Use Of Antacids Research Articles

Oral Antacid Use Is Negatively Associated with Serum Prealbumin Levels in Japanese Individuals Undergoing Health Checkups

Background/Objectives: The aim of this study is to investigate the association between physical and chemical digestion and nutrition markers (serum albumin (ALB), prealbumin (PAB), and vitamin B12 (B12) levels). Methods: During a detailed checkup at Fujita Health University, we examined the associations of physical (occlusal force, masticatory performance, and swallowing ability (via the 10-item Eating Assessment Tool, EAT-10)) and chemical (Helicobacter pylori (HP) eradication history, HP antibody levels, and oral antacid (proton pump inhibitors) use) digestion parameters with serum ALB, PAB, and B12 levels in 92 individuals (M:67, F:25). Results: Forty-eight percent of the participants were older than 65 years of age, 19% had decreased occlusal force, 3.2% had decreased masticatory strength, 3.2% had decreased swallowing function, 24% had a history of HP eradication, 23% were HP antibody positive, and 16% were taking oral antacid medication. Additionally, 14% and 11% of the patients had low serum ALB and PAB levels, respectively, and 14% of the patients had B12 deficiency. Multivariate analysis adjusted for age, sex, body mass index, and C-reactive protein levels revealed that there were no significant associations between the physical digestion parameters and the serum PAB, ALB, or B12 levels. On the other hand, there was a significant association between oral antacid use and PAB levels (β = −3.3, p = 0.04). Independent of physical or chemical digestion parameters, serum PAB and B12 levels were significantly associated with protein and B12 intake, respectively. Conclusions: Oral antacid use may decrease serum PAB levels, indicating protein synthesis.

Endoscopic Outcomes Before and Five Years After Laparoscopic Sleeve Gastrectomy: Is There a Significant Impact?

Laparoscopic sleeve gastrectomy (LSG) is a popular bariatric procedure with significant effects on weight and metabolic health. However, its impact on gastroesophageal reflux disease (GERD) and esophageal symptoms remains debated. This study aims to evaluate the endoscopic changes five years post-LSG. We conducted a retrospective analysis of patients who underwent LSG at our center between June 2017 and June 2019. Inclusion criteria included preoperative and at least five-year follow-up esophagogastroduodenoscopy (EGD). We analyzed demographic factors, esophageal symptoms, and endoscopic findings. Out of 118 patients who underwent LSG, 24 met the inclusion criteria. Two patients were excluded due to conversion to Roux-en-Y gastric bypass (RYGB). The final cohort included 22 patients with a mean age of 42 ± 10 years and a mean BMI of 45 ± 7 kg/m². Preoperative EGD showed no GERD in 21 patients (95.5%) and GERD in 1 patient (4.5%). At five-year follow-up, 14 patients (63.6%) had no GERD, 7 (31.8%) had GERD A, and 1 (4.5%) had GERD B. Esophageal symptoms included heartburn (54.5%), nausea (36.4%), regurgitation (31.8%), and epigastric pain (22.7%). PPI or antacid use was reported in 10 patients (45.5%). Extra-esophageal symptoms were rare. BMI was significantly higher in patients with GERD (34.5 ± 6.3 kg/m²) compared to those without GERD (30.2 ± 5.1 kg/m², p = 0.04). LSG may lead to the development or worsening of GERD in a subset of patients, despite the majority showing no significant GERD changes over five years. Continuous monitoring and tailored management strategies are essential for optimizing outcomes.

Antacids and reflux esophagitis as a risk factor for gastric neoplasm of fundic-gland type: A retrospective, matched case-control study.

