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Journal of Research in Medical Sciences... 2022Chronic dyspepsia's symptoms are frequently seen in primary to tertiary healthcare in Indonesia. This study aimed to describe the potential usability of pepsinogen (PG)...
BACKGROUND
Chronic dyspepsia's symptoms are frequently seen in primary to tertiary healthcare in Indonesia. This study aimed to describe the potential usability of pepsinogen (PG) values in determining gastric mucosal conditions, including superficial gastritis and atrophic gastritis.
MATERIALS AND METHODS
We recruited 646 adult dyspeptic patients and then analyzed PG values (including PGI, PGII, and PGI/II ratio) with endoscopic findings, gastric mucosal damages, and infection. The gastric mucosal damage and infection were evaluated using histological examination based on the updated Sydney system.
RESULTS
Among 646 enrolled patients, 308 (47.2%), 212 (32.8%), 91 (14.1%), 34 (5.2%), and 1 (0.2%) patient were diagnosed with normal mucosa, gastritis, reflux esophagitis, peptic ulcer disease, and gastric cancer, respectively. Significant differences in PGI, PGII, and PGI/II ratio values were observed among ethnic groups (all < 0.01). The PGI and PGII levels were significantly higher and PGI/II was significantly lower in -infected patients than in uninfected ones (all < 0.001). The optimal cutoff value for PGII and PGI/II was 12.45 ng/mL with an area under the curve (AUC) value of 0.755 (0.702-0.811), sensitivity 59.3%, and specificity 77.1%; and 4.75 with AUC value of 0.821 (0.763-0.855), sensitivity 81.5%, and specificity 78.7%, respectively, to determine moderate-severe atrophy.
CONCLUSION
Serum PG levels, a useful biomarker, represent the endoscopic findings, especially for reflux esophagitis. In addition, the benefits of PG values detecting atrophic gastritis were limited to moderate-severe atrophic gastritis. This usefulness requires careful attention for several ethnic groups in Indonesia.
PubMed: 36685023
DOI: 10.4103/jrms.jrms_983_21 -
Clinical and Experimental Hepatology Dec 2022Endoscopic variceal ligation (EVL) is important for emergency as well as prophylactic management of esophageal varices. Early bleeding after EVL is associated with...
AIM OF THE STUDY
Endoscopic variceal ligation (EVL) is important for emergency as well as prophylactic management of esophageal varices. Early bleeding after EVL is associated with significant morbidity and mortality. Assessing the likelihood of early post-EVL bleeding and its determinants can help deciding therapeutic strategies for high-risk patients. The aim of the present meta-analysis was to identify predictors of early bleeding after EVL.
MATERIAL AND METHODS
A comprehensive search of the literature was conducted from 2000 to November 2021 for studies evaluating the incidence, predictors and outcome of post-EVL bleeding. Pooled odds ratios (OR), mean difference (MD) and their 95% confidence intervals (CI) were calculated for prognostic variables.
RESULTS
A total of 16 studies with data on 13,378 patients were included in the meta-analysis. Among 34 parameters, 14 parameters were assessed for association with early bleeding after EVL. Lower hemoglobin at admission (MD = 1.11, 95% CI: -1.91 to -0.31), higher MELD score (MD = 2.00, 95% CI: 0.51-3.50), associated gastric varices (OR = 5.99, 95% CI: 1.06-33.90), higher number of bands (MD = 0.49, 95% CI: 0.02-0.97), and peptic esophagitis (OR = 11.38, 95% CI: 1.21-106.81) were significantly associated with increased risk of bleeding. However, there was significant heterogeneity among the studies with respect to all the analyzed parameters.
CONCLUSIONS
Major predictors for early post-EVL bleeding in cirrhosis are admission hemoglobin level and MELD score, associated gastric varices, number of bands deployed during EVL, and peptic esophagitis on follow-up endoscopy. These risk factors may be useful for risk stratification after EVL in cirrhotics.
PubMed: 36683871
DOI: 10.5114/ceh.2022.123096 -
In Vivo (Athens, Greece) 2023Gastric acid reflux into the esophagus can cause irritation and inflammation of the esophagus and progress to reflux esophagitis (RE). Vitamin D3 (VitD3) has...
BACKGROUND/AIM
Gastric acid reflux into the esophagus can cause irritation and inflammation of the esophagus and progress to reflux esophagitis (RE). Vitamin D3 (VitD3) has anti-inflammatory effects and plays an important regulatory role in adaptive and innate immunity. We hypothesized that VitD3 may play a protective role in RE.
MATERIALS AND METHODS
Seventy male Sprague-Dawley rats were used, and acute RE (n=35) or chronic RE (n=35) were surgically induced. The effects of different doses of VitD3 on morphological changes and alteration of pro-inflammatory cytokine levels were examined in the rat models. Western blot analysis was performed to determine protein expression levels of IL-1β, IL-6, and IL-8 in esophageal tissues. Serum levels of VitD3 and calcium were determined using enzyme-linked immunosorbent assays.
