DOCSLIB.ORG

Comparative Efficacy of Various Anti-Ulcer Medications After Gastric Endoscopic Submucosal Dissection: a Systematic Review and Network Meta-Analysis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Comparative Efficacy of Various Anti-Ulcer Medications After Gastric Endoscopic Submucosal Dissection: a Systematic Review and Network Meta-Analysis Surgical Endoscopy (2019) 33:1271–1283 and Other Interventional Techniques https://doi.org/10.1007/s00464-018-6409-4 Comparative efficacy of various anti-ulcer medications after gastric endoscopic submucosal dissection: a systematic review and network meta-analysis Eun Hye Kim1 · Se Woo Park2 · Eunwoo Nam3 · Jae Gon Lee4 · Chan Hyuk Park4 Received: 4 May 2018 / Accepted: 24 August 2018 / Published online: 30 August 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Background The comparative efficacy of various anti-ulcer medications after gastric endoscopic submucosal dissection (ESD) has not been fully evaluated. Recently, vonoprazan, a novel potassium-competitive acid blocker, has also been used in ulcer treatment after ESD. Methods We searched for all relevant randomized controlled trials examining the efficacy of anti-ulcer medications after gastric ESD, published through October 2017. Healing of iatrogenic ulcers was investigated at 4–8 weeks after ESD. A network meta-analysis was performed to calculate the network estimates. Results Twenty-one studies with 2005 patients were included. Concerning the comparative efficacy for ulcer healing at 4 weeks after ESD, no network inconsistency was identified (Cochran’s Q-test, df = 10, P = 0.13; I2 = 34%). A combination therapy of proton-pump inhibitor (PPI) and muco-protective agent was superior to PPI alone [risk ratio (RR) (95% confi- dence interval, CI) 1.69 (1.20–2.39)]. The combination therapy of PPI and muco-protective agents tended to be superior to vonoprazan [RR (95% CI) 1.98 (0.99–3.94)]. There was no difference of ulcer healing effect between PPI and vonoprazan [RR (95% CI) PPI vs. vonoprazan, 1.17 (0.64–2.12)]. Concerning the ulcer healing rate at 8 weeks after ESD, however, vonoprazan was superior to PPI [RR (95% CI) 1.27 (1.03–1.56)]. Additionally, vonoprazan tended to be superior to the combination therapy of PPI and muco-protective agent [RR (95% CI) 1.20 (0.96–1.51)]. Conclusions A combination therapy of PPI and muco-protective agent was superior to PPI alone for ulcer healing at 4 weeks after ESD. In the ulcer healing effect at 8 weeks after ESD, vonoprazan was superior to PPI. Keywords Endoscopic submucosal dissection · Anti-ulcer medication · Proton-pump inhibitor · Vonoprazan Gastric endoscopic submucosal dissection (ESD) has been the most common adverse event after the procedure and can widely used for the treatment of early gastric cancer and be life threatening [2, 3]. To prevent iatrogenic ulcer bleed- gastric adenoma [1]. Despite the minimal invasiveness of ing, endoscopists may perform second-look endoscopy after ESD, iatrogenic ulcer bleeding is a concern because it is ESD [4]. Unfortunately, however, many studies reported that second-look endoscopy cannot reduce the risk of post-ESD bleeding [5]. Electronic supplementary material The online version of this Currently, the best way to reduce iatrogenic ulcer bleed- article (https ://doi.org/10.1007/s0046 4-018-6409-4) contains ing is to administer anti-ulcer drugs, including proton-pump supplementary material, which is available to authorized users. * Chan Hyuk Park Hospital, Hallym University College of Medicine, Hwasung, [email protected] Republic of Korea 3 Biostatistical Consulting and Research Lab, Medical 1 Division of Gastroenterology, Department of Internal Research Coordinating Center, Hanyang University, Seoul, Medicine, Severance Hospital, Institute of Gastroenterology, Republic of Korea Yonsei University College of Medicine, Seoul, Republic of Korea 4 Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, 2 Division of Gastroenterology, Department of Internal Republic of Korea Medicine, Hallym University Dongtan Sacred Heart Vol.:(0123456789)1 3 1272 Surgical Endoscopy (2019) 33:1271–1283 inhibitors (PPIs) [3]. Several studies reported that PPIs were anti-ulcer medications after