Use Of Antacids Research Articles

2865 Acid Suppressants and Erosive Tooth Wear: An Analysis of National Health and Nutrition Examination Survey Data

INTRODUCTION: Antacids and acid suppressants (i.e., proton pump inhibitors and histamine2-blockers) are commonly used by individuals with heartburn and gastroesophageal reflux disease (GERD). Frequent heartburn and breakthrough symptoms of GERD have been shown to contribute to dental complications. The aim of this study is to compare the likelihood of erosive tooth wear (ETW) among users of antacids or acid suppressants. METHODS: We used data from the National Health and Nutrition Examination Survey (NHANES, 2003-2004) to identify a nationally representative sample of adults (age ≥ 18) who underwent an oral health exam by trained dental examiners. Self-reports of use of antacids and prescribed acid suppressants were collected by trained personnel during a home interview and used to classify individuals into groups. Erosive tooth wear was defined in NHANES using Smith and Knight's Tooth Wear Index modified by Millward, et al., which rates the severity of ETW from 0 (sound tooth surface) to 3 (complete loss of enamel). Erosive tooth wear was evaluated for 40 tooth surfaces; 24 proximal (facial or incisal) and 16 distal (lingual or occlusal) surfaces. Erosions were categorized based on location and severity. We used weighted linear and logistic regression to compare means and estimate the prevalence of erosions for each group. Estimates were adjusted for age, sex, and race/ethnicity. RESULTS: NHANES ETW data were available for 4,414 adults; antacid users (n = 595), acid suppressant users (n = 386), and non-users (n = 3,433). The mean number of assessable tooth surfaces varied between groups (P > 0.001). Erosive tooth wear was more prevalent among those who reported the use of antacids or acid suppressants compared with non-users, however the difference was not statistically significant (P = 0.06). The percent of patients with ETW on at least one distal tooth surface was higher for antacid and acid suppressant users (P = 0.01). In addition, acid suppressant users had a higher prevalence of extensive tooth wear (P = 0.007). CONCLUSION: Individuals using antacids or acid suppressants (potentially for control of acid-reflux symptoms) are associated with a higher rate of dental complications, as suggested by the prevalence of erosions on distal tooth surfaces. In addition, extensive erosions were more common among users of acid suppressants than non-users. Emphasizing the importance of following recommendations from the American Dental Association for routine dental care may be particularly important for these individuals.

Iron status and risk factors for iron depletion in a racially/ethnically diverse blood donor population.

The optimal approach for reducing iron depletion (ID) in blood donors may vary depending on biologic or behavioral differences across donors. More than 12,600 successful whole blood donors were enrolled from four US blood centers for ferritin testing. The study population was enriched for racial/ethnic minorities (1605 African American, 1616 Asian, 1023 Hispanic). Subjects completed questionnaires on ID risk factors. Logistic regression identified predictors of absent iron stores (AIS; ferritin <12 ng/mL) and low ferritin (LF; ferritin <26 ng/mL). Across all subjects, 19% had AIS and 42% had LF, with a sharp increase in risk observed with increasing donation intensity and among women a large decrease in risk in those more than 50 years old. When other factors were controlled for, African American and Asian donors showed 20% to 25% decreased risk for AIS compared to non-Hispanic Caucasian donors, while Hispanic donors had 25% higher risk. Daily iron supplementation reduced risk for LF and AIS by 30% to 40%, respectively, while the benefit from less frequent use was lower (7%-19% protection). Regular antacid use was associated with at least 20% increment to risk. Use of oral contraceptives or estrogen in females reduced risk by 16% to 22%, while males who reported supplemental testosterone use had a 50% to 125% greater risk for LF and AIS. This study confirms high prevalence of LF and AIS in US donors and the principal risk factors of age, sex, and donation frequency. Additional demographic and behavioral risk factors of secondary importance might allow for refinement of ID mitigation strategies.

Prevalence of multidrug-resistant organisms in nursing homes in Belgium in 2015.

