BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term...BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.展开更多
BACKGROUND Proton pump inhibitors(PPIs)are among the most commonly prescribed medications globally.While concerns exist regarding their association with adverse infection-related outcomes,their impact on coronavirus d...BACKGROUND Proton pump inhibitors(PPIs)are among the most commonly prescribed medications globally.While concerns exist regarding their association with adverse infection-related outcomes,their impact on coronavirus disease 2019(COVID-19)severity remains uncertain.Emerging preclinical data suggest immunomodulatory and antiviral properties of PPIs,yet clinical evidence is conflicting.AIM To investigate whether chronic pre-hospital PPI use is associated with improved outcomes in patients hospitalized with COVID-19.METHODS We conducted a retrospective case-control study of adult inpatients with severe acute respiratory syndrome coronavirus 2 infection admitted to a racially and ethnically diverse communityhospital in Massachusetts from July 2021 to March 2022. Patients were stratified by documented pre-hospital PPIuse. The primary outcomes were intensive care unit (ICU) admission, need for invasive mechanical ventilation, andin-hospital mortality. Multivariable logistic regression was used to adjust for demographics, comorbidities, andtreatment variables. Significance was set at P < 0.05.RESULTSAmong 248 patients, 83 (33.4%) were on PPIs prior to hospitalization. Compared to non-users, PPI users hadsignificantly lower rates of ICU admission (13.3% vs 24.8%, P = 0.034), mechanical ventilation (13.3% vs 25.5%, P =0.027), and in-hospital mortality (6.0% vs 17.6%, P = 0.013). Multivariable analysis confirmed these associations:ICU admission [adjusted odds ratios (aOR): 0.462, 95%CI: 0.223–0.955], mechanical ventilation (aOR: 0.447, 95%CI:0.216–0.923), and mortality (aOR: 0.144, 95%CI: 0.031–0.677). Findings were consistent across demographic andcomorbidity strata.CONCLUSIONIn this diverse, real-world United States cohort, chronic pre-hospital PPI use was independently associated withlower odds of intensive care unit admission, mechanical ventilation, and mortality among COVID-19 inpatients.These findings highlight a potentially protective role of PPIs and support continued therapy in eligible patients.展开更多
BACKGROUND Long-term use of proton pump inhibitors(PPIs)has been associated with poten-tial adverse effects,including an increased risk of gastric cancer.Despite wide-spread use awareness of these risks among physicia...BACKGROUND Long-term use of proton pump inhibitors(PPIs)has been associated with poten-tial adverse effects,including an increased risk of gastric cancer.Despite wide-spread use awareness of these risks among physicians varies considerably.Under-standing physicians’perceptions and prescribing behaviors is critical to impro-ving patient safety and promoting evidence-based practices.This study aimed to assess the level of awareness and risk perception among gastroenterologists and non-gastroenterologists regarding prolonged PPI use and its association with gastric malignancy.AIM To assess physicians’awareness of gastric cancer risk associated with long-term PPI use and compare perceptions between specialties.METHODS A cross-sectional observational study was conducted among 33 physicians(15 gastroenterologists and 18 non-gastroenterologists)in Israel.Participants com-pleted a structured questionnaire evaluating knowledge,attitudes,and prescri-bing behaviors related to PPI use.Data were analyzed using descriptive statistics and nonparametric tests to assess differences between groups and correlation patterns.Ethical approval and informed consent were obtained.RESULTS Gastroenterologists demonstrated significantly higher awareness of the potential gastric cancer risks linked to prolonged PPI use(mean awareness score:6.9±1.2)compared with non-gastroenterologists(4.1±1.3,P<0.01).Despite their awa-reness 80%of gastroenterologists reported frequent long-term prescribing.Non-parametric correlation analysis revealed associations between specialty,know-ledge level,and prescribing habits.Several misconceptions about cancer risk mechanisms were identified across specialties.CONCLUSION Physician awareness regarding gastric cancer risk of long-term PPI use remains inconsistent,especially among non-specialists,emphasizing the need for targeted educational programs and clearer prescribing guidelines.展开更多
BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenou...BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenous PPIs and oral potassium competitive acid blockers(PCABs)administered prior to endoscopic treatment of bleeding peptic ulcers.METHODS This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding(treated August 2023 to February 2024).Prior to emergency endoscopy,patients received either intravenous PPI(pantoprazole 80 mg bolus)or oral PCAB(tegoprazan 50 mg single-dose).Severity of bleeding was assessed using the Glasgow-Blatchford,Rockall,and AIMS65 scoring systems.Patients with severe comorbidities were excluded.Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding.Multivariate logistic regression was performed to adjust for potential confounding factors.RESULTS Total of the 105 patients,61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy.To minimize selection bias,bleeding severity was assessed using the Glasgow-Blatchford,Rockall and AIMS65 scores,with no statistically significant differences observed between the two groups.During emergency endoscopy performed within 48 hours,ulcer bed status was classified according to the Forrest classification.The proportion of lesions graded IIa or higher was significantly lower in the PCAB group(P<0.001),as was the frequency of therapeutic endoscopy intervention(odds ratio=0.272,95%confidence interval:0.111-0.665,P=0.004).The frequency of re-bleeding events was statistically significantly higher in the PPI group(odds ratio=0.141,95%confidence interval:0.024-0.844,P=0.032).CONCLUSION Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.展开更多
