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1.
Arch. argent. pediatr ; 119(6): S222-S235, dic. 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1353097

ABSTRACT

El reflujo gastroesofágico es una situación frecuente en el primer año de vida. En ausencia de signos y síntomas de alarma, se lo considera fisiológico. No requiere estudios y puede ser abordado por el pediatra con medidas no farmacológicas. La enfermedad por reflujo (definidaporsíntomasmolestosocomplicaciones) debe ser manejada por el gastroenterólogo. Los exámenes complementarios tienen indicaciones precisas y el tratamiento incluye medidas no farmacológicas, farmacológicas y quirúrgicas (si fuera necesario). Nuestro objetivo es describir los diferentes métodos diagnósticos, sus indicaciones y limitaciones, así como los recursos terapéuticos disponibles, incluidas las indicaciones y los efectos adversos


Gastro esophageal reflux is a frequent condition in infants. In the absence of warning symptoms and signs, it is considered physiologic. No exam is required and a non-pharmacologic approach can be instituted by pediatricians. Gastro esophageal reflux disease is characterized by troublesome symptoms or complications and should be managed by a pediatric gastroenterologist. Diagnostic tests have accurate indications and treatment includes pharmacologic and non-pharmacologic measures as well as surgery. Our objective is to describe the different diagnostic methods, their indications and limitations as well as the therapeutic resources available, including indications and adverse effects.


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy
2.
Arq. gastroenterol ; 58(3): 364-369, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345292

ABSTRACT

ABSTRACT BACKGROUND: Dyspeptic symptoms are among the eight symptoms that most lead to the use of self-medication globally. OBJECTIVE: The aim of the present study was to evaluate the frequency of use and profile of the population doing self-medication to control dyspeptic symptoms in a capital from South Brazil. METHODS: Application of a survey consisting of topics regarding individual's socio-cultural data, self-reported comorbidities, use of self-medication in the 15 days prior to the interview and information on the use of this medication. Statistical analysis was performed on the data collected to determine the prevalence of self-medication for dyspeptic symptoms (SMDS) and to establish correlations with independent factors, such as gender, age, body mass index (BMI), education, family income and self-reported comorbidities. RESULTS: A total of 719 individuals from the public health system were interviewed. Overall, 67.7% were female, 65.3% had a BMI greater than 25; 28.4% presented with self-reported hypertension, 21.4% with depression and 13.8% with diabetes. The prevalence of self-medication to control digestive symptoms in this population was 28.7% (95%CI: 25.3-32), 91.8% (n=189) due to complaints of dyspeptic origin. Proton pump inhibitors were the most used class of medication (67%), followed by antacids (15%). There was a relationship between SMDS and age >38 years (OR=1.734, 95%CI: 1.177-2.580, P=0.001), BMI >26 (OR=1.660, 95%CI: 1.166-2.362, P<0.001) and self-reported depression (OR=1.471, 95%CI: 0.983-2.201, P=0.04). CONCLUSION: There was a higher prevalence of the use of self-medication to control dyspeptic symptoms in relation to previous data from the literature. Age >38 years, BMI >26 and self-reported depression were associated with SMDS.


RESUMO CONTEXTO: Os sintomas dispépticos estão entre os oito sintomas que mais levam uso de automedicação. OBJETIVO: O presente estudo teve como objetivo avaliar a prevalência e o perfil da população que utiliza automedicação para controle dos sintomas dispépticos em uma capital do Sul do Brasil. MÉTODOS: Aplicação de inquérito composto por tópicos relativos aos dados socioculturais do indivíduo, comorbidades autorreferidas, uso de automedicação nos 15 dias anteriores à entrevista e informações sobre o uso deste medicamento. Foi realizada a análise estatística dos dados coletados para determinar a prevalência de automedicação para controle dos sintomas dispépticos e estabelecer correlações com fatores independentes, como sexo, idade, índice de massa corporal (IMC), escolaridade, renda familiar e comorbidades autorrelatadas. RESULTADOS: Foram entrevistados 719 indivíduos atendidos pela atenção primária. Destes, 67,7% de indivíduos do sexo feminino, 65,3% apresentavam IMC maior que 25 kg/m², 28,4% autorrelataram apresentar hipertensão arterial sistêmica, 21,4% depressão e 13,8% diabetes. A prevalência de uso de automedicação para controle de sintomas digestivos nesta população foi de 28,7% (n=206, IC95% 25,3-32), 91,8% (n=189) por queixas de origem dispéptica. A classe de medicação mais utilizada foi a dos inibidores de bomba de prótons (67%), seguidos dos antiácidos (15%). Houve relação entre o uso deste tipo de automedicação e idade maior de 38 anos (OR=1,734, IC95% 1,177-2,580, P=0,001), IMC acima de 26 kg/m² (OR=1,660, IC95% 1,166-2,362, P<0,001) e presença de autorrelato de depressão (OR= 1,471, IC95% 0,983-2,201, P=0,04). CONCLUSÃO: O presente estudo revelou uma alta prevalência do uso de automedicação para controle dos sintomas dispépticos em comparação com dados da literatura, sendo os inibidores de bomba de prótons a classe de droga mais utilizada. Idade maior que 38 anos, índice de massa corporal maior 26 kg/m² e autorrelato de depressão foram associados ao uso de automedicação para sintomas dispépticos.


