1
|
Patrignani P, Tacconelli S, Contursi A, Piazuelo E, Bruno A, Nobili S, Mazzei M, Milillo C, Hofling U, Hijos-Mallada G, Sostres C, Lanas A. Optimizing aspirin dose for colorectal cancer patients through deep phenotyping using novel biomarkers of drug action. Front Pharmacol 2024; 15:1362217. [PMID: 38495101 PMCID: PMC10941341 DOI: 10.3389/fphar.2024.1362217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
Background: Low-dose aspirin's mechanism of action for preventing colorectal cancer (CRC) is still debated, and the optimal dose remains uncertain. We aimed to optimize the aspirin dose for cancer prevention in CRC patients through deep phenotyping using innovative biomarkers for aspirin's action. Methods: We conducted a Phase II, open-label clinical trial in 34 CRC patients of both sexes randomized to receive enteric-coated aspirin 100 mg/d, 100 mg/BID, or 300 mg/d for 3 ± 1 weeks. Biomarkers were evaluated in blood, urine, and colorectal biopsies at baseline and after dosing with aspirin. Novel biomarkers of aspirin action were assessed in platelets and colorectal tissues using liquid chromatography-mass spectrometry to quantify the extent of cyclooxygenase (COX)-1 and COX-2 acetylation at Serine 529 and Serine 516, respectively. Results: All aspirin doses caused comparable % acetylation of platelet COX-1 at Serine 529 associated with similar profound inhibition of platelet-dependent thromboxane (TX)A2 generation ex vivo (serum TXB2) and in vivo (urinary TXM). TXB2 was significantly reduced in CRC tissue by aspirin 300 mg/d and 100 mg/BID, associated with comparable % acetylation of COX-1. Differently, 100 mg/day showed a lower % acetylation of COX-1 in CRC tissue and no significant reduction of TXB2. Prostaglandin (PG)E2 biosynthesis in colorectal tumors and in vivo (urinary PGEM) remained unaffected by any dose of aspirin associated with the variable and low extent of COX-2 acetylation at Serine 516 in tumor tissue. Increased expression of tumor-promoting genes like VIM (vimentin) and TWIST1 (Twist Family BHLH Transcription Factor 1) vs. baseline was detected with 100 mg/d of aspirin but not with the other two higher doses. Conclusion: In CRC patients, aspirin 300 mg/d or 100 mg/BID had comparable antiplatelet effects to aspirin 100 mg/d, indicating similar inhibition of the platelet's contribution to cancer. However, aspirin 300 mg/d and 100 mg/BID can have additional anticancer effects by inhibiting cancerous tissue's TXA2 biosynthesis associated with a restraining impact on tumor-promoting gene expression. EUDRACT number: 2018-002101-65. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03957902.
Collapse
Affiliation(s)
- Paola Patrignani
- Systems Pharmacology and Translational Therapeutics Laboratory, at the Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Science, “G. d’Annunzio” University Medical School, Chieti, Italy
| | - Stefania Tacconelli
- Systems Pharmacology and Translational Therapeutics Laboratory, at the Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Science, “G. d’Annunzio” University Medical School, Chieti, Italy
| | - Annalisa Contursi
- Systems Pharmacology and Translational Therapeutics Laboratory, at the Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Science, “G. d’Annunzio” University Medical School, Chieti, Italy
| | - Elena Piazuelo
- Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Annalisa Bruno
- Systems Pharmacology and Translational Therapeutics Laboratory, at the Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Science, “G. d’Annunzio” University Medical School, Chieti, Italy
| | - Stefania Nobili
- Systems Pharmacology and Translational Therapeutics Laboratory, at the Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Science, “G. d’Annunzio” University Medical School, Chieti, Italy
| | - Matteo Mazzei
- Systems Pharmacology and Translational Therapeutics Laboratory, at the Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Science, “G. d’Annunzio” University Medical School, Chieti, Italy
| | - Cristina Milillo
- Systems Pharmacology and Translational Therapeutics Laboratory, at the Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University, Chieti, Italy
- Department of Psychological Sciences, Health, and Territory, “G. d’Annunzio” University, Chieti, Italy
| | - Ulrika Hofling
- Systems Pharmacology and Translational Therapeutics Laboratory, at the Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Science, “G. d’Annunzio” University Medical School, Chieti, Italy
| | - Gonzalo Hijos-Mallada
- University Hospital LB, Aragon Health Research Institute (IISAragon), CIBERehd, University of Zaragoza, Zaragoza, Spain
| | - Carlos Sostres
- University Hospital LB, Aragon Health Research Institute (IISAragon), CIBERehd, University of Zaragoza, Zaragoza, Spain
| | - Angel Lanas
- University Hospital LB, Aragon Health Research Institute (IISAragon), CIBERehd, University of Zaragoza, Zaragoza, Spain
| |
Collapse
|
2
|
Azagra P, Sostres C, Ferrández Á, Riazuelo L, Tomasini C, Barbed OL, Morlana J, Recasens D, Batlle VM, Gómez-Rodríguez JJ, Elvira R, López J, Oriol C, Civera J, Tardós JD, Murillo AC, Lanas A, Montiel JMM. Endomapper dataset of complete calibrated endoscopy procedures. Sci Data 2023; 10:671. [PMID: 37789003 PMCID: PMC10547713 DOI: 10.1038/s41597-023-02564-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
Computer-assisted systems are becoming broadly used in medicine. In endoscopy, most research focuses on the automatic detection of polyps or other pathologies, but localization and navigation of the endoscope are completely performed manually by physicians. To broaden this research and bring spatial Artificial Intelligence to endoscopies, data from complete procedures is needed. This paper introduces the Endomapper dataset, the first collection of complete endoscopy sequences acquired during regular medical practice, making secondary use of medical data. Its main purpose is to facilitate the development and evaluation of Visual Simultaneous Localization and Mapping (VSLAM) methods in real endoscopy data. The dataset contains more than 24 hours of video. It is the first endoscopic dataset that includes endoscope calibration as well as the original calibration videos. Meta-data and annotations associated with the dataset vary from the anatomical landmarks, procedure labeling, segmentations, reconstructions, simulated sequences with ground truth and same patient procedures. The software used in this paper is publicly available.
Collapse
Affiliation(s)
- Pablo Azagra
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain.
| | - Carlos Sostres
- Digestive Disease Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Department of Medicine, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Ángel Ferrández
- Digestive Disease Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Department of Medicine, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Luis Riazuelo
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Clara Tomasini
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - O León Barbed
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Javier Morlana
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - David Recasens
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Víctor M Batlle
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Juan J Gómez-Rodríguez
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Richard Elvira
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Julia López
- Digestive Disease Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Cristina Oriol
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Javier Civera
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Juan D Tardós
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Ana C Murillo
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Angel Lanas
- Digestive Disease Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Department of Medicine, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - José M M Montiel
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| |
Collapse
|
3
|
Alfaro E, Sostres C, Lanas A. Diagnosis and Treatment of Helicobacter pylori Infection in Real Practice-New Role of Primary Care Services in Antibiotic Resistance Era. Diagnostics (Basel) 2023; 13:diagnostics13111918. [PMID: 37296770 DOI: 10.3390/diagnostics13111918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/12/2023] Open
Abstract
Helicobacter pylori (H. pylori) is a key agent in several upper gastrointestinal diseases. Treatment of H. pylori infection is the main strategy for resolving the associated gastroduodenal damage in infected patients and for the prevention of gastric cancer development. Infection management is becoming complex due to the increase in antibiotic resistance, which already represents a global healthcare problem. Resistance to clarithromycin, levofloxacin or metronidazole have forced the adaptation of eradication regimens in this new reality to reach the eradication rate target recommended in most international guidelines (>90%). In this challenging scenario, molecular methods are revolutionizing the diagnosis of antibiotic-resistant infections and the detection of antibiotic resistance and opening a path towards personalized treatments, although their use is not yet widespread. Moreover, the infection management by physicians is still not adequate, which contributes to aggravating the problem. Both gastroenterologists and mainly primary care physicians (PCPs), who currently routinely manage this infection, perform suboptimal management of the diagnosis and treatment of H. pylori infection by not following the current consensus recommendations. In order to improve H. pylori infection management and to increase PCPs' compliance with guidelines, some strategies have been evaluated with satisfactory results, but it is still necessary to design and evaluate new different approaches.
Collapse
Affiliation(s)
- Enrique Alfaro
- Department of Gastroenterology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Carlos Sostres
- Department of Gastroenterology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Angel Lanas
- Department of Gastroenterology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
- Medicine Department, University of Zaragoza, 50009 Zaragoza, Spain
| |
Collapse
|
4
|
Hijos-Mallada G, Saura N, Lué A, Velamazan R, Nieto R, Navarro M, Arechavaleta S, Chueca E, Gomollon F, Lanas A, Sostres C. A Point-of-Care Faecal Test Combining Four Biomarkers Allows Avoidance of Normal Colonoscopies and Prioritizes Symptomatic Patients with a High Risk of Colorectal Cancer. Cancers (Basel) 2023; 15:cancers15030721. [PMID: 36765678 PMCID: PMC9913693 DOI: 10.3390/cancers15030721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023] Open
Abstract
Most colonoscopies performed to evaluate gastrointestinal symptoms detect only non-relevant pathologies. We aimed to evaluate the diagnostic accuracy of a qualitative point-of-care (POC) test combining four biomarkers (haemoglobin, transferrin, calprotectin, and lactoferrin), a quantitative faecal immunochemical test (FIT) for haemoglobin, and a quantitative faecal calprotectin (FC) test in symptomatic patients prospectively recruited. Colorectal cancer (CRC), adenoma requiring surveillance, inflammatory bowel disease (IBD), microscopic colitis, and angiodysplasia were considered significant pathologies. A total of 571 patients were included. Significant pathology was diagnosed in 118 (20.7%), including 30 CRC cases (5.3%). The POC test yielded the highest negative predictive values: 94.8% for a significant pathology and 100% for CRC or IBD if the four markers turned negative (36.8% of the patients). Negative predictive values of FIT, FC, and its combination for diagnosis of a significant pathology were 88.4%, 87.6%, and 90.8%, respectively. Moreover, the positive predictive value using the POC test was 82.3% for significant pathology when all biomarkers tested positive (6% of the patients), with 70.6% of these patients diagnosed with CRC or IBD. The AUC of the POC test was 0.801 (95%CI 0.754-0.848) for the diagnosis of a significant pathology. Therefore, this POC faecal test allows the avoidance of unnecessary colonoscopies and prioritizes high risk symptomatic patients.
