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Crone V, Møller MH, Baekgaard ES, Perner A, Bytzer P, Alhazzani W, Krag M. Use of prokinetic agents in hospitalised adult patients: A scoping review. Acta Anaesthesiol Scand 2023; 67:588-598. [PMID: 36847067 DOI: 10.1111/aas.14222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Gastrointestinal motility is important for adequate uptake of fluids and nutrition but is often impaired in hospitalised patients. Prokinetic agents enhance gastrointestinal motility and are prescribed for many hospitalised patients. In this scoping review, we aimed to systematically describe the body of evidence on the use of prokinetic agents in hospitalised patients. We hypothesised, that the body of evidence would be limited and derive from heterogeneous populations. METHODS We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement. We searched Medline, Embase, Epistemonikos and the Cochrane Library for studies assessing the use of prokinetic agents on any indication and outcome in adult hospitalised patients. We used a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence. RESULTS We included 102 studies with a total of 8830 patients. Eighty-six studies were clinical trials (84%), and 52 (60%) of these were conducted in the intensive care unit, with feeding intolerance as the main indication. In the non-intensive care setting the indications were wider; most studies assessed use of prokinetic agents before gastroscopy to improve visualisation. The most studied prokinetic agent was metoclopramide (49% of studies) followed by erythromycin (31%). In total 147 outcomes were assessed with only 67% of the included studies assessing patient-centred outcomes, and with gastric emptying as the most frequently reported outcome. Overall, the data provided no firm evidence on the balance between the desirable and undesirable effects of prokinetic agents. CONCLUSIONS In this scoping review, we found that the studies addressing prokinetic agents in hospitalised adults had considerable variations in indications, drugs and outcomes assessed, and that the certainty of evidence was judged to be low to very low.
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Affiliation(s)
- Vera Crone
- Department of Intensive Care, Holbaek Hospital, Holbaek, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Bytzer
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mette Krag
- Department of Intensive Care, Holbaek Hospital, Holbaek, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Svendsen AT, Nielsen HL, Bytzer P, Coia JE, Engberg J, Holt HM, Lemming L, Lomborg S, Marmolin ES, Olesen BS, Andersen LP, Ethelberg S, Engsbro AL. The incidence of laboratory-confirmed cases of enteric pathogens in Denmark 2018: a national observational study. Infect Dis (Lond) 2023; 55:340-350. [PMID: 36868794 DOI: 10.1080/23744235.2023.2183253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Only a subset of enteric pathogens is under surveillance in Denmark, and knowledge on the remaining pathogens detected in acute gastroenteritis is limited. Here, we present the one-year incidence of all enteric pathogens diagnosed in Denmark, a high-income country, in 2018 and an overview of diagnostic methods used for detection. METHODS All 10 departments of clinical microbiology completed a questionnaire on test methods and provided 2018-data of persons with positive stool samples with Salmonella species, Campylobacter jejuni/coli, Yersinia enterocolitica, Aeromonas species, diarrheagenic Escherichia coli (Enteroinvasive (EIEC), Shiga toxin-producing (STEC), Enterotoxigenic (ETEC), Enteropathogenic (EPEC), and intimin-producing/attaching and effacing (AEEC)), Shigella species., Vibrio cholerae, norovirus, rotavirus, sapovirus, adenovirus, Giardia intestinalis, Cryptosporidium species, and Entamoeba histolytica. RESULTS Enteric bacterial infections were diagnosed with an incidence of 229.9 cases/100,000 inhabitants, virus had an incidence of 86/100,000 and enteropathogenic parasites of 12.5/100,000. Viruses constituted more than half of diagnosed enteropathogens for children below 2 years and elderly above 80 years. Diagnostic methods and algorithms differed across the country and in general PCR testing resulted in higher incidences compared to culture (bacteria), antigen-test (viruses), or microscopy (parasites) for most pathogens. CONCLUSIONS In Denmark, the majority of detected infections are bacterial with viral agents primarily detected in the extremes of ages and with few intestinal protozoal infections. Incidence rates were affected by age, clinical setting and local test methods with PCR leading to increased detection rates. The latter needs to be taken into account when interpreting epidemiological data across the country.
