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Yadlapati R, Cappell K, Sedgley R, Pelletier C, Jacob R, Bonafede M, Shah SC. A Linked Electronic Medical Record-Claims Analysis of the Clinical and Economic Outcomes of Patients Coded for Erosive Esophagitis in the United States. Adv Ther 2023; 40:5489-5501. [PMID: 37837526 PMCID: PMC10611850 DOI: 10.1007/s12325-023-02688-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/15/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Erosive esophagitis (EE) is a severe form of gastroesophageal reflux disease commonly treated with proton pump inhibitors (PPIs). The aim of this retrospective, observational cohort study was to describe the characteristics and healthcare burden of patients with EE. METHODS We identified adults in the USA with an EE diagnosis between January 1, 2016 and February 28, 2019 in a linked dataset containing electronic health records (EHR) from the Veradigm Network EHR and claims data from Komodo Health. Patients were required to have 1 year of baseline data and 3 years of follow-up data. Patients were stratified by the number of PPI lines of therapy (LOT) during the 4-year study period. We descriptively captured patient characteristics and treatment patterns, along with all-cause and EE-related healthcare utilization and costs. RESULTS Among the 158,347 qualifying adults with EE, 71,958 (45.4%) had 1 PPI LOT, 14,985 (9.5%) had 2 LOTs, 15,129 (9.6%) had 3+ LOTs, and 56,275 (35.5%) did not fill a PPI prescription. Omeprazole and pantoprazole comprised more than 70% of any LOT, with patients commonly switching between the two. Mean (standard deviation) annualized all-cause and EE-related healthcare costs in the follow-up period were $16,853 ($70,507) and $523 ($3659), respectively. Both all-cause and EE-related healthcare costs increased with LOTs. CONCLUSIONS Patients with EE are commonly treated with prescription PPIs; however, 19.0% of patients cycled through multiple PPIs. Higher PPI use was associated with a higher comorbidity burden and higher healthcare costs compared to 0 PPI use.
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Affiliation(s)
- Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, 9500 Gilman Drive, MC 0956, La Jolla, CA, 92093, USA.
| | | | | | - Corey Pelletier
- Medical Affairs, Phathom Pharmaceuticals, Florham Park, NJ, USA
| | - Rinu Jacob
- Medical Affairs, Phathom Pharmaceuticals, Florham Park, NJ, USA
| | | | - Shailja C Shah
- Division of Gastroenterology, University of California San Diego, 9500 Gilman Drive, MC 0956, La Jolla, CA, 92093, USA
- GI Section, VA San Diego Healthcare System, San Diego, CA, USA
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Wyllie T, Folaranmi E, Sekaran P, Watkins WJ, Chakraborty M. Prophylactic Acid-suppression Medication to Prevent Anastomotic Strictures After Oesophageal Atresia Surgery: A Systematic Review and Meta-analysis. J Pediatr Surg 2023; 58:1954-1962. [PMID: 37355433 DOI: 10.1016/j.jpedsurg.2023.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 11/18/2022] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Anastomotic stricture is a common postoperative complication of oesophageal atresia ± tracheoesophageal fistula (OA/TOF) repair. Acid gastro-oesophageal reflux disease (GORD) is considered to be a factor in stricture formation and acid suppression medication is recommended post-operatively in consensus guidance. We aimed to investigate whether patients who were treated prophylactically with acid suppression medication had a reduced incidence of strictures compared to those who did not receive it. METHODS A systematic review of studies was performed, searching multiple databases without language or date restrictions. Multiple reviewers independently assessed study eligibility and literature quality. The primary outcome was anastomotic stricture formation, with secondary outcomes of GORD, anastomotic leak, and oesophagitis. Meta-analysis was performed using a random effects model, and the results were expressed as an odds ratio (OR) with 95% confidence intervals (CI). RESULTS No randomised studies on the topic were identified. Twelve observational studies were included in the analysis with ten reporting the primary outcome. The quality assessment showed a high risk of bias in several papers, predominantly due to non-objective methods of assessment of oesophageal stricture and the non-prospective, non-randomised nature of the studies. Overall, 1395 patients were evaluated, of which 753 received acid suppression medication. Meta-analysis revealed a trend towards increased odds of anastomotic strictures in infants receiving prophylactic medication, but this was not statistically significant (OR 1.33; 95% CI 0.92, 1.92). No significant differences were found in secondary outcomes. CONCLUSIONS This meta-analysis found no evidence of a statistically significant link between the prophylactic prescribing of acid suppression medication and the risk of developing anastomotic stricture after OA repair. The literature in this area is limited to observational studies and a randomised controlled trial is recommended to explore this question. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Thomas Wyllie
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Eniola Folaranmi
- Department of Paediatric Surgery, University Hospital of Wales, Cardiff, UK
| | - Prabhu Sekaran
- Department of Paediatric Surgery, University Hospital of Wales, Cardiff, UK
| | - W John Watkins
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK; Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
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3
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Pan S, Thrift AP, Akhdar G, El-Serag HB. Gastric Cancer Risk in Patients with Long-Term Use of Proton Pump Inhibitors: A Systematic Review and Meta-Analysis of Observational and Interventional Studies. Dig Dis Sci 2023; 68:3732-3744. [PMID: 37432532 DOI: 10.1007/s10620-023-08018-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND A growing number of studies that differ in design, quality, and results report an association between the use of proton pump inhibitors (PPIs) and the risk of gastric cancer (GC). We conducted a systematic review and meta-analysis, when possible, of observational and interventional studies examining PPI use and risk of GC. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified studies fully published in English through January 2023 using MeSH and non-MeSH keywords. We used random effects models to calculate pooled risk estimates with 95% confidence interval (CI) between PPI use and overall GC, cardia GC, and non-cardia GC. We estimated heterogeneity (I2) among studies. We examined the effect of study design and quality, GC site, H. pylori infection, and PPI duration. We assessed quality using the Newcastle-Ottawa Quality Assessment Scale and Risk Of Bias In Non-randomized Studies of Interventions. RESULTS We identified 15 observational studies, of which 13 were included in the meta-analysis (six cohort and seven case-control). There was a modest 1.67-fold increase in overall GC risk (95% CI 1.39, 2.00) and no increase in cardia GC risk [odds ratio (OR) 1.12; 95% CI 0.80, 1.56] with PPI use. However, there was high heterogeneity (I2 = 61.3%, p = 0.004) among studies. All but one study had at least moderate risk of bias. In the six studies accounting for H. pylori, GC risk associated with PPI use increased slightly (OR 1.78; 95% CI 1.25, 2.52). Duration response was not reported consistently to allow pooled estimates. We identified only one interventional randomized controlled study that included GC as an outcome of interest, and it did not show increased GC risk. CONCLUSIONS The overall available evidence is not supportive of a meaningful change in GC risk, either cardia or non-cardia, with PPI use.
