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1.
BMJ ; 372: m4903, 2021 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-33414239

RESUMO

OBJECTIVE: To assess the use of proton pump inhibitors (PPIs) to treat persistent throat symptoms. DESIGN: Pragmatic, double blind, placebo controlled, randomised trial. SETTING: Eight ear, nose, and throat outpatient clinics, United Kingdom. PARTICIPANTS: 346 patients aged 18 years or older with persistent throat symptoms who were randomised according to recruiting centre and baseline severity of symptoms (mild or severe): 172 to lansoprazole and 174 to placebo. INTERVENTION: Random blinded allocation (1:1) to either 30 mg lansoprazole twice daily or matched placebo twice daily for 16 weeks. MAIN OUTCOME MEASURES: Primary outcome was symptomatic response at 16 weeks measured using the total reflux symptom index (RSI) score. Secondary outcomes included symptom response at 12 months, quality of life, and throat appearances. RESULTS: Of 1427 patients initially screened for eligibility, 346 were recruited. The mean age of the study sample was 52.2 (SD 13.7) years, 196 (57%) were women, and 162 (47%) had severe symptoms at presentation; these characteristics were balanced across treatment arms. The primary analysis was performed on 220 patients who completed the primary outcome measure within a window of 14-20 weeks. Mean RSI scores were similar between treatment arms at baseline: lansoprazole 22.0 (95% confidence interval 20.4 to 23.6) and placebo 21.7 (20.5 to 23.0). Improvements (reduction in RSI score) were observed in both groups-score at 16 weeks: lansoprazole 17.4 (15.5 to19.4) and placebo 15.6 (13.8 to 17.3). No statistically significant difference was found between the treatment arms: estimated difference 1.9 points (95% confidence interval -0.3 to 4.2 points; P=0.096) adjusted for site and baseline symptom severity. Lansoprazole showed no benefits over placebo for any secondary outcome measure, including RSI scores at 12 months: lansoprazole 16.0 (13.6 to 18.4) and placebo 13.6 (11.7 to 15.5): estimated difference 2.4 points (-0.6 to 5.4 points). CONCLUSIONS: No evidence was found of benefit from PPI treatment in patients with persistent throat symptoms. RSI scores were similar between the lansoprazole and placebo groups after 16 weeks of treatment and at the 12 month follow-up. TRIAL REGISTRATION: ISRCTN Registry ISRCTN38578686 and EudraCT 2013-004249-17.


Assuntos
Lansoprazol/administração & dosagem , Faringite/tratamento farmacológico , Inibidores da Bomba de Prótons/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Esofagite Péptica/complicações , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Faringite/etiologia , Qualidade de Vida , Reino Unido
2.
Artigo em Inglês | MEDLINE | ID: mdl-33461697

RESUMO

Rabeprazole belongs to the class of anti-secretory drugs, with benzimidazoles substitution. These drugs induce gastric acid secretion through precise inhibition of the enzyme H+/K+-ATPase (acid or proton pump). This effect helps to treat and prevent conditions in which gastric acid directly aggravates symptoms such as duodenal and gastric ulcers. This chapter includes a comprehensive review of rabeprazole in terms of nomenclature, its physical-chemical properties, methods of preparation and ADME profiles. In addition, the chapter also includes a review of several methods for analysis of rebeprazole in its dosage forms and biological fluids.


Assuntos
Antiulcerosos , Inibidores da Bomba de Prótons , Rabeprazol/farmacologia , Antiulcerosos/farmacologia , Ácido Gástrico , Humanos , Inibidores da Bomba de Prótons/farmacologia
3.
Khirurgiia (Mosk) ; (1): 42-46, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395511

