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American Journal of Respiratory and... May 2022This American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax guideline updates prior idiopathic...
This American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax guideline updates prior idiopathic pulmonary fibrosis (IPF) guidelines and addresses the progression of pulmonary fibrosis in patients with interstitial lung diseases (ILDs) other than IPF. A committee was composed of multidisciplinary experts in ILD, methodologists, and patient representatives. ) Update of IPF: Radiological and histopathological criteria for IPF were updated by consensus. Questions about transbronchial lung cryobiopsy, genomic classifier testing, antacid medication, and antireflux surgery were informed by systematic reviews and answered with evidence-based recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. ) Progressive pulmonary fibrosis (PPF): PPF was defined, and then radiological and physiological criteria for PPF were determined by consensus. Questions about pirfenidone and nintedanib were informed by systematic reviews and answered with evidence-based recommendations using the GRADE approach. ) Update of IPF: A conditional recommendation was made to regard transbronchial lung cryobiopsy as an acceptable alternative to surgical lung biopsy in centers with appropriate expertise. No recommendation was made for or against genomic classifier testing. Conditional recommendations were made against antacid medication and antireflux surgery for the treatment of IPF. ) PPF: PPF was defined as at least two of three criteria (worsening symptoms, radiological progression, and physiological progression) occurring within the past year with no alternative explanation in a patient with an ILD other than IPF. A conditional recommendation was made for nintedanib, and additional research into pirfenidone was recommended. The conditional recommendations in this guideline are intended to provide the basis for rational, informed decisions by clinicians.
Topics: Antacids; Biopsy; Humans; Idiopathic Pulmonary Fibrosis; Lung; Lung Diseases, Interstitial; United States
PubMed: 35486072
DOI: 10.1164/rccm.202202-0399ST -
The Journal of International Medical... Mar 2022Heartburn and acid regurgitation are the typical symptoms of gastroesophageal reflux. Despite the availability of several treatment options, antacids remain the mainstay... (Review)
Review
Heartburn and acid regurgitation are the typical symptoms of gastroesophageal reflux. Despite the availability of several treatment options, antacids remain the mainstay treatment for gastroesophageal reflux-related symptoms based on their efficacy, safety, and over-the-counter availability. Antacids are generally recommended for adults and children at least 12 years old, and the FDA recommends antacids as the first-line treatment for heartburn in pregnancy. This narrative review summarizes the mechanism, features, and limitations related to different antacid ingredients and techniques available to study the acid neutralization and buffering capacity of antacid formulations. Using supporting clinical evidence for different antacid ingredients, it also discusses the importance of antacids as OTC medicines and first-line therapies for heartburn, particularly in the era of the COVID-19 pandemic, in which reliance on self-care has increased. The review will also assist pharmacists and other healthcare professionals in helping individuals with heartburn to make informed self-care decisions and educating them to ensure that antacids are used in an optimal, safe, and effective manner.
Topics: Adult; Antacids; Child; Female; Heartburn; Humans; Pandemics; Pregnancy; Self-Management; COVID-19 Drug Treatment
PubMed: 35343261
DOI: 10.1177/03000605221086457 -
Medicine Sep 2022Gastroesophageal reflux disease (GERD) occurs in approximately two-thirds of all pregnancies. Around 25% of pregnant women experience heartburn daily. Symptomatic GERD... (Review)
Review
Gastroesophageal reflux disease (GERD) occurs in approximately two-thirds of all pregnancies. Around 25% of pregnant women experience heartburn daily. Symptomatic GERD usually presents in the first trimester and progresses throughout pregnancy. The treatment goal is to alleviate heartburn and regurgitation without jeopardizing the pregnancy or its outcome. An English language electronic literature search of MEDLINE, EMBASE, and Cochrane Reviews was undertaken to identify randomized controlled trials, observational studies, management recommendations and reviews of GERD and its treatment during pregnancy. The search period was defined by the date of inception of each database. The treatment in a pregnant GERD patient should follow the step-up approach, starting with lifestyle modification as the first step. If heartburn is severe, medication should be started after consultation with a physician (Recommendation Grade C). The preferred choice of antacids is calcium-containing antacids (Recommendation Grade A). If symptoms persist with antacids Sucralfate can be introduced at a 1g oral tablet, 3 times daily (Recommendation Grade C). Followed by histamine-2 receptor antagonist (Recommendation Grade B). Inadequate control while on histamine-2 receptor antagonist and antacid may mandate a step-up to proton pump inhibitors along with antacids as rescue medication for breakthrough GERD (Recommendation Grade C). This article presented the treatment recommendations for pregnant women with typical GERD, based on the best available evidence.