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Affiliation(s)
- Sharon Pan
- Texas A&M School of Medicine, Bryan, TX, USA
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ghida Akhdar
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hashem B El-Serag
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
- Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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Yekedüz E, Özbay MF, Çağlayan D, Yıldırım A, Erol C, Yıldırım HÇ, Tunç S, Özyurt N, Özdemir F, Şendur MAN, Işıkdoğan A, Kılıçkap S, Ürün Y, Yalçın Ş, Artaç M, Coşkun HŞ, Utkan G. Clinical outcomes of concomitant use of proton pump inhibitors and regorafenib in patients with metastatic colorectal cancer: a multicenter study. Eur J Clin Pharmacol 2022; 78:1973-1979. [PMID: 36266366 DOI: 10.1007/s00228-022-03403-1] [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: 08/04/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022]
Abstract
AIM To compare survival outcomes, response rates, and adverse events (AEs) in proton pump inhibitor (PPI) user and non-user patients with metastatic colorectal cancer (mCRC) treated with regorafenib. METHODS We included 272 patients with mCRC treated with regorafenib in this study. Patients were divided into two categories according to their status of PPI use. The primary endpoint was overall survival (OS). The secondary endpoints were time to treatment failure (TTF), response rates, and safety. To exclude immortal time bias in survival analyses, we compared PPI non-user patients and all patients. RESULTS There were 141 and 131 patients in the PPI non-user and user groups. Baseline characteristics were similar in each group. Pantoprazole was the most used PPI. At the median 35.2 (95% confidence interval (CI): 32.6-37.9) months follow-up, the median OS was similar in PPI non-user and all patients (6.9 months (95% CI: 5.3-8.5) and 7.7 months (95% CI:6.6-8.8), p = 0.913). TTF was also similar in PPI non-user and all patients (3.3 months (95% CI: 2.7-3.9) and 3.5 months (95% CI: 3.0-4.0), p = 0.661). In multivariable analysis, no statistically significant difference was observed between PPI user and non-user groups in OS and TTF (hazard ratio (HR), 0.99; 95% CI, 0.77-1.28; p = 0.963 for OS; HR, 0.93; 0.77-1.20, p = 0.598 for TTF). The objective response rates (ORR) were similar in the PPI non-user and user groups (19.8% and 16.8%, p = 0.455). The rates of any grade AEs were also similar in each group. CONCLUSION This study found no worse outcome in the combined use of PPI and regorafenib among patients with mCRC.
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Affiliation(s)
- Emre Yekedüz
- Department of Medical Oncology, Faculty of Medicine, Ankara University, 06590, Ankara, Turkey. .,Cancer Research Institute, Ankara University, Ankara, Turkey.
