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Scarpignato C, Hongo M, Wu JCY, Lottrup C, Lazarescu A, Stein E, Hunt RH. Pharmacologic treatment of GERD: Where we are now, and where are we going? Ann N Y Acad Sci 2020; 1482:193-212. [PMID: 32935346 DOI: 10.1111/nyas.14473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
The introduction of acid inhibition in clinical practice has revolutionized the management of acid-related diseases, leading to the virtual abolition of elective surgery for ulcer disease and relegating antireflux surgery to patients with gastroesophageal reflux disease (GERD) not adequately managed by medical therapy. Proton pump inhibitors (PPIs) are the antisecretory drugs of choice for the treatment of reflux disease. However, these drugs still leave some unmet clinical needs in GERD. PPI-refractoriness is common, and persistent symptoms are observed in up to 40-55% of daily PPI users. Potassium-competitive acid blockers (P-CABs) clearly overcome many of the drawbacks and limitations of PPIs, achieving rapid, potent, and prolonged acid suppression, offering the opportunity to address many of the unmet needs. In recent years, it has been increasingly recognized that impaired mucosal integrity is involved in the pathogenesis of GERD. As a consequence, esophageal mucosal protection has emerged as a new, promising therapeutic avenue. When P-CABS are used as add-on medications to standard treatment, a growing body of evidence suggests a significant additional benefit, especially in the relief of symptoms not responding to PPI therapy. On the contrary, reflux inhibitors are considered a promise unfulfilled, and prokinetic agents should only be used on a case-by-case basis.
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Affiliation(s)
- Carmelo Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta.,Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Michio Hongo
- Department of Comprehensive Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Christian Lottrup
- Department of Medicine, Aalborg University Hospital, Hobro, Denmark.,Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmak
| | - Adriana Lazarescu
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Ellen Stein
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland
| | - Richard H Hunt
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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María Pérez-Sánchez C, Nicolás Torres D, Hernández Morante JJ. Altered Eating Attitudes in Nursing Home Residents and Its Relationship with their Cognitive and Nutritional Status. J Nutr Health Aging 2018; 22:869-875. [PMID: 30080233 DOI: 10.1007/s12603-018-1056-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND although eating disorders are usually linked to young adolescents, these mental disorders can also appear in the elderly, especially in those living in nursing homes, which might be associated or not with the cognitive decline; however, there are few data regarding elderly subjects. OBJECTIVES the objective of the present work was to evaluate the presence of abnormal eating attitudes in nursing home residents and its relation with several cognitive, nutritional and psychological factors that could be influencing their nutritional state. DESIGN AND SETTING a observational experimental study was carried out at several nursing homes of Murcia, Spain. SUBJECTS 139 nursing home residents. METHODS EAT-26 test was used to screen classic eating disorders (anorexia and bulimia). Blandford's scale was employed to determine aversive eating attitudes. Moreover, subjective appetite sensations, body image perception, nutritional (MNA and diet composition) and biochemical data were also evaluated. RESULTS 33% of the subjects had malnutrition. No subject showed symptoms of anorexia or bulimia; however, subjects with cognitive decline frequently showed aversive feeding behaviours (21.6%). Albumin values were significantly lower in subjects with cognitive impairment. CONCLUSIONS our data showed a clear relation between cognitive impairment and altered eating attitudes, which was reflected by both biochemical (albumin) and nutritional parameters, while no classic eating disorder was observed in residents with normal cognitive-status. These data confirm the need to strengthen our efforts towards maintaining the nutritional status of the subjects with cognitive impairment.
