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Pădureanu V, Caragea DC, Florescu MM, Vladu IM, Rădulescu PM, Florescu DN, Rădulescu D, Pădureanu R, Efrem IC. Role of the SARS‑COV2 infection in the evolution of acute pancreatitis (Review). Biomed Rep 2023; 19:49. [PMID: 37383680 PMCID: PMC10293881 DOI: 10.3892/br.2023.1632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/10/2023] [Indexed: 06/30/2023] Open
Abstract
Acute pancreatitis is characterized as an inflammatory illness that is life-threatening and causes necrosis as well as simple edema when pancreatic enzymes are activated intraglandularly. It is not known whether severe acute respiratory syndrome coronavirus 2 causes acute pancreatitis. Patients with acute pancreatitis who test positive for coronavirus disease 2019 (COVID-19) frequently have biliary or alcoholic causes. It is unclear how common acute pancreatitis is in patients with COVID-19. By contrast with patients without COVID-19, however, COVID-19-positive patients with acute pancreatitis have a higher mortality as well as a higher risk of necrosis and admission to an intensive care unit. The most common cause of mortality in COVID-19-positive individuals with concurrent severe pancreatitis is acute respiratory distress syndrome. The present study discussed research on the link between COVID-19 infection and acute pancreatitis.
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Affiliation(s)
- Vlad Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Daniel Cosmin Caragea
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Mirela Marinela Florescu
- Department of Morphology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Ionela Mihaela Vladu
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Patricia Mihaela Rădulescu
- University of Medicine and Pharmacy of Craiova Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Dan Nicolae Florescu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Dumitru Rădulescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Rodica Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Ion Cristian Efrem
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
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What is the role of proton pump inhibitors consumption on the clinical presentation and severity of COVID-19 infection? ANNALES PHARMACEUTIQUES FRANÇAISES 2023; 81:210-219. [PMID: 36049543 PMCID: PMC9422333 DOI: 10.1016/j.pharma.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Proton pump inhibitors (PPI) are among the most prescribed drugs worldwide; therefore, assessing their effect on COVID-19 infection symptoms and severity is of great importance. This study was designed to evaluate the role of previous PPI consumption on the clinical presentation and severity of COVID-19. PATIENTS AND METHODS All adult COVID-19 patients were eligible in this observational cross-sectional study. The patients' demographic and clinical data, history of PPI consumption, and comorbid disease were recorded. Charlson comorbidity index (CCI) and quick COVID-19 severity index (qCSI) score were calculated for each patient. IBM SPSS version 25 was used for statistical analysis. RESULTS Totally 670 patients completed the study (PPI users=121). The average severity (qCSI) score of PPI user patients with comorbidity score of zero was significantly higher than non-users (P-value=0.001). Mortality rate was 6.6% and 3.8% in PPI-users and non-users respectively (P-value=0.117). PPI users were significantly more symptomatic compared to non-users (P-value=0.001). CONCLUSION We found that PPI users were meaningfully more symptomatic and had a higher severity (qCSI) score. Rational prescription of PPIs should be considered by physicians during and after the pandemic.
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Elekhnawy E, Negm WA, El-Sherbeni SA, Zayed A. Assessment of drugs administered in the Middle East as part of the COVID-19 management protocols. Inflammopharmacology 2022; 30:1935-1954. [PMID: 36018432 PMCID: PMC9411846 DOI: 10.1007/s10787-022-01050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 02/06/2023]
Abstract
The pandemic spread of coronavirus (COVID-19) has been reported first at the end of 2019. It continues disturbing various human aspects with multiple pandemic waves showing more fatal novel variants. Now Egypt faces the sixth wave of the pandemic with controlled governmental measures. COVID-19 is an infectious respiratory disease-causing mild to moderate illness that can be progressed into life-threatening complications based on patients- and variant type-related factors. The symptoms vary from dry cough, fever to difficulty in breathing that required urgent hospitalization. Most countries have authorized their national protocols for managing manifested symptoms and thus lowering the rate of patients' hospitalization and boosting the healthcare systems. These protocols are still in use even with the development and approval of several vaccines. These protocols were instructed to aid home isolation, bed rest, dietary supplements, and additionally the administration of antipyretic, steroids, and antiviral drugs. The current review aimed to highlight the administered protocols in the Middle East, namely in Egypt and the Kingdom of Saudi Arabia demonstrating how these protocols have shown potential effectiveness in treating patients and saving many soles.