| | - Mehmet Fatih Özbay
- Department of Medical Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Dilek Çağlayan
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Atila Yıldırım
- Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Cihan Erol
- Department of Medical Oncology, University Faculty of Medicine, Faculty of Medicine Ankara, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hasan Çağrı Yıldırım
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sezai Tunç
- Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Neslihan Özyurt
- Medical Oncology Clinic, Prof. Dr. İlhan Özdemir State Hospital, Giresun, Turkey
| | - Feyyaz Özdemir
- Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Mehmet Ali Nahit Şendur
- Department of Medical Oncology, University Faculty of Medicine, Faculty of Medicine Ankara, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Abdurrahman Işıkdoğan
- Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Saadettin Kılıçkap
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.,Faculty of Medicine, Liv Hospital Medical Oncology Clinic, İstinye University, Ankara, Turkey
| | - Yüksel Ürün
- Department of Medical Oncology, Faculty of Medicine, Ankara University, 06590, Ankara, Turkey.,Cancer Research Institute, Ankara University, Ankara, Turkey
| | - Şuayib Yalçın
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Artaç
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hasan Şenol Coşkun
- Department of Medical Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Güngör Utkan
- Department of Medical Oncology, Faculty of Medicine, Ankara University, 06590, Ankara, Turkey.,Cancer Research Institute, Ankara University, Ankara, Turkey
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Abu-Sulb A, Al-Najjar R, Maghnam R, Ashhab A. Acid-suppressive therapy among infants and risk of anemia at 12 months of age. SAGE Open Med 2022; 10:20503121221123117. [PMID: 36105547 PMCID: PMC9465608 DOI: 10.1177/20503121221123117] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Numerous studies have shown that links exist between exposure to acid
suppression among adults and nutritional deficiencies, especially vitamin
B12 and iron. While the use of acid suppression among children and infants
is common, nutritional deficiency remains a concern but does not have
numerous studies to support it. We conducted a cohort study to examine this
concern; the hypothesis we proposed is that acid-suppressive therapy (AST)
during infancy is linked to anemia in the first year of life. Methods: This retrospective cohort study included infants born between 2017 and 2018
who visited Legacy Community Health. The inclusion criteria were exposure to
acid suppression for a minimum of 1 month and a hemoglobin reading at
12–15 months. Infants who had hemoglobinopathies, failure to thrive, or
malabsorption syndromes were excluded. Mean hemoglobin was calculated, and
student’s t-test was applied to find statistical
differences between the two groups. Change in weight before and after
treatment was recorded. Occurrence of respiratory and gastroenterological
adverse events was recorded in the exposed group. Results: Overall, 135 exposed infants were identified 135 controls were selected. The
majority of the sample included Hispanic girls. Ranitidine was the most
commonly prescribed medicine. The duration of treatment was 3 months. Weight
improved significantly at termination of the treatment. There was no
significant difference between the hemoglobin level of cases and controls,
and both were not considered anemic. Conclusion: AST was not linked to anemia, despite the slightly lower hemoglobin in some
cases. There were few weaknesses in our study; therefore, further studies
can examine this link by focusing further on medication type and close
follow-up. We found that although proton pump inhibitors are considered the
first line of treatment, histamine-2 receptor antagonists were more
frequently prescribed. Strategies to familiarize general pediatricians with
the NSAPGHAN guidelines might be needed.
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Affiliation(s)
- Ahmad Abu-Sulb
- Division of Pediatrics, Legacy Community Health, Houston, TX, USA
| | - Rawan Al-Najjar
- Division of Neonatology, Baylor College of Medicine, Houston, TX, USA
| | - Rama Maghnam
- Department of Pediatrics, Monmouth Medical Center, Long Branch, NJ, USA
| | - Ashraf Ashhab
- Division of Digestive & Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Bowder AN, Bence CM, Rymeski BA, Gadepalli SK, Sato TT, Szabo A, Arendonk KV, Minneci PC, Downard CD, Hirschl RB, Markel T, Courtney CM, Deans KJ, Fallat ME, Fraser JD, Grabowski JE, Helmrath MA, Kabre RD, Kohler JE, Landman MP, Lawrence AE, Leys CM, Mak G, Port E, Saito J, Silverberg J, Slidell MB, St Peter SD, Troutt M, Wright TN, Lal DR. Acid suppression duration does not alter anastomotic stricture rates after esophageal atresia with distal tracheoesophageal fistula repair: A prospective multi-institutional cohort study. J Pediatr Surg 2022; 57:975-980. [PMID: 35304025 DOI: 10.1016/j.jpedsurg.2022.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Anastomotic stricture is the most common complication after esophageal atresia (EA) repair. We sought to determine if postoperative acid suppression is associated with reduced stricture formation. METHODS A prospective, multi-institutional cohort study of infants undergoing primary EA repair from 2016 to 2020 was performed. Landmark analysis and multivariate Cox regression were used to explore if initial duration of acid suppression was associated with stricture formation at hospital discharge (DC), 3-, 6-, and 9-months postoperatively. RESULTS Of 156 patients, 79 (51%) developed strictures and 60 (76%) strictures occurred within three months following repair. Acid suppression was used in 141 patients (90%). Landmark analysis showed acid suppression was not associated with reduction in initial stricture formation at DC, 3-, 6- and 9-months, respectively (p = 0.19-0.95). Multivariate regression demonstrated use of a transanastomotic tube was significantly associated with stricture formation at DC (Hazard Ratio (HR) = 2.21 (95% CI 1.24-3.95, p<0.01) and 3-months (HR 5.31, 95% CI 1.65-17.16, p<0.01). There was no association between acid suppression duration and stricture formation. CONCLUSION No association between the duration of postoperative acid suppression and anastomotic stricture was observed. Transanastomotic tube use increased the risk of anastomotic strictures at hospital discharge and 3 months after repair.
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Affiliation(s)
- Alexis N Bowder
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI, 53226, United States of America.
