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1.
Am Surg ; 85(11): 1269-1275, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775970

RESUMO

Hiatal hernia repair (HHR) and fundoplication are similarly performed among all hiatal hernia types with similar techniques. This study evaluates the effect of HHR using a standardized technique for cruroplasty with a reinforcing polyglycolic acid and trimethylene carbonate mesh (PGA/TMC) on patient symptoms and outcomes. A retrospective review of patient perioperative characteristics and postoperative outcomes was conducted for cases of laparoscopic hiatal hernia repair (LHHR) using a PGA/TMC mesh performed over 21 months. Gastroesophageal reflux disease symptom questionnaire responses were compared between preoperative and three postoperative time points. Ninety-six patients underwent LHHR with a PGA/TMC mesh. Postoperatively, the number of overall symptoms reported by patients decreased across all postoperative periods (P < 0.001). Patients reported a significant reduction in antacid use long term (P < 0.001). Laryngeal and regurgitation symptoms decreased at all time points (P < 0.05). There was no difference in dysphagia preoperatively and postoperatively at any time point. Individuals undergoing HHR with PGA/TMC mesh experienced improved regurgitation and laryngeal symptoms, and decreased use of antacid medication.


Assuntos
Fundoplicatura/métodos , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia , Qualidade de Vida , Telas Cirúrgicas , Implantes Absorvíveis , Antiácidos/uso terapêutico , Antiulcerosos/uso terapêutico , Dioxanos , Feminino , Refluxo Gastroesofágico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Poliglicólico , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
2.
World J Gastroenterol ; 25(37): 5578-5589, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31602159

RESUMO

Helicobacter pylori (H. pylori) is a gram-negative bacterium that infects approximately 4.4 billion individuals worldwide. However, its prevalence varies among different geographic areas, and is influenced by several factors. The infection can be acquired by means of oral-oral or fecal-oral transmission, and the pathogen possesses various mechanisms that improve its capacity of mobility, adherence and manipulation of the gastric microenvironment, making possible the colonization of an organ with a highly acidic lumen. In addition, H. pylori presents a large variety of virulence factors that improve its pathogenicity, of which we highlight cytotoxin associated antigen A, vacuolating cytotoxin, duodenal ulcer promoting gene A protein, outer inflammatory protein and gamma-glutamyl transpeptidase. The host immune system, mainly by means of a Th1-polarized response, also plays a crucial role in the infection course. Although most H. pylori-positive individuals remain asymptomatic, the infection predisposes the development of various clinical conditions as peptic ulcers, gastric adenocarcinomas and mucosa-associated lymphoid tissue lymphomas. Invasive and non-invasive diagnostic methods, each of them with their related advantages and limitations, have been applied in H. pylori detection. Moreover, bacterial resistance to antimicrobial therapy is a major challenge in the treatment of this infection, and new therapy alternatives are being tested to improve H. pylori eradication. Last but not least, the development of effective vaccines against H. pylori infection have been the aim of several research studies.


Assuntos
Mucosa Gástrica/microbiologia , Infecções por Helicobacter/terapia , Helicobacter pylori/patogenicidade , Gastropatias/terapia , Antiácidos/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Vacinas Bacterianas/uso terapêutico , Farmacorresistência Bacteriana , Quimioterapia Combinada , Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/patologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/transmissão , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/imunologia , Humanos , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Probióticos/administração & dosagem , Inibidores da Bomba de Prótons/uso terapêutico , Gastropatias/diagnóstico , Gastropatias/microbiologia , Resultado do Tratamento , Fatores de Virulência/metabolismo
3.
Orv Hetil ; 160(34): 1340-1345, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31423829

RESUMO

Introduction and aim: As the efficacy of the first-line traditional treatment used to eradicate Helicobacter pylori (H. p.) decreased below 75% in Hungary, a new protocol had to be created. Method: Supposing the success rate of the traditional therapy (14-day double dose of proton pump inhibitor [PPI], 1000 mg amoxicillin b.i.d., 500 mg clarithromycin b.i.d. [PAC]) to be 75% and the efficacy of the new protocol (10-day 120 mg bismuth dicitrate q.i.d., double dose PPI b.i.d., 500 mg tetracycline q.i.d. and 500 mg tinidazole b.i.d. [BQT]) to be 90%, we calculated 109 patients on each arm. Patients were recruited after upper gastrointestinal endoscopy from 5 endoscopic units in Vas county. The heterogeneity of groups, success rate and side effects of both therapies were evaluated by Fisher exact test; p<0.05 was considered significant. Results: 110 patients were included in the BQT and 109 patients in the PAC group. There was no heterogeneity between the two groups in age, gender and indication of eradication. H. p. eradication was successful in 103/110 (93.6%) in the BQT and 81/109 (74.3%) in the PAC group (p<0.001). The odds ratio in the BQT group for successful eradication was 5.05 (95% confidence interval: 2.02-14.42) as compared to the PAC group (p<0.001). The side effects of the two groups were similar, in the BQT group the frequency was 34.5%. Conclusion: 10 day-long BQT containing double dose PPI with 120 mg bismuth dicitrate q.i.d., 500 mg tetracycline q.i.d. and 500 mg tinidazole b.i.d. is recommended as the first-line treatment for the eradication of H. p. because of its high efficacy and tolerable side effects. Orv Hetil. 2019; 160(34): 1340-1345.


