Reflux Medication Research Articles

The effects of untreated reflux on the incidence of dysphagia, oral aversion, and feeding difficulty in the NICU population.

To determine whether late-preterm and full-term neonates in the neonatal intensive care unit (NICU) with diagnosed gastroesophageal reflux (GERD) have an increased incidence of feeding difficulties, dysphagia, and oral aversion. To determine the incidence of reflux medication use in late-preterm and full-term neonates in the NICU. Neonates greater than 34 weeks gestational age (GA) diagnosed with reflux, who were hospitalized for at least five days, were included in the study. Neonates with anatomical anomalies that interfere with feeding are excluded. The control group included neonates greater than 34weeksGA not diagnosed with reflux. The key outcome variables were subjective ease of feeding, oral aversion, and placement on nasogastric (NG), orogastric (OG), or requirement of total parenteral nutrition (TPN). Statistical analysis was performed using chi-squared and t-test to compare incidence of feeding difficulties between the groups. A p-value <0.05 was considered significant. In neonates with a diagnosis of reflux, 42.02% had feeding difficulties (66 patients). In the control group, 30.49% of neonates had feeding difficulties (218 patients). Feeding difficulties in neonates with reflux was 11.55% higher than in the control group (p=0.001). Late-preterm and full-term neonates diagnosed with reflux have a higher incidence of feeding difficulties than those who did not have reflux. Only 0.86% of neonates diagnosed with reflux were treated with anti-reflux medications at this large tertiary care children's hospital.

Trends in morbidities of late preterm infants in the neonatal intensive care unit.

To characterize demographics and trends in length of stay (LOS), morbidities, and mortality in late preterm infants. Cohort study of infants born between 34 0/7 and 36 6/7 weeks gestation between 1999 and 2018 without major congenital anomalies at Pediatrix Medical Group neonatal intensive care units (NICUs). 307,967 infants from 410 NICUs met inclusion criteria. The median (25th-75th percentile) LOS was 11 (8-16) days in the entire period. Postmenstrual age (PMA) at discharge increased during the cohort for all gestational ages (p < 0.001). There was a decrease in invasive ventilation, receipt of phototherapy, and reflux medications observed (p < 0.001). In this large cohort, given 20 years of time for medical advancement, there was no significant improvement in the LOS of late preterm infants. All infants had an increased PMA at discharge, despite multiple practice changes that were observed.

Corrosive Esophageal Strictures: Alarming News for Gastroenterologists

Dysphagia is a common yet alarming symptom reported by patients during routine visits to outpatient clinics of gastroenterology. Most of them have a chronic history gastroesophageal reflux disease and use of proton pump inhibitors or anti reflux medications for years. The agonising part is that they are not referred by the physicians in the general practice. One of the major reasons behind this is persistent reluctance of patients to go for invasive investigations Gastroesophgeal reflus disease, achalasia ,hiatal hernia,benign esophgeal strictures, barrets esophagus and esophageal carcinoma are common causes of dysphagia. One of the causes which has been quite prevalent in our country is use of corrosives especially young girls and boys who are emotionaland depressed. They do something very outrageous in a moment which becomes a reason for regret for a long time .Corrosive esophgeal strictures isn’t that difficult got gastroenterology experts in normal circumstances but the cases can get complicated rarely including the risk of perforation in early stages of injury. Endoscopic dilatation either by Savory or TTS Balloon has been the cardinal line of management of corrosive strictures. They are done after necessary workup and investigations including barium swallow . The real dilemma is that patent develop complications like tracheoesophageal fistula after repeated dilatations. The length of follow up session are also difficult to determine with some centres opting for one weekly and others for two weekly sessions .Weekly sessions have been reported to ease off symptoms like dyphagia but causes higher risk of complications while in case of two weekly follow up there is enhanced risk of recurrence of symptoms and lesser complications.

