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Joel A, Konjengbam A, Viswanath Y, Kourounis G, Hammond E, Frank H, Kuttuva S, Mbarushimana S, Hidayat H, Thulasiraman S. Endoscopic radiofrequency Stretta therapy reduces proton pump inhibitor dependency and the need for anti-reflux surgery for refractory gastroesophageal reflux disease. Clin Endosc 2024; 57:58-64. [PMID: 37157958 PMCID: PMC10834287 DOI: 10.5946/ce.2023.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND/AIMS Radiofrequency treatment of the gastroesophageal junction using the Stretta procedure for treating gastroesophageal reflux disease (GERD) is observed to improve the symptoms and proton pump inhibitor (PPI) dependence and reduce the need for anti-reflux operations. As one of the largest studies in Europe, we evaluated the clinical outcomes of Stretta in patients with medically refractory GERD. METHODS A tertiary UK center evaluated all patients with refractory GERD who underwent Stretta between 2014 and 2022. Patients and primary care professionals were contacted to obtain information regarding the initiation of PPI and reintervention after Stretta. RESULTS Of the 195 patients (median age, 55 years; 116 women [59.5%]) who underwent Stretta, PPI-free period (PFP) data were available for 144 (73.8%) patients. Overall, 66 patients (45.8%) did not receive PPI after a median follow-up of 55 months. Six patients (3.1%) underwent further interventions. The median PFP after Stretta was 41 months. There was a significant negative correlation between PFP and age (p=0.007), with no differences between sexes (p=0.96). Patients younger than 55 years of age had a longer PFP than their older counterparts (p=0.005). Younger males had a significantly longer PFP than older males (p=0.021). However, this was not observed in the female cohort (p=0.09) or between the younger men and women (p=0.66). CONCLUSION Our findings suggest that Stretta is a safe and feasible option for treating refractory GERD, especially in younger patients. It prevents further anti-reflux interventions in most patients and increases the lead-time to surgery in patients with refractory GERD.
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Affiliation(s)
- Abraham Joel
- Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital, Cleveland, UK
| | - Alakh Konjengbam
- Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital, Cleveland, UK
| | - Yirupaiahgari Viswanath
- Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital, Cleveland, UK
| | - Georgios Kourounis
- Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital, Cleveland, UK
| | - Emily Hammond
- Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital, Cleveland, UK
| | - Helen Frank
- Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital, Cleveland, UK
| | - Shivani Kuttuva
- Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital, Cleveland, UK
| | - Simon Mbarushimana
- Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital, Cleveland, UK
| | - Hena Hidayat
- Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital, Cleveland, UK
| | - Srivishnu Thulasiraman
- Department of General and Upper Gastrointestinal Surgery, James Cook University Hospital, Cleveland, UK
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Lynen A, Schömitz M, Vahle M, Jäkel A, Rütz M, Schwerla F. Osteopathic treatment in addition to standard care in patients with Gastroesophageal Reflux Disease (GERD) – A pragmatic randomized controlled trial. J Bodyw Mov Ther 2022; 29:223-231. [DOI: 10.1016/j.jbmt.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 07/19/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
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Rettura F, Bronzini F, Campigotto M, Lambiase C, Pancetti A, Berti G, Marchi S, de Bortoli N, Zerbib F, Savarino E, Bellini M. Refractory Gastroesophageal Reflux Disease: A Management Update. Front Med (Lausanne) 2021; 8:765061. [PMID: 34790683 PMCID: PMC8591082 DOI: 10.3389/fmed.2021.765061] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) is one of the most frequent gastrointestinal disorders. Proton pump inhibitors (PPIs) are effective in healing lesions and improving symptoms in most cases, although up to 40% of GERD patients do not respond adequately to PPI therapy. Refractory GERD (rGERD) is one of the most challenging problems, given its impact on the quality of life and consumption of health care resources. The definition of rGERD is a controversial topic as it has not been unequivocally established. Indeed, some patients unresponsive to PPIs who experience symptoms potentially related to GERD may not have GERD; in this case the definition could be replaced with “reflux-like PPI-refractory symptoms.” Patients with persistent reflux-like symptoms should undergo a diagnostic workup aimed at finding objective evidence of GERD through endoscopic and pH-impedance investigations. The management strategies regarding rGERD, apart from a careful check of patient's compliance with PPIs, a possible change in the timing of their administration and the choice of a PPI with a different metabolic pathway, include other pharmacologic treatments. These include histamine-2 receptor antagonists (H2RAs), alginates, antacids and mucosal protective agents, potassium competitive acid blockers (PCABs), prokinetics, gamma aminobutyric acid-B (GABA-B) receptor agonists and metabotropic glutamate receptor-5 (mGluR5) antagonists, and pain modulators. If there is no benefit from medical therapy, but there is objective evidence of GERD, invasive antireflux options should be evaluated after having carefully explained the risks and benefits to the patient. The most widely performed invasive antireflux option remains laparoscopic antireflux surgery (LARS), even if other, less invasive, interventions have been suggested in the last few decades, including endoscopic transoral incisionless fundoplication (TIF), magnetic sphincter augmentation (LINX) or radiofrequency therapy (Stretta). Due to the different mechanisms underlying rGERD, the most effective strategy can vary, and it should be tailored to each patient. The aim of this paper is to review the different management options available to successfully deal with rGERD.
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Affiliation(s)
- Francesco Rettura
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesco Bronzini
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michele Campigotto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Christian Lambiase
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Andrea Pancetti
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Ginevra Berti
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Santino Marchi
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Nicola de Bortoli
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico-Chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Massimo Bellini
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Efficacy and safety of the Chinese herbal formula Hewei Jiangni recipe for NERD with cold-heat complex syndrome: study protocol for a double-blinded randomized controlled trial. Trials 2021; 22:545. [PMID: 34407832 PMCID: PMC8371854 DOI: 10.1186/s13063-021-05471-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Proton pump inhibitor (PPI) is effective for the treatment of nonerosive gastroesophageal reflux (NERD), but long-term use of PPI is prone to have complications and recurrence after withdrawal. Traditional Chinese medicine (TCM) can relieve the symptoms of reflux and improve the quality of life. The purpose of this study is to evaluate the safety and efficacy of Hewei Jiangni recipe (HWJNR) in the treatment of NERD with cold-heat complex syndrome, and clarify the mechanism of HWJNR on NERD based on the correlation analysis of intestinal flora and metabolites. Methods This is a single-center, randomized controlled, double-blind, placebo-controlled clinical trial in which 72 eligible participants with NERD and TCM syndrome of intermingled heat and cold will be randomly allocated in the ratio of 1:1 to two groups: TCM group and western medicine group. The TCM group will receive HWJNR with omeprazole enteric-coated tablets placebo, while the western medicine group will receive omeprazole enteric-coated tablets with HWJNR placebo. Each group will be treated for 8 weeks. The primary outcome is the score of gastroesophageal reflux disease (GERD) health-related quality of life questionnaire (GERD-Q). Secondary outcomes include SF-36 quality of life scale (SF-36), patient-reported outcomes (PRO) self-rating scale score, syndrome score of TCM, and adverse events. Mechanistic outcome is the correlation analysis of intestinal flora and metabolites from healthy individuals and NERD participants before and after the treatment respectively. Discussion The goal of this trial is to investigate the efficacy and safety of HWJNR in the treatment of NERD with cold-heat complex syndrome, and to study the composition structure and metabolite expression profile of intestinal flora in patients with NERD through 16SrRNA sequencing and metabolomic correlation analysis of fecal flora, which makes us identify the dominant links of treatment and reveal the potential mechanism of HWJNR. ChiCTR2000041225. Registered on 22 December 2020
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Fass R, Boeckxstaens GE, El-Serag H, Rosen R, Sifrim D, Vaezi MF. Gastro-oesophageal reflux disease. Nat Rev Dis Primers 2021; 7:55. [PMID: 34326345 DOI: 10.1038/s41572-021-00287-w] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 02/07/2023]
Abstract
Gastro-oesophageal reflux disease (GERD) is a common disorder in adults and children. The global prevalence of GERD is high and increasing. Non-erosive reflux disease is the most common phenotype of GERD. Heartburn and regurgitation are considered classic symptoms but GERD may present with various atypical and extra-oesophageal manifestations. The pathophysiology of GERD is multifactorial and different mechanisms may result in GERD symptoms, including gastric composition and motility, anti-reflux barrier, refluxate characteristics, clearance mechanisms, mucosal integrity and symptom perception. In clinical practice, the diagnosis of GERD is commonly established on the basis of response to anti-reflux treatment; however, a more accurate diagnosis requires testing that includes upper gastrointestinal tract endoscopy and reflux monitoring. New techniques and new reflux testing parameters help to better phenotype the condition. In children, the diagnosis of GERD is primarily based on history and physical examination and treatment vary with age. Treatment in adults includes a combination of lifestyle modifications with pharmacological, endoscopic or surgical intervention. In refractory GERD, optimization of proton-pump inhibitor treatment should be attempted before a series of diagnostic tests to assess the patient's phenotype.