Subject(s)
Humans , Female , Adult , Primary Health Care , Brazil/epidemiology , Prevalence , Surveys and Questionnaires , Self Report
3.
Rev. colomb. gastroenterol ; 36(1): 73-80, ene.-mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1251524

ABSTRACT

Resumen La enfermedad por reflujo gastroesofágico (ERGE) se define como el tránsito anormal del contenido gástrico hacia el esófago, que se da por una alteración de la barrera antirreflujo, causando síntomas o complicaciones. Para su correcto diagnóstico y abordaje terapéutico, se requiere de la integración de hallazgos clínicos, endoscópicos y monitorización del pH esofágico en 24 horas con o sin impedanciometría, la cual debe ser realizada con especificaciones técnicas, y su interpretación debe basarse en la mejor evidencia clínica disponible, con el objetivo de tener diagnósticos precisos que permitan tomar las mejores decisiones con los pacientes. Recientemente, en el Consenso de Lyon se han incorporado nuevas directrices para el diagnóstico de ERGE por monitorización de pH esofágico, las cuales se revisan en este artículo.


Abstract Gastroesophageal reflux disease (GERD) is defined as the abnormal transit of gastric contents into the esophagus. It is caused by an alteration of the anti-reflux barrier, causing multiple symptoms or complications. In order to achieve accurate diagnosis and proper therapeutic approach, integration of clinical findings, endoscopic findings and 24-hour esophageal pH monitoring, with or without impedancometry, is required. These tests must be performed following technical specifications and their interpretation must be based on the best clinical evidence available to obtain accurate diagnoses that allow making the best decisions to the benefit of patients. Recently, the Lyon Consensus incorporated new guidelines for the diagnosis of GERD by esophageal pH monitoring, which are reviewed in this paper.


Subject(s)
Humans , Male , Female , Therapeutics , Gastroesophageal Reflux , Electric Impedance , Esophageal pH Monitoring , Disease
4.
Chinese Journal of Digestion ; (12): 599-605, 2021.
Article in Chinese | WPRIM | ID: wpr-912215