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Affiliation(s)
- Engy Elekhnawy
- Pharmaceutical Microbiology Department, Faculty of Pharmacy, Tanta University, Elguish Street (Medical Campus), Tanta, 31527 Egypt
| | - Walaa A. Negm
- Pharmacognosy Department, Faculty of Pharmacy, Tanta University, Elguish Street (Medical Campus), Tanta, 31527 Egypt
| | - Suzy A. El-Sherbeni
- Pharmacognosy Department, Faculty of Pharmacy, Tanta University, Elguish Street (Medical Campus), Tanta, 31527 Egypt
| | - Ahmed Zayed
- Pharmacognosy Department, Faculty of Pharmacy, Tanta University, Elguish Street (Medical Campus), Tanta, 31527 Egypt
- Institute of Bioprocess Engineering, Technical University of Kaiserslautern, Gottlieb-Daimler-Straße 49, 67663 Kaiserslautern, Germany
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Kodvanj I, Homolak J, Trkulja V. People exposed to proton-pump inhibitors shortly preceding COVID-19 diagnosis are not at an increased risk of subsequent hospitalizations and mortality: A nationwide matched cohort study. Br J Clin Pharmacol 2022; 89:787-831. [PMID: 36094656 PMCID: PMC9539175 DOI: 10.1111/bcp.15525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/18/2022] [Accepted: 08/16/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS To assess whether exposure to proton-pump inhibitors (PPIs) shortly preceding COVID-19 diagnosis affected the risk of subsequent hospitalizations and mortality. METHODS This population-based study embraced first COVID-19 episodes in adults diagnosed up to 15 August 2021 in Croatia. Patients were classified based on exposure to PPIs and burden of PPI-requiring morbidities as nonusers (no issued prescriptions, no recorded treatment-requiring conditions between 1 January 2019 and COVID-19 diagnosis), possible users (no issued prescriptions, but morbidities present; self-medication possible) and users (≥1 prescription within 3 months prior to the COVID-19 diagnosis; morbidities present). Subsets were mutually exactly matched for pre-COVID-19 characteristics. The contrast between users and possible users informed about the effect of PPIs that is separate of the effect of PPI-requiring conditions. RESULTS Among 433 609 patients, users and possible users were matched 41 195 (of 55 098) to 17 334 (of 18 170) in the primary and 33 272 to 16 434 in the sensitivity analysis. There was no relevant difference between them regarding mortality (primary: relative risk [RR] = 0.93 [95% confidence interval 0.85-1.02; absolute risk difference [RD] = -0.34% [-0.73, 0.03]; sensitivity: RR = 0.88 [0.78-0.98]; RD = -0.45% [-0.80, -0.11]) or hospitalizations (primary: RR = 1.04 [0.97-1.13]; RD = 0.29% [-0.16, 0.73]; sensitivity: RR = 1.05 [0.97-1.15]; RD = 0.32% [-0.12, 0.75]). The risks of both were slightly higher in possible users or users than in nonusers (absolutely by ~0.4-1.6%) indicating the effect of PPI-requiring morbidities. CONCLUSION Premorbid exposure to PPIs does not affect the risk of death or hospitalization in adult COVID-19 patients, but PPI-requiring morbidities seemingly slightly increase the risk of both.
