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ABSTRACT: BACKGROUND: Recent advances in eosinophilic oesophagitis (EoE) have confirmed the existence of a new disease phenotype, proton pump inhibitor (PPI)-responsive oesophageal eosinophilia (PPI-REE). AIM: To summarise evidence supporting the use of PPI therapy in patients with suspected EoE (oesophageal dysfunction plus >15 eos/HPF in oesophageal biopsies). METHODS: A literature search was conducted through MEDLINE, using the MeSH search terms 'eosinophilic oesophagitis', 'proton pump inhibitors' and 'oesophageal eosinophilia'. Relevant articles and their reference lists were identified through manual review. RESULTS: Ten articles, including 258 patients with suspected EoE (152 children, 106 adults) undergoing clinico-histological re-evaluation after PPI therapy, were identified. In children, clinical response ranged from 78% to 86% and histological remission from 23% to 40%. In adults, symptom response ranged from 25% to 80% and histological remission from 33% to 61%. Among PPI-REE patients with oesophageal pH-monitoring, 35 showed pathological and 10 normal studies. PPI-REE was significantly commoner with documented gastro-oesophageal reflux disease (GERD) when compared to patients with negative pH monitoring (70% vs. 29%, P < 0.001). Symptom improvement/resolution occurred in 50-85% of patients without histological remission on PPI therapy. Six PPI-REE patients demonstrated clinico-histological relapse on PPI therapy. CONCLUSIONS: At least one third of patients with suspected EoE achieve clinico-histological remission on PPI therapy. Response is more limited in children compared with that in adults. pH monitoring does not accurately predict response to PPI therapy, albeit histological remission is significantly higher, up to 70%, upon documented GERD. Symptom improvement is common with PPI therapy despite persistent eosinophilic infiltration.
Alimentary Pharmacology & Therapeutics 05/2013; · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 05/2013; 37(10):1029-1030. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 05/2013; 37(10):1025-1026. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 04/2013; 37(7):760-1. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 02/2013; 37(3):365-6. · 3.77 Impact Factor
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M J Casanova,
M Chaparro,
E Domènech,
M Barreiro-de Acosta,
F Bermejo,
E Iglesias,
F Gomollón,
L Rodrigo,
X Calvet,
M Esteve, [......],
B Beltrán,
M Piqueras,
C Saro,
B Botella,
C Dueñas,
A Ponferrada,
M Mañosa,
V García-Sánchez,
J Maté, J P Gisbert
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ABSTRACT: OBJECTIVES:The safety of thiopurines and anti-tumor necrosis factor-α (TNF-α) drugs during pregnancy remains controversial, as the experience with these drugs in this situation is limited. Our aim is to assess the safety of thiopurines and anti-TNF-α drugs for the treatment of inflammatory bowel disease (IBD) during pregnancy.METHODS:Retrospective, multicenter study in IBD patients. Pregnancies were classified according to the therapeutic regimens during pregnancy or during the 3 months before the conception: non-exposed group, pregnancies exposed to thiopurines alone (group A), and pregnancies exposed to anti-TNF-α drugs (group B). An unfavorable Global Pregnancy Outcome (GPO) was considered if pregnancy developed with obstetric complications in the mother and in the newborn.RESULTS:A total of 187 pregnancies in the group A, 66 pregnancies in the group B, and 318 pregnancies in the non-exposed group were included. The rate of unfavorable GPO was different among the three groups (31.8% in non-exposed group, 21.9% in group A, and 34.8% in group B), being lower in pregnancies under thiopurines than among non-exposed (P=0.01). The rate of pregnancy complications was similar among the three groups (27.7% in non-exposed, 20.9% in group A, and 30.3% in group B). The rate of neonatal complications was different among the three groups (23.3% in non-exposed group, 13.9% in group A, and 21.2% in group B), being lower in pregnancies under thiopurines than among non-exposed (P=0.01). In the multivariate analysis, the treatment with thiopurines (odds ratio=0.6; 95% confidence interval=0.4-0.9, P=0.02) was the only predictor of favorable GPO, whereas maternal age >35 years at conception was the only predictor of unfavorable GPO. The treatment with anti-TNF-α drugs was not associated with an unfavorable GPO.CONCLUSION:The treatment with thiopurines and anti-TNF-α drugs does not seem to increase the risk of complications during pregnancy and does seem to be safe for the newborn.Am J Gastroenterol advance online publication, 15 January 2013; doi:10.1038/ajg.2012.430.
The American Journal of Gastroenterology 01/2013; · 7.28 Impact Factor
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Alimentary Pharmacology & Therapeutics 01/2013; 37(1):163-4. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 01/2013; 37(1):160-1. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 10/2012; 36(7):685-6. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 10/2012; 36(8):812. · 3.77 Impact Factor
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ABSTRACT: Objectives:We assessed the effectiveness of hepatitis B virus (HBV) vaccine in inflammatory bowel disease (IBD) patients, evaluated the impact of immunosuppressors and anti-tumor necrosis factor (anti-TNF) agents, and assessed the effectiveness of revaccination.Methods:IBD patients were vaccinated against HBV with a quick (0, 1, and 2 months) and double-dose schedule (Engerix B). A second vaccination was administered to nonresponders.Results:Of 241 vaccinated patients, anti-HBs was >10 IU/l in 59% and >100 IU/l in 39%. The response rate (anti-HBs >10 IU/l) was lower among patients under anti-TNF therapy: 46% vs. 62%. In the multivariate analysis, a lower response rate was demonstrated in older patients and those receiving anti-TNFs. The response rate (anti-HBs >100 IU/l) after revaccination was 42%.Conclusions:The response rate to the HBV vaccination-even with a double-dose schedule-is very low in IBD patients, mainly in those receiving anti-TNFs. However, treatment with immunosuppressors did not affect the efficacy of the vaccine. A considerable-albeit insufficient-success rate may be obtained when two consecutive vaccination courses, each with a three-dose vaccine series, are administered.
