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Giok KC, Veettil SK, Menon RK. Risk factors for Peri-implantitis: An umbrella review of meta-analyses of observational studies and assessment of biases. J Dent 2024; 146:105065. [PMID: 38762079 DOI: 10.1016/j.jdent.2024.105065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVES To perform a comprehensive quantitative and qualitative analysis of the findings from previously published meta-analyses and to assess existing biases. DATA/SOURCES A search was conducted for meta-analyses of observational studies investigating the association between any risk factor and peri‑implantitis in PubMed, Scopus, Cochrane Database of Systematic Reviews, and Epistemonikos, from inception until October 2023 (PROSPERO: CRD42024512408). STUDY SELECTION From a total of 5002 publications, 51 full-text articles were evaluated for eligibility, and 12 articles that described 41 unique meta-analyses evaluating the association between risk factors and periimplantitis were selected. Among 41 associations, 24 associations were significant. None of the associations were graded as convincing evidence. Two associations, presence of periodontitis (OR = 3.84 [95 % CI 2.58,5.72]) and cigarette smoking (RR=2.07 [95 % CI 1.41,3.04]) were graded as highly suggestive. Eight associations, diabetes mellitus, hyperglycaemia, lack of prophylaxis, history of chronic periodontal disease, ongoing or history of periodontal disease, implants located in the anterior region of the jaw (maxillary and mandibular), osteoprotegerin (OPG) gene polymorphisms, and lack of keratinized mucosal width were graded as suggestive evidence. CONCLUSIONS Periodontitis and cigarette smoking are highly suggestive risk factors for peri‑implantitis. The remaining risk factors which are suggestive require more high-quality studies to be performed to upgrade the level of evidence. CLINICAL SIGNIFICANCE The highly suggestive and suggestive risk factors for peri‑implantitis summarized in this umbrella review should be rigorously assessed, monitored and managed by clinicians to reduce the risk peri‑implantitis, as well as to form part of the preoperative consent process.
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Affiliation(s)
- Koay Chun Giok
- School of Dentistry, International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sajesh K Veettil
- School of Pharmacy, Department of Pharmacy Practice, College of pharmacy, International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia; School of Medicine, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Rohit Kunnath Menon
- Prosthodontics, College of Dentistry, Ajman University, Ajman, United Arab Emirates.
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Zhou X, Duan H, Li Q, Wang Q, Sun X. Efficacy and safety of potassium-competitive acid inhibitors in the treatment of gastroesophageal reflux: a systematic review and meta-analysis. Scand J Gastroenterol 2024; 59:788-797. [PMID: 38741565 DOI: 10.1080/00365521.2024.2349638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a common disease caused by reflux of gastric contents to the esophagus. Proton-pump inhibitors (PPIs) are recommended as a first-line therapy to treat GERD. Recently, the potassium-competitive acid inhibitors have been increasingly in use in clinical practice. We aimed to evaluate the efficacy and safety of P-CABs in GERD. METHODS We searched PubMed, the Cochrane Library, EMBASE and Web Of Science for publications regarding randomized controlled trials comparing potassium-competitive acid inhibitors to PPI monotherapy or Placebo with respect to efficacy and safety in GERD (until April 2023). The primary outcome was an absence or global symptom improvement and the incidence of adverse events in GERD. The quality of the included literature was assessed using the bias assessment tool recommended in the Cochrane Systematic Assessor's Handbook 5.1.0. We use RevMan 5.3 software for Meta-analysis, sensitivity analysis and publication bias analysis. RESULTS Of the 991 screened studies, 14 studies including 4868 participants were analyzed. The ORs for the healing rates of GERD with P-CABs versus PPI/Placebo were 2.10 (95% confidence interval [CI] 1.53-2.88), additionally, 1.09 (95% CI 1.05-1.14), 1.03 (95% CI 1.00-1.06) and 1.03 (95% CI 0.99-1.06) in Weeks 2, 4, and 8, respectively. The effectiveness rate of the experimental group was significantly higher than that of the control group (RR 1.73; 95% CI 1.27-2.36). The overall OR of Incidence of adverse events with P-CABs versus PPI/Placebo was 1.08 (95% CI 0.88-1.12). Overall, the risk of bias was low to some concerns. Furthermore, sensitivity analyses confirmed the robustness of the study's conclusion. CONCLUSIONS Our findings suggest that potassium-competitive acid inhibitors is non-inferior to PPIs as therapy for patients with GERD. The safety outcomes for potassium-competitive acid inhibitors are similar to those for PPIs.