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Affiliation(s)
- Anna Tølbøll Svendsen
- Department of Medicine, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Bytzer
- Department of Medicine, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - John Eugenio Coia
- Department of Clinical Microbiology, Sydvestjysk Sygehus, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern, Odense, Denmark
| | - Jørgen Engberg
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
| | - Hanne Marie Holt
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Lars Lemming
- Department of Clinical Microbiology, Aarhus University Hospital, Denmark
| | - Steen Lomborg
- Department of Clinical Microbiology, Sygehus Sønderjylland, Aabenraa, Denmark
| | - Ea Sofie Marmolin
- Department of Clinical Microbiology, Sygehus Lillebælt, Vejle, Denmark
| | - Bente Scharvik Olesen
- Department of Clinical Microbiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Leif Percival Andersen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Steen Ethelberg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark.,Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Anne Line Engsbro
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark.,Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Nyssen OP, Vaira D, Pérez Aísa Á, Rodrigo L, Castro-Fernandez M, Jonaitis L, Tepes B, Vologzhanina L, Caldas M, Lanas A, Lucendo AJ, Bujanda L, Ortuño J, Barrio J, Huguet JM, Voynovan I, Lasala JP, Sarsenbaeva AS, Fernandez-Salazar L, Molina-Infante J, Jurecic NB, Areia M, Gasbarrini A, Kupčinskas J, Bordin D, Marcos-Pinto R, Lerang F, Leja M, Buzas GM, Niv Y, Rokkas T, Phull P, Smith S, Shvets O, Venerito M, Milivojevic V, Simsek I, Lamy V, Bytzer P, Boyanova L, Kunovský L, Beglinger C, Doulberis M, Marlicz W, Goldis A, Tonkić A, Capelle L, Puig I, Megraud F, Morain CO, Gisbert JP. Empirical Second-Line Therapy in 5000 Patients of the European Registry on Helicobacter pylori Management (Hp-EuReg). Clin Gastroenterol Hepatol 2022; 20:2243-2257. [PMID: 34954341 DOI: 10.1016/j.cgh.2021.12.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS After a first Helicobacter pylori eradication attempt, approximately 20% of patients will remain infected. The aim of the current study was to assess the effectiveness and safety of second-line empiric treatment in Europe. METHODS This international, multicenter, prospective, non-interventional registry aimed to evaluate the decisions and outcomes of H pylori management by European gastroenterologists. All infected adult cases with a previous eradication treatment attempt were registered with the Spanish Association of Gastroenterology-Research Electronic Data Capture until February 2021. Patients allergic to penicillin and those who received susceptibility-guided therapy were excluded. Data monitoring was performed to ensure data quality. RESULTS Overall, 5055 patients received empiric second-line treatment. Triple therapy with amoxicillin and levofloxacin was prescribed most commonly (33%). The overall effectiveness was 82% by modified intention-to-treat analysis and 83% in the per-protocol population. After failure of first-line clarithromycin-containing treatment, optimal eradication (>90%) was obtained with moxifloxacin-containing triple therapy or levofloxacin-containing quadruple therapy (with bismuth). In patients receiving triple therapy containing levofloxacin or moxifloxacin, and levofloxacin-bismuth quadruple treatment, cure rates were optimized with 14-day regimens using high doses of proton pump inhibitors. However, 3-in-1 single capsule or levofloxacin-bismuth quadruple therapy produced reliable eradication rates regardless of proton pump inhibitor dose, duration of therapy, or previous first-line treatment. The overall incidence of adverse events was 28%, and most (85%) were mild. Three patients developed serious adverse events (0.3%) requiring hospitalization. CONCLUSIONS Empiric second-line regimens including 14-day quinolone triple therapies, 14-day levofloxacin-bismuth quadruple therapy, 14-day tetracycline-bismuth classic quadruple therapy, and 10-day bismuth quadruple therapy (as a single capsule) provided optimal effectiveness. However, many other second-line treatments evaluated reported low eradication rates. ClincialTrials.gov number: NCT02328131.