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Affiliation(s)
- Ivan Kodvanj
- Department of Gastroenterology and HepatologyUniversity Hospital Center ZagrebZagrebCroatia
| | - Jan Homolak
- Department of PharmacologyZagreb University School of MedicineZagrebCroatia
| | - Vladimir Trkulja
- Department of PharmacologyZagreb University School of MedicineZagrebCroatia
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Park J, You SC, Cho J, Park CH, Shin WG, Park RW, In Seo S. Comparative risk of incidence and clinical outcomes of COVID-19 among proton pump inhibitor and histamine-2 receptor antagonist short-term users: a nationwide retrospective cohort study. BMC Pharmacol Toxicol 2022; 23:9. [PMID: 35039078 PMCID: PMC8762632 DOI: 10.1186/s40360-022-00549-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/11/2022] [Indexed: 01/14/2023] Open
Abstract
Background This study aimed to evaluate incidence risk and adverse clinical outcomes in COVID-19 disease among short-term users of acid-suppressants in South Korea. Methods This retrospective cohort study, conducted using a nationwide claims database for South Korea, used data from patients with COVID-19 tested between January 1 and May 15, 2020. Patients aged over 18 years and prescribed proton pump inhibitors (PPI) or histamine-2 receptor antagonist (H2RA) for more than 7 days were identified. Primary outcome was COVID-19 while secondary outcomes were all-cause mortality, hospitalization with respiratory disease, or intensive respiratory intervention. Large-scale propensity scores were used to match patients, while the Cox proportional hazard model was utilized to evaluate any association between exposure and outcome(s). The risk estimates were calibrated by using 123 negative control outcomes. Results We identified 26,166 PPI users and 62,117 H2RA users. After propensity score matching, compared to H2RA use, PPI use was not significantly associated with lower risk of COVID-19 (calibrated hazard ratio [HR], 0.81 [95% confidence interval (CI), 0.30–2.19]); moreover, PPI use was not associated with adverse clinical outcomes in COVID-19, namely, hospitalization with respiratory disease (calibrated HR, 0.88 [95% CI, 0.72–1.08]), intensive respiratory interventions (calibrated HR, 0.92 [95% CI, 0.46–1.82]), except for all-cause mortality (calibrated HR, 0.54 [95% CI, 0.31–0.95]). Conclusions In this study, we found that the PPI user was not associated with risk of COVID-19 compared to H2RA users. There was no significant relationship between severe clinical outcomes of COVID-19 and exposure to PPI compared with H2RA, except for all-cause mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s40360-022-00549-7.
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Affiliation(s)
- Jimyung Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Seng Chan You
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaehyeong Cho
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Woon Geon Shin
- Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Seoul, Gangdong-gu, 05355, South Korea
| | - Rae Woong Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea. .,Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea.
| | - Seung In Seo
- Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Seoul, Gangdong-gu, 05355, South Korea.
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Kariyawasam JC, Jayarajah U, Riza R, Abeysuriya V, Seneviratne SL. Gastrointestinal manifestations in COVID-19. Trans R Soc Trop Med Hyg 2021; 115:1362-1388. [PMID: 33728439 PMCID: PMC7989191 DOI: 10.1093/trstmh/trab042] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), a respiratory viral infection, has affected more than 78 million individuals worldwide as of the end of December 2020. Previous studies reported that severe acute respiratory syndrome coronavirus 1 and Middle East respiratory syndrome-related coronavirus infections may affect the gastrointestinal (GI) system. In this review we outline the important GI manifestations of COVID-19 and discuss the possible underlying pathophysiological mechanisms and their diagnosis and management. GI manifestations are reported in 11.4-61.1% of individuals with COVID-19, with variable onset and severity. The majority of COVID-19-associated GI symptoms are mild and self-limiting and include anorexia, diarrhoea, nausea, vomiting and abdominal pain/discomfort. A minority of patients present with an acute abdomen with aetiologies such as acute pancreatitis, acute appendicitis, intestinal obstruction, bowel ischaemia, haemoperitoneum or abdominal compartment syndrome. Severe acute respiratory syndrome coronavirus 2 RNA has been found in biopsies from all parts of the alimentary canal. Involvement of the GI tract may be due to direct viral injury and/or an inflammatory immune response and may lead to malabsorption, an imbalance in intestinal secretions and gut mucosal integrity and activation of the enteric nervous system. Supportive and symptomatic care is the mainstay of therapy. However, a minority may require surgical or endoscopic treatment for acute abdomen and GI bleeding.
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Affiliation(s)
- Jayani C Kariyawasam
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Rishdha Riza
- Colombo South Teaching Hospital, Colombo, Sri Lanka
| | - Visula Abeysuriya
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals, Colombo, Sri Lanka
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Anti-infective properties of proton pump inhibitors: perspectives. Int Microbiol 2021; 25:217-222. [PMID: 34476634 PMCID: PMC8413114 DOI: 10.1007/s10123-021-00203-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023]
Abstract
Infectious diseases are among the main causes of morbidity and mortality today. In facing this crisis, the development of new drug options and combat strategies is necessary. In this sense, drug repositioning or drug redirection has emerged for the faster identification of effective drugs. In this “Commentary,” the anti-infective properties of the class of proton pump inhibitors (PPIs) are emphasized. Studies report activities against bacterial, fungal, parasitic, and viral agents. In addition, we have provided in a table a summary of the specific characteristics of PPIs and some of their anti-infective activities.