Topics: Antacids; Calcium; Female; Gastroesophageal Reflux; Heartburn; Histamine; Histamine H2 Antagonists; Humans; Pregnancy; Proton Pump Inhibitors; Sucralfate
PubMed: 36107559
DOI: 10.1097/MD.0000000000030487 -
Diseases of the Esophagus : Official... May 2017In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some... (Meta-Analysis)
Meta-Analysis Review
In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some patients, especially those with nonerosive reflux disease or atypical GERD symptoms, acid-suppressive therapy with PPIs is not as successful. Alginates are medications that work through an alternative mechanism by displacing the postprandial gastric acid pocket. This study performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of patients with symptoms of GERD. PubMed/MEDLINE, Embase, and the Cochrane library electronic databases were searched through October 2015 for randomized controlled trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists (H2RAs), or PPIs for the treatment of GERD symptoms. Additional studies were identified through a bibliography review. Non-English studies and those with pediatric patients were excluded. Meta-analyses were performed using random-effect models to calculate odds ratios (OR). Heterogeneity between studies was estimated using the I2 statistic. Analyses were stratified by type of comparator. The search strategy yielded 665 studies and 15 (2.3%) met inclusion criteria. Fourteen were included in the meta-analysis (N = 2095 subjects). Alginate-based therapies increased the odds of resolution of GERD symptoms when compared to placebo or antacids (OR: 4.42; 95% CI 2.45-7.97) with a moderate degree of heterogeneity between studies (I2 = 71%, P = .001). Compared to PPIs or H2RAs, alginates appear less effective but the pooled estimate was not statistically significant (OR: 0.58; 95% CI 0.27-1.22). Alginates are more effective than placebo or antacids for treating GERD symptoms.
Topics: Adult; Alginates; Antacids; Female; Gastroesophageal Reflux; Glucuronic Acid; Hexuronic Acids; Histamine H2 Antagonists; Humans; Male; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 28375448
DOI: 10.1093/dote/dow020 -
BMJ Clinical Evidence Sep 2015Heartburn is a common complaint during pregnancy; the incidence is reported to be between 17% and 45%. (Review)
Review
INTRODUCTION
Heartburn is a common complaint during pregnancy; the incidence is reported to be between 17% and 45%.
METHODS AND OUTCOMES
We conducted a systematic overview and aimed to answer the following clinical question: What are the effects of interventions to prevent or treat heartburn in pregnancy? We searched Medline, Embase, The Cochrane Library, and other important databases up to December 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review).
RESULTS
At this update, searching of electronic databases retrieved 80 studies. After deduplication and removal of conference abstracts, 59 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 58 studies and the further review of one full publication. The full article evaluated did not meet our reporting criteria, and thus no new evidence was added at this update. We performed a GRADE evaluation for two PICO combinations.
CONCLUSIONS
In this systematic overview, we categorised the efficacy for six interventions, based on information about the effectiveness and safety of acid-suppressing drugs, antacids with or without alginates, raising the head of the bed, reducing caffeine intake, reducing intake of fatty foods, and reducing the size and frequency of meals.
Topics: Antacids; Beds; Diet; Female; Heartburn; Humans; Pregnancy; Pregnancy Complications
PubMed: 26348641
DOI: No ID Found -
The Korean Journal of Gastroenterology... Feb 2019Gastroesophageal reflux disease (GERD) is a condition that develops when reflux of stomach contents causes troublesome symptoms and/or complications. The prevalence of... (Review)
Review
Gastroesophageal reflux disease (GERD) is a condition that develops when reflux of stomach contents causes troublesome symptoms and/or complications. The prevalence of GERD is increasing worldwide and in Asia-Pacific. The latest Korean guidelines for GERD were published in 2012, and several international guidelines and consensus statements for the management of GERD have also been recently published. Here, we review these guidelines and consensus statements in order to provide a better understanding of the diagnosis and treatment of GERD.