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Affiliation(s)
- Olga P Nyssen
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Dino Vaira
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Ángeles Pérez Aísa
- Department of Gastroenterology, Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Marbella, Spain
| | - Luis Rodrigo
- Department of Gastroenterology, Hospital de Asturias, Oviedo, Spain
| | | | - Laimas Jonaitis
- Department of Gastroenterology, Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Bojan Tepes
- Department of Gastroenterology, AM DC Rogaska, Rogaska Slatina, Slovenia
| | | | - María Caldas
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Angel Lanas
- Department of Gastroenterology, Hospital Clínico Universitario/Instituto de Investigacion Sanitaria Aragón, University of Zaragoza, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Zaragoza, Spain
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universidad del País Vasco, San Sebastián, Spain
| | - Juan Ortuño
- Department of Gastroenterology, Hospital Universitari i Politècnic, La Fe, Valencia, Spain
| | - Jesús Barrio
- Department of Gastroenterology, Hospital Río Hortega, Valladolid, Spain
| | - Jose M Huguet
- Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Irina Voynovan
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | | | | | | | | | | | - Miguel Areia
- Department of Gastroenterology, Portuguese Oncology Institute Coimbra, Coimbra, Portugal
| | - Antonio Gasbarrini
- Medicina Interna, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Juozas Kupčinskas
- Department of Gastroenterology, Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dmitry Bordin
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, Moscow, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Tver State Medical University, Tver, Russia
| | - Ricardo Marcos-Pinto
- Department of Gastroenterology, Centro Hospitalar do Porto Institute of Biomedical Sciences Abel Salazar, Centro de Investigação em Tecnologias e Serviços de Saúde, University of Porto, Porto, Portugal
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Marcis Leja
- Department of Gastroenterology, Digestive Diseases Centre Gastro, Institute of Clinical and Preventive Medicine and Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Gyorgy M Buzas
- Department of Gastroenterology, Ferencváros Health Centre, Budapest, Hungary
| | - Yaron Niv
- Department of Gastroenterology, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel
| | - Theodore Rokkas
- Department of Gastroenterology, Henry Dunant Hospital, Athens, Greece
| | - Perminder Phull
- Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Sinead Smith
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Oleg Shvets
- Department of Gastroenterology, Internal Medicine, National Medical University, Kyiv, Ukraine
| | - Marino Venerito
- Department of Gastroenterology, Otto-von-Guericke University, Magdeburg, Germany
| | - Vladimir Milivojevic
- Department of Gastroenterology, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Ilkay Simsek
- Department of Gastroenterology, Internal Medicine, Hacettepe, University School of Medicine, Ankara, Turkey
| | - Vincent Lamy
- Department of Gastroenterology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Peter Bytzer
- Department of Gastroenterology, Clinical Medicine, Zealand University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Lyudmila Boyanova
- Department of Gastroenterology, Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria
| | - Lumír Kunovský
- Department of Gastroenterology and Internal Medicine, Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Michael Doulberis
- Emergency Department, University Hospital Inselspital of Bern, Bern, Switzerland, Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece, and First Laboratory of Pharmacology, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Adrian Goldis
- Department of Gastroenterology, Timisoara Hospital, Timisoara, Romania
| | - Ante Tonkić
- Department of Gastroenterology, University Hospital of Split, University of Split School of Medicine, Split, Croatia
| | - Lisette Capelle
- Department of Gastroenterology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ignasi Puig
- Department of Gastroenterology, Althaia Xarxa Assistencial Universitària de Manresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Spain
| | - Francis Megraud
- Institut national de la santé et de la recherche médicale (INSERM) U1312 BRIC Team 4, University of Bordeaux, Bordeaux, France
| | - Colm O' Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.
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Kang K, Imamovic L, Misiakou MA, Bornakke Sørensen M, Heshiki Y, Ni Y, Zheng T, Li J, Ellabaan MMH, Colomer-Lluch M, Rode AA, Bytzer P, Panagiotou G, Sommer MO. Expansion and persistence of antibiotic-specific resistance genes following antibiotic treatment. Gut Microbes 2022; 13:1-19. [PMID: 33779498 PMCID: PMC8018486 DOI: 10.1080/19490976.2021.1900995] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Oral antibiotics are commonly prescribed to non-hospitalized adults. However, antibiotic-induced changes in the human gut microbiome are often investigated in cohorts with preexisting health conditions and/or concomitant medication, leaving the effects of antibiotics not completely understood. We used a combination of omic approaches to comprehensively assess the effects of antibiotics on the gut microbiota and particularly the gut resistome of a small cohort of healthy adults. We observed that 3 to 19 species per individual proliferated during antibiotic treatment and Gram-negative species expanded significantly in relative abundance. While the overall relative abundance of antibiotic resistance gene homologs did not significantly change, antibiotic-specific gene homologs with presumed resistance toward the administered antibiotics were common in proliferating species and significantly increased in relative abundance. Virome sequencing and plasmid analysis showed an expansion of antibiotic-specific resistance gene homologs even 3 months after antibiotic administration, while paired-end read analysis suggested their dissemination among different species. These results suggest that antibiotic treatment can lead to a persistent expansion of antibiotic resistance genes in the human gut microbiota and provide further data in support of good antibiotic stewardship.Abbreviation: ARG - Antibiotic resistance gene homolog; AsRG - Antibiotic-specific resistance gene homolog; AZY - Azithromycin; CFX - Cefuroxime; CIP - Ciprofloxacin; DOX - Doxycycline; FDR - False discovery rate; GRiD - Growth rate index value; HGT - Horizontal gene transfer; NMDS - Non-metric multidimensional scaling; qPCR - Quantitative polymerase chain reaction; RPM - Reads per million mapped reads; TA - Transcriptional activity; TE - Transposable element; TPM - Transcripts per million mapped reads.