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Affiliation(s)
- C María Pérez-Sánchez
- Dr. Juan José Hernández Morante, Catholic University of Murcia, Campus de Guadalupe, 30107 Guadalupe, Murcia. Spain, E-mail:
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Schwartz DB, Armanios N, Monturo C, Frankel EH, Wesley JR, Patel M, Goldman B, Kliger G, Schwartz E. Clinical Ethics and Nutrition Support Practice: Implications for Practice Change and Curriculum Development. J Acad Nutr Diet 2016; 116:1738-1746. [DOI: 10.1016/j.jand.2016.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Indexed: 11/29/2022]
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Roy M, Gaudreau P, Payette H. A scoping review of anorexia of aging correlates and their relevance to population health interventions. Appetite 2016; 105:688-99. [DOI: 10.1016/j.appet.2016.06.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 12/21/2022]
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Abstract
Accounts of altered eating behavior in semantic dementia generally emphasize gluttony and abnormal food preferences. Here we describe two female patients with no past history of eating disorders who developed early prominent aversion to food in the context of an otherwise typical semantic dementia syndrome. One patient (aged 57) presented features in line with anorexia nervosa while the second patient (aged 58) presented with a syndrome more suggestive of bulimia nervosa. These cases add to the growing spectrum of apparently dichotomous behavior patterns in the frontotemporal dementias and illustrate a potentially under-recognized cause of eating disorders presenting in later life.
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Affiliation(s)
- Alexandra E Thompson
- a Dementia Research Centre, UCL Institute of Neurology , University College London , London , UK.,b Medical School , University of Adelaide , Adelaide , Australia
| | - Camilla N Clark
- a Dementia Research Centre, UCL Institute of Neurology , University College London , London , UK
| | - Christopher J Hardy
- a Dementia Research Centre, UCL Institute of Neurology , University College London , London , UK
| | - Phillip D Fletcher
- a Dementia Research Centre, UCL Institute of Neurology , University College London , London , UK
| | | | - Jonathan D Rohrer
- a Dementia Research Centre, UCL Institute of Neurology , University College London , London , UK
| | - Jason D Warren
- a Dementia Research Centre, UCL Institute of Neurology , University College London , London , UK
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High Sensitivity of Aged Mice to Deoxynivalenol (Vomitoxin)-Induced Anorexia Corresponds to Elevated Proinflammatory Cytokine and Satiety Hormone Responses. Toxins (Basel) 2015; 7:4199-215. [PMID: 26492270 PMCID: PMC4626729 DOI: 10.3390/toxins7104199] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/28/2015] [Accepted: 10/09/2015] [Indexed: 02/07/2023] Open
Abstract
Deoxynivalenol (DON), a trichothecene mycotoxin that commonly contaminates cereal grains, is a public health concern because of its adverse effects on the gastrointestinal and immune systems. The objective of this study was to compare effects of DON on anorectic responses in aged (22 mos) and adult (3 mos) mice. Aged mice showed increased feed refusal with both acute i.p. (1 mg/kg and 5 mg/kg) and dietary (1, 2.5, 10 ppm) DON exposure in comparison to adult mice. In addition to greater suppression of food intake from dietary DON exposure, aged mice also exhibited greater but transient body weight suppression. When aged mice were acutely exposed to 1 mg/kg bw DON i.p., aged mice displayed elevated DON and DON3GlcA tissue levels and delayed clearance in comparison with adult mice. Acute DON exposure also elicited higher proinflammatory cytokine and satiety hormone responses in the plasma of the aged group compared with the adult group. Increased susceptibility to DON-induced anorexia in aged mice relative to adult mice suggests that advanced life stage could be a critical component in accurate human risk assessments for DON and other trichothecenes.