Helicobacter pylori is a worldwide health problem;therefore,eradicating this bacterium is important for the health and economic status of the whole world.There are a variety of anti-secretory and antibiotic combinatio...Helicobacter pylori is a worldwide health problem;therefore,eradicating this bacterium is important for the health and economic status of the whole world.There are a variety of anti-secretory and antibiotic combinations for this purpose;however,antibiotic resistance is a major barrier to achieving an appropriate eradication rate(>90%).Blockage of gastric acid is the main supportive factor of the antibiotic effect on bacteria.Therefore,anti-secretory therapy with high efficacy and safety profiles should be used in eradication regimens.Vonoprazan(VPZ),a member of the potassium competitive acid blockers,is a novel agent with a potent anti-secretory effect.The present study aimed to summarize comparative and safety studies of VPZ and proton pump inhibitors(PPIs),especially the efficacy on Helicobacter pylori eradication.VPZ was reported to have a higher efficacy and safety profile in most studies that compared VPZ-based and PPIbased regimens for eradication therapy.Despite its greater cost,the effectiveness of VPZ emerges as a viable and cost-effective alternative to PPI on gastric acidrelated pathologies.展开更多
Proton pump inhibitors(PPIs)are widely utilized in oncology to treat gastroeso-phageal reflux disease,peptic ulcer disease,and chemotherapy-induced mucosal injury.Emerging evidence has suggested that prolonged use of ...Proton pump inhibitors(PPIs)are widely utilized in oncology to treat gastroeso-phageal reflux disease,peptic ulcer disease,and chemotherapy-induced mucosal injury.Emerging evidence has suggested that prolonged use of PPIs is associated with increased mortality in patients with cancer.The findings of Krishnan et al are proof of this but need to be considered cautiously due to potential confounding factors.This letter raised important methodological concerns,including con-founding by indication,reverse causality,and polypharmacy that can influence the observed association.While PPIs are important in oncology,their advantages and disadvantages should be weighed judiciously by clinicians.Future prospective studies with robust analytical approaches will be required to ascertain more definite causality.展开更多
Background:To investigate adverse event(AE)signals associated with six proton pump inhibitors(PPIs),enhance drug labeling information,and provide guidance for their safe clinical use.Methods:Adverse reaction data for ...Background:To investigate adverse event(AE)signals associated with six proton pump inhibitors(PPIs),enhance drug labeling information,and provide guidance for their safe clinical use.Methods:Adverse reaction data for musculoskeletal and connective tissue disorders related to six PPI formulations—omeprazole,pantoprazole,lansoprazole,esomeprazole,rabeprazole,and dexlansoprazole—from Q12004 to Q42023 were collected from the FDA Adverse Event Reporting System(FAERS).Signal detection was performed using the Reporting Odds Ratio(ROR),Proportional Reporting Ratio(PRR),Bayesian Confidence Propagation Neural Network(BCPNN),and Empirical Bayesian Geometric Mean(EBGM).Data processing and statistical analysis were conducted using R Studio 4.40.Results:A total of 6,635,3,853,1,792,15,731,483,and 534 adverse events were identified for the six PPIs,respectively.The four algorithms(ROR,PRR,BCPNN,and EBGM)generated 17,19,8,27,5,and 2 positive signals.Notably,signals for renal osteodystrophy and osteoporosis were more frequent,with stronger signals for lumbar flexion syndrome and renal osteodystrophy.Conclusion:Patients with chronic kidney disease,a high risk of osteoporosis and fractures,or those using statins should select PPIs with a lower risk of adverse musculoskeletal and connective tissue reactions to minimize these adverse effects and ensure standardized clinical use of PPIs.展开更多
Tonoplast-enriched vesicles were prepared from suspension-cultured Populus euphratica Oliv. cells by differential centrifugation and discontinuous sucrose density gradient centrifugation. The properties of the proton ...Tonoplast-enriched vesicles were prepared from suspension-cultured Populus euphratica Oliv. cells by differential centrifugation and discontinuous sucrose density gradient centrifugation. The properties of the proton pumping activity of H+-ATPases in tonoplast vesicles were studied by acridine orange fluorescent quenching measured at 22 degreesC. The proton pumping activity of ATPase was ATP-dependent with apparent Michaelis-Menten Constant (K-m) for ATP about 0.65 mmol/L. The optimal pH for H+-ATPases activity was 7.5. The proton pumping activity of H+-ATPase could be initiated by some divalent cations, Mg2+ being highly efficient, much more than Fe2+; and Ca2+, Cu2+ and Zn2+ were inefficient under the experimental condition. The proton translocation could be stimulated by halide anions, with potencies decreasing in the order Cl- > Br- > I- > F-. The proton pumping activity was greatly inhibited by N-ethylmaleimide (NEM), N, N'-dicyclohexylcarbodiimide (DCCD), NO3- and Bafilomycin A(1), but not by orthovanadate and azide. These results demonstrated that the H+-ATPase in the tonoplast of Populus euphratica belonged to vacuolar type ATPase. This work was the first time that tonoplast-enriched vesicles were isolated from Populus euphratica cells.展开更多
Recent studies have suggested the existence of a patient population with esophageal eosinophilia that responds to proton pump inhibitor therapy.These patients are being referred to as having proton pump inhibitor resp...Recent studies have suggested the existence of a patient population with esophageal eosinophilia that responds to proton pump inhibitor therapy.These patients are being referred to as having proton pump inhibitor responsive esophageal eosinophilia(PPI-REE),which is currently classified as a distinct and separate disease entity from both gastroesophageal reflux disease(GERD)and eosinophilic esophagitis(EoE).The therapeutic effect of proton pump inhibitor(PPI)on PPI-REE is thought to act directly at the level of the esophageal mucosa with an anti-inflammatory capacity,and completely independent of gastric acid suppression.The purpose of this manuscript is to review the mechanistic data of the proposed immune modulation/anti-inflammatory role of the PPI at the esophageal mucosa,and the existence of PPI-REE as a distinct disease entity from GERD and EoE.展开更多
AIM:To evaluate the efficacy of high-dose proton pump inhibitors(PPIs)vs low-dose PPIs for patients with upper gastrointestinal bleeding.METHODS:PubMed,Embase,the Cochrane Library,and Web of Science were searched to i...AIM:To evaluate the efficacy of high-dose proton pump inhibitors(PPIs)vs low-dose PPIs for patients with upper gastrointestinal bleeding.METHODS:PubMed,Embase,the Cochrane Library,and Web of Science were searched to identify relevant randomized controlled trials(RCTs).Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic hemostasis.The primary endpoint was rebleeding;secondary endpoints were patient numbers that needed surgery,and mortality.The meta-analysis was performed with a fixed effects model or random effects model.RESULTS:Nine eligible RCTs including 1342 patients were retrieved.The results showed that high-dose intravenous PPI was not superior to low-dose intra-venous PPI in reducing rebleeding[odds ratio(OR)= 1.091,95%confidential interval(CI):0.777-1.532],need for surgery(OR=1.522,95%CI:0.643-3.605) and mortality(OR=1.022,95%CI:0.476-2.196).Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients(OR=0.831,95%CI,0.467-1.480)and European patients(OR=1.263,95%CI:0.827-1.929).CONCLUSION:Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.展开更多
