'Azur, IRCAN, CNRS, INSERM, Centre Antoine Lacassagne, IHU RespirERA, FHU-Oncoage, Nice, France
- CHU de Nice, laboratory of Clinical and Experimental Pathology (LPCE), Université Côte d’Azur, CNRS, INSERM, IRCAN, IHU RespirERA, FHU-Oncoage, Nice, France
| | - Gilles Pagès
- Université Nice Côte d'Azur, IRCAN, CNRS, INSERM, Centre Antoine Lacassagne, IHU RespirERA, FHU-Oncoage, Nice, France
| | - Baharia Mograbi
- Université Nice Côte d'Azur, IRCAN, CNRS, INSERM, Centre Antoine Lacassagne, IHU RespirERA, FHU-Oncoage, Nice, France
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Mehta RS, Kochar B, Zhou Z, Broder JC, Chung P, Yang K, Lockery J, Fravel M, Ryan J, Mahady S, Orchard SG, McNeil JJ, Murray A, Woods RL, Ernst ME, Chan AT. Association of Proton Pump Inhibitor Use With Incident Dementia and Cognitive Decline in Older Adults: A Prospective Cohort Study. Gastroenterology 2023; 165:564-572.e1. [PMID: 37315867 PMCID: PMC10527011 DOI: 10.1053/j.gastro.2023.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND & AIMS Prior studies have suggested that proton pump inhibitor (PPI) use is associated with increased risk of dementia; however, these have been limited by incomplete assessment of medication use and failure to account for confounders. Furthermore, prior studies have relied on claims-based diagnoses for dementia, which can lead to misclassification. We investigated the associations of PPI and histamine-2 receptor antagonist (H2RA) use with dementia and cognitive decline. METHODS We conducted a post hoc analysis of ASPirin in Reducing Events in the Elderly (ASPREE), a randomized trial of aspirin in the United States and Australia, including 18,934 community-based adults ≥65 years of all races/ethnicities. Baseline and recent PPI and H2RA use were determined according to review of medications during annual in-person study visits. Incident dementia was defined according to Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, criteria. Secondary endpoints include cognitive impairment, no dementia (CIND) and changes in cognition. Associations of medication use with dementia and CIND outcomes were examined using Cox proportional hazards models. Changes in cognitive test scores were examined using linear mixed-effects models. RESULTS Baseline PPI use vs nonuse was not associated with incident dementia (multivariable hazard ratio, 0.88; 95% confidence interval, 0.72-1.08), CIND (multivariable hazard ratio, 1.00; 95% confidence interval, 0.92-1.09), or with changes in overall cognitive test scores over time (multivariable B, -0.002; standard error, 0.01; P = .85). Similarly, no associations were observed between H2RA use and all cognitive endpoints. CONCLUSIONS In adults ≥65 years of age, PPI and H2RA use were not associated with incident dementia, CIND, or decline in cognition over time. These data provide reassurance about the safety of long-term use of PPIs among older adults.
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Affiliation(s)
- Raaj S Mehta
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bharati Kochar
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jonathan C Broder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paget Chung
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Keming Yang
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jessica Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michelle Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Suzanne Mahady
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anne Murray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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9
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Shanika LGT, Reynolds A, Pattison S, Braund R. Proton pump inhibitor use: systematic review of global trends and practices. Eur J Clin Pharmacol 2023; 79:1159-1172. [PMID: 37420019 PMCID: PMC10427555 DOI: 10.1007/s00228-023-03534-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE Proton pump inhibitors (PPIs) reduce acid secretion in the stomach and rank as one of the most widely used acid-suppressing medicines globally. While PPIs are safe in the short-term, emerging evidence shows risks associated with long-term use. Current evidence on global PPI use is scarce. This systematic review aims to evaluate global PPI use in the general population. METHODS Ovid MEDLINE, Embase, and International Pharmaceutical Abstracts were systematically searched from inception to 31 March 2023 to identify observational studies on oral PPI use among individuals aged ≥ 18 years. PPI use was classified by demographics and medication factors (dose, duration, and PPI types). The absolute numbers of PPI users for each subcategory were summed and expressed as a percentage. RESULTS The search identified data from 28 million PPI users in 23 countries from 65 articles. This review indicated that nearly one-quarter of adults use a PPI. Of those using PPIs, 63% were less than 65 years. 56% of PPI users were female, and "White" ethnicities accounted for 75% of users. Nearly two-thirds of users were on high doses (≥ defined daily dose (DDD)), 25% of users continued PPIs for > 1 year, and 28% of these continued for > 3 years. CONCLUSION Given the widespread use PPIs and increasing concern regarding long-term use, this review provides a catalyst to support more rational use, particularly with unnecessary prolonged continuation. Clinicians should review PPI prescriptions regularly and deprescribe when there is no appropriate ongoing indication or evidence of benefit to reduce health harm and treatment cost.
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Affiliation(s)
- Lelwala Guruge Thushani Shanika
- New Zealand Pharmacovigilance Centre, University of Otago, 913, Dunedin, 9054, New Zealand
- Department of Pharmacy and Pharmaceutical Science, University of Sri Jayewardenepura, Gangodawila, Sri Lanka
| | - Andrew Reynolds
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sharon Pattison
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rhiannon Braund
- New Zealand Pharmacovigilance Centre, University of Otago, 913, Dunedin, 9054, New Zealand.
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10
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Dinesh D, Lee JS, Scott TM, Tucker KL, Palacios N. Proton Pump Inhibitor Use and Cognitive Function in the Boston Puerto Rican Health Study. J Gerontol A Biol Sci Med Sci 2023; 78:1461-1470. [PMID: 36420642 PMCID: PMC10395560 DOI: 10.1093/gerona/glac231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND There is a lack of consensus among studies on the association between proton pump inhibitor (PPI) use and cognitive impairment. This association is not well studied among minority populations, including among Puerto Ricans. Therefore, we sought to examine this association among Boston-area Puerto Ricans. METHODS The Boston Puerto Rican Health Study is an ongoing longitudinal cohort that enrolled 1499 Boston-area Puerto Rican adults, aged 45-75 years at baseline. Complete outcome and exposure data was available for 1290 baseline participants. Covariate-adjusted linear regression and linear mixed effects models were used to examine the association between PPI use, and global cognition, executive function, and memory cross-sectionally and longitudinally over ~12.7 years of follow-up. Furthermore, we examined the cross-sectional association between long-term PPI use (continuous use of ~6.2 years) and global cognition, executive function, and memory. RESULTS Among 1 290 participants at baseline, 313 (24.3%) self-reported PPI use. Baseline PPI use was not associated with baseline global cognition, executive function, or memory. Baseline PPI use also did not alter the trajectory of global cognition, executive function, or memory over ~12.7 years of follow-up. Long-term PPI use was not associated with global cognition, executive function, or memory over ~12.7 years of follow-up. CONCLUSION In this study of Boston-area Puerto Ricans, we did not observe an association between PPI use and global cognition, executive function, or memory either cross-sectionally or over 12.7 years of follow-up.
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Affiliation(s)
- Deepika Dinesh
- Center for Population Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Jong Soo Lee
- Center for Population Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
- Department of Mathematical Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Tammy M Scott
- Center for Population Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
- Department of Psychiatry, School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Katherine L Tucker
- Center for Population Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Natalia Palacios
- Center for Population Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
- Department of Nutrition, Harvard University School of Public Health, Boston, Massachusetts, USA
- Geriatric Research Education Clinical Center, Department of Veterans Affairs, ENRM VA Hospital, Bedford, Massachusetts, USA
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11
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Caetano C, Veloso M, Borda S. Proton pump inhibitors and dementia: what association? Dement Neuropsychol 2023; 17:e20220048. [PMID: 37261259 PMCID: PMC10229084 DOI: 10.1590/1980-5764-dn-2022-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/31/2022] [Accepted: 01/20/2023] [Indexed: 06/02/2023] Open
Abstract
Several recent studies have suggested an association between proton pump inhibitors and the development of cognitive changes. Objective To assess the existence of this association. Methods A comprehensive literature search was conducted including guidelines, meta-analyses, systematic reviews, observational and experimental studies published between February 2011 and February 2021. Results The initial research identified 393 articles, 28 of which were included: 8 systematic reviews, 1 clinical trial, 15 observational studies, 3 case-control studies, and 1 cross-sectional observational study. Conclusions Most studies classified with the highest level of evidence found no statistically significant association between the use of proton pump inhibitors and the development of cognitive impairment or dementia.
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Affiliation(s)
- Catarina Caetano
- Unidade de Saúde Familiar Delta, Administração Regional de Saúde de Lisboa e Vale do Tejo, Oeiras, Lisboa, Portugal
| | - Marta Veloso
- Unidade de Saúde Familiar Delta, Administração Regional de Saúde de Lisboa e Vale do Tejo, Oeiras, Lisboa, Portugal
| | - Susana Borda
- Unidade de Saúde Familiar Delta, Administração Regional de Saúde de Lisboa e Vale do Tejo, Oeiras, Lisboa, Portugal
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12
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Chen HL, Lei WY, Wang JH, Bair MJ, Chen CL. Proton pump inhibitor use and the risk for Parkinson's disease: A nationwide population-based study in Taiwan. Medicine (Baltimore) 2023; 102:e33711. [PMID: 37171333 PMCID: PMC10174385 DOI: 10.1097/md.0000000000033711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Previous studies have shown that proton pump inhibitors (PPIs) are associated with an increased risk of dementia. However, little is known about the relationship between PPIs use and Parkinson's disease (PD). This study aimed to examine whether PPI use was associated with an increased risk of developing clinically verified PD. This used data from the Taiwan National Health Insurance Research Database for the period between 1999 and 2011, and patients with PPI use were compared with 1 to 1 propensity score-matched controls by age, sex, cohort entry year, and comorbidity. A multivariate analysis was performed using Cox proportional hazards models to estimate the association between PPI use and PD risk. Subgroup analyses according to sex, age, and comorbidities were also conducted. In total, 56,785 PPI users and 56,785 matched controls were enrolled in this study. In the PPI cohort, 366 patients developed PD during a median follow-up of 5.0 years. The incidence rate of PD was 1.48-fold higher in PPI users than in non-PPI users (90.0 vs 133.2 per 100,000 person-years), with an adjusted hazard ratio of 1.76 (95% confidence interval, 1.48-2.08). In the subgroup analysis, the adjusted risk of PD in the PPI and non-PPI cohorts increased in the subgroups regardless of age, sex, and comorbidities. The results of this retrospective, nationwide, population-based cohort study in Taiwan indicate that PPI use is associated with the risk of PD development. Further mechanistic studies on the effect of PPI on PD are needed.