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Affiliation(s)
- Xinxu Zhou
- Department of Gastroenterology of The Third People's Hospital of Chengdu, Chengdu, China
| | - Hui Duan
- Department of Gastroenterology of The Third People's Hospital of Chengdu, Chengdu, China
| | - Qian Li
- Department of Gastroenterology of The Third People's Hospital of Chengdu, Chengdu, China
| | - Qiong Wang
- Department of Gastroenterology of The Third People's Hospital of Chengdu, Chengdu, China
| | - Xiaobin Sun
- Department of Gastroenterology of The Third People's Hospital of Chengdu, Chengdu, China
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3
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Jiang Y, Zhang R, Fang Y, Zhao R, Fu Y, Ren P, Zhan Q, Shao M. P-CAB versus PPI in the eradication of Helicobacter pylori: a systematic review and network meta-analysis. Therap Adv Gastroenterol 2024; 17:17562848241241223. [PMID: 38751605 PMCID: PMC11095192 DOI: 10.1177/17562848241241223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/06/2024] [Indexed: 05/18/2024] Open
Abstract
Background The efficacy and safety of potassium-competitive acid blockers (P-CABs) in the eradication of Helicobacter pylori (Hp) remains controversial when compared with proton pump inhibitors (PPIs). Objectives The current study set out to compare the differences in the eradication rate and adverse reactions between eradication regimens based on P-CAB or PPI drugs and the differences between the vonoprazan-based and the tegoprazan-based regimens to explore the efficacy and safety of different Hp eradication regimens. Data sources and methods Databases including PubMed, EMBASE, Cochrane Library, and WOS were searched from the inception of these databases up to July 2023, and eligible randomized controlled trials (RCTs) were included. The outcome measures were the eradication rate and the incidence of adverse reactions of different regimens in treating Hp. The results were estimated as relative risk (RR) and its 95% confidence interval (CI), and R 4.2.1 software was used to perform the network meta-analysis (NMA). Results A total of 20 studies were included in the analysis, involving 5815 patients with Hp. In terms of eradication rate, the 2-week vonoprazan-based triple regimen (V-Tri-2w) was the best, which was superior to the 2-week PPI-based quadruple regimen [P-Qua-2w, RR = 0.9, 95% CI: (0.85-0.95)] and the 1-week tegoprazan-based triple regimen [T-Tri-1w, RR = 0.79, 95% CI: (0.64-0.97)]; the 2-week tegoprazan-based quadruple regimen (T-Qua-2w) was superior to the 1-week PPI-based triple regimen [P-Tri-1w, RR = 0.82, 95% CI: (0.67-0.99)], and there was no difference between the remaining tegoprazan-based regimens and the PPI-based or vonoprazan-based regimens. In terms of the incidence of adverse reactions, the 2-week vonoprazan-based binary regimen (V-Bi-2w) was lower than that of the 2-week PPI-based quadruple regimen [P-Qua-2w, RR = 1.98, 95% CI: (1.57-2.52)]; there was no significant difference between 1 and 2 weeks for each regimen, such as the vonoprazan-based triple regimen [RR = 1.11, 95% CI: (0.82-1.52)]. Conclusion In the eradication treatment of Hp, the efficacy and safety of vonoprazan-based regimens are generally better than those of PPI-based regimens. Among them, the V-Tri-2w regimen has the highest eradication rate and may be the preferred choice for Hp eradication.
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Affiliation(s)
- Yutong Jiang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
- The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China
| | - Rongrong Zhang
- The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China
| | - Yuxuan Fang
- The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China
| | - Ruixia Zhao
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yu Fu
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Pingping Ren
- The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China
| | - Qingqing Zhan
- The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China
| | - Mingyi Shao
- The First Affiliated Hospital of Henan University of Chinese Medicine, 19 Renmin Road, Jinshui District, Zhengzhou, Henan 450000, China
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4
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Xia B, He Q, Smith FG, Gkoutos VG, Nirantharakumar K, Kuo ZC, Wang D, Feng Q, Cheung EC, Dai L, Huang J, Yu Y, Meng W, Qin X, Yuan J. Individualized prevention of proton pump inhibitor related adverse events by risk stratification. Nat Commun 2024; 15:3591. [PMID: 38678022 PMCID: PMC11055952 DOI: 10.1038/s41467-024-48007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
Proton pump inhibitors (PPIs) are commonly used for gastric acid-related disorders, but their safety profile and risk stratification for high-burden diseases need further investigation. Analyzing over 2 million participants from five prospective cohorts from the US, the UK, and China, we found that PPI use correlated with increased risk of 15 leading global diseases, such as ischemic heart disease, diabetes, respiratory infections, and chronic kidney disease. These associations showed dose-response relationships and consistency across different PPI types. PPI-related absolute risks increased with baseline risks, with approximately 82% of cases occurring in those at the upper 40% of the baseline predicted risk, and only 11.5% of cases occurring in individuals at the lower 50% of the baseline risk. While statistical association does not necessarily imply causation, its potential safety concerns suggest that personalized use of PPIs through risk stratification might guide appropriate decision-making for patients, clinicians, and the public.
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Affiliation(s)
- Bin Xia
- Department of Epidemiology and Biostatistics, Clinical Big Data Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Chinese Health RIsk MAnagement Collaboration (CHRIMAC), Shenzhen, Guangdong, China
| | - Qiangsheng He
- Department of Epidemiology and Biostatistics, Clinical Big Data Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Chinese Health RIsk MAnagement Collaboration (CHRIMAC), Shenzhen, Guangdong, China
| | - Fang Gao Smith
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - V Georgios Gkoutos
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- College of Medical and Dental Sciences, Centre for Health Data Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- College of Medical and Dental Sciences, Centre for Health Data Science, University of Birmingham, Edgbaston, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zi Chong Kuo
- Guangdong Provincial Key Laboratory of Gastroenterology, Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Danni Wang
- Department of Epidemiology and Biostatistics, Clinical Big Data Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Chinese Health RIsk MAnagement Collaboration (CHRIMAC), Shenzhen, Guangdong, China
| | - Qi Feng
- Oxford Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Eddie C Cheung
- Guangdong Provincial Key Laboratory of Gastroenterology, Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Division of Gastroenterology, Davis School of Medicine, University of California, Oakland, CA, USA
| | - Lunzhi Dai
- National Clinical Research Center for Geriatrics and Department of General Practice, West China Hospital, Sichuan University, Chengdu, China
| | - Junjie Huang
- J.C. School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - Yuanyuan Yu
- Department of Surgery, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - Wenbo Meng
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.
| | - Xiwen Qin
- School of Population and Global Health, Faculty of Medicine, Density and Health Sciences, University of Western Australia, Perth, AU-WA, Australia.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Technology Park, Sha Tin, Hong Kong, China.
| | - Jinqiu Yuan
- Department of Epidemiology and Biostatistics, Clinical Big Data Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China.