Valproic Acid is an Effective Anti-Emetic Treatment in Alexander Disease (P10-9.010)

<h3>Objective:</h3> To explore safety and effectiveness of anti-emetic strategies in Alexander disease (AxD). <h3>Background:</h3> Emesis is a frequent symptom in AxD and leads to inadequate intake and food avoidance behaviors. As a result, weight loss and failure to thrive are common in AxD. We explored emesis treatment strategies to determine their relative benefits and side effects in clinical practice. <h3>Design/Methods:</h3> Medical records of patients with AxD (&lt;21 years) participating in a natural history cohort study were reviewed for history of emesis, difficulty with weight gain, and medications. Patients were retrospectively evaluated for response to medication, which was defined as a clinically meaningful decrease in emesis. Treatment failure was defined as no improvement, worsened emesis, clinically significant weight loss, or presence of an intolerable side effect. Deceased patients, patients with a Nissen fundoplication, and patients with insufficient longitudinal data were excluded. Fisher’s exact tests were used to compare response rates of valproic acid to those of anti-reflux medications (proton pump inhibitors, H2 antagonists analyzed together) or cyproheptadine. <h3>Results:</h3> Among 59 subjects with vomiting, 34 subjects met inclusion criteria. Emesis was treated with multiple anti-reflux medications (N=24), cyproheptadine (N=19), and valproic acid (VPA, N=22). Overall, 48% of patients responded to multiple anti-reflux medications, 32% responded to cyproheptadine, and 95% responded to VPA. VPA had a higher success rate in reducing emesis compared to multiple reflux medications (p=0.0001) or cyproheptadine (p&lt;0.0001). Adverse effects from VPA included bone fractures (N=1) in a non-ambulatory patient, hyperammonemia (N=2) which resolved with dose lowering, and mild hair loss (N=2). <h3>Conclusions:</h3> Recognizing the limitations of retrospective review, 95% of AxD patients on VPA showed improvements in emesis and weight gain. Response rates to VPA were greater compared to anti-reflux medications or cyproheptadine. VPA is well tolerated overall, although use should be monitored for known adverse effects. <b>Disclosure:</b> Ms. Sergio has nothing to disclose. Miss Gallison has nothing to disclose. Dr. Porcari has nothing to disclose. The institution of Mr. Joung has received research support from Ionis Pharmaceuticals. Mr. Faig has nothing to disclose. An immediate family member of Geraldine Liu has received publishing royalties from a publication relating to health care. Dr. Waldman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for SwanBio. An immediate family member of Dr. Waldman has stock in Pfizer. The institution of Dr. Waldman has received research support from Ionis Pharmaceuticals. Dr. Waldman has received publishing royalties from a publication relating to health care.

`Tis the season

It was one of those busy days in the Children's Emergency Department (ED) in December. Concerns about Group A streptococcal infections resulted in sore throats and scarlet fever being referred to ED. There was a general air of heightened anxiety among clinicians and parents. The children were happy go lucky clients. They would come in febrile and clingy. Following a dose of antipyretics and Peppa Pig, they were pleased as punch and would go home clutching presents, compliments of the season. Lurking quietly among the many febrile children would be that one child with sepsis. One had to be watchful. Amidst all this, an innocuous looking 3-week-old arrived with a history of intermittent vomiting since birth and generalised rash. He was seen by the registrar, a diagnosis of gastroesophageal reflux and cows milk protein allergy was made. The consultant reviewed the baby with the registrar. The baby's father (about 6 ft 5 in. tall) was holding a tiny incredibly alert baby with a large towel under his neck. The consultant had a fondness for babies. A quick cuddle always warms the heart especially in a busy ED setting. History was revisited again with the baby in her arms. The baby took in the proceedings with interest staring keenly at her with piercing blue eyes. He was born at term, the second child in the family. He had intermittent, small volume, non-projectile vomiting since birth. Abdominal examination was unremarkable. Hydrolysed formula and reflux medications were prescribed. The father then gave the baby a bottle. He had a small vomit, then animatedly gulped the feed, this was not quite the behaviour of a baby with reflux. The consultant watched this curious behaviour and requested a blood gas. ED became busy with an influx of febrile children, the consultant and the registrar were pulled away in different directions. An hour later, having received medications the father prepared to go home, the baby was now peacefully sleeping in his arms. He was requested to wait as the blood gas was not done as yet. The blood gas as it turned out showed hypochloremic, hypokalaemic, metabolic alkalosis suggestive of pyloric stenosis, later confirmed by ultrasound. The consultant went back to the father, apologised and explained the new plan. Father took it stoically, but expressed puzzlement. He explained that he had been feeling the baby's belly and there was no lump. Father then whipped up his shirt and showed a little scar around his umbilicus. It turned out that he had been operated for pyloric stenosis and was instructed by his mother to monitor the baby post-feed. The baby too had surgery and went home in time for Christmas. Pyloric stenosis is usually seen in infants aged 3 weeks to 3 months and can be mistaken for other conditions.1 Pyloric stenosis can run in families and a family history is a risk factor, besides this child being first born and male. The infant will usually have a period of normal feeding for the first weeks of life. However, this baby had intermittent vomiting since birth, vomiting was not forceful and the classic findings of mass abdomen and weight loss were not present. Observation in ED is as important as history and examination. The baby's feeding was the clue: there was no irritability during feeds and the voracious appetite in an alert baby was unusual. And therein lies the magic of paediatrics, there will always be the one, among many febrile children, who will come in to teach us a lesson.

