Proton Pump Inhibitors Research Articles

Asymptomatic enteric pathogen carriage and its association with proton pump inhibitors use in men who have sex with men in Taiwan, 2019-2022

ObjectivesCurrently recognized risk factors for sexually transmitted enteric infections (STEIs) among men who have sex with men (MSM) include oroanal sex, multiple sexual partners, and chemsex. This study aimed to investigate the prevalence of the asymptomatic carriage of enteric pathogens in men who have sex with men (MSM) and to identify the associated risk factors. MethodsQuestionnaires were completed by 375 MSM in Taiwan from December 2019 to November 2022. Fecal samples were analyzed by multiplex PCR to determine whether seven enteric pathogens, including Entamoeba histolytica, Giardia duodenalis, Shiga toxin-producing Escherichia coli, Cryptosporidium, Campylobacter, Salmonella, and Shigella species, were present. ResultsAmong 375 fecal samples from asymptomatic MSM, 27 (7.2%) fecal samples tested positive for at least one enteric pathogen. The recent use of proton pump inhibitors (PPIs) was significantly associated with asymptomatic fecal carriage (22.2% vs. 2.0%, P < 0.001). G. duodenalis (2.1%, 8 cases), E. histolytica (1.6%, 6 cases), and Shigella species (1.3%, 5 cases) were commonly detected. Oroanal sex and PPI use were associated with the asymptomatic carriage of enteric pathogens. Specifically, Shigella, Salmonella, or Campylobacter carriage was significantly correlated with PPI use. In contrast, rectal gonorrhea was associated with multiple sexual partners and prior syphilis. ConclusionsRecent use of PPIs was associated with the asymptomatic carriage of enteric pathogens. Therefore, targeted education about the appropriate use of PPIs is necessary to mitigate the risk of STEIs among MSM.

Medicinal Herbs for the Treatment of Peptic Ulcers

: Peptic ulcers are common gastrointestinal disorders characterized by the erosion of the stomach lining, duodenum, or esophagus. Conventional treatments, such as proton pump inhibitors and antibiotics for Helicobacter pylori eradication, have been the mainstay of therapy. However, the emergence of drug resistance and potential side effects have led to the exploration of alternative and complementary approaches, including medicinal herbs. This comprehensive review examines the potential use of medicinal herbs in the management of peptic ulcers. Ten herbal remedies, including Liquorice, Slippery Elm, Marshmallow Root, Aloe Vera, Chamomile, Ginger, Turmeric, Meadowsweet, Fenugreek, and Cabbage, are analyzed for their therapeutic properties and scientific research findings. These herbs have demonstrated anti-inflammatory, antimicrobial, and mucoprotective effects that may support ulcer healing and symptom relief. Herbal formulations, such as teas, capsules, tablets, and extracts, offer convenient delivery methods for patients seeking herbal remedies. However, safety considerations and potential herb-drug interactions must be carefully monitored. Integrating herbal remedies with conventional treatments presents a comprehensive approach to peptic ulcer management. By combining these therapies, patients may experience enhanced therapeutic outcomes and improved quality of life. Dietary recommendations also play a crucial role, with the inclusion of soothing and beneficial foods, while avoiding trigger foods that may exacerbate symptoms. As the evidence base grows, collaborative efforts between traditional herbal medicine practitioners and mainstream medical professionals are vital to ensure safe and effective integration.

Prescribing patterns of proton pump inhibitors in patients with lung cancer treated with immunotherapy

Prescribing patterns of proton pump inhibitors in patients with lung cancer treated with immunotherapy

Impact of Antibiotics and Chronic Medications on Efficacy of Immune Checkpoint Inhibitors in Patients With Hepatocellular Carcinoma.