ABSTRACT

Objective:To explore the effects and underlying mechanisms of azintamide on gastric emptying and gastrointestinal hormone secretion in proton pump inhibitor related low gastric acid environment.Methods:A total of 60 rats were selected and randomly divided into low gastric acid control group, low gastric acid model group, low gastric acid and azintamide intervention group, high gastric acid control group, high gastric acid model group and high gastric acid and azintamide intervention group by random number table, with 10 rats in each group. The rats of low gastric acid control group and high gastric acid control group were all treated with 0.9% sodium chloride solution. The rats of low gastric acid model group and high gastric acid model group were established by intraperitoneal injection of 20 mg/kg omeprazole once per day for seven days, and subcutaneous injection of 2 mg/kg penta gastrin once per day for three days, respectively. The rats of low gastric acid and azintamide intervention group and high gastric acid and azintamide intervention group were gavaged with azintamide 50 mg/kg once per day for three days on the basis of low gastric acid model group and high gastric acid model group, respectively. Only the rats in three low gastric acid groups were analyzed. At Day 0, 2nd, 4th, 6th and 8th after modeling, the body weight of rats were compared. After modeling, the weight of gastric contents and pH of gastric fluid was measured and compared, and the peripheral blood levels of pepsinogen A (PGA), gastrin and cholecystokinin (CCK) were detected by enzyme linked immunosorbent assay. One-way analysis of variance and Tukey′s honestly significant difference post-hoc test were used for statistical analysis.Results:The pH value of gastric fluid in low gastric acid model group and low gastric acid and azintamide intervention group were both higher than that in the low gastric acid control group (2.17±0.53, 2.03±0.69 vs. 1.32±0.17), and the differences were statistically significant ( P=0.026 and 0.041, respectively). While there was no significant difference in pH value between the low gastric acid model group and low gastric acid and azintamide intervention group ( P>0.05). On the Day 0, 2nd, 4th, 6th and 8th after modeling, the body weight of rats of low gastric acid control group, low gastric acid model group and low gastric acid and azintamide intervention group was (285.40±10.86), (283.40±6.38), (282.00±5.04) g; (287.10±10.73), (283.20±5.83), (284.00±5.72) g; (292.20±11.18), (281.90±6.23), (289.00±5.82) g; (296.40±11.12), (277.70±6.96), (292.00±6.82) g; (300.80±11.29), (274.30±8.84), (297.00±4.17) g, respectively. On the Day 6th and 8th after modeling, the body weight of rats of low gastric acid model group was lower than that of the low gastric acid control group; and the body weight of rats of low gastric acid and azintamide intervention group was higher than that of low gastric acid model group, and the differences were statistically significant (both P<0.01). On the Day 0, 2nd, 4th, 6th and 8th, there was no statistically significant difference in body weight of rats between low gastric acid and azintamide intervention group and low gastric acid control group ( P>0.05). On the Day 0, 2nd, 4th, there were no statistically significant differences in body weight of rats between low gastric acid and azintamide intervention group and low gastric acid model group, and between low gastric acid model group and low gastric acid control group (both P>0.05). The weight of gastric contents of low gastric acid model group was heavier than that of low gastric acid control group ((2.36±0.11) g vs. (1.85±0.20) g), the weight of gastric contents of low gastric acid and azintamide intervention group was lighter than that of low gastric acid model group ((1.87±0.42) g vs. (2.36±0.11) g), and the differences were statistically significant ( P=0.019 and 0.016, respectively), and there was no statistically significant difference in weight of gastric contents between the low gastric acid and azintamide intervention group and the low gastric acid control group ( P>0.05). The peripheral blood level of PGA of rats of low gastric acid model group was lower than that of low gastric acid control group ((551.80±190.00) ng/L vs. (857.00±164.80) ng/L), while the peripheral blood level of PGA of the low gastric acid and azintamide intervention group was higher than that of the low gastric acid model group ((799.90±97.80) ng/L vs. (551.80±190.00) ng/L), and the differences were statistically significant ( P=0.011 and 0.037, respectively). There was no significant difference in peripheral blood level of PGA between the low gastric acid control group and the low gastric acid and azintamide intervention group ( P>0.05). The peripheral blood level of gastrin of the low gastric acid model group was higher than that of the low gastric acid control group ((49.31±11.93) ng/L vs. (35.59±5.29) ng/L), and the CCK level of the low gastric acid model group was lower than that of low gastric acid control group ((10.26±5.32) ng/L vs. (25.55±11.62) ng/L), and the differences were statistically significant ( P=0.037 and 0.035, respectively). The peripheral blood level of gastrin of the low gastric acid and azintamide intervention group was lower than that of low gastric acid model group ((35.65±6.49) ng/L vs. (49.31±11.93) ng/L), the level of CCK of the low gastric acid and azintamide intervention group was higher than that of low gastric acid model group ((27.59±11.22) ng/L vs. (10.26±5.32) ng/L), and the differences were statistically significant ( P=0.048 and 0.021, respectively). There were no significant differences in CCK and gastrin between low gastric acid and azintamide intervention group and low gastric acid control group (both P>0.05). Conclusion:Azintamide regulates the levels of gastrointestinal hormones CCK and gastrin under the condition of low gastric acid and affects the expression of pepsinogen A, thereby promoting gastric emptying in a low gastric acid environment.

5.
Article | IMSEAR | ID: sea-194610

ABSTRACT

Background: Acute upper gastrointestinal hemorrhage (UGIH) is a common condition worldwide frequently leads to hospital admission also has a significant associated morbidity and mortality, especially in the elderly. A systematic diagnostic and definite therapeutic approach is essential to establish a diagnosis, relevant to specific investigations for appropriate treatment in tertiary medical care center.Methods: A comparative trial was done on n=109 cases with an objective to find out the different causes of UGI bleed in population, to assess the requirement of blood transfusion in patients with massive GI Bleed and to compare the treatment outcome of Proton pump inhibitors over Tranexamic acid and Octreotide in non-variceal UGI bleed. The cases were assigned to three different groups by lottery system. Proton pump inhibitors (Omeprazole), Somatostatin (Octreotide), Anti-fibrinolytic (Tranexamic acid), outcome was assessed after complete treatment and follow up.Results: Out of 150 cases, 109 were diagnosed with non-variceal GI bleed, 35 cases were treated with Omeprazole out of which 11.42% cases received blood transfusion, and 4 had history of re bleeding, Mean Duration of stay in hospital was 4.4±1.75, when compared to the other two group the duration of hospitalization was least as the P value was <0.0001.Conclusions: In this study it was demonstrated the use of PPI in case of Non-Variceal Bleeding significantly reduces the need of blood transfusion. Even it reduces the cases of re bleeding and duration of hospital stay.