AIM： To compare two different daily doses of lansoprazole given for 12 weeks and to assess the role of gastrointestinal （GI） investigations as criteria for selecting patients. METHODS： Out of 45 patients referred ...AIM： To compare two different daily doses of lansoprazole given for 12 weeks and to assess the role of gastrointestinal （GI） investigations as criteria for selecting patients. METHODS： Out of 45 patients referred for unexplained chronic persistent cough, 36 had at least one of the GI investigations （endoscopy, 24-h esophageal pH- metry and a 4-week trial of proton pump inhibitor （PPI） therapy） positive and were randomly assigned to receive either 30 mg lansoprazole o.d. or 30 mg lansoprazole b.i.d, for 12 weeks. Symptoms were evaluated at baseline （visit 1） after the PPI test （visit 2） and after the 12-week lansoprazole treatment period （visit 3）. RESULTS： Thirty-five patients completed the study protocol. Twenty-one patients （60.0%） reported complete relief from their cough with no difference between the two treatment groups （58.8% and 61.1% had no cough in 30 mg lansoprazole and 60 mg lansoprazole groups, respectively）. More than 80% of the patients who had complete relief from their cough at the end of the treatment showed a positive response to the PPI test. CONCLUSION： Twelve weeks of lansoprazole treatment even at a standard daily dose, is effective in patients with chronic persistent cough. A positive response to an initial PPI test seems to be the best criterion for selecting patients who respond to therapy.展开更多
AIM To compare the outcomes between laparoscopic Nissen fundoplication(LNF)and proton pump inhibitors(PPIs)therapy in patients with laryngopharyngeal reflux(LPR)and typeⅠhiatal hernia diagnosed by oropharyngeal p H-m...AIM To compare the outcomes between laparoscopic Nissen fundoplication(LNF)and proton pump inhibitors(PPIs)therapy in patients with laryngopharyngeal reflux(LPR)and typeⅠhiatal hernia diagnosed by oropharyngeal p H-monitoring and symptom-scale assessment.METHODS From February 2014 to January 2015,70 patients who were diagnosed with LPR and type I hiatal hernia and referred for symptomatic assessment,oropharyngeal p H-monitoring,manometry,and gastrointestinal endoscopy were enrolled in this study.All of the patients met the inclusion criteria.All of the patients underwent LNF or PPIs administration,and completed a2-year follow-up.Patients’baseline characteristics and primary outcome measures,including comprehensive and single symptoms of LPR,PPIs independence,and satisfaction,and postoperative complications were assessed.The outcomes of LNF and PPIs therapy were analyzed and compared. RESULTS There were 31 patients in the LNF group and 39patients in the PPI group.Fifty-three patients(25 in the LNF group and 28 in the PPI group)completed reviews and follow-up.Oropharyngeal p H-monitoring parameters were all abnormal with high acid exposure,a large amount of reflux,and a high Ryan score,associated reflux symptom index(RSI)score.There was a significant improvement in the RSI and LPR symptom scores after the 2-year follow-up in both groups(P<0.05),as well as typical symptoms of gastroesophageal reflux disease.Improvement in the RSI(P<0.005)and symptom scores of cough(P=0.032),mucus(P=0.011),and throat clearing(P=0.022)was significantly superior in the LNF group to that in the PPI group.After LNF and PPIs therapy,13 and 53 patients achieved independence from PPIs therapy(LNF:44.0%vs PPI:7.14%,P<0.001)during follow-up,respectively.Patients in the LNF group were more satisfied with their quality of life than those in the PPI group(LNF:62.49±28.68 vs PPI:44.36±32.77,P=0.004).Body mass index was significantly lower in the LNF group than in the PPI group(LNF:22.2±3.1kg/m^2 vs PPI:25.1±2.9 kg/m^2,P=0.001).CONCLUSION Diagnosis of LPR should be assessed with oropharyngeal p H-monitoring,manometry,and the symptom-scale.LNF achieves better improvement than PPIs for LPR with type I hiatal hernia.展开更多
AIMTo compare the effectiveness and safety of vonoprazan-based therapy with proton pump inhibitor(PPI)-based therapies to treat Helicobacter pylori(H.pylori).METHODSWe retrospectively analysed data from first-line(von...AIMTo compare the effectiveness and safety of vonoprazan-based therapy with proton pump inhibitor(PPI)-based therapies to treat Helicobacter pylori(H.pylori).METHODSWe retrospectively analysed data from first-line(vonoprazan or PPI with 200 mg clarithromycin and 750 mg amoxicillin twice daily for 7 d)(n=1353)and second-line(vonoprazan or PPI with 250 mg metronidazole and 750 mg amoxicillin twice daily for 7 d)(n=261)eradication treatments for H.pylori-positive patients with associated gastrointestinal diseases from April 2014 to December 2015 at Hattori Clinic,Japan.The primary endpoint was the eradication rate,which was assessed with a full analysis set.The secondary endpoints were adverse events and related factors.RESULTSAfter the first-line treatments,the eradication rates for vonoprazan,esomeprazol,rabeprazole,and lansoprazole were 87.9%(95%CI:84.9%-90.5%),71.6%(95%CI:67.5%-75.5%),62.9%(95%CI:52.0%-72.9%),and 57.3%(95%CI:50.4%-64.1%),respectively.The vonoprazan eradication rate was significantly higher than that of the PPIs(P<0.01).Interestingly,smoking did not affect the H.pylori eradication rate in the vonoprazan group(P=0.34),whereas it decreased the rates in the PPI groups(P=0.013).The incidence of adverse events in the vonoprazan group was not different from the PPI group(P=0.054),although the vonoprazan group exhibited a wider range of adverse events.Vonoprazan-based triple therapy was highly effective as a second-line treatment,with an eradication rate similar to that of PPI-based therapy.CONCLUSIONVonoprazan might be superior to PPIs in first-line H.pylori therapy,particularly for smokers.However,caution is required due to possible adverse events.展开更多
