PROGRESS REPORT I. 2020.11.23

Brigitta Teutsch ABOUT THE LECTURER

Contacts: • E-mail: [email protected]

12-month fellowship programme

Clinical scientific supervisor(s): • Bálint Erőss Brigitta • Nándor Faluhelyi Scientific methodology supervisor: Teutsch • Szilárd Váncsa

Education supervisor: • Erika Pétervári TABLE OF CONTENTS

I. Prevention and treatment of NSAID-induced small bowel

enteropathies: A systematic review and meta-analysis • Project started: October 2020 PROJECTS II. Gastrointestinal Bleeding (GIB) Registry: cohort analysis

• Project started: October 2020

III. Indications of Abdominal CT Angiography in clinical

practice: observational study

• Project started: November 2020 I. Prevention and treatment of NSAID-induced Project started: small bowel enteropathies: → October 2020

A systematic review and meta-analysis Expected submission date:

→ February 2021 BACKGROUND:

→ NSAIDs: some of the most commonly prescribed drugs

→ Small bowel enteropathy: • frequent (approximately 70%) among chronic NSAID consumers • common cause of obscure gastrointestinal bleedings

→ Treatment of NSAID-induced small bowel injuries: NO PROOF • high number of RCT in the topic • no meta-analysis • necessary to prevent complications

QUESTIONS: Which medication is efficient and safe for the prevention or treatment of nonsteroidal anti-inflammatory drug (NSAID)-induced small intestinal injuries?

P1: Patients taking NSAIDs and receiving treatment for the prevention of small bowel enteropathy P P2: Patients diagnosed with NSAID-induced small intestinal injury

Medication for small bowel injury I (e.g. Rebamipide, Misoprostol, Irsogladine...) C Placebo/ Proton pump inhibitor

O1: primary: mucosal integrity, secondary: drug-induced adverse events, cost of treatment O O2: primary: mucosal injury improvement, secondary: drug-induced adverse events, cost of treatment SYSTEMATIC SEARCH • Databases: MEDLINE (1104), Embase (1173), CENTRAL (1882), Scopus (1266)

• Date of search: 20.10.2020

• Search key:

(NSAID OR "non steroidal" OR nonsteroidal OR "anti inflammat*" OR antiinflammat* OR Aspirin OR Acetylsalicyl* OR Salicyl* OR Diflunisal OR Salsalate OR Butylpyrazolidine OR Phenylbutazone OR Mofebutazone OR Oxyphenbutazone OR Clofezone OR Kebuzone OR Suxibuzone OR “Acetic acid derivative*” OR Indometacin OR Sulindac OR Tolmetin OR Zomepirac OR Diclofenac OR Alclofenac OR Bumadizone ORA Etodolac prezentáció OR Lonazolac OR Fentiazac OR Acemetacin OR Difenpiramide OR Oxametacin OR Proglumetacin OR Ketorolac OR Aceclofenac OR Bufexamac OR “Enolic acid derivative*” OR Oxicam OR Piroxicam OR Tenoxicam OR Droxicam OR Lornoxicam OR Meloxicam OR “Propionic acid derivative*”alcíme OR Ibuprofen OR Naproxen OR Ketoprofen OR Fenoprofen OR Fenbufen OR Benoxaprofen OR Suprofen OR Pirprofen OR Flurbiprofen OR Indoprofen OR Tiaprofen OR “Tiaprofenic acid” OR Oxaprozin OR Ibuproxam OR Dexibuprofen OR Flunoxaprofen OR Alminoprofen OR Dexketoprofen OR Naproxcinod OR Vedaprofen OR Carprofen OR Tepoxalin OR “Anthranilic acid derivative*” OR Fenamate OR Mefenamate OR “Mefenamic acid” OR Tolfenamate OR “Tolfenamic acid” OR Flufenamate OR “Flufenamic acid” OR Meclofenamate OR “Meclofenamic acid” OR Flunixin OR Clonixin OR Coxib OR “COX-2 inhibit*” OR “Cyclooxygenase-2 inhibit*” OR Celecoxib OR Rofecoxib OR Valdecoxib OR Parecoxib OR Etoricoxib OR Lumiracoxib OR Polmacoxib OR Firocoxib OR Robenacoxib OR Mavacoxib OR Cimicoxib OR Deracoxib OR Enflicoxib OR Nabumetone OR “Niflumic acid” OR Azapropazone OR Glucosamine OR Benzydamine OR “Glycosaminoglycan polysulfate” OR Proquazone OR Orgotein OR Nimesulide OR Feprazone OR Diacerein OR Morniflumate OR Tenidap OR Oxaceprol OR “Chondroitin sulfate” OR Aminopropionitrile OR Grapiprant) AND (enteropath* OR enteritis OR "small bowel" OR "small intestin*" OR jejun* OR ileum OR ileal OR ileitis OR “intestinal injury” OR “intestinal lesion” OR “intestinal mucosal lesion” OR “bowel injury” OR “bowel lesion” OR “bowel mucosal lesion”) AND random* FLOWCHART OF SELECTION