Collapse
Affiliation(s)
- Gonzalo Hijos-Mallada
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
- Correspondence:
| | - Nuria Saura
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | - Alberto Lué
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | - Raúl Velamazan
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | - Rocío Nieto
- Departamento de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Mercedes Navarro
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | | | - Eduardo Chueca
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | - Fernando Gomollon
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
- Departamento de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
- CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Angel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
- Departamento de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
- CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Carlos Sostres
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| |
Collapse
|
5
|
Alfaro E, Martínez-Domínguez SJ, Laredo V, Lanas Á, Sostres C. Evaluation of Different Strategies to Improve the Management of Helicobacter pylori Infection at the Primary Care Level: Training Sessions Increase Prescription Appropriateness of Treatment Regimens. Antibiotics (Basel) 2022; 11:antibiotics11121746. [PMID: 36551403 PMCID: PMC9774985 DOI: 10.3390/antibiotics11121746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/09/2022] Open
Abstract
Helicobacter pylori infection (H. pylori) is mainly managed at the primary care level. Our group previously performed a study demonstrating that providing specific counselling (SC) to primary care practitioners (PCPs) who requested a urea breath test (UBT) improved treatment management but not indications for H. pylori tests. SC was given in the form of a personal letter addressed to PCPs with UBT results which contained information about accepted UBT indications and a Helicobacter pylori treatment algorithm. The purpose of the present study was to evaluate the effect of training sessions (TS) on UBT indications, antibiotic prescriptions and eradication rates. This was a quasi-experimental study performed at primary care centres (PCCs). Phase I included 399 patients diagnosed with H. pylori infection after providing SC to PCPs. Phase II included 400 H. pylori-positive patients after giving TS to PCPs who had already received SC (100 from PCCs with TS and 300 from PCCs without TS). An improved trend in the appropriate indication of H. pylori diagnosis was observed between Phase I and PCCs with TS in Phase II (57.5% vs. 67%; p = 0.06). TS improved appropriate prescriptions in PCCs with TS compared to PCCs that only received SC in Phase I and II (94% vs. 75.3%, p = 0.01; 94% vs. 85.6%, p = 0.04, respectively). Eradication rates showed no differences between groups. In conclusion, training sessions after specific counselling improved antibiotic prescription appropriateness but not eradication rates.
Collapse
Affiliation(s)
- Enrique Alfaro
- Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Samuel J. Martínez-Domínguez
- Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence: ; Tel.: +34-976765700
| | - Viviana Laredo
- Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Ángel Lanas
- Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
- CIBER for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
| | - Carlos Sostres
- Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| |
Collapse
|
6
|
Hijos-Mallada G, Sostres C, Gomollón F. NSAIDs, gastrointestinal toxicity and inflammatory bowel disease. Gastroenterol Hepatol 2021; 45:215-222. [PMID: 34157367 DOI: 10.1016/j.gastrohep.2021.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 01/06/2023]
Abstract
Non-steroidal antiinflammatory drugs (NSAIDs) are currently one of the most widely used drugs. The use of NSAIDs is associated with gastrointestinal toxicity, affecting both upper gastrointestinal tract (peptic ulcer disease) and lower gastrointestinal tract (NSAID-induced enteropathy). NSAIDs use has been associated with an increased risk of clinical relapse in inflammatory bowel disease patients. In this article, we review the upper and lower gastrointestinal toxicity of NSAIDs, with a focus on the risks and specific data of these drugs in inflammatory bowel disease patients, giving recommendations for its appropriate use in the clinical practice. Although evidence is scarce, short-term use of NSAIDs appears to be safe, and the data available suggest that selective COX-2 inhibitors are the safer option. NSAIDs should be avoided as long-term treatment or with high doses, especially in patients with active inflammation.
Collapse
Affiliation(s)
- Gonzalo Hijos-Mallada
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria (ISS) Aragón, Zaragoza, España.
| | - Carlos Sostres
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria (ISS) Aragón, Zaragoza, España
| | - Fernando Gomollón
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria (ISS) Aragón, Zaragoza, España; Departamento de Medicina, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
| |
Collapse
|
7
|
Hijos-Mallada G, Lué A, Velamazan R, Saura N, Abril C, Lorenzo M, Navarro M, Chueca E, Arechavaleta S, Gomollón F, Lanas Á, Sostres C. The Addition of Other Fecal Biomarkers Does Not Improve the Diagnostic Accuracy of Immunochemical Fecal Occult Blood Test Alone in a Colorrectal Cancer Screening Cohort. Front Med (Lausanne) 2021; 8:665786. [PMID: 34150803 PMCID: PMC8212973 DOI: 10.3389/fmed.2021.665786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/11/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Screening with fecal occult blood test reduces colorectal cancer (CRC) incidence and mortality, and is currently implemented in most countries. However, around 40% of screening colonoscopies are normal. Thus, strategies to avoid these colonoscopies are highly necessary. Adding other fecal biomarkers, such as fecal calprotectin (FC), lactoferrin, and transferrin may be useful, but evidence is scarce. Aims: To evaluate the diagnostic accuracy of fecal occult blood immunochemical test (FIT), FC, and a one-step combo card test for the simultaneous semi-qualitative detection of human hemoglobin (hHb), transferrin (hTf), calprotectin (hCp) and lactoferrin (hLf) in a CRC screening program population. Methods: Single-center, prospective observational study, enrolling patients included in a CRC screening program, referred for a colonoscopy due to a positive FIT test. Participants collected a stool sample prior to bowel preparation, and FIT, FC and the combo semi-qualitative tests were performed on the sample. Sensitivity, specificity, positive and negative predictive values and area under receiver operator curve (AUC) for diagnosis of advanced neoplasia, advanced adenoma and CRC were estimated for each biomarker and their combinations. The primary endpoint of the study was to assess whether these biomarkers could improve the diagnostic accuracy of FIT alone. Results: 336 consecutive patients (64% males) were recruited. Advanced neoplasia was found in 129/336 (38.4%) patients, and of these, 22/336 (6.5%) were diagnosed of CRC. 153/336 (45.5%) colonoscopies were completely normal. The AUC for the diagnosis of advanced neoplasia were 0.725 (95%CI 0.665–0.784) for FIT, 0.477 (95%CI 0.413–0.541) for FC and 0.732 (95%CI 0.674–0.791) for the combination of both (FIT + FC) quantitative tests. The AUCs for the combo test were 0.70 (95%CI 0.641–0.760) for hHb, 0.625 (95%CI 0.562–0.698) for hTf, 0.532 (95%CI 0.469–0.595) for hCp, 0.531 (95%CI 0.466–0.595 ) for hLf and 0.681 (95%CI 0.620–0.741) for the combination of the four biomarkers. Conclusion: In average-risk population, FIT appears to be the best fecal marker for the diagnosis of CRC and advanced adenoma. None of the other biomarkers explored or their combinations provided a better diagnostic accuracy. Only hTF showed an acceptable diagnostic accuracy. FC and hLF were not useful in this setting.
Collapse
Affiliation(s)
- Gonzalo Hijos-Mallada
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain.,Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Alberto Lué
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain.,Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Raul Velamazan
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain.,Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Nuria Saura
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain.,Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | | | | | - Mercedes Navarro
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain.,Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Eduardo Chueca
- Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain.,CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain
| | - Samantha Arechavaleta
- Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain.,CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain
| | - Fernando Gomollón
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain.,Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain.,CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain
| | - Ángel Lanas
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain.,Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain.,CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain
| | - Carlos Sostres
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain.,Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain.,CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain
| |
Collapse
|
8
|
Hermoso-Durán S, García-Rayado G, Ceballos-Laita L, Sostres C, Vega S, Millastre J, Sánchez-Gracia O, Ojeda JL, Lanas Á, Velázquez-Campoy A, Abian O. Thermal Liquid Biopsy (TLB) Focused on Benign and Premalignant Pancreatic Cyst Diagnosis. J Pers Med 2020; 11:jpm11010025. [PMID: 33396529 PMCID: PMC7823923 DOI: 10.3390/jpm11010025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Current efforts in the identification of new biomarkers are directed towards an accurate differentiation between benign and premalignant cysts. Thermal Liquid Biopsy (TLB) has been previously applied to inflammatory and tumor diseases and could offer an interesting point of view in this type of pathology. Methods: In this work, twenty patients (12 males and 8 females, average ages 62) diagnosed with a pancreatic cyst benign (10) and premalignant (10) cyst lesions were recruited, and biological samples were obtained during the endoscopic ultrasonography procedure. Results: Proteomic content of cyst liquid samples was studied and several common proteins in the different groups were identified. TLB cyst liquid profiles reflected protein content. Also, TLB serum score was able to discriminate between healthy and cysts patients (71% sensitivity and 98% specificity) and between benign and premalignant cysts (75% sensitivity and 67% specificity). Conclusions: TLB analysis of plasmatic serum sample, a quick, simple and non-invasive technique that can be easily implemented, reports valuable information on the observed pancreatic lesion. These preliminary results set the basis for a larger study to refine TLB serum score and move closer to the clinical application of TLB providing useful information to the gastroenterologist during patient diagnosis.
