GI Medications Research Articles

5103 Synthroid Absorption Conundrum: A Case Deciphered

Abstract Disclosure: H. Nadeem: None. O. Alzohaili: None. Hypothyroidism is a disorder requiring lifelong Synthroid therapy. Untreated patients have high morbidity rate and suffer from weight gain, cold intolerance, fatigue and constipation. Inadequate therapeutic outcomes may result in the case of malabsorption, like GI tract conditions, medication interactions and dietary ingredients. Here, we describe the case of a 50-year-old woman who despite compliance to therapy, had refractory hypothyroidism. Complexity of unexplained Synthroid malabsorption is highlighted, emphasizing the importance of managing and optimizing thyroid hormone replacement therapy. A 50-year-old woman with a history of papillary carcinoma s/p thyroidectomy and radioactive iodine therapy came in with fatigue, weight gain and constipation. Despite taking Synthroid 150 mcg, thyroid function tests (TFTs) remained high with TSH 150 uIU/mL and fT4 0.25 ng/dL. Her dose was gradually increased until it reached 1800 mcg yet repeat TFTs showed refractory hypothyroidism with TSH 179 uIU/mL, fT4 0.8 ng/dL. Compliance was addressed to which she demonstrated strict adherence, while avoiding concurrent intake of food, supplements or medications interfering with the absorption. Autoimmune conditions were ruled out and no dietary patterns affecting absorption were identified. A thyroid absorption test was then performed, during which 2100 mcg of Synthroid were given orally in the AM, and thyroid hormones were measured for 8 hours. She was found to have a TSH in 200s uIU/mL and fT4 <0.10 ng/dL, deeming her to have refractory hypothyroidism. She was seen by GI and had an EGD/ colonoscopy, revealing no abnormalities. In a follow up visit, she was still complaining of the same symptoms, periorbital edema, and mild confusion. Her TSH was still elevated at 225 uIU/mL. She was then started on IV 500 mcg of weekly Synthroid infusions and after several weeks, she reported symptoms improvement. Subsequent TFTs showed a progress in TSH, now 26.6 uIU/mL, with fT4 1 ng/dL, indicating successful management of Synthroid malabsorption. During this process, she had a nutritional assessment and was consistently having hyperlipidemia with LDL 243 mg/dL. She was compliant with Praluent and max dose of atorvastatin 80 mg, but LDL only decreased to 134 mg/dL after adjusting her thyroid hormone levels. With nonadherence being the top cause of medication non responsiveness, ruling out causes of malabsorption is vital. In this case, compliance, nutritional assessment, medication interactions, GI abnormalities, autoimmune conditions were all addressed and no interfering factors were identified. IV treatment with unexplained thyroid hormone malabsorption was the effective treatment, ultimately improving outcomes. With the hope to transition her to oral medication, the possibility of it happening is still not clear. More research is necessary to discover the underlying causes in such an exceptional case. Presentation: 6/2/2024

Depression Screening Scores and Allergy and Gastrointestinal Medication Use in Adolescents.

Between 2005 and 2014, the 12-month prevalence of major depressive episodes among adolescents aged 12 to 17 years increased from 8.5% to 11.3%. Adolescent-onset depression is related to increased risk for depression and suicidal attempts in adulthood. It is known that depression is an adverse effect among adults taking OAM; however, the effect of OAM on adolescents is unknown. The aim of this study was to describe the relationship between Patient Health Questionnaire 9- Modified (PHQ9-M) scores and OAM use among adolescents. This study included data abstracted from charts of adolescents aged 12 to 21 years who completed a Kansas Be Healthy wellness appointment at the KUSM-W Peds Clinic in 2017. Odds ratios were used to calculate the relationship between oral allergy medication and gastrointestinal medication use among adolescents and PHQ9-M scores. Of the 425 adolescent charts analyzed, 22% (n=96) had positive PHQ9-M screens (a score of 10 or greater), and 13% (n=56) reported current use of allergy medication and/or GI medications. Adolescents taking oral allergy medication were 1.77 times more likely to have a positive PHQ9-M screen than those not taking oral allergy medication. Among adolescents on allergy medication, there was no difference in PHQ9- M scores based on the drug class (1^st or 2<up>nd</sup> generation antihistamine or Montelukast). Healthcare providers must diligently explore OAM/GI use with adolescents during clinical encounters and discuss possible adverse effects of OAM on mood.

