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Alomar HA, Fathallah N, Abdel-Aziz MM, Ibrahim TA, Elkady WM. GC-MS Profiling, Anti- Helicobacter pylori, and Anti-Inflammatory Activities of Three Apiaceous Fruits' Essential Oils. PLANTS (BASEL, SWITZERLAND) 2022; 11:2617. [PMID: 36235480 PMCID: PMC9570728 DOI: 10.3390/plants11192617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Eradication of Helicobacter pylori is a challenge due to rising antibiotic resistance and GIT-related disorders. Cuminum cyminum, Pimpinella anisum, and Carum carvi are fruits belonging to the Apiaceae family. Their essential oils were extracted, analyzed using GC-MS, tested for anti-H. pylori activity by a micro-well dilution technique, identified for potential anti-H. pylori inhibitors by an in-silico study, and investigated for anti-inflammatory activity using a COX-2 inhibition assay. Results showed that the main components of C. cyminum, P. anisum, and C. carvi were cumaldehyde (41.26%), anethole (92.41%), and carvone (51.38%), respectively. Essential oil of C. cyminum exhibited the greatest anti-H. pylori activity (3.9 µg/mL) followed by P. anisum (15.63 µg/mL), while C. carvi showed the lowest activity (62.5 µg/mL). The in-silico study showed that cumaldehyde in C. cyminum has the best fitting energy to inhibit H. pylori.C. cyminum essential oil showed the maximum ability to reduce the production of Cox-2 expression approaching celecoxib with IC50 = 1.8 ± 0.41 µg/mL, followed by the C. carvi oil IC50 = 7.3 ± 0.35 µg/mL and then oil of P. anisum IC50 = 10.7±0.63 µg/mL. The investigated phytochemicals in this study can be used as potential adjunct therapies with conventional antibiotics against H. pylori.
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Affiliation(s)
- Hatun A. Alomar
- Pharmacology and Toxicology Department, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Noha Fathallah
- Department of Pharmacognosy and Medicinal Plants, Faculty of Pharmacy, Future University in Egypt, Cairo 11835, Egypt
| | - Marwa M. Abdel-Aziz
- Regional Center for Mycology and Biotechnology (RCMB), Al-Azhar University, Cairo 11651, Egypt
| | - Taghreed A. Ibrahim
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Wafaa M. Elkady
- Department of Pharmacognosy and Medicinal Plants, Faculty of Pharmacy, Future University in Egypt, Cairo 11835, Egypt
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2
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Ho KY, Cardosa MS, Chaiamnuay S, Hidayat R, Ho HQT, Kamil O, Mokhtar SA, Nakata K, Navarra SV, Nguyen VH, Pinzon R, Tsuruoka S, Yim HB, Choy E. Practice Advisory on the Appropriate Use of NSAIDs in Primary Care. J Pain Res 2020; 13:1925-1939. [PMID: 32821151 PMCID: PMC7422842 DOI: 10.2147/jpr.s247781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022] Open
Abstract
Cyclo-oxygenase (COX)-2 selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are important in managing acute and chronic pain secondary to inflammation. As a greater understanding of the risks of gastrointestinal (GI), cardiovascular (CV) and renal events with NSAIDs use has emerged, guidelines have evolved to reflect differences in risks among NSAIDs. Updated guidelines have yet to reflect new evidence from recent trials which showed similar CV event rates with celecoxib compared to naproxen and ibuprofen, and significantly better GI tolerability for celecoxib. This practice advisory paper aims to present consensus statements and associated guidance regarding appropriate NSAID use based on a review of current evidence by a multidisciplinary group of expert clinicians. This paper is especially intended to guide primary care practitioners within Asia in the appropriate use of NSAIDs in primary care. Following a literature review, group members used a modified Delphi consensus process to determine agreement with selected recommendations. Agreement with a statement by 75% of total voting members was defined a priori as consensus. For low GI risk patients, any nonselective NSAID plus proton pump inhibitor (PPI) or celecoxib alone is acceptable treatment when CV risk is low; for high CV risk patients, low-dose celecoxib or naproxen plus PPI is appropriate. For high GI risk patients, celecoxib plus PPI is acceptable for low CV risk patients; low-dose celecoxib plus PPI is appropriate for high CV risk patients, with the alternative to avoid NSAIDs and consider opioids instead. Appropriate NSAID prescription assumes that the patient has normal renal function at commencement, with ongoing monitoring recommended. In conclusion, appropriate NSAID use requires consideration of all risks.