AIM:To investigate the risk factors for Clostridiumdifficile-associated diarrhea(CDAD)recurrence,and its relationship with proton pump inhibitors(PPIs). METHODS:Retrospective data of 125 consecutive hospitalized patie...AIM:To investigate the risk factors for Clostridiumdifficile-associated diarrhea(CDAD)recurrence,and its relationship with proton pump inhibitors(PPIs). METHODS:Retrospective data of 125 consecutive hospitalized patients diagnosed with CDAD between January 2006 and December 2007 were collected by medical chart review.Collected data included patient characteristics at baseline,underlying medical disease, antibiotic history before receiving a diagnosis of CDAD, duration of hospital stay,severity of CDAD,concurrenttreatment with PPIs,laboratory parameters,response to CDAD therapy,and recurrence of disease within 90 d of successful treatment.Various clinical and laboratory parameters were compared in patients in whom CDAD did or did not recur. RESULTS:Of the 125 patients(mean age,67.6± 13.9 years)that developed CDAD,98(78.4%)did not experience recurrence(non-recurrent group)and 27 (21.6%)experienced one or more recurrences(recurrent group).Prior to the development of CDAD,96% of the 125 patients were prescribed antibiotics,and 56(44.8%)of the patients received PPIs.Age older than 65 years(P=0.021),feeding via nasogastric tube(NGT)(P=0.045),low serum albumin level(P =0.025),and concurrent use of PPIs(P=0.014) were found to be risk factors for CDAD recurrence by univariate analysis.However,sex,length of hospital stay,duration and type of antibiotics used,severity of disease,leukocyte count and C-reactive protein(CRP) were not associated with risk of CDAD recurrence.On multivariate analysis,the important risk factors were advanced age(>65 years,adjusted OR:1.32,95% CI:1.12-3.87,P=0.031),low serum albumin level(< 2.5 g/dL,adjusted OR:1.85,95%CI:1.35-4.91,P= 0.028),and concurrent use of PPIs(adjusted OR:3.48, 95%CI:1.64-7.69,P=0.016). CONCLUSION:Advanced age,serum albumin level< 2.5 g/dL,and concomitant use of PPIs were found to be significant risk factors for CDAD recurrence.展开更多
AIM To perform a systematic review and meta-analysis on proton pump inhibitors(PPIs) therapy and the risk of Clostridium difficile infection(CDI). METHODS We conducted a systematic search of MEDLINE/Pub Med and seven ...AIM To perform a systematic review and meta-analysis on proton pump inhibitors(PPIs) therapy and the risk of Clostridium difficile infection(CDI). METHODS We conducted a systematic search of MEDLINE/Pub Med and seven other databases through January 1990 to March 2017 for published studies that evaluated the association between PPIs and CDI. Adult case-control and cohort studies providing information on the association between PPI therapy and the development of CDI were included. Pooled odds ratios(ORs) estimates with 95% confidence intervals(CIs) were calculated using the random effect. Heterogeneity was assessed by I^2 test and Cochran's Q statistic.Potential publication bias was evaluated via funnel plot, and quality of studies by the Newcastle-Otawa Quality Assessment Scale(NOS). RESULTS Fifty-six studies(40 case-control and 16 cohort) involving 356683 patients met the inclusion criteria and were analyzed. Both the overall pooled estimates and subgroup analyses showed increased risk for CDI despite substantial statistical heterogeneity among studies. Meta-analysis of all studies combined showed a significant association between PPI users and the risk of CDI(pooled OR = 1.99, CI: 1.73-2.30, P < 0.001) as compared with non-users. The association remained significant in subgroup analyses: by design-case-control(OR = 2.00, CI: 1.68-2.38, P < 0.0001), and cohort(OR = 1.98, CI: 1.51-2.59, P < 0.0001); adjusted(OR = 1.95, CI: 1.67-2.27, P < 0.0001) and unadjusted(OR = 2.02, CI: 1.41-2.91, P < 0.0001); unicenter(OR = 2.18, CI: 1.72-2.75, P < 0.0001) and multicenter(OR = 1.82, CI: 1.51-2.19, P < 0.0001); age ≥ 65 years(OR = 1.93, CI: 1.40-2.68, P < 0.0001) and < 65 years(OR = 2.06, CI: 1.11-3.81, P < 0.01). No significant differences were found in subgroup analyses(test for heterogeneity): P = 0.93 for case-control vs cohort, P = 0.85 for adjusted vs unadjusted, P = 0.24 for unicenter vs multicenter, P = 0.86 for age ≥ 65 years and < 65 years. There was significant heterogeneity across studies(I^2 = 85.4%, P < 0.001) as well as evidence of publication bias(funnel plot asymmetry test, P = 0.002). CONCLUSION This meta-analysis provides further evidence that PPI use is associated with an increased risk for development of CDI. Further high-quality, prospective studies are needed to assess whether this association is causal.展开更多
Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains ...Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome （ACS） after percuta- neous coronary intervention （PCI）. Methods We retrospectively analyzed data fi＇om a ＂real world＂, international, multi-center registry between 2003 and 2014 （n = 15,401） and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint （all-cause death, re-infarction, or severe bleeding） in patients with ACS after PCI. Results Of 9429 patients in the final cohort, 54.8% （n = 5165） was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel （ad- justed HR： 1.036; 95% CI： 0.903-1.189） or ticagrelor （adjusted HR： 2.320; 95% CI： 0.875-45.151） （Pinteraction = 0.2004）. Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.展开更多
Proton Pump Inhibitors (PPI) are very effective in inhibiting acid secretion and are extensively used in many acid related diseases. They are also often used in patients with cirrhosis sometimes in the absence of a sp...Proton Pump Inhibitors (PPI) are very effective in inhibiting acid secretion and are extensively used in many acid related diseases. They are also often used in patients with cirrhosis sometimes in the absence of a specific acid related disease, with the aim of preventing peptic complications in patients with variceal or hypertensive gastropathic bleeding receiving multidrug treatment. Contradicting reports support their use in cirrhosis and evidence of their efficacy in this condition is poor. Moreover there are convincing papers suggesting that acid secretion is reduced in patients with liver cirrhosis. With regard to Helicobacter pylori (H pylori) infection, its prevalence in patients with cirrhosis is largely variable among different studies, and it seems that H pylori eradication does not prevent gastro-duodenal ulcer formation and bleeding. With regard to the prevention and treatment of oesophageal complications after banding or sclerotherapy of oesophageal varices, there is little evidence for a protective role of PPI. Moreover, due to liver metabolism of PPI, the dose of most available PPIs should be reduced in cirrhotics. In conclusion, the use of this class of drugs seems more habit related than evidence- based eventually leading to an increase in health costs.展开更多
文摘BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.