| | - Christina M Bence
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI, 53226, United States of America
| | - Beth A Rymeski
- Department of Pediatric Surgery, Cincinnati Children's Hospital, 3333 Burnet Ave, ML 2023, Cincinnati, OH, 45229, United States of America
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, United States of America
| | - Thomas T Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI, 53226, United States of America
| | - Aniko Szabo
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI, 53226, United States of America
| | - Kyle Van Arendonk
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI, 53226, United States of America
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43206, United States of America
| | - Cynthia D Downard
- Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, 530 S. Jackson St, Louisville, KY, 40202, United States of America
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, United States of America
| | - Troy Markel
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr Emerson Hall, Indianapolis, IN, 46202, United States of America
| | - Cathleen M Courtney
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, Suite 5S40-Campus Box 8235, One Children's Place, St. Louis, MO, 63110, United States of America
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43206, United States of America
| | - Mary E Fallat
- Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, 530 S. Jackson St, Louisville, KY, 40202, United States of America
| | - Jason D Fraser
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, United States of America
| | - Julia E Grabowski
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL, 60611, United States of America
| | - Michael A Helmrath
- Department of Pediatric Surgery, Cincinnati Children's Hospital, 3333 Burnet Ave, ML 2023, Cincinnati, OH, 45229, United States of America
| | - Rashmi D Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL, 60611, United States of America
| | - Jonathan E Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, United States of America
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr Emerson Hall, Indianapolis, IN, 46202, United States of America
| | - Amy E Lawrence
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43206, United States of America
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, United States of America
| | - Grace Mak
- The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL, United States of America
| | - Elissa Port
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL, 60611, United States of America
| | - Jacqueline Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, Suite 5S40-Campus Box 8235, One Children's Place, St. Louis, MO, 63110, United States of America
| | - Jared Silverberg
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, United States of America
| | - Mark B Slidell
- The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL, United States of America
| | - Shawn D St Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, United States of America
| | - Misty Troutt
- Department of Pediatric Surgery, Cincinnati Children's Hospital, 3333 Burnet Ave, ML 2023, Cincinnati, OH, 45229, United States of America
| | - Tiffany N Wright
- Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, 530 S. Jackson St, Louisville, KY, 40202, United States of America
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI, 53226, United States of America
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Abstract
BACKGROUND The Food and Drug Administration requested withdrawal of ranitidine formulations, due to a potentially carcinogenic contaminant, N-nitrosodimethylamine. AIMS We evaluate whether ranitidine use is associated with gastric cancer. METHODS This is a retrospective multicenter, nationwide cohort study within the Veterans Health Administration, among patients with Helicobacter pylori (HP) prescribed long-term acid suppression with either: (1) ranitidine, (2) other histamine type 2 receptor blocker (H2RB), or (3) proton pump inhibitor (PPI)) between May 1, 1998, and December 31, 2018. Covariates included race, ethnicity, smoking, age, HP treatment, HP eradication. Primary outcome was non-proximal gastric adenocarcinomas, using multivariable Cox proportional hazards analysis. RESULTS We identified 279,505 patients with HP prescribed long-term acid suppression (median 53.4 years; 92.9% male). Compared to ranitidine, non-ranitidine H2RB users were more likely to develop cancer (HR 1.83, 95%CI 1.36-2.48); PPI users had no significant difference in future cancer risk (HR 0.92, 95% CI 0.82-1.04), p < 0.001. Demographics associated with future cancer included increasing age (HR 1.18, 95% CI 1.15-1.20, p < 0.001), Hispanic/Latino ethnicity (HR 1.46, 95% CI 1.21-1.75, p < 0.001), Black race (HR 1.89, 95% CI 1.68-2.14) or Asian race (HR 2.03, 95% CI 1.17-3.52), p < 0.001, and gender (female gender HR 0.64, 95% CI 0.48-0.85, p = 0.02). Smoking was associated with future cancer (HR 1.38, 95% CI 1.23-1.54, p < 0.001). Secondary analysis demonstrated decreased cancer risk in those with confirmed HP eradication (HR 0.24, 95% CI 0.14-0.40). No association between ranitidine and increased gastric cancer was found. CONCLUSION There is no demonstrable association between ranitidine use and future gastric cancer among individuals with HP on long-term acid suppression.
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, PCAM 7S GI, 3400 Civic Center Drive, Philadelphia, PA, 19104, USA.
| | - David S Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - David E Kaplan
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, PCAM 7S GI, 3400 Civic Center Drive, Philadelphia, PA, 19104, USA
- Division of Gastroenterology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, USA
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Badri H, Satia I, Bansal V, Mangi MA, Tangaroonsanti A, DeVault KR, Lee AS, Houghton LA, Smith JA. Heartburn as a Marker of the Success of Acid Suppression Therapy in Chronic Cough. Lung 2021; 199:597-602. [PMID: 34797407 DOI: 10.1007/s00408-021-00496-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/30/2021] [Indexed: 11/05/2022]
Abstract
Purpose Gastro-oesophageal reflux disease (GORD) is commonly thought to play an important role in chronic cough and patients are often empirically treated with acid suppression therapy. We sought to investigate the response rate to acid suppression treatment in patients with and without heartburn attending two specialist cough clinics. Methods A retrospective review of 558 consecutive patients referred to two specialist cough clinics was performed (UK and USA). Patients who were treated with acid suppression were included and their documented response to treatment was collected. Binary logistic regression was used to ascertain the value of reported heartburn in predicting the response of chronic cough to acid suppression therapy. Results Of 558 consecutive referrals, 238 patients were excluded due to missing data or cough duration of < 8 weeks. The remaining 320 patients were predominantly female (76%), with mean age 61 yrs (± 13) and 96.8% non-smokers, with chronic cough for 36 (18–117) months. Of 72 patients with heartburn, 20 (28%) noted improvement in their cough with acid suppression, whereas of 248 without heartburn, only 35 (14%) responded. Patients reporting heartburn were 2.7 (95% C.I. 1.3–5.6) times more likely to respond to acid suppression therapy (p = 0.007). Conclusion In specialist cough clinics, few patients report a response of their chronic cough to acid suppression therapy. Nonetheless, heartburn is a useful predictor substantially increasing the likelihood of benefit.