ObjectivesFollowing two studies conducted in 2005 and 2011, a third prevalence survey of multidrug-resistant microorganisms (MDRO) was organised in Belgian nursing homes (NHs) using a similar methodology. The aim was to measure the prevalence of carriage of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase producing Enterobacteriaceae (ESBLE) and carbapenemase-producing Enterobacteriaceae (CPE) in NH residents. Risk factors for MDRO carriage were also explored.MethodsUp to 51 randomly selected residents per NH were screened for MDRO carriage by trained local nurses between June and October 2015. Rectal swabs were cultured for ESBLE, CPE and VRE, while pooled samples of nose, throat and perineum and chronic wound swabs were obtained for culture of MRSA. Antimicrobial susceptibility testing, molecular detection of resistance genes and strain genotyping were performed. Significant risk factors for MDRO colonization MDRO was determined by univariate and multivariable analysis.ResultsOverall, 1447 residents from 29 NHs were enrolled. The mean weighted prevalence of ESBLE and MRSA colonization was 11.3% and 9.0%, respectively. Co-colonization occurred in 1.8% of the residents. VRE and CPE carriage were identified in only one resident each. Impaired mobility and recent treatment with fluoroquinolones or with combinations of sulphonamides and trimethoprim were identified as risk factors for ESBLE carriage, while for MRSA these were previous MRSA carriage/infection, a stay in several different hospital wards during the past year, and a recent treatment with nitrofuran derivatives. Current antacid use was a predictor for both ESBL and MRSA carriage.ConclusionsIn line with the evolution of MRSA and ESBL colonization/infection in hospitals, a decline in MRSA carriage and an increase in ESBLE prevalence was seen in Belgian NHs between 2005 and 2015. These results show that a systemic approach, including surveillance and enhancement of infection control and antimicrobial stewardship programs is needed in both acute and chronic care facilities.

Prevalence and Association of Pain Experiences, Medication Literacy, and Use of Medication among Children and Adolescents in Taiwan

ObjectiveThis study assessed the prevalence of children's and adolescents' pain experiences and use of medicine and examined the relationships between pain experiences, medication knowledge, literacy, and use of medicine. MethodA probability-proportionate-to-size sampling method was used to systematically draw a random sample of schools. In 2014, a national representative sample of 2309 students from 35 primary schools (5th–6th grade), 2700 students from 30 middle schools, and 2013 students from 20 high schools completed the online survey. ResultsOverall, 85.6% of children and adolescents reported experiencing pain during the past year that included headache (63.0%), throat ache (59.3%), muscle ache (58.3%), stomach pain (42.9%), menstrual pain (girls: 42.1%), and dental pain (38.5%). Children and adolescents had taken cold/cough medicine (48.1%), acetaminophen (15.0%), antacids (14.8%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (10.5%) in the past year. Multivariate analysis results indicated that after controlling for pain experiences children and adolescents who had lower levels of medication knowledge and literacy were more likely to use pain medication and antacids more frequently. In addition, children and adolescents who had lower medication knowledge, lower literacy, asked doctors to prescribe antacids, and co-administered with antacids were more likely to report long-term use of antacids. ConclusionsLower levels of medication knowledge and literacy among children and adolescents were associated with more frequent use of pain medication and antacids.

Ventilator associated pneumonia: incidence and risk factors in a tertiary care hospital