Topics: Antacids; Endoscopy, Gastrointestinal; Gastroesophageal Reflux; Histamine H2 Antagonists; Humans; Practice Guidelines as Topic; Proton Pump Inhibitors
PubMed: 30845382
DOI: 10.4166/kjg.2019.73.2.70 -
Nutrients Jan 2020Chronic functional constipation is a frequent condition. The aim of the study was to evaluate the efficacy of the probiotic Lactobacillus (L.) reuteri DSM 17938 and... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Chronic functional constipation is a frequent condition. The aim of the study was to evaluate the efficacy of the probiotic Lactobacillus (L.) reuteri DSM 17938 and magnesium oxide (MgO) for relieving chronic functional constipation in children.
STUDY DESIGN
A prospective, double-blind, placebo-controlled, randomized, and parallel-group trial was conducted in five pediatric outpatient clinics in Japan. Sixty patients who were more than six months old and under six years of age with a diagnosis of functional constipation according to Rome IV criteria were randomly divided into three groups: group A (n = 20) received L. reuteri DSM 17938 and lactose hydrate as a placebo of MgO; group B (n = 19) received L. reuteri DSM 17938 and MgO; and group C (n = 21) received a placebo of L. reuteri DSM 17938 and MgO.
RESULTS
All three groups exhibited significant improvement in defecation frequency in the fourth week compared with the baseline condition (group A: p < 0.05; group B: p < 0.05; group C: p < 0.05). The MgO group and combination group showed a significant decrease in stool consistency, but the L. reuteri DSM 17938 group did not (group A: p = 0.079; group B: p < 0.05; group C: p < 0.05). MgO significantly suppressed the presence of the genus Dialister. Defecation frequency negatively correlated with the frequency of Clostridiales-belonging bacteria among the gut microbiome.
CONCLUSIONS
L. rueteri DSM 17938 and MgO were both effective in the management of functional constipation in young children. MgO caused an imbalance in the gastrointestinal microbiome, which was not the case in the probiotic group.
Topics: Antacids; Child, Preschool; Chronic Disease; Constipation; Double-Blind Method; Female; Humans; Infant; Limosilactobacillus reuteri; Magnesium Oxide; Male; Probiotics
PubMed: 31952280
DOI: 10.3390/nu12010225 -
The Lancet. Respiratory Medicine May 2016Gastro-oesophageal reflux disease is a potential risk factor for the development and progression of idiopathic pulmonary fibrosis (IPF). We aimed to investigate the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Gastro-oesophageal reflux disease is a potential risk factor for the development and progression of idiopathic pulmonary fibrosis (IPF). We aimed to investigate the effect of antacid therapy on disease progression in patients randomly assigned to placebo through analysis of three large, phase 3 trials of pirfenidone in IPF.
METHODS
Patients with IPF from the placebo groups of three trials of pirfenidone (CAPACITY 004, CAPACITY 006, and ASCEND) were included in this post-hoc analysis. We analysed effects of antacid therapy use from baseline for pulmonary function, exercise tolerance, survival, hospital admission, and adverse events for 52 weeks with and without adjustment for potential confounders. The primary endpoint, disease progression by 1 year, was defined as a decrease in predicted forced vital capacity (FVC) by 10% or more, a decrease in 6 min walk distance (6MWD) by 50 m or more, or death. We did survival analyses with the Kaplan-Meier estimator and evaluated using the log-rank test.