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Affiliation(s)
- Huan-Lin Chen
- Division of Gastroenterology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung, Taiwan
- Mackay Medical College, New Taipei, Taiwan
| | - Wei-Yi Lei
- Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ming-Jong Bair
- Division of Gastroenterology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung, Taiwan
- Mackay Medical College, New Taipei, Taiwan
| | - Chien-Lin Chen
- Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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13
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Han CT, Islam MM, Poly TN, Lu YC, Lin MC. A Meta-Analysis of Proton Pump Inhibitor Use and the Risk of Acute Kidney Injury: Geographical Differences and Associated Factors. J Clin Med 2023; 12:jcm12072467. [PMID: 37048551 PMCID: PMC10095047 DOI: 10.3390/jcm12072467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 04/14/2023] Open
Abstract
Proton pump inhibitors (PPIs) are widely prescribed in medical practice for the treatment of several gastrointestinal disorders. Previous epidemiology studies have reported the association between PPI use and the risk of AKI, although the magnitude of the association between PPIs and the risk of acute kidney injury (AKI) remains uncertain. Therefore, we conducted a meta-analysis to determine the relationship between PPI therapy and the risk of AKI. We systematically searched for relevant articles published before January 2023 on PubMed, Scopus, and Web of Science. In addition, we conducted a manual search of the bibliographies of potential articles. Two independent reviewers examined the appropriateness of all studies for inclusion. We pooled studies that compared the risk of AKI with PPI against their control using a random effect model. The search criteria based on PRISMA guidelines yielded 568 articles. Twelve observational studies included 2,492,125 individuals. The pooled adjusted RR demonstrated a significant positive association between PPI therapy and the risk of AKI (adjusted RR 1.75, 95% CI: 1.40-2.19, p < 0.001), and it was consistent across subgroups. A visual presentation of the funnel plot and Egger's regression test showed no evidence of publication bias. Our meta-analysis indicated that persons using PPIs exhibited an increased risk of AKI. North American individuals had a higher risk of AKI compared to Asian and European individuals. However, the pooled effect from observational studies cannot clarify whether the observed association is a causal effect or the result of some unmeasured confounding factors. Hence, the biological mechanisms underlying this association are still unclear and require further research.
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Affiliation(s)
- Cheng Ta Han
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Md Mohaimenul Islam
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Tahmina Nasrin Poly
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Yu-Chun Lu
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Ming-Chin Lin
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
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14
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Baidya ATK, Das B, Devi B, Långström B, Ågren H, Darreh-Shori T, Kumar R. Mechanistic Insight into the Inhibition of Choline Acetyltransferase by Proton Pump Inhibitors. ACS Chem Neurosci 2023; 14:749-765. [PMID: 36749117 DOI: 10.1021/acschemneuro.2c00738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Various pharmacoepidemiological investigational studies have indicated that Proton Pump Inhibitors (PPIs) may increase the likelihood of developing Alzheimer's disease (AD) and non-AD related dementias. Previously, we have reported the inhibition of the acetylcholine biosynthesizing enzyme choline acetyltransferase (ChAT) by PPIs, for which omeprazole, lansoprazole, and pantoprazole exhibited IC50 values of 0.1, 1.5, and 5.3 μM, respectively. In this study we utilize a battery of computational tools to perceive a mechanistic insight into the molecular interaction of PPIs with the ChAT binding pocket that may further help in designing novel ChAT ligands. Various in-silico tools make it possible for us to elucidate the binding interaction, conformational stability, and dynamics of the protein-ligand complexes within a 200 ns time frame. Further, the binding free energies for the PPI-ChAT complexes were explored. The results suggest that the PPIs exhibit equal or higher binding affinity toward the ChAT catalytic tunnel and are stable throughout the simulated time and that the pyridine ring of the PPIs interacts primarily with the catalytic residue His324. A free energy landscape analysis showed that the folding process was linear, and the residue interaction network analysis can provide insight into the roles of various amino acid residues in stabilization of the PPIs in the ChAT binding pocket. As a major factor for the onset of Alzheimer's disease is linked to cholinergic dysfunction, our previous and the present findings give clear insight into the PPI interaction with ChAT. The scaffold can be further simplified to develop novel ChAT ligands, which can also be used as ChAT tracer probes for the diagnosis of cholinergic dysfunction and to initiate timely therapeutic interventions to prevent or delay the progression of AD.
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Affiliation(s)
- Anurag T K Baidya
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology (B.H.U.), Varanasi, 221005 U.P., India
| | - Bhanuranjan Das
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology (B.H.U.), Varanasi, 221005 U.P., India
| | - Bharti Devi
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology (B.H.U.), Varanasi, 221005 U.P., India
| | - Bengt Långström
- Department of Chemistry, Uppsala University, SE-751 20 Uppsala, Sweden
| | - Hans Ågren
- Department of Physics and Astronomy, Uppsala University, Box 516, SE-751 20 Uppsala, Sweden
| | - Taher Darreh-Shori
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, NEO, Eighth Floor, 141 52 Stockholm, Sweden
| | - Rajnish Kumar
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology (B.H.U.), Varanasi, 221005 U.P., India
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15
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Mann NK, Mathes T, Sönnichsen A, Pieper D, Klager E, Moussa M, A. Thürmann P. Potentially Inadequate Medications in the Elderly: PRISCUS 2.0. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:3-10. [PMID: 36507719 PMCID: PMC10035347 DOI: 10.3238/arztebl.m2022.0377] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/12/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The term potentially inadequate medication (PIM) is used to describe substances that may be unsuitable for use inthe elderly and should be avoided. The PRISCUS list, published in 2010, was the first catalog of PIM designed for the Germandrug market to become adopted in practice. While 24% of German patients aged ≥ 65 years were prescribed at least one PIMper year in 2009, the proportion in 2019 was only 14.5%. METHODS In a three-round Delphi process, experts from clinical practice and research evaluated whether selected substancesare PIM for the elderly. The participants were provided with dedicated literature including systematic reviews carried out for theparticular purposes of this project. RESULTS Fifty-nine persons took part in the Delphi process and, in addition, contributed comments and therapeutic alternatives.Altogether, 187 substances were classed as PIM. One hundred thirty-three of the substances now listed were not in the originalPRISCUS list: these include some oral antidiabetics, all of the selective COX-2 inhibitors, and moderately long acting benzodiazepinessuch as oxazepam. For some other substances, e.g., proton pump inhibitors (PPI), the advisability of treatment formore than 8 weeks was considered as potentially inappropriate, as was the use of ibuprofen in doses >1200 mg/day and formore than 1 week without PPI. Risperidone for more than 6 weeks is also PIM. CONCLUSION The new, greatly extended PRISCUS list must now be validated in epidemiological and prospective studies and itspracticability in routine daily use must be verified.
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Affiliation(s)
- Nina-Kristin Mann
- Chair of Clinical Pharmacology, Department of Medicine, Faculty of Health, University of Witten/Herdecke
| | - Tim Mathes
- Chair of Clinical Pharmacology, Department of Medicine, Faculty of Health, University of Witten/Herdecke
| | - Andreas Sönnichsen
- Chair of Clinical Pharmacology, Department of Medicine, Faculty of Health, University of Witten/Herdecke
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Department of Medicine, Faculty of Health, University of Witten/Herdecke
| | - Elisabeth Klager
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Austria
| | - Mahmoud Moussa
- Department of General and Family Medicine, Center for Public Health, Medical University of Vienna, Austria
| | - Petra A. Thürmann
- Chair of Clinical Pharmacology, Department of Medicine, Faculty of Health, University of Witten/Herdecke
- Philipp Klee Institute of Clinical Pharmacology, Helios University Hospital, Wuppertal
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Plehhova K, Haering M, Wray J, Coyle C, Ibáñez E, Kostev K. Prescribing Patterns of Proton Pump Inhibitors in Germany: A Retrospective Study Including 472 146 Patients. J Prim Care Community Health 2023; 14:21501319231221002. [PMID: 38142444 PMCID: PMC10749518 DOI: 10.1177/21501319231221002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/26/2023] Open
Abstract
The aims of this study were to analyze proton pump inhibitor (PPI) users in Germany, defining and classifying them in terms of treatment appropriateness, and to analyze the PPI prescription practices of healthcare providers. The updated DGVS (Deutsche Gesellschaft für Gastroenterologie, Verdauungs-und Stoffwechselkrankheiten) gastroesophageal reflux disease (GERD) treatment guideline (published March 2023) for mild heartburn symptoms recommends carrying out a probatory treatment of mild symptoms via other medication such as antacids, alginates, and H2 blockers before escalating to PPI treatments, if the patient profile allows. This retrospective cross-sectional study was based on data from the IQVIA™ Disease Analyzer database (DA) and included adult patients (18 years or older) in 1006 general and 39 gastroenterological practices in Germany who received at least 1 PPI prescription or alginate between September 2019 and September 2021 (hereinafter referred to as the index period). Analyses included indications associated with PPI prescription, co-diagnoses, co-therapies of PPI patients, duration of PPI therapy, dosages of PPI prescriptions, and proportions of practices prescribing PPIs and alginates. A total of 472 146 patients taking PPIs and 9101 patients taking alginates were available for analysis. Very few patients (4.5%) of the total cohort were treated in complete adherence to treatment guidelines. Conditions such as gastritis and duodenitis (47.2%) and reflux diseases (38.4%) were more frequently associated with PPI prescriptions. The average PPI treatment period lasted 141 days, and 36.6% of patients were treated for >6 months. High doses were prescribed relatively often (ie, 42.8% of esomeprazole prescriptions were 40 mg, 59.1% of lansoprazole prescriptions 30 mg, 28.6% of omeprazole prescriptions 40 mg). With each practice prescribing PPIs to at least 10% of their patients; 72% of general practitioners (GPs) and 8% of GENTS (Gastroenterologists) prescribed alginates. This study highlights that discrepancies exist between clinical guidelines and real-life prescribing practices of PPIs in Germany. Particular attention should be given to the incidence of patients being prescribed high-dose or long-duration PPI with mild indications. These findings are particularly apt considering the publication (March 2023) of new guidelines on the "management of gastroesophageal reflux disease and eosinophilic esophagitis," by the DGVS.