- Chinese Health RIsk MAnagement Collaboration (CHRIMAC), Shenzhen, Guangdong, China.
- Guangdong Provincial Key Laboratory of Gastroenterology, Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China.
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5
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Rodríguez-Alcolado L, Navarro P, Arias-González L, Grueso-Navarro E, Lucendo AJ, Laserna-Mendieta EJ. Proton-Pump Inhibitors in Eosinophilic Esophagitis: A Review Focused on the Role of Pharmacogenetics. Pharmaceutics 2024; 16:487. [PMID: 38675148 PMCID: PMC11054109 DOI: 10.3390/pharmaceutics16040487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Proton-pump inhibitors (PPIs) are the most administered first-line treatment for eosinophilic esophagitis (EoE). However, only around half of EoE patients respond histologically to a double dosage of PPI. In addition, 70% of responders maintain EoE in remission after tapering the PPI dose. In order to avoid endoscopy with biopsies-the only accurate method of assessing PPI response-efforts have been made to identify PPI responder patients. The clinical or endoscopic features and biomarkers evaluated so far, however, have not proven to be sufficient in predicting PPI response. Although new approaches based on omics technologies have uncovered promising biomarkers, the specialized and complex procedures required are difficult to implement in clinical settings. Alternatively, PPI pharmacogenetics based on identifying variations in CYP2C19 and STAT6 genes have shown promising results in EoE, and could easily be performed in most laboratories. Other genetic variations have also been associated with PPI response and may explain those cases not related to CYP2C19 or STAT6. Here, we provide an overview of PPI treatment in EoE and evidence of how genetic variations in CYP2C19 and other genes could affect PPI effectiveness, and also discuss studies evaluating the role of pharmacogenetics in predicting PPI response in patients with EoE.
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Affiliation(s)
- Leticia Rodríguez-Alcolado
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Tomelloso, Spain; (L.R.-A.); (P.N.); (L.A.-G.); (E.G.-N.)
- Department of Surgery, Medical and Social Sciences, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Pilar Navarro
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Tomelloso, Spain; (L.R.-A.); (P.N.); (L.A.-G.); (E.G.-N.)
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
- Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Laura Arias-González
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Tomelloso, Spain; (L.R.-A.); (P.N.); (L.A.-G.); (E.G.-N.)
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
- Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Elena Grueso-Navarro
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Tomelloso, Spain; (L.R.-A.); (P.N.); (L.A.-G.); (E.G.-N.)
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
- Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain
| | - Alfredo J. Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Tomelloso, Spain; (L.R.-A.); (P.N.); (L.A.-G.); (E.G.-N.)
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
- Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Emilio J. Laserna-Mendieta
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Tomelloso, Spain; (L.R.-A.); (P.N.); (L.A.-G.); (E.G.-N.)
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
- Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
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Gramont B, Fayolle S, Beltramin D, Bidat N, Boudet J, Chaux R, Grange L, Barrau M, Gagneux-Brunon A, Cathébras P, Killian M, Botelho-Nevers E, Célarier T. Proton pump inhibitors and risk of severe COVID-19 in older people. Age Ageing 2024; 53:afae082. [PMID: 38619123 DOI: 10.1093/ageing/afae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/11/2023] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 is a viral respiratory infection that can cause systemic disorders and lead to death, particularly in older people. Proton pump inhibitors (PPIs) increase the risk of enteric and lung infections. Considering the broad use of PPIs in older people, the potential role of PPIs in COVID-19 could be of dramatic significance. The objective of our study was to evaluate the link between PPIs and severe COVID-19 in older people. METHOD We performed a retrospective cohort study, including all patients aged ≥65, hospitalised for a diagnosis of COVID-19. Epidemiological, clinical and biological data were extracted and we performed an Inverse Probability of Treatment Weighing method based on a propensity score. RESULTS From March 2020 to February 2021, a total of 834 patients were included, with a median age of 83 and 52.8% were male. A total of 410 patients had a PPIs prescription, 358 (87.3%) were long-term PPIs-users and 52 (12.7%) were recent PPIs-users. Among PPIs-users, 163 (39.8%) patients developed severe COVID-19 versus 113 (26.7%) in PPIs-non users (odds ratio (OR) = 1.59 [1.18-2.14]; P < 0.05). Moreover, the double dose PPI-users had a higher risk of developing severe COVID-19 (OR = 3.36 [1.17-9.66]; P < 0.05) than the full dose PPI-users (OR = 2.15 [1.22-3.76]; P < 0.05) and the half dose PPI-users (OR = 1.64 [1.13-2.37]; P < 0.05). CONCLUSION Our study reports evidence that the use of PPIs was associated with an increased risk of severe COVID-19 in older people.