Background: The objective of this study is to find the occurrence and contributing risk factor of ventilator associated pneumonia (VAP) in 2 months-5 years age group.Methods: This was a prospective, observational, hospital-based study carried out in a tertiary care setting hospital. All patients between 2 months-5 years age admitted in the ICU who had undergone MV were included in the study. Inclusion criteria includes patients who developed pneumonia after the 48 hours of mechanical ventilation and those patients were excluded who developed pneumonia within 48 hours of mechanical ventilation and having respiratory system findings /involvement prior to the MV. After recruiting patients baseline clinical characteristics (age, sex, diagnosis, duration of MV) were taken, monitored and diagnosed VAP using CDC guidelines until they were discharged or deceased. The parameters such as fever, oxygenation, leucocytosis, other risk factors. chest X-ray and ETA&gt;105CFU/ML or microscopy (grain stain&gt;l bacteria/&gt;10 polymorphonuclear cells) were collected every 48 hours.Results: This study was done in 133 patients while 42 patients (31.58%) developed VAP during their ICU stay. Early onset VAP occurred in 34 (80.9%) while late onset VAP was observed in the remaining 8 (19.1%) patients. In ETA culture CFU&gt;105 Klebsiella (38%) was the predominant isolate followed by Pseudomonas (23%), Acinetobacter (17%), Staphylococcus (13%) and Citrobacter (10%) are offending organism responsible for VAP in MV patient in present study. On analysis (univariate) reintubation, altered sensorium at intubation and use of antacid are found significantly associated risk factors with the development of VAP. Multivariate analysis revealed that reintubation was an important risk factor for the development of the VAP.Conclusions: The various risk factors can be minimized for better outcome of patients undergoing mechanical ventilation. Risk factors such as reintubation, altered sensorium at intubation and use of antacid are associated with VAP and also the physician treating must have knowledge and awareness about prevention of these risk factor to improve the outcome of patients.

Influence of oral magnesium-containing supplement and antacid administration on hypomagnesemia induced by panitumumab.

Hypomagnesemia is a common side effect of panitumumab. The effect of magnesium-containing supplement as a laxative and concomitant antacid (proton pump inhibitor and histamine H2 antagonist) administration on panitumumab-induced hypomagnesemia was retrospectively investigated. Patients with advanced or recurrent colorectal cancer who received panitumumab were included in this study. Serum magnesium levels were extracted from the electronic medical records of 1753 administrations in 221 patients who received panitumumab. Serum magnesium levels in patients with or without oral magnesium-containing supplement and antacid treatment were compared using analysis of covariance as the number of panitumumab administration up to 16 times for covariates. The mean serum magnesium levels were significantly decreased with increasing number of panitumumab administrations (2.13mg/dL at 1st vs. 1.55mg/dL at 16th, p < 0.001). The use of oral magnesium-containing supplement significantly inhibited the decline in mean serum magnesium level (1.98mg/dL vs. 1.78mg/dL, p < 0.001). However, antacid use in patients receiving oral magnesium-containing supplement significantly decreased the effectiveness of the magnesium supplement on serum magnesium level (2.02mg/dL vs. 1.93mg/dL, p < 0.05). The use of oral magnesium-containing supplement might function as magnesium supplement based on the finding that use of oral magnesium-containing supplement during panitumumab administration decreased hypomagnesemia. However, combination of antacid decreased the supplemental effect of oral magnesium on hypomagnesemia. These results suggest the possibility that use of antacids during anti-EGFR antibody administration may promote hypomagnesemia.

Itch in Psoriasis: A New Look at Well-known Subject

Psoriasis is a chronic inflammatory dermatosis, frequently presenting with chronic itch. This study investigated the prevalence and detailed clinical characteristics of chronic itch in 143 psoriatic patients, with regard to different age groups, comorbidities and pharmacotherapy. Chronic itch was reported by 72% of subjects. Patients aged 65 years and over presented higher 4-Item Itch Questionnaire (4IIQ) scores (8.6 ± 3.4 vs. 7.4 ± 2.5 points; p = 0.03) and rarely experienced itching at midday (p = 0.009). Chronic itch correlated with aspirin intake and xerosis intensity. 4IIQ scores were higher in patients with asthma/chronic obstructive pulmonary disease, peptic ulcer disease and those taking insulin. Logistic regression analysis found that chronic itch was positively correlated with the use of antacids, angiotensin receptor blockers, angiotensin enzyme converting inhibitors, beta-blockers, xerosis intensity and Physician's Global Assessment score, whereas psychiatric drugs other than selective serotonin reuptake inhibitors, allopurinol, coexistence of arterial hypertension and application of emollients acted conversely. Elderly psoriatic patients present several differences in the characteristics of chronic itch, and chronic itch may be associated with comorbidities and pharmacotherapy. To the best of our knowledge, this is the first study to report possible associations between psoriatic pruritus and co-administration of drugs utilized in various systemic conditions.