S1653 Identification of Trends in Post COVID-19 Infection Gastroenterology Clinic Referrals

Introduction: Post-viral gastrointestinal symptoms are well recognized. Over 50% of patients hospitalized with COVID-19 experienced at least one GI symptom. Here we aim to look at longer-lasting sequelae of COVID infections on the digestive system by identifying trends in patients after the resolution of acute COVID symptoms. Methods: A retrospective chart review was performed on all patients referred to the Northwestern Medicine post-COVID GI clinic from November 2020 - June 2021. For each patient, data regarding demographics and hospitalization/ICU stays during their COVID infection, psychiatric comorbidities, and GI history/medications were reviewed. EMR was reviewed to determine if they had changes in bowel habits, loss of appetite, nausea, GE reflux, abdominal pain, and/or bloody stools. Results: 45 patients were referred to the clinic during this 8 month period; however, 6 missed their appointments and thus a total of 39 patients were evaluated. There were 10 males and 29 females (avg age 42). Five of these patients were hospitalized during their COVID infection (3 were in the ICU). The most common reported symptoms were change in bowel habits (85%), abdominal pain (69%), nausea (51%), GE reflux (38%), loss of appetite (31%), and/or bloody stools (15%). Of the 85% of patients who endorsed change in bowel habits, 8/33 reported constipation, 19/33 reported diarrhea, and 6/33 had a mixed picture. 51% of patients had a psychiatric comorbidity of anxiety or depression. 62% of patients had a prior GI history, of which GERD and IBS were the most common. 74% of patients were noted to be on a prior GI medication, of which a PPI or H2 blocker were most common. Conclusion: The majority of patients seen in the post-COVID GI clinic reported a change in bowel habits (primarily diarrhea). A large percentage of patients were also noted to have concomitant psychiatric comorbidities of depression and/or anxiety. As with other GI tract diseases (e.g. IBS, IBD), it is not unexpected that pre-existing psychiatric comorbidities contribute to a heightened GI sensitivity or reporting of GI symptoms. As SARS-CoV-2 binds to ACE-2 receptors located along the GI tract, and viral RNA is shed into feces, it is also possible that the infection can impact GI tract motility and/or gut flora leading to prolonged symptoms after the resolution of respiratory symptoms. Future longitudinal studies are anticipated to determine whether the impacts on GI function are transient or long-lasting.

Gastrointestinal medication burden among persons with the Ehlers-Danlos syndromes.

The Ehlers-Danlos syndromes (EDSs) are a group of heritable disorders of connective tissue associated with an increased prevalence of both structural and functional GI conditions. We used 10years (2005-2014) of administrative claims data comprised of 4294 people with clinician-diagnosed EDS, aged 5-62years, and compared their frequency of GI drug prescription claims to their age-, sex-, state of residence-, and earliest claim date-matched controls. We categorized the GI medications into the following groups: acid suppressants, anti-emetics, irritable bowel syndrome drugs, and visceral hypersensitivity (VHS) medications. Compared to controls, a significantly higher proportion of persons with EDS had prescription claims for at least one GI drug group, as well as for drugs in each of the four GI drug groups included in our study. By age-group, 25.7% children and 45.1% adults with EDS had prescription claims for at least one GI drug group compared with only 7.4% and 21.0% of controls, respectively (p<0.0001). By gender, 44.0% of women and 25.3% of men with EDS had prescription claims for at least one class of GI drugs compared with 19.2% and 9.6% of controls, respectively (p<0.0001). Predominant medication burden occurs among women with EDS, beginning peri-pubertally for anti-emetics and VHS drugs. High GI medication burden underscores previous evidence that GI dysmotility is common among persons with EDS.