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Yan C, Chen Y, Sun C, Ahmed MA, Bhan C, Guo Z, Yang H, Zuo Y, Yan Y, Hu L, Sun Y, Li Y, Zhou Q. Will Proton Pump Inhibitors Lead to a Higher Risk of COVID-19 Infection and Progression to Severe Disease? A Meta-analysis. Jpn J Infect Dis 2021; 75:10-15. [PMID: 34053958 DOI: 10.7883/yoken.jjid.2021.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous researches on the association between proton pump inhibitors (PPIs) use and the treatment and prevention of COVID-19 has generated inconsistent findings. Therefore, this meta-analysis was conducted to clarify the outcome in patients who take PPIs. Eight articles with more than 268,683 subjects were included. PPI use was not associated with increased or decreased risk of COVID-19 infection (OR:3.16, 95% CI=0.74-13.43, P=0.12) or mortality risk of COVID-19 patients (OR=1.91, 95% CI=0.86-4.24, P=0.11). While it can add risk of severe disease (OR=1.54, 95% CI=1.20-1.99, P<0.001;) and secondary infection (OR=4.33, 95% CI=2.57-7.29). In summary, PPI use is not associated with an increased risk of infection and may not change the mortality risk of COVID-19, but appeared to be associated with an increased risk of progression to severe disease and secondary infection. However, more original studies to further clarify the relationship between PPI and COVID-19 are still urgently needed.
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Affiliation(s)
- Cunye Yan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, University of Chinese Academy of Sciences, China
| | - Yue Chen
- Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, USA
| | | | | | - Zhichun Guo
- Massachusetts college of Pharmacy and Health sciences, USA
| | - Hongru Yang
- Massachusetts college of Pharmacy and Health sciences, USA
| | - Yijing Zuo
- Massachusetts college of Pharmacy and Health sciences, USA
| | - Yue Yan
- Massachusetts college of Pharmacy and Health sciences, USA
| | - Lei Hu
- Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, China
| | - Yiceng Sun
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, University of Chinese Academy of Sciences, China
| | - Yao Li
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, University of Chinese Academy of Sciences, China
| | - Qin Zhou
- Radiation Oncology, Mayo Clinic, USA
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Zippi M, Fiorino S, Budriesi R, Micucci M, Corazza I, Pica R, de Biase D, Gallo CG, Hong W. Paradoxical relationship between proton pump inhibitors and COVID-19: A systematic review and meta-analysis. World J Clin Cases 2021; 9:2763-2777. [PMID: 33969059 PMCID: PMC8058681 DOI: 10.12998/wjcc.v9.i12.2763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/01/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The proton pump inhibitors (PPIs), used to reduce gastric acid secretion, represent one of the most widely used pharmaceutical classes in the world. Their consumption as a risk factor for the evolution of severe forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been investigated as well as the mortality of these patients. These risks also appear to be linked to the duration and the dosage. On the other hand, several studies have emerged with regard to the protective or therapeutic effects of these drugs. More and more evidence underlines the immunomodulatory and anti-fibrotic role of PPIs. In addition, their ability to alkalize the contents of endosomes and lysosomes serves as an obstacle to the entry of the virus into the host cells. AIM To identify studies on the relationship between the intake of PPIs and coronavirus disease 2019 (COVID-19) in patients affected by SARS-CoV-2 infection, with the main objective of evaluating the outcomes related to severity and mortality. METHODS A literature review was performed in November 2020. The MEDLINE/PubMed, Cochrane Library, EMBASE and Google Scholar databases were searched for all relevant articles published in English on this topic. The search terms were identified by means of controlled vocabularies, such as the National Library of Medicine's MESH (Medical Subject Headings) and keywords. The MESH terms and keywords used were as follows: "COVID-19", "proton pump inhibitors", "PPIs", "SARS-CoV-2", "outcomes", "severity" and "mortality". The inclusion criteria regarding the studies considered in our analysis were: meta-analysis, case-control, hospital-based case-control, population-based case-control, retrospective studies, online survey, as well as cohort-studies, while articles not published as full reports, such as conference abstracts, case reports and editorials were excluded. We tried to summarize and pool all the data if available. RESULTS A total of 9 studies were found that described the use of PPIs, of which only 5 clearly reported the severity and mortality data in SARS-CoV-2 patients. Our pooled incidence analysis of severe events did not differ between patients with and without PPIs (odds ratio 1.65, 95% confidence interval: 0.62-4.35) (P = 0.314), or for mortality (odds ratio 1.77, 95% confidence interval: 0.62-5.03) (P = 0.286). CONCLUSION Detailed and larger case studies are needed to accurately understand the role of PPIs in this viral infection.