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Affiliation(s)
- Kang Kang
- Novo Nordisk Foundation Center for Biosustainability,Technical University of Denmark, Lyngby, Denmark,Leibniz Institute for Natural Product Research and Infection Biology, Systems Biology and Bioinformatics - Hans Knoell Institute, Jena, Germany,CONTACT Lejla Imamovic Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Kemitorvet 220, DK-2800, Lyngby, Denmark
| | - Lejla Imamovic
- Novo Nordisk Foundation Center for Biosustainability,Technical University of Denmark, Lyngby, Denmark,Gianni Panagiotou Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, Adolf-Reichwein-Straße 23, 07745 Jena, Germany
| | - Maria-Anna Misiakou
- Novo Nordisk Foundation Center for Biosustainability,Technical University of Denmark, Lyngby, Denmark,Morten O.A. Sommer Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Kemitorvet 220, DK-2800, Lyngby, Denmark
| | - Maria Bornakke Sørensen
- Novo Nordisk Foundation Center for Biosustainability,Technical University of Denmark, Lyngby, Denmark
| | - Yoshitaro Heshiki
- Leibniz Institute for Natural Product Research and Infection Biology, Systems Biology and Bioinformatics - Hans Knoell Institute, Jena, Germany,Kadoorie Biological Sciences Building, School of Biological Sciences, the University of Hong Kong, Hong Kong, S. A. R. China
| | - Yueqiong Ni
- Leibniz Institute for Natural Product Research and Infection Biology, Systems Biology and Bioinformatics - Hans Knoell Institute, Jena, Germany
| | - Tingting Zheng
- Leibniz Institute for Natural Product Research and Infection Biology, Systems Biology and Bioinformatics - Hans Knoell Institute, Jena, Germany,Kadoorie Biological Sciences Building, School of Biological Sciences, the University of Hong Kong, Hong Kong, S. A. R. China
| | - Jun Li
- Leibniz Institute for Natural Product Research and Infection Biology, Systems Biology and Bioinformatics - Hans Knoell Institute, Jena, Germany,Department of Infectious Diseases and Public Health, Colleague of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, S.A.R.China,School of Data Science, City University of Hong Kong, Hong Kong, S. A. R. China
| | - Mostafa M. H. Ellabaan
- Novo Nordisk Foundation Center for Biosustainability,Technical University of Denmark, Lyngby, Denmark
| | - Marta Colomer-Lluch
- Novo Nordisk Foundation Center for Biosustainability,Technical University of Denmark, Lyngby, Denmark
| | - Anne A. Rode
- Department of Medicine, Zealand University Hospital - Køge, Køge, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Bytzer
- Department of Medicine, Zealand University Hospital - Køge, Køge, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gianni Panagiotou
- Leibniz Institute for Natural Product Research and Infection Biology, Systems Biology and Bioinformatics - Hans Knoell Institute, Jena, Germany,Kadoorie Biological Sciences Building, School of Biological Sciences, the University of Hong Kong, Hong Kong, S. A. R. China,Department of Pharmacology and Pharmacy, the University of Hong Kong, Hong Kong, S. A. R. China
| | - Morten O.A. Sommer
- Novo Nordisk Foundation Center for Biosustainability,Technical University of Denmark, Lyngby, Denmark
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Krogsgaard LR, Bytzer P. [Cognitive behavioural therapy for refractory irritable bowel syndrome]. Ugeskr Laeger 2021; 183:V08200613. [PMID: 33998440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cognitive behavioural therapy (CBT) is a treatment option for refractory irritable bowel syndrome (IBS). In this review, we describe the background of CBT for IBS, the studies investigating the effect, and how CBT for IBS is executed. CBT addresses cognitive and emotional factors affecting perception and modulation of visceral stimuli. The aim of CBT is to identify and restructure thoughts and behaviours, which contribute to sustainment of symptoms. Based on 34 randomised, controlled trials, there is a symptomatic effect of CBT on IBS, and this is relevant to include in treatment of IBS in tertiary clinics.