Surgical Management of Gastroesophageal Reflux Disease in Patients with Severe Esophageal Dysmotility

BackgroundGastroesophageal reflux disease (GERD) and esophageal dysmotility are often disqualifying criteria for fundoplication due to dysphagia complications. A tailored partial fundoplication may improve GERD in patients with severe esophageal motility disorders. We evaluate this approach on GERD improvement in non-achalasia esophageal dysmotility patients. MethodsA single-institution prospective database was reviewed (2007–2016), with inclusion criteria of GERD, previous diagnosis of non-achalasia esophageal motility disorder, and laparoscopic partial fundoplication. Diagnosis of previous achalasia diagnosis or diffused esophageal spasm was excluded. Motility studies, pre- and post-upper gastrointestinal imaging (UGI), esophageal symptom scores, antacid, and PPI use were collected pre-op, 6 months, 12 months, and long-term (LT). Statistical analysis was made using SPSS v.23.0.0, α = 0.05. ResultsFifty-two patients met the inclusion criteria. A total of 17.3% had esophageal body amotility, 79.6% had severe esophageal dysmotility. A total of 65.9% women (mean age 64 ± 15.7), mean peristalsis 45.3 ± 32.6%, and failed peristalsis 36.0 ± 32.2%. Mean LES residual pressure was 15.0±18.0 mmHg, and 40.7% had hypotensive LES. Mean follow-up time was 25 months [1–7 years], with significant improvement in symptoms and reduction in PPI and antacid use at all time-points compared to pre-op. A total of 74% had UGI studies at 12 months; all showed persistent dysmotility. Six patients had radiographic hiatal hernia recurrence, with only one being clinically symptomatic postoperatively. Three required dilation for persistent dysphagia. ConclusionsA tailored partial fundoplication may be effective in symptom relief for non-achalasia patients with esophageal motility disorders and GERD. Significant symptom improvement, low HHR, and PPI use clearly indicate this approach to be effective for this population.

Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1)

This Enhanced Recovery After Surgery (ERAS) Guideline for perioperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for preoperative, intraoperative, and postoperative phases with, primarily, a maternal focus. The focused pathway process for scheduled and unscheduled cesarean delivery for this ERAS Cesarean Delivery Guideline will consider from the time from decision to operate (starting with the 30-60 minutes before skin incision) to hospital discharge. The literature search (1966-2017) used Embase and PubMed to search medical subject headings that included "Cesarean Section," "Cesarean Section," "Cesarean Section Delivery" and all pre- and intraoperative ERAS items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses that evaluated the quality of evidence and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system, as used and described in previous ERAS Guidelines. The ERAS Cesarean Delivery Guideline/Pathway has created a maternal focused pathway (for scheduled and unscheduled surgery starting from 30-60 minutes before skin incision to maternal discharge) with ERAS cesarean delivery consensus recommendations preoperative elements (anesthetic medications, fasting, carbohydrate supplementation, prophylactic antibiotics/skin preparation, ), intraoperative elements (anesthetic management, maternal hypothermia prevention, surgical technique, hysterotomy creation and closure, management of peritoneum, subcutaneous space, and skin closure), perioperative fluid management, and postoperative elements (chewing gum, management of nausea and vomiting, analgesia, timing of food intake, glucose management, antithrombotic prophylaxis, timing of ambulation, urinary management, and timing of maternal and neonate discharge). Limited topics for optimized care and for antenatal education and counselling and the immediate neonatal needs at delivery are discussed. Strong recommendations for element use were given for preoperative (antenatal education and counselling, use of antacids and histamine, H2 receptor antagonists, 2-hour fasting and small meal within 6 hours surgery, antimicrobial prophylaxis and skin preparation/chlorhexidine-alcohol), intraoperative (regional anesthesia, prevention of maternal hypothermia [forced warm air, warmed intravenous fluids, room temperature]), perioperative (fluid management for euvolemia and neonatal immediate care needs that include delayed cord clamping), and postoperative (fluid management to prevent nausea and vomiting, antiemetic use, analgesia with nonsteroidal antiinflammatory drugs/paracetamol, regular diet within 2 hours, tight capillary glucose control, pneumatic compression stocking for venous thromboembolism prophylaxis, immediate removal of urinary catheter). Recommendations against the element use were made for preoperative (maternal sedation, bowel preparation), intraoperative (neonatal oral suctioning or increased inspired oxygen), and postoperative (heparin should not be used routinely venous thromboembolism prophylaxis). Because these ERAS cesarean delivery pathway recommendations (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, this will create an opportunity for the focused and optimized areas of care research with further enhanced care and recommendation.

