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Medicine Nov 2020Kangfuxin (KFX), a well-known Chinese patent medicine which extracted from Periplaneta americana, is widely used as an adjuvant in the treatment of peptic ulcers (PUs)... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Kangfuxin (KFX), a well-known Chinese patent medicine which extracted from Periplaneta americana, is widely used as an adjuvant in the treatment of peptic ulcers (PUs) with proton pump inhibitors (PPIs) such as rabeprazole, in China. However, no clear consensus has been reached on the efficacy for PU treatment.
METHODS
We searched in 7 electronic databases to find randomized controlled trials (RCTs) completed before May 31, 2020 to explore the clinical efficiency of KFX plus rabeprazole in the treatment of PU. Risk ratio (RR) corresponding to 95% confidence interval (CI) was calculated to estimate the outcomes. Publication bias was assessed by both Egger's and Begg's tests. Statistical analyses were performed using RevMan 5.4 and Stata version 10.0.
RESULTS
Twenty-five RCTs, comprising 2555 PU patients, were included in this study. Meta-analysis showed that, when compared with rabeprazole-based treatment alone, KFX plus rabeprazole significantly improved the healing rate (RR = 1.34, 95% CI 1.25-1.44) and overall response rate of ulcers (RR = 1.16, 95% CI 1.13-1.20), alleviated the clinical symptoms of PU (RR = 1.14, 95% CI 1.08-1.21), and reduced the recurrence of PU (RR = 0.38, 95% CI 0.24-0.61) without an increase in the occurrence of adverse events (RR = 0.92, 95% CI 0.66-1.28).
CONCLUSION
Our study suggests that KFX combined with rabeprazole showed positive therapeutic effects and is safe for treating PU, which may provide more reliable evidence for the clinical use of KFX in the treatment of PU.
Topics: Drug Therapy, Combination; Humans; Materia Medica; Peptic Ulcer; Proton Pump Inhibitors; Rabeprazole; Treatment Outcome
PubMed: 33235070
DOI: 10.1097/MD.0000000000023103 -
Gastroenterology Nov 2021Helicobacter pylori infects approximately 50% of individuals worldwide. Successful H pylori eradication is associated with reduced risk of gastric cancer and peptic... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
Helicobacter pylori infects approximately 50% of individuals worldwide. Successful H pylori eradication is associated with reduced risk of gastric cancer and peptic ulcer disease, among other conditions. We hypothesized that host genetic determinants, especially those affecting gastric pH, might contribute to eradication therapy failure, particularly when treatment adherence and antibiotic susceptibility are confirmed. We aimed to conduct a meta-analysis of host genetic variants associated with H pylori eradication failure.
METHODS
We searched the literature for studies comparing posttreatment H pylori eradication failure vs success (outcome) according to host genetic polymorphisms (exposure). Reference groups were defined according to genotypes (or corresponding phenotypes) hypothesized to be associated with successful eradication. We pooled estimates using a random-effects model and performed comprehensive sensitivity analyses.
RESULTS
We analyzed 57 studies from 11 countries; the vast majority analyzed CYP2C19 polymorphisms. Among individuals prescribed eradication regimens with proton pump inhibitors predominantly CYP2C19 metabolized, enhanced vs poor metabolizer phenotypes were associated with a 2.52-fold significantly higher likelihood of eradication failure and 4.44-fold significantly higher likelihood when treatment adherence and H pylori clarithromycin susceptibility (if relevant) were confirmed. There was no association between CYP2C19 variants and eradication failure if proton pump inhibitors less metabolized by or that bypass CYP2C19 metabolism were used. IL1B polymorphisms that are vs are not associated with less gastric acid suppression were associated with 1.72-fold significantly higher likelihood of eradication failure. There was no association between MDR1 polymorphisms and H pylori eradication failure. The certainty of evidence was moderate.
CONCLUSION
Based on meta-analysis, we identified host genetic polymorphisms significantly associated with H pylori eradication failure; host genetics might underlie eradication failure among treatment-adherent individuals with confirmed H pylori antibiotic susceptibility.