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Affiliation(s)
- Kok Yuen Ho
- The Pain Clinic, Mt Alvernia Hospital, Singapore
| | | | - Sumapa Chaiamnuay
- Rheumatic Disease Unit, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Rudy Hidayat
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital, Jakarta, Indonesia
| | | | - Ozlan Kamil
- Gleneagles Hospital, Kuala Lumpur, Malaysia.,Prince Court Medical Center, Kuala Lumpur, Malaysia
| | - Sabarul A Mokhtar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ken Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Sandra V Navarra
- Section of Rheumatology, Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Van Hung Nguyen
- Department of Rheumatology, Bach Mai Hospital, Hanoi, Vietnam
| | - Rizaldy Pinzon
- Department of Neurology, Faculty of Medicine, Kristen Duta Wacana University, Bethesda Hospital, Yogyakarta, Indonesia
| | | | - Heng Boon Yim
- Mount Elizabeth Novena Hospital, Singapore.,Faculty of Medicine, National University of Singapore, Singapore
| | - Ernest Choy
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
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3
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Georgopoulos SD, Michopoulos S, Rokkas T, Apostolopoulos P, Giamarellos E, Kamberoglou D, Mentis A, Triantafyllou K. Hellenic consensus on Helicobacter pylori infection. Ann Gastroenterol 2020; 33:105-124. [PMID: 32127732 PMCID: PMC7049243 DOI: 10.20524/aog.2020.0446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023] Open
Abstract
The Hellenic Society of Gastroenterology recently organized the “Hellenic consensus on Helicobacter pylori (H. pylori) infection”. The aim of this publication is to report the guidelines in order to aid the national gastroenterology community in the management of H. pylori infection. Forty-one delegates from all Greek regions, including gastroenterologists, pathologists, clinical microbiologists, epidemiologists and basic scientists, were invited to this meeting. The participants were allocated to 1 of the 4 main topics of the meeting: i.e., H. pylori diagnosis and association with diseases; H. pylori and gastric cancer; H. pylori and extragastric associated disorders; and H. pylori treatment. The results of each subgroup were submitted to a final consensus vote that included all participants. Relevant data based on international and Greek publications were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. The cutoff level of 70% was considered as acceptance for the final statement. It is hoped that the recommendations and conclusions of this report will guide Greek doctors in their daily practice concerning the management of H. pylori infection.
