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Ariño-Pérez I, Martínez-Domínguez SJ, Alfaro Almajano E, Carrera-Lasfuentes P, Lanas Á. Mistakes in the diagnosis and treatment of Helicobacter pylori infection in daily clinical practice. Helicobacter 2023:e12957. [PMID: 36828666 DOI: 10.1111/hel.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND An adequate diagnostic and therapeutic approach to Helicobacter pylori (H. pylori) infection is the cornerstone to avoid overdiagnosis, overuse of health resources, and increase in antibiotic resistances. The aim of the study was to evaluate the most common errors in clinical practice and the associated risk factors. MATERIALS AND METHODS This is a retrospective observational study including patients with H. pylori infection and no previous treatment belonging to two defined areas of the National Health System in Spain; some of them were enrolled in the European Registry on H. pylori management (Hp-EuReg). Patients were attended by gastroenterologists between 2010 and 2019. According to current guidelines, we evaluated indications for H. pylori investigation, appropriateness of diagnostic test used in dyspeptic patients and discontinuation of surveillance after treatment. RESULTS A total of 1730 patients were included, receiving 2260 eradication regimens. H. pylori infection was investigated in 1.7% cases in absence of a formal indication. Oral endoscopy was incorrectly used in 56% of patients with dyspepsia under 55 years without alarm signs, and urea breath test (UBT) was incorrectly used in 22.4% of patients with dyspepsia ≥55 years or red flags. Levofloxacin containing regimens were used as first-line therapy in 7.5% of non-allergic to penicillin patients. After first-line failure, clarithromycin was repeated in 2.6% of the patients who received second-line therapy. Confirmatory test of H. pylori status was absent in 2.5% cases. Men, patients under 55 years, and patients diagnosed by UBT had a higher risk of not undergoing a confirmatory test. CONCLUSIONS Investigation of H. pylori infection by gastroenterologists is rare in absence of a formal indication; however, endoscopy is commonly used for dyspeptic patients <55 years without red flags and non-invasive tests are still used for dyspeptic patients ≥55 years or presenting alarm signs. Men, patients under 55 years, and patients diagnosed by UBT have an increased risk of being lost to follow-up after eradication treatment.
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Affiliation(s)
- Inés Ariño-Pérez
- Department of Gastroenterology, Obispo Polanco Hospital, Teruel, Spain
| | - Samuel J Martínez-Domínguez
- Department of Gastroenterology, Lozano Blesa University Hospital, Zaragoza, Spain.,Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain.,School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Enrique Alfaro Almajano
- Department of Gastroenterology, Lozano Blesa University Hospital, Zaragoza, Spain.,Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Patricia Carrera-Lasfuentes
- Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain.,CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Faculty of Health Sciences, Campus Universitario Villanueva de Gállego, Universidad San Jorge, Zaragoza, Spain
| | - Ángel Lanas
- Department of Gastroenterology, Lozano Blesa University Hospital, Zaragoza, Spain.,Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain.,School of Medicine, University of Zaragoza, Zaragoza, Spain.,CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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Campodónico DM, Zubiaur P, Soria‐Chacartegui P, Casajús A, Villapalos‐García G, Navares‐Gómez M, Gómez‐Fernández A, Parra‐Garcés R, Mejía‐Abril G, Román M, Martín‐Vílchez S, Ochoa D, Abad‐Santos F. CYP2C8*3 and *4 define CYP2C8 phenotype: An approach with the substrate cinitapride. Clin Transl Sci 2022; 15:2613-2624. [PMID: 36065758 PMCID: PMC9652446 DOI: 10.1111/cts.13386] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/08/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023] Open
Abstract