Topics: ATP Binding Cassette Transporter, Subfamily B; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cytochrome P-450 CYP2C19; Drug Resistance, Bacterial; Female; Helicobacter Infections; Helicobacter pylori; Humans; Interleukin-1beta; Male; Middle Aged; Pharmacogenetics; Pharmacogenomic Testing; Pharmacogenomic Variants; Polymorphism, Single Nucleotide; Predictive Value of Tests; Proton Pump Inhibitors; Risk Assessment; Risk Factors; Treatment Failure; Young Adult
PubMed: 34358488
DOI: 10.1053/j.gastro.2021.07.043 -
Journal of Traditional Chinese Medicine... Aug 2019To evaluate the effect and safety of Chinese herbal medicines on Helicobacter pylori (HP)-associated gastroduodenal ulcers. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effect and safety of Chinese herbal medicines on Helicobacter pylori (HP)-associated gastroduodenal ulcers.
METHODS
All randomized controlled trials (RCTs) listed in the PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure Database, WanFang, China Science and Technology Journal Database and SinoMed databases that were published in English or Chinese were searched, and the retrieval time range was from database inception to December 31, 2018. A comprehensive Meta-analysis of all publications was performed with RevMan 5.3 software, and the quality of the evidence reported in the results of Meta-analysis was analyzed with GRADE profiler software (version 3.6.1). Dichotomous data were analyzed by calculating odds ratios and 95% confidence intervals (CIs). Outcome measures included the HP clearance rate and percentage of adverse effects.
RESULTS
Eight trials with 919 participants were included in this Meta-analysis. Compared with the effects of single drug therapy on HP-associated gastroduodenal ulcers, according to the statistical analysis, odds ratios for the HP clearance rate and percentage of adverse effects of Chinese herbal medicines administered as complementary medicines combined with drugs were 3.10 [95% CI (2.21, 4.36), P < 0.01] and 0.28 [95% CI (0.15, 0.52), P < 0.01], respectively, and the differences were statistically significant. According to the GRADE analysis, the quality of evidence for the HP clearance rate and percentage of adverse effects were both very low.
CONCLUSION
Compared with using the drug therapy only, the combination of Chinese herbal medicines with the drug therapy more effectively eliminates HP and alleviates adverse reactions. However, the available studies were of low quality, and therefore more well-designed studies are required to further confirm the findings.
Topics: Adult; Drugs, Chinese Herbal; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Peptic Ulcer; Randomized Controlled Trials as Topic; Treatment Outcome; Young Adult
PubMed: 32186092
DOI: No ID Found -
Alimentary Pharmacology & Therapeutics Oct 2021Conflicting results exist on the association between Helicobacter pylori infection and gastro-oesophageal reflux (GOR), and its complications, such as erosive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Conflicting results exist on the association between Helicobacter pylori infection and gastro-oesophageal reflux (GOR), and its complications, such as erosive oesophagitis (EO) and Barrett's oesophagus (BO).
AIMS
To explore the association of H. pylori infection with GOR symptoms and their complications METHODS: We searched Embase, PubMed, Web of Science and Scopus databases through December 2020 for relevant articles. Regarding the association between H. pylori and GOR symptoms (heartburn, regurgitation or reflux), we included observational studies comparing the prevalence of GOR symptoms between H. pylori-positive and -negative individuals. Concerning the association between H. pylori and complications of GOR, we included studies comparing the prevalence of EO or BO between H. pylori-positive and -negative individuals.
RESULTS
In total, 36 papers were eligible. Based on seven cross-sectional surveys, H. pylori infection was associated with a lower odds of GOR symptoms (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.61-0.90). However, in four case-control studies, H. pylori infection was not associated with odds of GOR symptoms (OR 1.10, 95% CI 0.85-0.1.43). In 26 cross-sectional studies in patients with GOR symptoms, the OR for EO was 0.70 (95% CI 0.58-0.84) in H. pylori-positive vs -negative cases. Based on nine cross-sectional studies in subjects with GOR complications, no significant association was found between H. pylori infection and either endoscopically-diagnosed (OR 1.84, 95% CI 0.67-5.02) or histologically confirmed (OR 0.85, 95% CI 0.60-1.20) BO.
CONCLUSIONS
Helicobacter pylori infection appears to be associated with a decreased odds of GOR symptoms and EO. In contrast, H. pylori infection did not seem to affect the odds of BO in patients with GER complications.
Topics: Cross-Sectional Studies; Esophagitis, Peptic; Gastroesophageal Reflux; Helicobacter Infections; Helicobacter pylori; Humans
PubMed: 34437710
DOI: 10.1111/apt.16585 -
International Journal of Surgery... Mar 2024Marginal ulcer (MU) is a common complication of Roux-en-Y Gastric Bypass (RYGB). The primary goal of this meta-analysis was to identify potential risk factors for MU... (Meta-Analysis)
Meta-Analysis
BACKGROUNDS
Marginal ulcer (MU) is a common complication of Roux-en-Y Gastric Bypass (RYGB). The primary goal of this meta-analysis was to identify potential risk factors for MU post-RYGB.