The American Journal of Gastroenterology 10/2012; 107(10):1460-6. · 7.28 Impact Factor
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Alimentary Pharmacology & Therapeutics 09/2012; 36(5):498-9. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 09/2012; 36(5):497; author reply 498. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 09/2012; 36(6):600-1; author reply 601-2. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 09/2012; 36(6):606. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 08/2012; 36(4):400-1. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 08/2012; 36(3):297-8; author reply 298-9. · 3.77 Impact Factor
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ABSTRACT: The decreasing efficacy of H. pylori eradication treatments over time makes the search for better regimens and adjuvant medications a priority.
To conduct a meta-analysis of studies comparing rabeprazole or esomeprazole with other proton pump inhibitors (PPI) or with each other in H. pylori eradication treatment.
Selection of Studies: Randomised clinical trials comparing esomeprazole or rabeprazole with first-generation PPIs (omeprazole-lansoprazole-pantoprazole) or with each other.
The meta-analysis (35 studies, 5998 patients) showed higher eradication rates for esomeprazole than for first-generation PPIs: 82.3% vs. 77.6%; OR = 1.32(1.01-1.73); NNT = 21. Rabeprazole also showed better results than first-generation PPIs: 80.5% vs. 76.2%; OR = 1.21(1.02-1.42); NNT = 23. PPI dosage sub-analysis: only esomeprazole 40 mg b.d. improved results [83.5% esomeprazole vs. 72.4% first generation; OR = 2.27(1.07-4.82); NNT = 9]. Whereas rabeprazole 10 and 20 mg b.d. maintained results, esomeprazole 20 mg b.d. obtained lower efficacy. Esomeprazole vs. rabeprazole sub-analysis (five studies): no significant differences were found: 78.7% vs. 76.7%; OR = 0.90(0.70-1.17). CYP2C19 sub-analysis: Genotype did not significantly affect eradication either in first [OR = 1.76(0.99-3.12)] or new generation [OR = 1.19(0.73-1.95)] PPIs. However, sub-analysis considering only extensive metaboliser patients showed higher eradication with new-generation PPIs [OR = 1.37(1.02-1.84)].
Esomeprazole and rabeprazole show better overall H. pylori eradication rates than first-generation PPIs. This clinical benefit is more pronounced in esomeprazole 40 mg b.d. regimens. In CYP2C19 extensive metabolisers, new-generation PPIs are more effective than first-generation PPIs for H. pylori eradication. However, a general recommendation of using new-generation PPIs in all scenarios remains unclear.
Alimentary Pharmacology & Therapeutics 07/2012; 36(5):414-25. · 3.77 Impact Factor
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Alimentary Pharmacology & Therapeutics 07/2012; 36(2):208-9; author reply 209-10. · 3.77 Impact Factor
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J P Gisbert,
X Calvet,
A Cosme,
P Almela,
F Feu,
F Bory,
S Santolaria,
R Aznárez,
M Castro,
N Fernández,
R García-Grávalos,
A Benages,
N Cañete,
M Montoro,
F Borda,
A Pérez-Aisa,
J M Piqué
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ABSTRACT: To evaluate the effect of Helicobacter pylori (H. pylori) eradication on ulcer bleeding recurrence in a prospective, long-term study including 1,000 patients.
Patients with peptic ulcer bleeding were prospectively included. Prior non-steroidal anti-inflammatory drug (NSAID) use was not considered exclusion criteria. H. pylori infection was confirmed by rapid urease test, histology, or (13)C-urea breath test. Several eradication therapies were used. Subsequently, ranitidine 150 mg o.d. was administered until eradication was confirmed by (13)C-urea breath test 8 weeks after completing therapy. Patients with therapy failure received a second, third, or fourth course of eradication therapy. Patients with eradication success did not receive maintenance anti-ulcer therapy and were controlled yearly with a repeat breath test. NSAID use was not permitted during follow-up.
Thousand patients were followed up for at least 12 months, with a total of 3,253 patient-years of follow-up. Mean age 56 years, 75% males, 41% previous NSAID users. In all, 69% had duodenal ulcer, 27% gastric ulcer, and 4% pyloric ulcer. Recurrence of bleeding was demonstrated in three patients at 1 year (which occurred after NSAID use in two cases, and after H. pylori reinfection in another one), and in two more patients at 2 years (one after NSAID use and another after H. pylori reinfection). The cumulative incidence of rebleeding was 0.5% (95% confidence interval, 0.16-1.16%), and the incidence rate of rebleeding was 0.15% (0.05-0.36%) per patient-year of follow up.
Peptic ulcer rebleeding virtually does not occur in patients with complicated ulcers after H. pylori eradication. Maintenance anti-ulcer (antisecretory) therapy is not necessary if eradication is achieved. However, NSAID intake or H. pylori reinfection may exceptionally cause rebleeding in H. pylori-eradicated patients.
The American Journal of Gastroenterology 05/2012; 107(8):1197-204. · 7.28 Impact Factor