gastric endoscopic resection, superior to histamine-2-receptor antagonists (H2RAs) in by using the MEDLINE, Embase, and Cochrane Library terms of avoiding bleeding [3, 6]. In addition, it has been databases. The following search string was used: ((ESD) suggested that a combination therapy of PPI and muco- OR (endoscopic submucosal dissection) OR (EMR) OR protective agents including rebamipide may be effective for (endoscopic mucosal resection) OR (iatrogenic) OR (arti- iatrogenic ulcer healing [6]. ficial)) AND (ulcer*) AND ((vonoprazan) OR (TAK-438) Recently, vonoprazan (VPZ), a novel potassium-compet- OR (revaprazan) OR (YH1885) OR ((potassium) AND itive acid blocker, has been used for gastric acid inhibition (competitive)) OR (potassium-competitive) OR (PPI) OR [7]. Similar to PPIs, VPZ inhibits gastric H +/K+-adenosine (proton pump inhibitor*) OR (dexlansoprazole) OR (esome- triphosphatase [8]. However, it has a more rapid and potent prazole) OR (ilaprazole) OR (lansoprazole) OR (omepra- acid-inhibitory effect than PPIs [7]. The efficacy of VPZ has zole) OR (pantoprazole) OR (rabeprazole) OR (((histamine) been proven in various gastrointestinal diseases, including OR (histamine2) OR (histamine-2) OR (h2) OR (h-2)) AND erosive esophagitis, peptic ulcers, and Helicobacter pylori ((antagonist*) OR (blocker*))) OR (h2ra) OR (famotidine) infection [9–11]. In addition, one prospective study with OR (cimetidine) OR (ranitidine) OR (nizatidine) OR (lafu- a historical comparison showed that the risk of post-ESD tidine) OR (misoprostol) OR (rebamipide) OR (ecabet) OR bleeding can be reduced through the administration of VPZ (irsogladine) OR (polaprezinc) OR (muco-protective) OR after ESD [12]. VPZ may be a promising drug that facilitates (mucoprotective)). The detailed search strategies for each iatrogenic ulcer healing. database are shown in “Appendix”. In order to identify To date, two pairwise meta-analyses have compared iatro- additional studies, we also examined the references of the genic ulcer healing between PPI and H2RA, or between PPI screened articles. The latest date for updating our search was alone and PPI with a muco-protective agent [6, 13]. How- October 31, 2017. ever, comprehensive comparisons among the various drug regimens for iatrogenic ulcers have yet to be conducted. In Study selection addition, there are other studies comparing iatrogenic ulcer healing between PPI and muco-protective agents, H2RA In the first stage of the study selection, the titles and abstracts and muco-protective agents, or PPI and VPZ [14–18]. In of papers identified by our search were examined to exclude this situation, all relevant evidence, both direct and indi- irrelevant articles. Next, the full texts of all selected studies rect, should be considered in order to fully analyze each were screened according to inclusion and exclusion criteria. pairwise comparison [19]. Unlike the traditional pairwise The inclusion criteria were as follows: (a) patients: patients meta-analysis, a network meta-analysis can synthesize direct who underwent gastric ESD; (b) intervention: anti-ulcer and indirect estimates of multiple drug regimens [20]. In medication after the procedure; (c) comparator: another this study, therefore, we conducted a network meta-analysis regimen of anti-ulcer medication; and (d) outcome: ulcer of randomized controlled trials (RCTs) in order to identify healing rate. The exclusion criteria were (a) non-RCTs, (b) the efficacy of various drug regimens for iatrogenic ulcer non-human studies, and (c) publications in a language other healing after ESD. than English. Two investigators (E.H.K. and C.H.P.) independently evaluated the studies for eligibility and resolved any disa- Methods greements through discussion and consensus. If no agree- ment could be reached, a third investigator (S.W.P.) deter- This systematic review and network meta-analysis was mined eligibility. The Cochrane Risk of Bias assessment conducted according to the PRISMA (Preferred Reporting tool was used for assessing the risk of bias in individual Items for Systematic Reviews and Meta-Analyses) state- studies [23]. ment [21] and the report of the International Society for Pharmacoeconomics and Outcomes Research