Cinitapride is a gastrointestinal prokinetic drug, prescribed for the treatment of functional dyspepsia, and as an adjuvant therapy for gastroesophageal reflux disease. In this study, we aimed to explore the impact of relevant variants in CYP3A4 and CYP2C8 and other pharmacogenes, along with demographic characteristics, on cinitapride pharmacokinetics and safety; and to evaluate the impact of CYP2C8 alleles on the enzyme's function. Twenty-five healthy volunteers participating in a bioequivalence clinical trial consented to participate in the study. Participants were genotyped for 56 variants in 19 genes, including cytochrome P450 (CYP) enzymes (e.g., CYP2C8 or CYP3A4) or transporters (e.g., SLC or ABC), among others. CYP2C8*3 carriers showed a reduction in AUC of 42% and Cmax of 35% compared to *1/*1 subjects (p = 0.003 and p = 0.011, respectively). *4 allele carriers showed a 45% increase in AUC and 63% in Cmax compared to *1/*1 subjects, although these differences did not reach statistical significance. CYP2C8*3 and *4 alleles may be used to infer the following pharmacogenetic phenotypes: ultrarapid (UM) (*3/*3), rapid (RM) (*1/*3), normal (NM) (*1/*1), intermediate (IM) (*1/*4), and poor (PM) metabolizers (*4/*4). In this study, we properly characterized RMs, NMs, and IMs; however, additional studies are required to properly characterize UMs and PMs. These findings should be relevant with respect to cinitapride, but also to numerous CYP2C8 substrates such as imatinib, loperamide, montelukast, ibuprofen, paclitaxel, pioglitazone, repaglinide, or rosiglitazone.
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Affiliation(s)
- Diana María Campodónico
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Pablo Zubiaur
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIMadridSpain
| | - Paula Soria‐Chacartegui
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Ana Casajús
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Gonzalo Villapalos‐García
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Marcos Navares‐Gómez
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Antía Gómez‐Fernández
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Raúl Parra‐Garcés
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Gina Mejía‐Abril
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Manuel Román
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Samuel Martín‐Vílchez
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Dolores Ochoa
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
| | - Francisco Abad‐Santos
- Clinical Pharmacology Department, Instituto Teófilo HernandoInstituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM)MadridSpain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIMadridSpain
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de Cuevillas B, Álvarez Álvarez I, Cuervo M, Fernández Montero A, Navas Carretero S, Martínez JA. Definition of nutritionally qualitative categorizing (proto)nutritypes and a pilot quantitative nutrimeter for mirroring nutritional well-being based on a quality of life health related questionnaire. NUTR HOSP 2019; 36:862-874. [PMID: 31282167 DOI: 10.20960/nh.02532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Background: there are numerous approaches to assess nutritional status, which are putatively applied to nutritionally classify diseased people, but less information is available to study the role of environmental factors on nutritional well-being. A qualitative (nutritypes) and quantitative (nutrimeter) nutritional categorization based on dietary, lifestyle and disease criteria can be a useful nutritional approach to personalize health interventions and identify at risk individuals. Methods: cross-sectional study conducted on 102 patients (60 women), evaluating quality of life using the Short-Form 36 questionnaire (SF-36) and lifestyle factors with a general questionnaire, the Mediterranean Diet Adherence Screener (MEDAS) and the Global Physical Activity Questionnaire (GPAQ). A nutrimeter based on physical activity, fat mass, diet and diseases (hypertension, prediabetes, obesity and dyslipidemia) data was defined with an equation to quantitatively score the nutritive well-being of the participants, and classify them into two (proto)nutritypes. Results: participants were categorized into two groups (lower/higher global health) according to quality of life. Significant or marginal statistical differences in physical activity, fat mass, diet and disease were found (all p < 0.1). Two (proto)nutritypes were identified based on participant's age, sex, fat mass, physical activity, diet and diseases. Participants classified as high nutritional well-being nutritype showed higher values for physical, mental and global health dimensions. Age, fat mass, physical activity and diet, when categorized by the median, confirm that the designed nutritional well-being nutrimeter identified two (proto)nutritypes. Conclusions: the association between phenotypical (fat mass/diseases) and lifestyle factors (diet/physical activity) with quality of life allowed categorizing individuals with a nutritional quantitative score or nutrimeter according to their nutritional well-being and discriminate two qualitative (proto)nutritypes.
