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1.
Medicine (Baltimore) ; 99(11): e19520, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176102

RESUMO

Proton pump inhibitors (PPIs) have been the first line treatment for gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the efficacy of vonoprazan (VPZ), a potassium-competitive acid blocker for reflux esophagitis (RE), nonerosive reflux disease (NERD), and PPI-resistant GERD patients.An open-label, single-center, observational study in our hospital was performed from August 2016 to August 2017. All patients diagnosed with GERD were asked to self-report a questionnaire of frequency scale for the symptoms of GERD (FSSG) and rate their degree of satisfaction with the treatment of GERD during outpatient visit. A total of 200 (RE 47, NERD 49, PPI-resistant GERD 104) patients were included in the present study. The primary endpoint was the change of FSSG and the proportion of degree of satisfaction with the treatment at the end of the initial therapy. A percentage of improvement (improvement rate) and resolution (resolution rate) at the end of the initial therapy were evaluated. Secondary endpoint included the proportion of patients with symptomatic relapse in the 24-week maintenance phase.FSSG and the degree of satisfaction were significantly improved after the initial therapy in every group. Improvement and resolution rate after the initial therapy were 83.0% and 67.0% in RE, 66.7% and 60.4% in NERD, and 76.0% and 60.4% in PPI-resistant group. There was no significance between after the initial therapy and 24 weeks in improvement and resolution rate. Thirty-two of the total 48 patients did not take VPZ at 24 weeks. Total FSSG score in each group was 1.67 ±â€Š1.97, 2.71 ±â€Š4.91, and 4.0 ±â€Š4.93. The nonrelapse rate at 24 weeks in each group was 66.7%, 60.0%, and 50.0%. The resolution rate at 24 weeks in each group was 38.9%, 45.0%, and 30.0%.The VPZ therapy is effective for initial and maintenance therapy and improves heartburn and patient's satisfaction significantly in all 3 groups. Among patients who stopped taking VPZ during the maintenance period, 42.0% of RE and NERD group and 30% of PPI-resistant group experience complete remission from GERD at 24 weeks by introduction of VPZ.


Assuntos
Refluxo Gastroesofágico/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Pirróis/uso terapêutico , Sulfonamidas/uso terapêutico , Idoso , Feminino , Refluxo Gastroesofágico/fisiopatologia , Humanos , Masculino , Inibidores da Bomba de Prótons/administração & dosagem , Pirróis/administração & dosagem , Índice de Gravidade de Doença , Sulfonamidas/administração & dosagem , Inquéritos e Questionários , Resultado do Tratamento
2.
Khirurgiia (Mosk) ; (2): 89-94, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105262

RESUMO

Gastroesophageal reflux disease (GERD) is characterized by abnormal reflux of gastric content into the esophagus, pharynx, respiratory tract and oral cavity. In recent years, there has been a significant increase of the incidence of this disease, that significantly aggravates quality of life of the population. The 'gold standard' for treating GERD is anti-secretory therapy with proton pump inhibitors (PPIs). However, up to 40% of patients are unresponsive to PPIs even after dose adjustment. Advantages and disadvantages of modern surgical approaches for this pathology are reviewed. Laparoscopic fundoplication including Nissen (360°), Toupet (270°) and Dor procedures (180°) is the most common anti-reflux operation. In addition, new alternative surgical options are also discussed. For example, these are minimally invasive methods such as LINX reflux control system, electrical stimulation of the lower esophageal sphincter and transoral incisionless fundoplication (TIF). These methods are less aggressive and have less side effects. A comparative assessment of modern methods of surgical treatment of GERD is made.