Task Force on Data extraction Indirect Treatment Comparisons Good Research Practices [22]. Approval of Institutional Review Board was not needed Using a data extraction form developed in advance, two in this study because the meta-analysis only analyzed data reviewers (E.H.K. and C.H.P.) independently extracted derived from published articles or abstract proceedings. the following information from each chosen study: first author, year of publication, study design, country, enroll- Search strategy ment period, drug name and dosage of anti-ulcer medica- tions, assessment timing of ulcer healing, and ulcer healing We searched for all relevant studies published between Janu- rate according to the drug regimens. The assessment timing ary 1970 and October 2017 that examined the efficacy of of ulcer healing was categorized into two groups (4 weeks 1 3 Surgical Endoscopy (2019) 33:1271–1283 1273 after ESD vs. 8 weeks after ESD), by using a cutoff value the mixed estimates [27]. In addition, we calculated P-scores, of 6 weeks because most studies reported the ulcer healing which measured the extent of certainty that one treatment rate at 4 or 8 weeks after endoscopic resection whereas a few was better than another treatment, averaged over all com- studies assessed iatrogenic ulcer at 4–6 weeks after ESD. peting treatments [28]. To assess the robustness of
Load more

Recommended publications
  • The Toronto Consensus for the Treatment of Helicobacter Pylori Infection in Adults Carlo A
    Gastroenterology 2016;151:51–69 CONSENSUS STATEMENT The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults Carlo A. Fallone,1 Naoki Chiba,2,3 Sander Veldhuyzen van Zanten,4 Lori Fischbach,5 Javier P. Gisbert,6 Richard H. Hunt,3,7 Nicola L. Jones,8 Craig Render,9 Grigorios I. Leontiadis,3,7 Paul Moayyedi,3,7 and John K. Marshall3,7 1Division of Gastroenterology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; 2Guelph GI and Surgery Clinic, Guelph, Ontario, Canada; 3Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada; 4Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; 5Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; 6Gastroenterology Service, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; 7Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; 8Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Departments of Paediatrics and Physiology, University of Toronto, Toronto, Ontario, Canada; and 9Kelowna General Hospital, Kelowna, British Columbia, Canada This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e25. Learning Objective: Upon completion of this examination, successful learners will be able to establish a treatment plan for patients with H pylori infection. BACKGROUND & AIMS: Helicobacter pylori infection is lthough the prevalence of H pylori is decreasing in increasingly difficult to treat. The purpose of these consensus A some parts of the world, the infection remains pre- statements is to provide a review of the literature and specific, sent in 28% to 84% of subjects depending on the population updated recommendations for eradication therapy in adults.
    [Show full text]
  • A Systematic Review of Proton Pump Inhibitors for the Treatment of Adult Patients with Symptomatic Gastroesophageal Reflux Disease Or Peptic Ulcer Disease
    Title A systematic review of proton pump inhibitors for the treatment of adult patients with symptomatic gastroesophageal reflux disease or peptic ulcer disease. Review Question(s) Requested Requested by PSD 1. What is the comparative effectiveness of different proton pump inhibitors in patients with symptoms of gastroesophageal reflux disease? 2. What is the comparative effectiveness of different proton pump inhibitors in treating peptic (duodenal and gastric) ulcer? 3. What are the comparative safety and adverse events of different proton pump inhibitors in patients being treated for symptoms of gastroesophageal reflux disease and peptic ulcer? 