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[Possibilities for optimization of eradication therapy for Helicobacter pylori infection in modern clinical practice].
Andreev, DN, Dicheva, DT, Maev, IV
Terapevticheskii arkhiv. 2017;(2):84-90
Abstract
A steady decline in the effectiveness of standard eradication therapy (ET) regimens for Helicobacter pylori infection necessitates a search for ways of their optimization, by enhancing the efficiency of treatment protocols and by improving their safety and tolerability. The review systematizes the data available in the literature on main accessible methods for optimizing ET regimens. Among the optimization methods that can considerably enhance the efficiency of ET regimens, one may identify their addition of a bismuth agent (by 10-20%), the use of rebamipide (by 11.9%), adjuvant therapy with probiotics (by 8.1-13%), or double-dose proton pump inhibitors (by 8%). Only adjuvant therapy with probiotics results in a significant decrease in the incidence of side effects from ET. In posteradication period, rebamipide should be used to potentiate gastric mucosal repair and to regress inflammatory processes.
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Stress prophylaxis in intensive care unit patients and the role of enteral nutrition.
Hurt, RT, Frazier, TH, McClave, SA, Crittenden, NE, Kulisek, C, Saad, M, Franklin, GA
JPEN. Journal of parenteral and enteral nutrition. 2012;(6):721-31
Abstract
Use of acid-suppressive therapy (AST) to prevent stress gastropathy in the intensive care unit has grown rapidly over the past 20 years. The primary indications for such use of AST include need for mechanical ventilation, overt gastrointestinal bleeding, severe burn, and head trauma. Despite this limited list of indications, proton pump inhibitors (PPIs) often are overprescribed for purposes of stress prophylaxis. Decreased mucosal blood flow with subsequent tissue ischemia is thought to be the mechanism responsible for stress-induced gastropathy. Subsequent activation of inflammatory and vasoconstrictive mediators determines the severity of the gastropathy. Numerous basic science studies suggest that enteral nutrition (EN) can improve mucosal blood flow and reverse the generation of these inflammatory mediators. Clinical studies evaluating the effectiveness of EN vs acid-suppressive medications, however, have shown variable results (and there are no randomized controlled trials to date). In hypersecretory states (such as head trauma and burns), AST should be given, even in patients who are tolerating EN. In the absence of a hypersecretory state, pharmacologic AST may be avoided or discontinued in patients who are tolerating EN. Stress prophylaxis medications also should be discontinued in patients who do not have a clear indication for their use. Overt bleeding in a patient receiving EN for stress prophylaxis should prompt the initiation of a PPI. Randomized controlled studies investigating the efficacy of EN for stress ulcer prophylaxis are needed. Protocols should be developed to alert healthcare teams to consider discontinuation of AST, especially when tolerance of EN is achieved.
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3.
Hypomagnesaemia due to use of proton pump inhibitors--a review.
Kuipers, MT, Thang, HD, Arntzenius, AB
The Netherlands journal of medicine. 2009;(5):169-72
Abstract
Magnesium homeostasis is essential for many intracellular processes and depends on the balance of intestinal absorption and renal excretion. Hypomagnesaemia may arise from various disorders. We review the literature on hypomagnesaemia due to the use of proton pump inhibitors, as illustrated by a case of a 76-year-old woman with muscle cramps and lethargy caused by hypomagnesaemia and hypocalcaemia with a low parathyroid hormone level while using esomeprazole, a proton pump inhibitor (PPI). After oral magnesium repletion both abnormalities resolved. Fractional magnesium excretion was low, excluding excessive renal loss. A causal relation with PPI use was supported by the recurrence of hypomagnesaemia after rechallenge. In the past decade our understanding of transcellular magnesium transport was enhanced by the discovery of several gene mutations i.e. transient receptor potential melastin (TR PM) 6 and 7. In this light we discuss the possible aetiology of proton pump inhibitor related hypomagnesaemia.
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The effect of proton pump-inhibiting drugs on mineral metabolism.
Insogna, KL
The American journal of gastroenterology. 2009;:S2-4
Abstract
Two recent studies have reported increased hip fracture rates with long-term proton pump inhibitor (PPI) use raising concerns about adverse effects of this class of drugs on mineral metabolism. One plausible mechanism by which PPIs could affect calcium economy and skeletal homeostasis is by impairing intestinal calcium absorption. In the long term, this could potentially lead to a negative whole body calcium balance, resulting in higher rates of bone loss and a greater risk of fragility fractures.