METHODS
A comprehensive literature search was conducted on four databases (PubMed, Embase, Web of Science, and the Cochrane Library) to identify articles published from inception to 23 May 2023 that reported risk factors linked to ulcer occurrence post-RYGB. Hazard Ratio (HR) and Odds Ratio (OR) with respective 95% CI were calculated to estimate the impact of selected risk factors on MU. The risk factors were evaluated through multivariate analyses. The estimated risk factors were subjected to a random-effects model. Subgroup analysis based on study baseline characteristics and leave-one-out sensitivity analysis were also performed to investigate the potential sources of heterogeneity and assess the robustness of the findings.
RESULT
Herein, 14 observational studies involving 77 250 patients were included. Diabetes, smoking, and steroid use were identified to be risk factors of MU, with pooled ORs of (1.812; 95% CI: 1.226-2.676; P =0.003), (3.491; 95% CI: 2.204-5.531; P< 0.001), and (2.804; 95% CI: 1.383-5.685; P =0.004), respectively. Other risk factors, such as alcohol consumption, male sex, and PPI use, were deemed not significant due to differences in data acquisition and effect estimates.
CONCLUSION
Diabetes, smoking, and steroid use were identified as independent risk factors of MU. Enhancing awareness of these identified risk factors will lead to more effective preoperative prevention and targeted postoperative interventions for patients undergoing RYGB.
Topics: Humans; Male; Gastric Bypass; Obesity; Peptic Ulcer; Risk Factors; Diabetes Mellitus, Type 2; Cohort Studies; Steroids; Obesity, Morbid; Postoperative Complications; Retrospective Studies
PubMed: 38320087
DOI: 10.1097/JS9.0000000000001042 -
Orphanet Journal of Rare Diseases Dec 2019Primary hypertrophic osteoarthropathy (PHO) is a rare disease related to HPGD and SLCO2A1 gene mutation. Gastrointestinal involvement of PHO is even rarer with unknown...
Primary hypertrophic osteoarthropathy related gastrointestinal complication has distinctive clinical and pathological characteristics: two cases report and review of the literature.
BACKGROUND
Primary hypertrophic osteoarthropathy (PHO) is a rare disease related to HPGD and SLCO2A1 gene mutation. Gastrointestinal involvement of PHO is even rarer with unknown pathogenesis. Clinical features of GI complication in PHO mimics other auto-immune based bowel entities, such as inflammatory bowel diseases and cryptogenic multifocal ulcerous stenosing enteritis (CMUSE). We aimed to analyze the clinical, genetic, radiological and pathological features of Chinese patients with PHO and determine the difference between PHO patients presenting with and without GI involvement.
METHODS
We reported two PHO cases with gastrointestinal involvement and reviewed all the studies of PHO in Chinese population published from January 1, 2000, to April 30, 2018. Clinical and genetic presentations of PHO in Chinese patients were analyzed. We compared the characteristics of those patients with gastrointestinal involvement against those without.
RESULTS
The two patients were both males with complete-form PHO for more than 10 years. GI related symptoms included diarrhea, chronic gastrointestinal hemorrhage, incomplete intestinal obstruction, anemia, and edema, which were unresponsive to etoricoxib treatment. Radiological examinations revealed segmental intestinal stenosis and thickened intestinal wall. Endoscopic findings included multiple ulcers and mucosal inflammation. Both patients had mutations of SLCO2A1 according to sequence analysis. The surgical pathology revealed chronic inflammation involving the intestinal mucosa and submucosa, similar to histological changes in CMUSE. According to the systemic review of 158 Chinese patients with PHO, 17.2% had gastrointestinal involvement, including peptic ulcer, gastric polyps, hypertrophic gastritis, and segmental intestinal stenosis. Patients with gastrointestinal involvement were more likely to have anemia (40.0% vs. 4.5%, P < 0.001), hypoalbuminemia (16.7% vs. 0.9%, P = 0.003), and myelofibrosis (19.0% vs. 0.9%, P = 0.002) than those without. Most patients with gastrointestinal complication had SLCO2A1 mutation (86.7%, 13 /15).