4. Are there subgroups of patients based on demographics, other medications, or comorbidities (including nasogastric tubes and inability to swallow solid oral medication) for which a particular proton pump inhibitor or preparation is more effective or associated with fewer adverse effects? Drug The following five proton pump inhibitors (PPI) drugs will be reviewed 1. Esomeprazole (Nexium® and its generic equivalent) 2. Lansoprazole (Prevacid® and its generic equivalent) 3. Omeprazole* (Losec® and its generic equivalent) 4. Pantoprazole* sodium and magnesium (Pantoloc®, Panto IV and their generic equivalent and Tecta® 5. Rabeprazole* (Pariet® and its generic equivalent) Note: *Omeprazole, Pantoprazole and Rabeprazole have been identified as reference drugs by PSD. Esomeprazole and Lansoprazole will be compared to these three reference drugs. TABLE OF CONTENTS TABLE OF CONTENTS ..........................................................................................................................2
    [Show full text]
  • Phathom 2020 Annual Report
    A Note from Phathom’s CEO To Our Shareholders: After a year of unparalleled challenges, I hope that this letter finds you and your loved ones healthy and safe. The unforeseen personal and professional difficulties endured by many due to the COVID-19 pandemic pale in comparison to the millions of lives lost. Thanks to the relentless efforts of the healthcare community, including the groundbreaking development and distribution of lifesaving vaccines and treatments by our own pharmaceutical industry, there is a renewed hope and optimism that the end of the pandemic is in sight. Phathom, like so many others, faced uncertainties and significant challenges in 2020 due to COVID-19, including a three month pause in patient enrollment in our Phase 3 trials. The demands on medical institutions and clinicians during the beginning of the crisis, coupled with the safety of study participants and Phathom staff, made this the most prudent decision. Despite the obstacles 2020 presented, our teams rose to the challenge–showcasing Phathom’s culture of resilience and our unwavering commitment to meet the unmet needs of patients suffering from acid-related diseases. Last year, we completed and exceeded our enrollment target of 1,000 patients in our pivotal Phase 3 trial for vonoprazan in erosive esophagitis (PHALCON-EE) and achieved our target patient enrollment in our pivotal Phase 3 trial for vonoprazan in H. pylori infection (PHALCON-HP)–completing and again exceeding patient enrollment in January 2021. The progress made last year advancing the clinical development of vonoprazan, a potassium competitive acid blocker (P-CAB), demonstrates the urgent need for new therapeutic options for patients suffering from erosive esophagitis andH.
    [Show full text]
  • Patent Application Publication ( 10 ) Pub . No . : US 2019 / 0192440 A1
    US 20190192440A1 (19 ) United States (12 ) Patent Application Publication ( 10) Pub . No. : US 2019 /0192440 A1 LI (43 ) Pub . Date : Jun . 27 , 2019 ( 54 ) ORAL DRUG DOSAGE FORM COMPRISING Publication Classification DRUG IN THE FORM OF NANOPARTICLES (51 ) Int . CI. A61K 9 / 20 (2006 .01 ) ( 71 ) Applicant: Triastek , Inc. , Nanjing ( CN ) A61K 9 /00 ( 2006 . 01) A61K 31/ 192 ( 2006 .01 ) (72 ) Inventor : Xiaoling LI , Dublin , CA (US ) A61K 9 / 24 ( 2006 .01 ) ( 52 ) U . S . CI. ( 21 ) Appl. No. : 16 /289 ,499 CPC . .. .. A61K 9 /2031 (2013 . 01 ) ; A61K 9 /0065 ( 22 ) Filed : Feb . 28 , 2019 (2013 .01 ) ; A61K 9 / 209 ( 2013 .01 ) ; A61K 9 /2027 ( 2013 .01 ) ; A61K 31/ 192 ( 2013. 01 ) ; Related U . S . Application Data A61K 9 /2072 ( 2013 .01 ) (63 ) Continuation of application No. 16 /028 ,305 , filed on Jul. 5 , 2018 , now Pat . No . 10 , 258 ,575 , which is a (57 ) ABSTRACT continuation of application No . 15 / 173 ,596 , filed on The present disclosure provides a stable solid pharmaceuti Jun . 3 , 2016 . cal dosage form for oral administration . The dosage form (60 ) Provisional application No . 62 /313 ,092 , filed on Mar. includes a substrate that forms at least one compartment and 24 , 2016 , provisional application No . 62 / 296 , 087 , a drug content loaded into the compartment. The dosage filed on Feb . 17 , 2016 , provisional application No . form is so designed that the active pharmaceutical ingredient 62 / 170, 645 , filed on Jun . 3 , 2015 . of the drug content is released in a controlled manner. Patent Application Publication Jun . 27 , 2019 Sheet 1 of 20 US 2019 /0192440 A1 FIG .