文摘BACKGROUND Proton pump inhibitors(PPIs)are among the most commonly prescribed medications globally.While concerns exist regarding their association with adverse infection-related outcomes,their impact on coronavirus disease 2019(COVID-19)severity remains uncertain.Emerging preclinical data suggest immunomodulatory and antiviral properties of PPIs,yet clinical evidence is conflicting.AIM To investigate whether chronic pre-hospital PPI use is associated with improved outcomes in patients hospitalized with COVID-19.METHODS We conducted a retrospective case-control study of adult inpatients with severe acute respiratory syndrome coronavirus 2 infection admitted to a racially and ethnically diverse communityhospital in Massachusetts from July 2021 to March 2022. Patients were stratified by documented pre-hospital PPIuse. The primary outcomes were intensive care unit (ICU) admission, need for invasive mechanical ventilation, andin-hospital mortality. Multivariable logistic regression was used to adjust for demographics, comorbidities, andtreatment variables. Significance was set at P < 0.05.RESULTSAmong 248 patients, 83 (33.4%) were on PPIs prior to hospitalization. Compared to non-users, PPI users hadsignificantly lower rates of ICU admission (13.3% vs 24.8%, P = 0.034), mechanical ventilation (13.3% vs 25.5%, P =0.027), and in-hospital mortality (6.0% vs 17.6%, P = 0.013). Multivariable analysis confirmed these associations:ICU admission [adjusted odds ratios (aOR): 0.462, 95%CI: 0.223–0.955], mechanical ventilation (aOR: 0.447, 95%CI:0.216–0.923), and mortality (aOR: 0.144, 95%CI: 0.031–0.677). Findings were consistent across demographic andcomorbidity strata.CONCLUSIONIn this diverse, real-world United States cohort, chronic pre-hospital PPI use was independently associated withlower odds of intensive care unit admission, mechanical ventilation, and mortality among COVID-19 inpatients.These findings highlight a potentially protective role of PPIs and support continued therapy in eligible patients.
文摘BACKGROUND Long-term use of proton pump inhibitors(PPIs)has been associated with poten-tial adverse effects,including an increased risk of gastric cancer.Despite wide-spread use awareness of these risks among physicians varies considerably.Under-standing physicians’perceptions and prescribing behaviors is critical to impro-ving patient safety and promoting evidence-based practices.This study aimed to assess the level of awareness and risk perception among gastroenterologists and non-gastroenterologists regarding prolonged PPI use and its association with gastric malignancy.AIM To assess physicians’awareness of gastric cancer risk associated with long-term PPI use and compare perceptions between specialties.METHODS A cross-sectional observational study was conducted among 33 physicians(15 gastroenterologists and 18 non-gastroenterologists)in Israel.Participants com-pleted a structured questionnaire evaluating knowledge,attitudes,and prescri-bing behaviors related to PPI use.Data were analyzed using descriptive statistics and nonparametric tests to assess differences between groups and correlation patterns.Ethical approval and informed consent were obtained.RESULTS Gastroenterologists demonstrated significantly higher awareness of the potential gastric cancer risks linked to prolonged PPI use(mean awareness score:6.9±1.2)compared with non-gastroenterologists(4.1±1.3,P<0.01).Despite their awa-reness 80%of gastroenterologists reported frequent long-term prescribing.Non-parametric correlation analysis revealed associations between specialty,know-ledge level,and prescribing habits.Several misconceptions about cancer risk mechanisms were identified across specialties.CONCLUSION Physician awareness regarding gastric cancer risk of long-term PPI use remains inconsistent,especially among non-specialists,emphasizing the need for targeted educational programs and clearer prescribing guidelines.
文摘BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenous PPIs and oral potassium competitive acid blockers(PCABs)administered prior to endoscopic treatment of bleeding peptic ulcers.METHODS This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding(treated August 2023 to February 2024).Prior to emergency endoscopy,patients received either intravenous PPI(pantoprazole 80 mg bolus)or oral PCAB(tegoprazan 50 mg single-dose).Severity of bleeding was assessed using the Glasgow-Blatchford,Rockall,and AIMS65 scoring systems.Patients with severe comorbidities were excluded.Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding.Multivariate logistic regression was performed to adjust for potential confounding factors.RESULTS Total of the 105 patients,61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy.To minimize selection bias,bleeding severity was assessed using the Glasgow-Blatchford,Rockall and AIMS65 scores,with no statistically significant differences observed between the two groups.During emergency endoscopy performed within 48 hours,ulcer bed status was classified according to the Forrest classification.The proportion of lesions graded IIa or higher was significantly lower in the PCAB group(P<0.001),as was the frequency of therapeutic endoscopy intervention(odds ratio=0.272,95%confidence interval:0.111-0.665,P=0.004).The frequency of re-bleeding events was statistically significantly higher in the PPI group(odds ratio=0.141,95%confidence interval:0.024-0.844,P=0.032).CONCLUSION Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.