The interaction of immune checkpoint inhibitors (ICI) and concomitant medications such as antibiotics, metformin, statins, beta-blockers, proton pump inhibitors (PPIs), nonsteroidal anti-inflammatory drugs (NSAIDs), and low-dose aspirin has been studied in other malignancies. Our study aims to investigate the relationship between these medications and ICI efficacy in patients with advanced hepatocellular carcinoma (aHCC). A retrospective review of patients who received at least one dose of ICIs between May 2015 and November 2019 was performed. The primary objectives were to compare the overall survival (OS) and progression-free survival (PFS) between patients with and without medication usage. Log rank test was used to assess for differences in survival. Hazard ratios were reported using Cox proportional hazard regression analysis. The data cutoff date was December 31, 2020. A total of 168 patients were included. Median age was 69 years, 85.7% male, 60.7% ECOG 0, 78.0% Child-Pugh A liver cirrhosis, 57.7% hepatitis B etiology, 8.9% hepatitis C, and 33.3% nonviral. One hundred three patients (61.3%) received ICI monotherapy, while 38.7% received ICI in combination. Sixty-two patients (36.9%) had concomitant antibiotic usage, 26.8% metformin, 30.4% statin, 31.0% beta-blockers, 60.1% PPI, 6.5% NSAIDs, and 11.9% aspirin. Patients with aHCC receiving antibiotics did not have a shorter OS (adjusted HR [aHR] 1.40, 95% CI 0.94-2.09, p=0.096) or shorter PFS (aHR 0.94, 95% CI 0.66-1.34, p=0.73), as compared to those who did not receive antibiotics. However, patients with aHCC of viral hepatitis etiology receiving ICI treatment and concurrent antibiotics had shorter OS (5.5 vs. 14.2 months, aHR 1.93, 95% CI 1.17-3.17, p=0.010) and PFS (1.1 vs. 2.6 months, aHR 2.69, 95% CI 1.28-5.65, p=0.009), as compared to those who did not receive antibiotics. The use of antibiotics may diminish ICI efficacy in patients with aHCC of viral hepatitis etiology, while the use of metformin, statins, beta-blockers, NSAIDs, and aspirin is not associated with significant clinical outcomes.

Practical Application of the COuGH RefluX Score for Patients with Laryngopharyngeal Symptoms: Real-World Assessment in Predicting GERD and PPI Response.

The COuGH RefluX score has been validated to predict likelihood of gastroesophageal reflux disease (GERD) in patients with laryngopharyngeal symptoms (LPS) using parameters of Cough, Overweight, Globus, Hiatal Hernia, Regurgitation, and male seX. This study aimed to assess the real-world value of the COuGH RefluX score in predicting proton pump inhibitor (PPI) response in LPS patients. Patients with LPS for >3 months were prospectively enrolled, and assessed using the Reflux Symptom Index (RSI) and 24-hour impedance-pH monitoring. Based on COuGH RefluX scores, patients were designated unlikely GERD (≤2.5), inconclusive GERD (3.0-4.5), and likely GERD (≥5.0). PPI response was defined as a 50% reduction in RSI. Among 196 participants (mean age 47.8), 121 were unlikely, 60 were inconclusive, and 15 were likely to have GERD. Patients unlikely to have GERD had higher MNBI, lower hiatal hernia prevalence, and fewer confirmed GERD cases compared to inconclusive and likely GERD groups (P <0.05). Symptom severity and AET were similar across groups (P >0.05). PPI response rates were 12.4%, 45.0%, and 73.3% across the groups (P <0.001). Multivariate logistic regression showed COuGH RefluX scores and lower MNBI as independent predictors of PPI responsiveness (scores 3.0-4.5, OR =4.190, P =0.001; scores ≥5.0, OR =15.772, P <0.001; MNBI, OR =0.915, P =0.001). The COuGH RefluX score is effective in predicting GERD and guiding PPI use in LPS patients without esophagitis. The score can ensure appropriate PPI use and targeted testing during initial LPS patient encounters.