Overuse of Reflux Medications in Infants.

Overuse of Reflux Medications in Infants.

An overview of eosinophilic esophagitis in children

Based on the patient's age, eosinophilic esophagitis (EE) has different clinical manifestations. Infants and young children frequently have vague manifestations such difficulty eating, nausea, and discomfort in the abdomen. Despite having symptoms that resemble gastroesophageal reflux, children with EE, do not respond to intensive ant reflux medication. Dysphagia and food impaction became the most common symptoms in adults and adolescents. EE should also be considered when treating adults and children who continue to have heartburn. Pediatric and adult patients frequently have concurrent allergy disorders such asthma, rhinitis, and eczema, in addition to peripheral eosinophilia and increased total blood IgE levels. Mucosal oedema, furrows, exudates, corrugated bands, strictures, and the alleged "crepe paper sign" are some of the endoscopic characteristics of EE. EE is widely seen as a distinct condition from reflux disorder. According to current understanding, the former could be a symptom of eosinophilic gastroenteritis or be induced by cell-mediated food hypersensitivity. Reports back up the effectiveness of steroid treatment or food restriction. To ascertain the cause, enable early clinical identification, and enhance treatment, more research is required.

Scientific journey to the first FDA-approved drug for eosinophilic esophagitis

When eosinophilia was first associated with esophagitis, it was thought to reflect gastroesophageal reflux disease, especially given the efficacy of reflux medications to abate esophageal eosinophilia in many individuals. Subsequent studies demonstrated disease remittance with amino acid-based formulas and conversely induction of esophageal eosinophilia in mice following allergen challenge. These results, along with the finding that proton pump inhibitors alleviated esophageal eosinophilia by an anti-inflammatory mechanism, turned attention away from an acid-induced pathogenesis and established eosinophilic esophagitis (EoE) as a separate disease entity driven by allergic inflammation. The disease underpinnings were elucidated by analysis of esophageal transcriptomic profiling, revealing gene signatures orchestrated by type 2 cytokine signaling, mainly IL-13. Preclinical studies showed that IL-13 overproduction was sufficient to induce EoE-like changes in mice and human exvivo systems and conversely that inhibiting IL-13 signaling attenuated these processes. An early proof-of-principle study with a humanized anti-IL-13 mAb in patients with EoE revealed correction of the EoE transcriptome and attenuation of esophageal eosinophilia, providing a rationale for advancing anti-type 2 cytokine therapy for EoE. Dupilumab, a precision therapeutic mAb that blocks the shared IL-13 and IL-4 receptor, is the first drug to advance through clinical trials and receive US Food and Drug Administration approval for EoE. The ability of dupilumab to improve clinical, histologic, endoscopic, and molecular features of EoE and garner US Food and Drug Administration approval is a victory for science, rare diseases, patients, and advocacy and provides a framework for developing additional EoE treatments and approved treatments for eosinophilic gastrointestinal disease beyond the esophagus.