Since the first report of gastric adenocarcinoma of the fundic-gland type in 2010, the clinicopathological characteristics of gastric neoplasm of the fundic-gland type (GNFG) have become clearer; however, their risk factors remain unclear. This exploratory study aimed to identify the risk factors for GNFG. We conducted a single-center, retrospective, matched case-control study using medical information recorded at our health management center from January 2014 to July 2023. During this period, 39240 people underwent upper gastrointestinal endoscopy. GNFG were extracted as cases and matched to controls, according to age and sex, in a 1:8 ratio, excluding those with a history of gastrointestinal surgery and those with a history or comorbidity of cancer. Univariate analysis was used to compare patient background and endoscopic findings. Multivariable analysis was performed, adjusting for factors with P values <0.1 and antacid use. A total of 20 GNFG cases and 160 matched healthy controls were included. In the univariate analysis, only reflux esophagitis was significantly more common in GNFG (40.0% vs 18.1%; P=0.036). Factors antacids and duodenitis had P values <0.1. Logistic regression analysis was performed, adjusting for antacids, reflux esophagitis, and duodenitis. Antacids and reflux esophagitis were the independent risk factors for GNFG (odds ratio=3.68 [95% confidence interval: 1.04-11.91] and 3.25 [95% confidence interval: 1.11-9.35]). Although the sample of patients with GNFG was small, antacids and reflux esophagitis were identified as a risk factor. The pathogenesis of antacids and reflux esophagitis may be involved in the development of GNFG.

Acute Exacerbation of Interstitial Lung Disease: Definitions, Epidemiology, Prognosis and Management.

Abstract Acute exacerbation of interstitial ling disease (AE-ILD) denotes a rapid deterioration of respiratory function often leading to ICU admission due to severe hypoxemia. Definitions encompass the diverse spectrum of interstitial lung diseases and specific criteria for AE-ILD, originally established for idiopathic pulmonary fibrosis (IPF) and later expanded to other interstitial lung diseases. The incidence varies among the various interstitial lung disease subtypes, with around 10% of interstitial lung disease patients experiencing acute exacerbations within the initial two years of diagnosis. Clinical risk factors encompass advanced interstitial lung disease, compromised pulmonary function, and coexisting conditions. Prognostic markers include baseline pulmonary parameters, blood markers, and a newly developed Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) staging system. However, due to the scarcity of randomized studies, optimal treatment strategies remain uncertain. Current guidelines propose supportive care and oxygen therapy, with cautious use of corticosteroids in AE-IPF. Antibiotics are employed to manage infections, with procalcitonin-guided therapy showing potential. Management involves exposure elimination, targeted antibiotics, and antacid and antifibrotic use. For severe cases, mechanical ventilation, extracorporeal membrane oxygenation (ECMO), and even transplantation are considered. To conclude, AE-ILD poses formidable challenges and high mortality rates. Given the lack of standardized approaches, the pursuit of randomized trials is vital to enhance the understanding and management of AE-ILD, optimizing patient outcomes within the ICU setting. Keywords: acute exacerbation, interstitial lung disease, idiopathic pulmonary fibrosis, intensive care unit, definition.

Use of Acid-Suppression Therapy and Odds of Migraine and Severe Headache in the National Health and Nutrition Examination Survey.

Headache is an adverse event associated with the use of proton pump inhibitors (PPIs). Recently, migraine has emerged more specifically as a potential adverse event with PPI use. The objectives of this work were to capitalize on existing data to evaluate the association between migraine and severe headache prevalence and use of acid-suppression therapy, including PPIs, H2 receptor antagonists (H2RAs), and generic antacids; to compare risk from PPIs vs H2RAs; and to assess for potential mitigation by a dietary factor affected by acid-suppression therapy. Data from adults in the 1999-2004 National Health and Nutrition Examination Survey were used for this cross-sectional analysis. Acid-suppression therapy use was identified from self-report confirmed by product packaging review. Respondents who endorsed migraine or severe headache in the past 3 months were classified in the migraine or severe headache group. Dietary intake of magnesium was determined using one 24-hour recall interview. Multivariable logistic regression models were generated to analyze the relationship between acid-suppression therapy use and migraine or severe headache, and an interaction test was conducted to evaluate whether migraine or severe headache prevalence differed in relation to nutritional magnesium intake across acid-suppression therapy users and nonusers. In 11,818 US adults, the use of acid-suppression therapy was associated with higher odds of migraine or severe headache for all types of acid-suppression therapy and use of any type, as compared with those who did not use acid-suppression therapy: use of PPIs (70% higher), H2RAs (40% higher), and generic antacids (30% higher). Differences between acid-suppression therapy were not significant. An interaction was observed for H2RA use and magnesium intake (p = 0.024). These observations in US adults agree with previous findings that migraine or severe headache is a potential adverse event of PPIs, the most efficacious and most frequently used type of acid suppressing medication, and further suggest that other classes of acid suppressing medications (H2RAs and generic antacids) may also be implicated for migraine and severe headache. Future prospective analyses are needed to investigate migraine risk associated with acid suppressing medications while current evidence is sufficient to evaluate patients with migraine in light of recent deprescribing advice for PPIs.