Assuntos
Fundoplicatura , Refluxo Gastroesofágico , Laparoscopia , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/cirurgia , Humanos , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida , Resultado do Tratamento
3.
Artigo em Inglês | MEDLINE | ID: mdl-31861951

RESUMO

The aims of this study were to evaluate the efficacy of magnesium alginate in decreasing functional regurgitation symptoms in infants, and to assess the cost-benefit ratio of magnesium alginate compared to a thickened formula. A multicenter perspective cross-over study was conducted in formula-fed infants with persisting regurgitation, randomly assigned to receive two weeks of a magnesium-alginate-based formulation followed by two weeks of thickened formula, or vice-versa. Infants, exclusively breast-fed, were followed up for two weeks while receiving magnesium alginate. Symptoms of gastroesophageal reflux (GER) were evaluated through the Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R). Direct cost of treatments was also calculated. Seventy-two infants completed the study. We found a significant reduction of I-GERQ-R scores over time (F = 55.387; p < 0.001) in all groups with no difference between the sequences of administration (F = 0.268; p = 0.848) in formula-fed infants and between exclusively breast-fed and formula-fed infants receiving magnesium alginate (t = 1.55; p = 0.126). The mean cost savings per infant was € 4.60 (±11.2) in formula-fed infants treated with magnesium alginate compared to thickened formula (t = 2.91, p < 0.0005). Conclusions were that the magnesium-alginate formulation reduces GER symptoms both in formula-fed and breast-fed infants. In formula-fed infants, clinical efficacy is similar to thickened formulas with a slightly lower cost of treatment.


Assuntos
Alginatos/uso terapêutico , Refluxo Gastroesofágico/tratamento farmacológico , Fórmulas Infantis , Magnésio/uso terapêutico , Alginatos/administração & dosagem , Estudos Cross-Over , Feminino , Humanos , Lactente , Recém-Nascido , Magnésio/administração & dosagem , Masculino
4.
Methodist Debakey Cardiovasc J ; 15(3): 214-219, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687101

RESUMO

Proton pump inhibitors (PPIs) are effective agents for the treatment of gastroesophageal reflux (GERD). However, these drugs have not been approved for long-term use. Now sold over the counter, these agents are being used chronically for GERD without medical supervision. The long-term use of PPIs may have significant adverse effects, in part mediated by their effect of accelerating vascular aging. Physicians should assist patients in tapering off their use of PPIs and replacing them with lifestyle modifications and/or other agents that have better long-term safety profiles.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Refluxo Gastroesofágico/tratamento farmacológico , Inibidores da Bomba de Prótons/efeitos adversos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Esquema de Medicação , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Humanos , Prognóstico , Inibidores da Bomba de Prótons/administração & dosagem , Medição de Risco , Fatores de Risco , Fatores de Tempo
5.
Pharm Pat Anal ; 8(5): 175-191, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31612801

RESUMO

The global pharmaceutical industry consists of innovators and generics. Innovators focus on drug discovery, and bring new drugs into the marketplace after filing the new drug applications. In contrast, the generics enter the market by making a bioequivalent product by filing abbreviated new drug applications. In order to maximize their returns on R&D and maintain market share, the innovators introduce a wide range of drug products based on the same 'new molecular entity' and protect them against competition by filing what the industry term as secondary patents. The patents of four innovator viz., AstraZeneca, Takeda, Eisai and Wyeth related to the gastroesophageal reflux disease drugs and how their new molecular entity patents overcame the nonobviousness criteria is analyzed and studied in detail.


Assuntos
Refluxo Gastroesofágico/tratamento farmacológico , Patentes como Assunto , Inibidores da Bomba de Prótons/uso terapêutico , Descoberta de Drogas , Indústria Farmacêutica , Competição Econômica , Humanos
7.
Carbohydr Polym ; 226: 115205, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31582062

RESUMO

This study aimed to investigate a standardized biopolymer, cashew gum (CG), in human oesophageal mucosa and mice with experimentally-induced non-erosive reflux disease (NERD). Human oesophageal biopsies from NERD patients were collected to evaluate the mucosal protection of CG through transepithelial electrical resistance (TER), mucosal permeability, and mucoadhesiveness tests. A surgical model of NERD in mice was induced, and barrier functions followed by suggestive oesophageal inflammatory hallmarks were evaluated. Pre-coating of CG was effective in human oesophageal mucosa by attenuating drop of TER and mucosal permeability. Labelled-CG adheres to human oesophageal mucosa for up to 1 h. In animal studies, CG improved parameters of barrier function (TER and mucosal permeability) in distal oesophagus mucosa. CG also promoted sequential support by reducing inflammatory hallmarks of oesophageal damage. CG confers topical oesophageal mucosal protection due to its mucoadhesiveness and anti-inflammatory profile. Long-duration mucoprotective products can be further explored as first-line/adjuvant NERD therapy.