RESULTS
The protein expression of pro-inflammatory cytokines IL-1β, IL-6, and IL-8 was found significantly increased in RE. VitD3 treatment significantly reduced the levels of these pro-inflammatory cytokines in both the low-dose and high-dose VitD3 groups compared to control groups in acute RE, but not chronic RE. Macrographic and histopathological examination revealed various degrees of esophageal impairment in rats following surgical induction of acute or chronic RE in rats. These impairments were not improved by VitD3. Morphological grading of esophageal mucosa showed no significant differences between acute and chronic RE. Elevated serum levels of calcium were observed after VitD3 treatment.
CONCLUSION
IL-1β, IL-6, and IL-8 levels were significantly elevated in RE. The abnormal increase in these important pro-inflammatory cytokines was suppressed by VitD3 in the rat models of acute RE. These novel findings suggest a potential protective role of VitD3 in early-stage RE.
Topics: Male; Rats; Animals; Esophagitis, Peptic; Cytokines; Interleukin-8; Calcium; Interleukin-6; Rats, Sprague-Dawley; Gastroesophageal Reflux; Inflammation; Cholecalciferol
PubMed: 36593017
DOI: 10.21873/invivo.13056 -
Gut and Liver Nov 2023Reflux hypersensitivity (RH) is one of the phenotypes of gastroesophageal reflux disease. The latest Rome IV defines RH as a condition with typical reflux symptoms and... (Review)
Review
Reflux hypersensitivity (RH) is one of the phenotypes of gastroesophageal reflux disease. The latest Rome IV defines RH as a condition with typical reflux symptoms and positive reflux-symptom association despite normal acid exposure. Subsequently, the Lyon consensus proposed detailed cutoff values for the criteria on the basis of experts' consensus. Rome IV brought a clear-cut perspective into the pathophysiology of gastroesophageal reflux disease and the importance of esophageal hypersensitivity. This perspective can be supported by the fact that other functional gastrointestinal disorders such as irritable bowel syndrome and functional dyspepsia often overlap with RH. Although several possible pathophysiological mechanisms of esophageal hypersensitivity have been identified, there is still unmet medical needs in terms of treatment for this condition. This review summarizes the current knowledge regarding RH.
Topics: Humans; Esophageal pH Monitoring; Gastroesophageal Reflux; Esophagitis, Peptic; Dyspepsia
PubMed: 36588526
DOI: 10.5009/gnl220373 -
The Korean Journal of Gastroenterology... Dec 2022Proton pump inhibitors (PPIs) have several limitations to their efficacy including insufficient acid suppression, slow onset of action, and variable efficacy among... (Review)
Review
Proton pump inhibitors (PPIs) have several limitations to their efficacy including insufficient acid suppression, slow onset of action, and variable efficacy among patients due to CYP2C19 metabolism. Potassium-competitive acid blockers inhibit H-K-ATPase in a reversible and K-competitive manner, are novel acid suppressive drugs with rapid onset of action, meal independence, and prolonged control of intragastric acidity compared to PPIs. Potassium-competitive acid blockers exhibited non-inferior therapeutic efficacies on reflux esophagitis, gastric ulcers, and eradication. The review is focused on the unmet needs across the acid-related diseases and recent updates on clinical studies using vonoprazan and tegoprazan.
Topics: Humans; Potassium; Proton Pump Inhibitors; Esophagitis, Peptic; Helicobacter Infections; Helicobacter pylori
PubMed: 36567437
DOI: 10.4166/kjg.2022.143 -
Zhongguo Dang Dai Er Ke Za Zhi =... Dec 2022To study the clinical and gastroscopic features of children with cyclic vomiting syndrome.
OBJECTIVES
To study the clinical and gastroscopic features of children with cyclic vomiting syndrome.
METHODS
A retrospective analysis was performed on the medical data of 63 children with cyclic vomiting syndrome who were hospitalized and followed up in Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University from August 2019 to March 2022.
RESULTS
Among the 63 children, there were 30 boys and 33 girls, with a mean age of 6.11 years, a mean course of disease of 2.57 years, and a mean vomiting period of 4.04 days. The most common accompanying symptom was listlessness or somnolence (55/63, 87%), followed by anorexia (45/63, 71%), abdominal pain or abdominal discomfort (40/63, 63%), constipation (19/63, 30%), salivation (12/63, 19%), nausea (11/63, 17%), headache (11/63, 17%), fever (6/63, 10%), and rash (1/63, 2%). All 63 children underwent gastroscopy, among whom 3 had no marked abnormalities, 22 (35%) had chronic superficial gastritis or chronic non-atrophic gastritis alone, and 38 (60%) had other abnormal changes aside from chronic gastritis (16 children with reflux esophagitis, 12 with bile reflux gastritis, 13 with duodenitis, 10 with erosive gastritis, and 5 with gastric or duodenal ulcer). Among the 63 children, 42 underwent pathological examinations of gastric mucosa, among whom 5 had no marked abnormalities, 34 had mild chronic gastritis, 2 had moderate chronic gastritis, and 1 had severe chronic gastritis. Among the 63 children, 15 received 24-hour dynamic esophageal pH monitoring during the interictal period, among whom 9 children were found to have pathological acid reflux.