Burden of Exposure to Potential Interactions Between Antiretroviral and Non-Antiretroviral Medications in a Population of HIV-Positive Patients Aged 50 Years or Older.

As HIV-infected patients aged 50 years or older are at increased risk of comorbidities and multidrug treatments, we examined their exposure to the potential drug-drug interactions (PDDIs) of antiretroviral (ARV) and other medications. This cross-sectional study involved the patients aged 50 years or older receiving ARV and non-ARV medications at our clinic. PDDIs were identified using the University of Liverpool HIV Drug Interaction Checker. Logistic regression models were used to assess risk factors for PDDIs. The American Geriatrics Society Beers Criteria were used to identify potentially inappropriate medications (PIMs). A total of 395 (53.9%) of 744 patients showed ≥1 PDDI: 47.4% ≥ 1 amber-PDDI (comedications requiring appropriate management) and 5.6% ≥ 1 red-PDDI (contraindicated comedications). A higher risk of PDDIs was associated with the use of ≥5 medications (P < 0.001), of antiosteoporotics (P < 0.001), calcium channel blockers (P < 0.001), anti-benign prostatic hypertrophy agents (P < 0.001), hypnotics/sedatives (P = 0.022), and anticoagulants (P = 0.006). A higher risk of red-PDDIs was associated with the use of antacids (P < 0.001), anti-benign prostatic hypertrophy agents (P < 0.001) and antipsychotics (P = 0.023). The use of nucleoside reverse transcriptase inhibitor + nonnucleoside reverse transcriptase inhibitor and nucleoside reverse transcriptase inhibitor + integrase strand transfer inhibitor rather than protease inhibitor-based regimens was associated with a reduced risk of PDDIs (P < 0.001). Overall, 119 (16.0%) patients were receiving PIMs (mainly hypnotics/sedatives) and 49 (41.2%) of them had PDDIs able to increase the blood levels of these medications. Older patients with HIV are highly exposed to PDDIs between ARVs and comedications. The knowledge of their complete medication regimens and the screening for PDDIs and PIMs is therefore crucial to prevent drug-related adverse outcomes in this population.

Implementation of an Evidence-Based Guideline to Reduce Non-Indicated Antacid Use in the NICU

PURPOSE/OBJECTIVE: Acid suppressing medications (proton pump inhibitors [PPI] and histamine-2 receptor antagonists [H2RA]) are used extensively in hospitalized term and preterm neonates despite limited efficacy data and increasing evidence for potential harm in this vulnerable population. The unfavorable risk-benefit ratio of PPI/H2RAs in newborns recently highlighted by the Choosing Wisely campaign prompted our team to develop a quality improvement initiative to reduce inappropriate use of these medications in our level III/IV NICU. Our specific …

Implementation of an Evidence-Based Guideline to Reduce Non-Indicated Antacid Use in the NICU

Implementation of an Evidence-Based Guideline to Reduce Non-Indicated Antacid Use in the NICU

Early Antacid Exposure Increases Fracture Risk in Young Children

PURPOSE: Antacids, including proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2RAs) are frequently prescribed to treat gastro-esophageal reflux (GER) in healthy infants. PPI use has been associated with increased fracture risk in older adults. The purpose of this project is to examine the impact of antacid use during the first 6 months of life on the risk of fracture during infancy and early childhood. METHODS: We performed a retrospective cohort study of healthy children …

Clostridium difficile infection in hospitalized patients with inflammatory bowel disease: Prevalence, risk factors, and prognosis.