Alternative and Complimentary Medication Use in Singers: A Pilot Survey

Cannabidiol (CBD) is an active ingredient in marijuana that has demonstrated anti-inflammatory properties. It's therapeutic potential and accessibility has made the product popular. Over the counter products (OTC) products have also demonstrated therapeutic potential and have been accessible in public markets for a long time. The objective was to better understand the use of CBD and OTC products amongst singers with varying singing styles. An anonymous online survey was distributed to 1053 singers via The Research Electronic Data Capture (RED-Cap) program in association with Drexel University. The survey aimed to obtain information regarding singing proficiency, styles, if respondents used CBD/OTC products, reasons for use, perceived effects on the voice due to use of these products, and how informed were they in regards to use of these products. From 1053 singers, we obtained 144 respondents (response rate of 13.7%). The average age of respondents was 51.8 years; There were 47 males, 93 females, and four who were nonbinary or preferred not to provide their gender. The majority of respondents (63.2%) were professional singers. Primary singing styles included operatic (18.1%), sacred (20.8%), and musical theater (20.1%). Eighty-seven point five percent of respondents reported warming up before singing and 22.9% reported cooling down after singing. Thirteen respondents reported use of a cannabidiol (CBD) product. Information resources for CBD used primarily came from an online website (38.5%). Among the 13 respondents who reported use of CBD products, 46.2% of these respondents did not notice any positive effects and 46.2% reported no negative effects on the voice when using CBD products. Eighty-two respondents (56.9%) reported use of an OTC, supplement, or alternative medicine product. Majority received Information resources from a physician or other healthcare provider (81.7%). The most frequently reported OTC or complimentary medications used were reflux medications, antihistamines, acetaminophen, and NSAIDs. Reduced inflammation, improved voice recovery, improved voice quality, and improved voice endurance were commonly reported positive effects on the voice with OTC/AM use. Vocal strain, hoarseness, and dryness were the most commonly reported negative effects on the voice with OTC/AM use. Stress, anxiety, or chronic pain was often the primary reason for CBD use amongst singers. The most common OTC medications were used reflux medications, antihistamines, acetaminophen, and NSAIDs.

651. LAPAROSCOPIC TOTAL FUNDOPLICATION IS SUPERIOR TO MEDICAL TREATMENT FOR REDUCING THE CANCER RISK IN BARRETT'S ESOPHAGUS: A LONG-TERM ANALYSIS

Abstract Background: The present study aims to compare the effectiveness of surgical and medical therapy in reducing the risk of cancer in Barrett's esophagus in a long-term evaluation. Methods: A prospective cohort was designed that compared Barrett's esophagus patients submitted to medical treatment with omeprazole or laparoscopic Nissen fundoplication. The groups were compared using propensity score matching paired by Barrett’s esophagus length. A total of 398 patients met inclusion criteria. There were 207 patients in the omeprazole group (Group A) and 191 in the total fundoplication group (Group B). After applying the propensity score matching paired by Barrett’s esophagus length, the Groups were 180 (Group A) and 190 (Group B). Median follow-up was 80 months. Group B was significantly superior for controlling GERD symptoms, in promoting Barrett’s esophagus regression or blocking its progression. Also was more efficient in preventing the development of dysplasia and cancer. Logistic regression was performed for the outcomes of adenocarcinoma and dysplasia, using age and BMI as covariates. Even after regression analysis, Group B was still superior to Group A to prevent esophageal adenocarcinoma or dysplasia transformation (OR: 0.51; 95% CI: 0.27 to 0.97, for adenocarcinoma or any dysplasia; and OR: 0.26; 95% CI: 0.08 to 0.81, for adenocarcinoma or high-grade dysplasia). Surgical treatment is superior to medical management, allowing for better symptom control, less need for reflux medication use, higher regression rate of the columnar epithelium and intestinal metaplasia, and lower risk for progression to dysplasia and cancer.

Pulmonary Hypertension in Children with Down Syndrome: Results from the Pediatric Pulmonary Hypertension Network Registry

To characterize distinct comorbidities, outcomes, and treatment patterns in children with Down syndrome and pulmonary hypertension in a large, multicenter pediatric pulmonary hypertension registry. We analyzed data from the Pediatric Pulmonary Hypertension Network (PPHNet) Registry, comparing demographic and clinical characteristics of children with Down syndrome and children without Down syndrome. We examined factors associated with pulmonary hypertension resolution and a composite outcome of pulmonary hypertension severity in the cohort with Down syndrome. Of 1475 pediatric patients with pulmonary hypertension, 158 (11%) had Down syndrome. The median age at diagnosis of pulmonary hypertension in patients with Down syndrome was 0.49year (IQR, 0.21-1.77years), similar to that in patients without Down syndrome. There was no difference in rates of cardiac catheterization and prescribed pulmonary hypertension medications in children with Down syndrome and those without Down syndrome. Comorbidities in Down syndrome included congenital heart disease (95%; repaired in 68%), sleep apnea (56%), prematurity (49%), recurrent respiratory exacerbations (35%), gastroesophageal reflux (38%), and aspiration (31%). Pulmonary hypertension resolved in 43% after 3years, associated with a diagnosis of pulmonary hypertension at age <6months (54% vs 29%; P=.002) and a pretricuspid shunt (65% vs 38%; P=.02). Five-year transplantation-free survival was 88% (95% CI, 80%-97%). Tracheostomy (hazard ratio [HR], 3.29; 95% CI, 1.61-6.69) and reflux medication use (HR, 2.08; 95% CI, 1.11-3.90) were independently associated with a composite outcome of severe pulmonary hypertension. Despite high rates of cardiac and respiratory comorbidities that influence the severity of pulmonary hypertension, children with Down syndrome-associated pulmonary hypertension generally have a survival rate similar to that of children with non-Down syndrome-associated pulmonary hypertension. Resolution of pulmonary hypertension is common but reduced in children with complicated respiratory comorbidities.