Irritable Bowel Syndrome: Biopsychosocial Manifestations and Management

Introduction: Irritable bowel syndrome (IBS) is the most commonly diagnosed functional gastrointestinal disorder. Links between IBS and PTSD have been described in a previous study. Elimination of foods high in fermented oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is suggested for relief from IBS symptoms. High fructose corn syrup (HFCS) belongs to the FODMAP food family. Camden, NJ is considered to be a “food desert”, where dietary choices may be restricted due to lack of access to fresh, healthy ingredients and meals. This may result in increased consumption of foods high in HCFS. Thus, the interplay between IBS, societal circumstances and psychological disorders may all play a role in the course of the disease, and affect clinical management of patients. Methods: We looked into the medical records of 969 IBS patients with respect to demographic details, type of IBS, BMI, history of GI procedures, smoking, alcohol consumption, medications, current and past Helicobacter pylori infection, diabetes, hypertension, cholesterol, psychological disorders, adherence to a low-FODMAP diet, consumption of HCFS, and other known food triggers. We are now collecting patient surveys in order to fill in gaps in the dietary information from the chart review. USDA data was used in order to identify foods particularly high in HFCS Results: 83% IBS patients were female and 39% were obese. 78% patients were Caucasian (Figure 1). Significant percentage of our IBS patients has one or more psychological disorders. 519, 265, 92, 87 and 21 IBS patients had depression, anxiety, bipolar, PTSD, and psychosis, respectively (Figure 2). IBS-unsubtyped was most common (Figure 3). 240 out of 270 IBS patients with data about H. pylori infection did not have past or current infection. The few surveys collected so far suggest that consumption of HFCS is indeed high in our IBS patients.2782_A Figure 1. Demographics of IBS patients. Respective percentages are presented2782_B Figure 2. Psychiatric diagnoses of IBS patients. Presentation is based on respective numbers as some patients had more than one disorder.2782_C Figure 3. Types of IBS. Respective percentages are presented.Conclusion: Our data shows strong correlation between IBS and certain psychological disorders. With the help of ongoing surveys, we should be able to decipher the underlying dietary influences on IBS. This will help identify “problem areas” where access to healthy food options is difficult. We will also further explore lack of H. pylori infection in our IBS patients as Helicobacter has been hypothesized to confer protection against inflammatory disorders. Our study will allow earlier identification of risk factors to aid in treatment of IBS and its associated psychological disorders.

A Study to Evaluate Key Indicators of Prescription for Cvs and Gi Medications in Tertiary Care Teaching and District Hopitals of East Sikkim

A Study to Evaluate Key Indicators of Prescription for Cvs and Gi Medications in Tertiary Care Teaching and District Hopitals of East Sikkim

A Study to Evaluate Key Indicators of Prescription for Cvs and Gi Medications in Tertiary Care Teaching and District Hopitals of East Sikkim

A Study to Evaluate Key Indicators of Prescription for Cvs and Gi Medications in Tertiary Care Teaching and District Hopitals of East Sikkim

A cross-sectional study of factors related to gastrointestinal drug use in Korean adolescents

Adolescence is critical in the habituation of diverse lifestyles and is a base for future physical well-being. Although gastrointestinal disorders are frequently reported in adolescents, studies related to GI drug use or related factors in Korean adolescents are rare. Thus, this study examined Korean adolescents for the use of GI drugs for abdominal symptoms and analyzed the associated factors. This cross-sectional study was done with a total of 2,416 students who completed a given questionnaire. The health-related questions included GI medication intake, smoking, alcohol, caffeine, regular exercise, self-cognitive health level, GI symptom, non-steroidal anti-inflammatory drugs (NSAIDs) intake, and sleep problems. In questions about GI medication intake, drugs included digestives and antacids. And the intake of GI drugs more than once during the past 1 month was regarded as taking GI drugs. The sociodemographic questions included age, gender, grade, number of close friends, extracurricular activities, and school performance. The overall prevalence for taking GI drugs, including antacids and digestives, was 17.4 %. When students taking GI drugs were compared with those not taking GI drugs, the former group showed higher rates of girls (P < 0.001) and participants in extracurricular activities (P < 0.05) than the latter group. Factors including alcohol, caffeine, self-cognitive health levels, and GI symptoms showed statistical significance with the rate of GI drug intake. The rate of GI drug intake in NSAID users was 2.7 times higher than that in non-users (P < 0.001). The prevalence rate of every sleep problem was higher in students taking GI medications except snoring, witnessed apnea, and teeth grinding. From the multiple regression, it was found that gender (female), extracurricular activities, alcohol intake, self-cognitive health levels, NSAIDs intake, and nightmares were related factors to GI drug intake. Based on the results, it was conclude that encouragement to build healthy lifestyle habits in adolescents is very important for their academic performances and health status in adulthood.