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Affiliation(s)
| | | | - Joshua Wray
- Reckitt Benckiser Healthcare Limited, Hull, UK
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17
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Friesen KJ, Falk J, Chateau D, Kuo IF, Bugden S. Signal and Noise: Proton Pump Inhibitors and the Risk of Dementia? Clin Pharmacol Ther 2023; 113:152-159. [PMID: 36260313 DOI: 10.1002/cpt.2767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/03/2022] [Indexed: 12/24/2022]
Abstract
The association between proton pump inhibitor (PPI) use and dementia remains controversial. This cohort study re-examines this issue, addressing shortcomings identified in previous publications using a population-based and a high-dimension propensity-score matched cohort to follow patients for up to 22 years. Cox regression models using baseline characteristics, a lag period, and time-varying variables were used to examine the risk of dementia by cumulative PPI exposure. High-dose PPI users (> 180 days of use) had significantly higher risk of dementia in crude Cox models. After adjustment for medical diagnoses and prescription drug use, these associations disappeared. Among high-dose users starting PPI therapy between 46 and 55 years old, the unadjusted hazard ratio (HR) was 1.55 (95% confidence interval (CI) 1.14, 2.10); the adjusted hazard ratio (aHR) was 1.10 (95% CI 0.80, 1.51). For high-dose users starting therapy between 56 and 65 years, HR = 1.22 (95% CI1.03, 1.44); aHR = 0.99 (95% CI 0.83, 1.17). High-dose users between the ages of 66 and 75 years had no association with the risk of dementia. The use of lag models or time-varying parameters similarly found some association with dementia in crude, but not multivariable Cox models. Although high-dose PPI users were more likely to develop dementia, they were more likely to be diagnosed with dementia risk factors, such as diabetes and cardiovascular disease, which are risk factors for dementia. Controlling for these conditions using multivariable models or a propensity-score matched cohort eliminated this association.
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Affiliation(s)
- Kevin J Friesen
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jamie Falk
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - I Fan Kuo
- Optimal Use and Evaluation, Clinical Services and Evaluation Branch, Pharmaceutical, Laboratory & Blood Services, British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Shawn Bugden
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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18
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Choi HG, Kim JH, Kim JH, Kim ES, Park HY, Min KW, Kwon MJ. Associations between proton pump inhibitors and Alzheimer’s disease: a nested case–control study using a Korean nationwide health screening cohort. Alzheimers Res Ther 2022; 14:91. [PMID: 35773740 PMCID: PMC9248149 DOI: 10.1186/s13195-022-01032-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/22/2022] [Indexed: 01/22/2023]
Abstract
Background Safety concerns against the use of proton pump inhibitors (PPIs) based on the risk of dementia, especially Alzheimer’s disease (AD), remain controversial. Here, we investigated the likelihood of AD depending on previous PPI exposure, use duration, and PPI generation. Methods This nested case–control study comprised 17,225 AD patients who were 1:4 matched with 68,900 controls for age, sex, income, and region of residence from Korean National Health Insurance Service-Health Screening Cohort data between 2002 and 2015 using propensity-score matching method. Conditional and unconditional logistic regression analyses were used to evaluate the effects of previous PPI use on AD adjusting for multiple covariates. Results Prior PPI use increased likelihood for AD in current and past PPI users (adjusted odds ratio 1.36 [95% confidence interval (CI) = 1.26–1.46] and 1.11 [95% CI = 1.04–1.18], respectively). Participants with either < 30 days, 30–90 days, or > 90 days of PPI prescription showed higher odds for AD (1.13 [95% CI = 1.07–1.19]; 1.18 [95% CI = 1.10–1.27]; 1.26 [95% CI = 1.16–1.36], respectively). Participants with either 1st-generation or 2nd-generation PPIs demonstrated higher incidences of AD in those with < 30 days (1.14 [95% CI = 1.07–1.22] and 1.13 [95% CI = 1.05–1.22], respectively), 30–90 days (1.19 [95% CI = 1.09–1.30] and 1.17 [95% CI = 1.05–1.29], respectively), or > 90 days (1.18 [95% CI = 1.07–1.30] and 1.27 [95% CI = 1.14–1.43], respectively) of prescription. Conclusions Prior PPI use, regardless of current or past exposure, duration of use, or use of 1st- or 2nd-generation PPIs, may increase likelihood of AD, providing supportive evidence of previous pharmacoepidemiologic studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-022-01032-5.
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Barrett AK, Cashy JP, Thorpe CT, Hale JA, Suh K, Lambert BL, Galanter W, Linder JA, Schiff GD, Gellad WF. Latent Class Analysis of Prescribing Behavior of Primary Care Physicians in the Veterans Health Administration. J Gen Intern Med 2022; 37:3346-3354. [PMID: 34993865 PMCID: PMC9550922 DOI: 10.1007/s11606-021-07248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Benzodiazepines, opioids, proton-pump inhibitors (PPIs), and antibiotics are frequently prescribed inappropriately by primary care physicians (PCPs), without sufficient consideration of alternative options or adverse effects. We hypothesized that distinct groups of PCPs could be identified based on their propensity to prescribe these medications. OBJECTIVE To identify PCP groups based on their propensity to prescribe benzodiazepines, opioids, PPIs, and antibiotics, and patient and PCP characteristics associated with identified prescribing patterns. DESIGN Retrospective cohort study using VA data and latent class regression analyses to identify prescribing patterns among PCPs and examine the association of patient and PCP characteristics with class membership. PARTICIPANTS A total of 2524 full-time PCPs and their patient panels (n = 2,939,636 patients), from January 1, 2017, to December 31, 2018. MAIN MEASURES We categorized PCPs based on prescribing volume quartiles for the four drug classes, based on total days' supply dispensed of each medication by the PCP to their patients (expressed as days' supply per 1000 panel patient-days). We used latent class analysis to group PCPs based on prescribing and used multinomial logistic regression to examine patient and PCP characteristics associated with latent class membership. KEY RESULTS PCPs were categorized into four groups (latent classes): low intensity (23% of cohort), medium-intensity overall/high-intensity PPI (36%), medium-intensity overall/high-intensity opioid (20%), and high intensity (21%). PCPs in the high-intensity group were predominantly in the highest quartile of prescribers for all four drugs (68% in the highest quartile for benzodiazepine, 86% opioids, 64% PPIs, 62% antibiotics). High-intensity PCPs (vs. low intensity) were substantially less likely to be female (OR: 0.30, 95% CI: 0.21-0.42) or practice in the northeast versus other census regions (OR: 0.10, 95% CI: 0.06-0.17). CONCLUSIONS VA PCPs can be classified into four clearly differentiated groups based on their prescribing of benzodiazepines, opioids, PPIs, and antibiotics, suggesting an underlying typology of prescribing. High-intensity PCPs were more likely to be male.
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Affiliation(s)
- Alexis K Barrett
- VA Center for Medication Safety/Pharmacy Benefits Management Services, U.S. Department of Veteran Affairs, Hines, IL, USA.
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA.
| | - John P Cashy
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer A Hale
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA
| | - Kangho Suh
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bruce L Lambert
- Department of Communication Studies, Center for Communication and Health, Northwestern University, Evanston, IL, USA
| | - William Galanter
- Department of Medicine, Department of Pharmacy Systems, Outcomes & Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Jeffrey A Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gordon D Schiff
- Center for Patient Safety Research and Practice, Brigham and Women's Hospital, Boston, MA, USA
- Center for Primary Care, Harvard Medical School, Boston, MA, USA
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Zhang P, Li Z, Chen P, Zhang A, Zeng Y, Zhang X, Huang Q, Liu D, Qi S, Mao C. Regular proton pump inhibitor use and incident dementia: population-based cohort study. BMC Med 2022; 20:271. [PMID: 36045363 PMCID: PMC9434890 DOI: 10.1186/s12916-022-02478-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To examine the association between regular use of proton pump inhibitors and the risk of incident dementia, including dementia subtypes, and whether the association differs between APOE genotypes. METHODS Based on a prospective analysis of data from the UK Biobank, 501,002 individuals (female, 54.4%) aged between 40 and 70 years, who had no prevalent dementia at baseline, were enrolled between 2006 and 2010 and followed up to 2018. We compared all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD) incidence rates between proton pump inhibitor users and non-users by the Cox proportional hazard model. RESULTS During 4,438,839 person-years of follow-up (median length of follow-up, 9.0 years), there were 2505 incident cases of all-cause dementia, including 932 cases of AD and 524 cases of VaD. The incident rate of all-cause dementia among proton pump inhibitor users was 1.06 events per 1000 person-years, compared with 0.51 events per 1000 person-years among non-users. After adjustment for multiple confounders and indications, the hazard ratios (HRs) of the proton pump inhibitor users were 1.20 (95% CI, 1.07-1.35) for incident all-cause dementia, 1.23 (95% CI, 1.02-1.49) for incident AD, and 1.32 (95% CI, 1.05-1.67) for incident VaD. In addition, the association between proton pump inhibitor use and all-cause dementia differed by APOE genotype (P for interaction = 0.048). Among APOE ε4 heterozygotes, the fully adjusted HR of proton pump inhibitor use was 1.46 (95% CI, 1.22-1.75) and 1.68 (95% CI, 1.36-2.07), especially for individuals aged 65 years and older. CONCLUSIONS The finding of this large population-based cohort study indicates that the use of proton pump inhibitors is associated with an increased risk of incident dementia, particularly among APOE ε4 heterozygotes.
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Affiliation(s)
- Peidong Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.,Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Zhihao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Peiliang Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Ao Zhang
- State Key Laboratory of Molecular Neuroscience and Center of Systems Biology and Human Health, Division of Life Science, Hong Kong University of Science and Technology, Hong Kong, China
| | - Yu Zeng
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiru Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Qingmei Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Dan Liu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.,Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China. .,Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China. .,Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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Haefliger R, Dries LS, Perassolo MS, Cardoso CDO. Neuropsychological assessment after long-term omeprazole treatment. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 35930436 DOI: 10.1080/23279095.2022.2106570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Recent studies suggest that Omeprazole, a widely used treatment for gastric acid-related disorders, may have a significant effect on human cognition. However, there is no consensus on the matter. Though some studies suggest the drug is associated with an increased risk of cognitive decline, memory impairment, and dementia, this issue has not been sufficiently studied. Therefore, the goal of this study was to investigate the cognitive impairments associated with long-term Omeprazole treatment, with a focus on memory, attention, and executive functions. Additionally, we sought to verify whether the duration of treatment was associated with the magnitude of the associated cognitive impairments. The sample consisted of 30 participants of both genders treated with Omeprazole (experimental group) and 30 participants who did not use the drug (control group). The cognitive assessment battery: Verbal Fluency, Rey Auditory-Verbal Learning, Attention Assessment Battery, Five Digit Test, Hayling Test, and NEUPSILIN Subtest. The groups were compared using Student's T-tests, and the association between treatment duration and cognitive performance was examined using Pearson's coefficients. The results showed significant group differences in verbal fluency, short-term episodic memory, selective attention, and executive functions. The duration of Omeprazole treatment was also positively associated with the magnitude of cognitive impairment.
