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Xiao B, Ye Z, Cheng R, Han Z, Wu S, Wang G, Li Z, Liang T, Zhang S, Huang R. Optimal antiplatelet therapy for patients after antiplatelet therapy induced gastrointestinal bleeding: timing. Intern Emerg Med 2023; 18:1385-1396. [PMID: 37195594 DOI: 10.1007/s11739-023-03299-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
Adjusting antiplatelet strategies after antiplatelet-associated gastrointestinal bleeding (GIB) is a complex clinical challenge. To assess the risk of outcomes at different times of resumption of antiplatelet therapy in an attempt to find the optimal time to resume therapy. The study analyzed consecutive patients with antiplatelet-associated GIB from Beijing Friendship Hospital Information System between October 2019 and June 2022. The primary outcomes were recurrent bleeding, major adverse cardiovascular and cerebrovascular events (MACE), and all-cause death. Multivariate-adjusted Cox proportional hazards models were used to evaluate the risks of these outcomes. The receiver operating characteristic curve was used to find the optimal time to resume treatment. Of the 617 patients with GIB after antiplatelet therapy successfully followed up, the median follow-up was 246 (interquartile range: 120-466) days, most patients (87.36%) interrupted therapy after GIB and 45.22% resumed within 90 days, of which 35.13% resumed within 7 days and 64.87% resumed after 7 days. Resumption therapy had a low risk of recurrent bleeding (uninterrupted as a reference: HR 0.32, 95% CI 0.15-0.67, p = 0.003), MACE (no resumption as a reference: HR 0.66, 95% CI 0.45-0.98, p = 0.037), and all-cause death (no resumption as a reference: HR 0.18, 95% CI 0.08-0.40, p < 0.001). And resuming therapy within 7 days had a lower risk of MACE (HR 0.18, 95% CI 0.08-0.44, p < 0.001) than after 7 days without a significantly higher risk of re-bleeding. The optimal time point for resuming therapy in this study was 8.5 days. Resuming antiplatelet therapy after GIB provides better clinical benefits compared to discontinued and uninterrupted therapy, especially compared with resuming after 7 days, resuming within 7 days is associated with a lower risk of MACE and a less significant increased risk of recurrent bleeding, leading to a higher net clinical benefit. China Clinical Trial Registration: ChiCTR2200064063.
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Affiliation(s)
- Bin Xiao
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Rd, Xicheng District, Beijing, 100050, China
| | - Zhishuai Ye
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Rd, Xicheng District, Beijing, 100050, China
| | - Rui Cheng
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China
| | - Zhen Han
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shanshan Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China
| | - Guoxing Wang
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zeya Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Rd, Xicheng District, Beijing, 100050, China
| | - Tuo Liang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Rd, Xicheng District, Beijing, 100050, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China.
| | - Rongchong Huang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Rd, Xicheng District, Beijing, 100050, China.
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Elseidy SA, Sayed A, Awad AK, Mandal D, Mostafa M, Adigun A, Vorla M, Zamani Z, Iqbal A. PPI efficacy in the reduction of variceal bleeding incidence and mortality, a meta-analysis. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To review the efficacy and safety of proton pump inhibitors (PPIs) in gastroesophageal varices (GEVs).
Methods
We searched PubMed MEDLINE, Scopus, and Web of Science for studies that measured the effect of PPI for prophylaxis and treatment of post-band ligation ulcers up to July 20, 2021. We included studies that measured the effect of PPI as treatment or prophylaxis for post-band ligation ulcers; articles that were published in peer-reviewed international journals and had enough data for qualitative and quantitative analysis were included with no language restriction. Heterogeneity was evaluated using the inconsistency (I2) and chi-squared (χ2) test. I2 > 50% was considered substantial heterogeneity in the studies, and a P value less than 0.05 was considered statistically significant. The data was continuous, and we used the standardized mean difference (MD) and risk ratio (RR) with a 95% confidence interval to assess the estimated effect measure.