P.04.3 SERUM CHENODEOXYCHOLIC ACID, BMI AND TG, ARE INDEPENDENTLY RELATED TO INSULIN-RESISTANCE IN BLOOD DONORS: AN INTERIM ANALYSIS OF AN ONGOING PROSPECTIVE STUDY

Background and aim: Although the lack of extensive data in humans, bile acids (BAs) and particularly CDCA a potent FXR and TGR5 ligand, are signaling molecules in glucose, lipid and energy metabolism. Aim of our study was to evaluate serum BA profile including Glycine (G), Taurine (T) and Unconjugated (U)-Bas in blood donors (BD) and to identify correlations between individual BA concentration in normal and insulin-resistant (IR) subjects. Material and methods:We prospectively enrolled 160 blood donors from our Transfusion Center, from January to June 2011. Exclusion criteria were: alteration in blood tests, history of liver or GI disease, previous abdominal surgery and treatment with metabolic and GI medications. All patients underwent biochemistry tests (fasting glucose and insulin, total cholesterol, HDL, LDL, triglycerides (TG), ALT, GammaGT, ALP) and serum BA profile measurement (HPLC-ESI-MS/MS). All patients underwent an abdominal ultrasound within a week from enrollment. Medical history, laboratory parameters and ultrasonographic findings of all subjects were reviewed from our physicians and subjects were classified as Healthy (H, n=120), IR (n=28) and gallstone subjects (GS, n=12, excluded from analysis). Results: 148 subjects (84 male/64 female; mean age 41.7±12.6) met the inclusion criteria. BMI was 25.1±3.7; total cholesterol 194.6±35.6; HDL 60.5±15.2; TG 91.8±48.7; ALT, GammaGt, ALP and other mean biochemical index were within normal limits. In IR subjects, total serum BAs (5.02±2.39 vs 3.56±2.55 μmol/l; P= 0.0017), serum unconjugated BAs (1.95±1.25 vs 1.40±1.17 μmol/l; P= 0.025) and CDCA (2.28±1.39 vs 1.63±1.43; P=0.03) were significantly higher than in healthy subjects. On multivariate analysis, BMI (r=0.35; P<0.0001), CDCA (r= 0.194; P= 0.0033) and TG (r=0.26; P=0.0134) were independently and directly related to the HOMA-IR. No significant correlation were found between serum cholesterol or triglycerides levels and serum BA profile. Conclusions: Total serum Bas (U-Bas, G-Bas, T-Bas) and particularly CDCA are significantly increased in patients with IR. CDCA, together with BMI and TG are independently related to insulin-resistance.

P.04.4 SVR TO ANTIVIRAL TREATMENT FOR POST-OLT RECURRENT HCV HEPATITIS CAN BE IMPROVED BY THE USE OF GROWTH FACTORS

Background and aim: Although the lack of extensive data in humans, bile acids (BAs) and particularly CDCA a potent FXR and TGR5 ligand, are signaling molecules in glucose, lipid and energy metabolism. Aim of our study was to evaluate serum BA profile including Glycine (G), Taurine (T) and Unconjugated (U)-Bas in blood donors (BD) and to identify correlations between individual BA concentration in normal and insulin-resistant (IR) subjects. Material and methods:We prospectively enrolled 160 blood donors from our Transfusion Center, from January to June 2011. Exclusion criteria were: alteration in blood tests, history of liver or GI disease, previous abdominal surgery and treatment with metabolic and GI medications. All patients underwent biochemistry tests (fasting glucose and insulin, total cholesterol, HDL, LDL, triglycerides (TG), ALT, GammaGT, ALP) and serum BA profile measurement (HPLC-ESI-MS/MS). All patients underwent an abdominal ultrasound within a week from enrollment. Medical history, laboratory parameters and ultrasonographic findings of all subjects were reviewed from our physicians and subjects were classified as Healthy (H, n=120), IR (n=28) and gallstone subjects (GS, n=12, excluded from analysis). Results: 148 subjects (84 male/64 female; mean age 41.7±12.6) met the inclusion criteria. BMI was 25.1±3.7; total cholesterol 194.6±35.6; HDL 60.5±15.2; TG 91.8±48.7; ALT, GammaGt, ALP and other mean biochemical index were within normal limits. In IR subjects, total serum BAs (5.02±2.39 vs 3.56±2.55 μmol/l; P= 0.0017), serum unconjugated BAs (1.95±1.25 vs 1.40±1.17 μmol/l; P= 0.025) and CDCA (2.28±1.39 vs 1.63±1.43; P=0.03) were significantly higher than in healthy subjects. On multivariate analysis, BMI (r=0.35; P<0.0001), CDCA (r= 0.194; P= 0.0033) and TG (r=0.26; P=0.0134) were independently and directly related to the HOMA-IR. No significant correlation were found between serum cholesterol or triglycerides levels and serum BA profile. Conclusions: Total serum Bas (U-Bas, G-Bas, T-Bas) and particularly CDCA are significantly increased in patients with IR. CDCA, together with BMI and TG are independently related to insulin-resistance.