RESUMO

OBJECTIVE: To study the effectiveness of pharmacotherapy for perforated gastric ulcer in a surgical hospital. MATERIAL AND METHODS: A retrospective analysis of the treatment of 693 patients with perforated gastric and duodenal ulcers was carried out. Laparoscopic and open surgeries were performed. Statistical analysis was performed using the Statistica and MS Excel software packages. Student t-test was applied for independent samples and Fisher's F-test was calculated. RESULTS: Combined therapy included surgical treatment (suturing of the ulcer as a rule) and medication with proton pump inhibitors, antibacterial drugs. Over the past 5 years, postoperative quality of life has been significantly improved in patients with perforated ulcers. Stomach resection and vagotomy for perforated ulcers will become historical in the near future. Laparoscopic and open procedures ensure similar periods of ulcer closure. CONCLUSION: Currently, successful treatment of perforated gastric and duodenal ulcers requires an integrated approach at all levels of specialized care and is impossible without modern pharmacotherapy.


Assuntos
Úlcera Duodenal , Úlcera Péptica Perfurada , Úlcera Gástrica , Antibacterianos/uso terapêutico , Terapia Combinada , Úlcera Duodenal/complicações , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/cirurgia , Humanos , Úlcera Péptica Perfurada/diagnóstico , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/etiologia , Úlcera Péptica Perfurada/cirurgia , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida , Estudos Retrospectivos , Úlcera Gástrica/complicações , Úlcera Gástrica/tratamento farmacológico , Úlcera Gástrica/cirurgia , Resultado do Tratamento
4.
Anticancer Res ; 41(2): 811-819, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517286

RESUMO

BACKGROUND/AIM: The GastroPanel® test (Biohit Oyj) is interpreted by the GastroSoft® application distinguishing eight biomarker profiles, of which five profiles have a morphological equivalent in the Updated Sydney System (USS) classification of gastritis, and 3 others specify functional disorders of the stomach: 1) high acid output, 2) low acid output, and 3) effects of proton pump inhibitor (PPI) medication. This study evaluated the prevalence of these biomarker profiles in dyspeptic patients. PATIENTS AND METHODS: A cross-sectional study was designed to assess the point prevalence of these biomarker profiles in a random sample of 500 subjects derived from our archives of GastroPanel® samples. RESULTS: Reflux symptoms were reported by 35.2% and use of PPI medication by 36.8% of the study subjects. Biomarker profile 2 (high acid output) was the second most common GastroPanel® profile in this cohort; 31.2%, second only (33.6%) to profile 1 (healthy stomach). Hp-infection was detected in 25.0% of the subjects. Profiles related to use of PPI (low acid output, PPI effect) were found in 7.4% of the cases. AG was uncommon, diagnosed in 14 patients only (2.8%). CONCLUSION: These data are derived from the population with the highest frequency of dyspepsia, and the results might have widespread implications in diagnostic and screening practices.


Assuntos
Dispepsia/tratamento farmacológico , Gastrite Atrófica/diagnóstico , Infecções por Helicobacter/diagnóstico , Inibidores da Bomba de Prótons/uso terapêutico , Idoso , Estudos Transversais , Dispepsia/etiologia , Feminino , Determinação da Acidez Gástrica , Gastrite Atrófica/epidemiologia , Infecções por Helicobacter/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Kit de Reagentes para Diagnóstico , Testes Sorológicos
5.
Nihon Shokakibyo Gakkai Zasshi ; 118(1): 61-69, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33431751

