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The Medical Clinics of North America Jul 2016Several key areas in gastroenterology pharmacotherapy are rapidly evolving, including the treatment of hepatitis C virus (HCV), irritable bowel syndrome,... (Review)
Review
Several key areas in gastroenterology pharmacotherapy are rapidly evolving, including the treatment of hepatitis C virus (HCV), irritable bowel syndrome, gastroesophageal reflux disease (GERD) and peptic ulcer disease. HCV treatment has radically changed in the past 2 years and now most patients are treatment candidates and have a high likelihood of permanent cure. Pharmacotherapy is now first-line treatment for patients with moderate to severe symptoms of irritable bowel syndrome. Proton pump inhibitors (PPIs) are the mainstay of therapy in gastric and duodenal ulcers and GERD, although long-term use carries the risk of several side effects that should be considered.
Topics: Antacids; Anti-Bacterial Agents; Antidepressive Agents; Antidiarrheals; Antiviral Agents; Coinfection; Dietary Fiber; Drug Resistance, Viral; Gastroesophageal Reflux; Gastrointestinal Agents; Gastrointestinal Diseases; Genotype; HIV Infections; Helicobacter Infections; Hepatitis C; Histamine H2 Antagonists; Humans; Irritable Bowel Syndrome; Laxatives; Peptic Ulcer; Probiotics; Proton Pump Inhibitors
PubMed: 27235617
DOI: 10.1016/j.mcna.2016.03.009 -
Anaerobe Feb 2023Data from the past decade indicates that Clostridioides difficile infection (CDI) is not only a nosocomial infection but is also increasingly recognized as a disease in...
BACKGROUND
Data from the past decade indicates that Clostridioides difficile infection (CDI) is not only a nosocomial infection but is also increasingly recognized as a disease in the community.
OBJECTIVE
We aimed to study community-onset (CO) CDI in the various age groups in south Serbia with its clinical characteristics, risk factors and microbiological characterization.
METHODS
The study group included 93 patients with CO-CDI (median age 62). The control group consisted of 186 patients with community-onset diarrhea and stool samples negative tested for CDI.
RESULTS
Of all CDI cases diagnosed with a community onset, 74.19% had a previous contact with a healthcare facility in the previous 12 weeks, but 34.40% have no record on hospitalization in the previous 12 months. Using a multivariate statistical regression model, the following risk factors for CO-CDI development were found; antacid usage (OR = 0.267, 95%C.I.:0.10-0.291, p < 0.01), chronic kidney disease (OR = 0.234, 95%C.I.:0.10-0.51, p < 0.01) and antibiotic use during the prior 2 months (OR = 0.061, 95%C.I.:0.02-0.17, p < 0.01), especially tetracycline's (OR = 0.146, 95% C.I.:0.07-0.22, p < 0.01) and cephalosporin's (OR = 0.110, 95%C.I.:0.14-0.42, p < 0.01). The most common ribotypes (RTs) detected in patients with CO-CDI were RT001 (32.3%) and RT027 (24.7%). All tested toxin producing C. difficile isolates were sensitive to metronidazole, vancomycin and tigecycline. A high rate of resistance to moxifloxacin (73.11%) and rifampicin (23.65%) was found.
CONCLUSION
Patients with CO-CDI had frequently contact with healthcare facility in the previous 12 weeks. Restriction of antacid usage and of high-risk antibiotics in the community may help reduce the incidence of CO-CDI.
Topics: Humans; Middle Aged; Clostridioides difficile; Serbia; Antacids; Anti-Bacterial Agents; Cross Infection; Clostridium Infections; Ribotyping
PubMed: 36455757
DOI: 10.1016/j.anaerobe.2022.102669 -
Nature Reviews. Gastroenterology &... May 2016The management of patients with refractory GERD (rGERD) is a major clinical challenge for gastroenterologists. In up to 30% of patients with typical GERD symptoms... (Review)
Review
The management of patients with refractory GERD (rGERD) is a major clinical challenge for gastroenterologists. In up to 30% of patients with typical GERD symptoms (heartburn and/or regurgitation), acid-suppressive therapy does not provide clinical benefit. In this Review, we discuss the current management algorithm for GERD and the features and management of patients who do not respond to treatment (such as those individuals with an incorrect diagnosis of GERD, inadequate PPI intake, persisting acid reflux and persisting weakly acidic reflux). Symptom response to existing surgical techniques, novel antireflux procedures, and the value of add-on medical therapies (including prokinetics and reflux inhibitors) for rGERD symptoms are discussed. Pharmaceutical agents targeting oesophageal sensitivity, a condition that can contribute to symptom generation in rGERD, are also discussed. Finally, on the basis of available published data and our expert opinion, we present an outline of a current, usable algorithm for management of patients with rGERD that considers the timing and diagnostic use of pH-impedance monitoring on or off PPI, additional diagnostic tests, the clinical use of baclofen and the use of add-on neuromodulators (tricyclic agents and selective serotonin reuptake inhibitors).