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Affiliation(s)
- Baptiste Gramont
- Department of Internal Medicine, Saint-Etienne University Hospital, Saint-Etienne, France
- Team GIMAP, CIRI-Centre International de Recherche en Infectiologie, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, INSERM, U1111, Centre National de la Recherche Scientifique (CNRS), UMR530, F42023 Saint-Etienne, France
| | - Sophie Fayolle
- Department of General Practice, Université Jean Monnet, Saint-Etienne, France
| | - Diva Beltramin
- Department of Public Health and Medical Information, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nisrine Bidat
- Department of General Practice, Université Jean Monnet, Saint-Etienne, France
| | - Julie Boudet
- Department of General Practice, Université Jean Monnet, Saint-Etienne, France
| | - Robin Chaux
- Department of Public Health and Medical Information, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Lucile Grange
- Department of Internal Medicine, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Mathilde Barrau
- Team GIMAP, CIRI-Centre International de Recherche en Infectiologie, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, INSERM, U1111, Centre National de la Recherche Scientifique (CNRS), UMR530, F42023 Saint-Etienne, France
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Amandine Gagneux-Brunon
- Team GIMAP, CIRI-Centre International de Recherche en Infectiologie, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, INSERM, U1111, Centre National de la Recherche Scientifique (CNRS), UMR530, F42023 Saint-Etienne, France
- Infectious Disease Department, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Pascal Cathébras
- Department of Internal Medicine, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Martin Killian
- Department of Internal Medicine, Saint-Etienne University Hospital, Saint-Etienne, France
- Team GIMAP, CIRI-Centre International de Recherche en Infectiologie, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, INSERM, U1111, Centre National de la Recherche Scientifique (CNRS), UMR530, F42023 Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- Team GIMAP, CIRI-Centre International de Recherche en Infectiologie, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, INSERM, U1111, Centre National de la Recherche Scientifique (CNRS), UMR530, F42023 Saint-Etienne, France
- Infectious Disease Department, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Thomas Célarier
- Department of Clinical Gerontology, Saint-Etienne University Hospital, Saint-Etienne, France
- Chaire Santé des Ainés, Université Jean Monnet, Saint-Etienne, France
- Gérontopôle Auvergne-Rhône-Alpes, Saint-Etienne, France
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7
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Simadibrata DM, Lesmana E, Pratama MIA, Sugiharta AJ, Winarizal AS, Lee YY, Syam AF. A systematic review with meta-analysis: Efficacy and safety of potassium-competitive acid blocker compared with proton pump inhibitor in the maintenance of healed erosive esophagitis. JGH Open 2024; 8:e13053. [PMID: 38523708 PMCID: PMC10958938 DOI: 10.1002/jgh3.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/18/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024]
Abstract
Introduction Proton pump inhibitor (PPI) is the mainstay therapy for the maintenance of healed erosive esophagitis (EE). It is unknown whether potassium-competitive acid blockers (PCABs) are more efficacious and safer than PPIs. Methods Only randomized controlled trials (RCTs) comparing PCABs to PPIs in the maintenance of healing rates of endoscopically proven healed EE and indexed in MEDLINE, EMBASE, and CENTRAL until 3 February 2024, were included. A fixed-effects model meta-analysis was performed to pool primary efficacy outcome (maintenance of healing rates at week 24) and safety data (any treatment-emergent adverse event or TEAE). The risk of bias was assessed using Cochrane's Risk of Bias 2 (RoB2) tool. Results Four RCTs with a total of 2554 patients were eligible for inclusion. All trials were of low risk of bias. Compared to lansoprazole 15 mg, the maintenance rates of healed EE at week 24 were significantly higher with vonoprazan 10 mg (RR 1.13; 95% CI 1.07-1.19) and vonoprazan 20 mg (RR 1.15; 95% CI 1.10-1.21). Likewise, compared to lansoprazole 15 mg, any TEAEs were significantly greater with vonoprazan 20 mg (RR 1.10; 95% CI 1.01-1.20) but not vonoprazan 10 mg. Conclusion Vonoprazan 10 and 20 mg were superior to lansoprazole 15 mg in the maintenance of the healing of EE. Any TEAEs were greater with vonoprazan 20 mg.
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Affiliation(s)
- Daniel M Simadibrata
- Faculty of Medicine Universitas IndonesiaJakartaIndonesia
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Elvira Lesmana
- Faculty of Medicine Universitas IndonesiaJakartaIndonesia
| | | | | | | | - Yeong Y Lee
- School of Medical SciencesUniversiti Sains MalaysiaKota BharuMalaysia
- GI Function and Motility Unit, Hospital USMKota BharuMalaysia
| | - Ari F Syam
- Division of Gastroenterology, Department of Internal MedicineFaculty of Medicine Universitas Indonesia—Ciptomangkunkusumo General HospitalJakartaIndonesia
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8
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Alanazi AS, Almutairi H, Gupta JK, Mohanty D, Rath D, AlOdan AA, Mahal A, Khatib MN, Gaidhane S, Zahiruddin QS, Rustagi S, Satapathy P, Serhan HA. Osseous implications of proton pump inhibitor therapy: An umbrella review. Bone Rep 2024; 20:101741. [PMID: 38348455 PMCID: PMC10859261 DOI: 10.1016/j.bonr.2024.101741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
Background Proton pump inhibitors (PPIs) are among the most commonly prescribed medications worldwide for acid-related disorders. While their short-term efficacy and safety are well-established, concerns regarding their long-term effects on bone health have emerged. This umbrella review aimed to synthesize the available findings on the associations between PPI use and bone metabolism outcomes. Methods An electronic search was conducted using PubMed, Web of Science, Embase, and the Cochrane Database up to September 16, 2023. Systematic reviews and meta-analyses of randomized controlled trials (RCTs) and observational studies that evaluated the relationship between PPIs and bone metabolism outcomes were included. Data extraction, quality appraisal, and synthesis were performed in line with the Joanna Briggs Institute and PRISMA guidelines. The strength of the evidence was graded using the GRADE criteria. Statistical analysis was performed in R version 4.3. Results Out of 299 records, 27 studies met the inclusion criteria. The evidence indicated a statistically significant increased risk of fractures, notably hip, spine, and wrist fractures, in PPI users. PPI use was associated with changes in Bone Mineral Density (BMD) across various bones, though the clinical relevance of these changes remains uncertain. Furthermore, PPI-induced hypomagnesemia, which can influence bone health, was identified. A notable finding was the increased risk of dental implant failures in PPI users. However, the certainty of most of the evidence ranged from very low to low based on GRADE criteria. Conclusion The long-term use of PPIs may be associated with adverse bone health outcomes, including increased fracture risk, alterations in BMD, hypomagnesemia, and dental implant failure. While these findings highlight potential concerns for long-term PPI users, the current evidence's low certainty underscores the need for robust, high-quality research to clarify these associations.