Assuntos
Antiácidos/administração & dosagem , Antibacterianos/administração & dosagem , Bismuto/administração & dosagem , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Inibidores da Bomba de Prótons/administração & dosagem , Adulto , Idoso , Amoxicilina/administração & dosagem , Amoxicilina/uso terapêutico , Antiácidos/uso terapêutico , Antibacterianos/uso terapêutico , Bismuto/uso terapêutico , Claritromicina/administração & dosagem , Claritromicina/uso terapêutico , Esquema de Medicação , Farmacorresistência Bacteriana , Quimioterapia Combinada , Endoscopia Gastrointestinal , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/isolamento & purificação , Humanos , Hungria , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Tetraciclina/administração & dosagem , Tetraciclina/uso terapêutico , Tinidazol/administração & dosagem , Tinidazol/uso terapêutico , Resultado do Tratamento
4.
Arq Gastroenterol ; 56(2): 202-208, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31460587

RESUMO

BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal diseases. GERD generates significant impairment in patients' quality of life and it is associated to relevant medical resources utilization. A better understanding of GERD pathophysiology in the past five decades has favored the evolution of therapeutic strategies from non-drug interventions and antacids to more efficacious and safer alternatives. OBJECTIVE: To summarize data about the historical evolution of GERD management in Brazil, focusing on medical therapy and addressing evidence on efficacy and safety of drug classes currently recommended. METHODS: A narrative review was conducted by systematizing information about discoveries on GERD pathophysiology. We also addressed efficacy and safety of medications currently used to reduce symptoms and improve endoscopic healing of esophageal lesions. A structured search on Pubmed was performed to identify systematic reviews and meta-analysis investigating GERD outcomes positively impacted by proton pump inhibitors (PPIs), the first choice of pharmacotherapy for the disease. RESULTS: The chronological development of therapeutic measures for GERD in Brazil evolved from lifestyle interventions with relative poor effect on symptoms related to esophageal acid exposure, particularly heartburn, to effective and safe pharmacological interventions such as histamine H2-receptor antagonists and PPIs. In the present days, some drug classes play a minor role in disease management, namely prokinetics and antacids, due to their reduced efficacy and relevant safety concerns (particularly with prokinetics). The main challenge for prescribers and researchers seems to be finding long-acting acid suppressants strategies able to ameliorate patients' symptoms and quality of life, thereafter, reducing medical resource consumption. The dual delayed-release PPI dexlansoprazole seems to respond for some of the limitations other PPIs have. CONCLUSION: Recognizing the historical evolution of GERD management can help care providers to better understand therapeutic options for their patients, as well as focus on unmet needs that deserve further attention. PPIs are still the first choice therapy, with good evidence in favor of their efficacy, despite some safety concerns. However, as with any medical intervention, it is recommended to prescribe PPIs for patients with clear indication, using adequate dosing and monitoring for adverse events.


Assuntos
Terapia Comportamental/métodos , Medicina Baseada em Evidências , Refluxo Gastroesofágico/terapia , Estilo de Vida , Antiácidos/uso terapêutico , Antieméticos/uso terapêutico , Antagonistas dos Receptores Histamínicos H2/uso terapêutico , Humanos , Inibidores da Bomba de Prótons/uso terapêutico
5.
Medicine (Baltimore) ; 98(28): e16408, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305454

