Treatment Of Upper Gastrointestinal Disorders Research Articles

Drug treatment of upper gastrointestinal disorders due to hyperacidity and peptic ulcer

Drug treatment of upper gastrointestinal disorders due to hyperacidity and peptic ulcer

Pantoprazole, a proton pump inhibitor, increases orthodontic tooth movement in rats.

Pantoprazole, is a proton pump inhibitor (PPI) prescribed for the treatment of upper gastrointestinal disorders, which in high doses has been suggested to decrease calcium absorption leading to hypocalcaemia and therefore osteoporosis. The aim of this study was to assess whether pantoprazol, could alter the rate of orthodontic tooth movement (OTM) in rats. A time course study was established using 72 rats which were divided into six groups of 12 samples each (four: vehicle; eight: pantoprazole + vehicle). Pantoprazole at a dose of 200 mg/kg suspended in carboxymethyl cellulose (0.25 percent) was administered by a gastric tube. The upper incisors and first molars were ligated by a 5 mm nickel-titanium closed-coil spring to deliver an initial force of 60 g. Animals were euthanized two weeks after orthodontic treatment followed by assessment of tooth movement and histomorphometric evaluation of the detached maxillae. Lateral skull radiographs were obtained once a week, starting from the first day to the 6(th) week of the study. OTM and bone density data were analyzed using independent sample t-test and repeated measures ANOVA. No significant changes in OTM measurements and optical density were observed in vehicle-receiving animals during the study (P=0.994). OTM was significantly increased after six weeks pantoprazole therapy which continued until the 7(th) week of the experiment (P=0.007). Optical density significantly increased in the pantoprazole-treated rats after six weeks. Long term PPI therapy at high doses could lead to osteoporosis and enhanced OTM.

Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications.

Proton pump inhibitors (PPIs) remain the superior choice worldwide in antisecretory therapy in the evidence-based treatment of upper gastrointestinal disorders including gastroesophageal reflux disease, erosive esophagitis, dyspepsia and peptic ulcer disease. PPI overutilization in ambulatory care settings is often a result of failure to re-evaluate the need for continuation of therapy, or insufficient use of on-demand and step-down therapy. Nonjudicious use of PPIs creates both preventable financial as well as medical concerns. PPIs have been associated with an increased risk of vitamin and mineral deficiencies impacting vitamin B12, vitamin C, calcium, iron and magnesium metabolism. While these risks are considered to be relatively low in the general population, they may be notable in elderly and malnourished patients, as well as those on chronic hemodialysis and concomitant PPI therapy. No current evidence recommends routine screening or supplementation for these potential vitamin and mineral deficiencies in patients on either short- or long-term PPI therapy. Reducing inappropriate prescribing of PPIs can minimize the potential risk of vitamin and mineral deficiencies.

Magnitude and Economic Impact of Inappropriate Use of Proton Pump Inhibitors for Treatment of Upper Gastrointestinal Disorders in the Ambulatory Care Setting

Purpose: Proton pump inhibitors (PPIs) are the most commonly prescribed anti-secretory therapy for the treatment of upper gastrointestinal (UGI) disorders. Many patients prescribed PPIs in the ambulatory care setting do not have a valid indication, or are left on PPIs indefinitely without documented re-evaluation to determine appropriateness of continued therapy. Our aim was to determine the prevalence and economic impact of inappropriate PPI utilization in an ambulatory setting. Methods: A retrospective chart review of 946 consecutive adult patients in a VA hospital ambulatory care practice who were receiving PPI therapy was conducted. Patients were categorized according to appropriateness of pharmacotherapy based upon documented UGI diagnoses (e.g. gastroesophageal reflux disease, peptic ulcer disease, esophagitis, Barrett's esophagus), gastrointestinal or extraesophageal symptoms (e.g. dyspepsia, chest pain, cough, hoarseness) or gastroprotection (e.g. patients on coumadin or non-steroidal anti-inflammatory drugs). Costs were based on 2 settings: lowest over-the-counter (OTC) costs for the base case and average wholesale price (AWP) in a sensitivity analysis. Adverse events potentially associated with PPI use were identified. Results: 35.2% of patients were prescribed PPI therapy for a documented UGI diagnosis while 13.1% received PPIs empirically for symptoms, 18.9% received PPIs for gastroprotection and the remaining 32.8% had no documented appropriate indication for PPI therapy. 60.9% of patients across all four categories received PPIs for over one year without documentation of re-evaluation, accounting for 643.6 patient-years of PPI use without appropriate documented indication. The total cost of inappropriate PPI use was $145,647 based on OTC PPI costs and $974,893 based on AWP costs. Adverse events included Clostridium difficile colitis (6 cases) and community-acquired pneumonia (1 case), but no cases of hip fracture or vitamin B12 deficiency were identified. Conclusion: PPIs are often overutilized in the ambulatory care setting without documented valid indications. The majority of patients for whom PPIs are prescribed are not reassessed to confirm necessity of continued therapy. Inappropriate use of PPIs is associated with substantial cost expenditure and potential adverse events.

