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PPIs vs. Peptic Ulcer Bleeding
Proton pump inhibitors reduce the risk of bleeding and abdominal surgery in patients with peptic ulcers, and also reduce mortality among Asian patients with peptic ulcers, according to a metaanalysis of 24 randomized controlled trials.
Dr. Grigoris Leontiadis of the Democritus University of Thrace, General Hospital of Alexandroupolis, Greece, and his colleagues wrote that pooled data from all trials show no overall reduction in mortality (3.9% with PPI treatment vs. 3.8% with control treatment), but there were significant reductions in persistent bleeding (6.8% for PPI group vs. 16.2% for controls) and surgical interventions (6.1% and 9.3%, respectively). The data suggest that “mortality following an episode of ulcer bleeding may be unrelated to continued or recurrent bleeding but is more likely to be due to co-morbid disease being exacerbated because of the bleeding episode.”
The findings support using PPIs in patients with endoscopically documented peptic ulcer bleeding (Cochrane Database of Syst. Rev. 2006;DOI10.1002/14651858. CD002094.pub3).
Of the 24 trials included, 8 were conducted in Asia, and pooled mortality rates were significantly lower with PPI treatment (1.5%, vs. 4.4% for controls). Mortality rates for all non-Asian trials were higher with PPI therapy, although not significantly so (4.8% for PPI group vs. 3.6% for controls). None of the trials compared different PPIs head-to-head, so it could not be determined whether any one is more effective than the others.
Cancer Risk in Lynch Syndrome
Prophylactic surgery may help prevent gynecologic cancers in women with hereditary nonpolyposis colorectal cancer, reported Dr. Kathleen M. Schmeler of the University of Texas M.D. Anderson Cancer Center, Houston, and her associates.
In a retrospective study of patients who had germ-line mutations associated with hereditary nonpolyposis colorectal cancer (Lynch syndrome), significantly fewer endometrial cancers occurred in women who had a prophylactic hysterectomy (0 of 61) than in those who did not (69 of 210).
None of the 47 women who had undergone a bilateral salpingo-oophorectomy for cancer prevention or benign conditions at the same time as their hysterectomy developed ovarian cancer, but this was not significantly different from the number of controls who developed ovarian cancer (12 of 223). The women underwent hysterectomy or bilateral salpingo-oophorectomy at a median age of 41 years, whereas the median age at diagnosis was 46 years for endometrial cancer and 42 years for ovarian cancer, Dr. Schmeler and her colleagues wrote (N. Engl. J. Med. 2006;354:261–9).
Of the 107 women in the cohort who had colorectal cancer, endometrial or ovarian cancer occurred synchronously with colorectal cancer in 3 patients and at different times in 38 patients. In 21 of those patients, gynecologic cancer was diagnosed a median of 5 years after they underwent surgery for colorectal cancer. The gynecologic cancer in those 21 women “could have been prevented if prophylactic hysterectomy and bilateral salpingo-oophorectomy had been performed at the time of surgery for colorectal cancer,” the investigators noted.
Undetected Celiac Disease Rare in IBS
Routine serologic screening for undetected celiac disease in patients with irritable bowel syndrome is hard to justify in light of the low disease prevalence found in a large international study, Allison R. Northcutt asserted at the annual meeting of the American College of Gastroenterology.
Indeed, the prevalence of celiac disease in 1,334 screened patients with irritable bowel syndrome (IBS) in the United States and nine other countries was a mere 0.5%.
A positive test for serum IgA antibodies to tissue transglutaminase was used to diagnose celiac disease. None of the patients who participated in this study of a novel IBS drug were previously known to have had celiac disease, said Ms. Northcutt of GlaxoSmithKline in Research Triangle Park, N.C.
The gastrointestinal symptoms associated with celiac disease—abdominal pain, constipation, bloating, and diarrhea—are nonspecific. They are also characteristic of patients with IBS, the most common condition for which patients go to a gastroenterologist.
For this reason, it has been theorized that the prevalence of undetected celiac disease in IBS patients may be considerably enriched over the 1%–3% rate in the general population of North America and Europe. This theory is supported by a number of studies, mostly involving small numbers of IBS patients.
Some physicians have proposed that serologic screening for celiac disease should be routine in IBS patients, but Ms. Northcutt's data suggest that the cost may not be justified.