    [Show full text]
  • Seven-Day Vonoprazan and Low-Dose Amoxicillin Dual Therapy As First-Line
    Helicobacter pylori ORIGINAL RESEARCH Gut: first published as 10.1136/gutjnl-2019-319954 on 8 January 2020. Downloaded from Seven- day vonoprazan and low- dose amoxicillin dual therapy as first- line Helicobacter pylori treatment: a multicentre randomised trial in Japan Sho Suzuki ,1,2 Takuji Gotoda ,1 Chika Kusano,1 Hisatomo Ikehara,1 Ryoji Ichijima,1 Motoki Ohyauchi,3 Hirotaka Ito,3 Masashi Kawamura,4 Yohei Ogata,4 Masahiko Ohtaka,5 Moriyasu Nakahara,6 Koichi Kawabe7 1Division of Gastroenterology ABSTRact and Hepatology, Department Objective To date, no randomised trials have compared Significance of this study of Medicine, Nihon University the efficacy of vonoprazan and amoxicillin dual therapy School of Medicine, Tokyo, What is already known on this subject? Japan with other standard regimens for Helicobacter pylori 2Department of treatment. This study aimed to investigate the efficacy ► Macrolides, including clarithromycin, readily Gastroenterology, Yuri Kumiai of the 7- day vonoprazan and low- dose amoxicillin dual induce changes in the resistome of Helicobacter General Hospital, Yurihonjo, therapy as a first-line H. pylori treatment, and compared pylori, and the clarithromycin resistance of H. Akita, Japan pylori is high and increasing worldwide. 3Department of this with vonoprazan-based triple therapy. Gastroenterology, Osaki Citizen Design This prospective, randomised clinical trial ► Usage of clarithromycin should be discontinued Hospital, Osaki, Miyagi, Japan was performed at seven Japanese institutions. Patients as an empirical
    [Show full text]
  • Vonoprazan Study of Investigating the Effect on Sleep Disturbance Associated with Reflux Esophagitis - Exploratory Evaluation (VISTAEXE)
    Title: Vonoprazan Study of Investigating the Effect on Sleep Disturbance Associated with Reflux Esophagitis - Exploratory Evaluation (VISTAEXE) NCT Number: NCT03116841 Protocol Approve Date: 28-Mar-2017 Certain information within this protocol has been redacted (ie, specific content is masked irreversibly from view with a black/blue bar) to protect either personally identifiable information or company confidential information. This may include, but is not limited to, redaction of the following: Named persons or organizations associated with the study. Patient identifiers within the text, tables, or figures or in by-patient data listings. Proprietary information, such as scales or coding systems, which are considered confidential information under prior agreements with license holder. Other information as needed to protect confidentiality of Takeda or partners, personal information, or to otherwise protect the integrity of the clinical study. If needed, certain appendices that contain a large volume of personally identifiable information or company confidential information may be removed in their entirety if it is considered that they do not add substantially to the interpretation of the data (eg, appendix of investigator’s curriculum vitae). Note; This document was translated into English as the language on original version was Japanese. Vonoprazan-4006 Page 1 of 72 Version 1.0 March 28, 2017 PROTOCOL Vonoprazan study of investigating the effect on sleep disturbance associated with reflux esophagitis- exploratory evaluation (VISTAEXE) Sponsor Takeda Pharmaceutical Company Limited 12-10, Nihonbashi 2-chome, Chuo-ku, Tokyo Protocol number Vonoprazan-4006 (MACS-2016-101812) Version Number 1.0 Study drug: Vonoprazan fumarate Creation date March 28, 2017 CONFIDENTIAL Vonoprazan-4006 Page 2 of 72 Version 1.0 March 28, 2017 CONFIDENTIAL PROPERTY OF TAKEDA This document is a confidential communication of Takeda.