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Wysokiński A, Sobów T, Kłoszewska I, Kostka T. Mechanisms of the anorexia of aging-a review. AGE (DORDRECHT, NETHERLANDS) 2015; 37:9821. [PMID: 26232135 PMCID: PMC5005824 DOI: 10.1007/s11357-015-9821-x] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 07/22/2015] [Indexed: 05/05/2023]
Abstract
Many, even healthy, older people fail to adequately regulate food intake and experience loss of weight. Aging-associated changes in the regulation of appetite and the lack of hunger have been termed as the anorexia of aging. The etiology of the anorexia of aging is multi-factorial and includes a combination of physiological changes associated with aging (decline in smell and taste, reduced central and peripheral drive to eat, delayed gastric emptying), pathological conditions (depression, dementia, somatic diseases, medications and iatrogenic interventions, oral-health status), and social factors (poverty, loneliness). However, exact mechanisms of the anorexia of aging remain to be elucidated. Many neurobiological mechanisms may be secondary to age-related changes in body composition and not associated with anorexia per se. Therefore, further studies on pathophysiological mechanisms of the anorexia of aging should employ accurate measurement of body fat and lean mass. The anorexia of aging is associated with protein-energy malnutrition, sarcopenia, frailty, functional deterioration, morbidity, and mortality. Since this symptom can lead to dramatic consequences, early identification and effective interventions are needed. One of the most important goals in the geriatric care is to optimize nutritional status of the elderly.
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Affiliation(s)
- Adam Wysokiński
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, 92-216, Łódź, Poland,
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Posthauer ME, Dorner B, Friedrich EK. Enteral Nutrition for Older Adults in Healthcare Communities. Nutr Clin Pract 2014; 29:445-458. [PMID: 24964789 DOI: 10.1177/0884533614541482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Older adults living in healthcare communities (HCCs) have multiple comorbidities and are at increased risk of malnutrition and unintended weight loss. Aging affects nearly every system as well as body composition and structure, causing physiological changes that can affect nutrition status. A significant percentage (56%) of residents who live in nursing facilities require extensive help to eat and have dental problems such as ill-fitting dentures, missing teeth, and swallowing problems, which can lead to inadequate caloric intake and unintended weight loss. Alzheimer disease or dementia is prevalent in both nursing facilities and in assisted living/residential care communities, where it affects 45% of older adults. In cognitively impaired residents, most tube feeding placements occur in the acute care setting and result in significant use of additional healthcare resources, along with high postinsertion mortality rates within 60 days of insertion. Nursing facilities receiving Medicare or Medicaid funding must abide by state and federal regulations and undergo rigorous surveys while balancing complex decisions related to initial placement of feeding tubes. Healthcare professionals must recognize the importance of establishing nutrition treatment goals that are resident centered and that respect the unique values and personal decisions of the older adult. Informed choice, resident-centered care decisions, and the review of living wills and/or advance directives are essential in the decision-making process. After enteral nutrition is started, healthcare practitioners must carefully review the physician's orders and administer and monitor the resident's tolerance, checking for potential complications.
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Bernabeu-Wittel M, Murcia-Zaragoza J, Hernández-Quiles C, Escolano-Fernández B, Jarava-Rol G, Oliver M, Díez-Manglano J, Ruiz-Cantero A, Ollero-Baturone M. Development of a six-month prognostic index in patients with advanced chronic medical conditions: the PALIAR score. J Pain Symptom Manage 2014; 47:551-65. [PMID: 23998780 DOI: 10.1016/j.jpainsymman.2013.04.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/09/2013] [Accepted: 04/13/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Efforts in developing useful tools to properly identify the end-of-life trajectory of patients with advanced medical diseases have been made, but the calibration and/or discriminative power of these tools has not been optimal. OBJECTIVES Our objective was to develop a new, reliable prognostic tool to identify the probability of death within six months in patients with chronic medical diseases. METHODS This was a multicenter, prospective, observational study in 41 Spanish hospitals, which included 1778 patients with one or more of the following: advanced conditions such as heart failure, respiratory failure, chronic renal failure, chronic liver disease, and/or chronic neurological disease. All patients were followed over six months. Each factor independently associated with death in the derivation cohort (884 patients from eastern areas of Spain) was assigned a prognostic weight, and the score was calculated by summing up the factors. The score's accuracy in the validation cohort (894 patients from western areas of Spain) was assessed by analyzing its calibration and discriminative power; we also calculated sensitivity, specificity, and positive and negative predictive values. RESULTS Mortality in the derivation/validation cohorts was 37.6%/37.7%, respectively. We identified six independent predictors of mortality (≥85 years, three points; New York Heart Association Class IV/Stage 4 dyspnea on the modified Medical Research Council, 3.5 points; anorexia, 3.5 points; presence of pressure ulcer(s), three points; Eastern Cooperative Oncology Group Performance Status of three or more, four points; and albuminemia ≤2.5g/dL, four points). Mortality in the derivation/validation cohorts according to risk group was 20%/21.5% for patients with zero points; 33%/30.5% for those with 3-3.5 points; 46.3%/43% for those with four to seven points; and 67%/61% for those who reached 7.5 or more points, respectively. The calibration was good (Hosmer-Lemeshow test, P=0.39), as was the discriminative power (area under the receiver operating characteristic curve of 0.69 [0.66-0.72]). The sensitivity (85%), specificity (86%), positive and negative predictive values (64% and 80%, respectively) at 180 days were high. CONCLUSION The PALIAR score is a precise and reliable tool for identifying the end-of-life trajectory in patients with advanced medical diseases.