Results
A total of 7 studies with 2030 patients were included in our study of which 1480 participants were males (72%) and 550 females (18%). Mean age was 59.7 years old. Rebleeding post-band ligation was compared between PPI and placebo with significant favor for PPI (p = 0.00001). The pooled risk ratio was 0.53 (95% CI of 0.41, 0.68); furthermore, bleeding-related death at a 1-month period was compared between PPI and placebo with significant favor for PPI (p = 0.00001). The pooled risk ratio was significant at 0.33 (95% CI of 0.20, 0.53). The length of hospital stay postoperative was compared between PPI and placebo with cumulative mean difference of 0.13 (95% CI of −1.13, 1.39), yet without significance.
Conclusions
The study suggests a twofold reduction in the risk of bleeding and a threefold reduction in the risk of bleeding-related death with the use of PPI following EVL.
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Proton-pump-inhibitor use associated with lower short-term rebleeding and mortality in patients receiving esophageal variceal band ligation: a retrospective cohort study. Eur J Gastroenterol Hepatol 2020; 32:1571-1578. [PMID: 32868651 DOI: 10.1097/meg.0000000000001905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The impact of proton-pump inhibitor (PPI) therapy on subsequent hemorrhage and mortality after variceal hemorrhage is unclear. AIM Evaluate the associations of PPI use with upper gastrointestinal bleeding (UGIB) and death within 30 days of undergoing esophageal variceal band ligation (EBL) separately in inpatient and outpatient settings. METHODS Retrospective review of cirrhotic patients with variceal hemorrhage who underwent EBL between 2005 and 2018. Endoscopic findings, PPI use at admission (inpatients only), PPI use at discharge (inpatients and outpatients), and adverse outcomes data (liver transplant, UGIB, transjugular intrahepatic portosystemic shunt, and death within 30 days of discharge or death during hospitalization) were reviewed. RESULTS A total of 446 patients (164 inpatients, 282 outpatients) were included. The most commonly observed outcomes were death within 30 days of discharge in inpatients (12.8%), UGIB within 30 days of discharge in inpatients (21.3%), and UGIB within 30 days of discharge in outpatients (8.5%). For inpatients, prescription of PPI at discharge was associated with a lower risk of bleeding within 30 days (odds ratio: 0.30, P = 0.025) and death within 30 days (odds ratio = 0.16, P = 0.002). No other significant associations of PPI with death or UGIB were reported. CONCLUSION Post-EBL PPI therapy is associated with reduced risk of bleeding and death within 30 days after variceal hemorrhage in hospitalized patients.
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Affiliation(s)
- Ian L P Beales
- Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK
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Dinçer D, Ulukal Karancı E, Akın M, Adanır H. NSAID, antiaggregant, and/or anticoagulant-related upper gastrointestinal bleeding: Is there any change in prophylaxis rate after a 10-year period? TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 30:505-510. [PMID: 31199288 DOI: 10.5152/tjg.2019.19057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIMS Using proton-pump inhibitor (PPI) is a protective option for patients who require long-term non-steroidal anti-inflammatory drugs (NSAIDs) and antiaggregants. In our previous study, the rate of PPI use in prophylaxis was found to be 2%. Here we aimed to investigate whether there is a change in PPI use in prophylaxis in a similar patient group after 10 years. MATERIALS AND METHODS The patients who followed up with upper gastrointestinal (GI) bleeding diagnosis between January 01, 2016 and December 31, 2017 were retrospectively evaluated. Patients who had malignancy or variceal hemorrhage were excluded. Ninety-six patients, who had taken NSAIDs, antiaggregants, or anticoagulants that were considered as the possible cause of bleeding, were included in the study. Risk groups for NSAID GI toxicity and PPI use rates in these patients were evaluated. RESULTS Twenty (21%) of all patients with upper GI bleeding were using PPI. According to the pre-bleeding risk factor assessment, 86% of the patients were found to have moderate to high risk for NSAID-related GI bleeding, and 81% of these patients were not using PPI. PPI prophylaxis was not provided to 15 (75%) of the 20 patients with previous history of peptic ulcer bleeding. CONCLUSION Despite many studies and recommendations on risk factors and prophylaxis for NSAID-related bleeding, prophylactic PPI use is still largely ignored by physicians. The rate of PPI use in the patient group of this study was found still quite insufficient.