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Affiliation(s)
- Abdullah S. Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Al-Jouf, Saudi Arabia
| | - Hadiah Almutairi
- Department of Pharmacy Practice, College of Pharmacy, University of Hafr Albatin, Saudi Arabia
| | | | - Dibyalochan Mohanty
- Centre for Nano Medicine, Department of Pharmaceutics, School of Pharmacy, Anurag University, Hyderabad, India
| | - Deepankar Rath
- Department of Pharmacology, School of Pharmacy and Life Sciences, Centurion University of Technology and Management, Odisha, India
| | - Ali A. AlOdan
- Department of Family Medicine, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ahmed Mahal
- Department of Medical Biochemical Analysis, College of Health Technology, Cihan University-Erbil, Erbil, Kurdistan Region, Iraq
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001 Hillah, Babil, Iraq
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9
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Al Khoury A, Taheri Tanjani M, Hari B, Almadi MA, Martel M, Barkun AN. Primary and Specialty Care Trainees' Perceptions About Proton Pump Inhibitor Use. J Clin Gastroenterol 2024:00004836-990000000-00268. [PMID: 38385596 DOI: 10.1097/mcg.0000000000001983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/29/2023] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Proton pump inhibitors (PPIs) are widely prescribed with proven efficacy in many indications, yet longstanding controversy about potential adverse events persists. We aimed to acquire knowledge about perceptions of outpatient PPI long-term prescribing (≥8 wk) among primary and specialty care trainees at 2 Canadian Universities. METHODS Family medicine, internal medicine, and gastroenterology trainees completed a web-based survey that included 20 clinical scenarios assessing trainee knowledge about PPI efficacy. Contextual PPI prescribing decisions were also elicited, balancing possible PPI indications versus side effects. Management strategies were compared between junior and senior trainees, as well as across training programs. RESULTS Over a 4-month period,163 trainees (age <26 y: 12%; age 26 to 45: 88%; 59% females) participated in the survey (family medicine: 51%, internal medicine: 44%, and gastroenterology: 5%); 83% were considered junior residents. Only 42% had received formal education on prescribing PPI long-term. Overall, 93% believed they would benefit from such teaching, with 98% stating they would follow related guidelines. No between-group differences were noted in knowledge of appropriate PPI indications nor possible side effects when comparing juniors to seniors, or among different specialties. Across different management scenarios, inappropriate PPI discontinuation was chosen by 14.3% to 67.2%, whereas inappropriate PPI continuation was reported in up to 57%. Trainee seniority and specialty did not differ in appropriate deprescribing rates. CONCLUSIONS Training level and primary versus specialty care settings are associated with frequent inappropriate PPI prescribing and deprescribing. These findings highlight the need for and may inform future educational programs on PPI usage.
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Affiliation(s)
- Alex Al Khoury
- Department of Medicine, Division of Gastroenterology, University of Florida, Jacksonville, FL
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec
| | | | - Bretton Hari
- Department of Medicine, University of Calgary, Calgary, Alberta
| | - Majid A Almadi
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Myriam Martel
- Research Institute of the McGill University Health Center, Montreal, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec
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10
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Zou S, Ouyang M, Cheng Q, Shi X, Sun M. Acid-suppressive drugs: A systematic review and network meta-analysis of their nocturnal acid-inhibitory effect. Pharmacotherapy 2024; 44:171-183. [PMID: 38049205 DOI: 10.1002/phar.2899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND AND AIMS Acid-suppressive drugs (ASDs) are widely used in many gastric acid-associated diseases. Nocturnal acid breakthrough has been a common problem of many ASDs, such as proton-pump inhibitors (PPIs) and H2 -receptor antagonists (H2RAs). Potassium-competitive acid blockers (P-CABs) are expected to solve this continuing conundrum. This article examined major ASDs and compared them with placebo in terms of nocturnal acid-inhibitory effects, using a network meta-analysis of randomized controlled trials (RCTs). METHODS To compare the effectiveness of major ASDs, a Bayesian network meta-analysis (NMA) was applied to process data extracted from RCTs. The plausible ranking for each regimen and some subgroups were assessed by surface under the cumulative ranking curves (SUCRA). RESULTS Fifty-five RCTs were conducted with 2015 participants. In terms of nocturnal acid-inhibitory effects, the overall results showed that tegoprazan (SUCRA 91.8%) and vonoprazan (SUCRA 91.0%) had the best performance, followed by new PPIs (including tenatoprazole and ilaprazole) (SUCRA 76.6%), additional H2RAs once at bedtime (AHB) (SUCRA 61.3%), isomer PPIs (including esomeprazole and dexlansoprazole) (SUCRA 38.6%), revaprazan (SUCRA 34.7%), traditional PPIs (including omeprazole, rabeprazole, pantoprazole, lansoprazole) (SUCRA 32.6%), H2RAs (SUCRA 23.1%), and placebo (SUCRA 0.3%). In some subgroups, the nocturnal acid-inhibitory effect of vonoprazan or tegoprazan was better than most of the other regimens, even new PPIs and AHB. CONCLUSIONS This is the first study to compare the effect of ASDs on inhibiting nocturnal acid breakthrough. Overall, in terms of nocturnal acid-inhibitory effect, vonoprazan and tegoprazan had an advantage against other regimens including H2RAs, isomer PPIs, traditional PPIs, AHB, and new PPIs. Even in some subgroups, such as language classification (English), types of study design (crossover-RCT), age (≤40 years), BMI (18.5-24.9 kg/m2 ), continent (Asia and North America), disease status (health), the duration of therapy (2 weeks), and time of administration (at daytime or at night-time), the nocturnal acid-inhibitory effect of vonoprazan or tegoprazan were better than most regimens, even AHB and new PPIs.