Laparoscopic total fundoplication is superior to medical treatment for reducing the cancer risk in Barrett's esophagus: a long-term analysis.

The present study aims to compare the effectiveness of surgical and medical therapy in reducing the risk of cancer in Barrett's esophagus in a long-term evaluation. A prospective cohort was designed that compared Barrett's esophagus patients submitted to medical treatment with omeprazole or laparoscopic Nissen fundoplication. The groups were compared using propensity score matching paired by Barrett's esophagus length. A total of 398 patients met inclusion criteria. There were 207 patients in the omeprazole group (Group A) and 191 in the total fundoplication group (Group B). After applying the propensity score matching paired by Barrett's esophagus length, the groups were 180 (Group A) and 190 (Group B). Median follow-up was 80months. Group B was significantly superior for controlling GERD symptoms. Group B was more efficient than Group A in promoting Barrett's esophagus regression or blocking its progression. Group B was more efficient than Group A in preventing the development of dysplasia and cancer. Logistic regression was performed for the outcomes of adenocarcinoma and dysplasia. Age and body mass index were used as covariates in the logistic regression models. Even after regression analysis, Group B was still superior to Group A to prevent esophageal adenocarcinoma or dysplasia transformation (odds ratio [OR]: 0.51; 95% confidence interval [CI]: 0.27-0.97, for adenocarcinoma or any dysplasia; and OR: 0.26; 95% CI: 0.08-0.81, for adenocarcinoma or high-grade dysplasia). Surgical treatment is superior to medical management, allowing for better symptom control, less need for reflux medication use, higher regression rate of the columnar epithelium and intestinal metaplasia, and lower risk for progression to dysplasia and cancer.

Effect of mycophenolate mofetil dose on antibody response following initial SARS-CoV-2 vaccination in patients with systemic sclerosis.

Effect of mycophenolate mofetil dose on antibody response following initial SARS-CoV-2 vaccination in patients with systemic sclerosis.

Management of Medication-Induced Psychiatric Disorders.

Management of Medication-Induced Psychiatric Disorders.

Saliva RNA Biomarkers of Gastrointestinal Dysfunction in Children With Autism and Neurodevelopmental Disorders: Potential Implications for Precision Medicine.

Gastrointestinal (GI) disorders are common in children with neurodevelopmental disorders such as autism spectrum disorder (ASD). A limited understanding of the biologic factors that predispose this population to GI disorders has prevented development of individualized therapies to address this important medical issue. The goal of the current study was to determine if elements of the salivary micro-transcriptome could provide insight into the biologic perturbations unique to children with ASD-related GI disturbance. This cohort study included 898 children (ages 18–73 months) with ASD, non-ASD developmental delay (DD), or typical development (TD). The saliva micro-transcriptome of each child was assessed with RNA-seq. Outputs were aligned to microbial and human databases. A Kruskal Wallis analysis of variance (ANOVA) was used to compare levels of 1821 micro-transcriptome features across neurodevelopmental status (ASD, DD, or TD) and GI presence or absence. An ANOVA was also used to compare micro-transcriptome levels among GI sub-groups (constipation, reflux, food intolerance, other GI condition, no GI condition), and to identify RNAs that differed among children taking three common GI medications (probiotics, reflux medication, or laxatives). Relationships between features identified in ANOVA testing were examined for associations with scores on the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2) and the Vineland Adaptive Behavior Scales. GI disturbance rates were higher among children with ASD than peers with TD but were similar to those with DD. Five piwi-interacting RNAs and three microbial RNAs displayed an interaction between developmental status and GI disturbance. Fifty-seven salivary RNAs differed between GI sub-groups–with microRNA differences between food intolerance and reflux groups being most common. Twelve microRNAs displayed an effect of GI disturbance and showed association with GI medication uses and measures of behavior. These 12 microRNAs displayed enrichment for 13 physiologic pathways, including metabolism/digestion long-term depression, and neurobiology of addiction. This study identifies salivary micro-transcriptome features with differential expression among children with ASD-related GI disturbance. A subset of the RNAs displays relationships with treatment modality and are associated with autistic behaviors. The pathobiologic targets of the micro-transcriptome markers may serve as targets for individualized therapeutic interventions aimed at easing pain and behavioral difficulties seen in ASD-related GI disturbance.