RESUMO

RATIONALE: The Gitelman's syndrome (GS) is characterized by metabolic alkalosis, hypokalemia, hypomagnesemia, and hypocalciuria. However, the involvement of this deranged electrolyte balance in patients with GS in parathyroid hormone action has not been known. PATIENT CONCERNS: We report a 34-year-old woman with muscle weakness and tetany/seizures caused by electrolyte imbalance. She had hyperphosphatemia and hypocalciuric hypocalcemia in addition to severe hypomagnesemia with low potassium in the absence of metabolic alkalosis. We identified 2 heterozygous mutations in the solute carrier family 12 member 3 gene in this case (c.1732G>A, p.Val578Met and c.2537_38delTT, p.846fs) by targeted sequence for all causative genes of salt-losing tubulopathies. DIAGNOSES: A diagnosis of GS. Hypocalcemia and hyperphosphatemia were suggested to relate with the secondary obstruction of appropriate parathyroid hormone release following severe hypomagnesemia in GS. INTERVENTIONS: She was treated with single oral magnesium oxide administration. OUTCOMES: The electrolyte imbalance including hypocalcemia and hyperphosphatemia were resolved with a remission of clinical manifestations. LESSONS: These observations, in this case, suggest that even severe hypomagnesemia caused by GS was associated with resistance to appropriate parathyroid hormone secretion. Through this case, we recognize that secondary hypoparathyroidism would be triggered by severe hypomagnesemia in GS.


Assuntos
Antiácidos/uso terapêutico , Síndrome de Gitelman/complicações , Síndrome de Gitelman/tratamento farmacológico , Hiperfosfatemia/complicações , Hiperfosfatemia/tratamento farmacológico , Óxido de Magnésio/uso terapêutico , Administração Oral , Adulto , Feminino , Síndrome de Gitelman/genética , Humanos , Hiperfosfatemia/genética
6.
Intern Med ; 58(17): 2581-2583, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31178496

RESUMO

A 74-year-old Japanese man who was taking antacids presented with profuse diarrhea. Stool culture revealed Vibrio cholerae O1 strain, serogroup Ogawa, biotype El tor. He recalled he had consumed some sashimi but denied any history of travelling abroad, and another cholera case with almost the same strain was reported at the same time in a remote prefecture in the Kanto area. This is a rare case of travel-unrelated cholera in Japan, and it illustrates the importance of suspecting cholera in all patients presenting with large volumes of watery diarrhea in Japan, especially in those who are taking antacids, regardless of their international travel history.


Assuntos
Cólera/diagnóstico , Vibrio cholerae O1 , Idoso , Antiácidos/uso terapêutico , Diarreia/microbiologia , Humanos , Japão , Masculino , Sorogrupo , Viagem
7.
Genes (Basel) ; 10(5)2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31067837

RESUMO

Although lifestyle and physiology in obese individuals are accepted to lead to changes in the intestinal microbiota, uncertainty remains about microbiota dysbiosis, and xenobiotics intake, as a source of selective pressure, independent of antimicrobial chemotherapy. The aim of this study was to compare the occurrence of antimicrobial resistance genetic markers (ARG) in faecal specimens of eutrophic, overweight and obese individuals, and their correlation with xenobiotic intake and gut bacteria density. Methods: This was a cross-sectional case-controlled study including 72 adult participants with no record of intestinal or systemic diseases, or recent use of antimicrobials, grouped as eutrophic, overweight, or obese. Anthropometric profile, eating habits and oral xenobiotics intake were recorded. Faecal metagenomic DNA was used to screen for ARG by PCR, and to measure bacterial groups by fluorescence in situ hybridization (FISH). Student's t and Wilcoxon tests were used to compare means and differences in ARG detection (95% confidence intervals). Correlation analyses (odds ratio) and relationships between bacteria density and ARG were determined. Results: Increase in abdominal circumference, waist circumference, hip, waist-hip ratio, BMI, carbohydrate, fibres, and total calorie intakes were different from eutrophic to obese participants. Habitual use of antihypertensive and anti-inflammatory drugs, antacids, and artificial sweeteners were associated mainly with obesity and overweight. Nutritional supplements were associated to the eutrophic group. ARG screening showed differences being more frequent among obese, and positive for 27 genetic markers related to ß-lactams, tetracyclines, the macrolide lincosamide and streptogramin group, quinolones, sulfonamides, aminoglycosides, and efflux pump. Positive correlation between ARG and BMI, caloric intake, and intake of xenobiotics, was observed for obese individuals. Relationships among ARG detection and bacteria densities were also different. Conclusions: This study reinforces the hypothesis that obese individuals may harbour an altered gut microbiota, if compared to eutrophic. The overweight individuals display a transitional gut microbiota which seems to be between eutrophic and obese. Furthermore, the increased xenobiotic intake associated to obesity may play an important role in the antimicrobial resistance phenomenon.