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Affiliation(s)
| | | | - Theodoros Rokkas
- Gastroenterology Department, Henry Dynan Hospital (Theodoros Rokkas)
| | | | - Evangelos Giamarellos
- 4 Department of Internal Medicine, Attikon University Hospital (Evangelos Giamarellos)
| | | | - Andreas Mentis
- Laboratory of Medical Microbiology, Hellenic Pasteur Institute, (Andreas Mentis)
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4
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Menditto E, Gimeno Miguel A, Moreno Juste A, Poblador Plou B, Aza Pascual-Salcedo M, Orlando V, González Rubio F, Prados Torres A. Patterns of multimorbidity and polypharmacy in young and adult population: Systematic associations among chronic diseases and drugs using factor analysis. PLoS One 2019; 14:e0210701. [PMID: 30726245 PMCID: PMC6364882 DOI: 10.1371/journal.pone.0210701] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 12/07/2018] [Indexed: 11/26/2022] Open
Abstract
Objectives The objective was to identify the systematic associations among chronic diseases and drugs in the form of patterns and to describe and clinically interpret the constituted patterns with a focus on exploring the existence of potential drug-drug and drug-disease interactions and prescribing cascades. Methods This observational, cross-sectional study used the demographic and clinical information from electronic medical databases and the pharmacy billing records of all users of the public health system of the Spanish region of Aragon in 2015. An exploratory factor analysis was conducted based on the tetra-choric correlations among the diagnoses of chronic diseases and the dispensed drugs in 887,572 patients aged ≤65 years. The analysis was stratified by age and sex. To name the constituted patterns, assess their clinical nature, and identify potential interactions among diseases and drugs, the associations found in each pattern were independently reviewed by two pharmacists and two doctors and tested against the literature and the information reported in the technical medicinal forms. Results Six multimorbidity-polypharmacy patterns were found in this large-scale population study, named as respiratory, mental health, cardiometabolic, endocrinological, osteometabolic, and mechanical-pain. The nature of the patterns in terms of diseases and drugs differed by sex and age and became more complex as age advanced. Conclusions The six clinically sound multimorbidity-polypharmacy patterns described in this non-elderly population confirmed the existence of systematic associations among chronic diseases and medications, and revealed some unexpected associations suggesting the prescribing cascade phenomenon as a potential underlying factor. These findings may help to broaden the focus and orient the early identification of potential interactions when caring for multimorbid patients at high risk of adverse health outcomes due to polypharmacy.
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Affiliation(s)
- Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
- * E-mail:
| | - Antonio Gimeno Miguel
- Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
| | - Aida Moreno Juste
- Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Health Service (SALUD), Zaragoza, Spain
| | - Beatriz Poblador Plou
- Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
| | - Mercedes Aza Pascual-Salcedo
- Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Health Service (SALUD), Zaragoza, Spain
| | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | - Francisca González Rubio
- Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Health Service (SALUD), Zaragoza, Spain
| | - Alexandra Prados Torres
- Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Health Service (SALUD), Zaragoza, Spain
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Narayanan M, Reddy KM, Marsicano E. Peptic Ulcer Disease and Helicobacter pylori infection. MISSOURI MEDICINE 2018; 115:219-224. [PMID: 30228726 PMCID: PMC6140150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Peptic ulcer disease (PUD) is a common condition that both primary care providers and gastroenterologists encounter. Symptoms of peptic ulcer disease are variable and may include abdominal pain, nausea, vomiting, weight loss and bleeding or perforation with complicated disease. Identifying the risk factors and mechanisms that lead to the development of PUD helps to understand the approach behind diagnostic and treatment strategies.
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Affiliation(s)
- Mechu Narayanan
- Mechu Narayanan, MD, is Fellow in the Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo
| | - Kavya M Reddy
- Kavya M. Reddy, MD, is Fellow in the Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo
| | - Elizabeth Marsicano
- Elizabeth Marsicano, MD, is an Assistant Professor of Internal Medicine in the Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo
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6
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Yeo SH, Yang CH. [Peptic Ulcer Disease Associated with Helicobacter pylori Infection]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 67:289-99. [PMID: 27312829 DOI: 10.4166/kjg.2016.67.6.289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although the global prevalence of peptic ulcer disease (PUD) is decreasing, PUD is still one of the most common upper gastrointestinal diseases in the world due to Helicobacter pylori infection and increased use of non-steroidal anti-inflammatory drugs. In Korea, the prevalence of H. pylori infection is also declining, but it is still the major cause of PUD. The outcomes of H. pylori infection are caused by imbalances between bacterial virulence factors, host factors, and environmental influences. In this review, we describe the prevalence trends of H. pylori infection in Korea, the mechanism of H. pylori infection-related PUD, and treatment strategies.