Topics: Alginates; Algorithms; Antacids; Baclofen; Chronic Disease; Esophagoscopy; Gastroesophageal Reflux; Gastrointestinal Agents; Gastroscopy; Humans; Isoxazoles; Muscle Relaxants, Central; Neurotransmitter Agents; Phosphinic Acids; Propylamines; Triazoles
PubMed: 27075264
DOI: 10.1038/nrgastro.2016.50 -
Annals of the American Thoracic Society May 2022Idiopathic pulmonary fibrosis (IPF) is a fibrosing interstitial pneumonia with impaired survival. Previous guidelines recommend antacid medication to improve... (Meta-Analysis)
Meta-Analysis
Idiopathic pulmonary fibrosis (IPF) is a fibrosing interstitial pneumonia with impaired survival. Previous guidelines recommend antacid medication to improve respiratory outcomes in patients with IPF. This systematic review was undertaken during the development of an American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax guideline. The clinical question was, "Should patients with IPF who have documented abnormal gastroesophageal reflux (GER) with or without symptoms of GER disease ) be treated with antacid medication or ) undergo antireflux surgery to improve respiratory outcomes?" Medline, Embase, the Cochrane Central Register of Controlled Trials, and the gray literature were searched through June 30, 2020. Studies that enrolled patients with IPF and ) compared antacid medication to placebo or no medication or ) compared antireflux surgery to no surgery were selected. Meta-analyses were performed when possible. Outcomes included disease progression, mortality, exacerbations, hospitalizations, lung function, respiratory symptoms, GER severity, and adverse effects/complications. For antacid medication, when two studies were aggregated, there was no statistically significant effect on disease progression, defined as a 10% or more decline in FVC, more than 50-m decline in 6-minute walking distance, or death (risk ratio [RR], 0.88; 95% confidence interval [CI], 0.76-1.03). A separate study that could not be included in the meta-analysis found no statistically significant effect on disease progression when defined as a 5% or more decline in FVC or death (RR, 1.10; 95% CI, 1.00-1.21) and an increase in disease progression when defined as a 10% or more decline in FVC or death (RR, 1.28; 95% CI, 1.08-1.51). For antireflux surgery, there was also no statistically significant effect on disease progression (RR, 0.29; 95% CI, 0.06-1.26). Neither antacid medications nor antireflux surgery was associated with improvements in the other outcomes. There is insufficient evidence to conclude that antacid medication or antireflux surgery improves respiratory outcomes in patients with IPF, most of whom had not had abnormal GER confirmed. Well-designed and adequately powered prospective studies with objective evaluation for GER are critical to elucidate the role of antacid medication and antireflux surgery for respiratory outcomes in patients with IPF.
Topics: Antacids; Disease Progression; Gastroesophageal Reflux; Humans; Idiopathic Pulmonary Fibrosis; Prospective Studies
PubMed: 35486080
DOI: 10.1513/AnnalsATS.202102-172OC -
Australian Family Physician 2017Laryngopharyngeal reflux (LPR) is one of the most common and important disorders of upper airway inflammation. It causes significant impairment to quality of life, and... (Review)
Review
BACKGROUND
Laryngopharyngeal reflux (LPR) is one of the most common and important disorders of upper airway inflammation. It causes significant impairment to quality of life, and can predict serious laryngeal and oesophageal pathology, yet it remains under-diagnosed and under-treated.
OBJECTIVE
This paper attempts to unravel the diagnostic dilemma of LPR and provide a practical, discriminating approach to managing this common condition.
DISCUSSION
Historical red flags mandating early referral for specialist review are identified, and pathophysiology, symptomatology and common signs are reviewed. In addition, a comprehensive treatment plan consisting of lifestyle modifications, counselling aids and empirical medical therapy is proposed. A strategy for tracking clinical improvement using Belfasky's validated symptom index is included to aid counselling, compliance and follow-up.
Topics: Adenocarcinoma; Antacids; Cough; Deglutition Disorders; Diagnosis, Differential; Esophageal Neoplasms; Heartburn; Hoarseness; Humans; Laryngeal Diseases; Laryngopharyngeal Reflux; Proton Pumps; Weight Loss
PubMed: 28189129
DOI: No ID Found -
Journal of Clinical GastroenterologyThe last decade has seen the rise of multiple novel endoscopic techniques to treat gastroesophageal reflux disease, many of which are efficacious when compared with... (Review)
Review
The last decade has seen the rise of multiple novel endoscopic techniques to treat gastroesophageal reflux disease, many of which are efficacious when compared with traditional surgical options and allow relief from long-term dependence on antacid medications. This review will explore the latest endoscopic treatment options for gastroesophageal reflux disease including a description of the technique, review of efficacy and safety, and future directions.
Topics: Antacids; Anti-Ulcer Agents; Esophagitis, Peptic; Esophagoscopy; Gastroesophageal Reflux; Humans
PubMed: 36040930
DOI: 10.1097/MCG.0000000000001757 -
Cleveland Clinic Journal of Medicine Oct 2015Gastroesophageal reflux disease (GERD) is chronic, very common, and frequently encountered in internal medicine and subspecialty clinics. It is often diagnosed on... (Review)
Review
Gastroesophageal reflux disease (GERD) is chronic, very common, and frequently encountered in internal medicine and subspecialty clinics. It is often diagnosed on clinical grounds, but specialized testing such as endoscopy and pH monitoring may be necessary in certain patients. Although proton pump inhibitors (PPIs) are the mainstay of treatment, clinicians should be aware of their short-term and long-term side effects.