RESUMO

BACKGROUND: Marginal ulcer after pancreatoduodenectomy (PD) is a relatively common complication, but if massive bleeding or ulcer perforation occurs together with the marginal ulcer, this condition may be fatal. OBJECTIVE: To identify the risk factors and management of marginal ulcer after PD. METHODS: In all, 438 patients who underwent PD from 2003 to 2017 were retrospectively reviewed and analyzed. After surgery, all patients were administered a histamine H2 receptor antagonist (H2RA) or a proton pump inhibitor (PPI), which was continued after discharge. Marginal ulcer was diagnosed by endoscopy or surgery. The risk factors for marginal ulcer were then investigated using univariate and multivariate analyses. RESULTS: After a median follow-up time of 2.7 years, 29 patients (6.6%) developed marginal ulcer. Seventeen patients developed marginal ulcer within 1 year after PD, and 7 patients developed marginal ulcer more than 3 years after PD. All 8 patients who underwent surgery for the treatment of marginal ulcer developed acute peritonitis. Two patients with acute peritonitis died within 1 month after surgery. A multivariate analysis found that discontinuation of PPI treatment was the only independent risk factor for marginal ulcer development (P<0.001). In contrast, sex, age, primary disease, procedure, operation time, volume of blood loss, pancreatic texture, development of postoperative pancreatic fistula, postoperative complications, poor glycemic control after PD, and discontinuation of H2RA therapy after PD were not significantly different between the patient group that developed marginal ulcer and the patient group that did not. Sixteen patients were not treated with antacids at the time of marginal ulcer development. The reason for discontinuation of antacids was the decision of the family physician in 8 cases and the decision of the patient in 3 cases. CONCLUSION: Marginal ulcer can still develop a long time after PD, and sometimes, it may be fatal. PPI administration should be continued even after a long time has passed, although this therapy is often discontinued for various reasons. It is therefore important for family physicians and patients to recognize the danger of marginal ulcer after PD.


Assuntos
Pancreaticoduodenectomia , Úlcera Péptica , Antagonistas dos Receptores Histamínicos H2 , Humanos , Pancreaticoduodenectomia/efeitos adversos , Inibidores da Bomba de Prótons , Estudos Retrospectivos
6.
Am J Case Rep ; 22: e928021, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33473099

RESUMO

BACKGROUND Cameron lesions are linear erosions and ulcers on the crests of gastric mucosal folds in the neck of a hiatal hernia and can be difficult to diagnose and treat. This report is of a case of chronic iron deficiency in a 61-year-old woman with a late diagnosis of a Cameron lesion, who did not respond to a single treatment with the proton pump inhibitor (PPI) pantoprazole, but was then treated with oral poloxamer 407 with hyaluronic acid and chondroitin sulfate in addition to PPI. CASE REPORT We report the case of a 61-year-old women with recurrent iron-deficiency anemia, first diagnosed 40 years prior to her presentation at our Endoscopy Unit, and an ongoing melena. We discovered an intrahiatal gastric mucosal defect, which we at first treated with proton pump inhibitors and sucralfate. After a follow-up gastroscopy revealed the persistence of the lesion, we decided to incorporate into the treatment a gel-like substance containing, among others, hyaluronic acid and chondroitin sulfate, and observed that the lesion resolved completely. CONCLUSIONS This report highlights that Cameron lesions should be considered in patients with hiatal hernia who have iron-deficiency anemia and can be diagnosed on upper endoscopy. Further clinical studies are required to determine the role of combined poloxamer 407 with hyaluronic acid and chondroitin sulfate in the management of Cameron lesions.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Úlcera Gástrica/complicações , Úlcera Gástrica/tratamento farmacológico , Adjuvantes Imunológicos/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Doença Crônica , Portadores de Fármacos , Feminino , Gastroscopia , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico , Humanos , Ácido Hialurônico/uso terapêutico , Pessoa de Meia-Idade , Pantoprazol/uso terapêutico , Poloxâmero/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Úlcera Gástrica/diagnóstico
9.
Isr Med Assoc J ; 23(1): 38-42, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33443341

RESUMO

BACKGROUND: The antibiotic resistance profile of Helicobacter pylori (H. pylori) is constantly changing. Up-to-date and reliable data for the effectiveness of first-line H. pylori treatment protocols are necessary to provide evidence-based best-practice guidelines. OBJECTIVES: To determine the effectiveness, compliance and safety of first-line treatment for H. pylori in Israel. METHODS: An observational, prospective, multicenter study was conducted in tertiary referral centers in Israel, as part of the European registry on H. pylori management (Hp-EuReg). H. pylori-infected patients were included from 2013 to March 2020. Data collected included demographics, clinical data, diagnostic tests, previous eradication attempts, current treatment, compliance, adverse events, and treatment outcome result. RESULTS: In total, 242 patients were registered, including 121 (50%) who received first-line therapy, 41% of these individuals received clarithromycin based triple therapy and 58.9% received a four-drug regimen. The overall effectiveness of first-line therapy was 85% and 86% by modified intention-to-treat and per protocol analyses, respectively. The effectiveness of both sequential and concomitant therapies was 100% while clarithromycin-based triple therapy achieved an eradication rate of 79%. Treatment eradication was higher among patients who received high dose proton pump inhibitor (PPI) compared to those treated with low dose PPI (100% vs. 81.5% respectively, P < 0.01). No difference in treatment effectiveness was found between 7-, 10-, and 14-day treatment. CONCLUSIONS: The effectiveness of clarithromycin-based triple therapy is suboptimal. First-line treatment of H. pylori infection should consist of four drugs, including high dose PPI, according to international guidelines.