To evaluate the frequency, possible risk factors, and outcome of Clostridium difficile infection (CDI) in inflammatory bowel disease (IBD) patients.There has been an upsurge of CDI in patients with IBD who has been associated with increased morbidity and mortality. Various risk factors have been found to predispose IBD patients to CDI.A retrospective case-control study on IBD patients admitted with exacerbation and tested for CDI at the Tel Aviv Medical Center in 2008 to 2013. Epidemiologic, laboratory, and prognostic data were retrieved from electronic files and compared between patients who tested positive (CDI+) or negative (CDI-) for CDI.CDI was identified in 28 of 311 (7.31%) IBD patients hospitalized with diarrhea. IBD-specific risk factors (univariate analysis) for CDI included: use of systemic steroids therapy (odds ratio [OR] = 3.6, 95% confidence interval [CI] 1.2-10.6) and combinations of ≥2 immunomodulator medications (OR = 2.6, 95% CI 1.1-6.3). Additional risk factors for CDI that are common in the general population were hospitalization in the preceding 2 months (OR = 6.0, 95% CI 2.6-14.1), use of antacids (OR = 3.8, 95% CI 1.7-8.4), and high Charlson comorbidity score (OR = 2.5, 95% CI 1.1-5.7). A multivariate analysis confirmed that only hospitalization within the preceding 2 months and use of antacids were significant risk factors for CDI. The prognosis of CDI+ patients was similar to that of CDI- patients.Hospitalized IBD patients with exacerbation treated with antacids or recently hospitalized are at increased risk for CDI and should be tested and empirically treated until confirmation or exclusion of the infection.

Association of Acid Suppression and Antimicrobial Use with Clostridium difficile Infection in Children

Background Clostridium difficileinfections (CDIs) can cause severe diarrhea and be potentially life-threatening, especially in children. Possible risk factors include age, being immunocompromised, prior antibiotic exposure, the use of antacids, and diseases that alter intestinal microbiota. Data in adults are vast while limited data is available in children. The objectives of this study are to identify pediatric risk factors and determine if an association between acid suppression and CDI’s in children exists.MethodsA retrospective study was conducted between November 1, 2013 and October 31, 2016 at Arkansas Children’s Hospital. Children ages 1 – 18 years with a positive C. diff PCR test and ≥3 loose stools documented were included. Cases were excluded if previous positive PCR was within 60 days. Data collection included age, sex, encounter type (inpatient or outpatient), acid suppressing agents, previous antimicrobials within last 90 days and comorbidities including transplant, chronic pulmonary, hematology/oncology, and GI tract diseases. Statistical methods included descriptive analyses, χ2test, and Kruskal–Wallis test.ResultsA total of 139 cases of CDI among 123 patients were evaluated. Of these cases, the median (IQR) age is 8 years (3–13) with 77 (55.4%) being male and 86 (61.9%) of CDI cases identified inpatient of which 75 came from outpatient. Pediatric risk factors identified in C. diff cases included exposure to acid suppressing agents [61 (43.9%)] and antimicrobials [98 (70.5%)] with 90 (64.7%) having ≥1 comorbidities. Cases having ≥1 comorbidities were found to be associated with previous antacid exposure (P < 0.0005) while antimicrobial(s) use was associated with CDI hospitalization (P = 0.001). Similarly, exposure to either antacid suppression or antimicrobials or both with comorbidities were found to have a significant association (P < 0.0005) and associated with CDI hospitalization (P = 0.001).ConclusionExposure to acid suppression in patients with comorbidities was associated with increased risk of CDI. Antimicrobial usage was associated with increased risk for hospitalization due to CDI. As pediatric outpatient antimicrobial stewardship evolves, improving CDI rates can center on improving antimicrobial and acid suppressive agents usage.Disclosures All authors: No reported disclosures.