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Affiliation(s)
- Shupeng Zou
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Mengling Ouyang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qian Cheng
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xuan Shi
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Minghui Sun
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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11
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Sizgoric L, Likic R. Proton pump inhibitors: Weighing the benefits and risks across various health conditions. Br J Clin Pharmacol 2024; 90:388-391. [PMID: 38013514 DOI: 10.1111/bcp.15960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/29/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
- Luka Sizgoric
- University of Zagreb Medical School, Zagreb, Croatia
| | - Robert Likic
- University of Zagreb Medical School, Zagreb, Croatia
- Division of Clinical Pharmacology and Therapeutics, Department of Internal Medicine, Clinical Hospital Centre Zagreb, Zagreb, Croatia
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12
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Kindt S, Surmont M. Manual censoring of impedance tracings by the Wingate consensus reduces the number of impedance episodes, impacting on reflux categorization. Neurogastroenterol Motil 2023; 35:e14683. [PMID: 37793130 DOI: 10.1111/nmo.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The Lyon consensus classifies the evidence of gastroesophageal reflux (GERD) based on endoscopic features and results of pH/impedance monitoring (pH-MII) including the post-reflux swallow-induced peristaltic wave index (PSPWI) and mean nocturnal baseline impedance (MNBI). The Wingate consensus established criteria to reduce inter-reviewer variability when assessing reflux episodes and PSPWI by impedance. This study aims to assess the influence of the Wingate criteria on the different pH-MII parameters obtained by automated analysis. METHODS Thirty consecutive pH-MII off PPI were reviewed according to Wingate criteria. Number of impedance episodes and PSPWI were compared before and after censoring from automatic analysis. Reflux categorization according to Lyon consensus between censored and uncensored data was compared. Pearson correlations between impedance parameters and censored episodes were calculated. KEY RESULTS Censoring the tracings significantly reduced the number of reflux episodes (66 [42-90.25] vs. 44.5 [21.5-61.5], p = 0.0105). Reasons for censoring were as follows: 1/ anterograde episode: 9.5 [6-13], 2/ impedance drop <50%: 1 [0-3], 3/ duration <4 s: 1 [0-2], 4/ <2 distal channels: 2.5 [1-4], and 5/ artifacts: 2 [1-5]. Censored episodes were in majority non-acid (16.5 [13-26.5] vs. 2 [0-4], p < 0.00001). Censoring altered the categorization of impedance episodes (<40 episodes, 6 vs. 13 for resp. uncensored vs. censored tracings, 40-80 episodes: 13 vs. 13, and >80 episodes: 11 vs. 4, p = 0.0264), but not the symptom index, the symptom association probability, or the categorization according to the Lyon consensus. Nevertheless, individual tracings were affected. The percentage of censored episodes was inversely correlated with the number of acidic impedance episodes (r = -0.62, p = 0.0002). CONCLUSION AND INFERENCES Manual interpretation of impedance tracings based on the Wingate consensus reduces the number of impedance episodes, impacting on reflux categorization. Acidic reflux episodes are less likely to be censored, harboring a potential at improving automatic pH-MII analysis.
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Affiliation(s)
- Sébastien Kindt
- Department of Gastroenterology and Hepatology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Magali Surmont
- Department of Gastroenterology and Hepatology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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13
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Lee YY, Izham N, Mohd Zulkifly MF, Mohamed Mustafar MF, Ismail AK, Mohamed Shah NFFN, Ab Razak A, Abdul Halim S, Idris Z, Ghani ARI, Ismail MI, Fitzrol DN, Yee AS, Zakaria Z, Abd Hamid AI, Sapiai NA, Mat Nawi N, Hassan N, Abdullah JM. The Brain-Gut Clinic in Hospital Universiti Sains Malaysia: Pioneering New Service to Advance Neuro-Gastroenterology and Motility in Malaysia. Malays J Med Sci 2023; 30:1-7. [PMID: 37425382 PMCID: PMC10325127 DOI: 10.21315/mjms2023.30.3.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/29/2023] [Indexed: 07/11/2023] Open
Abstract
Neurogastroenterology and motility is a new but advanced subspecialty within gasteroenterology that cater to difficult, persistent and refractory gut-brain symptoms. Hospital USM has the country's first and new state-of-the art motility lab that was recently launched on the 25 May 2023, and is covered in nationwide media. Another first is the Brain-Gut Clinic, established on the 16 November 2022. The clinic is a new concept that builds on unique multiple disciplines in relation to the gut-brain axis. It is hoped that there will be more awareness on the existence of neurogastroenterology and motility among doctors and community, and that more research can be forthcoming to reduce the disease burden.