6.
Article | IMSEAR | ID: sea-212030

ABSTRACT

Background: Proton pump inhibitors are one of the most commonly used drugs worldwide. Often they are used for inappropriate indications too, imposing economic burden to patients and governments. Many studies have showed equipotent efficacy of oral and intravenous proton pump inhibitor therapy. Despite that, most of the hospitalized patients receive intravenous proton pump inhibitor without appropriate indications. This study aimed to assess use of proton pump inhibitors in government hospital.Methods: It was an observational cross-sectional study done in the general medicine department of a tertiary care teaching hospital in Eastern India, including 800 noncritical patients. Objective was to assess the use of proton pump inhibitors (indications, route of administration, dosing frequency).Results: 100% patient received intravenous proton pump inhibitor irrespective of diagnosis. 80% of them received it twice daily and 18% received it once daily. Majority of the patients received intravenous proton pump inhibitor despite taking other drugs by oral route.Conclusions: Most of the PPI administration was done without appropriate indication. All patients received Intravenous proton pump inhibitors, which may impose economic burden on a government hospital. Majority of the patients received proton pump inhibitors twice daily. These approaches are not cost effective and need to be rectified.

7.
Article in Chinese | WPRIM | ID: wpr-799003

ABSTRACT

Objective@#The consistency of 24-hour oropharyngeal Dx-pH monitoring and proton pump inhibitor(PPI) test in the diagnosis of laryngopharyngeal reflux disease (LPRD) was investigated.@*Methods@#Sixty patients with laryngopharyngeal reflux (LPR) related symptoms who had never received PPI treatment were assessed by reflux symptom index (RSI) and reflux finding score (RFS) between October 2017 and October 2018, including 28 males and 38 females, aged from 16 to 72 years, with a medium age of 38 years. Prior to treatment, all patients were evaluated with 24 hours oropharyngeal Dx-pH monitoring(Restech). After empiric therapy with PPI twice-daily for 8 weeks, the efficacy was evaluated according to posttreatment RSI score.The data was analysed with Kruskal-Wallis test, Student Newman Keuls test and consistency check.@*Results@#(1)Among all 60 patients,13 patients (21.7%) had pathologic Ryan score and all resulted responsive to PPI;27 patients (45.0%) with a negative Ryan score were unresponsive to PPI; 20 patients (33.3%) despite a negative Ryan score resulted responsive to PPI therapy. Considering responsiveness to PPI therapy as the gold standard for the diagnosis of LPRD, the sensitivity, specificity, positive predictive value and negative predictive value of Ryan score were 39.4%, 100%, 100% and 57.4% respectively. The Kappa value was 0.369 (P<0.01). (2)Among 34 patients (56.7%) with positive Dx-pH results (24-hour oropharyngeal acid reflux events≥ 3 times), 29 patients were positive and 5 patients were negative in PPI test. Among 26 patients with negative Dx-pH results (24-hour oropharyngeal acid reflux events<3 times), 4 patients were positive and 22 patients were negative in PPI test. Considering responsiveness to PPI therapy as the gold standard for the diagnosis of LPRD, the sensitivity, specificity, positive predictive value and negative predictive value of 24-hour oropharyngeal acid reflux events were 87.9%, 81.5%, 85.3% and 84.6% respectively. The Kappa value was 0.696(P<0.01).@*Conclusions@#There is a positive correlation between 24-hour oropharyngeal Dx-pH monitoring positive results (24-hour oropharyngeal acid reflux events≥3 times) and PPI test in the diagnosis of LPRD. The 24-hour oropharyngeal Dx-pH monitoring can be a promising tool for the diagnosis of suspected LPRD patients, and more sensitive and accurate Dx-pH diagnostic index will be required in the clinic.

8.
Article in Chinese | WPRIM | ID: wpr-843879

ABSTRACT

Objective To evaluate the efficacy and safety of magnesium aluminum suspension spraying in treating gastric ulcer after endoscopic submocosal dissection (ESD). Methods We made a prospective analysis of patients with gastric ESD surgery performed between January 2016 and June 2019. They were divided into control group, spraying group, and spraying + oral group on the basis of treatment method. All patients were followed up for 8 weeks to evaluate endoscopic ulcer healing and recovery rate. At the same time, postoperative symptoms and complications such as bleeding were also recorded. SPSS 24.0 software was used for statistical analysis. Results A total of 330 eligible cases were randomly divided into control group (124 cases), spraying group (108 cases), and spraying + oral group (98 cases). The results showed that the postoperative pain incidence in spraying group and spraying + oral group was significantly better than that in the control group (35.48% vs. 17.59%, P<0.01; 35.48% vs. 20.41%, P=0.01). The 4-week ulcer recovery rate was better in spraying + oral group than in the control group. It should be noted that ulcer healing rate achieved 100% for the antrum of patients in spraying + oral group. At the same time, the incidence of postoperative bleeding decreased, and no significant adverse drug reactions were observed during the follow-up. Conclusion Almagate suspension spraying is safe and effective in the treatment of upper gastrointestinal ESD postoperative ulcer. In addition, it can also relieve postoperative pain.