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Affiliation(s)
| | - Larissa Selbach Dries
- Program on Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, Brazil
| | - Magda Susana Perassolo
- Program on Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, Brazil
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22
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Chinzon D, Domingues G, Tosetto N, Perrotti M. SAFETY OF LONG-TERM PROTON PUMP INHIBITORS: FACTS AND MYTHS. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:219-225. [PMID: 35830032 DOI: 10.1590/s0004-2803.202202000-40] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are one of the most prescribed drugs in the world. Frequent use and long-term maintenance of these drugs drew the attention of researchers for sporadic adverse effects reports. OBJECTIVE The purpose of this narrative review is to discuss appropriate data and causality related to these adverse events and PPIs. METHODS A narrative review was conducted by systematizing information about safety and adverse events on PPIs from 2015 to 2020. A structured search on Pubmed was performed to identify systematic reviews and meta-analysis investigating the following situations: a) gastric cancer; b) micronutrients deficiency; c) acid rebound; d) infections; e) fractures; f) dementia; g) kidney disease; and h) sudden death and cardiovascular changes. RESULTS Recent studies have potentially associated PPIs with some adverse events as osteoporosis-related fractures. There are also reports of intestinal infections, including Clostridium difficile, besides poor vitamins absorption and minerals such as vitamin B12, magnesium, and iron. Furthermore, there are some dementia, pneumonia, kidney disease, myocardial infarction, and stroke reports. For kidney diseases, studies consistently suggest that the use of PPI may be associated with an increased risk of adverse kidney events, especially in the elderly, with long-term PPI use and pre-existing kidney disease. Another additional question is whether chronic PPI use would also lead to the onset of gastric cancer. The abrupt discontinuation of PPIs is also related to increased gastric acid production above pre-PPI treatment levels; this phenomenon is called acid rebound. CONCLUSION The key to mitigate adverse effects is the rational use of PPIs at the lowest effective dose and in the shortest possible duration. Although these adverse effects have a potential clinical impact, their causal association is still subject to validation.
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Affiliation(s)
- Decio Chinzon
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Gastroenterologia, São Paulo, SP, Brasil
| | - Gerson Domingues
- Faculdade de Medicina da Universidade do Estado do Rio Janeiro, Departamento de Gastroenterologia, Rio de Janeiro, RJ, Brasil
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23
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Inappropriateness of Proton Pump Inhibitors After Hospital Discharge Is Associated with Thirty-Day Hospital Readmission. Dig Dis Sci 2022; 67:817-825. [PMID: 33723702 DOI: 10.1007/s10620-021-06909-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/19/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Concerns have been raised about the adverse effects of proton pump inhibitors (PPIs). Rather than PPIs themselves causing harm, we hypothesized that PPIs prescribed without appropriate indications would be associated with adverse outcomes compared to appropriately indicated PPIs. METHODS Adult patients initiated on a new PPI during a hospitalization at our institution from 2014 to 2018 were analyzed. The primary outcome was all-cause 30-day readmission rate. The primary exposure was long-term appropriateness of PPI determined by the presence of prespecified diagnostic codes and discharge medications. Logistic regression modeling was used to estimate the odds of 30-day readmission in patients discharged on inappropriate compared to appropriate new PPIs. RESULTS Of 84,236 patients admitted to our institution, 7745 (9.2%) were discharged on a new PPI, of which 5136 (66.3%) lacked an appropriately documented indication. Inappropriate PPIs were associated with 30-day hospital readmission after adjusting for other factors (adjusted odds ratio 1.30, 95% confidence interval 1.10-1.53). The excess risk associated with lack of appropriate documentation for PPIs in these patients was 44 readmissions per 1000 hospitalizations (95% confidence interval 21-67). CONCLUSIONS Discharge on inappropriate PPIs was associated with 30-day hospital readmission compared to appropriate PPIs. The harm associated with inappropriate PPIs is not likely due to direct effects of PPIs because all patients in the study received PPIs. Rather, patients who receive inappropriate PPIs may have additional patient-specific factors that place them at increased risk for hospital readmission.
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24
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Wu C, Xiong LY, Ouk M, Rabin JS, Herrmann N, Lanctôt KL, Kapral MK, Law M, Cogo‐Moreira H, Edwards JD, Swardfager W. Gastric acid suppressants and cognitive decline in people with or without cognitive impairment. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12243. [PMID: 35169610 PMCID: PMC8829893 DOI: 10.1002/trc2.12243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Studies suggest associations between proton pump inhibitors (PPIs) and dementia risk; however, many neither considered histamine-2 receptor antagonists (H2RAs) nor baseline cognitive status. METHODS Participants (National Alzheimer's Coordinating Center Database; 2005-2021) using a PPI or H2RA were compared. Covariate-adjusted Cox regression was used to estimate hazard ratios (HR) for progression from normal cognition to mild cognitive impairment (MCI), and from MCI to dementia over 5 years. In a propensity-score-matched subsample of mild-moderate Alzheimer's disease (AD), mixed-effects negative binomial regression was used to estimate decline in delayed recall memory. RESULTS Compared to PPI, H2RA use was associated with earlier progression from MCI to dementia (HR = 1.40 [1.09-1.81]; n = 1701), and with faster memory decline in AD over time (rate ratio = 0.76 [0.64-0.92]; n = 628), but not with progression from normal cognition to MCI (HR = 0.94 [0.71-1.24]; n = 2784). DISCUSSION Compared to PPIs, H2RAs were associated with cognitive decline, specifically among people with pre-existing cognitive impairment.
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Affiliation(s)
- Che‐Yuan Wu
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Lisa Y. Xiong
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Michael Ouk
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Jennifer S. Rabin
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
- Division of NeurologyDepartment of MedicineSunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
- Rehabilitation Sciences InstituteUniversity of TorontoTorontoOntarioCanada
| | - Nathan Herrmann
- Department of PsychiatrySunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Krista L. Lanctôt
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- KITE University Health Network Toronto Rehabilitation InstituteTorontoOntarioCanada
| | - Moira K. Kapral
- ICESTorontoOntarioCanada
- Institute for Health Policy, Management, and EvaluationUniversity of TorontoTorontoOntarioCanada
- Division of General Internal MedicineDepartment of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Marcus Law
- University Health Network Toronto Rehabilitation InstituteTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Hugo Cogo‐Moreira
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Faculty of Education, ICT, and LearningØstfold University CollegeHaldenNorway
| | - Jodi D. Edwards
- University of Ottawa Heart InstituteUniversity of OttawaOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
- ICESOttawaOntarioCanada
| | - Walter Swardfager
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- KITE University Health Network Toronto Rehabilitation InstituteTorontoOntarioCanada
- Canadian Partnership for Stroke RecoverySunnybrook Research InstituteTorontoOntarioCanada
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25
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Mechanistic Link between Vitamin B12 and Alzheimer’s Disease. Biomolecules 2022; 12:biom12010129. [PMID: 35053277 PMCID: PMC8774227 DOI: 10.3390/biom12010129] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 01/27/2023] Open
Abstract
Alzheimer’s disease (AD) is the most common form of dementia in the elderly population, affecting over 55 million people worldwide. Histopathological hallmarks of this multifactorial disease are an increased plaque burden and tangles in the brains of affected individuals. Several lines of evidence indicate that B12 hypovitaminosis is linked to AD. In this review, the biochemical pathways involved in AD that are affected by vitamin B12, focusing on APP processing, Aβ fibrillization, Aβ-induced oxidative damage as well as tau hyperphosphorylation and tau aggregation, are summarized. Besides the mechanistic link, an overview of clinical studies utilizing vitamin B supplementation are given, and a potential link between diseases and medication resulting in a reduced vitamin B12 level and AD are discussed. Besides the disease-mediated B12 hypovitaminosis, the reduction in vitamin B12 levels caused by an increasing change in dietary preferences has been gaining in relevance. In particular, vegetarian and vegan diets are associated with vitamin B12 deficiency, and therefore might have potential implications for AD. In conclusion, our review emphasizes the important role of vitamin B12 in AD, which is particularly important, as even in industrialized countries a large proportion of the population might not be sufficiently supplied with vitamin B12.
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Kim Y, Seo SI, Lee KJ, Kim J, Yoo JJ, Seo WW, Lee HS, Shin WG. Long-term use of proton-pump inhibitor on Alzheimer’s disease: a real-world distributed network analysis of six observational Korean databases using a Common Data Model. Ther Adv Neurol Disord 2022; 15:17562864221135700. [PMID: 36389281 PMCID: PMC9647297 DOI: 10.1177/17562864221135700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background: Dementia has a crucial impact on the quality of life of elderly patients and
their caregivers. Proton-pump inhibitors (PPIs) are the most frequently
prescribed treatment, but they have been shown to be associated with
dementia. The data are inconsistent, however. Objective: To investigate the association between PPIs use and Alzheimer’s disease (AD)
or all-cause dementia in six observational Korean databases using a Common
Data Model (CDM) and to perform a distributed network analysis. Methods: Subjects aged over 18 years between 1 January 2004 and 31 December 2020.
Among 7,293,565 subjects from 6 cohorts, 41,670 patients met the eligibility
criteria. A total of 2206 patients who were included in both cohorts or with
a history of dementia were excluded. After propensity matching, 5699
propensity-matched pairs between the PPIs and histamine-2 receptor
antagonist (H2RA) users were included in this study. The primary
outcome was the incidence of AD at least 365 days after drug exposure. The
secondary outcome was the incidence of all-cause dementia at least 365 days
after drug exposure. Results: In the 1:1 propensity score matching, the risk of AD or all-cause dementia
was not significantly different between the PPIs and H2RA groups
in all six databases. In the distributed network analysis, the long-term PPI
users (⩾365 days) were unassociated with AD [hazard ratio (HR) = 0.92, 95%
confidence interval (CI) = 0.68–1.23; I2 = 0%]
and all-cause dementia (HR =1.04, 95% CI = 0.82–1.31;
I2 = 0%) compared with H2RA
users. Conclusion: In the distributed network analysis of six Korean hospital databases using
Observational Medical Outcomes Partnership (OMOP)-CDM data, the long-term
use of PPI was not associated with a statistically significantly increased
risk of AD or all-cause dementia. Therefore, we suggest that physicians
should not avoid these medications because of concern about dementia
risk.
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Affiliation(s)
- Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea
| | - Seung In Seo
- Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
| | - Kyung Joo Lee
- University Industry Foundation, Hallym University, Chuncheon, South Korea
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea
| | - Jong Jin Yoo
- Division of Rheumatology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea
| | - Won-Woo Seo
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea
| | - Hyung Seok Lee
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, South Korea
| | - Woon Geon Shin
- Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, 150, Seongan-ro, Gangdong-gu, Seoul 05355, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
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No association between acid suppressant use and risk of dementia: an updated meta-analysis. Eur J Clin Pharmacol 2021; 78:375-382. [PMID: 34811582 DOI: 10.1007/s00228-021-03248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Findings from large observational studies on whether the use of acid suppressants increases the risk of dementia have been inconsistent. Since proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA) are the most commonly used acid suppressants in clinical practice, we performed a meta-analysis to examine the influence of PPI and H2RA on the risk of dementia. METHODS A systematic search was performed on the PubMed, EMBASE, and Cochrane Library databases to identify studies published up to April, 2021. Studies that reported adjusted hazard ratio (HR) with 95% confidence intervals (CI) for the associations of interest were included. Data in the included studies were pooled using the random-effects model for meta-analysis. Statistical analysis was performed using Stata version 12.0 software. RESULTS Seventeen studies involving 1,251,562 participants were included. It was found that PPI users were not likely to develop dementia compared with those not taking PPI (HR = 0.98, 95% CI: 0.85-1.13). Subgroup analysis based on publication year, location, mean age, duration of PPI use, and female proportion also revealed no association between PPI use and dementia risk. Similarly, H2RA use was not associated with the risk of dementia, as indicated by the pooled HR of 1.20 (95% CI: 0.98-1.47). CONCLUSION Results of this meta-analysis suggest that PPI and H2RA do not increase the risk of dementia. These results may be used to inform the clinical application of acid suppressants. However, further randomized controlled trials are needed to confirm the present conclusions.