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Akiyama J, Hosaka H, Kuribayashi S, Moriyasu S, Hisada Y, Okubo H, Watanabe K, Imbe K, Nagata N, Kojima Y, Yokoi C, Uemura N, Shimoyama Y, Kawamura O, Yamada M, Kusano M. Efficacy of Vonoprazan, a Novel Potassium-Competitive Acid Blocker, in Patients with Proton Pump Inhibitor-Refractory Acid Reflux. Digestion 2020; 101:174-183. [PMID: 30897577 DOI: 10.1159/000497775] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 10/22/2018] [Accepted: 02/07/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIM We evaluated the efficacy of vonoprazan (VPZ), a novel potassium-competitive acid blocker, in patients with proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD), exhibiting continued pathological esophageal acid exposure (EAE). METHODS Despite ≥8 weeks of appropriate PPI therapy, patients with -persistent reflux symptoms and pathological EAE times (EAETs ≥4%) were invited to switch to VPZ treatment. After an 8-week-course of once-daily VPZ (20 mg), multichannel intraluminal impedance-pH (MII-pH) monitoring was repeated to compare gastric acid exposure times (GAETs), EAETs, and other reflux parameters relative to the baseline values. Before each MII-pH study, reflux symptom severities were scored using the Gastrointestinal Symptom Rating Scale; erosive esophagitis and fasting plasma gastrin levels were also assessed. RESULTS From among the 124 patients undergoing MII-pH monitoring, 13 patients (median age, 69 years; females, 64%) were monitored at baseline (while on PPI therapy) and after VPZ therapy. The median GAET associated with VPZ treatment (23.8%) was less than that for PPI treatment (41.1%; p = 0.01), including both daytime and nighttime measurements. VPZ therapy resulted in better median EAET values (4.5%) than did PPI therapy (10.6%) during the 24-h monitoring period (p = 0.055). EAE normalization was achieved in 46% of VPZ-treated patients and was associated with complete gastric acid suppression (p = 0.005). After switching to VPZ, reflux symptoms (p < 0.01) and erosive esophagitis (p = 0.01) improved. CONCLUSION In patients with PPI-refractory GERD, VPZ provides more potent gastric acid suppression, more effective EAE control, enhanced symptom improvement, and better esophagitis healing than PPIs.
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Affiliation(s)
- Junichi Akiyama
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan, .,Department of Medicine and Molecular Science, Gunma University, Maebashi, Japan,
| | - Hiroko Hosaka
- Department of Medicine and Molecular Science, Gunma University, Maebashi, Japan.,Division of Gastroenterology and Hepatology, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Shiko Kuribayashi
- Department of Medicine and Molecular Science, Gunma University, Maebashi, Japan.,Division of Gastroenterology and Hepatology, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Shiori Moriyasu
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuya Hisada
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidetaka Okubo
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazuhiro Watanabe
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koh Imbe
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naoyoshi Nagata
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasushi Kojima
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Chizu Yokoi
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naomi Uemura
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuyuki Shimoyama
- Department of Medicine and Molecular Science, Gunma University, Maebashi, Japan.,Division of Gastroenterology and Hepatology, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Osamu Kawamura
- Department of Medicine and Molecular Science, Gunma University, Maebashi, Japan.,Division of Gastroenterology and Hepatology, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Masanobu Yamada
- Department of Medicine and Molecular Science, Gunma University, Maebashi, Japan
| | - Motoyasu Kusano
- Department of Medicine and Molecular Science, Gunma University, Maebashi, Japan.,Division of Gastroenterology and Hepatology, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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10
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Hickman AW, Lonardo NW, Mone MC, Presson AP, Zhang C, Barton RG, Selzman CH, Drakos SG, Koliopoulou A, McKellar SH. Acid Suppression to Prevent Gastrointestinal Bleeding in Patients With Ventricular Assist Devices. J Surg Res 2018; 234:96-102. [PMID: 30527506 DOI: 10.1016/j.jss.2018.08.023] [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: 04/19/2018] [Revised: 07/16/2018] [Accepted: 08/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The high incidence of gastrointestinal bleeding (GIB) in patients with ventricular assist devices (VAD) is well known, but there is limited evidence to support the use of proton pump inhibitors (PPIs) or histamine receptor antagonists (H2RA) for preventing GIB in patients with VAD. MATERIALS AND METHODS The surgical ICU and VAD databases within a large regional academic cardiac mechanical support and transplant center were queried for patients who underwent VAD implantation between 2010 and 2014. An observational cohort study was conducted to identify which acid suppressing drug regimen was associated with the fewest number of GIB events within 30 d after VAD implantation: PPI, H2RA, or neither. Secondary outcomes included timing, etiology, and location of GIB. Multivariable logistic regression was used to compare treatment cohorts to GIB. Odds ratios, 95% confidence intervals, and P-values were reported from the model. RESULTS One hundred thirty-eight patients were included for final analysis, 19 of which had a GIB within 30 days of VAD implantation. Both H2RA and PPI use were associated with reduced GIB compared with the cohort with no acid suppressive therapy. In the multivariate analysis, the PPI cohort showed a statistically significant reduction in GIB (Odds ratio 0.18 [95% confidence interval 0.04-0.79] P = 0.026). CONCLUSIONS Using PPI postoperatively in patients with new VAD was associated with a reduced incidence of GIB. Given that GIB is a known complication after VAD placement, clinicians should consider the use of acid suppressive therapy for primary prevention.