Collapse
Affiliation(s)
- Sonia Hermoso-Durán
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Institute of Biocomputation and Physics of Complex Systems (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain;
| | - Guillermo García-Rayado
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Servicio de Digestivo, Hospital Clínico Universitario Lozano Blesa (HCULB), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Laura Ceballos-Laita
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Institute of Biocomputation and Physics of Complex Systems (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain;
| | - Carlos Sostres
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Servicio de Digestivo, Hospital Clínico Universitario Lozano Blesa (HCULB), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Sonia Vega
- Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Institute of Biocomputation and Physics of Complex Systems (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain;
| | - Judith Millastre
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Servicio de Digestivo, Hospital Clínico Universitario Lozano Blesa (HCULB), 50009 Zaragoza, Spain
| | | | - Jorge L. Ojeda
- Department of Statistical Methods, Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Ángel Lanas
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Servicio de Digestivo, Hospital Clínico Universitario Lozano Blesa (HCULB), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
- Department of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Adrián Velázquez-Campoy
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Institute of Biocomputation and Physics of Complex Systems (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
- Fundación ARAID, Gobierno de Aragón, 50009 Zaragoza, Spain
- Departamento de Bioquímica y Biología Molecular y Celular, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Correspondence: (A.V.-C.); (O.A.); Tel.: +34-976-762996 (A.V.-C.); +34-876-555417 (O.A.)
| | - Olga Abian
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Institute of Biocomputation and Physics of Complex Systems (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
- Fundación ARAID, Gobierno de Aragón, 50009 Zaragoza, Spain
- Instituto Aragonés de Ciencias de la Salud (IACS), 50009 Zaragoza, Spain
- Correspondence: (A.V.-C.); (O.A.); Tel.: +34-976-762996 (A.V.-C.); +34-876-555417 (O.A.)
| |
Collapse
|
9
|
Navarro M, Hijos G, Sostres C, Lué A, Puente-Lanzarote JJ, Carrera-Lasfuentes P, Lanas A. Reducing the Cut-Off Value of the Fecal Immunochemical Test for Symptomatic Patients Does Not Improve Diagnostic Performance. Front Med (Lausanne) 2020; 7:410. [PMID: 32984360 PMCID: PMC7492376 DOI: 10.3389/fmed.2020.00410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/29/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction: The fecal immunochemical test (FIT) has been established as a cost-effective test in colon cancer screening programmes. This test could also be helpful in symptomatic patients prior to colonoscopy, but data about diagnostic performance, and accurate cut-off values for these patients are still scarce. Materials and Methods: Prospective study that included consecutive unselected patients with gastrointestinal symptoms referred for colonoscopy between November 2016 and June 2018. We performed a FIT (FOB Gold® test, cut-off 20 micrograms of Hb/gram of feces) prior to colonoscopy and determined the accuracy of FIT in terms of sensitivity, specificity, positive and negative predictive value for clinically significant pathology, advanced neoplasia, and colorectal cancer in symptomatic patients, using two different cut-off values. Results: A total of 727 patients (44.3% men, aged 58.5 ± 14.9 years) was included in the study. The main symptom was history of previous (non-active) rectal bleeding (34.7%), followed by diarrhea (15.0%). Over one quarter of the patients (25.9%) had a positive FIT result. The caecal intubation rate was 95.5%. Clinically significant pathology was identified in 142 colonoscopies (19.5%), advanced neoplasia in 115 (15.8%) and colorectal cancer in 36 colonoscopies (5.0%). FIT performed very well for clinically significant pathology, advanced neoplasia and cancer, with a high negative predictive value (NPV). Reducing the cut-off value to 10 μg/g yielded similar NPV results, with a decrease in specificity. Using a combination of symptoms with a positive FIT result did not improve FIT performance. Only specificity was slightly higher compared to FIT alone, but this was paralleled by a decrease in sensitivity and NPV for cancer and clinically significant pathology. The odds of presenting clinically significant pathology, advanced neoplasia, or cancer increased with FIT concentration. Conclusions: The specificity and NPV of FIT for clinically significant pathology, advanced neoplasia, and cancer are high in symptomatic patients. FIT is a helpful test for determining the need to perform further studies. It may not be necessary to reduce the cut-off value for symptomatic patients, since FIT performance with the current standard cut-off value used in colorectal cancer screening was accurate. FIT can be used to avoid or prioritize colonoscopy procedures.
Collapse
Affiliation(s)
- Mercedes Navarro
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain
| | - Gonzalo Hijos
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain
| | - Carlos Sostres
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain
| | - Alberto Lué
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain
| | | | | | - Angel Lanas
- Digestive Diseases Service, University Clinic Hospital, Zaragoza, Spain.,CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain.,Department of Medicine, University of Zaragoza, Zaragoza, Spain.,IIS Aragón, Zaragoza, Spain
| |
Collapse
|
10
|
Hijos G, Abad D, Laredo V, Alfaro E, Cañamares P, García S, Velamazán R, Hernández M, Saura N, Sostres C. Abscess secondary to complicated peptic ulcer managed by endoscopic ultrasound-guided drainage with a lumen-apposing metal stent. Gastroenterol Hepatol 2020; 44:128-130. [PMID: 32718839 DOI: 10.1016/j.gastrohep.2020.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/08/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Gonzalo Hijos
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - Daniel Abad
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Viviana Laredo
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Enrique Alfaro
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | | | - Sandra García
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Raúl Velamazán
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - María Hernández
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Nuria Saura
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Carlos Sostres
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| |
Collapse
|
11
|
Lué A, Hijos G, Sostres C, Perales A, Navarro M, Barra MV, Mascialino B, Andalucia C, Puente JJ, Lanas Á, Gomollon F. The combination of quantitative faecal occult blood test and faecal calprotectin is a cost-effective strategy to avoid colonoscopies in symptomatic patients without relevant pathology. Therap Adv Gastroenterol 2020; 13:1756284820920786. [PMID: 32523623 PMCID: PMC7235671 DOI: 10.1177/1756284820920786] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/20/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Faecal occult blood test (FOBT) has demonstrated effectiveness in colorectal cancer (CRC) screening. Faecal calprotectin (FC) has proven efficient for evaluating activity in inflammatory bowel disease (IBD), but its value in CRC detection is less established. Most symptomatic patients have benign pathologies, but still undergo colonoscopy in many settings. AIMS To evaluate the diagnostic accuracy and cost-effectiveness of the combination of FOBT plus FC in symptomatic patients. METHODS Patients who completed colonic investigations and returned stool samples, on which FOBT and FC were performed, were recruited prospectively. CRC, advanced adenoma, IBD and angiodysplasia were considered as relevant pathologies. RESULTS A total of 404 patients were included, of whom 87 (21.5%) had relevant pathologies. Sensitivity and specificity were 50.6% and 69.6% for FOBT, 78.2% and 54.4% for FC. Negative predictive value (NPV) was 90.1% for FC and 86.9% for FOBT. NPV for the combination of FOBT and FC was 94.1%, with a sensitivity and specificity of 88.5% and 50.3%. The area under ROC (receiver operator curve) (AUC) was 0.741 for FOBT, 0.736 for FC and 0.816 for the combination. The total cost for visits and procedures was €233,016 (€577/patient). Using a combination of FOBT and FC as pre-endoscopic tool allows colonoscopies to be reduced by 39.4%, reducing total costs by 20.5%. CONCLUSION The combination of FOBT and FC has a better diagnostic accuracy compared with each test alone. Performing both tests before colonoscopy is a less costly and more effective strategy, reducing unnecessary procedures and complications.
Collapse
Affiliation(s)
- Alberto Lué
- Hospital Clínico Universitario Lozano Blesa, Servicio de Aparato Digestivo, Zaragoza, Spain,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | | | - Carlos Sostres
- Hospital Clínico Universitario Lozano Blesa, Servicio de Aparato Digestivo, Zaragoza, Spain,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain,CIBERehd, Madrid, Spain
| | | | - Mercedes Navarro
- Hospital Clínico Universitario Lozano Blesa, Servicio de Aparato Digestivo, Zaragoza, Spain,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Maria Victoria Barra
- Hospital Clínico Universitario Lozano Blesa, Servicio de Bioquímica, Zaragoza, Spain
| | | | | | - Juan José Puente
- Hospital Clínico Universitario Lozano Blesa, Servicio de Bioquímica, Zaragoza, Spain
| | - Ángel Lanas
- Hospital Clínico Universitario Lozano Blesa, Servicio de Aparato Digestivo, Zaragoza, Spain,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain,CIBERehd, Madrid, Spain Universidad de Zaragoza, Zaragoza, Spain
| | - Fernando Gomollon
- Hospital Clínico Universitario Lozano Blesa, Servicio de Aparato Digestivo, Zaragoza, Spain,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain,CIBERehd, Madrid, Spain Universidad de Zaragoza, Zaragoza, Spain
| |
Collapse
|
12
|
Sostres C, Marcén B, Laredo V, Alfaro E, Ruiz L, Camo P, Carrera-Lasfuentes P, Lanas Á. Risk of rebleeding, vascular events and death after gastrointestinal bleeding in anticoagulant and/or antiplatelet users. Aliment Pharmacol Ther 2019; 50:919-929. [PMID: 31486121 DOI: 10.1111/apt.15441] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/19/2019] [Accepted: 07/06/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with gastrointestinal bleeding during anticoagulant and/or antiplatelet therapy represent a clinical challenge. AIM To determine the risk/rates of rebleeding, vascular events and death in patients treated with antiplatelet or anticoagulant agents who developed major gastrointestinal bleeding METHODS: This was an observational cohort study of patients who developed gastrointestinal bleeding while on antiplatelet and/or anticoagulant therapy. Drug use information was collected prospectively during bleeding events. Cox proportional hazards models were used to evaluate rebleeding, vascular events and death. RESULTS Among 871 patients (mean age 78.9 ± 8.6 years), 38.9% used an anticoagulant, 52.5% used an antiplatelet and 8.6% used both; 93.1% interrupted treatment after gastrointestinal bleeding and 80.5% restarted therapy within 7.6 ± 36.4 days; 38.7% had upper gastrointestinal bleeds, 46.7% lower gastrointestinal bleeds and 14.6% gastrointestinal bleeds of unknown origin. Median follow-up was 24.9 months (IQR: 7.0-38.0). Resumption of both therapies was associated with a higher risk of rebleeding, lower risk of ischaemic events or death and a similar risk for upper and lower gastrointestinal events. Resumption of therapy ≤ 7 days after bleeding showed a similar pattern with no differences in death. Rebleeding rates were higher in anticoagulant vs antiplatelet patients (138.0 vs 99.0 events per 1000 patient-years), and the bleeding location was identical in 61.8% of cases. CONCLUSIONS Resumption of anticoagulant or antiplatelet therapy after a gastrointestinal bleeding event was associated with a lower risk of vascular events and death and a higher rebleeding risk. The benefits of early reinstitution of anticoagulant/antiplatelet therapy outweigh the gastrointestinal-related risks.