Evaluation of the management of Clostridioides difficile infection as a risk factor for recurrence. A retrospective observational study

One of the main problems with Clostridioides difficile infection (CDI) is its tendency to recur. The objective of the study is to analyze which factors in the clinical management of CDI favor recurrence. This is a retrospective study conducted at the Hospital Universitario Príncipe de Asturias on cases of CDI between January 2021 and June 2023. Demographic variables, comorbidities, risk factors for recurrence, and treatments used for CDI were recorded. Non-optimal clinical management was defined as: not discontinuing treatment with proton pump inhibitors (PPIs) if the patient was on them, not discontinuing concomitant antibiotic treatments if the patient was on these, the use of metronidazole monotherapy in any case, or the use of standard-dose vancomycin if there were risk factors for recurrence. A total of 327 cases were found in 256 patients. 69 patients died within 8 weeks after the episode (26.9%). Among the remaining 258 episodes, there were 68 recurrences (26.3%). Of these 68 recurrences, 63 cases received nonoptimal treatment (93.2%), compared to 112/190 (58.9%) among those who did not recur. In the multivariate analysis adjusted for confounding factors, patients who received optimal treatment had an 89% lower risk of recurrence compared to those who did not receive it (OR 0.1; p < 0.001). Reducing the use of PPIs and antibiotics and prioritizing more effective treatments against CDI could improve the recurrence rates of this infection.

Concomitant Use of Proton Pump Inhibitors and CDK4/6 inhibitors in Metastatic Hormone-Positive Breast Cancer: A Real World Cohort Study

Introduction: Conflicting evidence exists regarding the concurrent use of cyclin-dependent kinase (CDK) 4/6 inhibitors and proton pump inhibitors (PPIs) in the treatment of breast cancer. This study aimed to investigate whether PPI use interferes with the efficacy of CDK4/6 inhibitors. Methods: This retrospective, multicenter, real-world study included 205 patients with hormone receptor-positive, HER2-negative metastatic breast cancer. Patient data were collected from January 2020 to August 2023. Patients who received either ribociclib or palbociclib, with or without a PPI, were included. Median progression-free survival (mPFS) was estimated using the Kaplan-Meier method, and factors associated with mPFS were analyzed using Cox regression. Results: Among the patients, 100 received palbociclib and 105 received ribociclib. In the palbociclib group, 40 patients (40%) used a PPI, and 60 (60%) did not. The mPFS was 16.1 months for patients with a PPI versus 22.2 months for those without (p=0.26). In the ribociclib group, 44 patients used a PPI and 61 did not use a PPI. The median PFS was comparable between patients receiving PPIs and those not receiving PPIs. (19.3 months and 20.7 months, respectively). Poor PFS was associated with liver metastasis, brain metastasis, and high Ki-67. Conclusion: Concomitant use of PPIs with ribociclib or palbociclib did not affect the efficacy of either CDK4/6 inhibitor. PPIs can be administered alongside these medications when clinically indicated

A Meta-Analysis of Proton Pump Inhibitor Exposure and the Risk of Adverse Outcomes in Patients with Inflammatory Bowel Disease.

This study aims to investigate the association between proton pump inhibitors (PPIs) exposure and adverse outcomes in patients with inflammatory bowel disease (IBD). According to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE), we conducted a comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library databases for relevant cohort and case-control studies comparing the incidence of adverse outcomes between IBD patients exposed to PPIs and those not exposed, from the inception of the databases to April 2024. The primary adverse outcomes analyzed included hospitalization and surgery. Five studies, encompassing nearly 100,000 subjects, were included in this meta-analysis. The findings indicated that IBD patients exposed to PPIs had a significantly higher incidence of adverse outcomes compared to those not exposed (Odds ratio [OR]=1.24, 95%CI=1.07-1.44, p=0.004), although it was low-quality evidence. This increased risk was observed in both ulcerative colitis (UC) (OR=1.38, 95%CI=1.04-1.83, p=0.025) and Crohn's disease (CD) (OR=1.14, 95%CI=1.02-1.29, p=0.025). Additionally, the incidence of surgery was higher in IBD patients with PPI exposure (OR=1.31, 95%CI=1.02-1.68). However, the OR for hospitalization did not show a statistically significant difference (OR=1.43, p=0.244). Moreover, the use of glucocorticoids was more frequent among patients exposed to PPIs (OR=1.16, 95%CI=1.06-1.28, p=0.001). PPI exposure may be associated with an increased risk of adverse outcomes in IBD patients, particularly a higher rate of surgery. Limited by various factors, the evidence is considered low quality.