FINDINGS
Of 624 patients, 291 (47%) received antacid therapy and 333 (53%) did not. At 52 weeks, we noted no significant difference between groups for disease progression (114 [39%] for antacid therapy vs 141 [42%] for no antacid therapy, p=0·4844). Rates also did not differ for all-cause mortality (20 [7%] vs 22 [7%], p=0·8947), IPF-related mortality (11 [4%] vs 17 [5%]; p=0·4251), absolute FVC decrease by 10% or more (49 [17%] vs 64 [19%]; p=0·4411), or mean observed change in FVC (% predicted -4·9% [SD 6·4] vs -5·5% [7·2], p=0·3355; observed volume -0·2 L [0·3] vs -0·2 L [0·3], p=0·4238). The rate of hospital admission was non-significantly higher in the antacid therapy group (65 [22%] vs 54 [16%]; p=0·0522). When stratified by baseline FVC (<70% or ≥70%), disease progression, mortality, FVC, 6MWD, and hospital admission did not differ between groups. Adverse events were similar between treatment and no treatment groups; however, overall infections (107 [74%] vs 101 [62%]; p=0·0174) and pulmonary infections (20 [14%] vs 10 [6%]; p=0·0214) were higher in patients with advanced IPF (ie, FVC <70%) who were treated with antacids than not treated with antacids.
INTERPRETATION
Antacid therapy did not improve outcomes in patients with IPF and might potentially be associated with an increased risk of infection in those with advanced disease.
FUNDING
F Hoffmann-La Roche.
Topics: Aged; Antacids; Clinical Trials, Phase III as Topic; Disease Progression; Exercise Tolerance; Female; Gastroesophageal Reflux; Humans; Idiopathic Pulmonary Fibrosis; Kaplan-Meier Estimate; Lung; Male; Middle Aged; Patient Admission; Pyridones; Randomized Controlled Trials as Topic; Treatment Outcome; Vital Capacity; Walk Test
PubMed: 27050871
DOI: 10.1016/S2213-2600(16)00067-9 -
International Journal of Molecular... Apr 2021Calcium carbonate (CaCO)-based materials have received notable attention for biomedical applications owing to their safety and beneficial characteristics, such as pH...
Calcium carbonate (CaCO)-based materials have received notable attention for biomedical applications owing to their safety and beneficial characteristics, such as pH sensitivity, carbon dioxide (CO) gas generation, and antacid properties. Herein, to additionally incorporate antioxidant and anti-inflammatory functions, we prepared tannylated CaCO (TA-CaCO) materials using a simple reaction between tannic acid (TA), calcium (Ca), and carbonate (CO) ions. TA-CaCO synthesized at a molar ratio of 1:75 (TA:calcium chloride (CaCl)/sodium carbonate (NaCO)) showed 3-6 μm particles, comprising small nanoparticles in a size range of 17-41 nm. The TA-CaCO materials could efficiently neutralize the acid solution and scavenge free radicals. In addition, these materials could significantly reduce the mRNA levels of pro-inflammatory factors and intracellular reactive oxygen species, and protect chondrocytes from toxic hydrogen peroxide conditions. Thus, in addition to their antacid property, the prepared TA-CaCO materials exert excellent antioxidant and anti-inflammatory effects through the introduction of TA molecules. Therefore, TA-CaCO materials can potentially be used to treat inflammatory cells or diseases.
Topics: Antacids; Anti-Inflammatory Agents; Antioxidants; Calcium Carbonate; Cells, Cultured; Chondrocytes; Drug Delivery Systems; Humans; Tannins
PubMed: 33924775
DOI: 10.3390/ijms22094614 -
BMJ Clinical Evidence Jun 2008Up to 25% of people have symptoms of gastro-oesophageal reflux disease (GORD), but only 25-40% of these have oesophagitis visible on endoscopy. About 80% of people with... (Review)
Review
INTRODUCTION
Up to 25% of people have symptoms of gastro-oesophageal reflux disease (GORD), but only 25-40% of these have oesophagitis visible on endoscopy. About 80% of people with GORD will have recurrent symptoms if treatment is stopped, and severe oesophagitis may result in oesophageal stricture or Barrett's oesophagus.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of initial treatment of GORD associated with oesophagitis? What are the effects of maintenance treatment of GORD associated with oesophagitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations, such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 29 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antacids/alginates, H(2) receptor antagonists, laparoscopic surgery, lifestyle advice/modification, motility stimulants, open surgery, and proton pump inhibitors.
Topics: Adult; Antacids; Esophagitis; Gastroesophageal Reflux; Humans; Laparoscopy; Life Style; Proton Pump Inhibitors
PubMed: 19450297
DOI: No ID Found