S1308 Beliefs About GI Medications and Adherence to Pharmacotherapy in Functional GI Disorder (FGID) Outpatients

S1308 Beliefs About GI Medications and Adherence to Pharmacotherapy in Functional GI Disorder (FGID) Outpatients

The effect of a Helicobacter pylori treatment strategy on health care expenditures in patients with peptic ulcer disease and dyspepsia

Objective The aim of this study was to determine whether treatment for Helicobacter pylori ( H. pylori) for patients with dyspepsia or a history of peptic ulcer decreases hospital expenditures. Methods Patients receiving acid suppressive medications were interviewed. Those with a documented ulcer, a self-reported ulcer, or dyspepsia were tested for H. pylori and treated with antibiotics if seropositive. Acid suppressive medications were stopped on completion of H. pylori therapy unless there was a history of gastroesophageal reflux disease (GERD) or Barrett’s esophagus, and were started again at the discretion of primary care providers. Total hospital costs and GI medication costs in the 12 months before H. pylori treatment were compared to costs 12 months after H. pylori treatment. Results A total of 432 consecutive patients were treated for H. pylori. Of the patients, 125 (29%) had dyspepsia, 45 (10%) documented peptic ulcer, and 262 (61%) self-reported peptic ulcer. Total costs (mean $327 ± 349 vs $291 ± 362, p = 0.06) and medication costs (mean $207 ± 237 vs $224 ± 277, p = 0.38) were not significantly different after treatment versus before treatment. A significant decrease in expenditures was limited to patients chronically on acid suppressive medications who had documented peptic ulcers and no history of GERD or Barrett’s esophagus (mean $482 ± 274 vs $282 ± 218, p = 0.03). Conclusions Treatment of H. pylori for patients with chronic dyspepsia or self-reported peptic ulcer does not reduce expenditures over 1 yr of follow up. H. pylori treatment for patients chronically receiving acid suppressive treatment with a prior documented ulcer significantly reduces expenditures if GERD and Barrett’s esophagus are absent.

The Evaluation of GI Medication Treatment Pattern and Duration Associated with NSAID Therapy

ABSTRACTThe purpose of this retrospective drug utilization study was to assess the GI medication use pattern and to identify factors influencing the length of GI medication therapy associated with NSAID use in a managed care plan. Data for this study were from a pharmacy benefits manager's 15-month claims file dated October 1995 through January 1997. Patients (N = 454) who had no record of previous GI medication use prior to NSAID therapy were the focus of this study. Main outcome measures included the elapsed time between the initiation of NSAID use and the subsequent initiation of GI therapy and the length of GI drug therapy.The GI medication treatment pattern was analyzed with descriptive analysis, and the duration of GI therapy was evaluated by the Kaplan-Meier method. Factors affecting the length of GI treatment period were analyzed using the Cox proportional hazards model. The results of this study indicated that a significant portion of patients started on GI medications without clear indication of...