Assuntos
Resistência Microbiana a Medicamentos/genética , Trato Gastrointestinal/microbiologia , Sobrepeso/microbiologia , Adulto , Antiácidos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Suplementos Nutricionais , Fezes/microbiologia , Feminino , Microbioma Gastrointestinal/genética , Humanos , Hibridização in Situ Fluorescente , Masculino , Pessoa de Meia-Idade , Edulcorantes/administração & dosagem , Xenobióticos/administração & dosagem , Adulto Jovem
8.
BMC Pulm Med ; 19(1): 84, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053121

RESUMO

BACKGROUND AND OBJECTIVE: Gastroesophageal reflux disease (GORD) is highly prevalent in idiopathic pulmonary fibrosis (IPF) and may play a role in its pathogenesis. Recent IPF treatment guidelines suggest that all patients with IPF be considered for antacid therapy. However, emerging evidence suggests that antacid therapy does not improve IPF patient outcomes and may increase the risk of pulmonary infection. METHODS: Using prospectively collected data from the Australian IPF Registry including use of antacid therapy, GORD diagnosis and GORD symptoms, the relationship of these GORD variables to survival and disease progression was assessed. The severity of GORD symptoms using the frequency scale for symptoms of GORD (FSSG) and its relationships to outcomes was also assessed for the first time in an IPF cohort. RESULTS: Five hundred eighty-seven (86%) of the 684 patients in the Australian IPF Registry were eligible for inclusion. Patients were mostly male (69%), aged 71.0 ± 8.5 years with moderate disease (FVC 81.7 ± 21.5%; DLco 48.5 ± 16.4%). Most patients were taking antacids (n = 384; 65%), though fewer had a diagnosis of GORD (n = 243, 41.4%) and typical GORD symptoms were even less common (n = 171, 29.1%). The mean FSSG score was 8.39 ± 7.45 with 43% (n = 251) having a score > 8. Overall, there was no difference in survival or disease progression, regardless of antacid treatment, GORD diagnosis or GORD symptoms. CONCLUSIONS: Neither the use of antacid therapy nor the presence of GORD symptoms affects longer term outcomes in IPF patients. This contributes to the increasing evidence that antacid therapy may not be beneficial in IPF patients and that GORD directed therapy should be considered on an individual basis to treat the symptoms of reflux.


Assuntos
Antiácidos/uso terapêutico , Refluxo Gastroesofágico/tratamento farmacológico , Fibrose Pulmonar Idiopática/tratamento farmacológico , Idoso , Austrália , Progressão da Doença , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/fisiopatologia , Humanos , Fibrose Pulmonar Idiopática/complicações , Fibrose Pulmonar Idiopática/fisiopatologia , Estimativa de Kaplan-Meier , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Índice de Gravidade de Doença , Resultado do Tratamento , Capacidade Vital
9.
World J Gastroenterol ; 25(16): 1907-1912, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31086459

RESUMO

Helicobacter pylori (H. pylori) antimicrobial resistance is an urgent, global issue. In 2017, the World Health Organization designated clarithromycin-resistant H. pylori as a high priority bacterium for antibiotic research and development. In addition to clarithromycin, resistance to metronidazole and fluoroquinolones has also increased worldwide. Recent international guidelines for management of H. pylori infection recommend bismuth or non-bismuth quadruple therapy for 14 d as a first-line treatment for H. pylori in areas of high clarithromycin and/or metronidazole resistance. Although these treatment regimens provide acceptable H. pylori eradication rates, the regimens used should not contribute to future resistance of H. pylori to antimicrobials. Moreover, these regimens can promote resistance, due to prolonged therapy with multiple antibiotics. A new strategy that can eradicate H. pylori as well as reduce the antibiotics used is required to prevent future antimicrobial resistance in H. pylori. Dual-therapy with vonoprazan and amoxicillin could be a breakthrough for H. pylori eradication in an era of growing antimicrobial resistance. This regimen may provide a satisfactory eradication rate of H. pylori and also minimize antimicrobial resistance due to single antibiotic use and the strong inhibitory effect of vonoprazan on gastric acid secretion.


Assuntos
Antiácidos/farmacologia , Antibacterianos/farmacologia , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/fisiologia , Inibidores da Bomba de Prótons/uso terapêutico , Amoxicilina/farmacologia , Amoxicilina/uso terapêutico , Antiácidos/uso terapêutico , Antibacterianos/uso terapêutico , Bismuto/farmacologia , Bismuto/uso terapêutico , Erradicação de Doenças/métodos , Farmacorresistência Bacteriana/efeitos dos fármacos , Quimioterapia Combinada/métodos , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Humanos , Inibidores da Bomba de Prótons/farmacologia , Pirróis/farmacologia , Pirróis/uso terapêutico , Sulfonamidas/farmacologia , Sulfonamidas/uso terapêutico , Fatores de Tempo
10.
Gastrointest Endosc ; 90(3): 448-456.e1, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31034810