Assuntos
Anacardium/metabolismo , Biopolímeros/farmacologia , Biopolímeros/farmacocinética , Mucosa Esofágica , Refluxo Gastroesofágico/tratamento farmacológico , Adulto , Idoso , Animais , Impedância Elétrica , Mucosa Esofágica/efeitos dos fármacos , Mucosa Esofágica/metabolismo , Feminino , Humanos , Camundongos , Pessoa de Meia-Idade , Permeabilidade/efeitos dos fármacos , Substâncias Protetoras/farmacologia , Adulto Jovem
8.
N Engl J Med ; 381(16): 1513-1523, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31618539

RESUMO

BACKGROUND: Heartburn that persists despite proton-pump inhibitor (PPI) treatment is a frequent clinical problem with multiple potential causes. Treatments for PPI-refractory heartburn are of unproven efficacy and focus on controlling gastroesophageal reflux with reflux-reducing medication (e.g., baclofen) or antireflux surgery or on dampening visceral hypersensitivity with neuromodulators (e.g., desipramine). METHODS: Patients who were referred to Veterans Affairs (VA) gastroenterology clinics for PPI-refractory heartburn received 20 mg of omeprazole twice daily for 2 weeks, and those with persistent heartburn underwent endoscopy, esophageal biopsy, esophageal manometry, and multichannel intraluminal impedance-pH monitoring. If patients were found to have reflux-related heartburn, we randomly assigned them to receive surgical treatment (laparoscopic Nissen fundoplication), active medical treatment (omeprazole plus baclofen, with desipramine added depending on symptoms), or control medical treatment (omeprazole plus placebo). The primary outcome was treatment success, defined as a decrease of 50% or more in the Gastroesophageal Reflux Disease (GERD)-Health Related Quality of Life score (range, 0 to 50, with higher scores indicating worse symptoms) at 1 year. RESULTS: A total of 366 patients (mean age, 48.5 years; 280 men) were enrolled. Prerandomization procedures excluded 288 patients: 42 had relief of their heartburn during the 2-week omeprazole trial, 70 did not complete trial procedures, 54 were excluded for other reasons, 23 had non-GERD esophageal disorders, and 99 had functional heartburn (not due to GERD or other histopathologic, motility, or structural abnormality). The remaining 78 patients underwent randomization. The incidence of treatment success with surgery (18 of 27 patients, 67%) was significantly superior to that with active medical treatment (7 of 25 patients, 28%; P = 0.007) or control medical treatment (3 of 26 patients, 12%; P<0.001). The difference in the incidence of treatment success between the active medical group and the control medical group was 16 percentage points (95% confidence interval, -5 to 38; P = 0.17). CONCLUSIONS: Among patients referred to VA gastroenterology clinics for PPI-refractory heartburn, systematic workup revealed truly PPI-refractory and reflux-related heartburn in a minority of patients. For that highly selected subgroup, surgery was superior to medical treatment. (Funded by the Department of Veterans Affairs Cooperative Studies Program; ClinicalTrials.gov number, NCT01265550.).


Assuntos
Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/cirurgia , Azia/tratamento farmacológico , Omeprazol/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Adulto , Baclofeno/uso terapêutico , Desipramina/uso terapêutico , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Fundoplicatura , Refluxo Gastroesofágico/complicações , Azia/etiologia , Azia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/uso terapêutico , Qualidade de Vida , Inquéritos e Questionários , Veteranos
9.
Khirurgiia (Mosk) ; (9): 18-24, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532162