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Affiliation(s)
- Ronnie Fass
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical System, Case Western Reserve University, Cleveland, OH, USA.
| | - Guy E Boeckxstaens
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Hashem El-Serag
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Rachel Rosen
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Royal London Hospital, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Michael F Vaezi
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
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Bai P, Bano S, Kumar S, Sachdev P, Ali A, Dembra P, Bachani P, Shahid S, Jamil A, Rizwan A. Gastroesophageal Reflux Disease in the Young Population and Its Correlation With Anxiety and Depression. Cureus 2021; 13:e15289. [PMID: 34194886 PMCID: PMC8236209 DOI: 10.7759/cureus.15289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Stress and anxiety may disrupt normal GI function and lead to several GI disorders, including gastroesophageal reflux disease (GERD). In this study, we aimed to predict the prevalence of GERD in young patients and its association with anxiety and depression. Material and Methods This cross-sectional study enrolled 2,500 participants from the general public, with an age range of 18 to 40 years. Diagnosis of GERD was made via the Frequency Scale for the Symptoms of GERD (FSSG) questionnaire. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. Results GERD was diagnosis in 401 (16.0%) participants. Anxiety was significantly more common in participants with GERD compared to participants without GERD (40.3% vs. 19.5%; p < 0.01). Similarly, participants with GERD had a higher prevalence of depression compared to participants without GERD (42.6% vs. 18.3%; p < 0.01). Conclusion GERD is highly prevalent among the young population. Anxiety and depression are significantly more prevalent in patients with GERD. Hence, the young population must be thoroughly screened for GERD to minimize the risk of long-term complications. Furthermore, patients diagnosed with GERD should be screened for depression and anxiety.
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Affiliation(s)
- Pooja Bai
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Shehar Bano
- Internal Medicine, University of Health Sciences, Lahore, PAK
| | - Sameet Kumar
- Internal Medicine, Chandka Medical College, Larkana, PAK
| | - Priyanka Sachdev
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Ahmed Ali
- Infectious Diseases, University of Louisville, Louisville, USA
| | - Pariya Dembra
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Parkash Bachani
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Simra Shahid
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Amna Jamil
- Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Amber Rizwan
- Family Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Papp LA, Hancu G, Kelemen H, Tóth G. Chiral separation in the class of proton pump inhibitors by chromatographic and electromigration techniques: An overview. Electrophoresis 2021; 42:1761-1789. [PMID: 34004039 DOI: 10.1002/elps.202100032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 11/08/2022]
Abstract
Proton pump inhibitors (PPIs) are benzimidazole-derivative chiral sulfoxides, frequently used in the treatment of gastric hyperacidity-related disorders. Due to their stereoselective metabolism, the eutomeric forms of PPIs can present a more advantageous pharmacokinetic profile by comparison with the distomers or racemates. Moreover, two representatives of the class are used in therapy both as racemates and as pure enantiomers (esomeprazole, dexlansoprazole). A relatively large number of enantioseparation methods employed for the stereoselective determination of PPIs from pharmaceutical, biological, and environmental matrices were published in the past three decades. The purpose of the current overview is to provide a systematic survey of the available chiral separation methods published since the introduction of PPIs in the therapy up to the present. Analytical and bioanalytical methods using different chromatographic and electromigration techniques reported for the enantioseparation of omeprazole, lansoprazole, pantoprazole, rabeprazole, ilaprazole, and tenatoprazole are included. The analytical conditions of the presented methods are summarized in three comprehensive tables, while a critical discussion of the applied techniques, possible mechanism of enantiorecognition, and future perspectives on the topic are also presented.
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Affiliation(s)
- Lajos Attila Papp
- Department of Pharmaceutical Chemistry, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Romania
| | - Gabriel Hancu
- Department of Pharmaceutical Chemistry, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Romania
| | - Hajnal Kelemen
- Department of Pharmaceutical Chemistry, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Romania
| | - Gergő Tóth
- Department of Pharmaceutical Chemistry, Semmelweis University, Budapest, Hungary
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Xi L, Zhu J, Zhang H, Muktiali M, Li Y, Wu A. The treatment efficacy of adding prokinetics to PPIs for gastroesophageal reflux disease: a meta-analysis. Esophagus 2021; 18:144-151. [PMID: 32519226 DOI: 10.1007/s10388-020-00753-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/29/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder. Proton pump inhibitors (PPIs) are first-line drugs for GERD. For those who fail to respond to PPIs, adding prokinetics to PPIs is recommended and several trials have been conducted to evaluate the efficacy of prokinetic-PPI combination therapy. METHODS A systematic literature search was performed using PubMed and the Cochrane Library databases before February 2019 for randomized controlled trials (RCTs), which compared the efficacy of prokinetics plus PPI treatment with that of PPI monotherapy. Relevant studies were examined and data were extracted independently by two investigators. The risk ratios (RRs) with 95% CIs were used to evaluate the responder rate, and standard mean differences (SMDs) or mean differences (MDs) with 95% CIs were used for symptom score changes. Statistical heterogeneity was evaluated by the I2 statistic. Either a fixed-effect or a random-effect model was established for calculating the pooled data. RESULTS A total of 14 studies, comprising 1,437 patients were ultimately included in the meta-analysis. The pooled analysis showed that compared to PPI monotherapy, addition of prokinetics to PPI did not elevate the rate of endoscopic responders (RR = 0.996, 95% CI 0.929 - 1.068, p = 0.917), but improved symptom response (RR = 1.185, 95% CI 1.042 - 1.348, p = 0.010). Additionally, the combined therapy achieved a greater symptom relief than monotherapy both in FSSG and GERD-Q subgroups (MD = - 2.978, 95% CI - 3.319 to - 2.638, p < 0.001; MD = - 0.723, 95% CI - 0.968 to - 0.478, p < 0.001). CONCLUSIONS Adding prokinetics to PPIs achieves symptomatic improvement compared to PPI monotherapy, thus can enhance life quality of GERD patients. However, the combined treatment seems to have no significant effect on mucosal healing.
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Affiliation(s)
- Liting Xi
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Jinzhou Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Huixian Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Merlin Muktiali
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Youming Li
- College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Airong Wu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China.
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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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Torne S, Sheela A, Sarada N. Investigation of the Role of the Alkalizing Agent in Sodium Alginate Liquid Anti-reflux Suspension. CURRENT DRUG THERAPY 2020. [DOI: 10.2174/1574885514666190103140951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Anti-reflux formulation is one of the popular formulations across the globe
in the pharmaceutical industry used specifically for the management of gastro-oesophageal reflux
disease. But, this formulation is less explored with respect to research. Anti-reflux formulation has
challenges to show its antacid functionality, which could have synergies in the management of refluxes
in gastro-oesophageal reflux disease. Alkalizing agents act as antacid and improve the acid
neutralization capacity in the anti-reflux formulation, and can be used appropriately as they affect
raft strength beyond certain (optimum) limits.
Objective:
The objective of this work is to investigate the significance of alkalizing agent in sodium
alginate based on oral liquid anti-reflux suspension for the management of Gastro-oesophageal
Reflux Disease (GERD).
Methods:
In the present study, the formulation was prepared using sodium alginate along with different
alkalizing agents like calcium carbonate and sodium bicarbonate at different levels. The formulation
was further studied for in-vitro characterization like pH, viscosity, Acid Neutralization
Capacity (ANC), thickness, formation speed, flotation, and raft strength.
Results:
The formulation with a higher level of calcium carbonate as the alkalizing agent showed a
positive effect on the acid neutralization capacity (20.83mEq) and raft strength (16.95g) as well.
Whereas, the formulation with a higher level of sodium bi-carbonate (4.01%) showed improved
acid neutralization (22.31mEq) but showed a negative effect on raft strengths (10.08g).
Conclusion:
Based on the study, the optimum levels include 5% sodium alginate, 1.6% calcium
carbonate and 2.67% sodium bicarbonate to achieve good liquid suspension formulation possessing
good acid neutralization capacity as well as raft strength.