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Affiliation(s)
- Yeong Yeh Lee
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nabilah Izham
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Faizal Mohd Zulkifly
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neuroscience, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohamed Faiz Mohamed Mustafar
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neuroscience, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ahmad Karami Ismail
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Nutrition and Dietetics Unit, Hospital Universiti Sains Malaysia, Kelantan Malaysia
| | - Nur Farah Fathia Nabila Mohamed Shah
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Nutrition and Dietetics Unit, Hospital Universiti Sains Malaysia, Kelantan Malaysia
| | - Asrenee Ab Razak
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Psychiatry, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Sanihah Abdul Halim
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neuroscience, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Neurology Unit, Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Zamzuri Idris
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neuroscience, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Abdul Rahman Izaini Ghani
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neuroscience, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Muhammad Ihfaz Ismail
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neuroscience, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Diana Noma Fitzrol
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neuroscience, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ang Song Yee
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neuroscience, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Zaitun Zakaria
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neuroscience, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Aini Ismafairus Abd Hamid
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neuroscience, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nur Asma Sapiai
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Radiology, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Norazlina Mat Nawi
- Department of Nuclear Medicine, Radiotherapy and Oncology, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Norina Hassan
- Neuro Intensive Care Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Jafri Malin Abdullah
- Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neuroscience, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
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14
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Ahn N, Nolde M, Krause E, Güntner F, Günter A, Tauscher M, Gerlach R, Meisinger C, Linseisen J, Baumeister SE, Rückert-Eheberg IM. Do proton pump inhibitors increase the risk of dementia? A systematic review, meta-analysis and bias analysis. Br J Clin Pharmacol 2023; 89:602-616. [PMID: 36331350 DOI: 10.1111/bcp.15583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/08/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
AIM Previous studies on the association between proton pump inhibitor (PPI) intake and the increased risk of dementia has shown discrepancies in their conclusions. We aimed to provide updated evidence based on extensive bias assessments and quantitative sensitivity analyses. METHODS We searched the databases PubMed, EMBASE, SCOPUS, CENTRAL and clinicaltrials.gov for prospective studies that examined an association between PPI use and dementia, up to February 2022. Each study was assessed using the Cochrane risk of bias assessment tools for non-randomized studies of interventions (ROBINS-I) or randomized trials (RoB2). Pooled risk ratios (RRs) and 95% prediction intervals were computed using random-effects models. Sensitivity analyses were adjusted for small-study bias. RESULTS We included nine observational studies with 204 108 dementia cases in the primary analysis on the association between PPI use vs. non-use and dementia, and the RR was 1.16 (95% CI = 1.00; 1.35). After adjusting for small-study bias by Copas selection model and Rücker's shrinkage procedure, the RR was 1.16 (1.02; 1.32) and 1.15 (1.13; 1.17), respectively. A subgroup analysis of PPI use vs. non-use regarding Alzheimer's disease risk yielded an RR of 1.15 (0.89; 1.50). The secondary analysis on the risk of dementia by use of PPI vs. histamine-2 receptor antagonist showed an RR of 1.03 (0.66; 1.62). CONCLUSION This meta-analysis provided no clear evidence for an association between PPI intake and the risk of dementia. Due to discrepancies in sensitivity analyses, however, some risk of dementia by PPI use cannot be ruled out. Since an unequivocal conclusion is still pending, further research is warranted.
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Affiliation(s)
- Nayeon Ahn
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig Maximilian University of Munich, Munich, Germany
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
| | - Michael Nolde
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig Maximilian University of Munich, Munich, Germany
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
| | - Evamaria Krause
- Medical Library, Augsburg University Library, University of Augsburg, Augsburg, Germany
| | | | | | - Martin Tauscher
- Association of Statutory Health Insurance Physicians in Bavaria, Kassenärztliche Vereinigung Bayerns, KVB, Munich, Germany
| | - Roman Gerlach
- Association of Statutory Health Insurance Physicians in Bavaria, Kassenärztliche Vereinigung Bayerns, KVB, Munich, Germany
| | - Christa Meisinger
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
| | - Jakob Linseisen
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig Maximilian University of Munich, Munich, Germany
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
| | | | - Ina-Maria Rückert-Eheberg
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig Maximilian University of Munich, Munich, Germany
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
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15
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Raoul JL, Moreau-Bachelard C, Gilabert M, Edeline J, Frénel JS. Drug-drug interactions with proton pump inhibitors in cancer patients: an underrecognized cause of treatment failure. ESMO Open 2023; 8:100880. [PMID: 36764092 PMCID: PMC10024146 DOI: 10.1016/j.esmoop.2023.100880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 02/11/2023] Open
Abstract
New concepts and drugs have revolutionized medical treatment for cancers. These drugs, which are very expensive and usually well tolerated, have dramatically improved cancer prognosis. We must use them wisely for patients to fully benefit. Gastric acid antisecretory drugs and particularly proton pump inhibitors (PPIs) revolutionized the treatment of gastroduodenal ulcers and severe gastroesophageal reflux, but are frequently overused for symptomatic treatment of epigastric pain or heartburn. Long-term acid suppression may alter the efficacy of many anticancer drugs, such as tyrosine kinase inhibitors (TKIs), cyclin-dependent kinase (CDK) 4/6 inhibitors and immune checkpoint inhibitors (ICIs), by either decreasing gastric acid secretion and thus drug absorption, or by modifying the gut microbiome that modulates the response to ICIs. Oncologists thus need to pay particular attention to the concomitant use of PPIs and anticancer drugs. These interactions translate into major clinical impacts, with demonstrated loss of efficacy for some TKIs (erlotinib, gefitinib, pazopanib), and conflicting results with many other oral drugs, including capecitabine and CDK 4/6 inhibitors. Furthermore, the profound changes in the gut microbiome due to using PPIs have shown that the benefit of using ICIs may be suppressed in patients treated with PPIs. As the use of PPIs is not essential, we must apply the precautionary principle. The first sentence of a recent Comment in Nature was "Every day, millions of people are taking medications that will not help them". We fear that every day millions of cancer patients are taking medications that harm them. While this may well be only association and not causation, there is enough to make us pause until we reach a clear answer. All these data should encourage medical oncologists to refrain from prescribing PPIs, explaining to patients the risks of interaction in order to prevent inappropriate prescription by another physician.