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Affiliation(s)
- Dinç Dinçer
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ece Ulukal Karancı
- Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mete Akın
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Haydar Adanır
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Turkey
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Abstract
Peptic ulcer bleeding remains an important medical emergency. Important recent advances are reviewed. These include further support for a more restrictive transfusion strategy aiming for a target haemoglobin of 70-90 g/L. The Glasgow-Blatchford score remains the most useful assessment score for identifying the lowest risk patients suitable for outpatient management and predicting the need for intervention. Newer scores such as the AIMS65 and Progetto Nazionale Emorragia Digestive score (PNED) may be more accurate in predicting mortality. Pre-endoscopy erythromycin improves outcomes and is underused. A new disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Over-the-scope clips and haemostatic powders appear to have some role as endoscopic salvage therapies. Non- H. pylori, non-aspirin/non-steroidal anti-inflammatory drug (NSAID) ulcers contribute to an increasing percentage of bleeding peptic ulcers and are associated with a high rebleeding rate. The optimal management of these ulcers remains to be determined.
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Affiliation(s)
- Ian LP Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich, UK
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Affiliation(s)
- Ian L P Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
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Reilev M, Damkier P, Rasmussen L, Olesen M, Thomsen Ernst M, Rishøj RM, Rix Hansen M, Broe A, Dastrup AS, Hellfritzsch M, Arnspang S, Pottegård A, Hallas J. Use of beta-blockers and risk of serious upper gastrointestinal bleeding: a population-based case-control study. Therap Adv Gastroenterol 2017; 10:919-929. [PMID: 29204187 PMCID: PMC5703107 DOI: 10.1177/1756283x17734116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/07/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Some studies indicate a reduced risk of serious upper gastrointestinal bleeding (UGIB) for users of beta-blockers, but the association remains to be confirmed in larger studies and characterized with respect to differences among beta-blockers. We aimed to assess whether beta-blocker use decreases the risk of UGIB. METHODS We conducted a register-based, population-based case-control study in Denmark. We identified cases with a first validated discharge diagnosis of UGIB during the period 1995-2006. Controls were selected by risk-set sampling in a ratio of 10:1. We estimated crude and adjusted odds ratios (ORs) of the association between current beta-blocker use and the risk of UGIB by using conditional logistic regression and further stratified by selective and non-selective beta-blockers, respectively. RESULTS We identified 3571 UGIB cases and 35,582 controls. Use of beta-blockers was not found to be associated with a decreased risk of UGIB (adjusted OR 1.10; 95% CI: 1.00-1.21). The association remained neutral after stratification by selective and non-selective beta-blockers, and by single beta-blocker substances. Similarly, we found no association between current beta-blocker use and the risk of UGIB within different subgroups. CONCLUSIONS We found no association between beta-blocker use and UGIB.
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Affiliation(s)
- Mette Reilev
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Denmark
| | - Per Damkier
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark Department of Clinical Research, University of Southern Denmark, Denmark
| | - Lotte Rasmussen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Morten Olesen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Martin Thomsen Ernst
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Rikke Mie Rishøj
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Morten Rix Hansen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Anne Broe
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | | | - Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Sidsel Arnspang
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark
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9
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Abstract
Acute upper gastrointestinal haemorrhage due to peptic ulcer bleeding remains an important cause of emergency presentation and hospital admission. Despite advances in many aspects of management, peptic ulcer bleeding is still associated with significant morbidity, mortality, and healthcare costs. Comprehensive international guidelines have been published, but advances as well as controversies continue to evolve. Important recent advances include the evidence supporting a more restrictive transfusion strategy aiming for a target haemoglobin of 70–90 g/l. Comparative studies have confirmed that the Glasgow–Blatchford score remains the most useful score for predicting the need for intervention as well as for identifying the lowest-risk patients suitable for outpatient management. New scores, including the AIMS65 and Progetto Nazionale Emorragia Digestiva score, may be more accurate in predicting mortality. Pre-endoscopy erythromycin appears to improve outcomes and is probably underused. High-dose oral proton pump inhibition (PPI) for 11 days after PPI infusion is advantageous in those with a Rockall score of 6 or more. Oral is as effective as parenteral iron at restoring haemoglobin levels after a peptic ulcer bleed and both are superior to placebo in this respect. Within endoscopic techniques, haemostatic powders and over-the-scope clips can be used when other methods have failed. A disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Non-
Helicobacter pylori, non-aspirin/non-steroidal anti-inflammatory drug ulcers contribute an increasing percentage of bleeding peptic ulcers and are associated with a poor prognosis and high rebleeding rate. The optimal management of these ulcers remains to be determined.