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Affiliation(s)
- Abby W Hickman
- Pharmacy Department University of Utah Hospital, Salt Lake City, Utah.
| | - Nick W Lonardo
- Pharmacy Department University of Utah Hospital, Salt Lake City, Utah
| | - Mary C Mone
- General Surgery Division, Department of Surgery, Salt Lake City, Utah
| | - Angela P Presson
- Department of Epidemiology & Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Chong Zhang
- Department of Epidemiology & Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Richard G Barton
- General Surgery Division, Department of Surgery, Salt Lake City, Utah
| | - Craig H Selzman
- Cardiothoracic Division, Department of Surgery, Salt Lake City, Utah
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11
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Abstract
Proton pump inhibitors (PPI) have greatly improved the treatment of gastroesophageal reflux disease. However, recent investigations have revealed that reflux symptoms persist in a substantial number of patients. Therefore, treatment strategies beyond PPI are urgently required. One such strategy may involve more reliable acid suppression, e.g., with new acid inhibitory drugs. Furthermore, the rapid appearance of an acidic compartment in the proximal stomach after a meal, which is largely responsible for postprandial heartburn, requires a specific kind of therapy in addition to PPI which still needs to be established. Pharmacological augmentation of the lower esophageal sphincter may represent another approach to diminish reflux, but the clinical efficacy of compounds tested so far is limited. Altered e-sophageal perception represents a major component involved in the generation of reflux symptoms, particularly in non-erosive reflux disease, but effective pharmacological intervention is largely lacking. Presumed reflux-induced respiratory symptoms (cough, laryngitis, etc.) in the absence of typical esophageal symptoms (e.g., heartburn) remain a hot topic, but recent research points towards a hypersensitivity syndrome and only a minor role of gastroesophageal reflux. Treatment options for this condition are still pending.
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Affiliation(s)
- Herbert Koop
- formerly Department of General Internal Medicine and Gastroenterology, Helios Klinikum Berlin-Buch, Berlin, Germany
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12
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Zhu J, Qi X, Yu H, Su C, Guo X. Acid suppression in patients treated with endoscopic therapy for the management of gastroesophageal varices: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2018; 12:617-624. [PMID: 29564926 DOI: 10.1080/17474124.2018.1456918] [Citation(s) in RCA: 8] [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: 02/06/2023]
Abstract
BACKGROUND AND AIM Endoscopic therapy is the cornerstone choice for the management of varices and variceal hemorrhage. The aim of the present systematic review and meta-analysis was to evaluate the efficacy of acid suppression in patients treated with endoscopic therapy for gastroesophageal varices. METHODS All eligible studies were searched via the PubMed, EMBASE, and Cochrane Library databases. Incidence of bleeding, mortality, ulcers, chest pain, and dysphagia after endoscopic therapy and length of stay were analyzed. Subgroup analyses were performed according to the types and major indications of endoscopic treatments. Odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated. RESULTS Nine studies with 1470 patients were included. Acid suppression could significantly decrease the incidence of bleeding (OR = 0.39, 95%CI: 0.19-0.81, P = 0.01) and diminish the ulcer size (OR = 0.78, 95%CI: 0.38-1.57, P = 0.48) after endoscopic therapy. The subgroup analyses showed that acid suppression could significantly decrease the incidence of bleeding in patients undergoing prophylactic EVL, rather than in patients undergoing therapeutic EVL. There was no significant difference in the incidence of mortality, ulcers, chest pain, and dysphagia and length of stay between patients treated with and without acid suppression. CONCLUSION Acid suppression might be considered in patients undergoing prophylactic EVL for gastroesophageal varices.
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Affiliation(s)
- Jia Zhu
- a Liver Cirrhosis Study Group, Department of Gastroenterology , General Hospital of Shenyang Military Area , Shenyang , China
- b Postgraduate College , Shenyang Pharmaceutical University , Shenyang , China
| | - Xingshun Qi
- a Liver Cirrhosis Study Group, Department of Gastroenterology , General Hospital of Shenyang Military Area , Shenyang , China
| | - Haonan Yu
- b Postgraduate College , Shenyang Pharmaceutical University , Shenyang , China
| | - Chunping Su
- c Library of Fourth Military Medical University , Xi'an , China
| | - Xiaozhong Guo
- a Liver Cirrhosis Study Group, Department of Gastroenterology , General Hospital of Shenyang Military Area , Shenyang , China
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13
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Abstract
The incidence of gastroesophageal reflux disease (GERD) in the critically ill patient in the intensive care unit is unknown. Interventions used in critically ill patients, such as sedation, tracheal tubes, mechanical ventilation, enteral feedings, positioning, and medications, along with specific patient characteristics and comorbid conditions contribute to an increased risk for gastroesophageal reflux (GER) in this population. Critical care nurses have an integral role in helping identify critically ill patients at risk for GER or with known GERD, in preventing complications associated with these conditions.