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Affiliation(s)
- Se-Hwan Yeo
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Dongguk University School of Medicine, Gyeongju, Korea
| | - Chang-Hun Yang
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Dongguk University School of Medicine, Gyeongju, Korea
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7
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Metanat M. Self-Medication With Analgesics and Helicobacter pylori Infection. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2015; 4:e26155. [PMID: 26097839 PMCID: PMC4464574 DOI: 10.5812/ijhrba.4(2)2015.26155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 12/18/2014] [Accepted: 12/27/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Maliheh Metanat
- Infectious Diseases and Tropical Medicine Research Center, Boo-Ali Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding author: Maliheh Metanat, Infectious Diseases and Tropical Medicine Research Center, Boo-Ali Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran.Tel: +98-5413228101, Fax: +98-5413236722,, E-mail:
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8
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The Role of Helicobacter pylori and NSAIDs in the Pathogenesis of Uncomplicated Duodenal Ulcer. Gastroenterol Res Pract 2012; 2012:189373. [PMID: 23049545 PMCID: PMC3463179 DOI: 10.1155/2012/189373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 08/27/2012] [Indexed: 01/20/2023] Open
Abstract
Background/Aim. To identify the etiological role of Helicobacter pylori (Hp) and nonsteroidal anti-inflammatory drugs (NSAIDs) in endoscopically diagnosed duodenal ulcers (DUs). Methods. Patients undergoing esophagogastroduodenoscopy in two major hospitals in Antalya and Adiyaman were included in this study and assigned as duodenal ulcer (n = 152; median age: 41.0 (16-71) years; 58.6% males) or control group (n = 70; median age: 41.0 (18-68) years; 57.1% males). Patient demographics, risk factors, and NSAID/acetylsalicylic acid (ASA) use were recorded. Results. HP was more commonly located in the corpus (75.0 versus 50.0%; odds ratio [OR] = 3.00; 95% confidence interval [CI]: 1.66-5.44; P < 0.001), incisura (75.7 versus 60.0%; OR = 2.07; 95% CI: 1.13-3.79; P = 0.017), and antrum (80.3 versus 60.0%; OR = 2.71; 95% CI: 1.45-5.05; P = 0.001) among DU patients than controls. Hp positivity was 84.9% while Hp was negative in 15.1% of patients including those accompanied with NSAID and/or ASA use (9.2%), and those were negative for all three etiological factors (5.9%). Conclusion. Our findings indicate the substantial role of Hp in the pathogenesis of DU disease as identified in 84.9% of DU patients compatible with the background prevalence of 61.4% among age-matched control subjects. Hp was the single causative factor in 44.1% of our patients, while NSAID/ASA exposure was in 9.2%.
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9
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Fujinami H, Kudo T, Hosokawsa A, Ogawa K, Miyazaki T, Nishikawa J, Kajiura S, Ando T, Ueda A, Sugiyama T. A study of the changes in the cause of peptic ulcer bleeding. World J Gastrointest Endosc 2012; 4:323-7. [PMID: 22816013 PMCID: PMC3399011 DOI: 10.4253/wjge.v4.i7.323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 02/02/2012] [Accepted: 07/01/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To clarify the frequency of and changes in the cause of peptic ulcer bleeding.
METHODS: This study retrospectively evaluated the out- and inpatients who underwent endoscopy between 2002 to 2008. The subjects were patients presenting with peptic ulcer bleeding. The details of these patients were obtained from their endoscopic reports and medical records.
RESULTS: The rates of Helicobacter pylori (H. pylori) infection were significantly low (P = 0.039), while the proportion of nonsteroidal antiinflammatory drugs (NSAIDs) users and vascular disease significantly increased over the period studied (P = 0.034 and P = 0.04, respectively). However, there was no significant difference in the proportion of low-dose aspirin users (P = 0.832).