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Affiliation(s)
- Ian Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich, UK
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Gaydukova IZ, Khondkaryan EV, Aparkina AV, Rebrov AP. [Changes in the serum concentrations of adhesion molecules and vascular endothelial growth factor in active ankylosing spondylitis patients taking amtolmetin guacil: Results of a 56-week prospective ореn-label controlled observational study]. TERAPEVT ARKH 2017. [PMID: 28631697 DOI: 10.17116/terarkh201789538-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To estimate changes in the concentrations of adhesion molecules and vascular endothelial growth factor A after 30-day additional use of amtolmetin guacil (AMG) in patients with active ankylosing spondylitis (AS) who were unresponsive to previous one-year treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). SUBJECTS AND METHODS 20 patients with active AS who had not reached a BASDAI score <4.0 at week 52 of NSAID therapy and 10 healthy individuals matched for cardiovascular risk factors were examined. After 52 weeks of NSAID therapy, AMG was administered orally at 1200 mg/day to patients with AS for 30 days. The concentrations of adhesion molecules (sICAM-1 and sVCAM-1) and VEGF-A were measured. BASDAI and ASDAS scores and C-reactive protein (CRP) levels were determined in AS patients. The concentrations of adhesion molecules and VEGF-A were investigated in patients with AS at baseline, at 52 weeks after NSAID treatment start, and at 30 days following AMH initiation (at week 56) and in healthy individuals at baseline and at 30 days. RESULTS The concentration of sICAM-1 in patients with AS was 987.0±217.39, 938.98±293.31, and 364.25±363.3 ng/ml at weeks 0, 52, and 56, respectively; that in healthy individuals was 769.25±189.32 and 740.05±225.76 ng/ml at baseline and at 30 days, respectively. The differences from the baseline concentration were significant in patients with AS (p<0.05) and insignificant in healthy subjects (p≥0.05); the differences between the concentrations in patients with AS and the controls were significant at baseline and at 52 weeks (p<0.05). The concentration of sVCAM-1 in patients with AS was 364.25±160.49, 325.34±245.1, and 319.1±248.73 ng/ml at weeks 0, 52 and 56, respectively; that in healthy individuals was 245.13±40.4 and 248.73±34.42 ng/ml, respectively (p<0.05 vs baseline values and values in healthy subjects). The level of VEGF-A in AS patients was not different from that in healthy individuals, but decreased during treatment. Correlations were found between the concentration of adhesion molecules and the level of CRP (p<0.01). CONCLUSION Elevated concentrations of adhesion molecules have been found in AS patients compared with healthy individuals. The study has demonstrated that AMG treatment is efficient in treating patients with AS. NSAID/AMG treatment is associated with lower concentrations of adhesion molecules. Decreased CRP levels serve as predictors for reduced concentration of adhesion molecules. The level of VEGF-A at baseline did not differ from that in healthy subjects, but was decreased during treatment with NSAIDs.
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Affiliation(s)
- I Z Gaydukova
- V.I. Razumovsky Saratov State Medical University, Ministry of Health of Russia, Saratov, Russia
| | - E V Khondkaryan
- V.I. Razumovsky Saratov State Medical University, Ministry of Health of Russia, Saratov, Russia
| | - A V Aparkina
- V.I. Razumovsky Saratov State Medical University, Ministry of Health of Russia, Saratov, Russia
| | - A P Rebrov
- V.I. Razumovsky Saratov State Medical University, Ministry of Health of Russia, Saratov, Russia
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Kim SH, Yun JM, Chang CB, Piao H, Yu SJ, Shin DW. Prevalence of upper gastrointestinal bleeding risk factors among the general population and osteoarthritis patients. World J Gastroenterol 2016; 22:10643-10652. [PMID: 28082817 PMCID: PMC5192276 DOI: 10.3748/wjg.v22.i48.10643] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/13/2016] [Accepted: 10/31/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the prevalence of possible risk factors of upper gastrointestinal bleeding (UGIB) and their age-group specific trend among the general population and osteoarthritis patients.