    [Show full text]
  • Rhubarb Tions of Bismuth Compounds (P.1712), and Ranitidine (P.1766)
    1768 Gastrointestinal Drugs trolav; Gastrulcer; Pep-Rani; Peptab; Peptifar; Quardin†; Ran†; Ranitine; Sta- 3. Anonymous. Pylorid, H. pylori and peptic ulcer. Drug Ther Bull Revaprazan (rINN) cer; Ulcecur†; Ulcerol†; Zantac; Rus.: Aciloc (Ацилок); Histac (Гистак); 1996; 34: 69–70. Ranigast (Ранигаст); Ranisan (Ранисан); Rantac (Рантак); Ulran (Ульран)†; 4. van der Wouden EJ, et al. One-week triple therapy with raniti- Révaprazan; Revaprazán; Revaprazanum. N-(4-Fluorophenyl)- Zantac (Зантак); Zoran (Зоран); S.Afr.: GI-Tak†; Histak; Ranihexal; Ran- dine bismuth citrate, clarithromycin and metronidazole versus 4,5-dimethyl-6-[(1RS)-1-methyl-3,4-dihydroisoquinolin-2(1H)- teen†; Ulcaid; Ultak; Zantac; Singapore: Gastran†; Histac; Hyzan; Lumaren; two-week dual therapy with ranitidine bismuth citrate and clari- yl]pyrimidin-2-amine. Neoceptin-R; Rani†; Ranidine; Ratic; Xanidine; Zantac; Zendhin; Zoran†; thromycin for Helicobacter pylori infection: a randomized, clin- Spain: Alquen; Arcid; Ardoral; Coralen; Denulcer; Fagus; Lake; Meticel†; ical trial. Am J Gastroenterol 1998; 93: 1228–31. Ревапразан Quantor; Ran H2; Ranidin; Ranix; Ranuber; Rubiulcer; Tanidina; Terposen; Toriol; Underacid; Zantac; Swed.: Artonil; Inside; Rani-Q; Zantac; Switz.: Preparations C22H23FN4 = 362.4. Ranimed; Ranisifar; Ulcidine; Zantic; Thai.: Aciloc; Histac; Radine†; Ranicid; CAS — 199463-33-7. Ranidine; Rantac; Ratic; Ratica; Utac; Xanidine; Zanamet; Zantac; Zantidon; Proprietary Preparations (details are given in Part 3) Zardil; Turk.: Ranitab; Ranitine; Ranobel; Rozon; Santanol; Ulcuran; Zandid; Arg.: Pylorid†; Austria: Helirad; Pylorisin; Belg.: Pylorid†; Braz.: Pylorid; Zantac; UAE: Rantag; UK: Gavilast; Ranitic; Ranitil; Rantec; Ranzac; Vivatak†; Cz.: Eradipak†; Denm.: Pylorid†; Fin.: Pylorid; Gr.: Pylorid; Hong Kong: Zaedoc†; Zantac; USA: Zantac; Venez.: Aplom; Enteral; Gastac; Ranibloc; Pylorid†; Hung.: Pylorid†; Irl.: Pylorid†; Ital.: Elicodil†; Pylorid; Mex.: Ranifesa†; Ranix†; Ranizan†; Retamin; Vizerul; Zantac; Zoran†.
    [Show full text]
  • Bismuth Salts for Gastrointestinal Issues: a Review of the Clinical Effectiveness and Guidelines DATE
    TITLE: Bismuth Salts for Gastrointestinal Issues: A Review of the Clinical Effectiveness and Guidelines DATE: 24 November 2015 CONTEXT AND POLICY ISSUES Oral bismuth formulations have been used effectively for prophylaxis and treatment of both diarrhea and for treatment of Helicobacter pylori (H. pylori) infection.1,2 Bismuth formulations available without a prescription have been commonly used to treat episodic diarrhea for over a century. Bismuth has also been used to treat ulcers prior to the appreciation of its antimicrobial activity against the then unknown causative micro-organism, H. pylori.1 Episodes of diarrhea are especially common in travelers to resource-poor countries. It is estimated that 30% to 70% of international travelers will develop diarrhea during travels or upon return. Typically diarrhea is self-diagnosed and the causal infectious agent remains unknown. While the condition is frequently self-limiting, treatment can reduce the duration, severity, and inconvenience of diarrhea while travelling. Commonly used treatments include antibiotics, antimotility agents, oral rehydration solutions, and bismuth subsalicylate.2 H. pylori infection is a substantial public health concern as it plays a causative role in the pathogenesis of many gastrointestinal conditions such as gastritis, peptic ulcers, and gastric cancer.3 Current treatment regimens designed to eradicate infection utilize more than one antibiotic simultaneously in a standard triple therapy (STT) consisting of a proton-pump inhibitor (PPI), and two antibiotics.
