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Sung JJY, Moreea S, Dhaliwal H, Moffatt DC, Ragunath K, Ponich T, Barkun AN, Kuipers EJ, Bailey R, Donnellan F, Wagner D, Sanborn K, Lau J. Use of topical mineral powder as monotherapy for treatment of active peptic ulcer bleeding. Gastrointest Endosc 2022; 96:28-35.e1. [PMID: 35124074 DOI: 10.1016/j.gie.2022.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/26/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate the safety and effectiveness of Hemospray (Cook Medical, Winston-Salem, NC, USA), a hemostatic powder, as monotherapy for active peptic ulcer bleeding. METHODS In this prospective, multicenter, single-arm study, patients with Forrest Ia or Ib peptic ulcers underwent endoscopic application of Hemospray as treatment of first intent. Effectiveness endpoints were successful hemostasis at the end of the index endoscopy, recurrent bleeding within 72 hours and from 72 hours to 30 days, adverse events requiring reintervention or resulting in morbidity or mortality, and 30-day mortality. RESULTS Hemospray was successfully administered in 98.5% of patients (66/67). Hemostasis was achieved at the index endoscopy in 90.9% of patients (60/66) with Hemospray alone and in an additional 4 patients treated with additional modalities, yielding an overall hemostasis rate of 97.0% (64/66). Rebleeding occurred in 13.3% of patients (8/60), 5 within 72 hours and 3 between 72 hours and 30 days. Two cases of perforation and 2 patient deaths occurred during the study, but none of these cases or any other adverse events were attributed to the use of Hemospray. The rate of early rebleeding was significantly higher in patients with Forrest Ia ulcers compared with patients with Forrest Ib ulcers. Higher rates of early bleeding in patients with Forrest Ia ulcers is consistent with results from studies where Hemospray was used as rescue after failure of conventional methods. CONCLUSIONS Hemospray is an effective initial treatment for patients with active peptic ulcer bleeding, but care should be taken to monitor for recurrent bleeding. (Clinical trial registration number: NCT01306864.).
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Affiliation(s)
- Joseph J Y Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sulleman Moreea
- Department of Gastroenterology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Harinder Dhaliwal
- Department of Medicine, Division of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Dana C Moffatt
- Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Krish Ragunath
- Department of Gastroenterology, NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Terry Ponich
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert Bailey
- Department of Gastroenterology and Hepatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Fergal Donnellan
- Department of Gastroenterology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - David Wagner
- Cook Endoscopy, Winston-Salem, North Carolina, USA
| | - Keith Sanborn
- Cook Research Incorporated, West Lafayette, Indiana, USA
| | - James Lau
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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Beyda R, Johari D. Tranexamic Acid for Upper Gastrointestinal Bleeding. Acad Emerg Med 2019; 26:1181-1182. [PMID: 31329328 DOI: 10.1111/acem.13835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Raymond Beyda
- Department of Emergency MedicineDownstate Medical Center& Kings County HospitalBrooklyn NY
| | - Davood Johari
- Department of Internal Medicine Division of Pulmonary and Critical Care State University of New YorkDownstate Medical Center& Kings County Hospital Brooklyn NY
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Gibson W, Scaturo N, Allen C. Acute Management of Upper Gastrointestinal Bleeding. AACN Adv Crit Care 2019; 29:369-376. [PMID: 30523006 DOI: 10.4037/aacnacc2018644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Whitney Gibson
- Whitney Gibson is Critical Care Pharmacist, Department of Pharmacy Services, Tampa General Hospital, 1 Tampa General Circle, Tampa, FL 33606 . Nicholas Scaturo is Emergency Medicine Clinical Pharmacist, Sarasota Memorial Hospital, Sarasota, Florida. Christopher Allen is Critical Care Clinical Pharmacist, Trauma Surgical Critical Care, Department of Pharmacy Services, Tampa General Hospital, Tampa, Florida
| | - Nicholas Scaturo