The incidence and risk factors of marginal ulcers in the short and medium term in symptomatic post-pancreaticoduodenectomy patients ---- single-center experience

BackgroundMarginal ulcer (MU) is one of the postoperative complications of pancreaticoduodenectomy (PD), which needs particular attention in postoperative treatments. MethodsThe data of 190 patients who underwent PD and follow-up gastroscopic review due to upper GI symptoms within two years were retrospectively analyzed. The incidence of MU and risk factors were analyzed based on personal history, surgical procedure, past medical history, postoperative complications, and other relevant indicators. ResultsThe proportion of MU in patients who underwent endoscopic follow-up for upper gastrointestinal symptoms in the postoperative period in this cohort was 10.5% (20/190). Advanced age (69y vs. 59y, P ​= ​0.012), alcohol consumption (20% vs. 8.2%, P ​= ​0.03), and cigarette smoking (35% vs. 14.7%, P ​= ​0.022) were associated with an increased incidence of MU. Longer surgery time (276.5min vs. 240min, P ​= ​0.049), postoperative bleeding (10% vs. 1.8%, P ​= ​0.030), and failure to take antacid regularly postoperatively (75% vs. 97.1%, P ​= ​0.000) would increase the risk of MU; taking antacid regularly was an independent protective factor for postoperative anastomotic ulceration (OR: 0.091, CI: 0.022–0.383, P ​= ​0.001). ConclusionAdvanced age, alcohol consumption, smoking, longer operation time, or postoperative extraluminal hemorrhage are associated with MU. Regular use of antacids is an independent protective factor against the development of MU.

Two risk factors for hypozincemia in diabetic β-thalassemia patients: Hepatitis C and deferasirox.

Hypozincemia is a prevalent adverse consequence in diabetes mellitus (DM) and β-Thalassemia patients. We aimed to evaluate the level of serum zinc in β-thalassemia patients with DM and a risk assessment for hypozincemia. The study population included transfusion-dependent thalassemia (TDT) and non-transfusion-dependent thalassemia (NTDT) with overt DM (fasting plasma glucose (FPG) ≥126 mg/dL, and/or 2-h plasma glucose≥200 mg/dL). Serum zinc concentration was measured by the colorimetric method, and the values below 70 μg/dL were defined as hypozincemia. Myocardial and liver T2*-weighted magnetic resonance imaging (MRI T2*, millisecond [ms]) were valued by a free contrast MRI. The demographic, clinical, paraclinical, and laboratory data were also recorded. The data belonged to the period from December 2018 until December 2020. Of 64 diabetic β-thalassemia patients, 41 cases had zinc data in their medical files (aged 38 ± 9 years, 48.8% female). 78.05% of patients (n = 32) were TDT, and 21.95% were NTDT (n = 9). The mean ± standard deviation of zinc level was 110.2 ± 127.6 μg/dL. The prevalence of hypozincemia was 9.76%, 95% confidence interval [CI] 0.27 to 19.24 (four cases). After controlling age, the odds of hypozincemia for using deferasirox (DFX) was 8.77, 95% CI 0.60 to 127.1. In β-thalassemia patients, the age-adjusted risk of hypozincemia was calculated at 15.85, 95% CI 0.47 to 529.3 for hepatitis C. The adjusted risk of hypozincemia based on age for antacid use was 6.34, 95% CI 0.39 to 102.7. In light of this study, as well as hepatitis C, using DFX and antacids is associated with a high risk of hypozincemia amid diabetic β-thalassemia cases. However, upward bias should be taken into consideration.

Stepwise prolongation of overall survival from first- to third-generation EGFR-tyrosine kinase inhibitors in non-small cell lung cancer and the prognostic impact of concomitant antacids.