Assuntos
Antibacterianos , Claritromicina/administração & dosagem , Infecções por Helicobacter , Helicobacter pylori/efeitos dos fármacos , Inibidores da Bomba de Prótons/administração & dosagem , Antibacterianos/administração & dosagem , Antibacterianos/classificação , Relação Dose-Resposta a Droga , Quimioterapia Combinada/métodos , Quimioterapia Combinada/estatística & dados numéricos , Feminino , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Humanos , Israel/epidemiologia , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Retratamento/métodos , Retratamento/estatística & dados numéricos , Resultado do Tratamento
10.
Bioresour Technol ; 319: 124118, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32957047

RESUMO

The proton pump is a convincing mechanism for ammonia inhibition in anaerobic digestion, which explained how the ammonia accumulated intercellularly due to diffusion of free ammonia. Proton pump inhibitor (PPI) was dosed for mitigating the accumulation in anaerobic digestion with ammonia stress, with respect to kinetics. Results show PPI inhibited ß-oxidation of fatty acids by targeting ATPase in anaerobic digestion with ammonia stress. Alternatively, PPI stimulated syntrophic acetate oxidization. Random forest located key genera as syntrophic consortia. Methane increased 18.72 ± 7.39% with 20 mg/L PPI at the first peak, consistent with microbial results. The deterministic Gompertz kinetics and stochastic Gaussian processes contributed 97.63 ± 8.93% and 2.37 ± 8.93% in accumulated methane production, respectively. Thus, the use of PPI for anaerobic digestion allowed mitigate ammonia inhibition based on the mechanism of proton pump, facilitate intercellularly ammonia accumulation, stimulate syntrophic consortia, and eliminate uncertainty of process failure, which resulted in efficient methane production under ammonia stress.


Assuntos
Amônia , Microbiota , Anaerobiose , Reatores Biológicos , Cinética , Metano , Inibidores da Bomba de Prótons
14.
Physiol Rep ; 8(24): e14649, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33369281

RESUMO

Discovering therapeutics for COVID-19 is a priority. Besides high-throughput screening of compounds, candidates might be identified based on their known mechanisms of action and current understanding of the SARs-CoV-2 life cycle. Using this approach, proton pump (PPIs) and sodium-hydrogen exchanger inhibitors (NHEIs) emerged, because of their potential to inhibit the release of extracellular vesicles (EVs; exosomes and/or microvesicles) that could promote disease progression, and to directly disrupt SARs-CoV-2 pathogenesis. If EVs exacerbate SARs-CoV-2 infection as suggested for other viruses, then inhibiting EV release by PPIs/NHEIs should be beneficial. Mechanisms underlying inhibition of EV release by these drugs remain uncertain, but may involve perturbing endosomal pH especially of multivesicular bodies where intraluminal vesicles (nascent exosomes) are formed. Additionally, PPIs might inhibit the endosomal sorting complex for transport machinery involved in EV biogenesis. Through perturbing endocytic vesicle pH, PPIs/NHEIs could also impede cleavage of SARs-CoV-2 spike protein by cathepsins necessary for viral fusion with the endosomal membrane. Although pulmonary epithelial cells may rely mainly on plasma membrane serine protease TMPRSS2 for cell entry, PPIs/NHEIs might be efficacious in ACE2-expressing cells where viral endocytosis is the major or a contributing entry pathway. These pharmaceutics might also perturb pH in the endoplasmic reticulum-Golgi intermediate and Golgi compartments, thereby potentially disrupting viral assembly and glycosylation of spike protein/ACE2, respectively. A caveat, however, is that facilitation not inhibition of avian infectious bronchitis CoV pathogenesis was reported in one study after increasing Golgi pH. Envelope protein-derived viroporins contributed to pulmonary edema formation in mice infected with SARs-CoV. If similar pathogenesis occurs with SARs-CoV-2, then blocking these channels with NHEIs could ameliorate disease pathogenesis. To ascertain their potential efficacy, PPIs/NHEIs need evaluation in cell and animal models at various phases of SARs-CoV-2 infection. If they prove to be therapeutic, the greatest benefit might be realized with the administration before the onset of severe cytokine release syndrome.