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Affiliation(s)
- Sangmesh Torne
- Department of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Vellore-632014, Tamil Nadu, India
| | - A. Sheela
- Department of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Vellore-632014, Tamil Nadu, India
| | - N.C. Sarada
- Department of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Vellore-632014, Tamil Nadu, India
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Khalaf F, Albayati S. Gastroesophageal reflux disease questionnaire score and endoscopic findings in patients with gastroesophageal reflux disease. MUSTANSIRIYA MEDICAL JOURNAL 2019. [DOI: 10.4103/mj.mj_8_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Proton Pump Inhibitors Increase the Susceptibility of Mice to Oral Infection with Enteropathogenic Bacteria. Dig Dis Sci 2018; 63:881-889. [PMID: 29327263 DOI: 10.1007/s10620-017-4905-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/29/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Proton pump inhibitors (PPIs) are among the most frequently prescribed medications. Side effects including an increased risk of intestinal infections have been reported. It is assumed that PPIs can increase susceptibility to enteropathogens; however, the underlying mechanisms are unknown. Here in this study, we explored whether Lansoprazole (Laz), one of the PPIs, increases the susceptibility to enteropathogens, and further investigated the mechanism of it. METHODS Mice were administered Laz intraperitoneally once daily and orally infected with Citrobacter rodentium (C. rodentium). The establishment of intestinal infection was assessed by histology and inflammatory cytokine expression levels measured by quantitative PCR. To test whether Laz changes the intestinal environment to influence the susceptibility, intestinal pH, microbiota, metabolites and immune cell distributions were evaluated via pH measurement, 16S rRNA gene sequencing, metabolome, and flow cytometry analyses after Laz administration. RESULTS Colitis was induced with less C. rodentium in Laz-treated mice as compared with the controls. We found that increased numbers of C. rodentium could reach the cecum following Laz administration. Laz increased pH in the stomach but not in the intestines. It induced dysbiosis and changed the metabolite content of the small intestine. However, these changes did not lead to alterations of immune cell distribution. CONCLUSIONS Laz raised susceptibility to C. rodentium as increased numbers of the pathogen reach the site of infection. Our results suggest that it was due to increased stomach pH which allowed more peroral enteropathogens to pass the stomach, but not because of changes of intestinal environment.
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Mermelstein J, Chait Mermelstein A, Chait MM. Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions. Clin Exp Gastroenterol 2018; 11:119-134. [PMID: 29606884 PMCID: PMC5868737 DOI: 10.2147/ceg.s121056] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A significant percentage of patients with gastroesophageal reflux disease (GERD) will not respond to proton pump inhibitor (PPI) therapy. The causes of PPI-refractory GERD are numerous and diverse, and include adherence, persistent acid, functional disorders, nonacid reflux, and PPI bioavailability. The evaluation should start with a symptom assessment and may progress to imaging, endoscopy, and monitoring of esophageal pH, impedance, and bilirubin. There are a variety of pharmacologic and procedural interventions that should be selected based on the underlying mechanism of PPI failure. Pharmacologic treatments can include antacids, prokinetics, alginates, bile acid binders, reflux inhibitors, and antidepressants. Procedural options include laparoscopic fundoplication and LINX as well as endoscopic procedures, such as transoral incisionless fundoplication and Stretta. Several alternative and complementary treatments of possible benefit also exist.
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Affiliation(s)
- Joseph Mermelstein
- Gasteroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alanna Chait Mermelstein
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maxwell M Chait
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Fass R, Frazier R. The role of dexlansoprazole modified-release in the management of gastroesophageal reflux disease. Therap Adv Gastroenterol 2017; 10:243-251. [PMID: 28203282 PMCID: PMC5298478 DOI: 10.1177/1756283x16681701] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/20/2016] [Indexed: 02/04/2023] Open
Abstract
Dexlansoprazole modified-release (MR) is the R-enantiomer of lansoprazole and is currently the only proton-pump inhibitor (PPI) with a novel dual delayed release (DDR) formulation. Overall, dexlansoprazole MR demonstrates a similar safety and side-effect profile as lansoprazole. Dexlansoprazole MR has been shown to be highly efficacious in healing erosive esophagitis, maintaining healed esophageal mucosa in patients with erosive esophagitis and controlling symptoms of patients with nonerosive reflux disease (NERD). Recent studies have also demonstrated that dexlansoprazole MR is highly effective in improving nocturnal heartburn, gastroesophageal reflux disease (GERD) related sleep disturbances and bothersome regurgitation. Dexlansoprazole MR is well tolerated and can be taken without regard to food.
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Affiliation(s)
| | - Rosita Frazier
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH, USA
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15
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Knapik JJ, Jean RT, Austin KG, Steelman RA, Farina EK, Lieberman HR. Demographic factors associated with dietary supplement prescriptions filled by United States Military Service Members 2005-2013. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:84. [PMID: 28148262 PMCID: PMC5286846 DOI: 10.1186/s12906-017-1590-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/17/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Dietary supplements (DSs) can be purchased over-the-counter but may also be prescribed by medical personnel for specific therapeutic reasons. Few studies have examined this latter source of DSs despite the fact that 79% of physicians and 82% of nurses have recommended DSs to their patients. This investigation examined demographic factors associated with temporal trends in oral DS prescriptions filled by all United States (US) service members (SMs) from 2005 to 2013 (n = 1,427,080 ± 22,139, mean ± standard deviation per year). METHODS The Food and Drug Administration National Drug Code database and the formularies of the US Defense Health Agency's Pharmacoeconomic Center were queried to identify DSs available to SMs. The number of these DS prescriptions filled by all SMs from 2005 through 2013 was then obtained from the US Department of Defense Pharmacy Data Transaction System. Data were grouped by American Hospital Formulary System (AHFS) pharmacologic-therapeutic classifications and examined over time. Denominators (number of SMs each year) were obtained from the Defense Health Agency. RESULTS Major findings included 1) generally greater prevalence of prescriptions filled by women and older SMs for most AHFS categories; 2) a temporal decline in total prescriptions filled by Marine Corps personnel accounted for by a decline in the prevalence of zinc preparations filled by younger male Marines; 3) a temporal decline in the prevalence of iron preparations filled by women; 4) a temporal increase in the prevalence of prescriptions for replacement preparations filled by women accounted for largely by more prescriptions for calcium compounds; and 5) a temporal decline in the prevalence of prescriptions filled for cathartics/laxatives in older SMs accounted for largely by a decline in prescriptions for sodium/potassium compounds. CONCLUSIONS These temporal trends may be associated with the greater health care utilization of women and older SMs as well as the perceptions of prescribers and/or patients on appropriate roles of these substances in medicine and public health.
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Affiliation(s)
- Joseph J Knapik
- US Army Research Institute of Environmental Medicine, Natick, MA, USA.
- US Army Public Health Center, Aberdeen Proving Ground, MD, USA.
- Oak Ridge Institute for Science and Education, Belcamp, MD, USA.
- Research Physiologist, (USARIEM), 10 General Greene Ave, Natick, MA, 01760, USA.
| | - Rosenie T Jean
- Office of The US Army Surgeon's General Pharmacovigilance Center, Falls Church, VA, USA
| | - Krista G Austin
- US Army Research Institute of Environmental Medicine, Natick, MA, USA
- Oak Ridge Institute for Science and Education, Belcamp, MD, USA
| | | | - Emily K Farina
- US Army Research Institute of Environmental Medicine, Natick, MA, USA
- Oak Ridge Institute for Science and Education, Belcamp, MD, USA
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16
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Effectiveness and Tolerability of Different Recommended Doses of PPIs and H 2RAs in GERD: Network Meta-Analysis and GRADE system. Sci Rep 2017; 7:41021. [PMID: 28102361 PMCID: PMC5244481 DOI: 10.1038/srep41021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 12/15/2016] [Indexed: 02/05/2023] Open
Abstract
Proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H2RAs) are used for gastro-esophageal reflux disease (GERD); however, the clinical evidence for treatment is poor. We evaluated the effectiveness and tolerability of different doses of PPIs, H2RAs and placebo in adults with GERD. Six online databases were searched through September 1, 2016. All related articles were included and combined with a Bayesian network meta-analysis from randomized controlled trials (RCTs). The GRADE systems were employed to assess the main outcome. Ninety-eight RCTs were identified, which included 45,964 participants. Our analysis indicated that the full/standard dose of esomeprazole at 40 mg per day was the most efficient in healing among nine different dosages of PPIs and H2RAs. The main efficacy outcome did not change after adjustments for the area, age, level of disease from endoscopy, year of publication, pharmaceutical industry sponsorship, Intention-to-treat (ITT)/per-protocol (PP), withdrawal rate, pre-set select design bias, single blinded and unblinded studies, study origination in China, study arms that included zero events, inconsistency node or discontinued drug were accounted for in the meta-regressions and sensitivity analyses. This research suggests that the full/standard doses (40 mg per day) of esomeprazole should be recommended as first-line treatments for GERD in adults for short-term therapy.