文摘Helicobacter pylori is a worldwide health problem;therefore,eradicating this bacterium is important for the health and economic status of the whole world.There are a variety of anti-secretory and antibiotic combinations for this purpose;however,antibiotic resistance is a major barrier to achieving an appropriate eradication rate(>90%).Blockage of gastric acid is the main supportive factor of the antibiotic effect on bacteria.Therefore,anti-secretory therapy with high efficacy and safety profiles should be used in eradication regimens.Vonoprazan(VPZ),a member of the potassium competitive acid blockers,is a novel agent with a potent anti-secretory effect.The present study aimed to summarize comparative and safety studies of VPZ and proton pump inhibitors(PPIs),especially the efficacy on Helicobacter pylori eradication.VPZ was reported to have a higher efficacy and safety profile in most studies that compared VPZ-based and PPIbased regimens for eradication therapy.Despite its greater cost,the effectiveness of VPZ emerges as a viable and cost-effective alternative to PPI on gastric acidrelated pathologies.
文摘Proton pump inhibitors(PPIs)are widely utilized in oncology to treat gastroeso-phageal reflux disease,peptic ulcer disease,and chemotherapy-induced mucosal injury.Emerging evidence has suggested that prolonged use of PPIs is associated with increased mortality in patients with cancer.The findings of Krishnan et al are proof of this but need to be considered cautiously due to potential confounding factors.This letter raised important methodological concerns,including con-founding by indication,reverse causality,and polypharmacy that can influence the observed association.While PPIs are important in oncology,their advantages and disadvantages should be weighed judiciously by clinicians.Future prospective studies with robust analytical approaches will be required to ascertain more definite causality.
文摘Background:To investigate adverse event(AE)signals associated with six proton pump inhibitors(PPIs),enhance drug labeling information,and provide guidance for their safe clinical use.Methods:Adverse reaction data for musculoskeletal and connective tissue disorders related to six PPI formulations—omeprazole,pantoprazole,lansoprazole,esomeprazole,rabeprazole,and dexlansoprazole—from Q12004 to Q42023 were collected from the FDA Adverse Event Reporting System(FAERS).Signal detection was performed using the Reporting Odds Ratio(ROR),Proportional Reporting Ratio(PRR),Bayesian Confidence Propagation Neural Network(BCPNN),and Empirical Bayesian Geometric Mean(EBGM).Data processing and statistical analysis were conducted using R Studio 4.40.Results:A total of 6,635,3,853,1,792,15,731,483,and 534 adverse events were identified for the six PPIs,respectively.The four algorithms(ROR,PRR,BCPNN,and EBGM)generated 17,19,8,27,5,and 2 positive signals.Notably,signals for renal osteodystrophy and osteoporosis were more frequent,with stronger signals for lumbar flexion syndrome and renal osteodystrophy.Conclusion:Patients with chronic kidney disease,a high risk of osteoporosis and fractures,or those using statins should select PPIs with a lower risk of adverse musculoskeletal and connective tissue reactions to minimize these adverse effects and ensure standardized clinical use of PPIs.
文摘Tonoplast-enriched vesicles were prepared from suspension-cultured Populus euphratica Oliv. cells by differential centrifugation and discontinuous sucrose density gradient centrifugation. The properties of the proton pumping activity of H+-ATPases in tonoplast vesicles were studied by acridine orange fluorescent quenching measured at 22 degreesC. The proton pumping activity of ATPase was ATP-dependent with apparent Michaelis-Menten Constant (K-m) for ATP about 0.65 mmol/L. The optimal pH for H+-ATPases activity was 7.5. The proton pumping activity of H+-ATPase could be initiated by some divalent cations, Mg2+ being highly efficient, much more than Fe2+; and Ca2+, Cu2+ and Zn2+ were inefficient under the experimental condition. The proton translocation could be stimulated by halide anions, with potencies decreasing in the order Cl- > Br- > I- > F-. The proton pumping activity was greatly inhibited by N-ethylmaleimide (NEM), N, N'-dicyclohexylcarbodiimide (DCCD), NO3- and Bafilomycin A(1), but not by orthovanadate and azide. These results demonstrated that the H+-ATPase in the tonoplast of Populus euphratica belonged to vacuolar type ATPase. This work was the first time that tonoplast-enriched vesicles were isolated from Populus euphratica cells.
文摘Recent studies have suggested the existence of a patient population with esophageal eosinophilia that responds to proton pump inhibitor therapy.These patients are being referred to as having proton pump inhibitor responsive esophageal eosinophilia(PPI-REE),which is currently classified as a distinct and separate disease entity from both gastroesophageal reflux disease(GERD)and eosinophilic esophagitis(EoE).The therapeutic effect of proton pump inhibitor(PPI)on PPI-REE is thought to act directly at the level of the esophageal mucosa with an anti-inflammatory capacity,and completely independent of gastric acid suppression.The purpose of this manuscript is to review the mechanistic data of the proposed immune modulation/anti-inflammatory role of the PPI at the esophageal mucosa,and the existence of PPI-REE as a distinct disease entity from GERD and EoE.
基金Supported by First Affiliated Hospital,Guangxi Medical University
文摘AIM:To evaluate the efficacy of high-dose proton pump inhibitors(PPIs)vs low-dose PPIs for patients with upper gastrointestinal bleeding.METHODS:PubMed,Embase,the Cochrane Library,and Web of Science were searched to identify relevant randomized controlled trials(RCTs).Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic hemostasis.The primary endpoint was rebleeding;secondary endpoints were patient numbers that needed surgery,and mortality.The meta-analysis was performed with a fixed effects model or random effects model.RESULTS:Nine eligible RCTs including 1342 patients were retrieved.The results showed that high-dose intravenous PPI was not superior to low-dose intra-venous PPI in reducing rebleeding[odds ratio(OR)= 1.091,95%confidential interval(CI):0.777-1.532],need for surgery(OR=1.522,95%CI:0.643-3.605) and mortality(OR=1.022,95%CI:0.476-2.196).Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients(OR=0.831,95%CI,0.467-1.480)and European patients(OR=1.263,95%CI:0.827-1.929).CONCLUSION:Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.