RESUMO

OBJECTIVE: To evaluate the results of treatment of Barrett's esophagus using laparoscopic 270° Toupet fundoplication or radiofrequency ablation (RFA) and their combination. MATERIAL AND METHODS: We have analyzed data for the period 2011-2018. Antireflux surgery was performed in the first group, RFA - in the second group, both procedures were done in the third group. The majority of patients with hiatal hernia underwent cruroraphy, laparoscopic 270° Toupet fundoplication, endoscopic treatment as the second stage was performed in some of them. Patients without hiatal hernia and no signs of reflux underwent RFA without antireflux surgery. Control endoscopic examination was carried out after 3, 6 and 12 months and then annually. RESULTS: There were 84 patients with Barrett's esophagus. We performed 51 RFA procedures in 47 patients and fundoplication in 71 patients. Antireflux surgery as the first stage was preferred in patients with hiatal hernia (n=60), subsequent radiofrequency ablation (RFA) was performed in 28 of them. Seven patients without hiatal hernia, but with significant gastroesophageal reflux underwent antireflux surgery too. Other 12 patients without hiatal hernia underwent RFA alone. Need for delayed antireflux surgery after endoscopic treatment occurred in 23.5% of patients. Complete regression of metaplasia was noted in 95.2% after 1 procedure and in 100% after 2 procedures. Recurrent metaplasia was registered in 4.3% of patients. Progression to dysplasia was not detected. CONCLUSION: Two-stage surgical approach including antireflux surgery and radiofrequency ablation in combination with drug therapy is optimal. Endoscopic therapy is recommended for all types and length of metaplasia.


Assuntos
Esôfago de Barrett/cirurgia , Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Ablação por Radiofrequência/métodos , Esôfago de Barrett/tratamento farmacológico , Esôfago de Barrett/etiologia , Terapia Combinada , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/etiologia , Hérnia Hiatal/complicações , Hérnia Hiatal/cirurgia , Humanos , Laparoscopia , Resultado do Tratamento
11.
Nutrients ; 11(9)2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31484341

RESUMO

Poor diet quality is the leading cause of death both in the United States and worldwide, and the prevalence of obesity is at an all-time high and is projected to significantly worsen. Results from an eight-week group program utilizing an ad-libitum whole-food plant-based dietary pattern, were reviewed. There were 79 participants, all self-referred from the community, including 24 (30.4%) who were already vegetarian or vegan at baseline. Seventy-eight participants (98.7%) completed the eight-week program. Among completers, those with higher BMI at baseline lost a larger percentage of their body weight (total body weight loss of 3.0 ± SD 2.1%, 5.8 ± 2.8%, and 6.4 ± 2.5% for participants who had baseline BMI in normal, overweight, and obese range, respectively). The average weight loss for all the completers was 5.5 ± 3.0 kg (p < 0.0001). Final blood pressure and plasma lipids were reduced compared to baseline (SBP decreased 7.1 ± 15.5 mmHg (p = 0.0002), DBP decreased 7.3 ± 10.9 mmHg (p < 0.0001), total cholesterol decreased 25.2 ± 24.7 mg/dL (p < 0.0001), LDL decreased 15.3 ± 21.1 mg/dL (p < 0.0001)). Twenty-one (26.9%) participants were able to decrease or stop at least one chronic medication compared to two (2.6%) participants who required an increased dose of a chronic medication. Participants who were already vegetarian or vegan at baseline experienced statistically significant weight loss and reductions in total and LDL cholesterol. There was a non-significant trend toward less weight loss in these participants compared to participants who were non-vegetarian at baseline. Reductions in total and LDL cholesterol were not significantly different when comparing vegetarian or vegan and non-vegetarian participants. A whole-food plant-based dietary intervention may provide significant short-term benefits for both non-vegetarian, vegetarian, and vegan individuals.