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Affiliation(s)
- Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome 00157, Italy
| | - Sirio Fiorino
- Unit of Internal Medicine, Maggiore Hospital, Local Health Unit of Bologna, Bologna 40133, Italy
| | - Roberta Budriesi
- Food Chemistry and Nutraceuticals Laboratory, Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum, University of Bologna, Bologna 40133, Italy
| | - Matteo Micucci
- Food Chemistry and Nutraceuticals Laboratory, Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum, University of Bologna, Bologna 40133, Italy
| | - Ivan Corazza
- Experimental, Diagnostic and Speciality Medicine Department, University of Bologna, Bologna 40138, Italy
| | - Roberta Pica
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome 00157, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna 40138, Italy
| | | | - Wandong Hong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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Homolak J, Kodvanj I, Trkulja V. An Additional Perspective on Proton Pump Inhibitors as Risk Factors for COVID-19. Clin Drug Investig 2021; 41:287-289. [PMID: 33606199 PMCID: PMC7892720 DOI: 10.1007/s40261-021-01007-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jan Homolak
- Department of Pharmacology, University of Zagreb School of Medicine, 10 000, Zagreb, Croatia.
| | - Ivan Kodvanj
- Department of Pharmacology, University of Zagreb School of Medicine, 10 000, Zagreb, Croatia
| | - Vladimir Trkulja
- Department of Pharmacology, University of Zagreb School of Medicine, 10 000, Zagreb, Croatia
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11
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Zhang XY, Li T, Wu H, Ling Y, Qian ZP, Chen L. Analysis of the Effect of Proton-Pump Inhibitors on the Course of COVID-19. J Inflamm Res 2021; 14:287-298. [PMID: 33574690 PMCID: PMC7872926 DOI: 10.2147/jir.s292303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/14/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study is to evaluate the effect of proton-pump inhibitors on the course of COVID-19. METHODS Clinical data of moderate COVID-19 patients admitted to the Shanghai Public Health Clinical Center for treatment from January 20, 2020, to March 16, 2020, were collected. A retrospective study was conducted and the patients were divided into two groups according to whether they used proton-pump inhibitors or not. The differences in SARS-CoV-2 clearance and hospital stay between the two groups were compared by Cox proportional hazards (PH) regression models and the propensity score matching method. RESULTS A total of 154 patients with moderate COVID-19 were included in this study, including 80 males (51.9%), 35 patients (22.7%) in the proton-pump inhibitor group, and 119 patients (77.3%) in the control group. In the proton-pump inhibitor group and the control group, the duration of the SARS-CoV-2 clearance was 7 days (95% CI, 6-9) and 7 days (95% CI, 6-11), and the duration of the hospital stay was 21 days (95% CI, 16-25) and 20 days (95% CI, 15-26), respectively. There was no significant difference between the both groups in the cumulative incidence of the SARS-CoV-2 clearance and the discharge, and the same results were obtained after the propensity score matching, all P > 0.05. There was no significant association between the use of proton-pump inhibitors and the duration of SARS-CoV-2 clearance, according to univariate analysis (HR, 1.309; 95% CI, 0.893-1.918) and multivariate analysis (HR, 1.575; 95% CI, 0.993-2.499). There was no significant association between the use of proton-pump inhibitors and the duration of hospital stay for COVID-19, according to univariate analysis (HR, 1.044; 95% CI, 0.714-1.528) and multivariate analysis (HR, 1.064; 95% CI, 0.651-1.740). CONCLUSION The use of proton-pump inhibitors has no effect on prolonging or shortening the course of adults hospitalized with COVID-19.