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Rode AA, Chehri M, Krogsgaard LR, Heno KK, Svendsen AT, Ribberholt I, Helms M, Engberg J, Schønning K, Tvede M, Andersen CØ, Jensen US, Petersen AM, Bytzer P. Randomised clinical trial: a 12-strain bacterial mixture versus faecal microbiota transplantation versus vancomycin for recurrent Clostridioides difficile infections. Aliment Pharmacol Ther 2021; 53:999-1009. [PMID: 33694229 DOI: 10.1111/apt.16309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/03/2021] [Accepted: 02/11/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND A defined bacterial mixture could be a safer alternative to faecal microbiota transplantation (FMT). AIMS To compare the efficacy of a 12-strain mixture termed rectal bacteriotherapy with either FMT or vancomycin for recurrent Clostridioides difficile infection (CDI) in an open-label 3-arm randomised controlled trial. METHODS We screened all individuals positive for C difficile from May 2017 to March 2019. Persons with laboratory-confirmed recurrent CDI were included. Before FMT and rectal bacteriotherapy, we pre-treated with vancomycin for 7-14 days. Rectal bacteriotherapy was applied by enema on three consecutive days and FMT by enema once with possible repetition for two to three infusions within 14 days. The vancomycin group was treated for 14 days with additional five weeks of tapering for multiple recurrences. The primary outcome was clinical cure within 90 days. A secondary outcome was 180-day all-cause mortality. RESULTS Participants in the FMT group (n = 34) were cured more often than participants receiving vancomycin (n = 31), 76% vs 45% (OR 3.9 (1.4-11.4), P < 0.01) or rectal bacteriotherapy (n = 31), 76% vs 52% (OR 3.0 (1.1-8.8), P = 0.04). Rectal bacteriotherapy and vancomycin performed similarly (P = 0.61). The mortality rate was 6% in the FMT group, 13% in the bacteriotherapy group and 23% in the vancomycin group. FMT tended to reduce mortality compared with vancomycin, OR 0.2 (0.04-1.12), P = 0.07. CONCLUSIONS Rectal bacteriotherapy appears as effective as vancomycin but less effective than 1-3 FMTs. FMT by enema with 1-3 infusions is superior to vancomycin for treating recurrent C difficile infections and might reduce mortality.
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Affiliation(s)
- Anne Abildtrup Rode
- Department of Medicine, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mahtab Chehri
- Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark.,Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark
| | | | | | - Anna Tølbøll Svendsen
- Department of Medicine, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Iben Ribberholt
- Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark
| | - Morten Helms
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark
| | - Jørgen Engberg
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
| | - Kristian Schønning
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Michael Tvede
- MT MicroSearch by Michael Tvede, COBIS, Copenhagen, Denmark
| | | | - Ulrich Stab Jensen
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
| | - Andreas Munk Petersen
- Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark.,Department of Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Peter Bytzer
- Department of Medicine, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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Engsbro AL, Begtrup LM, Haastrup P, Storsveen MM, Bytzer P, Kjeldsen J, Schaffalitzky De Muckadell O, Jarbøl DE. A positive diagnostic strategy is safe and saves endoscopies in patients with irritable bowel syndrome: A five-year follow-up of a randomized controlled trial. Neurogastroenterol Motil 2021; 33:e14004. [PMID: 33029843 DOI: 10.1111/nmo.14004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/27/2020] [Accepted: 09/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previously, the diagnosis of irritable bowel syndrome (IBS) required exclusion of organic causes by extensive diagnostic testing. Newer guidelines recommend IBS as a positive diagnosis based on symptoms with limited testing. We investigated the long-term safety and impact on use of health resources of a positive diagnostic strategy compared to a strategy of exclusion in patients with symptoms compatible with IBS. METHODS In 2008-2010, primary care patients aged 18-50 years fulfilling the Rome III criteria for IBS without alarm signals were randomized to a positive diagnostic strategy (limited blood tests, n = 150) or a strategy of exclusion (extensive blood tests, fecal samples for intestinal parasites, and sigmoidoscopy with biopsies, n = 152). At five years, hospital-registered diagnoses and use of health resources including lower endoscopies were retrieved from national registries. Participants provided 5-year data on Rome III criteria for IBS, severity of symptoms, and quality of life. KEY RESULTS Baseline mean age was 31.4 (SD 9.1) years; 79% were female. No cases of celiac disease, and gastrointestinal or gynecological cancers were diagnosed within five years. Negligible and comparable numbers were diagnosed with inflammatory bowel disease, benign gynecological conditions, and upper GI conditions in the two groups. The positive diagnosis strategy carried a higher number of lower endoscopies from year 1 to 5 (23 patients versus 13 patients in the exclusion group), but overall saved endoscopies. CONCLUSIONS & INFERENCES A positive diagnosis of IBS was as safe as a diagnosis of exclusion in a five-year perspective and saved lower endoscopies; the study was registered at ClinicalTrials.gov numbers: NCT00659763/NCT01153295.