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Affiliation(s)
- Cathy A Cooper
- Middle Tennessee State University, School of Nursing, 1301 East Main Street, Murfreesboro, TN 37132, USA.
| | - Patti P Urso
- Nursing Education, Walden University, School of Nursing, 100 Washington Avenue South, Suite 900, Minneapolis, MN 55401, USA
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14
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Tolbert MK, Olin S, MacLane S, Gould E, Steiner JM, Vaden S, Price J. Evaluation of Gastric pH and Serum Gastrin Concentrations in Cats with Chronic Kidney Disease. J Vet Intern Med 2017; 31:1414-1419. [PMID: 28833548 PMCID: PMC5598879 DOI: 10.1111/jvim.14807] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/07/2017] [Accepted: 07/13/2017] [Indexed: 12/22/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a highly prevalent condition in cats. Advanced CKD is associated with hyporexia and vomiting, which typically are attributed to uremic toxins and gastric hyperacidity. However, gastric pH studies have not been performed in cats with CKD. Hypothesis/Objectives To determine if cats with CKD have decreased gastric pH compared to age‐matched, healthy cats. Based on previous work demonstrating an association of hypergastrinemia and CKD, we hypothesized that cats with CKD would have decreased gastric pH compared to healthy, age‐matched control cats. Animals 10 CKD cats; 9 healthy control cats. Methods All cats with concurrent disease were excluded on the basis of history, physical examination, CBC, plasma biochemistry profile, urinalysis, urine culture, serum total thyroxine concentration, and serum symmetric dimethylarginine concentration (controls only) obtained within 24 hours of pH monitoring and assessment of serum gastrin concentrations. Serum for gastrin determination was collected, and 12‐hour continuous gastric pH monitoring was performed in all cats. Serum gastrin concentration, mean pH, and percentage time that gastric pH was strongly acidic (pH <1 and <2) were compared between groups. Results No significant differences in serum gastrin concentrations were observed between groups (medians [range]: CKD, 18.7 ng/dL [<10–659.0]; healthy, 54.6 ng/dL [<10–98.0]; P‐value = 0.713) or of any pH parameters including mean ± SD gastric pH (CKD, 1.8 ± 0.5; healthy, 1.6 ± 0.3; P‐value = 0.23). Conclusions and Clinical Importance These findings suggest that cats with CKD may not have gastric hyperacidity compared to healthy cats and, therefore, may not need acid suppression. Thus, further studies to determine if there is a benefit to acid suppression in cats with CKD are warranted.
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Affiliation(s)
- M K Tolbert
- University of Tennessee College of Veterinary Medicine, Knoxville
| | - S Olin
- University of Tennessee College of Veterinary Medicine, Knoxville
| | - S MacLane
- Appalachian Animal Hospital, Piney Flats, TN
| | - E Gould
- University of Tennessee College of Veterinary Medicine, Knoxville
| | - J M Steiner
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX
| | - S Vaden
- North Carolina State University College of Veterinary Medicine, Raleigh, NC
| | - J Price
- University of Tennessee College of Veterinary Medicine, Knoxville
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15
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Abstract
In recent years, proton pump inhibitors (PPIs) have come under great scrutiny due to possible adverse, long-term side effects. At the same time, Barrett's esophagus, a premalignant condition in the esophagus, continues to be a disease whose course is thought to be improved by the use of PPIs. We review the impact of proton pump therapy on the esophagus and on Barrett's mucosa. In analyzing changes on a cellular level, we explore the effect of mixed gastric refluxate and the complex cascade that ensues with esophageal exposure of these contents. Because the incidence of esophageal adenocarcinoma is on the rise, we explore other factors that may contribute to the progression of Barrett's from non-dysplastic mucosa to esophageal adenocarcinoma. By revisiting the need for adequate acid suppression in Barrett's and increasing our understanding of other possible factors that may have an effect of Barrett's progression, we hope to support our multifaceted approach to acid suppression in patients with Barrett's esophagus.
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16
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Esan OB, Pearce M, van Hecke O, Roberts N, Collins DRJ, Violato M, McCarthy N, Perera R, Fanshawe TR. Factors Associated with Sequelae of Campylobacter and Non-typhoidal Salmonella Infections: A Systematic Review. EBioMedicine 2017; 15:100-11. [PMID: 27965105 DOI: 10.1016/j.ebiom.2016.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 12/12/2022] Open
Abstract
Despite the significant global burden of gastroenteritis and resulting sequelae, there is limited evidence on risk factors for sequelae development. We updated and extended previous systematic reviews by assessing the role of antibiotics, proton pump inhibitors (PPI) and symptom severity in the development of sequelae following campylobacteriosis and salmonellosis. We searched four databases, including PubMed, from 1 January 2011 to 29 April 2016. Observational studies reporting sequelae of reactive arthritis (ReA), Reiter's syndrome (RS), irritable bowel syndrome (IBS) and Guillain-Barré syndrome (GBS) following gastroenteritis were included. The primary outcome was incidence of sequelae of interest amongst cases of campylobacteriosis and salmonellosis. A narrative synthesis was conducted where heterogeneity was high. Of the 55 articles included, incidence of ReA (n = 37), RS (n = 5), IBS (n = 12) and GBS (n = 9) were reported following campylobacteriosis and salmonellosis. A pooled summary for each sequela was not estimated due to high level of heterogeneity across studies (I2 > 90%). PPI usage and symptoms were sparsely reported. Three out of seven studies found a statistically significant association between antibiotics usage and development of ReA. Additional primary studies investigating risk modifying factors in sequelae of GI infections are required to enable targeted interventions. There is no clear direction of the association between antibiotics and gastroenteritis triggered reactive arthritis. Precision of genomic methods and increased use of record linkage techniques may provide clarity.
Antibiotics are known to change the gut flora but little is known of their potential to cause complications in patients who have gastroenteritis. We conducted a systematic review of the existing evidence to assess the potential association of antibiotic usage in patients with gastroenteritis and the occurrence of complications such as reactive arthritis (ReA). The available evidence did not indicate a clear direction in the association of antibiotics and ReA. The lack of clarity in the association of antibiotics and ReA raises a call for further primary research on the role of medications in the development of complications of gastroenteritis.