Collapse
Affiliation(s)
- Carlos Sostres
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,IIS Aragón, Zaragoza, Spain.,CIBERehd, Zaragoza, Spain
| | - Beatriz Marcén
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Viviana Laredo
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Enrique Alfaro
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Lara Ruiz
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Patricia Camo
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Ángel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,IIS Aragón, Zaragoza, Spain.,CIBERehd, Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain
| |
Collapse
|
13
|
Salillas S, Alías M, Michel V, Mahía A, Lucía A, Rodrigues L, Bueno J, Galano-Frutos JJ, De Reuse H, Velázquez-Campoy A, Carrodeguas JA, Sostres C, Castillo J, Aínsa JA, Díaz-de-Villegas MD, Lanas Á, Touati E, Sancho J. Design, Synthesis, and Efficacy Testing of Nitroethylene- and 7-Nitrobenzoxadiazol-Based Flavodoxin Inhibitors against Helicobacter pylori Drug-Resistant Clinical Strains and in Helicobacter pylori-Infected Mice. J Med Chem 2019; 62:6102-6115. [DOI: 10.1021/acs.jmedchem.9b00355] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sandra Salillas
- Biocomputation and Complex Systems Physics Institute (BIFI)-Joint Units: BIFI-IQFR (CSIC) and GBsC-CSIC, University of Zaragoza, Zaragoza 50018, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza 50009, Spain
| | - Miriam Alías
- Biocomputation and Complex Systems Physics Institute (BIFI)-Joint Units: BIFI-IQFR (CSIC) and GBsC-CSIC, University of Zaragoza, Zaragoza 50018, Spain
| | - Valérie Michel
- Helicobacter Pathogenesis Unit, Department of Microbiology, CNRS ERL6002, Institut Pasteur, 25-28 Rue du Dr. Roux, Paris 75724, France
| | - Alejandro Mahía
- Biocomputation and Complex Systems Physics Institute (BIFI)-Joint Units: BIFI-IQFR (CSIC) and GBsC-CSIC, University of Zaragoza, Zaragoza 50018, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza 50009, Spain
| | - Ainhoa Lucía
- Aragon Health Research Institute (IIS Aragón), Zaragoza 50009, Spain
| | - Liliana Rodrigues
- Aragon Health Research Institute (IIS Aragón), Zaragoza 50009, Spain
| | | | - Juan José Galano-Frutos
- Biocomputation and Complex Systems Physics Institute (BIFI)-Joint Units: BIFI-IQFR (CSIC) and GBsC-CSIC, University of Zaragoza, Zaragoza 50018, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza 50009, Spain
| | - Hilde De Reuse
- Helicobacter Pathogenesis Unit, Department of Microbiology, CNRS ERL6002, Institut Pasteur, 25-28 Rue du Dr. Roux, Paris 75724, France
| | - Adrián Velázquez-Campoy
- Biocomputation and Complex Systems Physics Institute (BIFI)-Joint Units: BIFI-IQFR (CSIC) and GBsC-CSIC, University of Zaragoza, Zaragoza 50018, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza 50009, Spain
- Fundación ARAID, Gobierno de Aragón, Zaragoza 50009, Spain
| | - José Alberto Carrodeguas
- Biocomputation and Complex Systems Physics Institute (BIFI)-Joint Units: BIFI-IQFR (CSIC) and GBsC-CSIC, University of Zaragoza, Zaragoza 50018, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza 50009, Spain
| | - Carlos Sostres
- Aragon Health Research Institute (IIS Aragón), Zaragoza 50009, Spain
| | | | - José Antonio Aínsa
- Biocomputation and Complex Systems Physics Institute (BIFI)-Joint Units: BIFI-IQFR (CSIC) and GBsC-CSIC, University of Zaragoza, Zaragoza 50018, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza 50009, Spain
| | | | - Ángel Lanas
- Aragon Health Research Institute (IIS Aragón), Zaragoza 50009, Spain
| | - Eliette Touati
- Helicobacter Pathogenesis Unit, Department of Microbiology, CNRS ERL6002, Institut Pasteur, 25-28 Rue du Dr. Roux, Paris 75724, France
| | - Javier Sancho
- Biocomputation and Complex Systems Physics Institute (BIFI)-Joint Units: BIFI-IQFR (CSIC) and GBsC-CSIC, University of Zaragoza, Zaragoza 50018, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza 50009, Spain
| |
Collapse
|
14
|
Laredo V, Sostres C, Alfaro E, Arroyo MT, Lanas Á. Management of Helicobacter pylori infection at the primary care level. The implementation of specific counseling improves eradication rates. Helicobacter 2019; 24:e12586. [PMID: 30950147 DOI: 10.1111/hel.12586] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/05/2019] [Accepted: 02/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Management of Helicobacter pylori infection has been expanded from the gastroenterology specialist (GS) to primary care physicians (PCPs), with a large increase in requests for urea breath tests (UBT). Due to the lack of evidence at this level, we evaluated the appropriateness of UBT indications and treatment for H pylori infections between PCPs and GSs and the effect of introducing specific counseling to PCPs. MATERIALS AND METHODS This was a quasi-experimental study. Phase I included 650 consecutive UBT requested by PCPs (400) and GSs (250). Indications and treatments were classified as appropriate or inappropriate based on national guidelines. Data on eradication rates were also collected. In phase II, 240 UBT and patients' treatment outcomes were analyzed after individually counseling PCPs on both aspects. RESULTS Of 1049 UBT, inappropriate indications in phase I were significantly higher in tests requested by PCP compared with GS (35.9% vs 7.2%; P < 0.001). Inappropriate treatment regimens were significantly higher for PCPs in phase I (65.8% vs 26.4%; P < 0.001). Consequently, eradication rates were significantly lower in patients treated by PCPs compared with those treated by GS (63.7% vs 81.4%; P = 0.004). A significant increase in adherence to appropriate treatment regimens (75.8% vs 34.2%; P < 0.001) and eradication rates (79.2% vs 63.7%; P = 0.002) were observed in the PCP group after counseling; however, the appropriateness of indications did not improve. CONCLUSIONS Patients infected with H pylori managed at the primary care level had poorer outcomes. The introduction of specific counseling for PCPs significantly improved treatment management, but not indications.
Collapse
Affiliation(s)
- Viviana Laredo
- Service of digestive diseases, Hospital ClínicoUniversitario Lozano Blesa, Zaragoza, Spain
| | - Carlos Sostres
- Service of digestive diseases, Hospital ClínicoUniversitario Lozano Blesa, Zaragoza, Spain.,IIS Aragón, Zaragoza, Spain.,CIBERehd, Madrid, Spain.,University of Zaragoza, Zaragoza, Spain
| | - Enrique Alfaro
- Service of digestive diseases, Hospital ClínicoUniversitario Lozano Blesa, Zaragoza, Spain
| | - Maria Teresa Arroyo
- Service of digestive diseases, Hospital ClínicoUniversitario Lozano Blesa, Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain
| | - Ángel Lanas
- Service of digestive diseases, Hospital ClínicoUniversitario Lozano Blesa, Zaragoza, Spain.,IIS Aragón, Zaragoza, Spain.,CIBERehd, Madrid, Spain.,University of Zaragoza, Zaragoza, Spain
| |
Collapse
|
15
|
Sostres C, Lanas A. Low dose aspirin,
H. pylori
infection, and the risk of upper gastrointestinal bleeding. Med J Aust 2018; 209:297-298. [DOI: 10.5694/mja18.00742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Carlos Sostres
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Angel Lanas
- Centro de Investigación Biomédica en Red (CIBER), University of Zaragoza, Zaragoza, Spain
| |
Collapse
|
16
|
Sostres C, Carrera-Lasfuentes P, Lanas A. Non-steroidal anti-inflammatory drug related upper gastrointestinal bleeding: types of drug use and patient profiles in real clinical practice. Curr Med Res Opin 2017; 33:1815-1820. [PMID: 28569554 DOI: 10.1080/03007995.2017.1338178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The best available evidence regarding non-steroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) bleeding comes from randomized controlled trials including patients who use NSAIDs to manage chronic rheumatic diseases; however, patients with varying background profiles commonly take NSAIDs for many other reasons, often without prescription, and such usage has not been well studied. OBJECTIVES AND METHODS To define the characteristics of patients hospitalized for upper GI bleeding in clinical practice, we conducted a case-control study among patients with endoscopy-proven major upper GI bleeding due to gastroduodenal peptic lesions and control subjects. We used adjusted logistic regression models to estimate bleeding risks. Data analysis was performed using SPSS 22.0. RESULTS Our analysis included 3785 cases and 6540 controls, including 1270 cases (33.55%) and 834 controls (12.75%) reporting recent use (<30 days) of NSAIDs including high-dose acetylsalicylic acid (ASA). NSAID use was associated with increased risk of upper GI bleeding, with an adjusted relative risk of 4.86 (95% CI, 4.32-5.46). Acute musculoskeletal pain (36.1%), chronic osteoarthritis (13.5%), and headache (13.6%) were the most common reasons for NSAID use. Among cases, only 17.31% took NSAIDs and 6.38% took high dose ASA due to chronic osteoarthritis. Demographic characteristics significantly differed between subjects with chronic vs. acute musculoskeletal pain. Proton pump inhibitor use was significantly higher in patients who used NSAIDs due to chronic osteoarthritis compared to patients with acute musculoskeletal pain. NSAID (65.15%) or high-dose ASA use (65.83%) preceding upper GI bleeding was most often short-term. In over half of cases (63.62%), the upper GI bleeding event was not preceded by dyspeptic warning symptoms. CONCLUSIONS The majority of patients hospitalized due to NSAID-related upper GI bleeding reported short-term NSAID use for reasons other than chronic rheumatic disease. These findings suggest that current prevention strategies may not reach a wide population of short-term NSAID users.