9.
Article | IMSEAR | ID: sea-202656

ABSTRACT

Introduction: Because the prevalence of antibiotic resistancemarkedly increases with time worldwide, anti-H. pyloritreatment is continuing to be a great challenge for physiciansin clinical practice. Eradication of H. pylori infection markedlychanges the natural history of peptic ulcer in patients withduodenal or gastric ulcer. Most peptic ulcers associated withH. pylori infection are curable. Aim of present study was tostudy the efficacies of 14 days ‘ Reverse Hybrid Therapy’ inH.pylori positive G.I.patients.Material and methods: 100 H.pylori positive patients withupper G.I. complaints who underwent upper GI endoscopywere included in the study. H.pylori infection was documentedby at least 2 positive results of Rapid Urease Test. Subjectswith any of the following criteria were excluded from thestudy. 1. Previous eradication therapy 2. Allergy to anyantibiotic used in study. 3. Co- existence of any serious illness.4. Pregnancy or lactating women 5. Previous gastrectomy6. Use of antibiotics within last 4 week. Detailed medicalhistory and demographic details of the patients were recorded.Routine haematogical tests and USG was done. Patients weregiven 14 days dual therapy ie quadruple regimen (proton pumpinhibitor + amoxicillin + clarithromycin + metronidazole) forfirst 7 days followed by dual regimen of PPI+ amoxicillin fornext 7 days. Patients were asked to report at 7, 14 days and at6 weeks interval.Results: Out of 97 patients 93 patients became negative forH.pylori after 6 week of Reverse Hybrid eradication therapy.It was observed that majority of patients enrolled in the studywere in the age group of 41–60 years (50%) followed bybelow 40 yrs (27%), above 60 yrs (23%). Out of them, 74%were male and 26% were female.Conclusion: Out of 97 patients 93 patients became negativefor H.pylori after 6 week of Reverse Hybrid eradicationtherapy. Hence, Reverse Hybrid Therapy is equally potenttherapy to Bismuth based therapy though the latter has a lotof side effects.

10.
Article | IMSEAR | ID: sea-195921

ABSTRACT

Background & objectives: Prokinetics are extensively prescribed leading to several adverse events (AEs). The aim of this study was to assess the prescription pattern in patients receiving prokinetics, and characteristics of adverse drug reactions (ADRs) in an outpatient department set up in a tertiary care hospital in western India. Methods: Patients attending outpatient departments of a tertiary care hospital and who had received prokinetic agent for at least seven days over the last one month were enrolled. Causality assessment of AEs was done and assessed for severity, preventability, seriousness and predictability. Results: A total of 304 patients [161 males (52.96%); 143 females (47.04%)] were enrolled. Most prescriptions (299/304, 98%) included domperidone, most commonly prescribed as fixed-dose combination (FDC) with pantoprazole (274/304, 90%). Prokinetic dose was not mentioned in 251/304 (83%) prescriptions, and 18/304 (6%) did not mention frequency. Of the 378 AEs reported from 179 patients (47.35%), 306 (81%) were mild, all non-serious; 272 (72%) not preventable and 291 (77%) predictable in nature. Decreased appetite (n=31, 8.2%) and fatigue (n=27,7.14%) were most commonly reported. Causality assessment by the World Health Organization-Uppsala Monitoring Centre scale showed that 180 AEs were related to suspected drug (17 probable and 163 possible ADRs). Significant correlation was observed for AEs with increasing number of drugs per prescription (Spearman's R=+0.8, P =0.05) and with increasing therapy duration (Spearman's R=+1.00, P <0.001). Interpretation & conclusions: Our findings showed that prokinetics were often prescribed as FDCs, with incomplete prescriptions. Domperidone was found to be associated with multiple AEs. It is suggested that regular prescription monitoring should be done in hospitals to encourage rational use of drugs.