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Papazoglou A, Arshaad MI, Henseler C, Daubner J, Broich K, Haenisch B, Weiergräber M. The Janus-like Association between Proton Pump Inhibitors and Dementia. Curr Alzheimer Res 2021; 18:453-469. [PMID: 34587884 PMCID: PMC8778640 DOI: 10.2174/1567205018666210929144740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022]
Abstract
Early pharmacoepidemiological studies suggested that Proton Pump Inhibitors (PPIs) might increase the risk of Alzheimer’s Disease (AD) and non-AD related dementias. These findings were supported by preclinical studies, specifically stressing the proamyloidogenic and indirect anticholinergic effects of PPIs. However, further large-scale pharmacoepidemiological studies showed inconsistent results on the association between PPIs and dementia. Pharmacodynamically, these findings might be related to the LXR/RXR-mediated amyloid clearance effect and anti-inflammatory action of PPIs. Further aspects that influence PPI effects on AD are related to patient-specific pharmacokinetic and pharmacogenomic characteristics. In conclusion, a personalized (individualized) medicinal approach is necessary to model and predict the potential harmful or beneficial effects of PPIs in AD and non-AD-related dementias in the future.
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Affiliation(s)
- Anna Papazoglou
- Experimental Neuropsychopharmacology, Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM), Kurt-Georg-Kiesinger-Allee 3, 53175 Bonn, Germany
| | - Muhammad I Arshaad
- Experimental Neuropsychopharmacology, Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM), Kurt-Georg-Kiesinger-Allee 3, 53175 Bonn, Germany
| | - Christina Henseler
- Experimental Neuropsychopharmacology, Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM), Kurt-Georg-Kiesinger-Allee 3, 53175 Bonn, Germany
| | - Johanna Daubner
- Experimental Neuropsychopharmacology, Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM), Kurt-Georg-Kiesinger-Allee 3, 53175 Bonn, Germany
| | - Karl Broich
- Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM) 53127, Kurt-Georg- Kiesinger-Allee 3, 53175 Bonn, Germany
| | - Britta Haenisch
- Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM) 53127, Kurt-Georg- Kiesinger-Allee 3, 53175 Bonn, Germany
| | - Marco Weiergräber
- Experimental Neuropsychopharmacology, Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM), Kurt-Georg-Kiesinger-Allee 3, 53175 Bonn, Germany
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Yoon KT, Bang CS, Kim JS. Proton-pump Inhibitors and the Risk of Dementia: A Systematic Review and Meta-analysis. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2020.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wu B, Hu Q, Tian F, Wu F, Li Y, Xu T. A pharmacovigilance study of association between proton pump inhibitor and dementia event based on FDA adverse event reporting system data. Sci Rep 2021; 11:10709. [PMID: 34021217 PMCID: PMC8139970 DOI: 10.1038/s41598-021-90108-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/04/2021] [Indexed: 02/08/2023] Open
Abstract
Proton pump inhibitor (PPI) was widely used around the world. Studies suggested conflicting results between PPI treatment and dementia event. This study examined the association between six PPI agents and dementia event by mining the US FDA Adverse Event Reporting System (FAERS) database from 2004 to 2020. We employed proportional reporting ratio (PRR) and information element (IC) methods to detect the signals of dementia relevant to PPI. We also analyzed characteristics of PPI and positive control reports, compared dementia event between long- and short-duration of PPI treatment. Finally, we identified 2396 dementia cases with PPI treatment. We did not detect significant signal between PPI and dementia event: PRR = 0.98, 95%CI 0.94 to 1.02, IC = −0.03, 95%CI − 0.17 to 0.10, even in gastroesophageal reflux disease cases: PRR = 0.65, 95%CI 0.59 to 0.72, IC = −0.62, 95%CI − 0.97 to − 0.27. No significant differences of dementia event were detected between long- and short- duration groups, the OR (95%CI) of the 3 years, 5 years and 10 years comparison were 0.70 (0.48 to 1.02), 0.72 (0.45 to 1.15) and 1.65 (0.75 to 3.63), respectively. Based on the current FAERS data mining, we discovered no association between PPI use and dementia event, even in long-term PPI therapy case.
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Affiliation(s)
- Bin Wu
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China
| | - Qiaozhi Hu
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China
| | - Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China
| | - Fengbo Wu
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China
| | - Yuwen Li
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China
| | - Ting Xu
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China. .,West China School of Pharmacy, Sichuan University, Chengdu, 610041, Sichuan, China.
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Lack of association between proton pump inhibitor use and decline in cognitive performance in the ELSA-Brasil cohort. Eur J Clin Pharmacol 2021; 77:1725-1735. [PMID: 34014336 DOI: 10.1007/s00228-021-03156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The study aims to investigate the longitudinal association of use and time of use of proton pump inhibitors (PPIs) with decreased performance in three cognitive tests. METHODS Prospective cohort study included 7115 participants with mean age of 58.9 years at baseline (2008-2010) who participated in the second wave (2012-2014) of ELSA-Brasil (average interval between visits = 3.9 years (range: 1.7 to 6.0 years)). Cognitive performance was assessed by tests of memory, phonemic and semantic verbal fluency, and the trail making test, applied to both waves. Associations with the use and time of use of PPIs at baseline were investigated using linear models with mixed effects after adjusting for confounding factors. RESULTS At baseline, 7.4% (529) of the participants used PPIs on a regular basis. After all adjustments, the interaction term use of PPI × age was not statistically significant for the cognitive tests evaluated, indicating that the use of PPI at baseline was not associated with a more accelerated decline in cognitive performance between waves. The interaction term PPI use × age was not statistically significant, in any of the categories of medication use time, any of the cognitive function tests evaluated, indicating that PPI use time is not associated with decrease in cognitive scores as the time interval between visits increases. CONCLUSION In this cohort middle-aged and elderly adults, after average interval of 3.9 years (relatively short time to detect cognitive decline in a young cohort), the use and time of use of PPIs at the beginning of the study were not associated with a decline in cognitive performance in these tests between visits.
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Asdaq SMB, ALbasha M, Almutairi A, Alyabisi R, Almuhaisni A, Faqihi R, Alamri AS, Alsanie WF, Alhomrani M. Use of proton pump inhibitors: An exploration of awareness, attitude and behavior of health care professionals of Riyadh, Saudi Arabia. Saudi Pharm J 2021; 29:713-718. [PMID: 34400866 PMCID: PMC8347654 DOI: 10.1016/j.jsps.2021.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background & Objectives One of the broadly talked about class of medications for their extravagantly expanded abuse is proton pump inhibitors (PPIs). In spite of the fact that, they are known to be profoundly useful, it is accounted for several adverse manifestations. Health care professionals can assume an essential part in controlling its irrational use. The purpose of this study was to explore the knowledge, attitude and behavior of health care professionals of Riyadh region of Saudi Arabia on the use of PPIs by a cross-sectional study design. Methods The study data was obtained through a validated self-administered questionnaire covering knowledge (20 items), attitude (8 items) and behavior (6 items). Furthermore, demographic questions were placed to decide their effect on the intended three domains. The results were analysed by descriptive analysis and affirmed by multinomial regression method using SPSS-IBM 25. Results Of 414 surveyors, 121 (31%), 182 (44%) and 103 (25%) were doctors, pharmacist and nurses, respectively. Average age of participants' was 33.96 ± 8.37 years. Both doctors and pharmacist showed better degree of information (13.17/20 and 13.25/20) and good attitude (6.66/8 and 6.9/8) towards PPI use compared to nurses. Altogether higher extent of knowledge score showed by highly educated individuals, middle age groups and those with more practicing experience. The reliance on the utilization of PPI is less among pharmacist and nurses when compared to doctors. The outcome of the regression analysis exhibited that the odds of having low knowledge is more in young and bachelor degree holders. Interpretation & Conclusion Healthcare professionals in the Riyadh area are generally positive about the use of PPIs. However, increasing their level of knowledge and reducing their reliance on PPIs must be strengthened. Frequent professional development programs and trainings for healthcare professionals are needed to minimize widespread PPI overuse.
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Affiliation(s)
| | - Marah ALbasha
- Pharm.D Interns, College of Pharmacy, AlMaarefa University, Dariyah, 13713, Riyadh, Saudi Arabia
| | - Asmaa Almutairi
- Pharm.D Interns, College of Pharmacy, AlMaarefa University, Dariyah, 13713, Riyadh, Saudi Arabia
| | - Reham Alyabisi
- Pharm.D Interns, College of Pharmacy, AlMaarefa University, Dariyah, 13713, Riyadh, Saudi Arabia
| | - Alaa Almuhaisni
- Pharm.D Interns, College of Pharmacy, AlMaarefa University, Dariyah, 13713, Riyadh, Saudi Arabia
| | - Roaa Faqihi
- Pharm.D Interns, College of Pharmacy, AlMaarefa University, Dariyah, 13713, Riyadh, Saudi Arabia
| | - Abdulhakeem S Alamri
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.,Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Saudi Arabia
| | - Walaa F Alsanie
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.,Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Saudi Arabia
| | - Majid Alhomrani
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.,Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Saudi Arabia
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Abstract
Proton pump inhibitors (PPIs) are amongst the most commonly prescribed drugs in infants and children with the last decades witnessing a dramatic rise in their utilization. Although PPIs are clearly effective when used appropriately and have been regarded as safe drugs, there is growing evidence regarding their potential adverse effects. Although, largely based on adult data it is clear that many of these are also relevant to pediatrics. PPI use potentially affects gastrointestinal microbiota composition and function, decreases defence against pathogens resulting in increased risk for infections, interferes with absorption of minerals and vitamins leading to specific deficiencies and increased risk for bone fractures as well as interferes with protein digestion resulting in increased risk of sensitization to allergens and development of allergic diseases and eosinophilic esophagitis. An association with gastric, liver and pancreatic cancer has also been inferred from adult data but is tenuous and causation is not proven. Overall, evidence for these adverse events is patchy and not always compelling. Overall, the use of PPIs, for selected indications with a good evidence base, has significant potential benefit but carries more caution in infants and children. Pediatricians should be aware of the concerns regarding the potential adverse events associated with their use.