Collapse
Affiliation(s)
- Carlos Sostres
- a Service of Digestive Diseases, University Clinic Hospital Lozano Blesa , Zaragoza , Spain
- b Aragón Health Research Institute (IIS Aragón) , Spain
- c CIBERehd , Madrid , Spain
- d University of Zaragoza , Zaragoza , Spain
| | | | - Angel Lanas
- a Service of Digestive Diseases, University Clinic Hospital Lozano Blesa , Zaragoza , Spain
- b Aragón Health Research Institute (IIS Aragón) , Spain
- c CIBERehd , Madrid , Spain
- d University of Zaragoza , Zaragoza , Spain
| |
Collapse
|
17
|
Llamazares G, Sostres C, Vigueras A, Lué A, Calavia J, Alcaine C, Guerrero R, Gonzales A, Ramírez M, Lacueva A, González S, Lanas A, Ochoa I, Fernández L. Preserving tumor heterogeneity: A microfluidic reactor for ex vivo preservation of colorectal cancer biopsies. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx361.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
18
|
García-Rayado G, Sostres C, Lanas A. Aspirin and omeprazole for secondary prevention of cardiovascular disease in patients at risk for aspirin-associated gastric ulcers. Expert Rev Clin Pharmacol 2017; 10:875-888. [PMID: 28463532 DOI: 10.1080/17512433.2017.1324782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Cardiovascular disease is the most important cause of morbidity and mortality in the world and low-dose aspirin is considered the cornerstone of the cardiovascular disease prevention. However, low-dose aspirin use is associated with gastrointestinal adverse effects in the whole gastrointestinal tract. In this setting, co-therapy with a proton pump inhibitor is the most accepted strategy to reduce aspirin related upper gastrointestinal damage. In addition, some adverse effects have been described with proton pump inhibitors long term use. Areas covered: Low-dose aspirin related beneficial and adverse effects in cardiovascular system and gastrointestinal tract are reviewed. In addition, this manuscript summarizes current data on upper gastrointestinal damage prevention and adverse events with proton pump inhibition. Finally, we discuss the benefit/risk ratio of proton pump inhibitor use in patients at risk of gastrointestinal damage taking low-dose aspirin. Expert commentary: Nowadays, with the current available evidence, the combination of low-dose aspirin with proton pump inhibitor is the most effective therapy for cardiovascular prevention in patients at high gastrointestinal risk. However, further studies are needed to discover new effective strategies with less related adverse events.
Collapse
Affiliation(s)
- Guillermo García-Rayado
- a Service of Digestive Diseases , University Clinic Hospital Lozano Blesa , Zaragoza , Spain.,b Aragón Health Research Institute (IIS Aragón) , Zaragoza , Spain
| | - Carlos Sostres
- a Service of Digestive Diseases , University Clinic Hospital Lozano Blesa , Zaragoza , Spain.,b Aragón Health Research Institute (IIS Aragón) , Zaragoza , Spain.,c CIBERehd , Madrid , Spain.,d University of Zaragoza , Zaragoza , Spain
| | - Angel Lanas
- a Service of Digestive Diseases , University Clinic Hospital Lozano Blesa , Zaragoza , Spain.,b Aragón Health Research Institute (IIS Aragón) , Zaragoza , Spain.,c CIBERehd , Madrid , Spain.,d University of Zaragoza , Zaragoza , Spain
| |
Collapse
|
19
|
Abstract
Low dose aspirin (ASA), commonly defined as the cardiovascular (CV) dose of 75 to 325 mg daily, is one of the most widely prescribed drugs in the world and the cornerstone of therapy and prophylaxis for CV disease. However, the use of low dose ASA is well known to be associated with an increased risk of different upper and lower gastrointestinal (GI) complications, such as peptic ulceration and bleeding. In the recent past, clinical research was mainly focused on ASA-related injury of the upper GI tract. However, the introduction of new endoscopic techniques, such as capsule endoscopy and balloon-assisted endoscopy for the evaluation of small bowel lesions have resulted in an increasing interest among gastroenterologists about the side effects of ASA on the large and small bowel. Furthermore, it has been demonstrated that chronic use of low dose ASA results in a variety of lesions in the lower GI tract, including multiple petechiae, erosions, ulcers, diverticular bleeding and even circumferential ulcers with stricture. The ideal treatment for small bowel injury in low dose ASA users would be withdrawal of ASA, however, this withdrawal could increase the risk of CV/cerebrovascular morbidity and mortality in high percentage of patients. Therefore, several drugs have been evaluated to identify the best choice to prevent or treat ASA-induced small bowel injury with different results. Nevertheless, further specifically designed studies with more sample size are needed to determine the best treatment for low dose ASA related GI injury.
Collapse
Affiliation(s)
| | - Angel Lanas
- Division of Gastroenterology, Hospital Clínico Universitário Lozano Blesa, c/Domingo Miral s/n, 5009, Zaragoza, Spain.
| |
Collapse
|
20
|
Alvarez-Urturi C, Andreu M, Hernandez C, Perez-Riquelme F, Carballo F, Ono A, Cruzado J, Cubiella J, Hernandez V, Mao CG, Perez E, Salas D, Andrés M, Bujanda L, Portillo I, Sarasqueta C, Quintero E, Morillas JD, Lanas A, Sostres C, Augé JM, Castells A, Bessa X. Impact of age- and gender-specific cut-off values for the fecal immunochemical test for hemoglobin in colorectal cancer screening. Dig Liver Dis 2016; 48:542-551. [PMID: 26936343 DOI: 10.1016/j.dld.2016.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 01/15/2016] [Accepted: 02/01/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is no information on the impact of age and gender on the diagnostic yield of different positivity thresholds for the fecal immunochemical test for hemoglobin (FIT). OBJECTIVES To evaluate the performance of this test at distinct positivity cut-offs in a population-based colorectal cancer (CRC) screening program. METHODS CRC detection rate (DR), and analysis of resources were evaluated retrospectively, at different cut-offs of FIT (20, 25, 30, 35 and 40μg Hb/g) respect to a reference value (15μg Hb/g), according to age and gender, in a screening population of 10,611 participants of the ColonPrev study (Quintero. NEJM 2013). RESULTS At the reference cut-off value, 36 CRC and 252 advanced adenomas (AA) were diagnosed. Increasing the cut-off in women ≤60 years decreases colonoscopies performed by 44.5% without modifying the CRC (DR). Same CRC DR was observed in men ≤60 years and women >60 years increasing cut-off at 25-30μg Hb/g. In men >60 years, all increases in the cut-off affected the CRC DR, especially when the cut-off was increased from 35 to 40μg Hb/g (CRC miss rate 25%). CONCLUSIONS To improve the performance of FIT in CRC screening programs, FIT cut-offs could be individualized by age and gender.
Collapse
Affiliation(s)
- Cristina Alvarez-Urturi
- Department of Gastroenterology, Hospital del Mar, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Autonomous University of Barcelona and Pompeu Fabra University, Barcelona, Catalonia, Spain
| | - Montserrat Andreu
- Department of Gastroenterology, Hospital del Mar, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Autonomous University of Barcelona and Pompeu Fabra University, Barcelona, Catalonia, Spain
| | - Cristina Hernandez
- Department of Epidemiology and Evaluation, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Catalonia, Spain
| | - Francisco Perez-Riquelme
- Colorectal Cancer Prevention Program of Murcia, Dirección General de Salud Pública, Consejería de Sanidad y Política Social, Murcia, Spain
| | - Fernando Carballo
- Colorectal Cancer Prevention Program of Murcia, Dirección General de Salud Pública, Consejería de Sanidad y Política Social, Murcia, Spain
| | - Akiko Ono
- Colorectal Cancer Prevention Program of Murcia, Dirección General de Salud Pública, Consejería de Sanidad y Política Social, Murcia, Spain
| | - Jose Cruzado
- Colorectal Cancer Prevention Program of Murcia, Dirección General de Salud Pública, Consejería de Sanidad y Política Social, Murcia, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, IBIV - Institute of Biomedical Research of Vigo, Vigo, Spain
| | - Vicent Hernandez
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, IBIV - Institute of Biomedical Research of Vigo, Vigo, Spain
| | | | - Elena Perez
- Colorectal Cancer Screening Program, Dirección General de Salud Pública, València, Spain
| | - Dolores Salas
- Colorectal Cancer Screening Program, Dirección General de Salud Pública, València, Spain
| | - Mercedes Andrés
- Colorectal Cancer Screening Program, Dirección General de Salud Pública, València, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Donostia Hospital-Instituto Biodonostia, CIBERehd, University of Basque Country (UPV/EHU), San Sebastián, Spain
| | - Isabel Portillo
- Centro Coordinador del Programa de Cribado Cáncer Colorrectal, Organización Central de Osakidetza-Servicio Vasco de Salud, San Sebastián, Spain
| | - Cristina Sarasqueta
- Hospital Donostia, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián, Spain
| | - Enrique Quintero
- Department of Gastroenterology, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | | | - Angel Lanas
- Department of Gastroenterology, University of Zaragoza, IIS Aragón, CIBERehd, Zaragoza, Spain
| | - Carlos Sostres
- Department of Gastroenterology, University of Zaragoza, IIS Aragón, CIBERehd, Zaragoza, Spain
| | - Josep Maria Augé
- Department of Biochemistry and Molecular Genetics, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Xavier Bessa
- Department of Gastroenterology, Hospital del Mar, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Autonomous University of Barcelona and Pompeu Fabra University, Barcelona, Catalonia, Spain.
| | | |
Collapse
|
21
|
Sostres C, Lanas Á. Prescripción apropiada, adherencia y seguridad de los antiinflamatorios no esteroideos. Med Clin (Barc) 2016; 146:267-72. [DOI: 10.1016/j.medcli.2015.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 12/29/2022]
|
22
|
Affiliation(s)
- Beatriz Marcén
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Carlos Sostres
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Sustituir por Instituto de Investigación Sanitaria (IIS) de Aragón, Zaragoza, España
| | - Angel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Sustituir por Instituto de Investigación Sanitaria (IIS) de Aragón, Zaragoza, España; CIBERehd, Zaragoza, España; Universidad de Zaragoza, Zaragoza, España.