RESUMO

BACKGROUND AND AIMS: The effect of Helicobacter pylori eradication on de novo gastric cancer is controversial, although meta-analyses suggest a reduction in gastric cancer after eradication. The effect of high-density lipoprotein (HDL) on gastric cancer has been rarely reported. METHODS: In this large retrospective cohort study, participants underwent endoscopy and H pylori testing from 2003 to 2011 and underwent follow-up endoscopy and H pylori testing until 2013. H pylori infection was detected using a rapid urease test or histologic test. The H pylori eradication group was defined as successful eradication, whereas the H pylori persistent group was defined as noneradication or eradication failure. The risk of cancer was measured with hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Among 10,328 healthy subjects (5951 men; mean age, 48.7 years), 31 gastric cancers were detected during a median follow-up of 5.5 years. De novo gastric cancer developed in 21 of 3508 subjects (.6%) in the noneradication group, 4 of 2050 subjects (.2%) in the successful eradication group, and 6 of 4770 participants (.13%) in the absence of H pylori group. In the adjusted analysis, H pylori eradication decreased de novo gastric cancer risk (HR, .29; 95% CI, .10-.86) compared with the persistent group. The risk of de novo gastric cancer in absence of H pylori was also much lower compared with the persistent group (HR, .24; 95% CI, .09-.60). Low serum HDL increased the risk of de novo gastric cancer (HR, 2.67; 95% CI, 1.14-6.16). CONCLUSIONS: Successful H pylori eradication reduced de novo gastric cancer, whereas low HDL increased its risk.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Lipoproteínas HDL/sangue , Inibidores da Bomba de Prótons/uso terapêutico , Neoplasias Gástricas/epidemiologia , Adulto , Antiácidos/uso terapêutico , Estudos de Coortes , Feminino , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Proteção , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento
11.
JAMA ; 321(15): 1481-1490, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30990550

RESUMO

Importance: Oral mucositis causes substantial morbidity during head and neck radiotherapy. In a randomized study, doxepin mouthwash was shown to reduce oral mucositis-related pain. A common mouthwash comprising diphenhydramine-lidocaine-antacid is also widely used. Objective: To evaluate the effect of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash for the treatment of oral mucositis-related pain. Design, Setting, and Participants: A phase 3 randomized trial was conducted from November 1, 2014, to May 16, 2016, at 30 US institutions and included 275 patients who underwent definitive head and neck radiotherapy, had an oral mucositis pain score of 4 points or greater (scale, 0-10), and were followed up for a maximum of 28 days. Interventions: Ninety-two patients were randomized to doxepin mouthwash (25 mg/5 mL water); 91 patients to diphenhydramine-lidocaine-antacid; and 92 patients to placebo. Main Outcome and Measures: The primary end point was total oral mucositis pain reduction (defined by the area under the curve and adjusted for baseline pain score) during the 4 hours after a single dose of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash compared with a single dose of placebo. The minimal clinically important difference was a 3.5-point change. The secondary end points included drowsiness, unpleasant taste, and stinging or burning. All scales ranged from 0 (best) to 10 (worst). Results: Among the 275 patients randomized (median age, 61 years; 58 [21%] women), 227 (83%) completed treatment per protocol. Mucositis pain during the first 4 hours decreased by 11.6 points in the doxepin mouthwash group, by 11.7 points in the diphenhydramine-lidocaine-antacid mouthwash group, and by 8.7 points in the placebo group. The between-group difference was 2.9 points (95% CI, 0.2-6.0; P = .02) for doxepin mouthwash vs placebo and 3.0 points (95% CI, 0.1-5.9; P = .004) for diphenhydramine-lidocaine-antacid mouthwash vs placebo. More drowsiness was reported with doxepin mouthwash vs placebo (by 1.5 points [95% CI, 0-4.0]; P = .03), unpleasant taste (by 1.5 points [95% CI, 0-3.0]; P = .002), and stinging or burning (by 4.0 points [95% CI, 2.5-5.0]; P < .001). Maximum grade 3 adverse events for the doxepin mouthwash occurred in 3 patients (4%); diphenhydramine-lidocaine-antacid mouthwash, 3 (4%); and placebo, 2 (2%). Fatigue was reported by 5 patients (6%) in the doxepin mouthwash group and no patients in the diphenhydramine-lidocaine-antacid mouthwash group. Conclusions and Relevance: Among patients undergoing head and neck radiotherapy, the use of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash vs placebo significantly reduced oral mucositis pain during the first 4 hours after administration; however, the effect size was less than the minimal clinically important difference. Further research is needed to assess longer-term efficacy and safety for both mouthwashes. Trial Registration: ClinicalTrials.gov Identifier: NCT02229539.