- Whitney Gibson is Critical Care Pharmacist, Department of Pharmacy Services, Tampa General Hospital, 1 Tampa General Circle, Tampa, FL 33606 . Nicholas Scaturo is Emergency Medicine Clinical Pharmacist, Sarasota Memorial Hospital, Sarasota, Florida. Christopher Allen is Critical Care Clinical Pharmacist, Trauma Surgical Critical Care, Department of Pharmacy Services, Tampa General Hospital, Tampa, Florida
| | - Christopher Allen
- Whitney Gibson is Critical Care Pharmacist, Department of Pharmacy Services, Tampa General Hospital, 1 Tampa General Circle, Tampa, FL 33606 . Nicholas Scaturo is Emergency Medicine Clinical Pharmacist, Sarasota Memorial Hospital, Sarasota, Florida. Christopher Allen is Critical Care Clinical Pharmacist, Trauma Surgical Critical Care, Department of Pharmacy Services, Tampa General Hospital, Tampa, Florida
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Peng YC, Lin CL, Hsu WY, Chow WK, Lee SW, Yeh HZ, Chen CC, Kao CH. Association Between Cholangiocarcinoma and Proton Pump Inhibitors Use: A Nested Case-Control Study. Front Pharmacol 2018; 9:718. [PMID: 30018559 PMCID: PMC6037835 DOI: 10.3389/fphar.2018.00718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/13/2018] [Indexed: 12/20/2022] Open
Abstract
Background: The present study aimed to examine the odds of cholangiocarcinoma (CCA) in patients with proton pump inhibitors (PPIs) use. Methods: A nested case-control study design was employed using data obtained from Taiwan's National Health Insurance Research Database. In total, 2,293 patients with confirmed diagnosis of CCA were identified and served as the CCA group. The CCA patients were propensity score-matched with 2,293 subjects without CCA who served as the control group. The cumulative defined daily dose (DDD) of PPIs was calculated based on the total supply in days and quantity of individual PPIs. Univariable and multivariate logistic regression models were used to determine the odds of CCA, and calculated odds ratios (ORs) and 95% confidence intervals (CI) were used to assess PPIs use and odds of CCA. Results: The overall adjusted OR of PPIs use-associated CCA was 2.58 (95% CI 2.27, 2.93). The adjusted OR of CCA by cumulative DDD dose of PPIs and CCA was analyzed and revealed those odds of CCA are associated with all types of PPIs. Conclusions: There were odds of intrahepatic and extrahepatic CCA among PPIs users. All PPIs use was associated with odds of CCA. Analyses of larger numbers of cases are needed to confirm these findings.
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Affiliation(s)
- Yen-Chun Peng
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Wan-Yun Hsu
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wai-Keung Chow
- Division of Gastroenterology, Taichung Tsu-Chi Hospital, Taichung, Taiwan
| | - Show-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - Chia-Chang Chen
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Yao Y, Ji C, He Y, Pan Y. Relationship between Helicobacter pylori infection and vomiting induced by gastrointestinal cancer chemotherapy. Intern Med J 2017; 47:792-797. [PMID: 28321977 DOI: 10.1111/imj.13428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nausea and vomiting are the most common adverse reactions to chemotherapy. AIM To discuss the relationship between Helicobacter pylori and chemotherapy-induced nausea and vomiting (CINV). METHODS A total of 112 patients with malignant tumours of the gastrointestinal tract was selected. Based on the 14C-urea breath test results, the patients were divided into H. pylori-positive (n = 59) and H. pylori-negative (n = 53) groups. Both groups received prophylactic antiemetic treatment during chemotherapy. The incidence of nausea and vomiting and their effects on the patients' life functions was recorded using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemetic Tool (MAT) and the Functional Living Index Emesis (FLIE) from 0-120 h after chemotherapy. Records of the H. pylori-positive and H. pylori-negative groups were compared. RESULTS The rates of nausea and vomiting remission were higher in the H. pylori -negative group than in the H. pylori -positive group. The proportions of no effect in daily life (NIDL) patients in the nausea and vomiting section were 73.4 and 75.5% in the H. pylori -negative group respectively. There was a higher proportion of NIDL patients in the H. pylori -negative group than in the H. pylori -positive group (P < 0.001, P = 0.046). A multivariate unconditional logistic regression analysis was performed, and the results showed that H. pylori infection was a factor affecting the nausea scores on the FLIE (odds ratio = 0.757, 95% confidence interval 0.597-0.960, P = 0.021). CONCLUSION H. pylori infection in patients with cancer may be a factor that increases CINV.