530 Background: The introduction of new-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) has afforded promising overall survival (OS) outcomes in clinical trials for non-small cell lung cancer (NSCLC). However, given the high cost associated with these agents, the extent of their adoption and the resulting impact on OS in real-world clinical settings remains uncertain. Concomitant use of antacids reportedly decreases the absorption of first-generation EGFR-TKIs, accompanied by a reduction in OS. Although concomitant antacids do not reduce the absorption of second- and third-generation EGFR-TKIs, the impact on OS remains unexplored. Methods: We conducted a nationwide retrospective cohort study utilizing data from the Tokushukai Real-world Data project and reviewed clinical data of consecutive patients with NSCLC who were treated with EGFR-TKIs between April 2010 and March 2020. Cox regression analyses were performed to examine the associations between OS and patient/tumor-related factors, hospital volume, hospital type, study period, and first-line EGFR-TKIs. Furthermore, we examined differences in OS between patients treated with and without concomitant antacids. Results: A total of 758 patients (58.5% females; median age, 73 years) were included. Over the study period, we noted increased utilization of osimertinib as the first-line EGFR-TKI. With a median follow up of 15.8 months, median OS was 28.4 months (95% confidence interval, 15.3–31.0). Age, body mass index, disease status, EGFR mutational status, and first-line EGFR-TKI were identified as significant prognostic factors. The 2-year OS rates for gefitinib, erlotinib, afatinib, and osimertinib were 70.1, 67.8, 75.6, and 90.8%, respectively. Low-volume hospitals showed a treatment transition to osimertinib over time and were non-inferior to high-volume hospitals in terms of the OS achieved. Patients administering gefitinib, erlotinib, afatinib, and osimertinib with concomitant antacids had lower OS values than those not taking concomitant antacids, with hazard ratios of 1.742, 1.329, 1.729, and 5.040, respectively. Conclusions: Our real-world data revealed that new-generation EGFR-TKIs could afford a prolonged OS irrespective of the volume and type of the hospital. Surprisingly, the concomitant antacid use was associated with poor OS in patients treated with osimertinib.

Revisional bariatric surgery for gastroesophageal reflux disease: characterizing patient and procedural factors and 30-day outcomes for a retrospective cohort of 4412 patients.

Gastroesophageal reflux disease (GERD) is a well-established potential consequence of bariatric surgery and can require revisional surgery. Our understanding of the population requiring revision is limited. In this study, we aim to characterize patients requiring revisional surgery for GERD to understand their perioperative risks and identify strategies to improve their outcomes. Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry, a retrospective cohort of patients who required revisional surgery for GERD in 2020 was identified. Multivariable logistic regression modelling was used to assess correlations between baseline characteristics and morbidity. 4412 patients required revisional surgery for GERD, encompassing 24% of all conversion procedures. In most cases, patients underwent sleeve gastrectomy (SG) as their original surgery (n = 3535, 80.1%). The revisional surgery for most patients was a Roux-en-Y gastric bypass (RYGB) (n = 3722, 84.4%). Major complications occurred in 527 patients (11.9%) and 10 patients (0.23%) died within 30days of revisional surgery. Major complications included anastomotic leak in 31 patients (0.70%) and gastrointestinal bleeding in 38 patients (0.86%). Multivariable analyses revealed that operative length, pre-operative antacid use, and RYGB were predictors of major complications. GERD is the second most common indication for revisional surgery in patients who have undergone bariatric surgery. Patients who underwent SG as their initial procedure were the primary group who required revisional surgery for GERD; most underwent revision via RYGB. Further inquiry is needed to tailor operative approaches and pre-operative optimization for revisional surgery patients.

Microbiome changes in esophageal cancer: implications for pathogenesis and prognosis.

Esophageal cancer (EC) is an aggressive malignancy with a poor prognosis. Various factors, including dietary habits, and antacid and antibiotic use, have been shown to influence the esophageal microbiome. Conversely, enrichment and diversity of the esophageal microbiome can also impact its function. Recent studies have revealed prevalent changes in the esophageal microbiome among patients with EC, thus suggesting the potential contribution of the esophageal microbiome to EC development. Additionally, distinct microbiome compositions have been observed in patients with different responses to radiotherapy and chemotherapy, indicating the role of the esophageal microbiome in modulating treatment outcomes. In this review, we have examined previous studies on the esophageal microbiome in healthy individuals and patients with EC or other esophageal diseases, with a focus on identifying microbial communities associated with EC pathogenesis and prognosis. Understanding the role of the microbiome in EC may aid in early detection and optimized treatment strategies, ultimately leading to better outcomes for patients.