CONCLUSION: It’s found that the primary cause of peptic ulcer bleeding changed from H. pylori infection to use of NSAIDs over the 7-year period of study. It seems that the number of low-dose aspirin users has increased with the increase in the proportion of vascular disease. It is necessary to take measures to prevent peptic ulcer bleeding among NSAIDs and low dose aspirin users.
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Affiliation(s)
- Haruka Fujinami
- Haruka Fujinami, Takahiko Kudo, Ayumu Hosokawsa, Kouhei Ogawa, Takako Miyazaki, Jun Nishikawa, Shinya Kajiura, Takayuki Ando, Akira Ueda, Toshiro Sugiyama, Department of Gastroenterology, University of Toyama, 2630 Sugitani, Toyama 9300194, Japan
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10
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Struijk M, Postma DF, van Tuyl SAC, van de Ree MA. Optimal drug therapy after aspirin-induced upper gastrointestinal bleeding. Eur J Intern Med 2012; 23:227-30. [PMID: 22385878 DOI: 10.1016/j.ejim.2011.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/08/2011] [Accepted: 10/10/2011] [Indexed: 11/30/2022]
Abstract
Upper gastrointestinal bleeding is a common adverse effect of chronic aspirin treatment. Traditionally, most physicians might tend to discontinue aspirin therapy after related gastrointestinal bleeding. However, recent studies have shown that continuation of aspirin is beneficial because of a decrease of cardiovascular complications and only a relatively small increase of recurrent peptic ulcer bleeding when combined with a proton pump inhibitor. There might be individual cases where the burden of recurrent gastrointestinal complications outweighs the risk of vascular events. In these cases the physician needs to carefully consider other precipitating factors for the recurrent gastrointestinal symptoms. At the moment, alternative antiplatelet therapy does not lead to lower gastrointestinal risks. In the near future, therapies with a more favorable profile might emerge.
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Affiliation(s)
- M Struijk
- Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands.
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11
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Interaction of Helicobacter pylori infection and low-dose aspirin in the upper gastrointestinal tract: implications for clinical practice. Best Pract Res Clin Gastroenterol 2012; 26:163-72. [PMID: 22542154 DOI: 10.1016/j.bpg.2012.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 01/08/2012] [Indexed: 01/31/2023]
Abstract
Low-dose aspirin has been shown to increase the risk of upper gastrointestinal tract injury. Risk factors in upper gastrointestinal complications in low-dose aspirin users are less well defined than in other NSAID users, and there are enough intrinsic differences in the two agents to discuss them separately. In particularly, the role of Helicobacter pylori and the benefit of its eradication in decreasing the risk of upper gastrointestinal tract injury in low-dose ASA users remains controversial. Various consensus groups have recommended H. pylori testing and eradication in low-dose ASA users with a prior history of peptic ulcer or ulcer bleeding. The basis of this recommendation is derived from a limited, albeit expanding evidence on the role of H. pylori in upper gastrointestinal tract injury in low-dose ASA users and on the effectiveness of H. pylori eradication in reducing the risk of complications such as rebleeding in high-risk patients.
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12
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Hung IFN, Wong BCY. Assessing the risks and benefits of treating Helicobacter pylori infection. Therap Adv Gastroenterol 2011; 2:141-7. [PMID: 21180540 DOI: 10.1177/1756283x08100279] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Ivan F N Hung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
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13
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Triantafyllou K, Vlachogiannakos J, Ladas SD. Gastrointestinal and liver side effects of drugs in elderly patients. Best Pract Res Clin Gastroenterol 2010; 24:203-15. [PMID: 20227033 DOI: 10.1016/j.bpg.2010.02.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 02/07/2010] [Accepted: 02/08/2010] [Indexed: 01/31/2023]
Abstract
It is expected that the percentage of people >60 years of age will be 22% worldwide by the year 2050. Multi-morbidity and poly-pharmacy are common in individuals during old age, while adverse drug reactions are at least twice as common in the elderly compared to younger adults. Publications related to drug side effects are rather rare in this age group since most clinical trials exclude patients >75-80 years of age. Gastrointestinal adverse drug reactions studied in the elderly include non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulant-induced gastrointestinal tract mucosal injuries. Malabsorption, diarrhoea and constipation are common side effects of laxatives, antibiotics, anticholinergics and calcium channel blockers. Drug (amoxycilin/clavulanic acid, isoniazide, nitrofurantoin, diclifenac and methotrexate)-induced hepatotoxicity in the elderly is four times more common than in younger adults and may simulate almost all known liver disorders. Further clinical studies are needed to investigate gastrointestinal and hepatic side effects of drugs in elderly patients.