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Affiliation(s)
- Xiao-Yu Zhang
- Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Tao Li
- Department of Tuberculosis Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Haibing Wu
- Department of Neurosurgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Yun Ling
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Zhi-Ping Qian
- Department of Severe Hepatopathy, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Liang Chen
- Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
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Rustgi V, Makar M, Minacapelli CD, Gupta K, Bhurwal A, Li Y, Catalano C, Panettieri R. In-Hospital Mortality and Prediction in an Urban U.S. Population With COVID-19. Cureus 2020; 12:e11786. [PMID: 33409033 PMCID: PMC7779180 DOI: 10.7759/cureus.11786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has touched every aspect of society, and as the pandemic continues around the globe, many of the clinical factors that influence the disease course remain unclear. A useful clinical decision-making tool is a risk stratification model to determine in-hospital mortality as defined in this study. The study was performed at Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, New Jersey, USA. Data was extracted from our electronic medical records on 44 variables that included demographic, clinical, laboratory tests, treatments, and mortality information. We used the least absolute shrinkage and selection operator regression with corrected Akaike’s information criterion to identify a subset of variables that yielded the smallest estimated prediction error for the risk of in-hospital mortality. During the study period, 808 COVID-19 patients were admitted to RWJUH. The sample size was limited to patients with at least one confirmed in-house positive nasopharyngeal swab COVID-19 test. Pregnant patients or those who were transferred to our facility were excluded. Patients who were in observation and were discharged from the emergency room were also excluded. A total of 403 patients had complete values for all variables and were eligible for the study. We identified significant clinical, laboratory, and radiologic variables determining severe outcomes and mortality. An in-hospital mortality risk calculator was created after the identification of significant factors for the specific cohort, which were abnormal CT scan or chest X-ray, chronic kidney disease, age, white blood cell count, platelet count, alanine aminotransferase, and aspartate transaminase with a sensitivity, specificity, and negative predictive value of 82%, 72%, and 93%, respectively. While numerous reports from around the globe have helped outline the pandemic, demographic factors vary widely. This study is more applicable to an urban, highly diverse population in the United States.
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Affiliation(s)
- Vinod Rustgi
- Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.,Medicine, Center for Liver Diseases and Liver Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Michael Makar
- Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Carlos D Minacapelli
- Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.,Medicine, Center for Liver Diseases and Liver Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Kapil Gupta
- Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.,Medicine, Center for Liver Diseases and Liver Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Abhishek Bhurwal
- Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.,Medicine, Center for Liver Diseases and Liver Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - You Li
- Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.,Medicine, Center for Liver Diseases and Liver Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Carolyn Catalano
- Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.,Medicine, Center for Liver Diseases and Liver Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Reynold Panettieri
- Medicine, Rutgers Institute for Translational Medicine and Science, New Brunswick, USA.,Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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13
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Hunt RH, East JE, Lanas A, Malfertheiner P, Satsangi J, Scarpignato C, Webb GJ. COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist. Dig Dis 2020; 39:119-139. [PMID: 33040064 PMCID: PMC7705947 DOI: 10.1159/000512152] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND COVID-19 was initially considered a respiratory disease but the SARS-CoV-2 virus can lead to serious systemic consequences affecting major organs including the digestive system. SUMMARY This review brings new clinically important information for the gastroenterologist. This includes: the mechanisms of tissue damage seen with the SARS-CoV-2 virus; the consequences of immunosuppression in patients with inflammatory bowel disease (IBD) and chronic liver disease with the additional risks of decompensation in patients with cirrhosis; the impact of COVID-19 on gastrointestinal emergencies, on gastrointestinal endoscopy, diagnosis and treatments. These highlight the need to understand the clinical pharmacology, toxicology and therapeutic implications of drugs commonly used by gastroenterologists and their links with COVID-19. Key Messages: Any part of the digestive system may be affected by the SARS-CoV-2 virus, and those with pre-existing disease are at greatest risk of adverse outcomes. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who often require mechanical ventilation and life support. Some repurposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19-related gastrointestinal symptoms and can also induce liver injury. Ongoing clinical studies will hopefully identify effective drugs with a more favourable risk-benefit ratio than many initially tried treatments.