PPIs vs. Peptic Ulcer Bleeding
Proton pump inhibitors reduce the risk of bleeding and abdominal surgery in patients with peptic ulcers, and also reduce mortality among Asian patients with peptic ulcers, according to a metaanalysis of 24 randomized controlled trials.
Dr. Grigoris Leontiadis of the Democritus University of Thrace, General Hospital of Alexandroupolis, Greece, and his colleagues wrote that pooled data from all trials show no overall reduction in mortality (3.9% with PPI treatment vs. 3.8% with control treatment), but there were significant reductions in persistent bleeding (6.8% for PPI group vs. 16.2% for controls) and surgical interventions (6.1% and 9.3%, respectively). The data suggest that “mortality following an episode of ulcer bleeding may be unrelated to continued or recurrent bleeding but is more likely to be due to co-morbid disease being exacerbated because of the bleeding episode.”
The findings support using PPIs in patients with endoscopically documented peptic ulcer bleeding (Cochrane Database of Syst. Rev. 2006;DOI10.1002/14651858. CD002094.pub3).
Of the 24 trials included, 8 were conducted in Asia, and pooled mortality rates were significantly lower with PPI treatment (1.5%, vs. 4.4% for controls). Mortality rates for all non-Asian trials were higher with PPI therapy, although not significantly so (4.8% for PPI group vs. 3.6% for controls). None of the trials compared different PPIs head-to-head, so it could not be determined whether any one is more effective than the others.
Cancer Risk in Lynch Syndrome
Prophylactic surgery may help prevent gynecologic cancers in women with hereditary nonpolyposis colorectal cancer, reported Dr. Kathleen M. Schmeler of the University of Texas M.D. Anderson Cancer Center, Houston, and her associates.
In a retrospective study of patients who had germ-line mutations associated with hereditary nonpolyposis colorectal cancer (Lynch syndrome), significantly fewer endometrial cancers occurred in women who had a prophylactic hysterectomy (0 of 61) than in those who did not (69 of 210).
None of the 47 women who had undergone a bilateral salpingo-oophorectomy for cancer prevention or benign conditions at the same time as their hysterectomy developed ovarian cancer, but this was not significantly different from the number of controls who developed ovarian cancer (12 of 223). The women underwent hysterectomy or bilateral salpingo-oophorectomy at a median age of 41 years, whereas the median age at diagnosis was 46 years for endometrial cancer and 42 years for ovarian cancer, Dr. Schmeler and her colleagues wrote (N. Engl. J. Med. 2006;354:261–9).
Of the 107 women in the cohort who had colorectal cancer, endometrial or ovarian cancer occurred synchronously with colorectal cancer in 3 patients and at different times in 38 patients. In 21 of those patients, gynecologic cancer was diagnosed a median of 5 years after they underwent surgery for colorectal cancer. The gynecologic cancer in those 21 women “could have been prevented if prophylactic hysterectomy and bilateral salpingo-oophorectomy had been performed at the time of surgery for colorectal cancer,” the investigators noted.
Undetected Celiac Disease Rare in IBS
Routine serologic screening for undetected celiac disease in patients with irritable bowel syndrome is hard to justify in light of the low disease prevalence found in a large international study, Allison R. Northcutt asserted at the annual meeting of the American College of Gastroenterology.
Indeed, the prevalence of celiac disease in 1,334 screened patients with irritable bowel syndrome (IBS) in the United States and nine other countries was a mere 0.5%.
A positive test for serum IgA antibodies to tissue transglutaminase was used to diagnose celiac disease. None of the patients who participated in this study of a novel IBS drug were previously known to have had celiac disease, said Ms. Northcutt of GlaxoSmithKline in Research Triangle Park, N.C.
The gastrointestinal symptoms associated with celiac disease—abdominal pain, constipation, bloating, and diarrhea—are nonspecific. They are also characteristic of patients with IBS, the most common condition for which patients go to a gastroenterologist.
For this reason, it has been theorized that the prevalence of undetected celiac disease in IBS patients may be considerably enriched over the 1%–3% rate in the general population of North America and Europe. This theory is supported by a number of studies, mostly involving small numbers of IBS patients.
Some physicians have proposed that serologic screening for celiac disease should be routine in IBS patients, but Ms. Northcutt's data suggest that the cost may not be justified.