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Affiliation(s)
- Anne Line Engsbro
- Department of Medicine, Zealand University Hospital, Køge and Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, University Hospital Copenhagen Hvidovre, Hvidovre, Denmark
| | - Luise M Begtrup
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, København, Denmark.,Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Peter Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Maria Munch Storsveen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Peter Bytzer
- Department of Medicine, Zealand University Hospital, Køge and Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark
| | | | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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8
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Nyssen OP, Bordin D, Tepes B, Pérez-Aisa Á, Vaira D, Caldas M, Bujanda L, Castro-Fernandez M, Lerang F, Leja M, Rodrigo L, Rokkas T, Kupcinskas L, Pérez-Lasala J, Jonaitis L, Shvets O, Gasbarrini A, Simsek H, Axon ATR, Buzás G, Machado JC, Niv Y, Boyanova L, Goldis A, Lamy V, Tonkic A, Przytulski K, Beglinger C, Venerito M, Bytzer P, Capelle L, Milosavljević T, Milivojevic V, Veijola L, Molina-Infante J, Vologzhanina L, Fadeenko G, Ariño I, Fiorini G, Garre A, Garrido J, F Pérez C, Puig I, Heluwaert F, Megraud F, O'Morain C, Gisbert JP. European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients. Gut 2021; 70:40-54. [PMID: 32958544 DOI: 10.1136/gutjnl-2020-321372] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/08/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The best approach for Helicobacter pylori management remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care. DESIGN International multicentre prospective non-interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in H. pylori management by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap. Variables included demographics, previous eradication attempts, prescribed treatment, adverse events and outcomes. Data monitoring was performed to ensure data quality. Time-trend and geographical analyses were performed. RESULTS 30 394 patients from 27 European countries were evaluated and 21 533 (78%) first-line empirical H. pylori treatments were included for analysis. Pretreatment resistance rates were 23% to clarithromycin, 32% to metronidazole and 13% to both. Triple therapy with amoxicillin and clarithromycin was most commonly prescribed (39%), achieving 81.5% modified intention-to-treat eradication rate. Over 90% eradication was obtained only with 10-day bismuth quadruple or 14-day concomitant treatments. Longer treatment duration, higher acid inhibition and compliance were associated with higher eradication rates. Time-trend analysis showed a region-dependent shift in prescriptions including abandoning triple therapies, using higher acid-inhibition and longer treatments, which was associated with an overall effectiveness increase (84%-90%). CONCLUSION Management of H. pylori infection by European gastroenterologists is heterogeneous, suboptimal and discrepant with current recommendations. Only quadruple therapies lasting at least 10 days are able to achieve over 90% eradication rates. European recommendations are being slowly and heterogeneously incorporated into routine clinical practice, which was associated with a corresponding increase in effectiveness.