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Affiliation(s)
- Richard H. Hunt
- Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada,*Richard H. Hunt, Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University Health Sciences Centre, Hamilton, ON L8S 4L8 (Canada),
| | - James E. East
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Angel Lanas
- University Hospital Lozano Blesa, IIS Aragón, CIBER Enfermedades Hepáticas y Digestivas (CIBERehd) Digestive Diseases, Universidad de Zaragoza, Zaragoza, Spain
| | - Peter Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Magdeburg, Germany,Med. Klinik und Poliklinik II, Klinikum der Universität, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jack Satsangi
- Consultant Physician, Oxford University NHS Trust and Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom,Department of Gastroenterology, University of Edinburgh, Edinburgh, United Kingdom
| | - Carmelo Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta,Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Gwilym J. Webb
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom
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14
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Charpiat B, Bleyzac N, Tod M. Proton Pump Inhibitors are Risk Factors for Viral Infections: Even for COVID-19? Clin Drug Investig 2020; 40:897-899. [PMID: 32779119 PMCID: PMC7417108 DOI: 10.1007/s40261-020-00963-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
During the ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more attention should be paid to the balance of risks and benefits associated with proton pump inhibitors for the following reasons. One of the main functions of gastric juice is to inactivate swallowed microorganisms, thereby inhibiting infectious agents from reaching the intestine. Studies have documented that proton pump inhibitors are a risk factor for rotavirus, influenza virus, norovirus, and Middle East respiratory syndrome coronavirus infections, and are associated with an increased risk of acute gastroenteritis during periods of highest circulation of enteric viruses. In light of the evidence for gastrointestinal infection implying a fecal–oral transmission of SARS-CoV-2 and given the magnitude of the SARS-CoV-2/coronavirus disease 2019 pandemic, associated with the widespread misuse of proton pump inhibitors, this suggests that we should not rule out the hypothesis that patients treated with proton pump inhibitors may be more at risk of being infected by SARS-CoV-2.
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Affiliation(s)
- Bruno Charpiat
- Service Pharmacie, Hôpital de La Croix-Rousse, Groupement Hospitalier Nord, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
| | - Nathalie Bleyzac
- Service Pharmacie, Hôpital de La Croix-Rousse, Groupement Hospitalier Nord, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.,EMR 3738, Ciblage, Thérapeutique en Oncologie, Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Université Claude Bernard Lyon 1, Oullins Cedex, France
| | - Michel Tod
- Service Pharmacie, Hôpital de La Croix-Rousse, Groupement Hospitalier Nord, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.,EMR 3738, Ciblage, Thérapeutique en Oncologie, Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Université Claude Bernard Lyon 1, Oullins Cedex, France
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15
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Ray A, Sharma S, Sadasivam B. The Potential Therapeutic Role of Proton Pump Inhibitors in COVID-19: Hypotheses Based on Existing Evidences. Drug Res (Stuttg) 2020; 70:484-488. [PMID: 32877948 PMCID: PMC7672704 DOI: 10.1055/a-1236-3041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Although the major therapeutic uses of the proton pump inhibitors are in gastric-acid related diseases, evidences are suggestive of a pleiotropic nature of the compounds. We comment on the probable pathways and cellular machineries via which proton pump inhibitors could show beneficial therapeutic effects against SARS-CoV-2 based on the existing evidences. Proton pump inhibitors have shown antiviral potencies in various in vivo and in vitro studies. Some of the major possible ways through which they can act against SARS-CoV-2 are by exerting anti-inflammatory and anti-fibrotic effects, via vacuolar ATPase pumps leading to raised endolysosomal pH and by targeting endosomal complexes. The current pandemic has put forward a challenge to find treatment options. Although the potential roles of proton pump inhibitors against SARS-CoV-2 have been discussed in recent publications, the clinical evidences for their real-world effectiveness do not point towards a beneficial effect clearly yet. We suggest that although proton pump inhibitors should strongly be considered as potential therapeutic options for COVID-19, larger studies in the form of randomized controlled trials would be required to arrive at a definite conclusion.
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Affiliation(s)
- Avik Ray
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Swati Sharma
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Balakrishnan Sadasivam
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
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