Impact of post RFA treatment on neosquamous epithelium microstructure

Radiofrequency ablation (RFA) is effective treatment for Barrett’s esophagus (BE). Product of successful RFA is neosquamous epithelium (NSE), which resembles native squamous epithelium and has lower risk for neoplastic transformation. Dilated intercellular spaces (IS) are common microscopic feature of reflux induced injury of esophagus. The aim of this study was to analyze the ultrastructure of NSE by transmission electron microscopy (TEM), depending on the post RFA treatment modalities and to asses impact of these findings on BE recurrence. Prospective observational clinical study based on TEM analysis of biopsy of specimens obtained from patients in whom CE of BE was achieved minimum 6 months after the last RFA session. In each patient biopsies were taken from NSE and proximal esophagus. Two groups of patients were defined according to the post RFA treatment: proton pump inhibitors (PPI’s) or laparoscopic Nissen fundoplication (LNF). Comparative analysis of IS length was made between two groups. Endoscopic surveillance with biopsies was conducted for 5 years. Overall 22 patients with CE of BE after RFA underwent complete study protocol, out of whom in 10 LNF was performed, while 12 were treated with PPI’s. The mean values of IS length in the proximal esophagus and NSE in LNF group were 0.378 ± 0.116 µm and 0.878 ± 0.354, while in PPI’s group 0.724 ± 0.325 µm and 1.228 ± 0.226 µm, respectively. Mean lenghts of IS were statistically significantly higher in PPI’s group both in NSE (p = 0.032) and proximal esophagus (p = 0.009). There were 5 BE recurrences after 5 years surveillance, 4 in PPI group and 1 in LNF group, without statistical significance (p = 0.084). Dilated IS are commonly presented in NSE of patients with CE of BE with RFA who are treated with PPI’s. LNF provides may offer better reflux protection of NSE than PPI’s and may reduce the rates of recurrence after successful RFA treatment.

Bowel Colonization With Carbapenem-Resistant Bacteria Is Associated With Short-Term Outcomes in Patients With Acute-On-Chronic Liver Failure.

Bowel colonization with antimicrobial-resistant bacteria has been associated with worse clinical outcomes in patients with cirrhosis; however, it has not been studied in patients with acute-on-chronic liver failure (ACLF). We evaluated whether fecal isolation of carbapenem-resistant gram-negative bacteria (CR-GNB) among patients with ACLF affects short-term outcomes. Patients of APASL-ACLF (n = 339) were screened between June 2020 and December 2021, and 150 were included. Stool cultures were carried out at baseline and every 5 days thereafter until discharge or death. All surviving patients were followed until 60 days after discharge. Mean age was 44.8 (8.8) years, with 86% males and alcohol as etiology in 66%. CR-GNB organisms were isolated from stool in 42% of hospitalized ACLF patients, with E. coli and Klebsiella pneumoniae as the most common species. Patients with CR-GNB fecal carriage were associated with higher CTP, MELD, and DF scores but not with recent antibiotics, proton pump inhibitors, or lactulose use. Extraintestinal infections developed in 59.3% overall, most commonly UTI, pneumonia, and SBP. Infectious complications developed in 57.3% and 19.7% with and without CR-GNB in the stool (RR: 5.5; p < 0.001). Peripheral cultures were positive in 60.7% with infections, with species concordant with the fecal isolates found in 90.7%. Isolation of CR-GNB from stool and high bilirubin were independently associated with both in-hospital mortality and 60-day mortality (p = 0.05). Hospitalized ACLF patients with CR-GNB in the stool have a significantly higher risk of extraintestinal infections, in-hospital mortality, and short-term mortality up to 60 days. [NCT04383106].