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Affiliation(s)
- Olga P Nyssen
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Dmitry Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, AS Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation.,A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Bojan Tepes
- Gastroenterology, AM DC Rogaska, Rogaska Slatina, Slovenia
| | - Ángeles Pérez-Aisa
- Gastroenterology, Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Marbella, Spain
| | - Dino Vaira
- Department of of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Maria Caldas
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Luis Bujanda
- Gastroenterology, Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), CIBEREHD, San Sebastian, Spain
| | | | - Frode Lerang
- Gastroenterololgy, Østfold Hospital Trust, Grålum, Norway
| | - Marcis Leja
- Digestive Diseases Centre GASTRO, Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Luís Rodrigo
- Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Limas Kupcinskas
- Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Laimas Jonaitis
- Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Oleg Shvets
- Internal Medicine, National Medical University named after O.O.Bogomolets, Kyiv, Ukraine
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Halis Simsek
- Internal Medicine/Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - György Buzás
- Gastroenterology, Ferencváros Health Centre, Budapest, Hungary
| | - Jose Carlos Machado
- i3S - Instituto de Investigação e Inovação em Saúde. Medical Faculty of Porto. Universidade do Porto, Porto, Portugal
| | - Yaron Niv
- Gastroenterology, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel
| | | | - Adrian Goldis
- Gastroenterology, Timisoara Hospital, Timisoara, Romania
| | - Vincent Lamy
- Gastroenterology, Hepatology & Nutrition, CHU de Charleroi, Charleroi, Belgium
| | - Ante Tonkic
- Gastroenterology, University Hospital of Split, University of Split, Split, Croatia
| | | | | | - Marino Venerito
- Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Peter Bytzer
- Clinical Medicine, Zealand University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Lisette Capelle
- Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, Netherlands
| | - Tomica Milosavljević
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Milivojevic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lea Veijola
- Internal Medicine, Herttoniemi Hospital, Helsinki, Finland
| | | | | | - Galina Fadeenko
- Gastroenterology, Digestive Ukrainian Academy of Medical Sciences, Kyiv, Ukraine
| | - Ines Ariño
- Gastroenterology, Hospital Clinico Universitario Lozano Blesa, CIBEREHD, Zaragoza, Spain
| | - Giulia Fiorini
- Department of of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Ana Garre
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Jesús Garrido
- Departmento de Psicología Social y Metodología, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Cristina F Pérez
- Servicio de Medicina Preventiva, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ignasi Puig
- Gastroenterology, Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | | | - Francis Megraud
- Laboratoire de Bactétiologie, Hôpital Pellegrin, Bordeaux, France
| | - Colm O'Morain
- Gastroenterology, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
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9
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Nyssen OP, Pérez-Aisa Á, Tepes B, Rodrigo-Sáez L, Romero PM, Lucendo A, Castro-Fernández M, Phull P, Barrio J, Bujanda L, Ortuño J, Areia M, Brglez Jurecic N, Huguet JM, Alcaide N, Voynovan I, María Botargues Bote J, Modolell I, Pérez Lasala J, Ariño I, Jonaitis L, Dominguez-Cajal M, Buzas G, Lerang F, Perona M, Bordin D, Axon T, Gasbarrini A, Marcos Pinto R, Niv Y, Kupcinskas L, Tonkic A, Leja M, Rokkas T, Boyanova L, Shvets O, Venerito M, Bytzer P, Goldis A, Simsek I, Lamy V, Przytulski K, Kunovský L, Capelle L, Milosavljevic T, Caldas M, Garre A, Mégraud F, O'Morain C, Gisbert JP. Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp-EuReg). Helicobacter 2020; 25:e12686. [PMID: 32173974 DOI: 10.1111/hel.12686] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Experience in Helicobacter pylori eradication treatment of patients allergic to penicillin is very scarce. A triple combination with a PPI, clarithromycin (C), and metronidazole (M) is often prescribed as the first option, although more recently the use of a quadruple therapy with PPI, bismuth (B), tetracycline (T), and M has been recommended. AIM To evaluate the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin in the "European Registry of H pylori management" (Hp-EuReg). METHODS A systematic prospective registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H pylori infection. An e-CRF was created on AEG-REDCap. Patients with penicillin allergy were analyzed until June 2019. RESULTS One-thousand eighty-four patients allergic to penicillin were analyzed. The most frequently prescribed first-line treatments were as follows: PPI + C + M (n = 285) and PPI + B + T + M (classic or Pylera® ; n = 250). In first line, the efficacy of PPI + C + M was 69%, while PPI + B + T + M reached 91% (P < .001). In second line, after the failure of PPI + C + M, two rescue options showed similar efficacy: PPI + B + T + M (78%) and PPI + C + levofloxacin (L) (71%) (P > .05). In third line, after the failure of PPI + C + M and PPI + C + L, PPI + B + T + M was successful in 75% of cases. CONCLUSION In patients allergic to penicillin, a triple combination with PPI + C + M should not be generally recommended as a first-line treatment, while a quadruple regimen with PPI + B + T + M seems to be a better option. As a rescue treatment, this quadruple regimen (if not previously prescribed) or a triple regimen with PPI + C + L could be used but achieved suboptimal (<80%) results.