Positive bronchoalveolar lavage pepsin assay associated with viral and fungal respiratory infections in children with chronic cough.

To assess the association between commonly obtained endoscopic and serologic data and bronchoalveolar lavage pepsin assay (BAL) results in children with chronic cough. We performed a retrospective chart review of 72 children with a BAL pepsin obtained through our Aerodigestive Center over an 18-month period. BAL outcomes include evidence of viral, bacterial, or fungal infection, presence of lipid-laden macrophages, and cytology (eosinophils, neutrophils, and lymphocytes). Gastrointestinal outcomes include esophagogastroduodenoscopy (EGD) and pH impedance probe findings. Other characteristics include serum eosinophils, neutrophils, and lymphocytes; spirometry; FeNO; and IgE. Seventy-two patients underwent BAL pepsin testing. Median age was 4.9 years, 30.6% had severe persistent asthma, and 59.2% were on reflux medication. There was an association between positive BAL pepsin assay and positive viral panel (p = .002) or fungal culture (p = .027). No significant association found between positive BAL bacterial culture; BAL cytology; the presence of BAL lipid-laden macrophages; IgE; spirometry; FeNO; CBC neutrophil, eosinophil, or lymphocytes; pH impedance testing parameters; or EGD pathology. BAL pepsin is associated with a positive BAL viral PCR or fungal culture. Lack of correlation between pepsin-positivity and pH-impedance parameters or EGD pathology suggests microaspiration may be due to an acute event (such as a respiratory infection) rather than chronic gastroesophageal reflux disease. This may be especially true in the presence of a positive viral panel or fungal culture when a BAL pepsin is obtained.

Role of Famotidine and Other Acid Reflux Medications for SARS-CoV-2: A Pilot Study

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus-19 disease (COVID-19) pandemic. The H-2 blocker famotidine has been suggested as an FDA-approved drug that could potentially be repurposed for treatment of COVID-19. Famotidine has since been shown to improve patient outcomes and reduce symptom severity in patients acutely ill with COVID-19. Other studies have suggested that proton pump inhibitors (PPIs) might have an association with COVID-19.ObjectiveThe purpose of the present study was to determine whether famotidine or any other antireflux medications have a prophylactic or detrimental effect for SARS-CoV-2 infection when taken regularly for the management of acid reflux.MethodsAn anonymous, web-based survey was distributed via email to adult otolaryngology patients to collect demographic data, past medical history, medication history, incidence of symptoms associated with COVID-19, potential exposure to SARS-CoV-2, and results of any PCR or serological testing. Associations between reflux medications and incidence of COVID-19 cases were analyzed. Statistical analysis was performed using SPSS. Chi-square with Fisher's exact test, Point-Biserial correlation, Kendall's-tau-b, independent samples t test, and the Mann-Whitney U test were used as appropriate. A binary logistic regression model was fit to determine probability of COVID-19 cases after adjustment for other risk factors.ResultsThere were 307 patients who responded to the survey. The average age of respondents was 52.63 ± 17.03. Famotidine use was not associated with incidence of laboratory-confirmed (P= 0.717) or symptomatically suspected (P= 0.876) COVID-19. No other reflux medications were found to be significant predictors for laboratory-confirmed or suspected COVID-19 (P> 0.05). Younger age (odds ratio [OR] = 1.043, 95% CI: 1.020–1.065, P< 0.001), high risk obesity (OR = 4.005, 95% CI: 1.449–11.069, P= 0.007), and use of a corticosteroid nasal spray (OR = 3.529, 95% CI: 1.352–9.211, P= 0.010) were significant predictors for symptomatically suspected COVID-19 cases.ConclusionsThere was no association between incidence of COVID-19 and use of reflux medications, including famotidine at doses used orally to manage reflux and high dose PPIs. Reflux medications did not protect against or increase the risk of COVID-19.