Risk factors for decreased bone mineral density in patients with Hodgkin’s lymphoma

BACKGROUND: Osteoporosis is a disease characterized by a decrease in bone mineral density that leads to low-energy fractures. Hodgkin’s lymphoma, which occurs mainly in young people (16–35 years), may be one of the causes of impaired bone remodeling. Given the high prevalence of osteoporosis in young patients with Hodgkin’s lymphoma, it is important to identify early predictors of the development of osteoporosis. AIM: To evaluate risk factors for decreased bone mineral density in patients with Hodgkin’s lymphoma receiving pathogenetic therapy. MATERIALS AND METHOD: The study included 63 patients with Hodgkin’s lymphoma and 30 healthy volunteers who served as controls. All participants completed a questionnaire to identify common and specific risk factors for osteoporosis. Common risk factors included sex, age, body mass index, history of fractures in the patient and immediate family, use of hormone replacement therapy, proton pump inhibitors, corticosteroids, comorbidities, amenorrhea in women, level of physical activity, and calcium intake. Specific risk factors for osteoporosis included polychemotherapy as a pathogenetic therapy for Hodgkin’s lymphoma. RESULTS: The study identified four main risk factors for the development of osteopenia/osteoporosis in young patients with Hodgkin lymphoma following pathogenetic therapy such as use of proton pump inhibitors, corticosteroids, chemotherapy-induced amenorrhea in women, and low physical activity. CONCLUSION: Methods for predicting and preventing osteoporosis have not yet been developed for young patients, as this disease is considered to be associated with old age. However, some groups of young patients are at high risk for disruption of bone microarchitecture with low-energy fractures, significantly reducing quality of life. All these factors make early detection of osteoporosis predictors important.

Pharmacological Evaluation of the Traditional Brazilian Medicinal Plant Monteverdia ilicifolia in Gastroesophageal Reflux Disease: Preliminary Results of a Randomized Double-Blind Controlled Clinical Trial.

The present work aimed to compare the effects of the standardized dry extract from the leaves of Monteverdia ilicifolia, popularly known as "espinheira-santa", with omeprazole in the management of dyspepsia related to gastroesophageal reflux disease (GERD). A double-blind, randomized, non-inferiority and double-dummy clinical trial was conducted. In total, 86 patients with GERD symptoms were randomized into three groups: Omeprazol (20 mg), M. ilicifolia (400 mg), or M. ilicifolia (860 mg). Capsules were provided by SUSTENTEC®, Pato Bragato, Brazil. It was requested that the participants take three capsules before breakfast and dinner for 4 weeks. Clinical outcomes were obtained at the beginning and end of the study, with GERD symptoms (QS-GERD), the impact of heartburn symptoms on quality of life (HBQOL), and medical records. Overall, 75.6% of the participants showed adherence without any differences among the experimental groups. All groups had significant reductions in both QS-GERD and HBQOL scores. Omeprazole and 400 and 860 mg of M. ilicifolia decreased the QS-GERD total scores at the endpoint compared to the baseline (Chi-square = 129.808; p < 0.0001), as well as individual item scores, such as heartburn intensity (Chi-square = 93.568, p < 0.0001) and heartburn after meals (Chi-square = 126.426, p < 0.0001). There were no differences among the experimental groups after the intervention. Our results suggest that capsules with a standardized dry extract from the leaves of M. ilicifolia at a dosage of 400 or 860 mg are non-inferior to omeprazole, a proton pump inhibitor.

Risk of Cancer Diagnosis in Patients With Eosinophilic Esophagitis Using a Nationwide Swedish Population Cohort.

Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease of the esophagus. Chronic inflammation has been linked to cancer development. We aimed to study the potential association between EoE and later cancer diagnosis. In this nationwide population-based cohort study, we identified 1580 individuals with EoE diagnosed between 1990-2017 through Sweden's 28 pathology departments. Up to five general population reference individuals were matched on age and sex (n=7533). A Cox regression analysis estimated adjusted hazard ratios (aHRs) for cancer up until December 31, 2020. To reduce potential intrafamilial confounding, we also compared EoE individuals with their unaffected siblings. During a median follow-up of 7years, 47 individuals with EoE (3.9/1000person-years) developed cancer versus 183 (3.2/1000person-years) reference individuals. This corresponded to a non-significant aHR of 1.11 (95% CI=0.80-1.53). Incidence rates were independent of budesonide and proton-pump inhibitor use. Individuals with EoE however did have an increased risk of esophageal cancer where two EoE versus one reference individual were diagnosed (aHR=25.20; 95% CI=2.28-278.80), and also Barrett's esophagus risk was also increased in EoE (HR=18.18; 95% CI=6.75-48.95). Non-esophageal gastrointestinal (GI) cancer occurred in 11 EoE versus 24 reference individuals: aHR=2.03 (95% CI=0.99-4.18). We found no increased risk of cancers from the skin (EoE n=10), lung (n=0), breast (n=4), or blood (n=0). Sibling analyses supported these findings. We did not find any overall association between EoE and cancer development. EoE was associated with esophageal cancer, but this was very rare with wide confidence interval and few cases therefore we urge caution with generalization of these findings.