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17
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Knapik JJ, T Jean R, Austin KG, Steelman RA, Gannon J, Farina EK, Lieberman HR. Temporal trends in dietary supplement prescriptions of United States military service members suggest a decrease in pyridoxine and increase in vitamin D supplements from 2005 to 2013. Nutr Res 2016; 36:1140-1152. [PMID: 27865356 DOI: 10.1016/j.nutres.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/18/2016] [Accepted: 09/01/2016] [Indexed: 01/26/2023]
Abstract
Dietary supplements (DSs) can be obtained over-the-counter but can also be prescribed by health-care providers for therapeutic reasons. Few studies have documented this later source despite the fact that 79% of physicians and 82% of nurses have recommended DSs to patients. This investigation assessed prevalence and temporal trends in oral DS prescriptions filled by all United States service members (SMs) from 2005 to 2013 (n = 1 427 080 ± 22 139, mean ± standard deviation (SD)/y). We hypothesize that there would be temporal variations in specific types of DSs. Data obtained from Department of Defense Pharmacy Data Transaction System were grouped by American Hospital Formulary System pharmacologic-therapeutic classifications and prevalence examined over time. About 11% of SMs filled one or more DS prescriptions of 235 180 ± 4926 (mean ± SD) prescriptions/y over the 9-year period. Curve-fitting techniques indicated significant linear declines over time for multivitamins (P = .004), iron preparations (P < .001), antacids (P < .001), and vitamin B and B complex vitamins (P < .001). There were significant quadratic trends indicating a rise in early years followed by a leveling off in later years for replacement preparations (P < .001) and vitamin C (P < .001). There were significant quadratic trends (P < .001) for vitamin E indicating a decline in early years and leveling off in later years, and vitamin D indicating little change in early years followed by a large rise subsequently (P < .001). This study identified temporal trends in specific DS categories that may be associated with changing perceptions of prescribers and/or patients of the appropriate roles of DSs in medicine and public health.
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Affiliation(s)
- Joseph J Knapik
- US Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA; US Army Public Health Center, Aberdeen Proving Ground, MD, 21010, USA; Oak Ridge Institute for Science and Education, Belcamp, MD, 21017, USA.
| | - Rosenie T Jean
- Office of the US Army Surgeon's General, Pharmacovigilance Center, Falls Church, VA, 22041, USA.
| | - Krista G Austin
- US Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA; Oak Ridge Institute for Science and Education, Belcamp, MD, 21017, USA.
| | - Ryan A Steelman
- US Army Public Health Center, Aberdeen Proving Ground, MD, 21010, USA.
| | - Julia Gannon
- Office of the US Army Surgeon's General, Pharmacovigilance Center, Falls Church, VA, 22041, USA.
| | - Emily K Farina
- US Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA; Oak Ridge Institute for Science and Education, Belcamp, MD, 21017, USA.
| | - Harris R Lieberman
- US Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA.
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18
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Khan F, Maradey-Romero C, Ganocy S, Frazier R, Fass R. Utilisation of surgical fundoplication for patients with gastro-oesophageal reflux disease in the USA has declined rapidly between 2009 and 2013. Aliment Pharmacol Ther 2016; 43:1124-31. [PMID: 27060607 DOI: 10.1111/apt.13611] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/06/2016] [Accepted: 03/13/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Surgical fundoplication has been considered to be one of the leading therapeutic modalities for gastro-oesophageal reflux disease (GERD) during the last several decades. AIM To determine the trend of surgical fundoplication utilisation in GERD patients during the last decade in the United States. METHODS Population-based study using a large nationwide database, the Explorys database system, to identify patients diagnosed with GERD and those who underwent surgical fundoplication. Using a quadratic regression model, we determined and compared the trends of surgical fundoplication utilisation annually from 2004 to 2013. RESULTS We identified 4 059 060 patients with the diagnosis of GERD, of whom 2343 (0.05%) underwent surgical fundoplication between 2004 and 2013. There was a significant decline in the number of surgical fundoplications performed over the last 5 years from 0.062% in 2009 to 0.047% in 2013 (P < 0.05). Female patients accounted for the majority of those who underwent fundoplication (62.52%). Caucasian patients between the ages of 18 and 65 years were the most likely group to undergo surgical fundoplication (66.28%). The number of overweight patients undergoing surgical fundoplication has been significantly increasing over the last decade (P < 0.05). Importantly, 80% of surgical patients were treated with a proton pump inhibitor (PPI) post surgical fundoplication by 2013 (P < 0.001). CONCLUSIONS Utilisation of surgical fundoplication in GERD patients has been steadily declining over the past 5 years. The vast majority of patients will resume PPI treatment after surgical fundoplication.
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Affiliation(s)
- F Khan
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - C Maradey-Romero
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - S Ganocy
- Center Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA
| | - R Frazier
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - R Fass
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Mechanism of bombesin-induced tonic contraction of the porcine lower esophageal sphincter. Sci Rep 2015; 5:15879. [PMID: 26522854 PMCID: PMC4629149 DOI: 10.1038/srep15879] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/06/2015] [Indexed: 01/23/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a disorder that is related to an incompetent lower esophageal sphincter (LES). Previous studies showed that bombesin could increase LES pressure in humans and opossums. The aim of the present study was to characterize the effects of bombesin on porcine LES contraction. We used the selective agonists, neuromedin B (NMB), gastrin-releasing peptide (GRP), and [D-Tyr6,Apa-4Cl11,Phe13,Nle14]bombesin-(6-14) (DTACPN-BN), as well as receptor antagonists of bombesin receptor subtype 2 (BB2), and 3 (BB3) for ex vivo contraction studies. Atropine, nifedipine, tetrodotoxin, and ω-conotoxin GVIA were used to explore the agonist-induced LES contraction mechanism. Reverse transcription polymerase chain reaction and immunohistochemistry were applied to detect bombesin receptor expression. Our results indicate that GRP and DTACPN-BN, but not NMB, induced tonic contractions of the porcine LES in a dose-dependent manner, and the contractions were inhibited with selective BB2 and BB3 antagonists. The GRP-induced contraction is mainly caused by L-type Ca2+ channel-mediated Ca2+ influx. However, DTACPN-BN-induced contractions are associated with neuronal conduction. RT-PCR and immunohistochemistry revealed that BB2 and BB3 were expressed in the porcine LES. Bombesin-induced tonic contraction of the LES is mediated through BB2 and BB3. Bombesin, BB2, and BB3 agonists might have the potential to treat GERD.
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Hopkins J, Switzer NJ, Karmali S. Update on novel endoscopic therapies to treat gastroesophageal reflux disease: A review. World J Gastrointest Endosc 2015; 7:1039-1044. [PMID: 26322157 PMCID: PMC4549661 DOI: 10.4253/wjge.v7.i11.1039] [Citation(s) in RCA: 15] [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: 04/27/2015] [Revised: 06/26/2015] [Accepted: 07/27/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic treatments for gastroesophageal reflux disease (GERD) have become increasingly popular in recent years. While surgical intervention with the Laparoscopic Nissen Fundoplication remains the gold standard, two endoscopic interventions, specifically, are gaining traction in clinical use (EsophyX and Stretta). The EsophyX (EndoGastric Solutions, Inc., Redmond, WA, United States) was developed as a method of restoring the valve at the GE junction through an endoluminal fundoplication (ELF) technique. Long-term data suggests that transoral incisional fundoplication (TIF) with EsophyX may be effective for symptom control and proton pump inhibitor reduction or cessation for up to 2-6 years. There is no evidence that EsophyX is more effective than surgical intervention. TIF may be most effective for patients with HH < 2 cm and Hill Grade I/II valves. Stretta (Mederi Therapeutics, Greenwich, CT, United States) was approved by the Food and Drug Administration in 2000. It delivers radiofrequency energy to the lower esophageal sphincter and gastric cardia. Published reviews of the literature are conflicted in their recommendations of Stretta in the management of GERD. The literature suggests that the Stretta procedure has an acceptable safety profile and may be effective in reducing symptom burden and quality of life scores up to 8 years post-intervention. However, there does not appear to be any sustained improvement in objective outcomes and there is no evidence that Stretta results in improved outcomes as compared to surgical intervention. Treatment modalities for GERD, as a field, suffer from a lack of standardization in primary and secondary outcomes. Although many studies have looked at health related quality of life, the tools used to do so are markedly heterogeneous. Future directions for the endoscopic treatment of GERD include novel techniques like endoscopic submucosal dissection.