Unexplained Chronic Abdominal Pain Manifesting as Celiac Artery Compression Syndrome

Celiac artery compression syndrome (CACS), also known as median arcuate ligament syndrome, is a rare condition which causes chronic recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament with resultant ischemia. Clinical presentation involves the triad of upper abdominal pain, weight loss and epigastric bruit in examination. The diagnosis is one of exclusion. The purpose of this case report is to describe a common presentation of an infrequently described rare disorder in literature. A 28-year-old healthy female presented to the emergency department (ED) with recurrent progressively worsening post-prandial sharp right upper quadrant abdominal pain for the past four months. Her pain has been associated with a 10-pound weight loss and intermittent episodes of nausea and vomiting without any fever, chills, diarrhea, or loss of appetite. She reported to no improvement with use of antacids, antiemetics and analgesics. She previously underwent outpatient ultrasonography revealing gallstones and esophagogastroduodenoscopy (EGD) revealing mild gastritis. Examination, laboratory studies, repeat ultrasound and computerized tomography (CT) scan revealed no acute abnormalities, including no gallstones. Due to nature of her chronic pain to be postprandial, a duplex ultrasound was ordered, which revealed elevated systolic velocities of the celiac artery, suggesting celiac artery stenosis and subsequently confirmed with angiography. Patient underwent a laparoscopic celiac artery decompression with a median arcuate ligament resection release. Patient was discharged following an uneventful postoperative period during her hospitalization. CACS is a rare syndrome. The pathophysiology, while not completely understood, is believed to be celiac arterial compression by variations in median arcuate ligament position. Patients are typically asymptomatic as the incidence of attributable clinical symptoms is much lower than the imaging finding. However, we present a case of a patient with chronic post-prandial pain and weight loss, in the absence of any obvious etiology, found to have a rare diagnosis of median arcuate ligament compressing on the celiac artery. We encourage clinicians to consider celiac artery compression syndrome in patients with chronic abdominal pain without a clearly established etiology.

The Difference in Clinical Features Between Acute Esophageal Mucosal Lesions and Severe Reflux Esophagitis

Introduction: The term “acute esophageal mucosal lesion” includes black esophagitis, also known as acute esophageal necrosis, and non-black esophagitis, which is characterized by diffuse circumferential erosions without black-appearing mucosa. Black esophagitis is easily diagnosed by its typical endoscopic findings, whereas non-black esophagitis is often misdiagnosed as severe reflux esophagitis. In this retrospective study, we investigated differences in clinical characteristics of patients with acute esophageal mucosal lesions and those with severe reflux esophagitis. Methods: Thirty-nine patients with severe reflux esophagitis and 32 with acute esophageal mucosal lesions were diagnosed on the basis of endoscopic findings at Saga Medical School Hospital from 2009 to 2016. Characteristics assessed included age, sex, presence of hiatal hernia, gastric atrophy, use of nonsteroidal anti-inflammatory drugs and antacids, comorbidities, and blood chemistry findings. Results: In contrast with severe reflux esophagitis, male sex, need for emergency endoscopy (P<0.001), presence of duodenal lesions (P=0.013), hypertension, and renal dysfunction were positively associated with acute esophageal mucosal lesions whereas hiatal hernia (P=0.003) was inversely associated with them. Analysis of associations between laboratory data and acute esophageal mucosal lesions showed that high white blood cell count (P<0.001), blood urea nitrogen (P<0.001), and blood glucose (P=0.018) were significantly associated with an increase odds ratio for acute esophageal mucosal lesions compared with severe reflux esophagitis. Conclusion: Thus, we found that acute esophageal mucosal lesions differed from severe reflux esophagitis regarding both endoscopic findings and clinicopathological features. We propose that AEML is a distinct inflammatory disease of the esophagus consisting of both black and non-black esophagitis.

Routine use of mesh during hiatal closure is safe with no increase in adverse sequelae.