Association between proton pump inhibitors and dementia risk: a Mendelian randomization study

Numerous observational studies suggest associations between proton pump inhibitors (PPIs) and dementia, but causal relationships remain uncertain. Using large-scale genome-wide association study (GWAS) data, we performed univariable Mendelian randomization (UVMR) analysis to assess the causality between five PPI types, and all-cause dementia and its five subtypes. Confounders were controlled through multivariable MR (MVMR) analysis to isolate PPIs’ direct effects on dementia. Heterogeneity and pleiotropy assessments, and leave-one-out analysis, were conducted to validate the robustness of our results. Initial UVMR estimates suggested that lansoprazole (odds ratio [OR] 1.291; 95%confidence interval [CI] 1.001–1.665; p = 0.049) and pantoprazole (OR 1.118; 95% CI 1.014–1.233; p = 0.025) potentially increased VD risk, with their respective direct associations also discovered in MVMR. Additionally, FTD was found to reversely increase rabeprazole use (OR 1.086; 95% CI 1.011–1.167; p = 0.023). However, after adjustment for the false discovery rate (FDR), none of these associations remained statistically significant (pFDR> 0.05). The robustness of our results is supported by consistent estimates across complementary MR methods and the absence of pleiotropy. Our study indicates no robust causality between PPI use and increased dementia risk. Thus, it is inappropriate to restrict clinically justified PPI prescriptions merely due to potential cognitive risks.

Molecular insights: zebrafish embryo damage linked to hospital effluent.

This study addresses the pressing issue of pollutants, particularly heavy metals and pharmaceuticals, infiltrating aquatic ecosystems due to untreated hospital effluents. These contaminants, known for their toxicity and bioaccumulative potential, adversely affect water quality and ecosystem health. The research focuses on the intricate relationship between oxidative stress and embryonic damage in Danio rerio exposed to hospital effluent, offering a detailed understanding of the underlying mechanisms. Concentrations of pharmaceutical residues (ng L-1) such as NSAIDs, corticosteroids, proton pump inhibitors, H2-receptor antagonists, and heavy metals (mg L-1) like Cd, As, Cu, Cr, Hg, Ni, Pb, and Zn were meticulously quantified. The effluent exhibited a significant embryolethal potential with an LC50 of 2.328% and an EC50 for malformation at 2.607%. Notable embryonic malformations included yolk sac edema, tail abnormalities, pericardial edema, scoliosis, craniofacial deformities, eye hypopigmentation, developmental delays, and body malformations. Zebrafish embryos were exposed to varying concentrations of the effluent (0.5% to 4.0%) and assessed for lethality and malformations at specific intervals (12, 24, 48, 72, and 96h post-fertilization). The study also scrutinized oxidative damage and monitored the expression of genes central to antioxidant processes, detoxification, and apoptosis (sod, cat, nrf2, cyp1a1, bax, casp3, casp6, casp7, and casp9) at 48-, 72-, and 96-h post-fertilization across all concentrations. Findings consistently revealed lipid and protein damage, heightened antioxidant activity, and altered gene expression at all time points and effluent concentrations. These results highlight the environmental threat posed by untreated hospital effluent, emphasizing the need for comprehensive effluent treatment measures to protect aquatic ecosystems from the detrimental impacts of pharmaceuticals and heavy metals. The study underscores the critical role of oxidative stress in embryonic damage and advocates for improved environmental stewardship and regulatory measures.