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Affiliation(s)
- J L Raoul
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France.
| | - C Moreau-Bachelard
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - M Gilabert
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - J Edeline
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - J S Frénel
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
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16
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Simadibrata DM, Syam AF, Lee YY. A comparison of efficacy and safety of potassium-competitive acid blocker and proton pump inhibitor in gastric acid-related diseases: A systematic review and meta-analysis. J Gastroenterol Hepatol 2022; 37:2217-2228. [PMID: 36181401 PMCID: PMC10092067 DOI: 10.1111/jgh.16017] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Potassium-competitive acid blocker (PCAB) is a recent alternative to proton pump inhibitor (PPI) for potent acid suppression. The current systematic review and meta-analysis aimed to compare the efficacy and safety of PCAB versus PPI in treating gastric acid-related diseases. METHODS We searched up to June 5, 2022, for randomized controlled trials of gastric acid-related diseases that included erosive esophagitis, symptomatic gastroesophageal reflux disease (GERD), peptic ulcers, and Helicobacter pylori infection. The pooled risk ratio (RR) was evaluated for the efficacy outcome and treatment-emergent adverse events (TEAEs) as the safety outcome. Sensitivity analyses were performed to test the robustness of the study findings. RESULTS Of the 710 screened studies, 19 studies including 7023 participants were analyzed. The RRs for the healing of erosive esophagitis with Vonoprazan versus PPI were 1.09 (95% confidence interval [CI] 1.03-1.14), 1.03 (95% CI 1.00-1.07), and 1.02 (95% CI 1.00-1.05) in Weeks 2, 4, and 8, respectively. There were no differences in the improvement of GERD symptoms and healing of gastric and duodenal ulcers between PCAB and PPI. The pooled eradication rates of H. pylori were significantly higher in Vonoprazan versus PPI first-line treatment (RR 1.13; 95% CI 1.04-1.22). The overall RR of TEAEs with Vonoprazan versus PPI was 1.08 (95% CI 0.89-1.31). Overall, the risk of bias was low to some concerns. Furthermore, sensitivity analyses confirmed the robustness of the study's conclusion. CONCLUSION Vonoprazan is superior to PPI in first-line H. pylori eradication and erosive esophagitis but non-inferior in other gastric acid-related diseases. Likewise, short-term safety is comparable in both treatment groups.
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Affiliation(s)
| | - Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Ciptomangunkusumo General Hospital, Jakarta, Indonesia
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,GI Function and Motility Unit, Hospital USM, Kota Bharu, Malaysia
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Trenaman SC, Harding A, Bowles SK, Kirkland SA, Andrew MK. A Prescribing Cascade of Proton Pump Inhibitors Following Anticholinergic Medications in Older Adults With Dementia. Front Pharmacol 2022; 13:878092. [PMID: 35814221 PMCID: PMC9257131 DOI: 10.3389/fphar.2022.878092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Prescribing cascade refers to use of a medication to treat a drug-related adverse event. Prescribing cascades increase medication use, cost, and risk of adverse events. Objective: Our objective was to use administrative health data to identify whether use of medications from the anticholinergic cognitive burden scale was associated with proton pump inhibitor (PPI) prescribing consistent with a prescribing cascade in older adults with dementia. Method: The cohort was comprised of Nova Scotia Seniors’ Pharmacare beneficiaries identified to have dementia and medication dispensation data recorded between 1 April 2010, or cohort entry and 31 March 2015. Anticholinergic medications from the anticholinergic cognitive burden scale (ACB) were abstracted. A look back period of 365 days identified if a PPI had been dispensed preceding anticholinergic dispensation. PPI initiation within 30, 60, 90, or 180 days of the anticholinergic medication was assessed. Demographic description of those dispensed anticholinergic medications or PPIs were reported. Risk factors for the prescribing cascade were investigated with logistic regression and Cox proportional hazards modelling including a sex-stratified analysis. Results: We identified 28,952 Nova Scotia Seniors’ Pharmacare beneficiaries with dementia and prescription dispensation data. Anticholinergic medications were frequently dispensed with 63.4% of the cohort dispensed at least one prescription for an anticholinergic medication. The prescribing cascade defined as up to 180-days between anticholinergic medication inititation and PPI dispensation, occurred in 1,845 Nova Scotia Seniors’ Pharmacare beneficiaries with dementia (incidence 6.4%). Multivariate regression showed those experiencing the prescribing cascade after initiating any anticholinergic were younger (OR 0.98, 95%CI [0.97–0.98]), less likely to live in an urban location (OR 0.82, 95%CI [0.74–0.91]), or to be men (OR 0.74, 95%CI [0.67–0.82]). Cox regression demonstrated an increased risk of starting a PPI within 180 days when initiating any medication from the ACB (HR 1.38, 95%CI [1.29–1.58]). Discussion: Regression modelling suggested that anticholinergic medications increased the risk of PPI dispensation consistent with a prescribing cascade in the cohort. The identification of the prescribing cascade in this population of older Nova Scotia Seniors’ Pharmacare Program beneficiaries with dementia using administrative health data highlights how routinely collected health data can be used to identify prescribing cascades.
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Affiliation(s)
- Shanna C. Trenaman
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
- *Correspondence: Shanna C. Trenaman,
| | | | - Susan K. Bowles
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health, Halifax, NS, Canada
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Susan A. Kirkland
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Melissa K. Andrew
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health, Halifax, NS, Canada
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Hirota K. H2 antagonists, proton pump inhibitors and COVID-19. J Anesth 2022; 36:329-331. [PMID: 35067766 PMCID: PMC8784200 DOI: 10.1007/s00540-021-03032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan.
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Wu DN, Li GF, Yu G. Use of proton pump inhibitors and adverse clinical outcomes. Br J Clin Pharmacol 2021; 88:2452-2453. [PMID: 34957603 DOI: 10.1111/bcp.15161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dan-Na Wu
- Department of Pharmacy, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Hainan, China
| | - Guo-Fu Li
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Guo Yu
- Clinical Medical College, Yangzhou University, Yangzhou, China
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