Assuntos
Pressão Sanguínea , Dieta Vegetariana , Estilo de Vida , Adulto , Idoso , Antiácidos/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Glicemia , Peso Corporal , Colesterol/sangue , Diabetes Mellitus Tipo 2/sangue , Gorduras na Dieta , Ingestão de Energia , Feminino , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/prevenção & controle , Humanos , Hipoglicemiantes/administração & dosagem , Masculino , Pessoa de Meia-Idade , Triglicerídeos/sangue , Estados Unidos
12.
Presse Med ; 48(9): 897-903, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31471090

RESUMO

Ineffective esophageal motility is the most frequent esophageal motility disorder. It is currently defined by 50% or more ineffective esophageal contractions and a normal lower esophageal sphincter relaxation on high-resolution esophageal manometry. Although reported in patients without symptoms, it is typically associated with gastro-esophageal reflux disease, and might be a consequence of the reflux. Ineffective esophageal motility can account for a certain degree of dysphagia, and is associated with a more severe gastroesophageal reflux. Todate, no specific endoscopic or pharmacologic treatment is available, and proton pump inhibitor are advisable when gastro-esophageal reflux is associated.


Assuntos
Transtornos da Motilidade Esofágica/etiologia , Refluxo Gastroesofágico/complicações , Doenças Assintomáticas , Transtornos de Deglutição/etiologia , Esofagite Eosinofílica/complicações , Transtornos da Motilidade Esofágica/tratamento farmacológico , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Inibidores da Bomba de Prótons/uso terapêutico , Escleroderma Sistêmico/complicações , Síndrome
13.
Cell Mol Biol (Noisy-le-grand) ; 65(5): 73-78, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31304910

RESUMO

Heweijiangni decoction (HWJND) is an effective traditional Chinese medicine prescription in clinical treatment of nonerosive reflux disease (NERD). Esophageal hypersensitivity and acid contribute to the disease. However, the exact underlying mechanism of action remains unclear. In this study, we observed the effect of HWJND on esophageal morphology in a rat model of ovalbumin (OVA)-induced visceral hypersensitivity followed by acid exposure. Esophageal morphology was assessed by measuring the extent of dilated intercellular spaces (DIS), desmosome disruption, and mitochondrial fragmentation. HWJND in low, moderate, and high doses relieved DIS and desmosome disruption in esophageal epithelium compared with model group (P<0.05 for all doses). In addition, HWJND in high dose protected mitochondria from fragmentation (P<0.05). Other findings suggest that DIS and mitochondrial fragmentation are independent events, and that omeprazole protects mitochondria. Overall, HWJND significantly resists esophageal morphology changes in OVA-induced and acid exposure rat model.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Esôfago/efeitos dos fármacos , Refluxo Gastroesofágico/induzido quimicamente , Refluxo Gastroesofágico/tratamento farmacológico , Ácido Clorídrico/farmacologia , Ovalbumina/farmacologia , Animais , Desmossomos/efeitos dos fármacos , Modelos Animais de Doenças , Esôfago/patologia , Espaço Extracelular/efeitos dos fármacos , Ácido Clorídrico/administração & dosagem , Injeções Intraperitoneais , Masculino , Mitocôndrias/efeitos dos fármacos , Omeprazol/farmacologia , Ovalbumina/administração & dosagem , Ratos , Ratos Sprague-Dawley
14.
Complement Ther Med ; 45: 215-221, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31331564

RESUMO

INTRODUCTION: Since the treatment of gastroesophageal reflux disease (GERD) symptoms in children is of the utmost importance, the current study is aimed to evaluating the efficacy of quince syrup and ranitidine in the management of pediatric patients with symptomatic GERD. METHODS AND MATERIALS: This double-blind, randomized clinical trial was performed on 96 children suspected of suffering from GERD. The patients referred to the gastrointestinal clinic of Ghaem Hospital, Iran, during 2017. The participants were randomly categorized into two groups (ranitidine and ranitidine plus quince syrup). The GERD symptoms, including the severity and frequency of vomiting, refusal of eating, difficulty in swallowing, choking at the time of eating, burping or belching, and abdominal or belly pain, were gathered before and after the intervention (4 weeks) using standardized Global Severity Questionnaire (GSQ-YC). RESULTS: The comparison of two groups in terms of vomiting, refusal of eating, burping or belching, and abdominal or belly pain showed a significant difference 4 and 6 weeks after the intervention (P< 0.05). However, the comparison of difficulty in swallowing and choking at the time of eating between the two groups showed that there was no significant difference after 2, 4, and 6 weeks of the intervention (P > 0.05). The comparison of the total scores between the two groups showed that there was a significant difference 2 (17.8 ±â€¯2.6 vs 23.4 ±â€¯4.0; P < 0.05), 4 (11.5 ±â€¯2.3 vs 18.8 ±â€¯3.6; P< 0.05), and 6 (12.2 ±â€¯2.3 vs 21.1 ±â€¯4.1; P<  0.05) weeks after the intervention. CONCLUSION: The results showed that the administration of ranitidine plus quince syrup was useful to improve pediatric GERD. However, it is recommended to conduct the future studies with a larger sample size and different dosage.