METHODS We utilized data from the National Health Insurance Service that included claims data and results of the national health check-up program. Comorbid conditions (peptic ulcer, diabetes, liver disease, chronic renal failure, and gastroesophageal reflux disease), concomitant drugs (aspirin, clopidogrel, cilostazol, non-steroidal anti-inflammatory drugs, steroid, anticoagulants, and SSRI), personal habits (smoking, and alcohol consumption) were considered as possible UGIB risk factors. We randomly imputed the prevalence of infection in the data considering the age-specific prevalence of Helicobacter pylori (H. pylori) infection in Korea. The prevalence of various UGIB risk factors and the age-group specific trend of the prevalence were identified. Prevalence was compared between osteoarthritis patients and others.
RESULTS A total of 801926 subjects (93855 osteoarthritis patients) aged 20 and above were included. The prevalence of individual and concurrent multiple risk factors became higher as the age increased. The prevalence of each comorbid condition and concomitant drug were higher in osteoarthritis patients. Thirty-five point zero two percent of the overall population and 68.50% of osteoarthritis patients had at least one or more risk factors of UGIB. The prevalence of individual and concurrent multiple risk factors in younger age groups were also substantial. Furthermore, when personal habits (smoking, and alcohol consumption) and H. pylori infection were included, the prevalence of concurrent multiple risk factors increased greatly even in younger age groups.
CONCLUSION Prevalence of UGIB risk factors was high in elderly population, but was also considerable in younger population. Patient with osteoarthritis was at higher UGIB risk than those without osteoarthritis. Physicians should consider individualized risk assessment regardless of age when prescribing drugs or performing procedures that may increase the risk of UGIB, and take necessary measures to reduce modifiable risk factors such as H. pylori eradication or lifestyle counseling.
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Jung S, Kim EH, Kim HY, Roh YH, Park CH, Park SJ, Chung H, Kim BK, Lee H, Park JJ, Hong SP, Park JY, Shin SK, Lee SK, Lee YC, Park JC. Factors that affect visibility during endoscopic hemostasis for upper GI bleeding: a prospective study. Gastrointest Endosc 2016; 81:1392-400. [PMID: 25771067 DOI: 10.1016/j.gie.2014.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/01/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Adequate visibility is an important factor for achieving successful endoscopic hemostasis for the treatment of upper GI bleeding (UGIB). The independent factors that affect visibility during endoscopic procedures have yet to be determined. OBJECTIVE To determine the factors that affect endoscopic visibility and to create a model that can predict in which patients unacceptable visibility is suspected before emergent endoscopic procedures for UGIB. DESIGN Prospective, observational study. SETTING University-affiliated tertiary care hospital in South Korea. PATIENTS A total of 121 patients admitted because of UGIB. INTERVENTION Analysis of the visibility score of the emergency endoscopies for UGIB. MAIN OUTCOME MEASUREMENTS Factors affecting the visibility score of endoscopy and a classification and regression tree (CART) model for predicting of visibility. RESULTS The EGD time and the appearance of the nasogastric (NG) tube aspirate were independent factors that were significantly associated with visibility (EGD time, P<.001; red blood appearance in NG tube aspirate, P<.001; coffee grounds appearance of NG tube aspirate, P=.006). Based on these results, a CART model was developed by using 70 patients who had been allocated to the training set. The CART generated algorithms that proposed the use of the appearance of the NG tube aspirate and the EGD time (8.5 hours) to predict visibility. The sensitivity and specificity for predicting poor visibility were 71.4% and 86.4%, respectively. CONCLUSION The use of the CART model enables the prediction of which patients will have poor visibility during emergent endoscopy.