Assuntos
/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Bombas de Próton/metabolismo , Trocadores de Sódio-Hidrogênio/antagonistas & inibidores , Internalização do Vírus , Animais , Humanos , Inibidores da Bomba de Prótons/farmacologia , /fisiologia , Trocadores de Sódio-Hidrogênio/metabolismo
15.
Gut ; 70(1): 76-84, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732368

RESUMO

OBJECTIVE: The adverse effects of proton pump inhibitors (PPIs) have been documented for pneumonia; however, there is no consensus regarding whether the use of PPIs might be harmful regarding the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this regard, we aimed to measure the potential associations of the current use of PPIs with the infection rates of COVID-19 among patients who underwent SARS-CoV-2 testing. DESIGN: Data were derived from a Korean nationwide cohort study with propensity score matching. We included 132 316 patients older than 18 years who tested for SARS-CoV-2 between 1 January and 15 May 2020. Endpoints were SARS-CoV-2 positivity (primary) and severe clinical outcomes of COVID-19 (secondary: admission to intensive care unit, administration of invasive ventilation or death). RESULTS: In the entire cohort, there were 111 911 non-users, 14 163 current PPI users and 6242 past PPI users. After propensity score matching, the SARS-CoV-2 test positivity rate was not associated with the current or past use of PPIs. Among patients with confirmed COVID-19, the current use of PPIs conferred a 79% greater risk of severe clinical outcomes of COVID-19, while the relationship with the past use of PPIs remained insignificant. Current PPI use starting within the previous 30 days was associated with a 90% increased risk of severe clinical outcomes of COVID-19. CONCLUSION: Patients taking PPIs are at increased risk for severe clinical outcomes of COVID-19 but not susceptible to SARS-CoV-2 infection. This suggests that physicians need to assess benefit-risk assessments in the management of acid-related diseases amid the COVID-19 pandemic.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Inibidores da Bomba de Prótons , Respiração Artificial/estatística & dados numéricos , Gastropatias , /complicações , /terapia , /estatística & dados numéricos , Causas de Morte , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/efeitos adversos , República da Coreia/epidemiologia , Índice de Gravidade de Doença , Gastropatias/tratamento farmacológico , Gastropatias/epidemiologia
16.
APMIS ; 129(1): 14-22, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32981186

RESUMO

The aim of this study was to investigate the appearance of a disturbed oropharyngeal microbiota during hospitalization and explore the patient characteristics that maybe associated with such a disturbance. Oropharyngeal swabs were collected from 134 patients at hospital admission and every 3-4 days thereafter. The samples were cultivated to determine the presence of a disturbed microbiota, which, in turn, was subcategorized into respiratory tract pathogens, gut microbiota and yeast species. Demographics, medical history data and hospitalization events were compared. The percentage of disturbed oropharyngeal microbiota increased significantly with length of stay (LOS). Receiving antibiotic treatment during the hospitalization tended to be associated with a disturbed microbiota (OR 2.75 [0.99-7.60]). Proton pump inhibitor (PPI) medication and receiving antibiotics before hospitalization were associated with the development of a disturbed oropharyngeal microbiota with colonization of gut pathogens (OR 3.49 [1.19-10.2] and OR 4.52 [1.13-18.1], respectively), while acute hospital admission was associated with a lower risk of colonization of gut pathogens (OR: 0.23 [0.074-0.72]). The risk of developing a disturbed oropharyngeal microbiota increased with LOS in hospitalized patients. PPI medication and receiving antibiotics before hospitalization were independent risk factors for developing oropharyngeal colonization of gut pathogens.