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Affiliation(s)
- Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine - Propaedeutic, Attikon University General Hospital, Medical School, Athens University, Chaidari, Greece
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14
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Lee YC, Liou JM, Wu MS, Wu CY, Lin JT. Eradication of helicobacter pylori to prevent gastroduodenal diseases: hitting more than one bird with the same stone. Therap Adv Gastroenterol 2008; 1:111-20. [PMID: 21180520 PMCID: PMC3002494 DOI: 10.1177/1756283x08094880] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Helicobacter pylori (H. pylori) are gram-negative bacteria that selectively colonizes the gastric mucosa. The prevalence of H. pylori infection varies from 20 to 50% in industrialized countries to over 80% in developing countries. The infection may persist lifelong without specific treatment. Prolonged infection and inflammation due to bacterial virulence and host genetic factors will lead to chronic gastritis. A certain portion of infected patients then develop more severe pathologies such as peptic ulcer (10-15%), gastric cancer (1%), and mucosa-associated lymphoid tissue lymphoma (50.01%). Although the majority of infected patients remain asymptomatic, much of the evidence has shown that eradication of H. pylori infection can reduce the recurrence of peptic ulcer and benefit a substantial portion of patients with nonulcer dyspepsia. Though controversial in population-based clinical trials, several cost-effectiveness analyses also reveal that H. pylori eradication is cost effective in the primary prevention of gastric cancer. Therefore, the discovery of H. pylori offers the chance to prevent several gastroduodenal diseases by means of their eradication. In other words, gastroenterologists could hit more than one bird with one stone. However, there are concerns regarding application of a 'test and treat' strategy in the general population. In this review, we will focus on current evidence of H. pylori eradication in the primary and secondary prophylaxis of gastric cancer and peptic ulcer disease.
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Affiliation(s)
- Yi-Chia Lee
- Departments of Internal Medicine, College of Medicine, National Taiwan
University, Taipei, Taiwan and Division of Biostatistics, Graduate Institute
of Epidemiology, College of Public Health, National Taiwan University,
Taipei, Taiwan
| | - Jyh-Ming Liou
- Departments of Internal Medicine, College of Medicine, National Taiwan
University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Departments of Internal Medicine, College of Medicine, National Taiwan
University, Taipei, Taiwan
| | - Chun-Ying Wu
- Department of Internal Medicine, Veteran General Hospital, Taichung,
Taiwan
| | - Jaw-Town Lin
- Department of Internal Medicine, College of Medicine, National Taiwan
University, Taipei, Taiwan and Department of Internal Medicine, E-DA
Hospital/Kaohsiung County I-Shou University No. 7, Chung-Shan South Road,
Taipei, Taiwan
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15
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Kiltz U, Zochling J, Schmidt WE, Braun J. Use of NSAIDs and infection with Helicobacter pylori--what does the rheumatologist need to know? Rheumatology (Oxford) 2008; 47:1342-7. [PMID: 18477642 DOI: 10.1093/rheumatology/ken123] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES NSAID-induced gastroduodenal lesions are a frequent and potentially serious health problem in patients with rheumatic diseases. Helicobacter pylori (H. pylori) has also been recognized as a major risk factor for the development of ulcer disease. However, the role of H. pylori in the pathogenesis of NSAID-induced gastroduodenal lesions has remained controversial, and there is currently no clear consensus on the management of NSAID users