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Affiliation(s)
- Begoña de Cuevillas
- Department of Nutrition, Food Sciences and Physiology. Center for Nutrition Research. Universidad de Navarra
| | - Ismael Álvarez Álvarez
- Department of Nutrition, Food Sciences and Physiology. Center for Nutrition Research. Universidad de Navarra
| | - Marta Cuervo
- Department of Nutrition, Food Sciences and Physiology. Center for Nutrition Research. Universidad de Navarra
- CIBERObn, Obesity and Nutrition, Instituto de Salud Carlos III, Madrid
- IdisNA Health Research Institute of Navarra. Pamplona
| | - Alejandro Fernández Montero
- IdisNA Health Research Institute of Navarra. Pamplona
- Department of Occupational Medicine. Universidad de Navarra. Pamplona
| | - Santiago Navas Carretero
- Department of Nutrition, Food Sciences and Physiology. Center for Nutrition Research. Universidad de Navarra
- CIBERObn, Obesity and Nutrition, Instituto de Salud Carlos III, Madrid
- IdisNA Health Research Institute of Navarra. Pamplona
| | - José Alfredo Martínez
- Department of Nutrition, Food Sciences and Physiology. Center for Nutrition Research. Universidad de Navarra
- CIBERObn, Obesity and Nutrition, Instituto de Salud Carlos III, Madrid
- IdisNA Health Research Institute of Navarra. Pamplona
- Precision Nutrition Program, Research Institute on Food and Health Sciences IMDEA Food
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Laredo V, Sostres C, Alfaro E, Arroyo MT, Lanas Á. Management of Helicobacter pylori infection at the primary care level. The implementation of specific counseling improves eradication rates. Helicobacter 2019; 24:e12586. [PMID: 30950147 DOI: 10.1111/hel.12586] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/05/2019] [Accepted: 02/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Management of Helicobacter pylori infection has been expanded from the gastroenterology specialist (GS) to primary care physicians (PCPs), with a large increase in requests for urea breath tests (UBT). Due to the lack of evidence at this level, we evaluated the appropriateness of UBT indications and treatment for H pylori infections between PCPs and GSs and the effect of introducing specific counseling to PCPs. MATERIALS AND METHODS This was a quasi-experimental study. Phase I included 650 consecutive UBT requested by PCPs (400) and GSs (250). Indications and treatments were classified as appropriate or inappropriate based on national guidelines. Data on eradication rates were also collected. In phase II, 240 UBT and patients' treatment outcomes were analyzed after individually counseling PCPs on both aspects. RESULTS Of 1049 UBT, inappropriate indications in phase I were significantly higher in tests requested by PCP compared with GS (35.9% vs 7.2%; P < 0.001). Inappropriate treatment regimens were significantly higher for PCPs in phase I (65.8% vs 26.4%; P < 0.001). Consequently, eradication rates were significantly lower in patients treated by PCPs compared with those treated by GS (63.7% vs 81.4%; P = 0.004). A significant increase in adherence to appropriate treatment regimens (75.8% vs 34.2%; P < 0.001) and eradication rates (79.2% vs 63.7%; P = 0.002) were observed in the PCP group after counseling; however, the appropriateness of indications did not improve. CONCLUSIONS Patients infected with H pylori managed at the primary care level had poorer outcomes. The introduction of specific counseling for PCPs significantly improved treatment management, but not indications.