| |
Collapse
|
23
|
Solanas E, Sostres C, Serrablo A, García-Gil A, García JJ, Aranguren FJ, Jiménez P, Hughes RD, Serrano MT. Effect of Dimethyl Sulfoxide and Melatonin on the Isolation of Human Primary Hepatocytes. Cells Tissues Organs 2015; 200:316-25. [DOI: 10.1159/000433521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 11/19/2022] Open
|
24
|
Lanas Á, Carrera-Lasfuentes P, Arguedas Y, García S, Bujanda L, Calvet X, Ponce J, Perez-Aísa Á, Castro M, Muñoz M, Sostres C, García-Rodríguez LA. Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol 2015; 13:906-12.e2. [PMID: 25460554 DOI: 10.1016/j.cgh.2014.11.007] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/31/2014] [Accepted: 11/05/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin is associated with increased risk of upper gastrointestinal bleeding. There is little evidence on the risk of lower gastrointestinal bleeding with NSAIDs, antiplatelet agents (APAs), or anticoagulants. We aimed to quantify the relative risk (RR) of upper and lower gastrointestinal bleeding associated with use of NSAIDs, APAs, or anticoagulants. METHODS We performed a case-control study that used data collected from consecutive patients hospitalized for gastrointestinal bleeding (563 upper, mean age, 63.6 ± 16.7 years and 415 lower, mean age, 70.8 ± 13.8 years), confirmed by endoscopy or other diagnostic procedures. Unhospitalized patients were used as controls (n = 1008) and matched for age, hospital, and month of admission. Drug use was considered current when taken within 7 days or less before hospitalization. RRs and 95% confidence intervals (CIs) were estimated by unconditional logistic regression analysis. RESULTS Use of anticoagulants, low-dose aspirin, and other drugs (non-aspirin-APA, 82.3% thienopiridines) was associated with upper and lower gastrointestinal bleeding; the risk was 2-fold higher for anticoagulants (RR, 4.2; 95% CI, 2.9-6.2) than for low-dose aspirin (RR, 2.1; 95% CI, 1.4-3.3) or other non-aspirin-APA drugs (RR, 2.0; 95% CI, 1.6-2.6). NSAID use was also associated with increased risk of gastrointestinal bleeding and greater for upper (RR, 2.6; 95% CI, 2.0-3.5) than lower gastrointestinal bleeding (RR, 1.4; 95% CI, 1.0-1.9). Use of proton pump inhibitors was associated with reduced risk of upper, but not lower, gastrointestinal bleeding. CONCLUSIONS Anticoagulants, low-dose aspirin, NSAIDs, and other non-aspirin-APA drugs are associated with increased risk of upper and lower gastrointestinal bleeding. Use of anticoagulants appears to be the strongest risk factor for gastrointestinal bleeding.
Collapse
Affiliation(s)
- Ángel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico, University of Zaragoza, Zaragoza, Spain; CIBERehd, Barcelona, Spain.
| | | | - Yolanda Arguedas
- Servicio de Aparato Digestivo, Hospital Clínico, University of Zaragoza, Zaragoza, Spain
| | - Santiago García
- Servicio de Aparato Digestivo, Hospital Universiatrio Miguel Servet, Zaragoza, Spain
| | - Luis Bujanda
- CIBERehd, Barcelona, Spain; Hospital Donostia, San Sebastian, Spain
| | - Xavier Calvet
- CIBERehd, Barcelona, Spain; Servicio de Aparato Digestivo, Corporació Sanitària Universitària, Sabadell, Barcelona, Spain
| | - Julio Ponce
- CIBERehd, Barcelona, Spain; Servicio de Aparato Digestivo, Hospital La Fe, Valencia, Spain
| | | | - Manuel Castro
- CIBERehd, Barcelona, Spain; Gastroenterología, Hospital de Valme, Sevilla, Spain
| | - Maria Muñoz
- Servicio de Aparato Digestivo, Hospital Clínico, University of Zaragoza, Zaragoza, Spain
| | - Carlos Sostres
- Servicio de Aparato Digestivo, Hospital Clínico, University of Zaragoza, Zaragoza, Spain
| | | |
Collapse
|
25
|
Sostres C, Carrera-Lasfuentes P, Benito R, Roncales P, Arruebo M, Arroyo MT, Bujanda L, García-Rodríguez LA, Lanas A. Peptic Ulcer Bleeding Risk. The Role of Helicobacter Pylori Infection in NSAID/Low-Dose Aspirin Users. Am J Gastroenterol 2015; 110:684-9. [PMID: 25895518 DOI: 10.1038/ajg.2015.98] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/01/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Helicobacter pylori (H. pylori) infection and NSAID/low-dose aspirin (ASA) use are associated with peptic ulcer disease. The risk of peptic ulcer bleeding (PUB) associated with the interaction of these factors remains unclear. The objective of this study was to determine the risk of PUB associated with the interaction between H. pylori infection and current nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose ASA use. METHODS This was a case-control study of consecutive patients hospitalized because of PUB. Controls were matched by age, sex, and month of admission. H. pylori infection status was determined in all cases and controls by serology. Drug use was determined by structured questionnaire. Adjusted relative risk (RR) associated with different factors, and the interaction between NSAID/ASA and H. pylori infection was estimated by logistic regression analysis. RESULTS The study included 666 cases of PUB and 666 controls; 74.3% cases and 54.8% controls (RR: 2.6; 95% confidence interval (CI): 2.0-3.3) tested positive for H. pylori infection; 34.5% of cases had current NSAID use compared with 13.4% of controls (RR: 4.0; 95% CI: 3.0-5.4). Respective proportions for low-dose ASA use were 15.8 and 12%, respectively (RR: 1.9; 95% CI: 1.3-2.7). The RR of PUB for concomitant NSAID use and H. pylori infection suggested an additive effect (RR: 8.0; 95% CI: 5.0-12.8), whereas no interaction was observed with ASA use (RR: 3.5; 95% CI: 2.0-6.1). CONCLUSIONS NSAID, low-dose ASA use, and H. pylori infection are three independent risk factors for the development of PUB, but there were differences in the interaction effect between low-dose ASA (no interaction) or NSAID (addition) use and H. pylori infection, which may have implications for clinical practice in prevention strategies.
Collapse
Affiliation(s)
- C Sostres
- Universitary Hospital Lozano Blesa, Gastroenterology Unit, Zaragoza, Spain
| | | | - R Benito
- Universitary Hospital Lozano Blesa, Microbiology Unit, Zaragoza, Spain
| | - P Roncales
- Health Science Institute of Aragon, Zaragoza, Spain
| | - M Arruebo
- Health Science Institute of Aragon, Zaragoza, Spain
| | - M T Arroyo
- Universitary Hospital Lozano Blesa, Gastroenterology Unit, Zaragoza, Spain
| | - L Bujanda
- Universitary Hospital of Donostia, San Sebastian, Spain
| | | | - A Lanas
- 1] Universitary Hospital Lozano Blesa, Gastroenterology Unit, Zaragoza, Spain [2] CIBERehd, Madrid, Spain [3] Health Science Institute of Aragon, Zaragoza, Spain
| |
Collapse
|
26
|
Solanas E, Sostres C, Serrablo A, García-Gil A, Aranguren F, Jimenez P, Serrano MT. Incubation with dimethyl sulfoxide prior to cryopreservation improves functionality of thawed human primary hepatocytes. Biopreserv Biobank 2015; 10:446-53. [PMID: 24845046 DOI: 10.1089/bio.2012.0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Efficient cryopreservation of human hepatocytes is essential for their use in cell therapy. This study investigated the effects of adding melatonin and/or dimethyl sulfoxide (DMSO) to pre-incubation and/or freezing solutions on the viability and function of thawed human hepatocytes. METHODS Isolated human hepatocytes were pre-incubated for 90 min at 4°C in Williams' Medium E (WEM), WEM containing 5 mM melatonin dissolved in DMSO, or WEM containing the equivalent amount of DMSO (1%). The hepatocytes were frozen in University of Wisconsin solution (UW) and 10% DMSO, with or without 5 mM melatonin. After thawing, viability, plating efficiency, mitochondrial dehydrogenase activity (MTT), and albumin and urea production were analyzed. RESULTS Viability and plating efficiency were not affected by melatonin or DMSO in pre-incubation media. Unexpectedly, hepatocytes pre-incubated with DMSO had significantly higher MTT (29.7% vs. control, p<0.01), albumin (82.8% vs. control, p<0.05), and urea amounts (26.2% vs. control, p=0.06) than those incubated only with WEM. Hepatocytes pre-incubated in media containing melatonin had amounts between those of cells incubated with DMSO or only with WEM (p<0.05 for MTT and p>0.05 for albumin and urea values). Also, the addition of melatonin to the freezing media did not significantly improve any of the studied parameters (p>0.05). DISCUSSION Adding 1% DMSO to pre-incubation media prior to the cryopreservation of human hepatocytes preserves hepatocyte function after thawing. These findings could be considered in current hepatocyte cryopreservation protocols.
Collapse
Affiliation(s)
- Estela Solanas
- 1 IIS Aragón, CIBER Enfermedades Hepáticas y Digestivas (CIBERehd). Molecular Research Laboratory , Zaragoza, Spain
| | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Abstract
A new study suggests that co-prescription of low-dose aspirin and PPIs increases the incidence of small-bowel mucosal breaks. Should we be concerned about the potential negative interactions of these drugs? Or is the balance of evidence still substantially tipped towards the need for PPIs to protect against aspirin-induced upper gastrointestinal damage?
