Effect of long-term proton pump inhibitors on phosphocalcium metabolism and bone mineral density.

Aim: Although Proton pump inhibitors (PPIs) are well-tolerated, their long-term use may be associated with decreased bone mass. Methods: This is a case-control study including patients treated with PPIs (>1 year) and control subjects who have not received PPIs treatment. Results: A total of 90 patients and 90 matched controls were included. PPIs use was associated with hypocalcemia and hypomagnesemia. Vitamin D3 deficiency and hyperparathyroidism were associated with PPIs use. Long-term PPIs use was significantly associated with decreased bone density. Risk factors of decreased bone mineral density (BMD) included age >50 years, menopause, lack of sun exposure, double PPIs dose, daily intake, post-meal intake and association with a mucoprotective agent. Conclusion: Our results highlight the risk of decreased BMD in patients on long-term PPIs treatment.

In this study, we investigated the impact of long-term use of proton pump inhibitors (PPIs) on bone health. Examining 90 patients on PPIs for over a year and matching them with control subjects, we found that PPIs were linked to lower bone density. Factors such as age over 50. menopause, limited sun exposure, higher PPIs dosage, daily intake, post-meal usage and combining PPIs with a mucoprotective agent were associated with decreased bone mineral density. Our findings emphasize the concern of reduced bone density in individuals undergoing prolonged PPIs treatment.

Role of splenic and hepatic stiffness in predicting esophageal varices.

INTRODUCTION: Non-invasive assessment of portal hypertension in chronic liver disease is a topical subject. AIM: Evaluate accuracy of splenic (SS) and liver (LS) stiffness in predicting the presence of esophageal varices (OV) in chronic hepatitis B patients and determine a non-invasive composite score. METHODS: This was a monocentric cross-sectional study, including carriers of chronic hepatitis B. All patients benefited of SS and LS measurement by impulse elastography (FibroScan Echosens), FIB-4 score calculation and oeso-gastro-duodenal endoscopy. RESULTS: We included 84 patients. The average age was 49.04 ± 12.8 years. The mean value of SS and LS was significantly higher in presence of OV; p=0.000. At respective threshold values of 33.1 KPa and 43KPa, SS was able to predict the presence of OV and large OV with AUROC of 0.795 and 0.906. At respective threshold values of 7.75 KPa and 13.55 KPa, LS was able to predict the presence of OV and large OV with AUROC of 0.836 and 0.894. Arithmetic sum of SS, LS and FIB-4 values was able to predict the presence of OV and large OV with AUROC of 0.918 and 0.942. CONCLUSION: SS and LS are simple and reliable non-invasive tools for predicting OV and large OV. Their association with FIB-4 score improves their diagnostic accuracy.

Cirrhotic cardiomyopathy: is there any correlation between the stage of cardiac impairment and the severity of liver disease?

Cirrhotic cardiomyopathy is associated with poor prognosis and risk of acute heart failure after liver transplantation or interventional procedures. We aimed to assess the relationship between the severity of cardiac impairment and hepatic disease. Eighty patients and eighty controls underwent echocardiography, tissue Doppler imaging and speckle tracking measures. We assess the correlation between echocardiographic parameters and Child and MELD scores. Systolic parameters function (s wave, p < 0.001) and global longitudinal strain (p < 0.001) as well as diastolic parameters were significantly more impaired in cirrhotic patients compared to controls. There were no differences among the different groups in 'Child score' regarding systolic function as well as diastolic function. Paradoxically, the left atrium size correlated positively to both Child (p = 0.01, r = 0.26) and MELD scores (p = 0.02, r = 0.24). Left ventricular ejection fraction was significantly lower in decompensated patients as compared to compensated patients(p = 0.02).. We did not identify any association between severity of liver disease and cardiac dysfunction. Therefore, a transthoracic echocardiography should be performed in all cirrhotic patients before interventional and surgical procedures regardless of the severity of liver disease.