PPIs vs. Peptic Ulcer Bleeding
Proton pump inhibitors reduce the risk of bleeding and abdominal surgery in patients with peptic ulcers, and also reduce mortality among Asian patients with peptic ulcers, according to a metaanalysis of 24 randomized controlled trials.
Dr. Grigoris Leontiadis of the Democritus University of Thrace, General Hospital of Alexandroupolis, Greece, and his colleagues wrote that pooled data from all trials show no overall reduction in mortality (3.9% with PPI treatment vs. 3.8% with control treatment), but there were significant reductions in persistent bleeding (6.8% for PPI group vs. 16.2% for controls) and surgical interventions (6.1% and 9.3%, respectively). The data suggest that “mortality following an episode of ulcer bleeding may be unrelated to continued or recurrent bleeding but is more likely to be due to co-morbid disease being exacerbated because of the bleeding episode.”
The findings support using PPIs in patients with endoscopically documented peptic ulcer bleeding (Cochrane Database of Syst. Rev. 2006;DOI10.1002/14651858. CD002094.pub3).
Of the 24 trials included, 8 were conducted in Asia, and pooled mortality rates were significantly lower with PPI treatment (1.5%, vs. 4.4% for controls). Mortality rates for all non-Asian trials were higher with PPI therapy, although not significantly so (4.8% for PPI group vs. 3.6% for controls). None of the trials compared different PPIs head-to-head, so it could not be determined whether any one is more effective than the others.
Cancer Risk in Lynch Syndrome
Prophylactic surgery may help prevent gynecologic cancers in women with hereditary nonpolyposis colorectal cancer, reported Dr. Kathleen M. Schmeler of the University of Texas M.D. Anderson Cancer Center, Houston, and her associates.
In a retrospective study of patients who had germ-line mutations associated with hereditary nonpolyposis colorectal cancer (Lynch syndrome), significantly fewer endometrial cancers occurred in women who had a prophylactic hysterectomy (0 of 61) than in those who did not (69 of 210).
None of the 47 women who had undergone a bilateral salpingo-oophorectomy for cancer prevention or benign conditions at the same time as their hysterectomy developed ovarian cancer, but this was not significantly different from the number of controls who developed ovarian cancer (12 of 223). The women underwent hysterectomy or bilateral salpingo-oophorectomy at a median age of 41 years, whereas the median age at diagnosis was 46 years for endometrial cancer and 42 years for ovarian cancer, Dr. Schmeler and her colleagues wrote (N. Engl. J. Med. 2006;354:261–9).
Of the 107 women in the cohort who had colorectal cancer, endometrial or ovarian cancer occurred synchronously with colorectal cancer in 3 patients and at different times in 38 patients. In 21 of those patients, gynecologic cancer was diagnosed a median of 5 years after they underwent surgery for colorectal cancer. The gynecologic cancer in those 21 women “could have been prevented if prophylactic hysterectomy and bilateral salpingo-oophorectomy had been performed at the time of surgery for colorectal cancer,” the investigators noted.
Undetected Celiac Disease Rare in IBS
Routine serologic screening for undetected celiac disease in patients with irritable bowel syndrome is hard to justify in light of the low disease prevalence found in a large international study, Allison R. Northcutt asserted at the annual meeting of the American College of Gastroenterology.
Indeed, the prevalence of celiac disease in 1,334 screened patients with irritable bowel syndrome (IBS) in the United States and nine other countries was a mere 0.5%.
A positive test for serum IgA antibodies to tissue transglutaminase was used to diagnose celiac disease. None of the patients who participated in this study of a novel IBS drug were previously known to have had celiac disease, said Ms. Northcutt of GlaxoSmithKline in Research Triangle Park, N.C.
The gastrointestinal symptoms associated with celiac disease—abdominal pain, constipation, bloating, and diarrhea—are nonspecific. They are also characteristic of patients with IBS, the most common condition for which patients go to a gastroenterologist.
For this reason, it has been theorized that the prevalence of undetected celiac disease in IBS patients may be considerably enriched over the 1%–3% rate in the general population of North America and Europe. This theory is supported by a number of studies, mostly involving small numbers of IBS patients.
Some physicians have proposed that serologic screening for celiac disease should be routine in IBS patients, but Ms. Northcutt's data suggest that the cost may not be justified.