Measuring Students' Scientific Argumentation Skills in Explaining Phenomena Related to Acid-Base Concepts

Scientific argumentation is one of the main competencies of students in communicating chemical phenomena through the application of conceptual mastery that they have understood. The development of this ability has been postulated in the 2013 curriculum through constructivist-based learning approaches and scientific inquiry, either in the classroom or the laboratory. However, there is relatively little information on how students' scientific argumentation skills develop. This study aims to measure students' scientific argumentation skills in explaining five science phenomena related to the acid-base concept, namely: acid rain, salt crystal making, the use of antacids as ulcer medicine, the use of CaMgCO3 dolomite fertilizer, and the difference in the acidity level of HCl and H2SO4, using Rasch modeling. Each phenomenon was measured by three multiple-choice test items, which were developed to test students' ability to make claims (Q1), evidence (Q2), and justification (Q3). The data were analyzed using Rasch modeling, allowing researchers to measure the item and individual respondent levels. Respondents were 100 chemistry students in Gorontalo, who were differentiated in gender and adversity quotient. The results showed that the measurement instrument has good validity and reliability. In addition, it was found that students' abilities differed; some items responded differently regarding gender and adversity quotient. Most students tended to be weak in explaining the phenomenon of acid rain, the use of antacids for ulcer disease, the use of dolomite fertilizer, and the difference in the acidity level of HCl and H2SO4

A Plant Pathogen in a Human Host! A Case Report and a Review of Literature

In this case report, we present a renal transplant recipient who developed an infection due to a plant pathogen – Pantoea agglomerans. This pathogen is a rare organism with no case reports in a renal transplant recipient from India so far. A 50-year-old renal transplant recipient presented with fever for 20 days associated with productive cough and upper back pain. She had received her graft kidney 8 months earlier in a deceased donor program in her local state. In the immediate postoperative period, she had one episode of a mixed rejection, which required a course of antithymocyte globulin and plasmapheresis. On examination, tenderness was noted in her upper back over the cervical and thoracic vertebrae. Her computed tomography scan showed a collection over the cervical vertebrae and consolidation in the lung. Blood culture grew P. agglomerans. P. agglomerans is a rare plant pathogen usually occurring after trauma involving organic debris being deposited within the body. Spontaneously occurring infection is seen only in special situations such as immunocompromised states, malignancy, or excessive antacid use. It has been known to cause lung infections, bone and joint infections, and fever with systemic signs. Spontaneously occurring infections like in this patient are very rare with a handful of case reports worldwide. In an immunocompromised host, a multitude of infections can occur. This case report highlights the importance of removing unnecessary medication from our transplant recipients and optimizing immunosuppression while pursuing the underlying microbiologic cause of infection aggressively.

Longer-term outcomes of gastroesophageal reflux disease treated with magnetic sphincter augmentation.

Surgical intervention for gastroesophageal reflux disease (GERD) has historically been limited to fundoplication. Magnetic sphincter augmentation (MSA) is a less invasive alternative that was introduced 15years ago, and it may have a superior side-effect profile. To date, however, there has been just a single published study reporting outcomes in a UK population. This study reports quality-of-life (QOL) outcomes and antacid use in patients undergoing MSA, with a particular focus on postoperative symptoms and those with severe reflux. A single-center cohort study was carried out to assess the QOL outcomes and report long-term safety outcomes in patients undergoing MSA. GERD-health-related quality of life (GERD-HRQL) and Reflux Symptom Index (RSI) scores were collected preoperatively, and immediately postoperatively, at 1-, 2-, 3-, and 5-year follow-up time points. All patients underwent preoperative esophagogastroduodenoscopy, impedance, and manometry. Two hundred and two patients underwent laparoscopic MSA over 9years. The median preoperative GERD-HRQL score was 31, and the median RSI score was 17. There was a reduction in all scores from preoperative values to each time point, which was sustained at 5-year follow-up; 13% of patients had a preoperative DeMeester score of >50, and their median preoperative GERD-HRQL and RSI scores were 32 and 15.5, respectively. These were reduced to 0 at the most recent follow-up. There was a significant reduction in antacid use at all postoperative time points. Postoperative dilatation was necessary in 7.4% of patients, and the device was removed in 1.4%. Erosion occurred in no patients. MSA is safe and effective at reducing symptom burden and improving QOL scores in patients with both esophageal and laryngopharyngeal symptoms, including those with severe reflux.