MGB-OAGB International Club-Results of a Modified Delphi Consensus on Controversies in OAGB.

One anastomosis gastric bypass (OAGB) presently constitutes 7.6% of all metabolic and bariatric surgery (MBS) procedures globally. Despite being approved by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) as a standalone MBS procedure and two consensus efforts in the past, multiple areas of controversies remain. This consensus builds upon previous consensus efforts to address unresolved controversies in the field. A modified Delphi consensus exercise was conducted over 4weeks under the aegis of the MGB-OAGB International Club. A panel of 86 bariatric experts from 25 countries participated in 3 rounds of voting on 29 questions on patient selection, technical standardization, revisional surgeries, and post-operative care. Consensus was defined as at least 70% agreement. Consensus was achieved on 22 out of 29 questions. Key areas of agreement included suitability of OAGB for adolescents above the age of 15years and patients with class 1 obesity with uncontrolled type 2 diabetes. Patients with severe esophagitis and Barrett's esophagus were not considered as good candidates for OAGB. Crural repair with OAGB was considered as an appropriate procedure in patients with large hiatus hernia. While a bilio-pancreatic limb (BPL) length of 150 - 200cm was deemed suitable, it was recommended to tailor the BPL length to prevent protein energy malnutrition. It was also agreed to routinely administer ursodeoxycholic acid and proton-pump inhibitors for 6months post-operatively. This modified Delphi consensus represents a critical step forward in addressing the controversies surrounding OAGB. It also emphasizes on the importance of individualized patient care and the need for ongoing research to refine surgical practices and improve outcomes.

Effects of Tegoprazan, Potassium-Competitive Acid Blocker, on the Gastric Emptying and Postprandial Symptoms in Healthy Humans.

Proton pump inhibitors are potent gastric acid inhibitors. However, they may worsen symptoms such as postprandial fullness and early satiation by reducing gastric emptying (GE). This study aims to evaluate the effects of tegoprazan, a new potassium-competitive acid blocker, on GE and dyspeptic symptoms. A randomized, double-blind, placebo-controlled design was adopted for this study. Participants underwent GE tests and responded to a questionnaire regarding gastrointestinal symptoms before and after administration of tegoprazan 50mg. GE was assessed using scintigraphy over 4h with a standardized solid meal. Thirty participants were recruited (19 men, mean age 28.2 ± 7.3years). After medication, no significant differences were observed in gastric half emptying time (T1/2) and gastric retention at 4h (GE 4h) between the tegoprazan and the control group (114.2 ± 48.9min vs. 93.7 ± 34.7min, P = 0.20; 10.1 ± 12.0% vs. 4.3 ± 5.4%, P = 0.11, respectively). Furthermore, there were no statistically significant differences detected in the changes within each group between two groups (T1/2, 9.9 ± 52.7min vs. -4.7 ± 30.5min, P = 0.36; GE 4h, 5.2 ± 13.9% vs. -1.3 ± 6.5%, P = 0.12). The changes in dyspeptic symptom scores after tegoprazan administration did not significantly differ from those in the control group with no correlation between symptoms and GE parameters. In healthy adults, the administration of tegoprazan did not show a significant impact on GE and dyspeptic symptoms, especially postprandial fullness or early satiation.

Comparative efficacy of Helicobacter pylori eradication therapy between tegoprazan-based concomitant and bismuth quadruple therapies: A real-world evidence.