    [Show full text]
  • Evidence-Based Clinical Practice Guidelines for Peptic Ulcer Disease 2015
    J Gastroenterol DOI 10.1007/s00535-016-1166-4 SPECIAL ARTICLE Evidence-based clinical practice guidelines for peptic ulcer disease 2015 1,2 2 2 2 Kiichi Satoh • Junji Yoshino • Taiji Akamatsu • Toshiyuki Itoh • 2 2 2 2 Mototsugu Kato • Tomoari Kamada • Atsushi Takagi • Toshimi Chiba • 2 2 2 2 Sachiyo Nomura • Yuji Mizokami • Kazunari Murakami • Choitsu Sakamoto • 2 2 2 2 Hideyuki Hiraishi • Masao Ichinose • Naomi Uemura • Hidemi Goto • 2 2 2 2 Takashi Joh • Hiroto Miwa • Kentaro Sugano • Tooru Shimosegawa Received: 25 December 2015 / Accepted: 6 January 2016 Ó Japanese Society of Gastroenterology 2016 Abstract The Japanese Society of Gastroenterology bleeding is first treated by endoscopic hemostasis. If it (JSGE) revised the evidence-based clinical practice fails, surgery or interventional radiology is chosen. Second, guidelines for peptic ulcer disease in 2014 and has created medical therapy is provided. In cases of NSAID-related an English version. The revised guidelines consist of seven ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is items: bleeding gastric and duodenal ulcers, Helicobacter provided. If NSAID use must continue, the ulcer is treated pylori (H. pylori) eradication therapy, non-eradication with a proton pump inhibitor (PPI) or prostaglandin analog. therapy, drug-induced ulcer, non-H. pylori, non-nons- In cases with no NSAID use, H. pylori-positive patients teroidal anti-inflammatory drug (NSAID) ulcer, surgical receive eradication and anti-ulcer therapy. If first-line treatment, and conservative therapy for perforation and eradication therapy fails, second-line therapy is given. In stenosis. Ninety clinical questions (CQs) were developed, cases of non-H.
    [Show full text]
  • Refractory Gastroesophageal Reflux Disease: Pathophysiology, Diagnosis, and Management
    Refractory Gastroesophageal Reflux Disease: Pathophysiology, Diagnosis, and Management My Editor’s Pick for this edition is Nabi et al.’s review on the topic of refractory gastroesophageal reflux disease in the context of its pathophysiology, diagnosis, and treatment. The authors explore these elements in great detail, offering a timely and helpful update on this common gastrointestinal complaint. Authors: *Zaheer Nabi, Arun Karyampudi, and D. Nageshwar Reddy Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India *Correspondence to [email protected] Disclosure: The authors have declared no conflicts of interest. Received: 10.05.19 Accepted: 02.07.19 Keywords: Antireflux surgery, endoscopy, gastroesophageal reflux, proton pump inhibitors (PPI). Citation: EMJ Gastroenterol. 2019;8[1]:62-71. Abstract Gastroesophageal reflux disease (GERD) is one of the most commonly encountered gastrointestinal diseases in clinical practice. Proton pump inhibitors (PPI) remain the cornerstone of the treatment of GERD. Up to one-third of patients do not respond to optimal doses of PPI and fall into the category of refractory GERD. Moreover, the long-term use of PPI is not risk-free, as previously thought. The pathophysiology of refractory GERD is multifactorial and includes reflux related and unrelated factors. It is therefore paramount to address refractory GERD as per the aetiology of the disease for optimal outcomes. The management options for PPI refractory GERD include optimisation of PPI, lifestyle modifications, and the addition of alginates and histamine-2 receptor blockers. Neuromodulators, such as selective serotonin reuptake inhibitors or tricyclic antidepressants, may be beneficial in those with functional heartburn and reflux hypersensitivity. Laparoscopic antireflux surgeries, including Nissen’s fundoplication and magnetic sphincter augmentation, are useful in patients with objective evidence of GERD on pH impedance studies with or without a hiatal hernia.