Food insecurity and risk of cholera: A cross-sectional study and exploratory analysis of potential mediators.

Food insecurity has been independently associated with developing cholera and there is an inverse relationship between national food security and annual cholera incidence. However, the factors that mediate the risk of cholera among food insecure households remain largely unexplored. In a cross-sectional survey of rural households in Haiti, we explored the role of food behaviors (i.e., dietary choices and food-handling practices) as mediators of cholera risk among food-insecure families. We generated a series of multivariable regression models to test hypothesized associations between the severity of food insecurity (measured by the Household Hunger Scale), hygiene and food behaviors, and history of severe, medically-attended cholera. Moderate household hunger (Adjusted Odds Ratio [AOR] 1.47, 95% Confidence Interval (CI) 1.05-2.04; p = 0.021) and severe hunger (AOR 2.45, 95% CI 1.45-4.15; p = 0.001) were positively associated with a history of severe, medically-attended cholera compared with little to no household hunger. Household hunger was positively associated with three behaviors: antacid use, consumption of leftover non-reheated food, and eating food and beverages prepared outside of the home (i.e., at a restaurant or from a vendor). Consumption of outside food items and antacid use were positively associated with a history of cholera. Our findings suggest that food behaviors may mediate the association between food insecurity and cholera and contribute to an understanding of how interventions could be designed to target food insecurity as part of cholera prevention and control.

Retrospective analysis of drug intake affecting the intestinal microbiota and the therapeutic effects of chemotherapy on gastric cancer.

379 Background: Administration of some medications, such as antibiotics, antacids, and probiotic supplementation, may affects the treatment outcomes of immune checkpoint inhibitors (ICIs), through the change of gut microbiota in cancer patients. Even when ICIs are combined with cytotoxic chemotherapy (Chemo), a use of such medications is expected to be a potential biomarker. However, the impacts of medications that affect gut microbiota on the efficacy of Chemo alone is unclear. Methods: We retrospectively analyzed patients who received fluoropyrimidines and platinum-based therapy for advanced gastric cancer in our institutions between January 2010 and December 2019. Progression-free survival (PFS) and overall survival (OS) by history of antibiotic/antacid/probiotic supplementation, were analysed. Results: A total of 101 pts were analyzed. Median age was 66 years (range, 30-81), female/male; 36/65, 1st-line regimen SP/XP/SOX/XELOX/FOLFOX; 52/2/39/1/7. In all patients, The median PFS for first-line treatment was 5.8 months (95% CI: 5.0-7.3) and the median OS was 15.5 months (95% CI: 12.5-18.6).Univariate analysis for PFS of first-line treatment did not show a significant difference in antibiotic use (median 7.6 vs 5.5 months, HR: 0.79 [95%CI: 0.50-1.24], p=0.31), oral antacids (median 6.6 vs 5.8 months, HR: 0.96 [95%CI: 0.61-1.54], p=0.89) and probiotic supplementation (median 9.1 vs 5.5 months, HR: 0.7 [95%CI: 0.38-1.26], p=0.24). Similarly in OS, the use of antibiotics (median 18.4 versus 13.4 months, HR: 0.85 [95%CI: 0.53-1.37], p=0.49), oral antacids (median 16.3 vs 13.8 months, HR: 1.15 [95%CI: 0.70-1.88], p=0.58), and oral probiotic supplementation (median 20.2 vs 13.8 months, HR: 0.77 [95%CI: 0.42-1.40], p=0.40), with no statistically significant differences. Conclusions: In this study, there were no significant differences in PFS and OS between patients administered with or without antibiotics, antacids, or probiotic supplementation. Future studies are expected to investigate the impacts of these medications on the treatment outcomes of ICIs+Chemo combination.