Assuntos
Antiácidos/uso terapêutico , Difenidramina/uso terapêutico , Doxepina/uso terapêutico , Neoplasias de Cabeça e Pescoço/radioterapia , Lidocaína/uso terapêutico , Antissépticos Bucais , Lesões por Radiação/tratamento farmacológico , Estomatite/tratamento farmacológico , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Difenidramina/efeitos adversos , Método Duplo-Cego , Doxepina/efeitos adversos , Fadiga/induzido quimicamente , Feminino , Humanos , Lidocaína/efeitos adversos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Estomatite/etiologia
12.
Gastroenterology ; 157(1): 44-53, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30998990

RESUMO

Increasing resistance to antibiotics worldwide has adverse effects on the effectiveness of standard therapies to eradicate Helicobacter pylori infection. We reviewed guidelines developed by expert groups in Europe, Canada, and the United States for the treatment of H pylori infection. We compared the recommendations of these guidelines, reconciled them, and addressed the increasing resistance of H pylori to antibiotic therapy regimens. The guidelines recommend bismuth quadruple therapy for first-line treatment, replacing clarithromycin-based triple therapy. There is consensus for concomitant 4-drug therapy as an alternative, especially when bismuth is not available. When therapy is unsuccessful, it is likely due to resistance to clarithromycin, levofloxacin, and/or metronidazole; these drugs, if used previously, should be avoided in subsequent eradication attempts. Second-line therapies should be bismuth quadruple therapy or levofloxacin triple therapy, depending on suspected resistance, reserving rifabutin-based triple and high-dose dual amoxicillin proton pump inhibitor therapy for subsequent treatment attempts. The increasing resistance of H pylori to antibiotic therapy necessitates local availability of susceptibility tests for individuals, and establishment of regional and national monitoring programs to develop evidence-based locally relevant eradication strategies. Further studies into the development of more easily accessible methods of resistance testing, such as biomarker analysis of stool samples, are required. Options under investigation include substituting vonoprazan for proton pump inhibitors, adding probiotics, and vaccine development. Narrow-spectrum antibiotics and new therapeutic targets could be identified based on genomic, proteomic, and metabolomic analyses of H pylori.


Assuntos
Antiácidos/uso terapêutico , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Guias de Prática Clínica como Assunto , Inibidores da Bomba de Prótons/uso terapêutico , Amoxicilina/uso terapêutico , Bismuto/uso terapêutico , Canadá , Claritromicina/uso terapêutico , Quimioterapia Combinada , Europa (Continente) , Infecções por Helicobacter , Helicobacter pylori , Humanos , Levofloxacino/uso terapêutico , Metronidazol/uso terapêutico , Testes de Sensibilidade Microbiana , Rifabutina/uso terapêutico , Tetraciclina/uso terapêutico , Estados Unidos
14.
J Pediatr Nurs ; 46: e64-e71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30898459

RESUMO

OBJECTIVE: This study assessed the prevalence of children's and adolescents' pain experiences and use of medicine and examined the relationships between pain experiences, medication knowledge, literacy, and use of medicine. METHOD: A probability-proportionate-to-size sampling method was used to systematically draw a random sample of schools. In 2014, a national representative sample of 2309 students from 35 primary schools (5th-6th grade), 2700 students from 30 middle schools, and 2013 students from 20 high schools completed the online survey. RESULTS: Overall, 85.6% of children and adolescents reported experiencing pain during the past year that included headache (63.0%), throat ache (59.3%), muscle ache (58.3%), stomach pain (42.9%), menstrual pain (girls: 42.1%), and dental pain (38.5%). Children and adolescents had taken cold/cough medicine (48.1%), acetaminophen (15.0%), antacids (14.8%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (10.5%) in the past year. Multivariate analysis results indicated that after controlling for pain experiences children and adolescents who had lower levels of medication knowledge and literacy were more likely to use pain medication and antacids more frequently. In addition, children and adolescents who had lower medication knowledge, lower literacy, asked doctors to prescribe antacids, and co-administered with antacids were more likely to report long-term use of antacids. CONCLUSIONS: Lower levels of medication knowledge and literacy among children and adolescents were associated with more frequent use of pain medication and antacids.


Assuntos
Analgésicos/uso terapêutico , Antiácidos/uso terapêutico , Alfabetização em Saúde , Dor/tratamento farmacológico , Dor/epidemiologia , Automedicação/estatística & dados numéricos , Adolescente , Criança , Feminino , Humanos , Masculino , Prevalência , Taiwan/epidemiologia
15.
Korean J Gastroenterol ; 73(2): 70-76, 2019 Feb 25.
Artigo em Coreano | MEDLINE | ID: mdl-30845382

RESUMO

Gastroesophageal reflux disease (GERD) is a condition that develops when reflux of stomach contents causes troublesome symptoms and/or complications. The prevalence of GERD is increasing worldwide and in Asia-Pacific. The latest Korean guidelines for GERD were published in 2012, and several international guidelines and consensus statements for the management of GERD have also been recently published. Here, we review these guidelines and consensus statements in order to provide a better understanding of the diagnosis and treatment of GERD.