文摘AIM： To compare two different daily doses of lansoprazole given for 12 weeks and to assess the role of gastrointestinal （GI） investigations as criteria for selecting patients. METHODS： Out of 45 patients referred for unexplained chronic persistent cough, 36 had at least one of the GI investigations （endoscopy, 24-h esophageal pH- metry and a 4-week trial of proton pump inhibitor （PPI） therapy） positive and were randomly assigned to receive either 30 mg lansoprazole o.d. or 30 mg lansoprazole b.i.d, for 12 weeks. Symptoms were evaluated at baseline （visit 1） after the PPI test （visit 2） and after the 12-week lansoprazole treatment period （visit 3）. RESULTS： Thirty-five patients completed the study protocol. Twenty-one patients （60.0%） reported complete relief from their cough with no difference between the two treatment groups （58.8% and 61.1% had no cough in 30 mg lansoprazole and 60 mg lansoprazole groups, respectively）. More than 80% of the patients who had complete relief from their cough at the end of the treatment showed a positive response to the PPI test. CONCLUSION： Twelve weeks of lansoprazole treatment even at a standard daily dose, is effective in patients with chronic persistent cough. A positive response to an initial PPI test seems to be the best criterion for selecting patients who respond to therapy.
文摘AIM To compare the outcomes between laparoscopic Nissen fundoplication(LNF)and proton pump inhibitors(PPIs)therapy in patients with laryngopharyngeal reflux(LPR)and typeⅠhiatal hernia diagnosed by oropharyngeal p H-monitoring and symptom-scale assessment.METHODS From February 2014 to January 2015,70 patients who were diagnosed with LPR and type I hiatal hernia and referred for symptomatic assessment,oropharyngeal p H-monitoring,manometry,and gastrointestinal endoscopy were enrolled in this study.All of the patients met the inclusion criteria.All of the patients underwent LNF or PPIs administration,and completed a2-year follow-up.Patients’baseline characteristics and primary outcome measures,including comprehensive and single symptoms of LPR,PPIs independence,and satisfaction,and postoperative complications were assessed.The outcomes of LNF and PPIs therapy were analyzed and compared. RESULTS There were 31 patients in the LNF group and 39patients in the PPI group.Fifty-three patients(25 in the LNF group and 28 in the PPI group)completed reviews and follow-up.Oropharyngeal p H-monitoring parameters were all abnormal with high acid exposure,a large amount of reflux,and a high Ryan score,associated reflux symptom index(RSI)score.There was a significant improvement in the RSI and LPR symptom scores after the 2-year follow-up in both groups(P<0.05),as well as typical symptoms of gastroesophageal reflux disease.Improvement in the RSI(P<0.005)and symptom scores of cough(P=0.032),mucus(P=0.011),and throat clearing(P=0.022)was significantly superior in the LNF group to that in the PPI group.After LNF and PPIs therapy,13 and 53 patients achieved independence from PPIs therapy(LNF:44.0%vs PPI:7.14%,P<0.001)during follow-up,respectively.Patients in the LNF group were more satisfied with their quality of life than those in the PPI group(LNF:62.49±28.68 vs PPI:44.36±32.77,P=0.004).Body mass index was significantly lower in the LNF group than in the PPI group(LNF:22.2±3.1kg/m^2 vs PPI:25.1±2.9 kg/m^2,P=0.001).CONCLUSION Diagnosis of LPR should be assessed with oropharyngeal p H-monitoring,manometry,and the symptom-scale.LNF achieves better improvement than PPIs for LPR with type I hiatal hernia.
文摘AIMTo compare the effectiveness and safety of vonoprazan-based therapy with proton pump inhibitor(PPI)-based therapies to treat Helicobacter pylori(H.pylori).METHODSWe retrospectively analysed data from first-line(vonoprazan or PPI with 200 mg clarithromycin and 750 mg amoxicillin twice daily for 7 d)(n=1353)and second-line(vonoprazan or PPI with 250 mg metronidazole and 750 mg amoxicillin twice daily for 7 d)(n=261)eradication treatments for H.pylori-positive patients with associated gastrointestinal diseases from April 2014 to December 2015 at Hattori Clinic,Japan.The primary endpoint was the eradication rate,which was assessed with a full analysis set.The secondary endpoints were adverse events and related factors.RESULTSAfter the first-line treatments,the eradication rates for vonoprazan,esomeprazol,rabeprazole,and lansoprazole were 87.9%(95%CI:84.9%-90.5%),71.6%(95%CI:67.5%-75.5%),62.9%(95%CI:52.0%-72.9%),and 57.3%(95%CI:50.4%-64.1%),respectively.The vonoprazan eradication rate was significantly higher than that of the PPIs(P<0.01).Interestingly,smoking did not affect the H.pylori eradication rate in the vonoprazan group(P=0.34),whereas it decreased the rates in the PPI groups(P=0.013).The incidence of adverse events in the vonoprazan group was not different from the PPI group(P=0.054),although the vonoprazan group exhibited a wider range of adverse events.Vonoprazan-based triple therapy was highly effective as a second-line treatment,with an eradication rate similar to that of PPI-based therapy.CONCLUSIONVonoprazan might be superior to PPIs in first-line H.pylori therapy,particularly for smokers.However,caution is required due to possible adverse events.