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21
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Sharma VD, Akocak S, Ilies MA, Fassihi R. Solid-state interactions at the core-coat interface: physicochemical characterization of enteric-coated omeprazole pellets without a protective sub-coat. AAPS PharmSciTech 2015; 16:934-43. [PMID: 25595125 DOI: 10.1208/s12249-014-0263-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/08/2014] [Indexed: 11/30/2022] Open
Abstract
Conventionally, scanning electron or transmission microscopy, Raman and near infrared (NIR) spectroscopy, terahertz, florescence, and nuclear magnetic resonance imaging have been used to characterize functional coating structure. This study highlights the use of fluorescence microscopy to investigate the physicochemical stability and coating integrity of the commercially available enteric-coated omeprazole pellets containing a basic excipient and prepared by extrusion and spheronization or drug layering on the nonpareil seed, immediately followed by enteric coating (i.e., absence of protective sub-coat). The nature of coating interface and the likely development of an in situ interfacial layer after the application of enteric coating solution was examined using HPLC, NMR, differential scanning calorimetry (DSC), and fluorescent imaging methods. Likewise for the characterization of the solid pellet structure via fluorescence microscopy, a new approach based on fracturing technique (to avoid surface contamination) rather than microtome sectioning was used and validated. Analytical data showed that the pellets containing omeprazole remained chemically stable (>99.5% recovered). Control of the microenvironmental pH by the addition of alkalinizing excipient within a core formulation or as part of drug layering on top of nonpareil seed appears to efficiently neutralize the acidic effect of enteric coating dispersion. Fluorescence images further illustrate the absence of any discernable in situ layer formation at the coat-core interface.
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22
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How Do You Treat Gastroesophageal Reflux Disease in Your Practice? Med Acupunct 2015. [DOI: 10.1089/acu.2015.29004.cpl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dickman R, Maradey-Romero C, Gingold-Belfer R, Fass R. Unmet Needs in the Treatment of Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2015; 21:309-19. [PMID: 26130628 PMCID: PMC4496897 DOI: 10.5056/jnm15105] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 12/13/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder. Proton pump inhibitors have profoundly revolutionized the treatment of GERD. However, several areas of unmet need persist despite marked improvements in the ther-apeutic management of GERD. These include the advanced grades of erosive esophagitis, nonerosive reflux disease, main-tenance treatment of erosive esophagitis, refractory GERD, postprandial heartburn, atypical and extraesophageal manifestations of GERD, Barrett's esophagus, chronic protein pump inhibitor treatment, and post-bariatric surgery GERD. Consequently, any fu-ture development of novel therapeutic modalities for GERD (medical, endoscopic, or surgical), would likely focus on the afore-mentioned areas of unmet need.
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Affiliation(s)
- Ram Dickman
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio,
USA
| | - Carla Maradey-Romero
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio,
USA
| | - Rachel Gingold-Belfer
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio,
USA
| | - Ronnie Fass
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio,
USA
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Ghebremariam YT, Cooke JP, Khan F, Thakker RN, Chang P, Shah NH, Nead KT, Leeper NJ. Proton pump inhibitors and vascular function: A prospective cross-over pilot study. Vasc Med 2015; 20:309-16. [PMID: 25835348 DOI: 10.1177/1358863x14568444] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Proton pump inhibitors (PPIs) are commonly used drugs for the treatment of gastric reflux. Recent retrospective cohorts and large database studies have raised concern that the use of PPIs is associated with increased cardiovascular (CV) risk. However, there is no prospective clinical study evaluating whether the use of PPIs directly causes CV harm. We conducted a controlled, open-label, cross-over pilot study among 21 adults aged 18 and older who are healthy (n=11) or have established clinical cardiovascular disease (n=10). Study subjects were assigned to receive a PPI (Prevacid; 30 mg) or a placebo pill once daily for 4 weeks. After a 2-week washout period, participants were crossed over to receive the alternate treatment for the ensuing 4 weeks. Subjects underwent evaluation of vascular function (by the EndoPAT technique) and had plasma levels of asymmetric dimethylarginine (ADMA, an endogenous inhibitor of endothelial function previously implicated in PPI-mediated risk) measured prior to and after each treatment interval. We observed a marginal inverse correlation between the EndoPAT score and plasma levels of ADMA (r = -0.364). Subjects experienced a greater worsening in plasma ADMA levels while on PPI than on placebo, and this trend was more pronounced amongst those subjects with a history of vascular disease. However, these trends did not reach statistical significance, and PPI use was also not associated with an impairment in flow-mediated vasodilation during the course of this study. In conclusion, in this open-label, cross-over pilot study conducted among healthy subjects and coronary disease patients, PPI use did not significantly influence vascular endothelial function. Larger, long-term and blinded trials are needed to mechanistically explain the correlation between PPI use and adverse clinical outcomes, which has recently been reported in retrospective cohort studies.
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Affiliation(s)
- Yohannes T Ghebremariam
- Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA
| | - John P Cooke
- Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA
| | - Fouzia Khan
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Rahul N Thakker
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter Chang
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nigam H Shah
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin T Nead
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nicholas J Leeper
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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25
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Liang WT, Wang ZG, Wang F, Yang Y, Hu ZW, Liu JJ, Zhu GC, Zhang C, Wu JM. Long-term outcomes of patients with refractory gastroesophageal reflux disease following a minimally invasive endoscopic procedure: a prospective observational study. BMC Gastroenterol 2014. [PMID: 25304252 DOI: 10.1186/1471-230x-14-1781471-230x-14-178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is the most common digestive disease, affecting one third of the world's population. The minimally invasive endoscopic Stretta procedure is being increasingly used as an alternative strategy to manage refractory GERD. However, long-term benefits of this procedure have to be further evaluated in clinical settings. This prospective observational study was therefore conducted to evaluate the outcome of patients with refractory GERD 5 years after the Stretta procedure. METHODS A total of 152 patients with refractory GERD underwent the Stretta procedure in our department between April 2007 and September 2008. They were followed up for 5 years, during which the primary outcome measures including symptom scores of heartburn, regurgitation, chest pain, cough and asthma and the secondary outcome measures including proton pump inhibitor (PPI) use and patients' satisfaction were analysed at 6, 12, 24, 36, 48 and 60 months respectively. RESULTS Of the 152 patients, 138 completed the designated 5-year follow-up and were included in the final analysis. At the end of the 5-year follow-up, the symptom scores of heartburn (2.47 ± 1.22 vs. 5.86 ± 1.52), regurgitation (2.23 ± 1.30 vs. 5.56 ± 1.65), chest pain (2.31 ± 0.76 vs. 4.79 ± 1.59), cough (3.14 ± 1.43 vs. 6.62 ± 1.73) and asthma (3.26 ± 1.53 vs. 6.83 ± 1.46) were all significantly decreased as compared with the corresponding values before the procedure (P < 0.001). After the Stretta procedure, 59 (42.8%) patients achieved complete PPI therapy independence and 104 (75.4%) patients were completely or partially satisfied with the GERD symptom control. Moreover, no severe complications were observed except for complaint of abdominal distention in 12 (8.7%) patients after the Stretta procedure. CONCLUSION The Stretta procedure may achieve an effective and satisfactory long-term symptom control and considerably reduce the reliance on medication without significant adverse effects in adult patients with refractory GERD, thereby having profound clinical implications.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ji-Min Wu
- Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of the Chinese People's Liberation Army, 16 Xinwai Street, Xicheng District, Beijing 100088, China.