Assuntos
Refluxo Gastroesofágico/patologia , Antiácidos/uso terapêutico , Endoscopia Gastrointestinal , Refluxo Gastroesofágico/tratamento farmacológico , Antagonistas dos Receptores Histamínicos H2/uso terapêutico , Humanos , Guias de Prática Clínica como Assunto , Inibidores da Bomba de Prótons/uso terapêutico
16.
Clin Perinatol ; 46(1): 129-143, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30771814

RESUMO

Multicenter groups have reported reductions in the incidence of necrotizing enterocolitis (NEC) among preterm infants over the past 2 decades. These large-scale prevalence studies have coincided with reports from multicenter consortia and single centers of modifications in practice using quality-improvement techniques aimed at either reducing NEC risk specifically or reducing risk of mortality and multiple morbidities associated with extreme prematurity. The modifications in practice have been based on mechanistic studies, epidemiologic association data, and clinical trials. Recent reports from centers modifying practice to reduce NEC are reviewed and select modified/modifiable practices discussed.


Assuntos
Colostro , Nutrição Enteral/métodos , Enterocolite Necrosante/prevenção & controle , Leite Humano , Melhoria de Qualidade , Antiácidos/uso terapêutico , Antibacterianos/uso terapêutico , Transfusão de Sangue , Enterocolite Necrosante/epidemiologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Probióticos/uso terapêutico , Fatores de Risco
17.
Helicobacter ; 24(2): e12565, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30698318

RESUMO

BACKGROUND AND AIMS: An increase in the use of antibiotics leads to increased antibiotic resistance of Helicobacter pylori (H pylori). Consequently, it has been considered that the first-line standard regimen should be changed. The main purpose of this study was to evaluate the efficacy of nonantibiotic (bismuth) supplements as a first-line regimen for H pylori eradication. METHODS: We searched PubMed, EMBASE, CINAHL, and the Cochrane Library databases for randomized controlled trials (RCTs) reported in English and undertaken up until August 2018. A meta-analysis of all randomized controlled trials comparing bismuth supplements with non-bismuth-containing regimens in H pylori eradication was performed. RCTs of classic bismuth-containing quadruple therapy as a first-line regimen were excluded. RESULTS: We identified twenty-five randomized trials (3990 patients), and the total H pylori eradication rate, according to per protocol analyzed, was 85.8%. The odds ratio was 1.83 (95% confidence interval (CI). 1.57-2.13). Among these RCTs, there were 7 RCTs for bismuth add-on therapy, and the odds ratio was 2.81 (95% CI. 2.03-3.89). When the studies were performed in a high clarithromycin resistance area (≥15%) or included patients with clarithromycin resistance, bismuth-containing regimens were superior to non-bismuth regimens. Moreover, the incidence of total side effects was insignificant. CONCLUSIONS: Bismuth supplements as a first-line regimen could be effective, with bismuth add-on regimens being the most effective. Particularly, bismuth supplements showed the potential efficacy for clarithromycin-resistant strains and would be the most viable alternative in clinical practice.


Assuntos
Bismuto/farmacologia , Bismuto/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Antiácidos/farmacologia , Antiácidos/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Claritromicina/farmacologia , Claritromicina/uso terapêutico , Farmacorresistência Bacteriana , Quimioterapia Combinada , Humanos , Resultado do Tratamento
18.
Gastroenterol Nurs ; 42(1): 20-28, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30688703

RESUMO

Gastroesophageal reflux disease (GERD) is a common chronic disorder in industrialized countries. Gastroesophageal reflux disease is one of the most frequent diseases encountered by primary care providers. The primary symptoms of GERD include heartburn, regurgitation, globus sensation, dysphagia, chest pain, and belching. If symptoms are left untreated, a major concern is complications and the potential risk of esophageal adenocarcinoma associated with GERD. With the increasing prevalence and incidence of GERD and the increasing cost of this disease, there is a need for advanced practice registered nurses to understand the nature of GERD including its pathophysiology, signs and symptoms, and treatment options to address the disease.