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Affiliation(s)
| | | | | | | | | | - Miguel Oliver
- Internal Medicine Department, Hospital de Sanlúcar de Barrameda, Cádiz, Spain
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Bossola M, Tazza L. Appetite Is Associated with the Time of Recovery after the Dialytic Session in Patients on Chronic Hemodialysis. ACTA ACUST UNITED AC 2013; 123:129-33. [PMID: 23887186 DOI: 10.1159/000353219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Maurizio Bossola
- Hemodialysis Service, Department of Surgery, Catholic University, Rome, Italy.
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Brownie S. Older Australians' views about the impact of ageing on their nutritional practices: Findings from a qualitative study. Australas J Ageing 2012; 32:86-90. [DOI: 10.1111/j.1741-6612.2012.00607.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schwerthöffer D, Fatke B, Bäuml J, Förstl H. Senile anorexia: three cases with complicated treatment and two occurrences of a Pisa syndrome. Int J Geriatr Psychiatry 2012; 27:765-8. [PMID: 22685070 DOI: 10.1002/gps.2778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Bastian Fatke
- Klinik für Psychiatrie und Psychotherapie; TU-München; München; Germany
| | - Josef Bäuml
- Klinik für Psychiatrie und Psychotherapie; TU-München; München; Germany
| | - Hans Förstl
- Klinik für Psychiatrie und Psychotherapie; TU-München; München; Germany
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Dorner B, Posthauer ME, Friedrich EK, Robinson GE. Enteral Nutrition for Older Adults in Nursing Facilities. Nutr Clin Pract 2011; 26:261-72. [DOI: 10.1177/0884533611405794] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:293-304. [DOI: 10.1097/spc.0b013e328340e983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- L M Donini
- Sapienza, University of Rome, Department of Medical Physiopathology, Food Science Section, P.le Aldo Moro, 5, 00185 Rome, Italy.
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Abstract
Drugs have the potential to interact with nutrients potentially leading to reduced therapeutic efficacy of the drug, nutritional risk or increased adverse effects of the drug. Despite significant interest in such interactions going back to over more than 40 years, the occurrence and clinical significance of many drug–nutrient interactions remains unclear. However, interactions involving drugs with a narrow therapeutic margin such as theophylline and digoxin and those that require careful blood monitoring such as warfarin are likely to be those of clinical significance. Drugs can affect nutrition as a result of changes in appetite and taste as well as having an influence on absorption or metabolism of nutrients. Moreover, foods and supplements can also interact with drugs, of which grapefruit juice and St John's wort are key examples. Significant numbers of people take both supplements and medication and are potentially at risk from interactions. Professionals, such as pharmacists, dietitians, nurses and doctors, responsible for the care of patients should therefore check whether supplements are being taken, while for researchers this is an area worthy of significant further study, particularly in the context of increasingly complex drug regimens and the plethora of new drugs.
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&NA;. Consider the cause of anorexia when treating elderly patients. DRUGS & THERAPY PERSPECTIVES 2010. [DOI: 10.2165/11204280-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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