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Military Medical Research Apr 2018Type A lactic acidosis resulted from hypoxic mitochondrial dysfunction is an independent predictor of mortality for critically ill patients. However, current therapeutic... (Review)
Review
Type A lactic acidosis resulted from hypoxic mitochondrial dysfunction is an independent predictor of mortality for critically ill patients. However, current therapeutic agents are still in shortage and can even be harmful. This paper reviewed data regarding lactic acidosis treatment and recommended that pyruvate might be a potential alkalizer to correct type A lactic acidosis in future clinical practice. Pyruvate is a key energy metabolic substrate and a pyruvate dehydrogenase (PDH) activator with several unique beneficial biological properties, including anti-oxidant and anti-inflammatory effects and the ability to activate the hypoxia-inducible factor-1 (HIF-1α) - erythropoietin (EPO) signal pathway. Pyruvate preserves glucose metabolism and cellular energetics better than bicarbonate, lactate, acetate and malate in the efficient correction of hypoxic lactic acidosis and shows few side effects. Therefore, application of pyruvate may be promising and safe as a novel therapeutic strategy in hypoxic lactic acidosis correction accompanied with multi-organ protection in critical care patients.
Topics: Acidosis, Lactic; Antacids; Bicarbonates; Erythropoietin; Fluid Therapy; Humans; Hypoxia; Hypoxia-Inducible Factor 1, alpha Subunit; Pyruvic Acid; Ringer's Lactate
PubMed: 29695298
DOI: 10.1186/s40779-018-0160-y -
Current Opinion in Clinical Nutrition... May 2015Provide research that relates the developing intestinal microbiome, nutrition, and the subsequent host response to the development of necrotizing enterocolitis (NEC),... (Review)
Review
PURPOSE OF REVIEW
Provide research that relates the developing intestinal microbiome, nutrition, and the subsequent host response to the development of necrotizing enterocolitis (NEC), one of the most common and deadliest diseases seen in newborn infants. After nearly 50 years of little to no progress in this area, we are finally beginning to obtain evidence that is likely to lead to better understanding of both pathophysiology and prevention of the disease.
RECENT FINDINGS
We will discuss new discoveries related to the development of the microbiome from prenatal to postnatal life, as well as new findings of microbes and human milk oligosaccharides in human milk as they relate to pathogenesis of NEC. The effect of antibiotics and acid blocking agents, as they may increase the odds of development of NEC, will also be discussed.
SUMMARY
The implications of these findings are that improved understanding of the developing microbiome, the factors that affect the microbiome including nutrition such as donor milk versus baby's own mother's milk, and certain drugs, will help clinicians to adjust their current feeding and drug utilization to potentially prevent this disease.
Topics: Antacids; Anti-Bacterial Agents; Enterocolitis, Necrotizing; Gastrointestinal Microbiome; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Premature; Milk, Human
PubMed: 25807349
DOI: 10.1097/MCO.0000000000000169 -
Current Gastroenterology Reports Nov 2017Guidelines were recently published highlighting why esophageal atresia (EA) patients are prone to complication risks, and the need for long-term follow-up. In this... (Review)
Review
PURPOSE OF REVIEW
Guidelines were recently published highlighting why esophageal atresia (EA) patients are prone to complication risks, and the need for long-term follow-up. In this review, we will focus on how to investigate and treat potential complications, as well as the pros and cons of different investigative and treatment modalities, and what areas continue to need further research.
RECENT FINDINGS
EA patients are at high risk for gastroesophageal reflux and esophageal strictures, and the sequela that result. Extraintestinal manifestations of gastroesophageal reflux disease (GERD) can appear similar to other pathologic diagnoses commonly found in EA patients, such as congenital stricture, eosinophilic esophagitis, esophageal dysmotility, tracheomalacia, recurrent fistula, aspiration, etc. Therefore, it is important to have a standardized way to monitor for these issues. pH impedance allows for detection of nonacid reflux and the height of reflux, which are important in correlating symptoms with reflux episodes. A multidisciplinary approach is beneficial in evaluating and monitoring EA patients in the long term.