Assuntos
Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Antiácidos/uso terapêutico , Endoscopia , Monitoramento do pH Esofágico , Refluxo Gastroesofágico/fisiopatologia , Antagonistas dos Receptores Histamínicos H2/uso terapêutico , Humanos , Manometria , Inibidores da Bomba de Prótons/uso terapêutico , Fatores de Risco , Avaliação de Sintomas
19.
Support Care Cancer ; 27(3): 849-856, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30062585

RESUMO

PURPOSE: SN-38, an active metabolite of irinotecan, is reabsorbed by the intestinal tract during excretion, causing diarrhoea and neutropenia. In addition, the association between blood levels of SN-38 and neutropenia has been reported previously, and the rapid excretion of SN-38 from the intestinal tract is considered to prevent neutropenia. Oral alkalization drugs are used as prophylactic agents for suppressing SN-38 reabsorption. The relationship between oral alkalization drugs and neutropenia, however, has not been well studied. The aim of this study was to investigate the relationship between oral alkalization drugs and neutropenia in irinotecan-treated patients. METHODS AND RESULTS: Patients with cervical or ovarian cancer were administered irinotecan and investigated by medical chart reviews to determine whether oral alkalization drugs were effective at ameliorating irinotecan-induced neutropenia. The drug combination in the oral alkalization drugs-ursodeoxycholic acid, magnesium oxide, and sodium hydrogen carbonate-significantly improved neutrophil counts and reduced dose intensity compared with those of non-users. In the large-scale Japanese Adverse Drug Event Report database, the reporting odds ratio of irinotecan-induced neutropenia was significantly lower when irinotecan had been given in combination with oral alkalization drugs. CONCLUSIONS: These data indicate that oral alkalization drugs may reduce the frequency of neutropenia caused by irinotecan administration, making it possible to increase the dose safely.


Assuntos
Irinotecano/efeitos adversos , Neutropenia/induzido quimicamente , Inibidores da Topoisomerase I/efeitos adversos , Adulto , Idoso , Antiácidos/uso terapêutico , Antineoplásicos Fitogênicos/efeitos adversos , Tampões (Química) , Camptotecina/análogos & derivados , Colagogos e Coleréticos/uso terapêutico , Diarreia/prevenção & controle , Feminino , Humanos , Intestinos/efeitos dos fármacos , Óxido de Magnésio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Bicarbonato de Sódio/uso terapêutico , Ácido Ursodesoxicólico/uso terapêutico , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias Uterinas/tratamento farmacológico
20.
Drug Dev Ind Pharm ; 45(3): 430-438, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30470147

RESUMO

OBJECTIVE: To investigate the intragastric acid neutralization activity of a combined alginate-antacid formulation. SIGNIFICANCE: Published studies have investigated the reflux-suppressing alginate component of Gaviscon Double Action (Gaviscon DA; RB, UK) but intragastric acid neutralization activity of the antacid component has not been evaluated in vivo. METHODS: Intragastric pH monitoring, using a custom-made 10-electrode catheter, was evaluated in a two-part exploratory study in healthy subjects; Part I (n = 6) tested suitability of the catheter using antacid tablets (Rennie; Bayer, Germany); Part II (n = 12) evaluated gastric acid neutralization activity of Gaviscon DA liquid (20 ml) versus placebo in fasted subjects using a randomized, open-label, crossover design. The primary endpoint was the percentage of time that intragastric pH ≥4 was measured during 30 min post-treatment. A confirmatory study of identical design was subsequently conducted (n = 20). RESULTS: Monitoring pH using the multielectrode catheter was a viable approach, directly detecting changes in intragastric pH following a single dose of antacid tablets. In the exploratory study, the percentage of time that pH ≥4 during 30 minutes post-treatment was 46.8% with Gaviscon DA liquid versus 4.7% with placebo (p = 0.0004). These findings were supported by the confirmatory study, where pH ≥4 was recorded 50.8% of the time with Gaviscon DA versus 3.5% with placebo (p = 0.0051). In this study, Gaviscon DA was safe and well tolerated. CONCLUSIONS: These studies demonstrate the effective acid neutralizing capacity of Gaviscon DA versus placebo in healthy, fasted subjects. This adds to the evidence base for the combination of alginates and antacids.


Assuntos
Alginatos/uso terapêutico , Hidróxido de Alumínio/uso terapêutico , Antiácidos/uso terapêutico , Antiulcerosos/uso terapêutico , Ácido Gástrico/metabolismo , Ácido Silícico/uso terapêutico , Bicarbonato de Sódio/uso terapêutico , Adulto , Carbonato de Cálcio/uso terapêutico , Química Farmacêutica/métodos , Estudos Cross-Over , Combinação de Medicamentos , Feminino , Refluxo Gastroesofágico/tratamento farmacológico , Voluntários Saudáveis , Humanos , Concentração de Íons de Hidrogênio , Magnésio/uso terapêutico , Masculino , Comprimidos/uso terapêutico , Adulto Jovem
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