Pervasiveness and Sway of Peptic Ulcer Caused by Heliocobacter Pylori H. Pylori among Undergraduate Students in Wukari, Taraba State, North East, Nigeria

Peptic ulcer disease is one of the most common chronic infections in human population. Regardless of centuries of research, it still worries a lot of individuals, especially in the third world countries. Expressive investigation on the pervasiveness and impact of peptic ulcer was carried out among two hundred (200) undergraduate students in Federal University Wukari and Kwararafa University Wukari, Taraba State, North East, Nigeria with the use of well-designed and detailed questionnaires. These studies showed that majority of the students were between the ages of 21-25 years (108) representing (54%) and ages between 31 – 35 years has the lowest 8(4%). One hundred and three (103) of the 200 students reported to have ulcer (51.5%) whereas 97 (48.5%) of the total students reported no ulcer. Preponderance of the students have duodenal ulcer 67 (65%) whereas 36 (35%) has gastric ulcer and this gives ratio of approximately 2:1 respectively. The students reported the use of antacids 40 (39%), antibiotics 30 (29%), proton pump inhibitors (PPI) 8(9%), herbal medicine 18 (18%) and histamine 7 (7%) in the treatment of peptic ulcer, some students however, reported the used of mixed treatment. Conclusively, this study shed light on the prevalence of peptic ulcer (gastric and duodenal). Eliminating or reducing the drinking of alcohols if possible and helping the ulcer to heal with medication. Medications for treatment of ulcer include antibiotic medications to kill H. pylori. Also lessening of acid producing foods and drinks should be shunned. Avoiding tobacco products,caution with aspirin, non- ignoring ulcer symptoms, protect one from infections by washing hands regularly and consuming foods that have been cooked thoroughly are sure ways of preventing peptic ulcer.

Gastric Candidiasis Leading to Gastric Perforation: A Case Report

Gastric candidiasis is commonly seen in immunocompromised patients with malignant conditions and patients who have undergone gastrectomy. It is also observed in patients who frequently use antacids. The most common presentation of gastric candidiasis is single or multiple ulcerations, with perforation being an infrequent occurrence. The present case report describes a 38- year-old male with a known history of peptic ulcer disease, who presented with abdominal pain and shortness of breath for the past two days. The patient had been using antacids and Proton Pump Inhibitors (PPIs) for two years. Chest and abdomen radiographs revealed an air shadow under the right diaphragm. Emergency surgery was performed, revealing two stomach perforations. The patient underwent primary repair and a Modified Graham’s patch repair. Histological examination of the perforation margin showed invasive candidal colonisation. The patient experienced a series of postoperative complications during their hospital stay, all of which were successfully managed. The patient was discharged on the 40th postoperative day. Therefore, it was concluded in this case that the chronic use of antacids and PPIs may have created an alkaline environment, facilitating candidal colonisation of the stomach, ultimately leading to ulceration and perforation.

Deprescribing antacids after the diagnosis of Clostridioides difficile infection: A single-center observational study

Overuse of antacids is associated with the development and recurrence of Clostridioides difficile infection (CDI). Discontinuation of unnecessary antacids for CDI management is advocated; however, the clinical pervasiveness on the discontinuation of antacids remains unclear. We conducted a single-center retrospective observational study to determine the rate of antacid discontinuation following CDI diagnosis. Among 51 patients (58 infections; median age 76.5 years, range 69–82; 53.5% women) treated with antimicrobials against C. difficile, 41 had been treated with antacids, and of these, 18 exhibited no indication for antacid administration. However, none had discontinued antacid use. While CDI provides an opportunity for antacid stewardship, it is not implemented in clinical practice. In addition to the efforts of individual clinicians, the dissemination of knowledge of the indications and side effects of antacids, establishment of a multidisciplinary support system, and creation and implementation of a clinical stewardship pathway are necessary to increase the deprescription of antacids in patients with CDI.