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Affiliation(s)
- Sungmo Jung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Hye Kim
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Chan Hyuk Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Soo Jung Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyunsoo Chung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Beom Kyung Kim
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyuk Lee
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Jun Park
- Department of Internal Medicine, Institute of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Pil Hong
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Yong Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Kwan Shin
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Chan Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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Kuusniemi K, Pöyhiä R. Present-day challenges and future solutions in postoperative pain management: results from PainForum 2014. J Pain Res 2016; 9:25-36. [PMID: 26893579 PMCID: PMC4745947 DOI: 10.2147/jpr.s92502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper is a summary of presentations on postoperative pain control by the authors at the 2014 PainForum meeting in People's Republic of China. Postoperative pain is often untreated or undertreated and may lead to subsequent chronic pain syndromes. As more procedures migrate to the outpatient setting, postoperative pain control will become increasingly more challenging. Evidence-based guidelines for postoperative pain control recommend pain assessment using validated tools on a consistent basis. In this regard, consistency may be more important than the specific tool selected. Many hospitals have introduced a multidisciplinary acute pain service (APS), which has been associated with improved patient satisfaction and fewer adverse events. Patient education is an important component of postoperative pain control, which may be most effective when clinicians chose a multimodal approach, such as paracetamol (acetaminophen) and opioids. Opioids are a mainstay of postoperative pain control but require careful monitoring and management of side effects, such as nausea, vomiting, dizziness, and somnolence. Opioids may be administered using patient-controlled analgesia systems. Protocols for postoperative pain control can be very helpful to establish benchmarks for pain management and assure that clinicians adhere to evidence-based standards. The future of postoperative pain control around the world will likely involve more and better established APSs and greater communication between patients and clinicians about postoperative pain. The changes necessary to implement and move forward with APSs is not a single step but rather one of continuous improvement and ongoing change.
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Affiliation(s)
| | - Reino Pöyhiä
- Department of Anaesthesiology, University of Helsinki, Helsinki, Finland
- Department of Palliative Medicine and Oncology, University of Turku, Turku, Finland
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Xin W, Huang C, Zhang X, Xin S, Zhou Y, Ma X, Zhang D, Li Y, Zhou S, Zhang D, Zhang T, Du G. Methyl salicylate lactoside inhibits inflammatory response of fibroblast-like synoviocytes and joint destruction in collagen-induced arthritis in mice. Br J Pharmacol 2015; 171:3526-38. [PMID: 24712652 DOI: 10.1111/bph.12715] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/23/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Methyl salicylate 2-O-β-d-lactoside (MSL), whose chemical structure is similar to that of salicylic acid, is a natural product derivative isolated from a traditional Chinese herb. The aim of this study was to investigate the therapeutic effect of MSL in mice with collagen-induced arthritis (CIA) and explore its underlying mechanism. EXPERIMENTAL APPROACH The anti-arthritic effects of MSL were evaluated on human rheumatoid fibroblast-like synoviocytes (FLS) in vitro and CIA in mice in vivo by obtaining clinical scores, measuring hind paw thickness and inflammatory cytokine levels, radiographic evaluations and histopathological assessments. KEY RESULTS Treatment with MSL after the onset of arthritis significantly prevented the progression and development of rheumatoid arthritis (RA) in CIA mice without megascopic gastric mucosa damage. In addition, MSL inhibited the production of pro-inflammatory mediators, the phosphorylation and translocation of NF-κB, and cell proliferation induced by TNF-α in FLS. MSL non-selectively inhibited the activity of COX in vitro, but was a more potent inhibitor of COX-2 than COX-1. MSL also inhibited the phosphorylation of inhibitor of NF-κB kinase, IκBα and p65, thus blocking the nuclear translocation of NF-κB in TNF-α-stimulated FLS. CONCLUSION AND IMPLICATIONS MSL exerts therapeutic effects on CIA mice, suppressing the inflammatory response and joint destruction by non-selectively inhibiting the activity of COX and suppressing activation of the NF-κB signalling pathway, but without damaging the gastric mucosa. Therefore, MSL has great potential to be developed into a novel therapeutic agent for the treatment of RA.