who are infected with H. pylori. METHODS To clarify this situation we have performed a systematic literature search to find randomized controlled trials comparing the efficacy of eradication in patients receiving NSAIDs to prevent ulcer development. RESULTS Seven randomized controlled trials and one meta-analysis were identified. There were three papers on NSAID-naive patients. According to this data, NSAID-naive users benefit from testing for H. pylori infection and subsequent H. pylori eradication therapy prior to the initiation of NSAID. In contrast, H. pylori eradication alone does not protect chronic NSAID users with recent ulcer complications from further gastrointestinal (GI) events. To prevent recurrent ulcer bleeding long-term acid suppressive therapy is needed. CONCLUSIONS In conclusion, ulcer risk reduction after H. pylori eradication therapy is clearly more marked in patients beginning NSAID therapy than in patients who were already receiving and tolerating NSAID therapy. Thus, the management of H. pylori infection and the prevention of GI complications in NSAID users need to be individualized on the basis of recently published data.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, St. Josefs Hospital, Landgrafenstr. 15, 44652 Herne, Germany.
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Bayyurt N, Abasiyanik MF, Sander E, Salih BA. Canonical correlation analysis of factors involved in the occurrence of peptic ulcers. Dig Dis Sci 2007; 52:140-6. [PMID: 17180541 DOI: 10.1007/s10620-006-9229-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Accepted: 01/02/2006] [Indexed: 01/30/2023]
Abstract
The impact of risk factors on the development of peptic ulcers has been shown to vary among different populations. We sought to establish a correlation between these factors and their involvement in the occurrence of peptic ulcers for which a canonical correlation analysis was applied. We included 7,014 patient records (48.6% women, 18.4% duodenal ulcer [DU], 4.6% gastric ulcer [GU]) of those underwent upper gastroendoscopy for the last 5 years. The variables measured are endoscopic findings (DU, GU, antral gastritis, erosive gastritis, pangastritis, pyloric deformity, bulbar deformity, bleeding, atrophy, Barret esophagus and gastric polyp) and risk factors (age, gender, Helicobacter pylori infection, smoking, alcohol, and nonsteroidal anti-inflammatory drugs [NSAIDs] and aspirin intake). We found that DU had significant positive correlation with bulbar deformity (P=2.6 x 10(-23)), pyloric deformity (P=2.6 x 10(-23)), gender (P=2.6 x 10(-23)), H. pylori (P=1.4 x 10(-15)), bleeding (P=6.9 x 10(-15)), smoking (P=1.4 x 10(-7)), aspirin use (P=1.1 x 10(-4)), alcohol intake (P=7.7 x 10(-4)), and NSAIDs (P=.01). GU had a significantly positive correlation with pyloric deformity (P=1,6 x 10(-15)), age (P=2.6 x 10(-14)), bleeding (P=3.7 x 10(-8)), gender (P=1.3 x 10(-7)), aspirin use (P=1.1 x 10(-6)), bulbar deformity (P=7.4 x 10(-4)), alcohol intake (P=.03), smoking (P=.04), and Barret esophagus (P=.03). The level of significance was much higher in some variables with DU than with GU and the correlations with GU in spite of being highly significant the majority, were small in magnitude. In conclusion, Turkish patients with the following endoscopic findings bulbar deformity and pyloric deformity are high-risk patients for peptic ulcers with the risk of the occurrence of DU being higher than that of GU. Factors such as H. pylori, smoking, alcohol use, and NSAIDs use (listed in a decreasing manner) are risk factors that have significant impact on the occurrence of DU; aspirin has a significant impact on both DU and GU.
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Affiliation(s)
- Nizamettin Bayyurt
- Fatih University, Faculty of Science and Literature, Department of Mathematics, Istanbul, Turkey
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