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26
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Liang WT, Wang ZG, Wang F, Yang Y, Hu ZW, Liu JJ, Zhu GC, Zhang C, Wu JM. Long-term outcomes of patients with refractory gastroesophageal reflux disease following a minimally invasive endoscopic procedure: a prospective observational study. BMC Gastroenterol 2014; 14:178. [PMID: 25304252 PMCID: PMC4287567 DOI: 10.1186/1471-230x-14-178] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 09/29/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is the most common digestive disease, affecting one third of the world's population. The minimally invasive endoscopic Stretta procedure is being increasingly used as an alternative strategy to manage refractory GERD. However, long-term benefits of this procedure have to be further evaluated in clinical settings. This prospective observational study was therefore conducted to evaluate the outcome of patients with refractory GERD 5 years after the Stretta procedure. METHODS A total of 152 patients with refractory GERD underwent the Stretta procedure in our department between April 2007 and September 2008. They were followed up for 5 years, during which the primary outcome measures including symptom scores of heartburn, regurgitation, chest pain, cough and asthma and the secondary outcome measures including proton pump inhibitor (PPI) use and patients' satisfaction were analysed at 6, 12, 24, 36, 48 and 60 months respectively. RESULTS Of the 152 patients, 138 completed the designated 5-year follow-up and were included in the final analysis. At the end of the 5-year follow-up, the symptom scores of heartburn (2.47 ± 1.22 vs. 5.86 ± 1.52), regurgitation (2.23 ± 1.30 vs. 5.56 ± 1.65), chest pain (2.31 ± 0.76 vs. 4.79 ± 1.59), cough (3.14 ± 1.43 vs. 6.62 ± 1.73) and asthma (3.26 ± 1.53 vs. 6.83 ± 1.46) were all significantly decreased as compared with the corresponding values before the procedure (P < 0.001). After the Stretta procedure, 59 (42.8%) patients achieved complete PPI therapy independence and 104 (75.4%) patients were completely or partially satisfied with the GERD symptom control. Moreover, no severe complications were observed except for complaint of abdominal distention in 12 (8.7%) patients after the Stretta procedure. CONCLUSION The Stretta procedure may achieve an effective and satisfactory long-term symptom control and considerably reduce the reliance on medication without significant adverse effects in adult patients with refractory GERD, thereby having profound clinical implications.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ji-Min Wu
- Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of the Chinese People's Liberation Army, 16 Xinwai Street, Xicheng District, Beijing 100088, China.
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Yamaji Y, Isomura Y, Yoshida S, Yamada A, Hirata Y, Koike K. Randomized controlled trial comparing the efficacy of mosapride plus omeprazole combination therapy to omeprazole monotherapy in gastroesophageal reflux disease. J Dig Dis 2014; 15:469-76. [PMID: 24957863 DOI: 10.1111/1751-2980.12167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We investigated whether the prokinetic activity of mosapride, a 5-hydroxytryptamine 4 receptor agonist, in combination with proton pump inhibitor (PPI) would ameliorate symptoms of gastroesophageal reflux disease (GERD) in Japanese patients. METHODS Patients who experienced reflux symptoms more than twice weekly were eligible for this study. In all, 60 patients were randomized to receive mosapride 5 mg thrice daily combined with omeprazole 10 mg once daily (GO group), or omeprazole alone (O group) for 4 weeks. The patients completed the frequency scale for the symptoms of GERD (FSSG) at the beginning and the end of the study. The primary outcome compared changes in the FSSG reflux-related symptom (RS) score between treatment groups during the study period. RESULTS The FSSG RS scores significantly decreased both in the GO group and the O group, with no differences in improvement between the groups (-5.86 for the GO group vs -4.89 for the O group, P = 0.49). In non-erosive reflux disease (NERD) patients the improvement was significantly lower than that in erosive GERD patients (-4.00 vs -7.67, P = 0.02). However, the addition of mosapride was effective in subgroup analyses of specific symptoms, such as burping. CONCLUSIONS Combining mosapride with PPI provided no additional amelioration of reflux symptoms compared to PPI alone. Both regimens provided less relief from reflux symptoms in NERD than in erosive GERD patients. The addition of mosapride ameliorated reflux in patients with symptoms like burping.
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Affiliation(s)
- Yutaka Yamaji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Lidor AO, Ensor CR, Sheer AJ, Orens JB, Clarke JO, McDyer JF. Domperidone for delayed gastric emptying in lung transplant recipients with and without gastroesophageal reflux. Prog Transplant 2014; 24:27-32. [PMID: 24598562 DOI: 10.7182/pit2014823] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Evidence demonstrates a link between gastroesophageal reflux disease and chronic allograft dysfunction in lung transplant recipients. Delayed gastric emptying plays an important role in the occurrence of gastroesophageal reflux disease, with limited therapeutic options available for treatment. This retrospective observational study reports the use of domperidone in the management of delayed gastric emptying in lung transplant recipients. All patients who underwent lung transplant at our institution from 2007 to 2011 were reviewed and patients who were treated with domperidone were identified. Clinical symptoms and results of gastric emptying studies before and after initiation of domperidone were documented. QTc intervals were compared from before to after domperidone treatment at 3 months and at 1 year. Weight and dose-normalized calcineurin inhibitor troughs were evaluated before and 2 weeks after domperidone treatment was started. Of 82 patients, 24% (n = 20) had documented delayed gastric emptying and 35% (n = 29) had documented gastroesophageal reflux disease. Twelve of the 20 patients with delayed gastric emptying started treatment with domperidone. All patients responded symptomatically and 6 patients with gastric emptying studies before and after domperidone had documented improvement. No adverse effects were observed in any patients treated with domperidone. Results indicate that domperidone can be used safely and may improve symptoms related to delayed gastric emptying in lung transplant recipients.
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Khinchi P, Saha S, Saraf SA, Kaithwas G. Combination therapy of gamma-aminobutyric acid derivative promotes proton pump inhibitor based healing of reflux esophagitis in animal model. Pharmacol Rep 2014; 66:165-8. [DOI: 10.1016/j.pharep.2013.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 06/14/2013] [Accepted: 06/25/2013] [Indexed: 12/12/2022]
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Curcic J, Sauter M, Schwizer W, Fried M, Boesiger P, Steingoetter A. Validation of a golden angle radial sequence (GOLD) for abdominal T1 mapping during free breathing: demonstrating clinical feasibility for quantifying gastric secretion and emptying. J Magn Reson Imaging 2014; 41:157-64. [PMID: 24391022 DOI: 10.1002/jmri.24530] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/14/2013] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To validate a magnetic resonance imaging sequence suitable for quantitative assessment of acid suppression by a proton pump inhibitor (PPI) on gastric secretion and emptying in clinical practice. METHODS A golden angle radial sequence (GOLD) was validated in a series of in vitro and in vivo experiments and clinical feasibility was shown in two studies. The impact of free breathing and image plane orientation on T1 values was evaluated in a controlled in vivo experiment. The free-breathing GOLD sequence was compared against a standard breath-hold gradient echo sequence for gastric half emptying time in 23 subjects during a gastric emptying study. Pilot data from five subjects assessed the sensitivity of the GOLD sequence to detect changes in acid secretion volume produced by PPI treatment. RESULTS The coronal free-breathing GOLD sequence and the axial breath-hold standard gradient echo sequence showed good agreement of the gastric half emptying time (6 ± 3 min, P = 0.053). The GOLD sequence demonstrated sensitivity to reduction of gastric secretion volumes induced by PPI treatment (55 ± 5 mL, P < 0.001). CONCLUSION The GOLD sequence allowed for free breathing, multislice, combined imaging and T1 mapping of the stomach content. GOLD presents a promising multipurpose, noninvasive imaging tool for monitoring gastric function in clinical studies.
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Affiliation(s)
- Jelena Curcic
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
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Elliott BM, Steckbeck KE, Murray LR, Erk KA. Rheological investigation of the shear strength, durability, and recovery of alginate rafts formed by antacid medication in varying pH environments. Int J Pharm 2013; 457:118-23. [DOI: 10.1016/j.ijpharm.2013.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/15/2013] [Accepted: 09/24/2013] [Indexed: 12/22/2022]
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Zhou JH, Liu BR. Proton pump inhibitors. Shijie Huaren Xiaohua Zazhi 2013; 21:3083-3088. [DOI: 10.11569/wcjd.v21.i29.3083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Proton pump inhibitors (PPIs) can bind to the proton pump and inhibit it to secrete hydrogen ions. Since currently used PPIs have a short plasma half-life and can interact with other drugs, there is still an urgent need to develop new and interesting PPIs that can overcome these problems. This review summarizes the latest progress in research of PPIs with regard to the mechanism of action, side effects, and interactions with other drugs and provides an update of the status of acid-suppression therapy.
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Abstract
Gastroesophageal reflux disease (GERD) is a common presentation in primary care. New research findings have implications for the diagnosis and management of GERD. The purpose of this article is to synthesize current research related to the diagnosis and management of GERD in adults and to make practice recommendations.