Collapse
Affiliation(s)
- Angel Lanas
- University Clinic Hospital, University of Zaragoza, CIBERehd, IIS Aragón, Calle de San Juan Bosco 15, 5009 Zaragoza, Spain
| | - Carlos Sostres
- University Clinic Hospital, University of Zaragoza, CIBERehd, IIS Aragón, Calle de San Juan Bosco 15, 5009 Zaragoza, Spain
| |
Collapse
|
29
|
Patrignani P, Tacconelli S, Piazuelo E, Di Francesco L, Dovizio M, Sostres C, Marcantoni E, Guillem-Llobat P, Del Boccio P, Zucchelli M, Patrono C, Lanas A. Reappraisal of the clinical pharmacology of low-dose aspirin by comparing novel direct and traditional indirect biomarkers of drug action. J Thromb Haemost 2014; 12:1320-30. [PMID: 24942808 DOI: 10.1111/jth.12637] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/10/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Even though the acetylation of platelet cyclooxygenase (COX)-1 at serine-529 is the direct mechanism of action of low-dose aspirin, its antiplatelet effect has been characterized using indirect indexes of COX-1 activity. OBJECTIVES We performed a clinical study with enteric-coated low-dose aspirin (EC-aspirin), in healthy subjects, to evaluate the effects on the extent and duration of platelet COX-1 acetylation, using a novel proteomic strategy for absolute protein quantification (termed AQUA), as compared with traditional pharmacokinetic and pharmacodynamic parameters. SUBJECTS AND METHODS In a phase I, single-arm, open-label study of EC aspirin (100 mg day(-1) ) administered to 24 healthy subjects, we compared, over a 24 h-period on day 1 and 7, % platelet acetylated COX-1 (AceCOX-1) with traditional pharmacokinetic and pharmacodynamics [i.e. serum thromboxane (TX) B2 , platelet function by monitoring CEPI(collagen/epinephrine) closure time (CT) using whole-blood PFA-100 and urinary excretion of 11-dehydro-TXB2 ] parameters. RESULTS Acetylation of platelet COX-1 was measurable before detection of aspirin levels in the systemic circulation and increased in a cumulative fashion upon repeated dosing. After the last dose of EC-aspirin, %AceCOX-1, serum TXB2 and CEPI-CT values were maximally and persistently modified throughout 24 h; they averaged 76 ± 2%, 99.0 ± 0.4% and 271 ± 5 s, respectively. EC-aspirin caused 75% reduction in urinary 11-dehydro-TXB2 excretion. After chronic dosing with aspirin, the pharmacokinetics of acetylsalicylic acid was completely dissociated from pharmacodynamics. CONCLUSIONS The demonstrated feasibility of quantifying the extent and duration of platelet COX-1 acetylation will allow characterizing the genetic, pharmacokinetic and pharmacodynamic determinants of the inter-individual variability in the antiplatelet response to low-dose aspirin as well as identifying extra-platelet sites of drug action.
Collapse
Affiliation(s)
- P Patrignani
- Section of Cardiovascular and Pharmacological Sciences, Department of Neuroscience, Imaging and Clinical Science, Center of Excellence on Aging (CeSI), 'G. d'Annunzio' University, Chieti, Italy; Center of Excellence on Aging (CeSI), "G. d'Annunzio" University, Chieti, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Sostres C, Gargallo CJ, Lanas A. Interaction between Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs and/or low-dose aspirin use: Old question new insights. World J Gastroenterol 2014; 20:9439-9450. [PMID: 25071338 PMCID: PMC4110575 DOI: 10.3748/wjg.v20.i28.9439] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/15/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Previous reports clearly demonstrated that Helicobacter pylori (H. pylori) infection, nonsteroidal anti-inflammatory drugs (NSAID) or low dose aspirin (ASA) use significantly and independently increased the risk for the development of peptic ulcer disease. Today, the presence of H. pylori infection associated with low dose ASA and/or NSAID use in the same patient is becoming more frequent and therefore the potential interaction between these factors and the consequences of it has important implications. Whether NSAID intake in the presence of H. pylori infection may further increase the risk of peptic ulcer carried by the presence of only one risk factor is still a matter of debate. Studies on the interaction between the two risk factors yielded conflicting data and no consensus has been reached in the last years. In addition, the interaction between H. pylori infection and low-dose ASA remains even more controversial. In real clinical practice, we can find different clinical scenarios involving these three factors associated with the presence of different gastrointestinal and cardiovascular risk factors. These huge variety of possible combinations greatly hinder the decision making process of physicians.
Collapse
|
31
|
Sostres C, Gargallo CJ, Lanas A. Aspirin, cyclooxygenase inhibition and colorectal cancer. World J Gastrointest Pharmacol Ther 2014; 5:40-49. [PMID: 24605250 PMCID: PMC3944468 DOI: 10.4292/wjgpt.v5.i1.40] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 12/11/2013] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common type of cancer worldwide. Screening measures are far from adequate and not widely available in resource-poor settings. Primary prevention strategies therefore remain necessary to reduce the risk of developing CRC. Increasing evidence from epidemiological studies, randomized clinical trials and basic science supports the effectiveness of aspirin, as well as other non-steroidal anti-inflammatory drugs, for chemoprevention of several types of cancer, including CRC. This includes the prevention of adenoma recurrence and reduction of CRC incidence and mortality. The detectable benefit of daily low-dose aspirin (at least 75 mg), as used to prevent cardiovascular disease events, strongly suggests that its antiplatelet action is central to explaining its antitumor efficacy. Daily low-dose aspirin achieves complete and persistent inhibition of cyclooxygenase (COX)-1 in platelets (in pre-systemic circulation) while causing a limited and rapidly reversible inhibitory effect on COX-2 and/or COX-1 expressed in nucleated cells. Aspirin has a short half-life in human circulation (about 20 minutes); nucleated cells have the ability to resynthesize acetylated COX isozymes within a few hours, while platelets do not. COX-independent mechanisms of aspirin have been suggested to explain its chemopreventive effects but this concept remains to be demonstrated in vivo at clinical doses.
Collapse
|
32
|
Abstract
This article describes the mechanism of action, pharmacokinetics, and pharmacodynamics of aspirin at doses used for cardiovascular prevention and provides specific management recommendations for optimal use in clinical practice. The paper highlights practical aspects related to antiplatelet therapy, including the optimal dose of aspirin, concomitant treatment with other NSAIDs, and strategies for the prevention of gastrointestinal toxicity. Specifically, we revise the benefits and hazards in different clinical settings to help the clinician in the decision-making process for individuals who have different risks for cardiovascular and gastrointestinal bleeding events.
Collapse
Affiliation(s)
- Rubén Casado-Arroyo
- Heart Rhythm Management Center, Cardiovascular Division, Cardiovascular Center, Free University of Brussels (UZ Brussels) VUB, Laarbeeklaan 101, Brussels, Belgium.
| | | | | |
Collapse
|
33
|
Abstract
Declining Helicobacter pylori prevalence rates have resulted in a decrease of peptic ulcer bleeding incidence. Moreover, eradication reduces peptic ulcer recurrence rate. Newer studies confirm that H. pylori eradication lowers the risk of recurrent peptic ulcer bleeding. Guidelines therefore advocate a test-and-treat strategy for patients with a history of ulcer bleeding and NSAIDs and/or aspirin use. There is mounting evidence that H. pylori status has no effect on symptoms and treatment efficacy in patients with gastroesophageal reflux disease (GERD). Some studies observed an improvement of GERD complaints after H. pylori eradication, which underlines that H. pylori treatment is not contra-indicated in GERD patients. The exact role of H. pylori in functional dyspepsia (FD) remains controversial. However, there is growing consensus that H. pylori-positive FD should be assessed as a separate entity. In these patients, eradication can be beneficial and appropriate. Finally, several studies suggest that H. pylori infection may also be associated with beneficial effects for the host. Epidemiologic studies showed an inverse relation between H. pylori infection and asthma and allergy, although data are conflicting and need to be expanded.
Collapse
Affiliation(s)
- Wouter J den Hollander
- Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | | | | |
Collapse
|
34
|
Sostres C, Gargallo CJ, Lanas A. Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage. Arthritis Res Ther 2013; 15 Suppl 3:S3. [PMID: 24267289 PMCID: PMC3890944 DOI: 10.1186/ar4175] [Citation(s) in RCA: 224] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
NSAIDs are among the most commonly used drugs worldwide and their beneficial therapeutic properties are thoroughly accepted. However, they are also associated with gastrointestinal (GI) adverse events. NSAIDs can damage the whole GI tract including a wide spectrum of lesions. About 1 to 2% of NSAID users experienced a serious GI complication during treatment. The relative risk of upper GI complications among NSAID users depends on the presence of different risk factors, including older age (>65 years), history of complicated peptic ulcer, and concomitant aspirin or anticoagulant use, in addition to the type and dose of NSAID. Some authors recently reported a decreasing trend in hospitalizations due to upper GI complications and a significant increase in those from the lower GI tract, causing the rates of these two types of GI complications to converge. NSAID-induced enteropathy has gained much attention in the last few years and an increasing number of reports have been published on this issue. Current evidence suggests that NSAIDs increase the risk of lower GI bleeding and perforation to a similar extent as that seen in the upper GI tract. Selective cyclooxygenase-2 inhibitors have the same beneficial effects as nonselective NSAIDs but with less GI toxicity in the upper GI tract and probably in the lower GI tract. Overall, mortality due to these complications has also decreased, but the in-hospital case fatality for upper and lower GI complication events has remained constant despite the new therapeutic and prevention strategies.
Collapse
|
35
|
Sostres C, Lacarta P, Lanas A. [Screening for adenocarcinoma in Barrett's esophagus: yes or no, when and how?]. Gastroenterol Hepatol 2013; 36:520-6. [PMID: 23453559 DOI: 10.1016/j.gastrohep.2012.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
Abstract
Barrett's esophagus (BE) is the main recognized risk factor for the development of esophageal adenocarcinoma (EAC). The incidence of this cancer and its associated mortality has increased in developed countries during the last few years. Detection of EAC at earlier stages could potentially improve survival dramatically in these patients, which is especially important as mortality from EAC remains high despite the available treatments. Therefore, endoscopic surveillance is an attractive option for patients with Barrett's esophagus. Consequently, periodic endoscopic surveillance is recommended by all the International Gastroenterology Societies in an attempt to detect EAC at an early and potentially curable stage. Currently, the frequency of endoscopic surveillance and its need in Barrett's esophagus with low-grade dysplasia or without dysplasia are under discussion. This review presents the available evidence in order to assist clinicians in the decision-making process.