Associations between socioeconomic deprivation and pharmaceutical prescribing in primary care in England

BackgroundSocioeconomic deprivation is associated with health inequality. Previous studies have described associations between primary care prescribing rates and deprivation for individual drugs or drug classes. We explore the correlation between...

Identifying Patterns of Comorbidities with Cancers of the Colon and Rectum, as Related to age at Diagnosis

IntroductionAustralians have a high incidence of Colorectal cancer (CRC) and it is the second leading cause of cancer death. CRC patients experience more comorbid conditions such as diabetes and heart diseases than expected from population norms. It is anticipated that older patients with CRC will have even more comorbidities.&#x0D; ApproachData from South Australia Cancer Registry were linked with hospital inpatient separations (public and private) and Pharmaceutical Benefit Scheme data to acquire a detailed dataset of CRC patients in South Australia. We have investigated the prevalence of different comorbidities by age and subsite (colon vs rectal) in the 12 months period prior to CRC diagnosis using the chronic comorbid conditions used by Charlson and RX-risk indices.&#x0D; ResultsOf 11,656 CRCs diagnosed in 2003-2013, a significant higher prevalence of comorbidity presented in colon than rectal cancer patients using either indices. The most prevalent comorbidities for colon and rectal cancers respectively were: hypertension (25.9%, 22.0%), diabetes (17.3%, 15.6%) and gastric disease (11.4%, 12.4%). Common medications for colon and rectal cancers respectively were: hyperlipidaemia (38.4%, 33.7%), hypertension (38.0%, 31.7%) and gastroesophageal reflux diseases (36.2%, 26.8%). In younger patients (&lt;50 years) with colon and rectal cancer anaemia (9.1%) and diabetes (7.4%) were the most prevalent comorbidities and gastroesophageal reflux medications (17.1%) and opioids (14.5%) were used most frequently whereas, in older patients (&gt;79 years) hypertension (36.7%, 32.7%) was the most prevalent comorbid condition and hypertensive drugs (52.23%, 51,72%)were the most frequently used medication respectively.&#x0D; ConclusionAlthough often regarded as a single disease (CRC), colon and rectal cancers have different predisposing factors and clinical features. As expected, older patients have a higher prevalence of comorbid chronic diseases. We observe, however, that colon and rectal cancer have different comorbidity patterns by age.

The Relationship Between Chronic Cough and Laryngopharyngeal Reflux

The purpose of our study was to investigate the relationship between chronic cough and LPR by using the objective results of 24-hour pH impedance studies. We conducted a retrospective chart review of all patients who presented to the voice center of the senior author (RTS) with a chief complaint of chronic cough and no previous diagnosis of reflux. Patient demographics, past medical history, laboratory data, and exam findings during the initial visit from 2015 to 2020 and at follow-up were analyzed. We identified 28 patients who presented with a chief complaint of chronic cough and who had not been diagnosed with or treated for reflux previously. Twenty-three had additional risk factors for chronic cough (asthma, chronic sinusitis, and bronchial schwannoma). All 28 had findings consistent with LPR upon exam. Treatment with reflux medications and lifestyle modification decreased the reflux finding score significantly from 11.39 to 9.21 (P= 0.005). Of all, 60.7% of patients reported subjective improvement in cough symptoms. The cough had improved in 50.0% and had resolved completely in 10.7%. Patients with VF paresis were less likely to report improvement in their cough. Further workup was performed for the 11 patients who had cough that did not resolve completely after reflux treatment. Detectable levels of antimycoplasma antibodies were found in nine patients, and antipertussis antibodies were found in two patients. Six patients followed up after a course of clarithromycin, three of whom had experienced improvement in their cough. Our findings suggest that LPR may be a prevalent contributing or etiologic factor for chronic cough. The expected improvement after initiating reflux treatment is 60% at 3 months. Cough resolved completely in 10% of patients at 4 months. Nonresponders may have other contributing causes of cough, including esophageal dysmotility, mycoplasma, pertussis, and other contributors. Further studies are needed to confirm or refute these findings.