ODP093 Hunt for Hypercalcemia

Abstract Hypercalcemia is a relatively common clinical problem. Among all causes of hypercalcemia, primary hyperparathyroidism and malignancy are the most common. This case highlights the importance of collaboration between subspecialists to identify the etiology of a patient's hypercalcemia. A 71-year-old male with history of tobacco use and untreated hepatitis C, presented to the emergency department with several weeks of progressively painful, non-traumatic right upper extremity (RUE) swelling. Chest CT showed a 1.4 cm right axillary lymph node and the patient was referred to general surgery for a biopsy which was deferred due to size. Due to worsening lymphedema, the patient underwent a venogram with plans for a lymphedema pump, however in the interim he presented with worsening RUE edema. Labs were notable for Ca 12.7 mg/dL(8.6-10.3) though the patient reported taking chlorthalidone and calcium-based antacids. The patient was admitted with lymphedema progression and new-onset hypercalcemia. Labs were significant for suppressed PTH 6.8 pg/ml(10-66), undetectable PTHrP, Vit D 9.9 ng/mL(32-100), 1,25-Vit D 110 pg/mL(19.9-79.3), and SPEP/UPEP without an M-spike. Additional labs included PSA 17.96 ng/mL(0-3.9) and LDH 3471 units/L(94-260). Chest CT demonstrated a few sub-centimeter calcified pulmonary nodules with the appearance of chronic granulomas, but no evidence of hilar or mediastinal lymphadenopathy, significantly reducing the likelihood of sarcoidosis. RUE CT showed cortical destruction of the humeral head and proximal shaft, along with infiltrative enlargement of the muscles. There were also a few enlarged axillary lymph nodes, the largest measuring 2 cm. The patient was hydrated with initial improvement of his labs however calcium subsequently increased to 13.5 mg/dL. Due to concern for 1,25-Vit D mediated hypercalcemia and the source still unknown, the patient was started on prednisone 20 mg with normalization of the calcium level. An excisional lymph node biopsy followed by flow cytometry confirmed the diagnosis of diffuse large B cell lymphoma(DLBCL). The patient was treated with chemotherapy and had since been in remission. Of note the patient was also found to have localized prostate cancer treated with external beam radiation . Hypercalcemia is estimated to occur in approximately 30% of patients with malignancy and is associated with a poorer prognosis. Mechanisms include humoral hypercalcemia (PTHrP), osteolytic cytokine production, extensive bone metastasis in the absence of excess osteolytic factors, and production of 1,25-Vit D. Our patient had several risk factors for hypercalcemia including thiazide and antacid use, which may cause milk-alklai syndrome; an elevated PSA, which was eventually confirmed to be prostate cancer; and an elevated 1,25-Vit D of unknown etiology. Due to the risks associated with hypercalcemia and after extensive conversations amongst the subspecialists, the decision was made to start empiric treatment with prednisone. Eventually the patient underwent CT guided biopsy confirming the diagnosis of DLBCL, but it was a "hunt". Presentation: No date and time listed

Effect of Antacid Use on Immune Checkpoint Inhibitors in Advanced Solid Cancer Patients: A Systematic Review and Meta-analysis.

The influence of antacids use on immune checkpoint inhibitor (ICI) efficacy remains unclear. A systematic review and meta-analysis was performed to evaluate the effect of proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H2RAs) on ICI efficacy in advanced solid cancer patients. A systematic literature search in PubMed, EMBASE, and Web of Science was performed to retrieve studies investigating the effect of antacid use on ICI efficacy. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and immune-related adverse events were measured using hazard ratios (HRs) or odds ratios (ORs). Thirty studies enrolling 16,147 advanced cancer patients receiving ICI treatment were included. The pooled analysis indicated that PPI use was associated with shorter OS (HR=1.40, 95% CI, 1.25-1.57) and PFS (HR=1.34, 95% CI, 1.19-1.52) in advanced cancer patients treated with ICIs. PPI use did not show effect on ORR or immune-related adverse event of advanced cancer patients receiving ICI treatment. OS, PFS, and ORR did not differ between H2RA users and non-H2RA users. In subgroup analyses, PPI use was associated with shorter OS and PFS in NSCLC and urothelial carcinoma patients and in patients treated with anti-programmed cell death 1 or anti-programmed cell death ligand 1 monotherapy. In addition, ICI efficacy was different in the antacid exposure time frame subgroups. In conclusion, PPI use has a negative effect on OS and PFS among advanced cancer patients receiving ICI treatment. PPIs should be cautiously administered among advanced cancer patients treated with ICI. The safety of H2RAs and the influence of H2RAs on ICI efficacy need further investigation.