11.
Article in Korean | WPRIM | ID: wpr-760106

ABSTRACT

BACKGROUND AND OBJECTIVES: Laryngopharyngeal reflux (LPR) is a prevalent condition with an increasing incidence, and several recent studies have reported the association of LPR with chronic rhinosinusitis (CRS). In this study, we studied the effect of proton-pump inhibitors (PPIs) on symptom improvement for LPR and comorbid CRS. SUBJECTS AND METHOD: Enrolled in the study from January 2017 to December 2017 were 164 patients (54 male, 110 female, mean age 48.8 years) who were diagnosed as LPR by reflux symptom index (RSI) or reflux finding scores (RFS) and comorbid CRS. Sino-Nasal Outcome Test (SNOT)-20 and Lund-Kennedy endoscopic scores were evaluated for CRS severity. The study group was divided into PPI treatment group (Ilaprazole 20 mg, once a day for 8 weeks) and non-treatment group. The RSI, RFS, SNOT-20, and Lund-Kennedy endoscopic scores were repeated at the end of treatment. RESULTS: Ninety-two patients were prescribed PPI and 72 patients were not. Initial RSI, RFS, SNOT-20, and Lund-Kennedy score did not differ between the two groups. RSI and RFS decreased significantly after eight weeks of PPI medication (p=0.002 and p<0.001, respectively). In the non-treatment group, only RFS showed statistically significant decrease. SNOT-20 and Lund-Kennedy endoscopic scores decreased significantly in the treatment group (p=0.005 and p<0.001, respectively) compared to the non-treatment group. CONCLUSION: The results of our study suggest that PPI treatment for 8 weeks was effective in reducing signs and symptoms of both LPR and CRS.


Subject(s)
Female , Humans , Incidence , Laryngopharyngeal Reflux , Male , Methods , Proton Pumps , Protons
12.
Article in English | WPRIM | ID: wpr-759820

ABSTRACT

Anxiety disorders are the most prevalent psychiatric disorders in the general population. The relationship between dyspepsia and particularly gastroesophageal reflux disease (GERD) and psychiatric comorbidity such as anxiety is poorly defined. However, GERD was noted to be strongly associated and often coincident in onset with generalized anxiety disorder in the community. In this paper, we report the case of an adult man who presented with severe weight loss and underlying GERD, and was later found to have an anxiety disorder as the cause of both.


Subject(s)
Adult , Anxiety Disorders , Anxiety , Comorbidity , Dyspepsia , Gastroesophageal Reflux , Humans , Proton Pumps , Protons , Shadowing Technique, Histology , Weight Loss
13.
Article in Korean | WPRIM | ID: wpr-759628

ABSTRACT

OBJECTIVES: The purpose of this study was to investigate the association between fracture risk and proton pump inhibitor (PPI) use to establish evidence for defining high-risk groups of fracture among PPI users. METHODS: A case-control study was performed using the National Health Insurance Sample Cohort Database from January 2002 to December 2013. The cases included all incidences of major fractures identified from January 2011 to December 2013, and up to four controls were matched to each case by age, gender, osteoporosis, and Charlson comorbidity index. Conditional logistic regression was used to calculate the adjusted odds ratio (aOR) and associated 95% confidence interval (CI). RESULTS: Overall, 14,295 cases were identified, and 63,435 controls were matched to the cases. The aOR of fractures related to the use of PPIs was 1.06 (95% CI: 1.01–1.11). There was a statistically significant association between fracture and PPI use within 3 months of the last dose, and a trend of increasing fracture risk with increasing cumulative PPI dose. The risk of fracture was significantly higher in patients who took PPIs for more than 1 year during the 2-year observation period. CONCLUSION: Patients who have been using PPIs for more than 1 year should be warned about the risk of fracture during or at least 3 months after discontinuing the PPI.


Subject(s)
Case-Control Studies , Cohort Studies , Comorbidity , Humans , Incidence , Logistic Models , National Health Programs , Odds Ratio , Osteoporosis , Proton Pumps , Protons
14.
Frontiers of Medicine ; (4): 277-284, 2019.
Article in English | WPRIM | ID: wpr-771310

ABSTRACT

The development of new proton-pump inhibitors (PPIs) with less adverse effects by lowering the pKa values of nitrogen atoms in pyrimidine rings has been previously suggested by our group. In this work, we proposed that new PPIs should have the following features: (1) number of ring II = number of ring I + 1; (2) preferably five, six, or seven-membered heteroatomic ring for stability; and (3) 1 < pKa1 < 4. Six molecular scaffolds based on the aforementioned criteria were constructed, and R groups were extracted from compounds in extensive data sources. A virtual molecule dataset was established, and the pKa values of specific atoms on the molecules in the dataset were calculated to select the molecules with required pKa values. Drug-likeness screening was further conducted to obtain the candidates that significantly reduced the adverse effects of long-term PPI use. This study provided insights and tools for designing targeted molecules in silico that are suitable for practical applications.