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Ali SB, Mahmood K, Saeed R, Salman T, Choudhary MI, Haleem DJ. Elevated anxiety, hypoactivity, memory deficits, decreases of brain serotonin and 5-HT-1A receptors expression in rats treated with omeprazole. Toxicol Res 2021; 37:237-248. [PMID: 33868980 DOI: 10.1007/s43188-020-00060-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/11/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022] Open
Abstract
Omeprazole (OM) is one of the most prescribed drugs worldwide for the treatment of hyperacidity and gastric reflux. However, concerns regarding its safety have emerged recently, and the drug is reported to enhance the risk for anxiety and cognitive deficits, particularly in elderly patients. The present study investigated these adverse effects, if any, in adult male rats. Associated changes in brain serotonin (5-hydroxytryptamine; 5-HT) and dopamine metabolism and the expression of 5-HT-1A receptors in the raphe and hippocampus were also determined. The drug was injected i.p. in doses of 10 and 20 mg/kg for 15 days. Both doses of OM decreased motor activity in an open field and impaired learning and memory in the Morris water maze test. Anxiety monitored in an elevated plus maze test was enhanced in rats treated with 20 mg/kg OM only. The levels of 5-HT and its metabolite 5-hydroxyindoleacetic acid and of homovanillic acid, a metabolite of dopamine, determined by HPLC-EC, were decreased in the brain of OM treated rats. The expression of 5-HT-1A receptor, determined by qRT-PCR, was reduced markedly in the hippocampus and moderately in the raphe. Our results provide evidence that OM use can reduce raphe hippocampal serotonin neurotransmission to lead to anxiety/depression and cognitive impairment. There is a need for increased awareness and prescription guidelines for therapeutic use of OM and possibly also other proton pump inhibitors.
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Affiliation(s)
- Sadia Basharat Ali
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Khalid Mahmood
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Raheel Saeed
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Tabinda Salman
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Muhammad Iqbal Choudhary
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Darakhshan Jabeen Haleem
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
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Emmanuel K, von Rahden BHA, Kalff J. Antirefluxchirurgie 2021. Zentralbl Chir 2021; 146:163-164. [PMID: 33851380 DOI: 10.1055/a-1384-4468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lin HC, Huang KT, Lin HL, Uang YS, Ho Y, Keller JJ, Wang LH. Use of gastric acid-suppressive agents increases the risk of dementia in patients with upper gastrointestinal disease: A population-based retrospective cohort study. PLoS One 2021; 16:e0249050. [PMID: 33765029 PMCID: PMC7993796 DOI: 10.1371/journal.pone.0249050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Prescriptions for gastric acid-suppressive agents, including proton-pump inhibitors (PPIs) and histamine type-2 receptor antagonists (H2RAs), are rising. However, little data exist regarding their association with dementia in the Asian population. The objective of this study was thus to investigate the impact of the use of PPIs and H2RAs on the risk of dementia in an Asian population with upper gastrointestinal disease (UGID). METHODS We conducted a population-based retrospective cohort study with a 10-year follow-up using data from 2000 to 2015 derived from Taiwan's Longitudinal Health Insurance Database. We included 6711 patients with UGID receiving gastric acid-suppressive agents, 6711 patients with UGID not receiving agents, and 6711 patients without UGID or treatment thereof, all at least 20 years of age. Groups were matched for age, sex, and index date. The association between gastric acid-suppressive agent use and dementia was analyzed using a Cox proportional hazards regression model adjusted for potential confounders. RESULTS The adjusted hazard ratio (aHR) of dementia for patients with UGID receiving gastric acid-suppressive agents compared with patients with UGID without gastric acid-suppressive agents was 1.470 (95% confidence interval [CI] 1.267-1.705, p < 0.001). Both PPIs and H2RAs increase the risk of dementia (PPIs: aHR 1.886 [95% CI 1.377-2.582], p < 0.001; H2RAs: aHR 1.357 [95% CI 1.098-1.678], p < 0.01), with PPIs exhibiting significantly greater risk (aHR 1.456 [95% CI 1.022-2.075], p < 0.05). CONCLUSIONS Our results demonstrate an increased risk of dementia in patients with UGID receiving gastric acid-suppressive agents, including PPIs and H2RAs, and the use of PPIs was associated with a significantly greater risk than H2RA use.
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Affiliation(s)
- Hsiu-Chen Lin
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Clinical Pathology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuan-Tzu Huang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Division of Clinical Pharmacy, Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Li Lin
- Department of Neurology, General Cathay Hospital, New Taipei City, Taiwan
| | - Yow-Sheng Uang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yi Ho
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Joseph Jordan Keller
- College of Medicine, Ohio State University, Columbus, Ohio, United States of America
| | - Li-Hsuan Wang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan
- * E-mail:
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Collin BG, Raju D, Altman J, Katsikas S. The effects of proton pump inhibitors on neuropsychological functioning. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1403-1412. [PMID: 33651951 DOI: 10.1080/23279095.2021.1883019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The current study investigated the effects of proton pump inhibitor use and apolipoprotein ε4 carrier status on changes in neuropsychological functioning in healthy adults with familial risk factors for dementia. METHODS As part of the Wisconsin Registry for Alzheimer's Prevention study, 1,573 subjects were administered questionnaires on their medical history, gave blood samples, and were administered neuropsychological assessments during four visits over a 10-15 year period. Linear mixed models assessed if non-users, subjects who stopped, started, or consistently used proton pump inhibitors differed in changes in working memory, verbal memory, psychomotor speed, and cognitive flexibility. RESULTS The models did not yield significant main effects for proton pump inhibitor use or interaction effects between proton pump inhibitor use and apolipoprotein ε4 carrier status on a decline in memory or processing speed. An interaction effect suggested stopping a proton pump inhibitor may be protective against declines in cognitive flexibility among non-carriers. CONCLUSIONS Although stopping a proton pump inhibitor use may have mild protective effects on executive functioning for non-apolipoprotein ε4 carriers, proton pump inhibitor use was not associated with memory decline in a sample of subjects with familial risk factors for dementia.
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Affiliation(s)
| | - Dheeraj Raju
- Cancer Treatment Centers of America Global Inc, Boca Raton, FL, USA
| | - Jennifer Altman
- Spalding University School of Professional Psychology, Louisville, KY, USA
| | - Steve Katsikas
- Spalding University School of Professional Psychology, Louisville, KY, USA
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Dries LS, Haefliger R, Seibert BS, de Lima AG, Cardoso CDO, Perassolo MS. Cognition, oxidative stress and vitamin B12 levels evaluation on patients under long-term omeprazole use. J Pharm Pharmacol 2021; 74:547-555. [PMID: 33793790 DOI: 10.1093/jpp/rgab001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/08/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the differences concerning cognitive performance, oxidative stress and vitamin B12 levels in omeprazole users under treatment for longer than six months. METHODS A case-control study was developed with 44 omeprazole users (OU; 81.8 % female, 66 ± 8.7 years old) and 35 nonusers (NOU; 88.6 % female, 62 ± 8.7 years old). The cognitive ability was assessed through tests approaching attention, memory and executive functions. The vitamin B12 was dosage using a chemiluminescent immunoassay and oxidative stress analysis, based on the evaluation of malondialdehyde, enzymatic activity of extracellular superoxide dismutase, glutathione peroxidase, catalase and the ferric reducing antioxidant power in plasma. KEY FINDINGS A significant increase of the ferric reducing antioxidant power [omeprazole users (OU) group = 1690 µM ± 441 and nonusers (NOU) group = 1308 ± 616; P value=0.002] and a decrease on glutathione peroxidase levels [OU group = 0.534 (0.27-10.63) and NOU group = 71.86 (14.36-173.1); P value=0.006] were found on omeprazole users group, as well as differences on cognitive performance, with impairments on executive functions, automatic and attentional processing. CONCLUSIONS Long-term use of omeprazole is suggested to induce an oxidative stress condition, which causes neurotoxicity and cognitive decline.
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Affiliation(s)
- Larissa Selbach Dries
- Graduate Program on Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil
| | | | | | | | | | - Magda Susana Perassolo
- Program on Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil
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Arai J, Kato J, Toda N, Kurokawa K, Shibata C, Kurosaki S, Funato K, Kondo M, Takagi K, Kojima K, Ohki T, Seki M, Tagawa K. Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers. BMC Gastroenterol 2021; 21:16. [PMID: 33407172 PMCID: PMC7789673 DOI: 10.1186/s12876-020-01580-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 12/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU. Methods In total, 582 patients diagnosed with HGU were retrospectively analyzed. Admission to a care facility or the need for home adaptations during hospitalization were defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis. Results Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR] 3.43; 95% confidence interval [CI] 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR 5.80; 95% CI 2.08–16.2), and heart disease (OR 3.05; 95% CI 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR 8.24; 95% CI 2.36–28.7). Conclusion In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.
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Affiliation(s)
- Junya Arai
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Jun Kato
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Nobuo Toda
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
| | - Ken Kurokawa
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Chikako Shibata
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Shigeyuki Kurosaki
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kazuyoshi Funato
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Mayuko Kondo
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kaoru Takagi
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kentaro Kojima
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Takamasa Ohki
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Michiharu Seki
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kazumi Tagawa
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
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Azhar M, Fiedler L, Espinosa PS, Hennekens CH. Proton Pump Inhibitors and Risk of Dementia: A Hypothesis Generated but Not Adequately Tested. Am J Alzheimers Dis Other Demen 2021; 36:15333175211062413. [PMID: 34935509 PMCID: PMC10581100 DOI: 10.1177/15333175211062413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We reviewed the evidence on proton pump inhibitors (PPIs) and dementia. PPIs are among the most widely utilized drugs in the world. Dementia affects roughly 5% of the population of the United States (US) and world aged 60 years and older. With respect to PPIs and dementia, basic research has suggested plausible mechanisms but descriptive and analytic epidemiological studies are not inconsistent. In addition, a single large-scale randomized trial showed no association. When the evidence is incomplete, it is appropriate for clinicians and researchers to remain uncertain. Regulatory or public health authorities sometimes need to make real-world decisions based on real-world data. When the evidence is complete, then the most rational judgments for individual patients the health of the general public are possible At present, the evidence on PPIs and dementia suggests more reassurance than alarm. Further large-scale randomized evidence is necessary to do so.
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Affiliation(s)
- Mishah Azhar
- PGY-3 Internal Medicine Resident, Charles E. Schmidt College of Medicine, Graduate Medical Education Consortium (Bethesda Hospital, Boca Raton Regional Hospital, Delray Medical Center, St Mary’s Medical Center, West Boca Raton Hospital), Florida Atlantic University, Boca Raton, FL, USA
| | - Lawrence Fiedler
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Charles H. Hennekens
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Krivanek TJ, Gale SA, McFeeley BM, Nicastri CM, Daffner KR. Promoting Successful Cognitive Aging: A Ten-Year Update. J Alzheimers Dis 2021; 81:871-920. [PMID: 33935078 PMCID: PMC8293659 DOI: 10.3233/jad-201462] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.