Assuntos
Antibacterianos/efeitos adversos , Microbioma Gastrointestinal , Tempo de Internação , Orofaringe/microbiologia , Inibidores da Bomba de Prótons/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Suécia , Adulto Jovem
17.
Med Clin North Am ; 105(1): 19-30, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246519

RESUMO

Dyspepsia affects a large percentage of the general population and can lead to lost work productivity and reduced quality of life. Patients with dyspepsia younger than 60 should not routinely undergo endoscopy but instead should pursue Helicobacter pylori test-and-treat approach. For patients 60 and older, endoscopy should be performed. Patients without any identifiable cause for their symptoms are diagnosed with functional dyspepsia. Guideline-based treatment includes H pylori eradication and proton pump inhibitor use. If acid suppression is not adequate, treatment with a tricyclic antidepressant followed by a prokinetic agent and psychological therapy are considered. Complementary therapies are not recommended due to limited evidence.


Assuntos
Dispepsia , Antibacterianos/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Terapia Cognitivo-Comportamental , Terapias Complementares , Diagnóstico Diferencial , Dieta , Dispepsia/diagnóstico , Dispepsia/etiologia , Dispepsia/fisiopatologia , Dispepsia/terapia , Fármacos Gastrointestinais/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Humanos , Período Pós-Prandial , Prebióticos , Probióticos/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Síndrome
18.
J Clin Rheumatol ; 27(1): 40-41, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33347033

RESUMO

BACKGROUND/AIMS: A role for Helicobacter pylori in triggering systemic sclerosis (SSc) has been proposed, but data are conflicting. In previous studies, infection has been generally searched for by using serology. We designed this study to assess H. pylori prevalence in SSc patients with histology of gastric mucosa, considered the criterion standard for infection diagnosis. METHODS: This cross-sectional study enrolled 30 SSc patients who complained of upper gastrointestinal symptoms. All underwent upper endoscopy with gastric biopsies. Endoscopic alterations were recorded, and gastric mucosa biopsies were used for both histological examination and searching for H. pylori. The role for proton-pump inhibitor (PPI) therapy was considered. Fisher exact test was used for statistical analysis. RESULTS: Data of 28 SSc patients were available, 14 with ongoing PPI therapy. Helicobacter pylori infection at histology was detected in 14.3% patients, and it equally occurred in patients with or without PPI therapy. Erosive esophagitis/Barrett esophagus was detected in 26.6% of cases. Among patients with PPI therapy, 30% received half dose only. The prevalence of intestinal metaplasia was low (14.3%). Endoscopic esophageal alterations were significantly more frequent in those patients showing anti-Scl70 antibody positivity. CONCLUSIONS: This study showed that prevalence of H. pylori is very low in SSc patients, so that it seems not having a role in triggering SSc. Management of gastroesophageal diseases in SSc patients needs to be improved, and looking to the autoimmune profile may be of help. Thus, collaboration between rheumatologist and gastroenterologist is highly recommended.


Assuntos
Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Proteínas Nucleares/imunologia , Inibidores da Bomba de Prótons/uso terapêutico , Escleroderma Sistêmico , Trato Gastrointestinal Superior , Autoanticorpos/sangue , Esôfago de Barrett/patologia , Biópsia/métodos , Endoscopia do Sistema Digestório/métodos , Feminino , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Refluxo Gastroesofágico/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Escleroderma Sistêmico/sangue , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/microbiologia , Escleroderma Sistêmico/fisiopatologia , Trato Gastrointestinal Superior/diagnóstico por imagem , Trato Gastrointestinal Superior/microbiologia , Trato Gastrointestinal Superior/patologia
19.
Arq Gastroenterol ; 57(4): 404-408, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331473