Subject(s)
Computer Simulation , Drug Design , Humans , Proton Pump Inhibitors , Toxicity , Toxicological Phenomena
15.
Article in Chinese | WPRIM | ID: wpr-803261

ABSTRACT

Objective@#To evaluate the prevalence and characteristics of Jackhammer esophagus (JE).@*Methods@#From December 2015 to December 2018, the clinical data of 20 patients with JE in the People's Hospital of Yuhuan were retrospectively analyzed.The clinical data of JE patients with typical symptoms of proton pump inhibitor reactive gastroesophageal reflux disease (GERD) were evaluated.The differences between JE patients with or without GERD or allergic esophagus were analyzed, which including esophagogastroscopy (EGD), dynamic pH impedance monitoring of proton pump inhibitors and proton pump inhibitor tests.@*Results@#Of 20 patients with JE, the average age was (55.86±3.23) years old, and BMI was (26.10±3.21)kg/m2.Among JE patients, 10 cases (50.0%) were GERD positive, 2 cases (10.0%) were acid sensitive esophagus, and 8 cases (40.0%) were GERD negative.There were no statistically significant differences in heartburn (P=0.167), nausea (P=0.250), dysphagia (P=0.714) or non-cardiac chest pain (P=0.906) and their duration (P=0.319) among the three types of patients.It also affected the intake of proton pump inhibitor (P=0.377) and heartburn (P=0.494). The total number of reflux in patients with positive GERD caused by JE proton pump inhibitor was significantly increased (P=0.027).@*Conclusion@#JE has a low prevalence rate in patients with typical symptoms of GERD and proton pump inhibitor treatment response.In this study, only nearly half of the people were diagnosed as GERD positive, which indicates that additional objective tests are needed to stratify JE phenotypes.

16.
Article in Chinese | WPRIM | ID: wpr-845221

ABSTRACT

Tacrolimus,a macrolide immunosuppressive agent,has been used as a first-line drug for the inhibi- tion of rejection after organ transplantation. In general, the organ-transplanted patients need to administer proton pump in- hibitors to prevent gastrointestinal syndrome when tacrolimus is used,and a high proportion of patients use the two drug combination. However,the combined use of tacrolimus with the proton pump inhibitor often gives rise to the fluctuation in the tacrolimus blood concentration. This fluctuation has been suggested to be likely related to the competition of the CYP3A4 metabolic enzyme between the two drugs. In this paper,the interaction between tacrolimus and different kinds of proton pump inhibitors is reviewed in order to provide reference for their clinical application.

17.
China Pharmacy ; (12): 417-420, 2019.
Article in Chinese | WPRIM | ID: wpr-816900

ABSTRACT

OBJECTIVE: To design Proton pump inhibitor (PPI) medical order evaluation software, and to promote rational drug use in clinic. METHODS: According to the use of PPI (PPI injection as an example) of inpatients in a Third Grade Class A hospital (hereinafter referred to as "sample hospital"), the evaluation process of medical order evaluation software was designed. On this basis, medical order evaluation software for inpatients was developed in collaboration with computer engineers. Taking the detection rate of irrational drug use and the time consuming per capita as indicators, the effects of software evaluation and manual evaluation were compared. Dispensing medical orders of PPI injection in PIVAS of sample hospital was evaluated with the software pre-evaluation in Feb. 2018. Irrational use of PPI injection (including irrational medication for treatment, prevention and non-indication) in the inpatients was evaluated retrospectively during Jan. 2015-Dec. 2017. RESULTS: The software of PPI audit includes four modules:users and tasks (timing audit), system settings, confirmation of audit results (check the results audited by the software automatically) and reports exporting. Compared with manual evaluation, there was no significant difference in detection rate of irrational drug use in software audit (69.50% vs. 77.00%, P>0.05); the time consuming per capita was shortened significantly (9.25 min vs. 1.50 min, P<0.05). In the application of pre-evaluation, 27 (2.23%) were irrational for treatment, 318 (26.24%) were irrational for prevention and 602 (49.67%) for non-indications. In the application of retrospective review, 4 884 (2.68%) were irrational medication for treatment, 50 399 (27.67%) irrational medication for prevention and 85 106 (46.72%) medication without indications. CONCLUSIONS: The application of PPI medical order evaluation software shortens the time of pharmacist's evaluation, improves the efficiency of evaluation, and promotes the rational use of PPI in clinic.

18.
Article in English | WPRIM | ID: wpr-760891

ABSTRACT

PURPOSE: On the basis of evidence, we aimed to reevaluate the necessity of the empirical proton pump inhibitor (PPI) trial for children with suspected gastroesophageal reflux disease (GERD). METHODS: We analyzed the frequency of GERD in 85 school-age children with gastroesophageal reflux (GER) symptoms, who received 24-hour esophageal pH monitoring and/or upper endoscopy. According to the reflux index (RI), the children were classified into normal (RI <5%), intermediate (5%≤ RI <10%), or abnormal (RI ≥10%) groups. RESULTS: Fifty six were female and 29 were male. Their mean age was 12.6±0.5 (±standard deviation) years (range: 6.8–18.6). The RI analysis showed that the normal group included 76 patients (89.4%), the intermediate group included 6 patients (7.1%), and the abnormal group included 3 patients (3.5%). The DeMeester score was 5.93±4.65, 14.68±7.86 and 40.37±12.96 for the normal, intermediate and abnormal group, respectively (p=0.001). The longest reflux time was 5.56±6.00 minutes, 9.53±7.84 minutes, and 19.46±8.35 minutes in the normal, intermediate, and abnormal group, respectively (p=0.031). Endoscopic findings showed reflux esophagitis in 7 patients. On the basis of the Los Angeles Classification of Esophagitis, 5 of these patients were included in group A, 1 patient, in group B and 1 patient, in group C. CONCLUSION: The incidence of GERD was very low in school-age children with GER symptoms. Therefore, injudicious diagnostic PPI trials would be postponed until the actual prevalence of GERD is verified in future prospective studies.