Topics: Antacids; Eosinophilic Esophagitis; Esophageal Atresia; Esophageal Stenosis; Esophageal pH Monitoring; Gastroesophageal Reflux; Humans; Long-Term Care; Tracheoesophageal Fistula
PubMed: 29177550
DOI: 10.1007/s11894-017-0605-6 -
Paediatric Drugs Sep 2023Proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA) are commonly used medications in neonates and infants for the treatment of gastroesophageal... (Review)
Review
Proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA) are commonly used medications in neonates and infants for the treatment of gastroesophageal reflux disease (GERD), especially in neonatal intensive care units (NICUs). A literature review was conducted to evaluate the efficacy and safety of histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) in preterm neonates, term neonates, and infants. A total of 27 studies were included in this review. Antacid medications in studies have consistently shown positive pharmacodynamic effects, including increasing gastric pH, reducing the reflux index, and reducing the number of acidic reflux events. The benefit found in placebo-controlled trials are limited exclusively to these surrogate outcomes. The actual clinically salient outcomes which H2RAs and PPIs are used for, such as reduction in GERD symptoms, especially irritability and improved feed tolerance and weight gain, have consistently shown no clinical benefit. H2RAs and PPIs appear to be extremely well tolerated by the neonatal and infant populations, which would mimic our experience with these medications in our unit. The available data from large, retrospective cohort and case-control studies paint a much more concerning picture regarding the potential for an increased risk in the development of allergies, anaphylactic reactions, necrotizing enterocolitis (NEC), other nosocomial infections, and lower respiratory tract infections. Given the risks associated with and lack of clinical effectiveness of both H2RAs and PPIs, use of these medications should be limited to specific clinical situations. Further studies are required to determine whether antacid pharmacologic therapy might benefit certain neonates and infants, such as those with complex medical issues.
Topics: Infant; Infant, Newborn; Humans; Proton Pump Inhibitors; Antacids; Histamine; Retrospective Studies; Gastroesophageal Reflux; Histamine H2 Antagonists
PubMed: 37458926
DOI: 10.1007/s40272-023-00580-z -
Alimentary Pharmacology & Therapeutics Sep 2020
Topics: Alginates; Antacids; Esophageal Diseases; Esophageal Mucosa; Humans; Silicic Acid
PubMed: 33119153
DOI: 10.1111/apt.15970 -
American Journal of Therapeutics 2017Bismuth salts exert their activity within the upper gastrointestinal tract through action of luminal bismuth. Bismuth exerts direct bactericidal effect on Helicobacter... (Review)
Review
Bismuth salts exert their activity within the upper gastrointestinal tract through action of luminal bismuth. Bismuth exerts direct bactericidal effect on Helicobacter pylori by different ways: forms complexes in the bacterial wall and periplasmic space, inhibits different enzymes, ATP synthesis, and adherence of the bacteria to the gastric mucosa. Bismuth also helps ulcer healing by acting as a barrier to the aggressive factors and increasing mucosal protective factors such as prostaglandin, epidermal growth factor, and bicarbonate secretion. To date, no resistance to bismuth has been reported. Also synergism between bismuth salts and antibiotics was present. It was shown that metronidazole and clarithromycin resistant H. pylori strains become susceptible if they are administered together with bismuth. Bismuth-containing quadruple therapy was recommended both by the Second Asia-Pacific Consensus Guidelines and by the Maastricht IV/Florence Consensus Report as an alternative first choice regimen to standard triple therapy, in areas with low clarithromycin resistance, and it is recommended as the first-line therapeutic option in areas with a high prevalence of clarithromycin resistance. Greater than 90% eradication success can be obtained by bismuth-containing quadruple therapy. Choosing bismuth as an indispensable part of first-line therapy is logical as both metronidazole and clarithromycin resistances can be overcome by adding bismuth to the regimen.
Topics: Antacids; Anti-Bacterial Agents; Bismuth; Clarithromycin; Disease Eradication; Drug Resistance, Bacterial; Drug Therapy, Combination; Gastric Mucosa; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Peptic Ulcer; Practice Guidelines as Topic; Proton Pump Inhibitors; Ranitidine
PubMed: 26808355
DOI: 10.1097/MJT.0000000000000389 -
Arquivos de Gastroenterologia Aug 2019Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal diseases. GERD generates significant impairment in patients' quality of life and it... (Review)
Review
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.