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Lin K, Chen X, Zhang L, Wang Y, Shan Z. Proton pump inhibitors as also inhibitors of atrial fibrillation. Eur J Pharmacol 2013; 718:435-40. [PMID: 23973848 DOI: 10.1016/j.ejphar.2013.07.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/26/2013] [Accepted: 07/11/2013] [Indexed: 02/07/2023]
Abstract
Proton pump inhibitors (PPIs) are widely used for the treatment of acid-related upper digestive diseases, including gastric and duodenal ulcer and gastroesophageal reflux disease (GERD). Remarkably, several small clinical trials have shown that these drugs also reduce the symptoms and frequency of atrial fibrillation (AF) episodes in patients treated for comorbid acid reflux. Although the mechanism remains unclear, the effect might pinpoint a connection between GERD and AF. To this end, it is known that both oxidants and inflammation affect initiation and maintenance of AF, and PPIs may reduce symptoms and frequency of AF episodes through their antioxidant and anti-inflammatory effects. This review focuses on the anti-AF effects of PPIs beyond their inhibition of gastric acid production.
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Affiliation(s)
- Kun Lin
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
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Konturek PC, Brzozowska I, Targosz A, Pawlik M, Kania J, Hess T, Kwiecien S, Konturek SJ, Reiter RJ, Brzozowski T. Esophagoprotection mediated by exogenous and endogenous melatonin in an experimental model of reflux esophagitis. J Pineal Res 2013; 55:46-57. [PMID: 23480366 DOI: 10.1111/jpi.12048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/08/2013] [Indexed: 12/12/2022]
Abstract
Reflux esophagitis is a common clinical entity in western countries with approximately 30% of the population experiencing the symptoms at least once every month. The imbalance between the protective and aggressive factors leads to inflammation and damage of the esophageal mucosa. We compared the effect of exogenous melatonin and melatonin derived endogenously from L-tryptophan with that of pantoprazole or ranitidine in acid reflux esophagitis due to ligation of the rat pylorus and the limiting ridge between the forestomach and the corpus. Four hours after the induction of gastric reflux, an increase in mucosal lesions associated with edema of the submucosa and with the infiltration of numerous neutrophils and the fall in esophageal blood flow (EBF) were observed. Both melatonin and L-tryptophan or pantoprazole significantly reduced the lesion index (LI) and raised the EBF. Pinealectomy that significantly decreased plasma melatonin levels aggravated LI and these effects were reduced by melatonin and L-tryptophan. Luzindole, the MT2 receptor antagonist, abolished the melatonin-induced reduction in LI and the rise in EBF. L-NNA and capsaicin that augmented LI and decreased EBF, also significantly reduced melatonin-induced protection and hyperemia; both were restored with L-arginine and calcitonin gene-related peptide (CGRP) added to melatonin. Upregulation of IL-1β and TNF-α mRNAs and plasma IL-1β and TNF-α levels were significantly attenuated by melatonin and L-tryptophan. We conclude that melatonin protects against acid reflux-induced damage via activation of MT2 receptors mediated by NO and CGRP released from sensory nerves and the suppression of expression and release of TNF-α and IL-1β.
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Affiliation(s)
- Peter C Konturek
- Department of Internal Medicine, Thuringia-Clinic Saalfeld, Teaching Hospital of the University Jena, Saalfeld, Germany
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Affiliation(s)
- Carla Maradey
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, 2500 MetroHealth Drive, Case Western Reserve University, Cleveland, OH 44109-1998, USA
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Abstract
Acid suppression, with proton pump inhibitors (PPI), is the mainstay of therapy for reflux disease; despite this, symptoms and injury persist in many patients. Novel approaches have focused on (1) augmenting acid suppression with reformulated current PPIs, new PPIs or new acid pump blockers and (2) preventing reflux with reflux inhibitors. Other strategies to reduce reflux, improve gastric emptying or esophageal clearance, protect the mucosa, or reduce esophageal sensitivity are under investigation alone or in combination with PPIs; however, novel approaches face significant challenges. The safety and efficacy of current PPIs hamper demonstration of clinical superiority for new acid suppressants, and the multifactorial etiology of reflux disease means that monotherapy using a non-acid suppressant is unlikely to match PPI therapy while combination therapy will be superior only if susceptible patients can be identified reliably. Advances will come, not from a 'one size fits all' approach but rather from novel pharmaceuticals allied to novel investigations to permit targeted, personalized reflux therapy.
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Affiliation(s)
- Usha Dutta
- Division of Gastroenterology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
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Management of patients with chronic cough using a clinical protocol: a prospective observational study. COUGH 2013; 9:2. [PMID: 23347748 PMCID: PMC3565860 DOI: 10.1186/1745-9974-9-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 01/18/2013] [Indexed: 11/10/2022]
Abstract
Background and aims Chronic cough is a common symptom the aetiology of which can be challenging to diagnose. Diagnostic protocols for chronic cough have required the use of specialist investigations which are not always easily available. We wanted to determine whether patients with chronic cough can be successfully managed using a clinical algorithm. Methods 112 consecutive patients with chronic cough were prospectively recruited into this study. They were assessed by history, physical examination, chest radiograph, spirometry and reversibility to nebulised salbutamol. A clinical diagnosis was made and the patient had an 8-week trial of appropriate therapy. Further therapeutic trials were carried out depending on response to treatment and the possible differential diagnoses. Investigations were carried out in cases of failed clinical trials and to exclude specific pathology. The “clinical arm” comprised patients managed on the basis of clinical assessment and without any investigations. The “investigative arm” comprised those who needed further investigations. Results 81 (72%) were managed in the clinical arm. Of these 74 (66%) were discharged following response to therapy. 31 (28%) patients were converted to the investigative arm after failure of diagnosis in the clinical protocol. The commonest causes of cough were gastroesophageal reflux, asthma and chronic rhinitis. 51 (45.5%) patients responded to therapy based on diagnosis at initial assessment while a further 23 (20.5%) patients responded to sequential clinical trials for the commonest causes of cough. Cough severity score improved by a mean of 3.6 points on a numeric response score (from 0–10, p < 0.0001). Conclusion It is possible to manage a majority of chronic cough patients successfully using a protocol based on presenting symptoms and therapeutic trials for the common causes of cough.
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Seifert R, Strasser A, Schneider EH, Neumann D, Dove S, Buschauer A. Molecular and cellular analysis of human histamine receptor subtypes. Trends Pharmacol Sci 2013; 34:33-58. [PMID: 23254267 PMCID: PMC3869951 DOI: 10.1016/j.tips.2012.11.001] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/03/2012] [Accepted: 11/05/2012] [Indexed: 01/08/2023]
Abstract
The human histamine receptors hH(1)R and hH(2)R constitute important drug targets, and hH(3)R and hH(4)R have substantial potential in this area. Considering the species-specificity of pharmacology of H(x)R orthologs, it is important to analyze hH(x)Rs. Here, we summarize current knowledge of hH(x)Rs endogenously expressed in human cells and hH(x)Rs recombinantly expressed in mammalian and insect cells. We present the advantages and disadvantages of the various systems. We also discuss problems associated with the use of hH(x)R antibodies, an issue of general relevance for G-protein-coupled receptors (GPCRs). There is much greater overlap in activity of 'selective' ligands for other hH(x)Rs than the cognate receptor subtype than generally appreciated. Studies with native and recombinant systems support the concept of ligand-specific receptor conformations, encompassing agonists and antagonists. It is emerging that for characterization of hH(x)R ligands, one cannot rely on a single test system and a single parameter. Rather, multiple systems and parameters have to be studied. Although such studies are time-consuming and expensive, ultimately, they will increase drug safety and efficacy.
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Affiliation(s)
- Roland Seifert
- Institute of Pharmacology, Medical School of Hannover, Hannover, Germany.