CONCLUSIONS
Digestive tract involvement is uncommon in patients with PHO and often presents with anemia, and hypoalbuminemia resulted from intestinal inflammation. The intestinal pathologic characteristics are distinct from Crohn's disease but similar to CMUSE. Mutations in SLCO2A1 might be the pathogenic cause of GI involvement of PHO. NSAIDs may not be effective for PHO patients with gastrointestinal complications.
Topics: Asian People; Gastrointestinal Diseases; Humans; Intramolecular Oxidoreductases; Mutation; Organic Anion Transporters; Osteoarthropathy, Primary Hypertrophic
PubMed: 31878983
DOI: 10.1186/s13023-019-1264-5 -
Non-Operative Approach to Contained Perforated Marginal Ulcers: A Systematic Review and Case Series.The American Surgeon Apr 2024Perforated marginal ulcers (PMUs) are a rare but known complication of bariatric surgery. Management typically involves prompt surgical intervention, but limited data...
BACKGROUND
Perforated marginal ulcers (PMUs) are a rare but known complication of bariatric surgery. Management typically involves prompt surgical intervention, but limited data exists on non-operative approaches. This study reviews published data on non-operative management of PMUs and presents a case series of patients who were managed non-operatively. Our hypothesis is that certain patients with signs of perforation can be successfully managed non-operatively with close observation.
METHODS
We completed a systematic review searching PubMed, Embase, Web of Science, Cochrane, and clinicaltrials.gov. Ultimately 3 studies described the presentation and non-operative management of 5 patients. Additionally, we prospectively collected data from our institution on all patients who presented between Dec. 2022 and Dec. 2023 with PMUs confirmed on imaging and managed non-operatively.
RESULTS
In our literature review, three patients had Roux-en-Y gastric bypass (RYGB), while two had one anastomosis gastric bypass. One patient required surgery two days after admission. Another underwent elective conversion surgery weeks later for a non-healing ulcer. Two received endoscopic interventions. One patient recovered with nil-per-os (NPO) status, and intravenous proton pump inhibitor (PPI) treatment. The patients in our case series presented with normal vital signs, an average of 30 months after RYGB, and with CT scan signs of perforation. None of these patients required surgical or endoscopic intervention.
CONCLUSION
In conclusion, while perforated marginal ulcers have traditionally been considered a surgical emergency, some patients can be successfully treated with non-operative management. More research is needed to identify the clinical presentation features, comorbidities, and imaging findings of this group.
Topics: Humans; Administration, Intravenous; Gastric Bypass; Peptic Ulcer; Research; Ulcer
PubMed: 37927010
DOI: 10.1177/00031348231209533 -
BMC Surgery Aug 2019In theory, proximal gastrectomy with double-tract reconstruction (PG-DT) was superior to total gastrectomy (TG) in hematologic and nutritional outcomes. However, its... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
In theory, proximal gastrectomy with double-tract reconstruction (PG-DT) was superior to total gastrectomy (TG) in hematologic and nutritional outcomes. However, its clinical effects in proximal early gastric cancer (EGC) have been controversial.
METHODS
The purpose of this study was to investigate the outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DT) for proximal EGC. For this systematic review and meta-analysis, we searched for articles published before December of 2018 in the following databases: PubMed, Web of Science, EBSCO, Medline, and Cochrane Library.
RESULTS
The results showed no significant difference in the anastomotic stenosis (OR = 0.91, 95%CI = 0.33-2.50, p = 0.85) and reflux esophagitis (OR = 1.87, 95%CI = 0.62-5.65, p = 0.27) between LPG-DT and laparoscopic total gastrectomy (LTG). The vitamin B12 supplementation rate in the LPG-DT group was lower than the LTG group (OR = 0.06, 95%Cl = 0.01-0.59, p = 0.02).
CONCLUSIONS
Due to comparable clinical effect, PG-DT is comparable to TG for patients with proximal EGC. In addition, LPG-DT not only appears superior to TG in terms of preventing vitamin B12 deficiency, but also does not increase the risk of anastomotic stricture and reflux esophagitis.
Topics: Anastomosis, Surgical; Constriction, Pathologic; Esophagitis, Peptic; Gastrectomy; Humans; Laparoscopy; Retrospective Studies; Stomach Neoplasms; Treatment Outcome; Vitamin B 12 Deficiency
PubMed: 31438918
DOI: 10.1186/s12893-019-0584-7