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Affiliation(s)
- Taylor J. Krivanek
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Seth A. Gale
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Brittany M. McFeeley
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Casey M. Nicastri
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Kirk R. Daffner
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
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Lei WY, Wang JH, Yi CH, Liu TT, Hung JS, Wong MW, Bair MJ, Vaezi MF, Orr WC, Chen CL. Association between use of proton pump inhibitors and colorectal cancer: A nationwide population-based study. Clin Res Hepatol Gastroenterol 2021; 45:101397. [PMID: 32224118 DOI: 10.1016/j.clinre.2020.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/14/2020] [Accepted: 02/21/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) use is associated with hypergastrinemia and gut microbiota alteration. Concern over the risk that these factors may increase chances of colorectal cancer (CRC) has risen. To investigate the association between PPIs use and CRC using a large population-based cohort and examine whether the PPIs may differ regarding the risk of CRC. METHODS We conducted a nationwide cohort study using a database from Taiwan National Health Insurance followed up longitudinally from 1999 through 2011. Patients with PPIs use were compared with non-use controls at a 1:1 ratio, for age, sex, comorbidities, and medications. We performed Cox proportional-hazards regression analysis to estimate the association between PPIs use and the development of CRC. RESULTS Among the 45382 eligible PPIs users, 172 (0.4%) developed CRC during a median follow-up of 5.4 years. PPIs use was associated with a higher risk of CRC with an adjusted HR of 2.03 (95% CI 1.56-2.63, P<0.001). The risk increased with more frequent use of PPIs (HR 1.59, 95% CI 1.19-2.14; 2.59, 95% CI 1.84-3.65 and 4.33, 95% CI 2.75-6.80 for ≤30 cDDD per year, 30-90 cDDD per year, and ≥90 cDDD per year, respectively). There was also a statistically significant trend toward an increased risk with long-term PPIs use for more than one year. All PPIs, except pantoprazole and rabeprazole, were associated with an increased risk of CRC. CONCLUSIONS The present study suggests that PPIs use might increase the risk of CRC in a dose-dependent manner.
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Affiliation(s)
- Wei-Yi Lei
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chih-Hsun Yi
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Tso-Tsai Liu
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Jui-Sheng Hung
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Ming-Wun Wong
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Ming-Jong Bair
- Department of Internal Medicine, Taitung Mackay Memorial Hospital and Mackay Medical College, New Taipei, Taiwan
| | - Michael F Vaezi
- Divison of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William C Orr
- Lynn Institute for Healthcare Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Chien-Lin Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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43
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Jacks A, Kavookjian H, Kraft S. Comparative Evaluation and Management of Dysphonia Between Adults <65 and ≥65 Years of Age. Otolaryngol Head Neck Surg 2020; 165:142-148. [PMID: 33290166 DOI: 10.1177/0194599820978435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare presenting symptoms, etiology, and treatment outcomes among dysphonic adults <65 and ≥65 years of age. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care voice center between January 2011 and June 2016. METHODS A total of 755 patients presenting for dysphonia were included in the study: 513 adults <65 years of age and 242 adults ≥65. Data collected included demographics, referral information, prior diagnoses, prior treatments, clinical examination findings, diagnosis, coexisting symptoms, treatments, and pre- and postintervention Voice Handicap Index scores. Statistical analysis was performed with SPSS to determine significant relationships between variables of interest. RESULTS The most common etiologies of dysphonia were vocal cord atrophy (44.8%) in the ≥65 cohort and benign vocal cord lesions (17.8%) in the <65 cohort. When compared with adults <65 years old, patients ≥65 had a higher incidence of neurologic dysphonia (P = .006) and vocal cord atrophy (P < .001) but were less likely to have laryngopharyngeal reflux (P = .001), benign vocal cord lesions (P < .001), or muscle tension dysphonia (P < .001). Overall, 139 patients had surgery, 251 received medical therapy, and 156 underwent voice therapy. The ≥65 cohort demonstrated improvement in Voice Handicap Index scores after surgery (P = .001) and voice therapy (P = .034), as did the <65 cohort (surgery, P < .001; voice therapy, P = .015). Adult surgical patients <65 reported greater improvements than patients ≥65 (P = .021). CONCLUSIONS There are notable differences in the pathophysiology of dysphonia between patients aged ≥65 and <65 years. Although adults <65 reported slightly better outcomes with surgery, patients ≥65 obtained significant benefit from surgery and voice therapy.
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Affiliation(s)
- Amy Jacks
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hannah Kavookjian
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shannon Kraft
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Torres-Bondia F, Dakterzada F, Galván L, Buti M, Besanson G, Gill E, Buil R, de Batlle J, Piñol-Ripoll G. Proton pump inhibitors and the risk of Alzheimer's disease and non-Alzheimer's dementias. Sci Rep 2020; 10:21046. [PMID: 33273636 PMCID: PMC7713356 DOI: 10.1038/s41598-020-78199-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Proton pump inhibitors (PPIs) are among the most prescribed medications. Previous epidemiological studies have presented contradictory results about PPIs and the risk of dementia. Our objective was to investigate the association between the use of PPIs and an increasing risk of incident AD or non-AD dementias. A community-based retrospective cohort study was conducted based on the data available from 1st January 2002 to 31st December 2015 in the Catalan health service (CatSalut) system. This cohort included all PPI users (N = 36,360) and non-users (N = 99,362). A lag window of 5 years was considered between the beginning of the PPI treatment and the diagnosis of dementia. PPI use was not associated with the risk of AD (adjusted odds ratio (OR) 1.06) (95% CI 0.93–1.21; p = 0.408). A weakly but significantly increased risk of non-AD dementias was observed among PPI users (adjusted OR 1.20, 95% CI 1.05–1.37; p = 0.007). A higher dose of PPIs was not associated with an increased risk of either AD or non-AD dementias (OR 1.20; 95% CI 0.91–1.61 and OR 0.95; 95% CI 0.74–1.22, respectively). Regarding the number of PPIs used, we observed an increased risk of AD (OR 1.47; 95% CI 1.18–1.83) and non-AD dementias (OR 1.38; 95% CI 1.12–1.70) in users of two types of PPIs compared with those who used only one type. We did not find a higher incidence of AD among PPI users, but a weak increase in the risk of non-AD dementias among PPI users was observed.
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Affiliation(s)
- Francisco Torres-Bondia
- Unitat Trastorns Cognitius (Cognitive Disorders Unit), Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Rovira Roure no. 44, 25198, Lleida, Spain
| | - Farida Dakterzada
- Unitat Trastorns Cognitius (Cognitive Disorders Unit), Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Rovira Roure no. 44, 25198, Lleida, Spain
| | - Leonardo Galván
- Pharmacy Department, Servei Català de La Salut (Catalan Health Services), Lleida, Spain
| | - Miquel Buti
- Unitat D'Avaluació Clínica (Clinical Evaluation Unit), Institut Català de La Salut (Catalan Institute of Health), Lleida, Spain
| | - Gaston Besanson
- Accenture Innovation Center, Barcelona, Spain.,Barcelona Graduate School of Economics (BGSE), Barcelona, Spain
| | - Eric Gill
- Accenture Innovation Center, Barcelona, Spain
| | - Roman Buil
- Accenture Innovation Center, Barcelona, Spain.,Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Arnau de Vilanova University Hospital and Santa Maria University Hospital, IRBLleida, Lleida, Spain.,Biomedical Research Networking Center in Respiratory Diseases (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Gerard Piñol-Ripoll
- Unitat Trastorns Cognitius (Cognitive Disorders Unit), Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Rovira Roure no. 44, 25198, Lleida, Spain.
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Wu CL, Lei WY, Wang JS, Lin CE, Chen CL, Wen SH. Acid suppressants use and the risk of dementia: A population-based propensity score-matched cohort study. PLoS One 2020; 15:e0242975. [PMID: 33253311 PMCID: PMC7703973 DOI: 10.1371/journal.pone.0242975] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/23/2020] [Indexed: 01/30/2023] Open
Abstract
In this population-based propensity score matched (PSM) cohort study, we aimed to investigate the risk of developing dementia with the use of acid suppressants, including proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2 antagonists). Cohorts of PPI users (n = 2,778), H2 antagonist users (n = 6,165), and non-users (n = 86,238) were selected from a dataset covering the years 2000 to 2010 in Taiwan’s National Health Insurance Research Database. Patients in the three groups were PSM at a ratio of 1:1 within each comparison cohort (CC). Three CCs were created: (1) PPI users compared to non-users (CC1, n = 2,583 pairs); (2) H2 antagonist users compared to non-users (CC2, n = 5,955 pairs); and (3) PPI users compared to H2 antagonist users (CC3, n = 2,765 pairs). A multivariable robust Cox proportional hazard model was used to estimate the adjusted hazard ratio (aHR) and the 95% confidence interval (CI) for the risk of developing dementia. The multivariable analysis results show that the aHR of developing dementia during the follow-up period was 0.72 (CC1: 95% CI = 0.51–1.03, P = 0.07) for PPI users and 0.95 (CC2: 95% CI = 0.74–1.22, P = 0.69) for H2 antagonist users, when compared to non-users. Between the patients using acid suppressants, there was no difference between PPI and H2 antagonist users in the risk of developing dementia (CC3: aHR = 0.82, 95% CI = 0.58–1.17, P = 0.28). In conclusion, no association was observed between the use of acid suppressants and the risk of developing dementia in any of the three CCs. Further, randomized controlled trials are warranted to confirm this relationship.
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Affiliation(s)
- Chia-Liang Wu
- Department of Psychiatry, Taipei Veterans General Hospital, Hualien City, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien City, Taiwan
| | - Wei-Yi Lei
- Institute of Medical Sciences, Tzu Chi University, Hualien City, Taiwan
- Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien City, Taiwan
| | - Jaw-Shing Wang
- Department of Psychiatry, Taipei Veterans General Hospital, Hualien City, Taiwan
| | - Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Chien-Lin Chen
- Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien City, Taiwan
| | - Shu-Hui Wen
- Institute of Medical Sciences, Tzu Chi University, Hualien City, Taiwan
- Department of Public Health, College of Medicine, Tzu Chi University, Hualien City, Taiwan
- * E-mail:
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Asdaq SMB, Swathi E, Dhamanigi SS, Asad M, Ali Mohzari Y, Alrashed AA, Alotaibi AS, Mohammed Alhassan B, Nagaraja S. Role of Daucus carota in Enhancing Antiulcer Profile of Pantoprazole in Experimental Animals. MOLECULES (BASEL, SWITZERLAND) 2020; 25:molecules25225287. [PMID: 33202703 PMCID: PMC7696376 DOI: 10.3390/molecules25225287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022]
Abstract
The carrot plant (Daucus carota) and its components are traditionally reported for the management of gastric ulcers. This study was performed to evaluate the role of carrot when administered concurrently with a conventional antiulcer treatment, pantoprazole, in alleviating gastric and duodenal ulcers in female experimental animals. The study involved standard animal models to determine the ulcer preventive effect using pylorus ligation, ethanol, and stress induced acute gastric ulcer models and duodenal ulcer models involving cysteamine. Acetic acid-induced chronic gastric ulcer and indomethacin-induced gastric ulcer models were used to evaluate the ulcer healing effect. Carrot fruit (500 mg/kg) and its co-administration with pantoprazole produced significant protection in an ethanol- and stress-induced acute gastric ulcer and cysteamine-induced duodenal ulcer. The healing of the acetic acid-induced chronic gastric ulcer was also augmented with this combination. Both total proteins and mucin contents were significantly increased in indomethacin-induced gastric ulcers. Similarly, in pylorus ligation, the pepsin content of gastric juice, total acidity, and free acidity were reduced. Overall, both ulcer preventive effects and ulcer healing properties of the pantoprazole were significantly enhanced in animals who received the co-administration of carrot fruit (500 mg/kg).