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Affiliation(s)
- Wenyu Xin
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Key Laboratory of Molecular Pharmacology and Drug Evaluation (Ministry of Education of China), School of Pharmacy, Yantai University, Yantai, China; Binzhou Medical University, Yantai, China
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15
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Mattar R, Villares CA, Marostegam PFF, Chaves CE, Pinto VB, Carrilho FJ. Low dose capsule based 13c-urea breath test compared with the conventional 13c-urea breath test and invasive tests. ARQUIVOS DE GASTROENTEROLOGIA 2015; 51:133-8. [PMID: 25003266 DOI: 10.1590/s0004-28032014000200012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/26/2014] [Indexed: 12/17/2022]
Abstract
CONTEXT One of the limitations of 13C-urea breath test for Helicobacter pylori infection diagnosis in Brazil is the substrate acquisition in capsule presentation. OBJECTIVES The purpose of this study was to evaluate a capsule-based 13C-urea, manipulated by the Pharmacy Division, for the clinical practice. METHODS Fifty patients underwent the conventional and the capsule breath test. Samples were collected at the baseline and after 10, 20 and 30 minutes of 13C-urea ingestion. Urease and histology were used as gold standard in 83 patients. RESULTS In a total of 50 patients, 17 were positive with the conventional 13C-urea (75 mg) breath test at 10, 20 and 30 minutes. When these patients repeated breath test with capsule (50 mg), 17 were positive at 20 minutes and 15 at 10 and 30 minutes. The relative sensitivity of 13C-urea with capsule was 100% at 20 minutes and 88.24% at 10 and at 30 minutes. The relative specificity was 100% at all time intervals. Among 83 patients that underwent capsule breath test and endoscopy the capsule breath test presented 100% of sensitivity and specificity. CONCLUSIONS Capsule based breath test with 50 mg 13C-urea at twenty minutes was found highly sensitive and specific for the clinical setting.
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Affiliation(s)
- Rejane Mattar
- Divisão de Gastroenterologia e Hepatologia, Hospital das Clinicas da Faculdade de Medicina de São Paulo ? FMUSP, São Paulo, SP, Brasil
| | - Cibele Aparecida Villares
- Divisão de Gastroenterologia e Hepatologia, Hospital das Clinicas da Faculdade de Medicina de São Paulo ? FMUSP, São Paulo, SP, Brasil
| | | | - Cleuber Esteves Chaves
- Divisão de Farmácia, Hospital das Clinicas da Faculdade de Medicina de São Paulo ? FMUSP, São Paulo, SP, Brasil
| | - Vanusa Barbosa Pinto
- Divisão de Farmácia, Hospital das Clinicas da Faculdade de Medicina de São Paulo ? FMUSP, São Paulo, SP, Brasil
| | - Flair José Carrilho
- Divisão de Gastroenterologia e Hepatologia, Hospital das Clinicas da Faculdade de Medicina de São Paulo ? FMUSP, São Paulo, SP, Brasil
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Clinical guidelines «Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice». Part I. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:70-82. [DOI: 10.17116/jnevro20151154170-82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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17
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Nalamachu S, Pergolizzi JV, Raffa RB, Lakkireddy DR, Taylor R. Drug-drug interaction between NSAIDS and low-dose aspirin: a focus on cardiovascular and GI toxicity. Expert Opin Drug Saf 2014; 13:903-17. [PMID: 24905189 DOI: 10.1517/14740338.2014.924924] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The aging of the population in the US and other countries means that a large number of people will likely take NSAIDs for the relief of pain and low-dose aspirin (LD-ASA) for cardioprotection. However, the cardioprotective value of LD-ASA can be compromised in patients who take NSAIDs concomitantly, because some NSAIDs competitively bind to critical amino-acid residues on cyclooxygenase (COX) enzymes and interfere with the mechanism of antiplatelet activity of LD-ASA. AREAS COVERED A review of the literature was conducted to provide an overview of current issues surrounding the concomitant use of NSAIDs and LD-ASA, to explore potential mechanisms for this drug-drug interaction and to consider current and future treatment options that may mitigate the risk associated with their concomitant use. EXPERT OPINION NSAIDs offer effective pain relief for the most common forms of pain, such as low back pain, musculoskeletal pain associated with arthritis, postsurgical pain, headache, acute pain syndromes, menstrual pain and dental pain. The development of NSAID formulations that offer effective pain control with fewer or less serious adverse effects due to interference with ASA would be a valuable medical advance. Several promising treatment options and regimens may be available in the future.
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Onuchina EV. [Antiplatelet therapy with acetylsalicylic acid: approaches to reducing the frequency of gastrointenstinal adverse reactions]. TERAPEVT ARKH 2014; 86:98-103. [PMID: 25804049 DOI: 10.17116/terarkh2014861298-103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acetylsalicylic acid (ASA) is highly effective in preventing cardiovascular events, but associated with increased risk for digestive adverse reactions. The paper provides an update on the epidemiology, mechanisms, and risk factors of esophagogastroduodeno- and enteropathies during long-term low-dose ACA therapy. It outlines the key principles of their prevention.
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