Primary laparoscopic hiatal repair with fundoplication is associated with a high recurrence rate. We wanted to evaluate the potential risks posed by routine use of onlay-mesh during hiatal closure, when compared to primary repair. Utilizing single-institutional database, we identified patients who underwent primary laparoscopic hiatal repair from January 2005 through December 2014. Retrospective chart review was performed to determine perioperative morbidity and mortality. Long-term results were assessed by sending out a questionnaire. Results were tabulated and patients were divided into 2 groups: fundoplication with hiatal closure+absorbable or non-absorbable mesh and fundoplication with hiatal closure alone. A total of 505 patients underwent primary laparoscopic fundoplication. Mesh reinforcement was used in 270 patients (53.5%). There was no significant difference in the 30-day perioperative outcomes between the 2 groups. No clinically apparent erosions were noted and no mesh required removal. Standard questionnaire was sent to 475 patients; 174 (36.6%) patients responded with a median follow-up of 4.29years. Once again, no difference was noted between the 2 groups in terms of dysphagia, heartburn, long-term antacid use, or patient satisfaction. Of these, 15 patients (16.9%, 15/89) in the 'Mesh' cohort had symptomatic recurrence as compared to 19 patients (22.4%, 19/85) in the 'No Mesh' cohort (p=0.362). A reoperation was necessary in 6 patients (6.7%) in the 'Mesh' cohort as compared to 3 patients (3.5%) in the 'No Mesh' cohort (p=0.543). Onlay-mesh use in laparoscopic hiatal repair with fundoplication is safe and has similar short and long-term results as primary repair.

Use of proton-pump inhibitors is associated with depression: a population-based study.

Treatment with proton-pump inhibitors (PPIs) might be associated with neuropsychological side effects. We examined the association between use of PPIs and depressive symptoms in an elderly population. Mood was assessed by the 30-item Geriatric Depression Scale (GDS) in all 344 inhabitants of Tuscania (Italy) aged 75 years and over, without exclusion criteria; depression was defined by a GDS score ≥11. Use of PPIs was associated with a higher GDS score in linear regression analysis (B = 2.43; 95% CI = 0.49-4.38; p = 0.014) after adjusting; also, use of PPIs was associated with increased adjusted probability of depression in logistic regression (OR = 2.38; 95% CI = 1.02-5.58; p = 0.045). Higher PPIs dosages were associated with increased probability of depression (p for trend = 0.014). This association was independent of the diagnosis of peptic disease, as well as the use of antidepressant medications. No association was found between use of H2-blockers or antacids and the GDS score. Calculation of the population attributable risk indicated that 14% of depression cases could be avoided by withdrawal of PPIs. Use of PPIs might represent a frequent cause of depression in older populations; thus, mood should be routinely assessed in elderly patients on PPIs.

Estimates of total body iron indicate 19 mg and 38 mg oral iron are equivalent for the mitigation of iron deficiency in individuals experiencing repeated phlebotomy.

Iron deficiency anemia is a common clinical condition often treated with tablets containing 65 mg of elemental iron. Such doses can elicit gastrointestinal side effects lowering patient compliance. Oral iron supplements also increase hepcidin production causing decreased fractional absorption of subsequent doses. Frequent blood donors often become iron deficient. Therefore, they were enrolled in a two-year study involving continued blood donations and randomization to receive no pill, placebo, 19, or 38 mg ferrous gluconate for 60 days. Total body iron (TBI) did not change for the subset of donors in the no pill and placebo groups who completed both enrollment and final visits (P = .21 and P = .28, respectively). However, repeated measures regression analysis on the complete dataset estimated a significant decrease in TBI of 52 mg/year for the placebo and no pill groups (P = .001). The effects of 19 and 38 mg iron supplementation on TBI were indistinguishable (P = .54). TBI increased by 229 mg after the initial 60 days of iron supplementation (P < .0001) and was maintained at this higher level with continued iron supplementation following each subsequent donation. The TBI increase was apportioned 51 mg to red cell iron (P < .0001) and 174 mg to storage iron (P < .0001). Changes in storage iron were negatively impacted by 57 mg due to concurrent antacid use (P = .04). These findings in blood donors suggest that much lower doses of iron than are currently used will be effective for clinical treatment of iron deficiency anemia.