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5.
Systematic review: impaired drug absorption related to the co-administration of antisecretory therapy.
Lahner, E, Annibale, B, Delle Fave, G
Alimentary pharmacology & therapeutics. 2009;(12):1219-29
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Abstract
BACKGROUND Due to suppression of gastric acidity during antisecretory therapy, an impaired absorption of co-administered drugs may occur. AIM: To review evidence of impaired drug absorption related to the use of co-administered PPIs or H2RAs. METHODS Systematic search of MEDLINE/EMBASE/SCOPUS databases (1980-September 2008) for English articles with keywords: drug malabsorption and absorption, stomach, anti-secretory/acid inhibitory drugs, histamine H2 antagonists, PPIs, gastric acid, pH, hypochlorhydria, gastric hypoacidity. From 2126 retrieved articles, 16 randomized crossover studies were identified investigating impaired absorption of nine different drugs in association with co-administration of PPIs or H2RAs. Information on investigated drug, study type, features of investigated subjects, study design, type of intervention, and study results were extracted. RESULTS The identified studies investigated the absorption kinetics of nine drugs. Acid suppression reduced absorption of ketoconazole, itraconazole, atazanavir, cefpodoxime, enoxacin and dipyridamole (median C(max) reduction by 66.5%). An increased absorption of nifedipine and digoxin (median AUC increase by 10%) and a 2-fold-increase in alendronate bioavailability were observed. CONCLUSIONS Gastric pH appears relevant for absorption of some cardiovascular or infectious disease agents. Antisecretory treatment may significantly modify the absorption of co-administered drugs.
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Systematic review: Helicobacter pylori infection and impaired drug absorption.
Lahner, E, Annibale, B, Delle Fave, G
Alimentary pharmacology & therapeutics. 2009;(4):379-86
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BACKGROUND Impaired acid secretion may affect drug absorption and may be consequent to corporal Helicobacter pylori-gastritis, which may affect the absorption of orally administered drugs. AIM: To focus on the evidence of impaired drug absorption associated with H. pylori infection. METHODS Data sources were the systematic search of MEDLINE/EMBASE/SCOPUS databases (1980-April 2008) for English articles using the keywords: drug malabsorption/absorption, stomach, Helicobacter pylori, gastritis, gastric acid, gastric pH, hypochlorhydria, gastric hypoacidity. Study selection was made from 2099 retrieved articles, five studies were identified. Data were extracted from selected papers, investigated drugs, study type, main features of subjects, study design, intervention type and results were extracted. RESULTS In all, five studies investigated impaired absorption of l-dopa, thyroxine and delavirdine in H. pylori infection. Eradication treatment led to 21-54% increase in l-dopa in Parkinson's disease. Thyroxine requirement was higher in hypochlorhydric goitre with H. pylori-gastritis and thyrotropin levels decreased by 94% after treatment. In H. pylori- and HIV-positive hypochlorhydric subjects, delavirdine absorption increased by 57% with orange juice administration and by 150% after eradication. CONCLUSIONS A plausible mechanism of impaired drug absorption is decreased acid secretion in H. pylori-gastritis patients. Helicobacter pylori infection and hypochlorhydria should be considered in prescribing drugs the absorption of which is potentially affected by intragastric pH.
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Proton pump inhibitors and bone fractures?
Laine, L
The American journal of gastroenterology. 2009;:S21-6
Abstract
The objective of this study was to critically assess studies regarding proton pump inhibitors (PPIs) and fractures. A MEDLINE search was conducted to identify relevant articles. Three case-control studies assessed fractures and PPI use. A study of all subjects with fracture in Denmark in 2000 revealed adjusted OR=1.18 (1.12-1.43) for PPI use within the last year (hip fracture OR=1.45,1.28-1.65); no dose-response relationship was identified. A study of hip fractures in UK patients > or =50 years found adjusted OR=1.44 (1.30-1.59) for >1 year of PPIs; duration and average daily dose were significantly associated with fracture risk: adjusted OR for >1.75 times average daily dose for >1 year was 2.65 (1.80-3.90). A study of vertebral, wrist, and hip fractures in Manitoba patients > or =50 years found adjusted OR=0.99 (0.90-1.11) for > or =1 year of continuous PPI; association became significant > or =7 years (OR=1.92, 1.16-3.18). Consistency of some positive results in all studies, the dose and/or duration response in two studies, the possibility that acid inhibition may decrease calcium absorption, and association with histamine(2)-receptor antagonists in some studies support a causal association. The low magnitude of the association (ORs<2), lack of dose-response in one study, lack of association with histamine(2)-receptor antagonists in one study, lack of experimental evidence documenting a mechanism, and inability to assess potential confounding factors limit statements regarding causality. As with all medications, PPIs should be used for appropriate indications and not in higher doses or longer durations than necessary to achieve the desired outcomes.