Assuntos
Refluxo Gastroesofágico/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Ranitidina/uso terapêutico , Rosaceae/química , Dor Abdominal/tratamento farmacológico , Adulto , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Lactente , Irã (Geográfico) , Masculino , Índice de Gravidade de Doença , Inquéritos e Questionários , Vômito/tratamento farmacológico
15.
Indian Pediatr ; 56(7): 541-546, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31333204

RESUMO

Medications that reduce gastric acid secretion are commonly prescribed for treating gastroesophageal reflux disease. However, several studies have shown that these medications are not very effective, and are associated with adverse effects. This article discusses the physiology of gastric acid secretion, clinical indications and pharmacology of acid suppressing medications, and possible adverse effects of these medications.


Assuntos
Antiácidos , Refluxo Gastroesofágico , Trato Gastrointestinal , Antiácidos/administração & dosagem , Antiácidos/efeitos adversos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/fisiopatologia , Trato Gastrointestinal/efeitos dos fármacos , Trato Gastrointestinal/fisiopatologia , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Neonatologia/métodos , Administração dos Cuidados ao Paciente/métodos
16.
Intern Med ; 58(17): 2427-2433, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31178490

RESUMO

Objective Gastroesophageal reflux disease (GERD) is a highly prevalent disorder that negatively affects patients' quality of life and reduces their work productivity. The medical expenses associated with the treatment of GERD are the highest among all digestive diseases. Current guidelines recommend the administration of a standard dose of proton pump inhibitor (PPI) for eight weeks as an initial GERD treatment. However, there is growing concern regarding the safety of PPI treatment. Recently, a novel potassium-competitive acid blocker (P-CAB), vonoprazan (VPZ), was approved for the treatment of reflux esophagitis in Japan and may provide clinical benefits in GERD treatment. This study was conducted to evaluate the cost-effectiveness of a P-CAB, VPZ vs. a PPI, lansoprazole (LPZ), for the acute medical treatment of reflux esophagitis. Methods A clinical decision analysis was performed using a Markov chain approach to compare VPZ to LPZ in the acute treatment of reflux esophagitis in Japan. Results The P-CAB strategy was superior to the PPI strategy in terms of cost-effectiveness (direct cost per patient to achieve clinical success) and the number of days for which medication was required. Sensitivity analyses revealed that this superiority was robust within the plausible range of probabilities. This remained true even when the healing rates in cases of mild esophagitis were applied. Conclusion The P-CAB strategy was consistently superior to the conventional PPI strategy using the original LPZ in terms of cost-effectiveness and the number of days for which medication was required. Thus, VPZ appears to be the drug of choice for the acute medical treatment of reflux esophagitis.


Assuntos
Refluxo Gastroesofágico/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Lansoprazol/uso terapêutico , Pirróis/uso terapêutico , Sulfonamidas/uso terapêutico , Adulto , Análise Custo-Benefício , Esquema de Medicação , Feminino , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/economia , Humanos , Japão , Lansoprazol/administração & dosagem , Lansoprazol/economia , Cadeias de Markov , Pirróis/administração & dosagem , Pirróis/economia , Qualidade de Vida , Sulfonamidas/administração & dosagem , Sulfonamidas/economia
17.
Drug Dev Ind Pharm ; 45(9): 1444-1450, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31170849