    [Show full text]
  • New and Future Drug Development for Gastroesophageal Reflux Disease
    J Neurogastroenterol Motil, Vol. 20 No. 1 January, 2014 pISSN: 2093-0879 eISSN: 2093-0887 http://dx.doi.org/10.5056/jnm.2014.20.1.6 JNM Journal of Neurogastroenterology and Motility Review New and Future Drug Development for Gastroesophageal Reflux Disease Carla Maradey-Romero and Ronnie Fass* The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA Medical therapy remains the most popular treatment for gastroesophageal reflux disease (GERD). Whilst interest in drug devel- opment for GERD has declined over the last few years primarily due to the conversion of most proton pump inhibitor (PPI)’s to generic and over the counter compounds, there are still numerous areas of unmet needs in GERD. Drug development has been focused on potent histamine type 2 receptor antagonist’s, extended release PPI’s, PPI combination, potassium-competitive acid blockers, transient lower esophageal sphincter relaxation reducers, prokinetics, mucosal protectants and esophageal pain modulators. It is likely that the aforementioned compounds will be niched for specific areas of unmet need in GERD, rather than compete with the presently available anti-reflux therapies. (J Neurogastroenterol Motil 2014;20:6-16) Key Words Erosive esophagitis; Gastroesophageal reflux; Heartburn; Proton pump inhibitors Most patients with GERD fall into 1 of 3 categories: non- erosive reflux disease (NERD), erosive esophagitis (EE), and Introduction Barrett’s esophagus (BE). The 2 main phenotypes of GERD, Gastroesophageal reflux disease (GERD) is a common con- NERD and EE, appear to have different pathophysiological and dition that develops when reflux of stomach contents cause trou- clinical characteristics.
    [Show full text]
  • (12) United States Patent (10) Patent No.: US 8,158,152 B2 Palepu (45) Date of Patent: Apr
    US008158152B2 (12) United States Patent (10) Patent No.: US 8,158,152 B2 Palepu (45) Date of Patent: Apr. 17, 2012 (54) LYOPHILIZATION PROCESS AND 6,884,422 B1 4/2005 Liu et al. PRODUCTS OBTANED THEREBY 6,900, 184 B2 5/2005 Cohen et al. 2002fOO 10357 A1 1/2002 Stogniew etal. 2002/009 1270 A1 7, 2002 Wu et al. (75) Inventor: Nageswara R. Palepu. Mill Creek, WA 2002/0143038 A1 10/2002 Bandyopadhyay et al. (US) 2002fO155097 A1 10, 2002 Te 2003, OO68416 A1 4/2003 Burgess et al. 2003/0077321 A1 4/2003 Kiel et al. (73) Assignee: SciDose LLC, Amherst, MA (US) 2003, OO82236 A1 5/2003 Mathiowitz et al. 2003/0096378 A1 5/2003 Qiu et al. (*) Notice: Subject to any disclaimer, the term of this 2003/OO96797 A1 5/2003 Stogniew et al. patent is extended or adjusted under 35 2003.01.1331.6 A1 6/2003 Kaisheva et al. U.S.C. 154(b) by 1560 days. 2003. O191157 A1 10, 2003 Doen 2003/0202978 A1 10, 2003 Maa et al. 2003/0211042 A1 11/2003 Evans (21) Appl. No.: 11/282,507 2003/0229027 A1 12/2003 Eissens et al. 2004.0005351 A1 1/2004 Kwon (22) Filed: Nov. 18, 2005 2004/0042971 A1 3/2004 Truong-Le et al. 2004/0042972 A1 3/2004 Truong-Le et al. (65) Prior Publication Data 2004.0043042 A1 3/2004 Johnson et al. 2004/OO57927 A1 3/2004 Warne et al. US 2007/O116729 A1 May 24, 2007 2004, OO63792 A1 4/2004 Khera et al.
    [Show full text]