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[Bismuth preparations in the treatment of patients with gastric and duodenal ulcer disease].
Maev, IV, Samsonov, AA, Golubev, NN
Klinicheskaia meditsina. 2008;(9):57-63
Abstract
Studies of the role of H. pylori (Hp) in etiopathogenesis of a number of common diseases of the upper gastrointestinal tract changed traditional approaches to their management with emphasis on antibiotic therapy. Positive effect of Hp eradication was confirmed in numerous randomized clinical studies. Bismuth-containing drugs have been used for a long time to treat gastrointestinal disorders. To-day, bismuth tri-potassium di-citrate (de---nol) is considered to be an optimal tool for different schemes of eradication therapy (triple and quadruple therapy of the first and second lines) and recommended to improve its efficiency by overcoming resistance of Hp to antibiotics. The overall efficacy of anti-helicobacterial therapy using bismuth tri-potassium di-citrate amounts to 81-98%. This compound has cytoprotective effect on gastric and duodenal mucosa, besides antibacterial action. All these properties characterize de-nol as a single universal preparation for the treatment of erosive ulcers in the gastrointestinal tract.
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9.
Treatment of gastroesophageal reflux disease.
GuimarĂ£es, EV, Marguet, C, Camargos, PA
Jornal de pediatria. 2006;(5 Suppl):S133-45
Abstract
OBJECTIVES To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on pharmacological aspects. To identify particularities of pharmacological treatment of esophageal and extraesophageal manifestations of the disease. SOURCES Electronic search of the PubMed/MEDLINE and Cochrane Collaboration databases. Controlled and randomized studies published since 2000 and reviews representing consensus positions and directives published within the last 10 years were identified. SUMMARY OF THE FINDINGS The drugs currently available for the treatment of GERD do not act in the primary mechanism of the disease, i.e. transitory relaxation of the lower esophageal sphincter. Pharmacological treatment of GERD with symptoms or with esophageal injury is based on the suppression of acid secretion, particularly with proton pump inhibitors. When the hyperreactivity of the lower airways coexists with esophageal GERD symptoms, suppression of acid secretions should be of benefit in managing the respiratory disease in the presence of a causal relationship; however, this is not usual. When esophageal symptoms are not present, esophageal 24-hour pH study should be carried out prior to starting pharmacological treatment for GERD. Improvement of respiratory symptoms may be delayed with relation to esophageal symptoms. It is common for GERD to recur and pharmacological treatment should be repeated or continued indefinitely, depending on clinical presentation of the disease. CONCLUSIONS The strategies that have been proposed for the pharmacological treatment of GERD in children are primarily based on studies of case series or on studies with adults. There have been very few controlled and randomized studies in children. Undertaking a greater number of these studies might reinforce existing aspects or establish new aspects of management.
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10.
Review article: proton pump inhibitors and bacterial overgrowth.
Williams, C, McColl, KE
Alimentary pharmacology & therapeutics. 2006;(1):3-10
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Proton pump inhibitors are potent drugs producing profound suppression of gastric acid secretion. Consequently, they are highly effective at treating acid-related disorders. There have been concerns that the suppression of gastric acid will alter the bacterial flora of the upper gastrointestinal tract and lead to complications such as cancer, enteric or other infections and malabsorption. Studies have confirmed that proton pump inhibitors do alter the bacterial population but present evidence indicates that this only rarely leads to clinical disease. As with all drugs, proton pump inhibitors should only be used for disorders shown clearly to benefit from the therapy and where the benefits will outweigh the small risks associated with them. Further research to more fully quantify the risk associated with PPI therapy is required.