Topics: Antacids; Antiemetics; Behavior Therapy; Evidence-Based Medicine; Gastroesophageal Reflux; Histamine H2 Antagonists; Humans; Life Style; Proton Pump Inhibitors
PubMed: 31460587
DOI: 10.1590/S0004-2803.201900000-41 -
Expert Opinion on Drug Safety Jul 2015The management of gastro-esophageal reflux and esophagitis in infants and children is challenging, and there are currently no clear practice guidelines. Given a paucity... (Review)
Review
INTRODUCTION
The management of gastro-esophageal reflux and esophagitis in infants and children is challenging, and there are currently no clear practice guidelines. Given a paucity of evidence in the treatment of pediatric esophagitis, there are concerns over both the efficacy and safety of proton-pump inhibitors, histamine type 2 receptor antagonists, and prokinetics.
AREAS COVERED
Comprehensive data from randomized-controlled trials, meta-analyses and observational studies have helped to illustrate the efficacy and safety of various pharmacologic and non-pharmacologic treatments in pediatric esophagitis. We review the evidence on the risks of antacid therapy including bone mineral density, respiratory infections and enteric infections including necrotizing enterocolitis.
EXPERT OPINION
Evidence pertaining to the safety of proton-pump inhibitors and histamine 2 receptor antagonists in pediatric populations is lacking. Largely based on small observational and randomized controlled trials, it does appear both antacids pose an increased risk of respiratory and enteric infections, which can occur even with a short course of treatment. The benefits of treatment, especially in pediatric esophagitis, must be weighed against the potential risks. More large-scale studies are needed to better quantify short-term and long-term risks of treatment. Anti-secretory medications, mostly proton pump inhibitors, have substantially improved the management of pediatric esophagitis. Nevertheless, because of possible infectious safety concerns, their use must be restricted to validated indications only.
Topics: Antacids; Child; Clinical Trials as Topic; Enterocolitis, Necrotizing; Esophagitis; Gastroesophageal Reflux; Histamine H2 Antagonists; Humans; Infant; Meta-Analysis as Topic; Proton Pump Inhibitors; Respiratory Tract Infections
PubMed: 25913014
DOI: 10.1517/14740338.2015.1040389 -
The Lancet. Respiratory Medicine Jul 2017Idiopathic pulmonary fibrosis (IPF) is a progressive parenchymal lung disease of complex cause. Gastro-oesophageal reflux (GER) and microaspiration have been proposed as... (Review)
Review
Idiopathic pulmonary fibrosis (IPF) is a progressive parenchymal lung disease of complex cause. Gastro-oesophageal reflux (GER) and microaspiration have been proposed as risk factors for the development and progression of IPF, but robust definitive data are few. A recent international guideline conditionally recommended the use of antacid therapy (proton pump inhibitors or histamine-2-receptor antagonists) for patients with IPF, in the absence of oesophageal reflux or symptoms. In this Position Paper, we summarise the literature addressing the association between GER and IPF, and also identify future research priorities that could clarify this issue. We shed light on the process through which the guideline recommendation was achieved and aim to contextualise the recommendation for providers caring for patients with IPF.
Topics: Antacids; Disease Progression; Gastroesophageal Reflux; Histamine H2 Antagonists; Humans; Idiopathic Pulmonary Fibrosis; Practice Guidelines as Topic; Proton Pump Inhibitors; Risk Factors; Severity of Illness Index
PubMed: 28664861
DOI: 10.1016/S2213-2600(17)30219-9 -
International Journal of Sports Medicine Apr 2015In the past 2 decades, molecular hydrogen emerged as a novel therapeutic agent, with antioxidant, anti-inflammatory and anti-apoptotic effects demonstrated in plethora... (Review)
Review
In the past 2 decades, molecular hydrogen emerged as a novel therapeutic agent, with antioxidant, anti-inflammatory and anti-apoptotic effects demonstrated in plethora of animal disease models and human studies. Beneficial effects of molecular hydrogen in clinical environment are observed especially in oxidative stress-mediated diseases, such as diabetes mellitus, brain stem infarction, rheumatoid arthritis, or neurodegenerative diseases. A number of more recent studies have reported that molecular hydrogen affects cell signal transduction and acts as an alkalizing agent, with these newly identified mechanisms of action having the potential to widen its application in clinical medicine even further. In particular, hydrogen therapy may be an effective and specific innovative treatment for exercise-induced oxidative stress and sports injury, with potential for the improvement of exercise performance. This review will summarize recent research findings regarding the clinical aspects of molecular hydrogen use, emphasizing its application in the field of sports medicine.
Topics: Acidosis; Animals; Antacids; Antioxidants; Athletic Injuries; Exercise; Humans; Hydrogen; Oxidative Stress; Water
PubMed: 25525953
DOI: 10.1055/s-0034-1395509