Topics: Antacids; Cough; Endoscopy, Digestive System; Esophageal pH Monitoring; Fundoplication; Gastric Bypass; Gastroesophageal Reflux; Heartburn; Histamine H2 Antagonists; Hoarseness; Humans; Laryngopharyngeal Reflux; Obesity; Proton Pump Inhibitors
PubMed: 26469826
DOI: 10.3949/ccjm.82a.14138 -
World Journal of Surgery Jul 2017Medical treatment is effective in the majority of patients with gastroesophageal reflux disease (GERD). Lifestyle modifications are often recommended for patients with... (Review)
Review
Medical treatment is effective in the majority of patients with gastroesophageal reflux disease (GERD). Lifestyle modifications are often recommended for patients with GERD, although the data supporting lifestyle recommendations are limited. Antacids are often used to treat the symptoms of GERD, but their effect is short-lived. H2-receptor antagonists and proton-pump inhibitors provide more effective options for remission of GERD symptoms and healing of esophagitis. Prokinetic medications (e.g., metoclopramide) have not been proven to help in the control of symptoms. Baclofen, which inhibits transient lower esophageal sphincter relaxations, provide an additional option for patients with persistent symptoms related to GERD; however its use is limited by side effects. Long-term medical therapy for GERD should be tailored to each patient to provide symptomatic control and maintain esophageal mucosal healing.
Topics: Alginates; Antacids; Gastroesophageal Reflux; Glucuronic Acid; Hexuronic Acids; Histamine H2 Antagonists; Humans; Life Style; Proton Pump Inhibitors
PubMed: 28321555
DOI: 10.1007/s00268-017-3954-2 -
Digestive Diseases and Sciences Jan 2022There are few reports about reflux esophagitis (RE) as a cause of severe upper gastrointestinal bleeding (UGIB).
BACKGROUND
There are few reports about reflux esophagitis (RE) as a cause of severe upper gastrointestinal bleeding (UGIB).
AIMS
This study aims to evaluate (1) changes in its prevalence over the last three decades and (2) clinical and endoscopic characteristics and 30-day outcomes among RE patients with and without focal esophageal ulcers (EUs) and stigmata of recent hemorrhage (SRH).
METHODS
A retrospective study of prospectively collected data of esophagitis patients hospitalized with severe UGIB between 1992 and 2020. Descriptive analysis and statistical comparisons were performed.
RESULTS
Of 114 RE patients, the mean age was 61.1 years and 76.3% were males. 38.6% had prior gastroesophageal reflux disease (GERD) symptoms; overall 36% were on acid suppressants. Over three consecutive decades, the prevalence of RE as a cause of severe UGIB increased significantly from 3.8 to 16.7%. 30-day rebleeding and all-cause mortality rates were 11.4% and 6.1%. RE patients with focal EUs and SRH (n = 23) had worse esophagitis than those with diffuse RE (n = 91) (p = 0.012). There were no differences in 30-day outcomes between RE patients with and without EUs and SRH.
CONCLUSIONS
For patients with severe UGIB caused by RE, (1) the prevalence has increased significantly over the past three decades, (2) the reasons for this increase and preventive strategies warrant further study, (3) most patients lacked GERD symptoms and did not take acid suppressants, and (4) those with focal ulcers and SRH had more severe esophagitis and were treated endoscopically.
Topics: Antacids; Endoscopy, Digestive System; Esophageal and Gastric Varices; Esophagitis, Peptic; Female; Gastrointestinal Hemorrhage; Hospitalization; Humans; Male; Middle Aged; Peptic Ulcer; Prevalence; Recurrence; Retrospective Studies; Severity of Illness Index
PubMed: 33590404
DOI: 10.1007/s10620-021-06828-3 -
Expert Review of Gastroenterology &... 2015Comprehensive guidelines for the diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) were developed by the European and North American... (Review)
Review
Comprehensive guidelines for the diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) were developed by the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition. GERD is reflux associated with troublesome symptoms or complications. The recognition of GER and GERD is relevant to implement best management practices. A conservative management is indicated in infants with uncomplicated physiologic reflux. Children with GERD may benefit from further evaluation and treatment. Since the publications of the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition guidelines in 2009, no important novelties in drug treatment have been reported. Innovations are mainly restricted to the management of regurgitation in infants. During the last 5 years, pros and cons of multichannel intraluminal impedance have been highlighted. However, overall 'not much has changed' in the diagnosis and management of GER and GERD in infants and children.
Topics: Adolescent; Alginates; Antacids; Child; Child, Preschool; Cystic Fibrosis; Gastroesophageal Reflux; Humans; Infant; Milk Hypersensitivity; Pediatrics; Practice Guidelines as Topic; Proton Pump Inhibitors
PubMed: 26414355
DOI: 10.1586/17474124.2015.1093932