RESUMO

The aim of this study was to improve the solubility, oral bioavailability, and anti-gastroesophageal reflux activity of curcumin (CM) by preparing two CM-loaded, novel, binary mixed micelles (CM-M). The two CM-M were prepared by ethanol thin-film hydration method. One (CM-T) was prepared using D-alpha-tocopheryl polyethylene glycol 1000 succinate and Solutol®HS15, and the other (CM-F) was prepared using Pluronic®F127 and Solutol®HS15. The entrapment efficiency and drug loading of CM-T were 83.61 ± 0.54% and 2.20 ± 0.65%, respectively, which were lower than those of CM-F (88.66 ± 0.12% and 1.47 ± 0.26%, respectively). TEM results demonstrated that CM-T and CM-F were homogeneous and spherical. The permeability of CM delivered via CM-T and CM-F was enhanced across a Caco-2 cell monolayer, and CM-T and CM-F showed a 5.24- and 4.76-fold increase in relative oral bioavailability, respectively compared with free CM. In addition, the in vivo anti-gastroesophageal reflux study showed that CM-T and CM-F achieved higher anti-gastroesophageal reflux efficacy compared with free CM. Collectively, these findings were indicative of an oral micelle formulation of CM with increased solubility, oral bioavailability, and anti-gastroesophageal reflux activity.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Curcumina/administração & dosagem , Portadores de Fármacos/química , Composição de Medicamentos/métodos , Refluxo Gastroesofágico/tratamento farmacológico , Administração Oral , Animais , Anti-Inflamatórios não Esteroides/farmacocinética , Disponibilidade Biológica , Células CACO-2 , Curcumina/farmacocinética , Avaliação Pré-Clínica de Medicamentos , Liberação Controlada de Fármacos , Humanos , Absorção Intestinal , Mucosa Intestinal , Masculino , Camundongos , Micelas , Modelos Animais , Permeabilidade , Poloxâmero/química , Polietilenoglicóis/química , Ratos , Ratos Sprague-Dawley , Solubilidade , Ácidos Esteáricos/química , Vitamina E/química
18.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31175146

RESUMO

BACKGROUND: Acid suppression therapy (AST), including proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2RAs), is frequently prescribed to treat symptomatic gastroesophageal reflux in otherwise healthy infants. PPI use has been associated with increased fracture risk in older adults; 2 preliminary studies in children have conflicting results. METHODS: A retrospective cohort of children born 2001 to 2013 who were followed for ≥2 years was formed. Those with osteogenesis imperfecta, cholestasis, or child maltreatment were excluded. Prescription data were used to identify AST prescription before age 1 year. International Classification of Diseases, Ninth Revision, Clinical Modification codes identified fractures after age 1 year. A Cox proportional hazard analysis assessed fracture hazard and was adjusted for sex, prematurity, low birth weight, previous fracture, anti-epileptics, and overweight or obesity. RESULTS: Of 851 631 included children, 97 286 (11%) were prescribed AST in the first year of life; 7998 (0.9%) children were prescribed PPI, 71 578 (8%) were prescribed H2RA, and 17 710 (2%) were prescribed both a PPI and H2RA. Infants prescribed AST had an earlier median first fracture age (3.9 vs 4.5 years). After adjustment, increased fracture hazard was associated with PPI use (21%) and PPI and H2RA use (30%), but not H2RA use alone. Longer duration of AST treatment and earlier age of first AST use was associated with increased fracture hazard. CONCLUSIONS: Infant PPI use alone and together with H2RAs is associated with an increased childhood fracture hazard, which appears amplified by days of use and earlier initiation of ASTs. Use of AST in infants should be weighed carefully against possible fracture.


Assuntos
Fraturas Ósseas/epidemiologia , Refluxo Gastroesofágico/tratamento farmacológico , Antagonistas dos Receptores Histamínicos H2/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Fatores Etários , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Fraturas Ósseas/etiologia , Antagonistas dos Receptores Histamínicos H2/efeitos adversos , Humanos , Incidência , Lactente , Masculino , Inibidores da Bomba de Prótons/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia
20.
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
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