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17
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Badillo R, Francis D. Diagnosis and treatment of gastroesophageal reflux disease. World J Gastrointest Pharmacol Ther 2014; 5:105-112. [PMID: 25133039 PMCID: PMC4133436 DOI: 10.4292/wjgpt.v5.i3.105] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [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: 01/10/2014] [Revised: 02/21/2014] [Accepted: 06/20/2014] [Indexed: 02/07/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a common disease with a prevalence as high as 10%-20% in the western world. The disease can manifest in various symptoms which can be grouped into typical, atypical and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms, these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. In certain situations, further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. GERD complications include erosive esophagitis, peptic stricture, Barrett’s esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modification, medical therapy and surgical therapy. Lifestyle modifications including weight loss and/or head of bed elevation have been shown to improve esophageal pH and/or GERD symptoms. Medical therapy involves acid suppression which can be achieved with antacids, histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy, others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. The purpose of this review is to discuss the current approach to the diagnosis and treatment of gastroesophageal reflux disease.
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18
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Kangwan N, Park JM, Kim EH, Hahm KB. Quality of healing of gastric ulcers: Natural products beyond acid suppression. World J Gastrointest Pathophysiol 2014; 5:40-47. [PMID: 24891974 PMCID: PMC4024519 DOI: 10.4291/wjgp.v5.i1.40] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [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: 06/20/2013] [Revised: 08/06/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
Gastric ulcer is a chronic disease featured with unexpected complications, including bleeding, stenosis and perforation, as well as a high incidence of recurrence. Clinical treatments for gastric ulcer have allowed the rapid development of potent anti-ulcer drugs during the last several decades. Gastric ulcer healing is successful with conventional treatments including H2-receptor antagonists, and proton pump inhibitors (PPIs) have been essential for ulcer healing and prevention of complications. Additionally, Helicobacter pylori eradication therapy is effective in reducing ulcer recurrence and leads to physiological changes in the gastric mucosa which affect the ulcer healing process. However, in spite of these advancements, some patients have suffered from recurrence or intractability in spite of continuous anti-ulcer therapy. A new concept of the quality of ulcer healing (QOUH) was initiated that considers the reconstruction of the mucosal structure and its function for preventing ulcer recurrence. Although several gastroprotection provided these achievements of the QOUH, which PPI or other acid suppressants did not accomplish, we found that gastroprotection that originated from natural products, such as a newer formulation from either Artemisia or S-allyl cysteine from garlic, were very effective in the QOUH, as well as improving clinical symptoms with fewer side effects. In this review, we will introduce the importance of the QOUH in ulcer healing and the achievements from natural products.
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19
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Hong KS, Kang SJ, Choi JK, Kim JH, Seo H, Lee S, Jung JW, Kang HR, Cho SH, Kim JS. Gastrointestinal tuberculosis is not associated with proton pump inhibitors: A retrospective cohort study. World J Gastroenterol 2013; 19:258-64. [PMID: 23345949 PMCID: PMC3547571 DOI: 10.3748/wjg.v19.i2.258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/29/2012] [Revised: 09/28/2012] [Accepted: 10/22/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effect of proton pump inhibitors (PPIs) on the development of gastrointestinal tuberculosis.
METHODS: All patients who were more than 20 years old and who had received a prescription for PPIs among those who visited Seoul National University Hospital from January 1, 2005 to December 31, 2009 were identified. Due to the low sensitivity of the microbiologic test and the nonspecific pathologic findings, the diagnosis of gastrointestinal tuberculosis was confirmed through the presence of active ulcerations and the responses to anti-tuberculosis medications. The patients were divided into two groups according to treatment duration (group 1: ≤ 3 mo; group 2: > 3 mo) and were followed up from the time they took the first prescription of PPIs until their last visit. Logistic regression analysis was used to calculate the relative risks (RR) and 95%CI, adjusting for covariates.
RESULTS: Among the 61 834 patients exposed to PPIs (50 534 in group 1; 11 300 in group 2), 21 patients were diagnosed with PPI-associated gastrointestinal tuberculosis during 124 274 person-years of follow-up. Of 21 patients, the 12 who revealed only scar changes in the colonoscopy were excluded from the statistical analyses. Of those who remained, 2 were excluded because they underwent gastrointestinal endoscopy within 4 wk of the first prescription for PPIs. Longer exposure to PPI was associated with a higher mean age (55.0 ± 14.5 in group 1 vs 58.2 ± 13.3 in group 2, P < 0.001) and a higher Charlson co-morbidity index (0.50 ± 0.93 in group 1 vs 0.77 ± 1.14 in group 2, P < 0.001). The true incidence of active gastrointestinal tuberculosis was 0.65 per 1000 person-years in group 1 and 0.03 per 1 000 person-years in group 2. Like the less-than-three-month PPI treatment period in group 1, the over-three-month PPI therapy period in group 2 was not associated with increased risk of acquiring gastrointestinal tuberculosis, after adjusting for age and co-morbidities, whereas the Charlson co-morbidity index was associated with increased risk of acquiring gastrointestinal tuberculosis based on the score [RR: (reference 1) in group 1 vs 1.518 in group 2; 95% CI: 1.040-2.216, P = 0.03].
CONCLUSION: Long-term PPI therapy does not seem to be associated with increased risk of acquiring gastrointestinal tuberculosis, but a higher Charlson co-morbidity index is associated with such.
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