基金Supported by A Seoul National University Boramae Hospital Grant(03-2007-1)
文摘AIM:To investigate the risk factors for Clostridiumdifficile-associated diarrhea(CDAD)recurrence,and its relationship with proton pump inhibitors(PPIs). METHODS:Retrospective data of 125 consecutive hospitalized patients diagnosed with CDAD between January 2006 and December 2007 were collected by medical chart review.Collected data included patient characteristics at baseline,underlying medical disease, antibiotic history before receiving a diagnosis of CDAD, duration of hospital stay,severity of CDAD,concurrenttreatment with PPIs,laboratory parameters,response to CDAD therapy,and recurrence of disease within 90 d of successful treatment.Various clinical and laboratory parameters were compared in patients in whom CDAD did or did not recur. RESULTS:Of the 125 patients(mean age,67.6± 13.9 years)that developed CDAD,98(78.4%)did not experience recurrence(non-recurrent group)and 27 (21.6%)experienced one or more recurrences(recurrent group).Prior to the development of CDAD,96% of the 125 patients were prescribed antibiotics,and 56(44.8%)of the patients received PPIs.Age older than 65 years(P=0.021),feeding via nasogastric tube(NGT)(P=0.045),low serum albumin level(P =0.025),and concurrent use of PPIs(P=0.014) were found to be risk factors for CDAD recurrence by univariate analysis.However,sex,length of hospital stay,duration and type of antibiotics used,severity of disease,leukocyte count and C-reactive protein(CRP) were not associated with risk of CDAD recurrence.On multivariate analysis,the important risk factors were advanced age(>65 years,adjusted OR:1.32,95% CI:1.12-3.87,P=0.031),low serum albumin level(< 2.5 g/dL,adjusted OR:1.85,95%CI:1.35-4.91,P= 0.028),and concurrent use of PPIs(adjusted OR:3.48, 95%CI:1.64-7.69,P=0.016). CONCLUSION:Advanced age,serum albumin level< 2.5 g/dL,and concomitant use of PPIs were found to be significant risk factors for CDAD recurrence.
文摘AIM To perform a systematic review and meta-analysis on proton pump inhibitors(PPIs) therapy and the risk of Clostridium difficile infection(CDI). METHODS We conducted a systematic search of MEDLINE/Pub Med and seven other databases through January 1990 to March 2017 for published studies that evaluated the association between PPIs and CDI. Adult case-control and cohort studies providing information on the association between PPI therapy and the development of CDI were included. Pooled odds ratios(ORs) estimates with 95% confidence intervals(CIs) were calculated using the random effect. Heterogeneity was assessed by I^2 test and Cochran's Q statistic.Potential publication bias was evaluated via funnel plot, and quality of studies by the Newcastle-Otawa Quality Assessment Scale(NOS). RESULTS Fifty-six studies(40 case-control and 16 cohort) involving 356683 patients met the inclusion criteria and were analyzed. Both the overall pooled estimates and subgroup analyses showed increased risk for CDI despite substantial statistical heterogeneity among studies. Meta-analysis of all studies combined showed a significant association between PPI users and the risk of CDI(pooled OR = 1.99, CI: 1.73-2.30, P < 0.001) as compared with non-users. The association remained significant in subgroup analyses: by design-case-control(OR = 2.00, CI: 1.68-2.38, P < 0.0001), and cohort(OR = 1.98, CI: 1.51-2.59, P < 0.0001); adjusted(OR = 1.95, CI: 1.67-2.27, P < 0.0001) and unadjusted(OR = 2.02, CI: 1.41-2.91, P < 0.0001); unicenter(OR = 2.18, CI: 1.72-2.75, P < 0.0001) and multicenter(OR = 1.82, CI: 1.51-2.19, P < 0.0001); age ≥ 65 years(OR = 1.93, CI: 1.40-2.68, P < 0.0001) and < 65 years(OR = 2.06, CI: 1.11-3.81, P < 0.01). No significant differences were found in subgroup analyses(test for heterogeneity): P = 0.93 for case-control vs cohort, P = 0.85 for adjusted vs unadjusted, P = 0.24 for unicenter vs multicenter, P = 0.86 for age ≥ 65 years and < 65 years. There was significant heterogeneity across studies(I^2 = 85.4%, P < 0.001) as well as evidence of publication bias(funnel plot asymmetry test, P = 0.002). CONCLUSION This meta-analysis provides further evidence that PPI use is associated with an increased risk for development of CDI. Further high-quality, prospective studies are needed to assess whether this association is causal.
文摘Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome （ACS） after percuta- neous coronary intervention （PCI）. Methods We retrospectively analyzed data fi＇om a ＂real world＂, international, multi-center registry between 2003 and 2014 （n = 15,401） and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint （all-cause death, re-infarction, or severe bleeding） in patients with ACS after PCI. Results Of 9429 patients in the final cohort, 54.8% （n = 5165） was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel （ad- justed HR： 1.036; 95% CI： 0.903-1.189） or ticagrelor （adjusted HR： 2.320; 95% CI： 0.875-45.151） （Pinteraction = 0.2004）. Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.
文摘Proton Pump Inhibitors (PPI) are very effective in inhibiting acid secretion and are extensively used in many acid related diseases. They are also often used in patients with cirrhosis sometimes in the absence of a specific acid related disease, with the aim of preventing peptic complications in patients with variceal or hypertensive gastropathic bleeding receiving multidrug treatment. Contradicting reports support their use in cirrhosis and evidence of their efficacy in this condition is poor. Moreover there are convincing papers suggesting that acid secretion is reduced in patients with liver cirrhosis. With regard to Helicobacter pylori (H pylori) infection, its prevalence in patients with cirrhosis is largely variable among different studies, and it seems that H pylori eradication does not prevent gastro-duodenal ulcer formation and bleeding. With regard to the prevention and treatment of oesophageal complications after banding or sclerotherapy of oesophageal varices, there is little evidence for a protective role of PPI. Moreover, due to liver metabolism of PPI, the dose of most available PPIs should be reduced in cirrhotics. In conclusion, the use of this class of drugs seems more habit related than evidence- based eventually leading to an increase in health costs.
基金Supported by Grant support from Daiichi Sankyo Co.,Ltd.,Astra Zeneca Co.,Ltd.,and Otsuka Pharmaceutical Co.,Ltd(To Yokosuka O)the lecture fees from Daiichi Sankyo,AstraZeneca(To Arai M)
文摘AIM: To investigate the optimum period of treatment for post endoscopic submucosal dissection (ESD) ulcers.