Tegoprazan, a potassium-competitive acid blocker, can be used as a substitute for proton pump inhibitors in Helicobacter pylori eradication therapy; some studies have reported improved efficacy. In Korea, where clarithromycin resistance rates are high, we aimed to compare the efficacies of tegoprazan-based concomitant and bismuth quadruple therapies. We retrospectively analyzed data from patients with H.pylori infection who received either 10-day tegoprazan-based concomitant therapy or 14-day tegoprazan-based bismuth quadruple therapy as first-line treatment. The primary outcome was H.pylori eradication rate, with secondary outcomes including adverse events and insufficient medication rates. Among the 1082 patients included in the study, 620 and 462 were treated with tegoprazan-based concomitant and bismuth quadruple therapies, respectively. Intention-to-treat analysis demonstrated no difference in eradication rates between the tegoprazan-based concomitant and bismuth quadruple therapy groups (74.7% [95% confidence interval-CI, 71.1-78.0%] vs 74.7% [95% CI, 70.6-78.5%], P=0.999). Per-protocol analysis also showed similar eradication rates between the two groups (88.0% [95% CI, 85.0-90.6%] vs 89.7% [95% CI, 86.3-92.5%], P=0.424). The overall adverse event rates (49.6% vs 39.2%, P=0.001) and insufficient medication rates (4.8% vs 2.4%, P=0.036) were higher in the bismuth quadruple therapy group than in the concomitant therapy group. The eradication rates of tegoprazan-based 10-day concomitant therapy and 14-day bismuth quadruple therapy were comparable. However, because of its shorter treatment duration, better medical adherence, and lower incidence of adverse events, tegoprazan-based concomitant therapy may be preferable in regions with high rates of clarithromycin and metronidazole resistance.

Expert consensus on the multifaceted utility of alginates in addressing diverse manifestations of acid reflux

Gastroesophageal reflux disease (GERD) is one of the most frequent reasons for seeking outpatient gastroenterology consultations. Current professional guidelines advocate the use of proton pump inhibitors (PPIs) as the primary medical approach to manage GERD. However, PPIs may not be as effective, especially for certain patients like those with non-erosive reflux disease (NERD). An alternative strategy for addressing symptomatic GERD involves obstructing the flow of acidic refluxate. Alginate-based pharmaceutical formulations have proven effective in alleviating symptoms of acid reflux for many years and provide rapid relief of symptoms with a long duration of action. Alginic acid derivatives, or alginates, combat acid reflux through a unique mechanism: they create a physical barrier that displaces the post-prandial acid pocket. Alginates have recently garnered renewed interest for promoting symptomatic relief especially when employed alongside antacids or PPIs. Here, the role of alginates is reviewed in the treatment of various profiles of acid reflux, including post-prandial acid reflux, nocturnal GERD, refractory GERD, and GERD during pregnancy, along with the opinion of expert gastroenterologists on the same. The experts believed that not all alginate formulations are equivalent and raft strength is the most important physicochemical property to be considered while selecting the alginate-based product. The physicochemical properties of the rafts eventually impact their effectiveness in relieving symptoms in clinical settings.

Proton pump inhibitors reduce chemotherapeutic hepatotoxicity and enhance hepatic uptake and accumulation of drug-loaded extracellular vesicles

Extracellular vesicles (EVs) are involved in the progression of various diseases. Tumor cell-derived EVs (TEVs) are a particular concern, as they can induce fatty liver by promoting liver macrophages to secrete tumor necrosis factor (TNF), thus enhancing the toxicity of chemotherapy. Therefore, reducing pathogenic EV production is a potential strategy for treating EV-related diseases. However, there are currently no effective clinical reagents to obtain this purpose. In addition, EVs are also natural and ideal drug-delivery vehicles. Improving the delivery efficiency of EVs remains a challenge. Proton pump inhibitors (PPIs) have been demonstrated to promote cell uptake of EVs by inducing micropinocytosis. Here, we show that PPIs can accelerate TEV clearance, reduce TEV uptake by liver macrophages and decrease the mRNA expression of TNF in liver macrophages of tumor-bearing mice. Correspondingly, the fatty liver phenotypes are alleviated, and the tolerance to chemotherapy is improved in these mice. Furthermore, our findings indicate that PPIs facilitate the uptake of red blood cell-derived EVs (RBC-EVs) loaded with antisense oligonucleotides of Trim21 (Trim21-ASOs) by the liver macrophages of obesity. Consequently, the inhibition of macrophage inflammatory responses in obese mice mediated by RBC-EVs/Trim21-ASOs was further enhanced by PPIs, resulting in a more profound improvement in obesity and related metabolic disorders. In conclusion, our findings demonstrated that PPIs can effectively clear pathogenic EVs and enhance the delivery efficacy of EV vehicles, making them a highly promising clinical prospect.