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Affiliation(s)
- Syed Mohammed Basheeruddin Asdaq
- Department of Pharmacology, College of Pharmacy, AlMaarefa University, Riyadh 13713, Saudi Arabia
- Correspondence: ; Tel.: +966-1-403555-3399
| | - Earla Swathi
- Department of Pharmacology, Krupanidhi College of Pharmacy, Bangalore 560035, India; (E.S.); (S.S.D.)
| | - Sunil S Dhamanigi
- Department of Pharmacology, Krupanidhi College of Pharmacy, Bangalore 560035, India; (E.S.); (S.S.D.)
| | - Mohammed Asad
- College of Applied Medical Sciences, Shaqra University, Shaqra 11911, Saudi Arabia;
| | - Yahya Ali Mohzari
- Clinical Pharmacy Department, King Saud Medical City, Riyadh 12746, Saudi Arabia;
| | - Ahmed A. Alrashed
- Pharmaceutical Service Department, Inpatient Pharmacy, King Fahad Medical City, Riyadh 11525, Saudi Arabia; (A.A.A.); (A.S.A.)
| | - Abdulrahman S. Alotaibi
- Pharmaceutical Service Department, Inpatient Pharmacy, King Fahad Medical City, Riyadh 11525, Saudi Arabia; (A.A.A.); (A.S.A.)
| | | | - Sreeharsha Nagaraja
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
- Department of Pharmaceutics, Vidya Siri College of Pharmacy, Off Sarjapura Road, Bangalore 560035, India
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Chen LY, Lin HJ, Wu WT, Chen YC, Chen CL, Kao J, You SL, Chou YC, Sun CA. Clinical Use of Acid Suppressants and Risk of Dementia in the Elderly: A Pharmaco-Epidemiological Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8271. [PMID: 33182362 PMCID: PMC7664895 DOI: 10.3390/ijerph17218271] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Results of studies regarding the potential link between acid suppressant use and dementia risk are inconsistent. This study aimed to evaluate the association of cumulative exposure to histamine 2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) with dementia risk in an Asian older cohort aged ≥65 years. METHODS Patients initiating H2RA (the H2RA user cohort, n = 21,449) or PPI (the PPI user cohort, n = 6584) and those without prescription for H2RA (the H2RA non-user cohort, n = 21,449) or PPI (the PPI non-user cohort, n = 6584) between 1 January 2000 and 31 December 2005 without a prior history of dementia were identified from Taiwan's National Health Insurance Research Database (NHIRD). The outcome of interest was all-cause dementia. Patients' exposure to H2RAs or PPIs was followed-up from dates of initial prescription to the earliest outcome of incident dementia, death, or the end of 2013. Potential associations between acid suppressant use and dementia risk were analyzed using time-dependent Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS After mutual adjustment for H2RA and PPI use and other potential confounders, patients with H2RA use had significantly higher risk of developing dementia as compared to those not treated with H2RAs (adjusted HR, 1.84; 95% CI, 1.49-2.20). Likewise, PPI users had significantly elevated risk of dementia compared to PPI non-users (adjusted HR, 1.42; 95% CI, 1.07-1.84). CONCLUSIONS Our results indicate that exposures to H2RAs and PPIs are associated with increased dementia risk.
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Affiliation(s)
- Liang-Yu Chen
- Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114, Taiwan; (L.-Y.C.); (W.-T.W.)
- School of Public Health, National Defense Medical Center, Taipei City 114, Taiwan; (C.-L.C.); (J.K.)
| | - Huey-Juan Lin
- Department of Neurology, Chi-Mei Medical Center, Tainan City 710, Taiwan;
| | - Wen-Tung Wu
- Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114, Taiwan; (L.-Y.C.); (W.-T.W.)
- School of Public Health, National Defense Medical Center, Taipei City 114, Taiwan; (C.-L.C.); (J.K.)
| | - Yong-Chen Chen
- Department of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan; (Y.-C.C.); (S.-L.Y.)
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan
| | - Cheng-Li Chen
- School of Public Health, National Defense Medical Center, Taipei City 114, Taiwan; (C.-L.C.); (J.K.)
| | - Jing Kao
- School of Public Health, National Defense Medical Center, Taipei City 114, Taiwan; (C.-L.C.); (J.K.)
| | - San-Lin You
- Department of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan; (Y.-C.C.); (S.-L.Y.)
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei City 114, Taiwan; (C.-L.C.); (J.K.)
| | - Chien-An Sun
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan
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Abstract
As our population continues to age, the early diagnosis and optimal management of patients with gastroesophageal reflux disease becomes paramount. Maintaining a low threshold for evaluating atypical symptoms in this population is key to improving outcomes. Should patients develop complications including severe esophagitis, peptic stricture, or Barrett esophagus, then a discussion of medical, endoscopic, and surgical treatments that accounts for patient's comorbidities and survival is important. Advances in screening, surveillance, and endoscopic treatment of Barrett esophagus have allowed us to dispel concerns of futility and treat a larger subset of the at-risk population.
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Affiliation(s)
- Fouad Otaki
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, L461, 3181 SouthWest Sam Jackson Park Road, Portland, OR 97229, USA.
| | - Prasad G Iyer
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SouthWest, Rochester, MN 55905, USA
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49
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Desai M, Nutalapati V, Srinivasan S, Fathallah J, Dasari C, Chandrasekhar VT, Mohammad B, Kohli D, Vaezi M, Katz PO, Sharma P. Proton pump inhibitors do not increase the risk of dementia: a systematic review and meta-analysis of prospective studies. Dis Esophagus 2020; 33:5848915. [PMID: 32476013 DOI: 10.1093/dote/doaa041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/18/2020] [Accepted: 04/26/2020] [Indexed: 12/11/2022]
Abstract
Published studies have reported variable results on the association between duration of proton pump inhibitor (PPI) use and the risk of dementia. An extensive literature search was performed in PubMed, Embase, Google Scholar, and Cochrane for studies examining the risk of cognitive decline and dementia among PPI users versus non-PPI users in prospective studies. Retrospective database linkage studies, case reports, case series, editorials, uncontrolled cohort studies, cross-sectional studies, and review articles were excluded. Primary outcome was pooled hazard rate (HR) of any dementia among PPI users compared with non-PPI users. Secondary outcomes were pooled HR of Alzheimer's dementia (AD) and risk with long-term PPI follow-up (more than 5 years) studies. Meta-analysis outcomes, heterogeneity (I2), and meta-regression (for the effect of covariates) were derived by statistical software R and Open meta-analyst. A total of six studies (one RCT and five prospective) with 308249 subjects, average age of 75.8 ± 5.2 years, and follow-up of 5 (range 1.5-11) years were included in the analysis. Pooled HR of any dementia was 1.16 (n = 6, 95% confidence interval (CI) = 0.86-1.47). Results remained unchanged when only studies with long-term PPI use (more than 5 years) were analyzed (n = 4, pooled HR 1.10, 95% CI 0.66-1.53). Finally, the pooled HR for AD was 1.06 (n = 3, 95% CI 0.70-1.41). There was substantial heterogeneity among inclusion studies (I2 = 93%). Meta-regression did not demonstrate a significant role of age at study start (P = 0.1) or duration of PPI use (P = 0.62) to incident dementia. The results of this systematic review and meta-analysis do not show a significant relationship between PPI use and dementia in prospective studies with at least a 5-year follow-up.
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Affiliation(s)
- Madhav Desai
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
| | - Venkat Nutalapati
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
| | - Sachin Srinivasan
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
| | - Jihan Fathallah
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
| | - Chandra Dasari
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
| | - Viveksandeep Thoguluva Chandrasekhar
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
| | - Bilal Mohammad
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
| | - Divyanshoo Kohli
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
| | - Michael Vaezi
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
| | - Philip O Katz
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
| | - Prateek Sharma
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
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Binding of omeprazole to protein targets identified by monoclonal antibodies. PLoS One 2020; 15:e0239464. [PMID: 32946534 PMCID: PMC7500594 DOI: 10.1371/journal.pone.0239464] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023] Open
Abstract
Omeprazole is the most commonly used proton pump inhibitor (PPI), a class of medications whose therapeutic mechanism of action involves formation of a disulfide linkage to cysteine residues in the H+/K+ ATPase pump on gastric secretory cells. Covalent linkage between the sole sulfur group of omeprazole and selected cysteine residues of the pump protein results in inhibition of acid secretion in the stomach, an effect that ameliorates gastroesophageal reflux and peptic ulcer disease. PPIs, though useful for specific conditions when used transiently, are associated with diverse untoward effects when used long term. The mechanisms underlying these potential off-target effects remain unclear. PPIs may, in fact, interact with non-canonical target proteins (non-pump molecules) resulting in unexpected pathophysiological effects, but few studies describe off-target PPI binding. Here, we describe successful cloning of monoclonal antibodies against protein-bound omeprazole. We developed and used monoclonal antibodies to characterize the protein target range of omeprazole, stability of omeprazole-bound proteins, and the involvement of cysteines in binding of omeprazole to targets. We demonstrate that a wide range of diverse proteins are targeted by omeprazole. Protein complexes, detected by Western blotting, are resistant to heat, detergents, and reducing agents. Reaction of omeprazole occurs with cysteine-free proteins, is not fully inhibited by cysteine alkylation, occurs at neutral pH, and induces protein multimerization. At least two other clinically used PPIs, rabeprazole and tenatoprazole, are capable of binding to proteins in a similar fashion. We conclude that omeprazole binds to multiple proteins and is capable of forming highly stable complexes that are not dependent on disulfide linkages between the drug and protein targets. Further studies made possible by these antibodies may shed light on whether PPI-protein complexes underlie off-target untoward effects of chronic PPI use.
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