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Powley TL, Gilbert JM, Baronowsky EA, Billingsley CN, Martin FN, Phillips RJ. Vagal sensory innervation of the gastric sling muscle and antral wall: implications for gastro-esophageal reflux disease? Neurogastroenterol Motil 2012; 24:e526-37. [PMID: 22925069 PMCID: PMC3776304 DOI: 10.1111/nmo.12003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The gastric sling muscle has not been investigated for possible sensory innervation, in spite of the key roles the structure plays in lower esophageal sphincter (LES) function and gastric physiology. Thus, the present experiment used tracing techniques to label vagal afferents and survey their projections in the lesser curvature. METHODS Sprague-Dawley rats received injections of dextran biotin into the nodose ganglia. Fourteen days postinjection, animals were euthanized and their stomachs were processed to visualize the vagal afferent innervation. In different cases, neurons, muscle cells, or interstitial cells of Cajal (ICC) were counterstained. KEY RESULTS The sling muscle is innervated throughout its length by vagal afferent intramuscular arrays (IMAs) associated with ICC. In addition, the distal antral attachment site of the sling muscle is innervated by a novel vagal afferent terminal specialization, an antral web ending. The muscle wall of the distal antrum is also innervated by conventional IMAs and intraganglionic laminar endings, the two types of mechanoreceptors found throughout stomach smooth muscle. CONCLUSIONS & INFERENCES The innervation of sling muscle by IMAs, putative stretch receptors, suggests that sling sensory feedback may generate vago-vagal or other reflexes with vagal afferent limbs. The restricted distribution of afferent web endings near the antral attachments of sling fibers suggests the possibility of specialized mechanoreceptor functions linking antral and pyloric activity to the operation of the LES. Dysfunctional sling afferents could generate LES motor disturbances, or normative compensatory sensory feedback from the muscle could compromise therapies targeting only effectors.
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Affiliation(s)
- Terry L. Powley
- Corresponding author: Terry L. Powley, Purdue University, 703 Third Street, West Lafayette, IN 47907-2091, , Phone: 765-494-6269, Fax: 765-496-1264
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Wolf-Johnston AS, Hanna-Mitchell AT, Buffington CA, Shinde S, Roppolo JR, Mayer E, Birder LA. Alterations in the non-neuronal acetylcholine synthesis and release machinery in esophageal epithelium. Life Sci 2012; 91:1065-9. [PMID: 22569297 DOI: 10.1016/j.lfs.2012.04.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 03/12/2012] [Accepted: 04/13/2012] [Indexed: 02/07/2023]
Abstract
AIMS A non-neuronal cholinergic system has been described in epithelial cells including that of the urinary bladder (urothelium) and the upper gastrointestinal tract (esophagus). Epithelial dysfunction has been implicated in the pathophysiology of persistent pain conditions such as painful bladder syndrome as well as functional heartburn. For example, alterations in the ability to synthesize and release acetylcholine may contribute to changes in epithelial sensory and barrier function associated with a number of functional genitourinary and intestinal disorders. MAIN METHODS We examined using immunoblot, acetylcholine (ACh)-synthesis and release components in cat esophageal mucosa and whether elements of these components are altered in a naturally occurring model of chronic idiopathic cystitis termed feline interstitial cystitis (FIC). KEY FINDINGS We identified proteins involved in ACh synthesis and release (high affinity choline transporter, CHT1; ACh synthesizing enzyme choline acetyltransferase ChAT and carnitine acetyltransferase CarAT; vesicular ACh transporter VAChT and the organic cation transporter isoforms 1-3 or OCT-1-3) in cat esophageal mucosa. Significant alterations in CHT, ChAT, VAChT and OCT-1 were detected in the esophageal mucosa from FIC cats. Changes in the vesicular nucleotide transporter (VNUT) and the junctional protein pan-cadherin were also noted. SIGNIFICANCE Taken together, these findings suggest that changes in the non-neuronal cholinergic system may contribute to alterations in cell-cell contacts and possibly communication with underlying cells that may contribute to changes in sensory function and visceral hyperalgesia in functional esophageal pain.
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Affiliation(s)
- Amanda S Wolf-Johnston
- University of Pittsburgh School of Medicine, Department of Medicine, Pittsburgh, PA 15261, USA
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Gill RS, Whitlock KA, Mohamed R, Birch DW, Karmali S. Endoscopic Treatment Options in Patients With Gastrojejunal Anastomosis Stricture Following Roux-en-Y Gastric Bypass. Gastroenterology Res 2012; 5:1-5. [PMID: 27785171 PMCID: PMC5051034 DOI: 10.4021/gr385w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2012] [Indexed: 12/16/2022] Open
Abstract
The proportion of obese individuals continues to increase worldwide. Bariatric surgery remains the only evidence-based treatment strategy to produce marked weight loss. Roux-en-Y gastric bypass is an effective and common bariatric surgical procedure offered to obese patients. However, a small percentage of individuals can develop narrowing or stricture formation of the gastrojejunal anastomosis. Endoscopic treatment of gastrojejunostomy (GJ) is preferred compared to surgical revision, as it is less invasive. The endoscopic treatment strategy most common employed is balloon dilatation. Endoscopic balloon dilatation is successful in majority of cases with low morbidity, however multiple dilatation may be required. Other endoscopic strategies such as incisional therapy has been successful in treating other gastrointestinal anastomotic strictures, however remain to be evaluated in post-RYGB GJ strictures. Further research is needed to determine the effectiveness of incision therapy and other endoscopic treatment strategies compared to endoscopic balloon dilatation.
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Affiliation(s)
- Richdeep S Gill
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Richdeep S. Gill and Kevin A. Whitlock were co-first authors
| | - Kevin A Whitlock
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Richdeep S. Gill and Kevin A. Whitlock were co-first authors
| | - Rachid Mohamed
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel W Birch
- Center of the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandria Hospital, Edmonton, Alberta, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Bageshwar D, Khanvilkar V, Kadam V. Stability indicating high performance thin-layer chromatographic method for simultaneous estimation of pantoprazole sodium and itopride hydrochloride in combined dosage form. J Pharm Anal 2011; 1:275-283. [PMID: 29403710 PMCID: PMC5760802 DOI: 10.1016/j.jpha.2011.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 09/16/2011] [Indexed: 11/28/2022] Open
Abstract
A specific, precise and stability indicating high-performance thin-layer chromatographic method for simultaneous estimation of pantoprazole sodium and itopride hydrochloride in pharmaceutical formulations was developed and validated. The method employed TLC aluminium plates precoated with silica gel 60F254 as the stationary phase. The solvent system consisted of methanol:water:ammonium acetate; 4.0:1.0:0.5 (v/v/v). This system was found to give compact and dense spots for both itopride hydrochloride (Rf value of 0.55±0.02) and pantoprazole sodium (Rf value of 0.85±0.04). Densitometric analysis of both drugs was carried out in the reflectance–absorbance mode at 289 nm. The linear regression analysis data for the calibration plots showed a good linear relationship with R2=0.9988±0.0012 in the concentration range of 100–400 ng for pantoprazole sodium. Also, the linear regression analysis data for the calibration plots showed a good linear relationship with R2=0.9990±0.0008 in the concentration range of 200–1200 ng for itopride hydrochloride. The method was validated for specificity, precision, robustness and recovery. Statistical analysis proves that the method is repeatable and selective for the estimation of both the said drugs. As the method could effectively separate the drug from its degradation products, it can be employed as a stability indicating method.
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Affiliation(s)
- Deepak Bageshwar
- Bharati Vidyapeeth's College of Pharmacy, Sector-8, CBD Belapur, Navi Mumbai 400614, India
| | - Vineeta Khanvilkar
- Bharati Vidyapeeth's College of Pharmacy, Sector-8, CBD Belapur, Navi Mumbai 400614, India
| | - Vilasrao Kadam
- Bharati Vidyapeeth's College of Pharmacy, Sector-8, CBD Belapur, Navi Mumbai 400614, India
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Morton M, Prendergast C, Barrett TD. Targeting gastrin for the treatment of gastric acid related disorders and pancreatic cancer. Trends Pharmacol Sci 2011; 32:201-5. [PMID: 21397342 DOI: 10.1016/j.tips.2011.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Revised: 02/04/2011] [Accepted: 02/07/2011] [Indexed: 01/16/2023]
Abstract
Gastrin, acting through peripheral cholecystokinin (CCK) 2 receptors, is a major hormonal regulator of gastric acid secretion. The effects of gastrin on acid secretion occur both acutely and chronically because gastrin directly stimulates gastric acid secretion and also exerts trophic effects on the enterochromaffin-like and parietal cells that together constitute the acid secretory apparatus of the stomach. Several antagonists that target the CCK2 receptor have been identified and investigated for the treatment of gastroesophageal reflux disease and pancreatic cancer. In this paper, we discuss the contribution of gastrin to these disease pathologies and the data generated to date from clinical studies investigating CCK2 receptor antagonists.
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Affiliation(s)
- Magda Morton
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., 3210 Merryfield Row, San Diego, CA 92121, USA
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