The Evaluation of GI Medication Treatment Pattern and Duration Associated with NSAID Therapy

The Evaluation of GI Medication Treatment Pattern and Duration Associated with NSAID Therapy

Over-the-counter nonsteroidal anti-inflammatory drugs and risk of gastrointestinal symptoms

OBJECTIVE: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications. Although much is known about prescription NSAIDs and risk of GI side effects, little is known about over-the-counter (OTC) NSAIDs and their risk of GI side effects. The aim of this study was to estimate use of OTC NSAIDs, GI side effects, and professional and self-care for these side effects. METHODS: We conducted a telephone survey of an age-stratified U.S. random sample of 535 persons at least 40 yr old, who used an OTC NSAID for 4 of the previous 7 days, and a matched comparison population of 1068 persons who used no NSAID within the previous 30 days. We measured current use of OTC NSAIDs, GI symptoms, diagnoses and their treatment, and prescription and OTC GI medications. RESULTS: The most commonly used OTC NSAID was aspirin (alone or in combination compounds). Prevention of myocardial infarction or stroke was the most common reason for use (43.2%), followed by all forms of pain relief (44.2%) and relief of arthritis symptoms (24.5%). NSAID users were twice as likely as nonusers to report GI side effects (19.6% vs 9.5%, p = 0.0001), and more than twice as likely to use an OTC GI medication when they had GI symptoms (46.7% vs 20.8%, p = 0.001). CONCLUSIONS: OTC NSAIDs are not a benign medication even at low dosages. Physicians may be unaware that patients self-medicate with OTC NSAIDs and for GI side effects with additional OTC GI medications. Therefore, physicians should routinely ask patients about all forms of self-treatment.

Over-the-counter nonsteroidal anti-inflammatory drugs and risk of gastrointestinal symptoms.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications. Although much is known about prescription NSAIDs and risk of GI side effects, little is known about over-the-counter (OTC) NSAIDs and their risk of GI side effects. The aim of this study was to estimate use of OTC NSAIDs, GI side effects, and professional and self-care for these side effects. We conducted a telephone survey of an age-stratified U.S. random sample of 535 persons at least 40 yr old, who used an OTC NSAID for 4 of the previous 7 days, and a matched comparison population of 1068 persons who used no NSAID within the previous 30 days. We measured current use of OTC NSAIDs, GI symptoms, diagnoses and their treatment, and prescription and OTC GI medications. The most commonly used OTC NSAID was aspirin (alone or in combination compounds). Prevention of myocardial infarction or stroke was the most common reason for use (43.2%), followed by all forms of pain relief (44.2%) and relief of arthritis symptoms (24.5%). NSAID users were twice as likely as nonusers to report GI side effects (19.6% vs 9.5%, p = 0.0001), and more than twice as likely to use an OTC GI medication when they had GI symptoms (46.7% vs 20.8%, p = 0.001). OTC NSAIDs are not a benign medication even at low dosages. Physicians may be unaware that patients self-medicate with OTC NSAIDs and for GI side effects with additional OTC GI medications. Therefore, physicians should routinely ask patients about all forms of self-treatment.

Laparoscopic nissen fundoplication reduces pharmacy costs in GERD

INTRO: In addition to providing symptom relief and preventing complications of GERD, the laparoscopic Nissen fundoplication has been promoted as a cost-saving operation to reduce the use of GI medications. PURPOSE: Retrospectively analyze the use of ormedications before and after laparoscopic Nissen fundoplication. METHODS: From a database of 200.000 covered patient lives in a large managed care plan, all individuals who underwent laparoscopic Nissen fundoplication from 1-1-98 to 6-30-98 were analyzed via paid claims data retrospectively for prescriptions of antisecretory and prokinetic medications. Only members continuously enrolled in the program from 7-1-97 to 12-3 1-98 were studied. RESULTS: 17 patients (9M, 8F; mean age=44 yrs) underwent laparoscopic Nissen fundoplication during the study period. In the 6 months priorto surgery, 17/17 patients received 110 prescriptions with a total cost of $10,245 and an average cost of $99.38/pt/mo. In the 6 months aft er laparoscopic Nissen fundoplication, only 3/ 17 patients received a total of ten prescriptions for ormedications at a total cost of $595 and an average cost of $5.85/pt/mo. CONCLUSION: In the six month period following surgery, laparoscopic Nissen fundoplication was associated with significant reduction in the number of patients requiring medication for GERO, reduced total costs for GI medications and reductions in medication costs for those few patients requiring continuing medical therapy.