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Affiliation(s)
- Viviana Laredo
- Service of digestive diseases, Hospital ClínicoUniversitario Lozano Blesa, Zaragoza, Spain
| | - Carlos Sostres
- Service of digestive diseases, Hospital ClínicoUniversitario Lozano Blesa, Zaragoza, Spain.,IIS Aragón, Zaragoza, Spain.,CIBERehd, Madrid, Spain.,University of Zaragoza, Zaragoza, Spain
| | - Enrique Alfaro
- Service of digestive diseases, Hospital ClínicoUniversitario Lozano Blesa, Zaragoza, Spain
| | - Maria Teresa Arroyo
- Service of digestive diseases, Hospital ClínicoUniversitario Lozano Blesa, Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain
| | - Ángel Lanas
- Service of digestive diseases, Hospital ClínicoUniversitario Lozano Blesa, Zaragoza, Spain.,IIS Aragón, Zaragoza, Spain.,CIBERehd, Madrid, Spain.,University of Zaragoza, Zaragoza, Spain
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Herreros Martínez B, Almela Notari P, Amorós García C. Measuring health-related quality of life (HRQoL) in functional dyspepsia: is it really important? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 110:7-9. [PMID: 29284270 DOI: 10.17235/reed.2017.5418/2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although health-related quality of life (HRQoL) measure instruments in functional dyspepsia (FD) have been available for many years, as in other functional gastrointestinal disorders, their real application in clinical practice, beyond therapeutic studies, is unknown. For first time, the new Rome IV diagnostic criteria include the consideration of symptom severity enough to impact on usual patients' activities. A new focus on the management of this entity is proposed, therefore we should carefully revise the HRQoL measures and define its real role in our clinical practice.
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Aguayo-Albasini JL, Flores-Pastor B, Soria-Aledo V. Sistema GRADE: clasificación de la calidad de la evidencia y graduación de la fuerza de la recomendación. Cir Esp 2014; 92:82-8. [DOI: 10.1016/j.ciresp.2013.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/13/2013] [Accepted: 08/19/2013] [Indexed: 02/07/2023]
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Khansari M, Sohrabi M, Zamani F. The Useage of Opioids and their Adverse Effects in Gastrointestinal Practice: A Review. Middle East J Dig Dis 2013; 5:5-16. [PMID: 24829664 PMCID: PMC3990131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/15/2012] [Indexed: 11/10/2022] Open
Abstract
Opium is one of the oldest herbal medicines currently used as an analgesic, sedative and antidiarrheal treatment. The effects of opium are principally mediated by the μ-, κ- and δ-opioid receptors. Opioid substances consist of all natural and synthetic alkaloids that are derived from opium. Most of their effects on gastrointestinal motility and secretion result from suppression of neural activity. Inhibition of gastric emptying, increase in sphincter tone, changes in motor patterns, and blockage of peristalsis result from opioid use. Common adverse effects of opioid administration include sedation, dizziness, nausea, vomiting, constipation, dependency and tolerance, and respiratory depression. The most common adverse effect of opioid use is constipation. Although stool softeners are frequently used to decrease opioid-induced bowel dysfunction, however they are not efficacious. Possibly, the use of specific opioid receptor antagonists is a more suitable approach. Opioid antagonists, both central and peripheral, could affect gastrointestinal function and visceromotor sensitivity, which suggests an important role for endogenous opioid peptides in the control of gastrointestinal physiology. Underlying diseases or medications known to influence the central nervous system (CNS) often accelerate the opioid's adverse effects. However, changing the opioid and/or route of administration could also decrease their adverse effects. Appropriate patient selection, patient education and discussion regarding potential adverse effects may assist physicians in maximizing the effectiveness of opioids, while reducing the number and severity of adverse effects.
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Affiliation(s)
- MahmoudReza Khansari
- 1Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Tehran University of Medical Sciencse, Tehran, Iran
| | - MasourReza Sohrabi
- 1Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Tehran University of Medical Sciencse, Tehran, Iran
| | - Farhad Zamani
- 1Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Tehran University of Medical Sciencse, Tehran, Iran
,Corresponding Author: Farhad Zamani, MD Gastrointestinal and Liver Disease Research Center (GILDRC), Firoozgar Hospital, Tehran, Iran Tel: + 98 21 82141633 Fax:+ 98 21 88940489
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