Collapse
Affiliation(s)
- Carlos Sostres
- Sección de Endoscopias Digestivas, Hospital Clínico Lozano Blesa, Zaragoza, España.
| | | | | |
Collapse
|
36
|
Dovizio M, Tacconelli S, Sostres C, Ricciotti E, Patrignani P. Mechanistic and pharmacological issues of aspirin as an anticancer agent. Pharmaceuticals (Basel) 2012; 5:1346-71. [PMID: 24281340 PMCID: PMC3816673 DOI: 10.3390/ph5121346] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 11/16/2012] [Accepted: 11/30/2012] [Indexed: 02/08/2023] Open
Abstract
Recent findings have shown that aspirin, taken for several years, reduces the long-term risk of some cancers, particularly colorectal cancer. The result that aspirin benefit is detectable at daily low-doses (at least 75mg), the same used for the prevention of cardiovascular disease, positions the antiplatelet action of aspirin at the center of its antitumor efficacy. At low-doses given every 24 h, aspirin is acting by a complete and persistent inhibition of cyclooxygenase (COX)-1 in platelets (in the pre-systemic circulation) while causing a limited and rapidly reversible inhibitory effect on COX-2 and/or COX-1 expressed in nucleated cells. Aspirin has a short half-life in human circulation (approximately 20 min); nucleated cells have the ability to resynthesize the acetylated COX-isozymes within a few hours, while platelets do not. COX-independent mechanisms of aspirin, such as the inhibition of Wnt/ β-catenin and NF-kB signaling and the acetylation of extra-COX proteins, have been suggested to play a role in its chemo-preventive effects, but their relevance remains to be demonstrated in vivo at clinical doses. In conclusion, the results of clinical pharmacology and the analysis of randomized and epidemiological studies suggest that colorectal cancer and atherothrombosis share a common mechanism of disease, i.e. enhanced platelet activation in response to injury at distinct sites.
Collapse
Affiliation(s)
- Melania Dovizio
- Department of Neuroscience and Imaging, Center of Excellence on Aging (CeSI), “G. d’Annunzio” University, Via dei Vestini 31, 66100 Chieti, Italy; E-Mail: (M.D.); (S.T.); (P.P.)
| | - Stefania Tacconelli
- Department of Neuroscience and Imaging, Center of Excellence on Aging (CeSI), “G. d’Annunzio” University, Via dei Vestini 31, 66100 Chieti, Italy; E-Mail: (M.D.); (S.T.); (P.P.)
| | - Carlos Sostres
- University of Zaragoza School of Medicine, University Hospital Lozano Blesa, IIS Aragón. CIBERehd, 50009 Zaragoza, Spain; E-Mail: (C.S.)
| | - Emanuela Ricciotti
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA; E-Mail: (E.R)
| | - Paola Patrignani
- Department of Neuroscience and Imaging, Center of Excellence on Aging (CeSI), “G. d’Annunzio” University, Via dei Vestini 31, 66100 Chieti, Italy; E-Mail: (M.D.); (S.T.); (P.P.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-0871-541473; Fax: +39-0871-3556718
| |
Collapse
|
37
|
Patrignani P, Tacconelli S, Bruno A, Sostres C, Lanas A. Managing the adverse effects of nonsteroidal anti-inflammatory drugs. Expert Rev Clin Pharmacol 2012; 4:605-21. [PMID: 22114888 DOI: 10.1586/ecp.11.36] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Conventional medical treatment for rheumatoid arthritis and osteoarthritis includes the use of NSAIDs (traditional and selective inhibitors of cyclooxygenase [COX]-2), because they provide unmistakable and significant health benefits in the treatment of pain and inflammation. However, they are associated with an increased risk of serious gastrointestinal (GI) and cardiovascular (CV) adverse events. Both beneficial and adverse effects are due to the same mechanism of action, which is inhibition of COX-dependent prostanoids. Since CV and GI risk are related to drug exposure, a reduction in the administered dose is recommended. However, this strategy will not eliminate the hazard owing to a possible contribution of individual genetic background. Further studies will be necessary to develop genetic and/or biochemical markers predictive of the CV and GI risk of NSAIDs.
Collapse
Affiliation(s)
- Paola Patrignani
- Department of Medicine and Center of Excellence on Aging, G. d'Annunzio University, and CeSI, Via dei Vestini 31, 66100 Chieti, Italy.
| | | | | | | | | |
Collapse
|
38
|
Sostres C, Gargallo CJ. Gastrointestinal lesions and complications of low-dose aspirin in the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2012; 26:141-51. [PMID: 22542152 DOI: 10.1016/j.bpg.2012.01.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 01/20/2012] [Accepted: 01/24/2012] [Indexed: 01/31/2023]
Abstract
Low dose aspirin (ASA) use has been associated with a wide range of adverse side effects in the upper gastrointestinal (GI) tract, which range from troublesome symptoms without mucosal lesions to more serious toxicity, including ulcers, GI bleeding, perforation and even death. Upper GI symptoms in low dose ASA users are common but often careless or misinterpreted and they are not always related to the presence of mucosal injury. Usually, low dose ASA related ulcers are reasonably small and asymptomatic, and probably heal over a period of weeks to a few months. But, the real clinical problem occurs when the ulcer results in a GI complication (mostly bleeding). The estimated average excess risk of symptomatic or complicated ulcer related to low dose ASA is five cases per 1000 ASA users per year. Death is the worst outcome of GI complications in low dose ASA users, but data about this aspect are scarce. Current evidence indicates that low dose ASA can damage the lower GI tract also, but the real size of the problem is still unknown.
Collapse
Affiliation(s)
- Carlos Sostres
- Service of Digestive Diseases, University Hospital Lozano Blesa, Zaragoza, Spain.
| | | |
Collapse
|
39
|
García-Gil FA, Serrano MT, Fuentes-Broto L, Arenas J, García JJ, Güemes A, Bernal V, Campillo A, Sostres C, Araiz JJ, Royo P, Simón MA. Celsior versus University of Wisconsin preserving solutions for liver transplantation: postreperfusion syndrome and outcome of a 5-year prospective randomized controlled study. World J Surg 2011; 35:1598-607. [PMID: 21487851 DOI: 10.1007/s00268-011-1078-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Celsior solution (CS) is a high-sodium, low-potassium, low-viscosity extracellular solution that has been used for liver graft preservation in recent years, although experience with it is still limited. We performed an open-label randomized active-controlled trial comparing CS with the University of Wisconsin solution (UW) for liver transplantation (LT), with a follow-up period of 5 years. METHODS Adult transplant recipients (n=102) were prospectively randomized to receive either CS (n=51) or UW (n=51). The two groups were comparable with respect to donor and recipient characteristics. The primary outcome measure was the incidence of postreperfusion syndrome (PRS). Secondary outcome measures included primary nonfunction (PNF) or primary dysfunction (PDF), liver retransplantation, and graft and patient survival. Other secondary outcome measures were days in the intensive care unit (ICU) and the rates of acute rejection, chronic rejection, infectious complications, postoperative reoperations, and vascular and biliary complications. RESULTS In all, 14 posttransplant variables revealed no significant differences between the groups. There were no cases of PNF or PDF. The incidence of PRS was 5.9% in the CS group and 21.6% in the UW group (P=0.041). After reperfusion, CS revealed greater control of serum potassium (P=0.015), magnesium levels (P=0.005), and plasma glucose (P=0.042) than UW. Respective patient survivals at 3, 12, and 60 months were 95.7, 87.2, and 82.0% for the CS group and 95.7, 83.3, and 66.6% for the UW group (P=0.123). CONCLUSIONS While retaining the same degree of safety and effectiveness as UW for LT, CS may yield postliver graft reperfusion benefits, as shown in this study by a significant reduction in the incidence of PRS and greater metabolic control.
Collapse
Affiliation(s)
- Francisco A García-Gil
- Department of Surgery, University of Zaragoza, Domingo Miral s/n, 50009, Zaragoza, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
|
41
|
Sostres C, Gargallo CJ, Arroyo MT, Lanas A. Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs, aspirin and coxibs) on upper gastrointestinal tract. Best Pract Res Clin Gastroenterol 2010; 24:121-32. [PMID: 20227026 DOI: 10.1016/j.bpg.2009.11.005] [Citation(s) in RCA: 395] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 11/09/2009] [Accepted: 11/25/2009] [Indexed: 01/31/2023]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most widely prescribed medication in the world. Their main benefit derives from their anti-inflammatory and analgesic effect, but the use of these agents is not innocuous since they mainly increase the risk of gastrointestinal (GI) and cardiovascular complications compared with non-NSAID users. NSAIDs injures the upper and lower gut by depleting COX-1 derived prostaglandins and causing topical injury to the mucosa. The risk of upper GI complications varies, depending on the presence of one or more risk factors. Among them, the three main risk factors are prior history of peptic ulcer, the single most important risk factor, age, the most common, and concomitant aspirin use, due to their GI and cardiovascular implications. Those individuals at-risk should be considered for alternatives to NSAID therapy and modifications of risk factors. If NSAID therapy is required, patients at risk will need prevention strategies including co-therapy of NSAID with gastroprotectants (PPI or misoprostol) or the prescription of COX-2 selective inhibitors. The probable introduction of NO-NSAIDs in the market in the near future may open a new therapeutic option for patients with hypertension who need NSAIDs.
Collapse
Affiliation(s)
- Carlos Sostres
- Service of Digestive Diseases, University Hospital Lozano Blesa, Zaragoza, Spain
| | | | | | | |
Collapse
|
42
|
Sostres C, Gargallo C, Lanas A. Drug-related damage of the ageing gastrointestinal tract. Best Pract Res Clin Gastroenterol 2009; 23:849-60. [PMID: 19942163 DOI: 10.1016/j.bpg.2009.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 10/01/2009] [Accepted: 10/05/2009] [Indexed: 01/31/2023]
Abstract
Drug use increases with age and the elderly is at increased risk of adverse drug reactions. Gastrointestinal adverse effects are one of the most often reported. Serious event are mostly caused by NSAIDs and/or aspirin which are the most widely prescribed medications in the world. NSAIDs and/or aspirin use are associated with complications from both the upper and the lower gastrointestinal tract. The risk of these complications depends on presence of risk factors, and age is the most frequent and relevant one. At-risk patients should be on prevention strategies including the use of the lowest effective dose, co-therapy with a gastroprotective agents or use of a COX-2 selective agent. Treatment of Helicobacter pylori infection is beneficial in patients starting therapy with these agents, especially in the presence of ulcer history. The best strategy to prevent lower GI complications has yet to be defined.
Collapse
Affiliation(s)
- Carlos Sostres
- Service of Digestive Diseases, University Hospital, Instituto Aragones de Ciencias de la Salud, CIBERehd, University of Zaragoza, Spain
| | | | | |
Collapse
|