Subject(s)
Child , Classification , Endoscopy , Esophageal pH Monitoring , Esophagitis , Esophagitis, Peptic , Female , Gastroesophageal Reflux , Humans , Incidence , Male , Prevalence , Prospective Studies , Proton Pump Inhibitors , Proton Pumps , Protons
19.
Article in Chinese | WPRIM | ID: wpr-733913

ABSTRACT

Objective To analyze the use of proton pump inhibitors( PPIs) in the perioperative period of Zhoushan Hospital,thus to make appropriate management regulations for the clinical application of PPIs. Methods From September 2016 to October 2016,the use of PPIs in 614 surgical patients of Zhoushan Hospital were statistically analyzed. The rationality of the indications,drug use,drug administration,dosage,time,course of treatment,combined medication were analyzed. Results In 614 cases,there were 341 reasonable,unreasonable 273,the failure rate was 44. 46% (273/614). The main manifestations in the non indication of medication and medication course of treatment was too long. Conclusion There are many unreasonable phenomena in the course of clinical use of PPIs. Hospital and clinical pharmacists should strengthen supervision and management of the use of PPIs.

20.
Chinese Critical Care Medicine ; (12): 539-544, 2019.
Article in Chinese | WPRIM | ID: wpr-754006

ABSTRACT

Objective To investigate the benefits and risks of stress ulcer prevention (SUP) using proton pump inhibitors (PPI) for critical patients. Methods The clinical data of adult critically ill patients admitted to the intensive care unit (ICU) of Northern Jiangsu People's Hospital from January 2016 to December 2018 were retrospectively analyzed. All patients who were treated with PPI for SUP within the first 48 hours after ICU admission were enrolled in the SUP group. Those who not received PPI were enrolled in the control group. A one-to-one propensity score matching (PSM) was performed to control for potential biases. The gender, age, underlying diseases, main diagnosis of ICU, drug use before ICU admission, sequential organ failure score (SOFA) at ICU admission, risk factors of stress ulcer (SU) and PPI usage were recorded. The end point was the incidence of gastrointestinal bleeding, hospital acquired pneumonia, Clostridium difficile infection and 30-day mortality. Kaplan-Meier survival curves were plotted, and survival analysis was performed using the log-rank test. Results 1 972 critical patients (788 in the SUP group and 1 184 in the control group) were enrolled, and each group enrolled 358 patients after PSM. Prior to PSM, compared with the control group, the SUP group had older patients, more underlying diseases, higher proportion of acute coronary syndrome (ACS), acute cerebrovascular disease, acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and poisoning in main diagnosis of ICU, more serious illness, and more risk factors of SU, indicating that ICU physicians were more likely to prescribe SUP for these patients. The incidence of gastrointestinal bleeding in the SUP group was significantly lower than that in the control group [1.8% (14/788) vs. 3.7% (44/1 184), P < 0.05], while the incidence of hospital acquired pneumonia and 30-day mortality were significantly higher than those in the control group [6.6% (52/788) vs. 3.5% (42/1 184), 17.9% (141/788) vs. 13.1% (155/1 184), both P < 0.01]. There was no significant difference in the incidence of Clostridium difficile infection between the SUP group and the control group [2.9% (23/788) vs. 1.8% (21/1 184), P >0.05]. After the propensity scores for age, underlying diseases, severity of illness and SU risk factors were matched, there was no significant difference in the incidence of gastrointestinal bleeding or 30-day mortality between the SUP group and the control group [2.2% (8/358) vs. 3.4% (12/358), 15.9% (57/358) vs. 13.7% (49/358), both P > 0.05], but the incidence of hospital acquired pneumonia in the SUP group was still significantly higher than that in the control group [6.7% (24/358) vs. 3.1% (11/358), P < 0.05]. Kaplan-Meier survival curve analysis showed that the 30-day cumulative survival rate of the SUP group was significantly lower than that of the control group before the PSM (log-rank test: χ2 = 9.224, P = 0.002). There was no significant difference in the 30-day cumulative survival rate between the two groups after PSM (log-rank test: χ2 = 0.773, P = 0.379). Conclusion For critical patients, the use of PPI for SUP could not significantly reduce the incidence of gastrointestinal bleeding and mortality, but increase the risk of hospital acquired pneumonia.

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