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Affiliation(s)
- Yiwei Yao
- Department of Medical Oncology, Anhui Provincial Hospital, Hefei, China
| | - Chushu Ji
- Department of Medical Oncology, Anhui Provincial Hospital, Hefei, China
| | - Yifu He
- Department of Medical Oncology, Anhui Provincial Cancer Hospital, Hefei, China
| | - Yueyin Pan
- Department of Medical Oncology, Anhui Provincial Cancer Hospital, Hefei, China
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Garber A, Jang S. Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding. Clin Endosc 2016; 49:421-424. [PMID: 27744662 PMCID: PMC5066413 DOI: 10.5946/ce.2016.110] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 01/10/2023] Open
Abstract
Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application. Endoscopically delivered pharmacotherapy, including Hemospray (Cook Medical), EndoClot (EndoClot Plus Inc.), and Ankaferd Blood Stopper (Ankaferd Health Products), in addition to standard epinephrine, show promise in this regard, although their mechanisms of action require further investigation. Non-pharmacologic endoscopic techniques use one of the following two methods to achieve hemostasis: ablation or mechanical tamponade, which may involve using endoscopic clips, cautery, argon plasma coagulation, over-the-scope clipping devices, radiofrequency ablation, and cryotherapy. This review aimed to highlight these novel and fundamental hemostatic strategies and the research supporting their efficacy.
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Affiliation(s)
- Ari Garber
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
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Peng YC, Lin CL, Yeh HZ, Chang CS, Wu YL, Kao CH. Association Between the Use of Proton Pump Inhibitors and the Risk of ESRD in Renal Diseases: A Population-Based, Case-Control Study. Medicine (Baltimore) 2016; 95:e3363. [PMID: 27082596 PMCID: PMC4839840 DOI: 10.1097/md.0000000000003363] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Proton pump inhibitors (PPIs) use may be associated with nephritis and acute renal injury. The risk of PPIs and deterioration of renal function, in patients with renal diseases, needs to be investigated. A case-control study was conducted in a nation-wide data setting from the Taiwan National Health Insurance Research Database (NHIRD). This case-control study used data extracted from NHIRD between the years 2006 and 2011. We used propensity scores to match 3808 patients suffering from renal diseases (ICD-9-CM codes 580-589), with patients (aged ≥20 years) who had had a recent diagnosis of end-stage renal diseases (ESRDs) and had undertaken renal replacement therapy during the period of 2006 to 2011. The 3808 control subjects were selected from people who had a history of renal diseases, but no ESRD. The risk of ESRD in patients with renal diseases and PPIs use was estimated by using odds ratios (ORs) and 95% confidence intervals (CI). The use of a PPIs was associated with a significantly higher risk of ESRD (adjusted OR = 1.88, 95% CI = 1.71-2.06) in renal disease patients. Of all the types of PPI combined, the adjusted OR was 1.92 (95% CI = 1.74-2.13) for those on <100 cumulative DDD and was 1.74-fold (95% CI = 1.52-2.00) for those on ≥100 cumulative DDD. PPIs use is associated with the risk of ESRD in patients with renal diseases. It is necessary that appropriate prescription of PPIs coordinated with the close monitoring renal function of patients diagnosed with renal disease.
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Affiliation(s)
- Yen-Chun Peng
- From the Division of Gastroenterology (Y-CP, H-ZY, C-SC), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung; School of Medicine (Y-CP, H-ZY), National Yang-Ming University, Taipei; Management Office for Health Data (C-LL), China Medical University Hospital; College of Medicine (C-LL), China Medical University, Taichung; Department of Physiology (Y-LW), School of Medicine, National Yang-Ming University, Taipei; Graduate Institute of Clinical Medical Science and School of Medicine (C-HK), College of Medicine, China Medical University; and Department of Nuclear Medicine and PET Center(C-HK), China Medical University Hospital, Taichung, Taiwan
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