Hormones of the gut–brain axis as targets for the treatment of upper gastrointestinal disorders

The concept of the gut forming the centre of an integrated gut-brain-energy axis - modulating appetite, metabolism and digestion - opens up new paradigms for drugs that can tackle multiple symptoms in complex upper gastrointestinal disorders. These include eating disorders, nausea and vomiting, gastroesophageal reflux disease, gastroparesis, dyspepsia and irritable bowel syndrome. The hormones that modulate gastric motility represent targets for gastric prokinetic drugs, and peptides that modify eating behaviours may be targeted to develop drugs that reduce nausea, a currently poorly treated condition. The gut-brain axis may therefore provide a range of therapeutic opportunities that deliver a more holistic treatment of upper gastrointestinal disorders.

Good bugs and bad bugs: indications and therapies for Helicobacter pylori eradication.

The discovery of Helicobacter pylori has had a major clinical impact. Clinical research is now focused on the role of H. pylori and H. pylori eradication in the treatment of several upper gastrointestinal disorders such as non-ulcer dyspepsia, ulceration during therapy with aspirin or other anti-inflammatory drugs, the treatment of precancerous conditions of the stomach, and the prevention of gastric cancer. Triple and quadruple therapies have become the standard for H. pylori eradication. The expansion of knowledge and the development of new therapeutic modalities are likely to lead to a further implementation of H. pylori-related methods in strategies for the prevention and treatment of upper gastrointestinal disorders.

Development of an economic model for the management of upper gastrointestinal disease in primary care. Preliminary findings.

Health economic models for identifying therapeutic options that maximise health benefits from limited healthcare resources are being developed in a number of therapeutic areas. The development of such a model for upper gastrointestinal (UGI) symptoms to support decision-making by primary care clinicians is of particular importance, given the prevalence of this symptomatology. This economic model was based upon the clinical guidelines aimed at improving the management of UGI disorders at the primary care level that were developed by the International Gastro Primary Care Group. This paper discusses the derivation, methodology and results of the economic model developed to assess the resource implications arising from these clinical guidelines. In order to construct the economic model, it was necessary to identify the following: every therapeutic pathway followed by patients resource use along each pathway the probabilities of following alternative pathways. One crucial factor underlying the interpretation of results obtained from any economic model is the time period covered by the model. The model presented here analysed the initial 12-month treatment period of 'new' patients presenting with UGI symptoms. In order to test the implications of a longer term perspective, the model is currently being developed to analyse resource use over a 24-month period. The model demonstrates that utilising the predominant symptom approach to the diagnosis and treatment of patients with UGI disorders appears to provide significant benefits in terms of patient management and effective resource use. This factor, together with the more intensive use of Helicobacter pylori eradication therapy, provides the potential to reduce the cost of drugs for the treatment of UGI disorders by approximately 15% in the UK. A major strength of the model is its adaptability to a wide range of clinical and cost scenarios. Such adaptability enables the model to effectively reflect the potential resource implications in countries exhibiting significantly different levels of cost and patient management. In this manner, the model provides one valuable method by which clinicians can be supported in optimising the management of UGI disorders within current resource constraints.