CONCLUSIONS
In addition to recurrent vomiting, most children with cyclic vomiting syndrome also have the symptoms such as somnolence or listlessness, anorexia, and abdominal pain. The main manifestation on gastroscopy is chronic gastritis, and most children may also have reflux esophagitis, bile reflux gastritis, and erosive gastritis. Mild chronic gastritis is the main pathological change of gastric mucosa.
Topics: Male; Female; Humans; Child; Gastroscopy; Esophagitis, Peptic; Bile Reflux; Anorexia; Retrospective Studies; Sleepiness; Gastritis; Gastric Mucosa; Vomiting; Abdominal Pain
PubMed: 36544416
DOI: 10.7499/j.issn.1008-8830.2206007 -
Toxicology Reports 2022Proton pump inhibitors (PPIs) and H blockers are commonly prescribed medications to treat ulcers in the stomach and the upper part of the small intestine and prescribed...
BACKGROUND
Proton pump inhibitors (PPIs) and H blockers are commonly prescribed medications to treat ulcers in the stomach and the upper part of the small intestine and prescribed for some other common gastrointestinal complications such as gastroesophageal reflux disease, esophagitis, irritable bowel syndrome, and dyspepsia. Previous studies claimed that, apart from other side effects, these anti-ulcerant therapies significantly altered bone mineral density by interfering with intestinal reabsorption of minerals and vitamin B12, and the most widely prescribed PPIs were significantly associated with increased risks of hip and spine fractures. However, the potential skeletal side effects of these antiulcerants are unknown in Bangladesh.
METHODS
To examine safety concerns of anti-ulcer therapies and their impact on musculoskeletal health among patients in Bangladesh, the present work surveyed 200 patients in five different hospitals from December 2019 to February 2020.
RESULTS
The current study revealed that most respondents (95 %) received PPIs for gastrointestinal indications while the rest were taking H2 receptor antagonists for their gastric ailments. Most patients taking PPIs alone (> 3 years; 95 % of respondents) claimed some unusual musculoskeletal side effects, such as weakness, flank pain, spasm of hands and feet, muscle aches, numbness, and tremor. About 61 % of patients taking PPIs experienced low back pain whereas the respondents with neck pain and knee joint pain were 10 % and 7 %, respectively. However, few osteopenia and osteoporotic incidences have been also recorded. Although further studies are required to confirm the impact of these antiulcerants on the bone, these patient responses suggest that these musculoskeletal side effects might have some links with altered bone metabolism.
CONCLUSIONS
It is possible that anti-ulcerant therapies may worsen the bone metabolism of patients suffering from osteoporosis or other bone disorders, and awareness and precautions should be raised among the patients and clinicians for the careful administration of PPIs to patients suffering from bone disorders.
PubMed: 36518456
DOI: 10.1016/j.toxrep.2022.09.007 -
Przeglad Gastroenterologiczny 2022Dyspepsia is a common gastrointestinal (GI) complaint with predominant underlying normal findings or trivial lesions and may be a symptom of serious morbidity.
INTRODUCTION
Dyspepsia is a common gastrointestinal (GI) complaint with predominant underlying normal findings or trivial lesions and may be a symptom of serious morbidity.
AIM
To assess the significance of endoscopic findings in the case of uninvestigated dyspepsia in adults.
MATERIAL AND METHODS
This is a single-centre cross-sectional descriptive study of 372 patients (198 females, 174 males) who presented with dyspepsia and underwent endoscopic examination. Demographic, clinical complaints with alarm features, drug use, and endoscopic findings were collected and analysed. Gastric biopsy was performed to detect Helicobacter pylori (H. pylori) infection. Findings of erosions, ulcers, and neoplasms were regarded as significant lesions.
RESULTS
Mean age of patients was 35.7 ±13.5 years. The main presenting symptom of dyspepsia was epigastric pain (61.6%). The endoscopic findings were gastroduodenitis (GD) (47.6%), esophagitis (15.1%), peptic ulcers (7.3%), cancer of the stomach (0.8%), and gastric polyps (0.5%). Non-significant and normal findings represented 70.2% (261/372, < 0.001). Age group ≥ 50 years manifested significant lesions in 45.7% (32/70), and age group < 50 years 26.2% (79/302). Weight loss, anaemia, vomiting, and nonsteroidal anti-inflammatory drugs (NSAIDs) were associated with significant lesions in 85.7%, 84.2%, 32.7%, and 58.3%, respectively. H. pylori prevalence in patients without organic lesions was 47.7%.
CONCLUSIONS
In two thirds of patients presented with dyspepsia, endoscopy revealed minor or normal findings. Age group ≥ 50 years, alarm features, and use of NSAIDs were predictive of significant endoscopic findings. Strict clinical criteria should be adopted before referring patients with dyspepsia to endoscopy.
PubMed: 36514452
DOI: 10.5114/pg.2021.112250