542 N0 of records before the duplicate removal 5

334 N0 of records after the duplicate removal 0 Cohen’s Kappa: 0.88 108 N0 of eligible titles A prezentáció

Cohen’s Kappa: 0.81 alcíme 56 N0 of eligible abstracts

Cohen’s Kappa: 1.00 38

Data collection is under process ELIGIBLE FULL TEXTS:

11 4 5 4 4 10

Others: Ecabet sodium-2, Egualen sodium-2, Isinglass-2, Rifaximin-1, Polaprezinc-1, Rabeprazol-1, Mucoprotective drugs-1 II. Gastrointestinal Bleeding Registry: Project started: cohort analysis → November 2020

Expected submission date:

→ May 2021 GASTROINTESTINAL BLEEDINGS REGISTRY

A prezentáció alcíme

PRELIMINARY PATIENT ENROLLMENT FORMS ANALYSIS MGT CONFERENCE ABSTRACTS

A prezentáció alcíme

AIM: To describe the characteristics AIM: To give a descriptive analysis AIM: To give a descriptive analysis of and markers of renal dysfunction of of patients from our prospective patients from our prospective patients presenting with GIB. registry with a focus on symptoms registry with a focus on symptoms and etiology. and etiology. EFOP CONFERENCE ABSTRACTS

AIM: To describe the characteristics and markers of renal dysfunction of patients presenting with GIB.

AIM: To evaluate the mortality rate and describe the cause of death of the study population. A prezentáció alcíme AIM: To examine the connection between the common risk factors and GIB.

AIM: To provide a descriptive analysis of body weight and BMI in patients with GIB. FUTURE PLANS ANALYSES AND TEST SAMPLES STORED IN THE BIOBANK JOIN OF 14th of December, 2020: HUNGARIAN → 300 patients AND FOREIGN INSTITUTIONS

A prezentáció alcíme CLINICAL TRIALS Project started: III. Indications of Abdominal CT Angiography → November 2020 in clinical practice: observational study Expected submission date:

→ July 2021 ABDOMINAL CT-ANGIOGRAPHY

Abdominal CT-angiography: → Fast detection and localisation of the bleeding site → Information about patients anatomy → Highly available → Minimally invasive → Lack of information regarding the indications ABDOMINAL CT-ANGIOGRAPHY

Future plans: →Ethical approval →Retrospective data collection →CT scan reevaluation →Inclusion of multiple centers TABLE OF CONTENTS

I. Systematic review and meta-analysis – data collection is

under process • Expected submission date: February 2021 PROJECTS II. Registry analysis – patient enrollment is still ongoing

• Expected submission date: May 2021

III. Indications of Abdominal CT Angiography in clinical

practice: observational study - under ethical approval

• Expected submission date: July 2021 THANK YOU FOR YOUR ATTENTION! QUESTIONS