RESUMO

BACKGROUND: Clinical guidelines are available to steer decisions regarding diagnosis, management and treatment of gastrointestinal disorders. Despite this, variations in physician's practices regarding gastroesophageal reflux disease (GERD) symptoms are well described in the literature. OBJECTIVE: To describe practices of physicians from different specialties on the management of patients with typical symptoms of GERD (heartburn and regurgitation) in a Brazilian sample. METHODS: National online survey enrolling a sample of general practitioners, gastroenterologists, cardiologists and otolaryngologists. The survey was conducted from August 6th to September 12th, 2018. Subjects answered a structured questionnaire addressing variables regarding physicians' profile (age, sex, specialty, practice setting, years in practice, type of medical expense reimbursement), their patients characteristics and prescribing behaviors. RESULTS: The final weighted sample was comprised of 400 physicians, 64% male, with an average of 15 years of experience. Physicians' estimates of gastroesophageal symptoms prevalence among their pool of patients was 37.6% for the total sample, reaching 70.3% among gastroenterologists. The medical specialty with lower average percentage of patients presenting gastroesophageal symptoms was otolaryngology (24.5%). Physicians reported that they request ancillary tests for 64.5% of patients with GERD typical symptoms. The most common diagnostic test was endoscopy (69.4%), followed by video nasolaryngoscopy (16.6%). The percentage of patient to whom endoscopy is performed was significantly higher among gastroenterologists and general practitioners as compared to otolaryngologists and cardiologists, while video nasolaryngoscopy is markedly more frequent among otolaryngologists. In terms of therapeutic options, the most frequently reported strategy was lifestyle modifications followed by proton pump inhibitors. CONCLUSION: Overall patients' profile and patterns of GERD diagnosis and management seem different between gastroenterologists, general practitioners, otolaryngologists, and cardiologists. Clinical guidelines should address this variability and include other medical specialties besides gastroenterologists in their scope.


Assuntos
Refluxo Gastroesofágico , Brasil , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Humanos , Masculino , Médicos , Padrões de Prática Médica , Inibidores da Bomba de Prótons/uso terapêutico , Inquéritos e Questionários
20.
Medicine (Baltimore) ; 99(50): e23436, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327272

RESUMO

There is evidence that intake of proton pump inhibitors (PPI) increases the risk for spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis. However, data regarding the impact of PPI intake on occurrence of infections other than SBP are still lacking.We hypothesized that PPI use is associated with a higher rate of infections other than SBP in patients with liver cirrhosis.The current case-control study sample included patients with liver cirrhosis from the Disease Analyzer database (IQVIA), which compiles data such as risk factors, drug prescriptions and diagnoses obtained from general practitioners and specialists in Germany. In total, 2,823 patients with infections were matched with 2,823 patients without infections by propensity scores. For quantification of PPI use the prescribed quantity of PPI during the past 12 months before index date was analyzed.Frequency of PPI users was significantly higher in patients with infections than in patients without infections (47.9% vs 37.9%). In regression analysis, PPI use was significantly associated with the occurrence of infections overall (OR 1.55, 95% CI 1.39-1.72, P < .001), and associated with the occurrence of lower respiratory tract infections, urinary tract infections and infectious gastroenteritis. There was no association between PPI use and skin infections. Pantoprazole and omeprazole were the most frequently prescribed PPIs and were both independently associated with the occurrence of infections.PPI use may be associated with infections other than SBP in patients with liver cirrhosis. Prescription of PPI should be limited to patients with a clear indication.


Assuntos
Infecções Bacterianas/induzido quimicamente , Cirrose Hepática/tratamento farmacológico , Inibidores da Bomba de Prótons/efeitos adversos , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Alemanha , Humanos , Cirrose Hepática/microbiologia , Masculino , Pessoa de Meia-Idade , Omeprazol/efeitos adversos , Pantoprazol/efeitos adversos , Pontuação de Propensão , Análise de Regressão , Fatores de Risco
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