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Affiliation(s)
- Olga P Nyssen
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ángeles Pérez-Aisa
- Digestive Unit, Agencia Sanitaria Costa del Sol, Marbella, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga, Spain
| | - Bojan Tepes
- Gastroenterology Unit, AM DC Rogaska, Rogaska Slatina, Slovenia
| | - Luis Rodrigo-Sáez
- Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | | | - Luis Bujanda
- Department of Gastroenterology, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), Donosti, Spain
| | - Juan Ortuño
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Areia
- Portuguese Oncology Institute, Coimbra, Portugal
| | | | | | - Noelia Alcaide
- Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Irina Voynovan
- Department of Pancreatobiliary and Upper GI Diseases, Moscow Clinical Scientific Center, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | | | | | - Inés Ariño
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - György Buzas
- Gastroenterology Unit, Ferencváros Policlinic, Budapest, Hungary
| | - Frode Lerang
- Medical Department, Central Hospital Ostfold, Fredrikstad, Norway
| | | | - Dmitry Bordin
- Department of Pancreatobiliary and Upper GI Diseases, Moscow Clinical Scientific Center, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Toni Axon
- Gastroenterology Unit, University of Leeds, Leeds, UK
| | - Antonio Gasbarrini
- Gastronterology Area, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Ricardo Marcos Pinto
- Centro Hospitalar do Porto, Institute of Biomedical Sciences Abel Salazar, University of Porto and CINTESIS, University of Porto, Porto, Portugal
| | - Yaron Niv
- Department of Gastroenterology, Rabin Medical Center, Tel Aviv University, Petach Tikva, Israel
| | - Limas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ante Tonkic
- Department of Gastroenterology, School of Medicine, University Hospital of Split, University of Split, Split, Croatia
| | - Marcis Leja
- Faculty of Medicine, Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Theodore Rokkas
- Gastroenterology Unit, Henry Dunant Hospital, Athens, Greece
| | - Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria
| | - Oleg Shvets
- Internal Diseases Department No. 1, National Medical University named after O.O. Bogomolets, Kyiv, Ukraine
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Peter Bytzer
- Department of Medicine, Zealand University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Adrian Goldis
- Gastroenterology Unit, Timisoara Hospital, Timisoara, Romania
| | - Ilkay Simsek
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Vincent Lamy
- Department of Gastroenterology, Hepatology & Nutrition, CHU Charleroi, Charleroi, Belgium
| | - Krzysztof Przytulski
- Gastroenterology Unit, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Lumír Kunovský
- Department of Gastroenterology and Internal Medicine and Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lisette Capelle
- Gastroenterology and Hepatology, Erasmus MC University, Rotterdam, The Netherlands
| | - Tomica Milosavljevic
- Medical Department, Clinical Center of Serbia Clinic for Gastroenterology and Hepatology, University of Belgrade, Belgrade, Serbia
| | - María Caldas
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Garre
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Francis Mégraud
- Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux Cedex, France
| | - Colm O'Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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10
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Hesselø H, Bak M, Boysen T, Bytzer P, Hasselbalch HC. [Myeloproliferative neoplasms and chronic inflammatory bowel disease]. Ugeskr Laeger 2020; 182:V09190483. [PMID: 32515326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Studies have suggested a possible association between inflammatory bowel disease (IBD) and the Philadelphia-negative chronic myeloproliferative neoplasms (MPNs). The mechanisms behind this association have not been investigated yet, but in this review, we find it most likely to involve complex interactions between genetic, treatment-related and inflammation- and immune-mediated factors. When patients with IBD present with persistent leukocytosis and/or thrombocytosis, it may reflect concomitant MPN, and early detection and treatment of MPNs may prevent some of the complications related to these diseases.
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11
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Abstract
Objective: Acute gastroenteritis (AGE) is a risk factor for post-infectious irritable bowel syndrome (PI-IBS). This systematic review evaluates the prevalence and risk-factors of PI-IBS after AGE by specific pathogens. Materials and methods: Medline (1966-2019) and Embase (1974-2019) were searched for studies evaluating PI-IBS minimum 3 months after AGE with Campylobacter spp., Salmonella spp., Shigella spp., Escherischia coli, Clostridium difficile, norovirus, rotavirus, Cryptosporidium spp. or Giardia intestinalis using validated criteria for IBS. Pooled prevalence (PP), odds ratios (OR) and risk factors were determined for single pathogens, groups of bacteria, viruses and parasites, and overall for AGE caused by any pathogen. Random-effect models were used for meta-analyses. Results: A total of 34 articles were included. PP of PI-IBS after Campylobacter spp. was 12% (confidence interval 95% [CI]: 10-15%), Salmonellosis 12% (CI: 9-15%), Shigellosis 11% (CI: 8-15%), C. difficile 14% (CI: 4-29%) and E. coli spp. 12% (CI: 5-20%). OR of PI-IBS after salmonellosis was 5.5 (CI: 2.3-12.8) and after shigellosis 13.8 (CI: 4.2-45.4). Bacterial AGE overall showed OR 5.8 (CI: 4.0-8.3) and AGE caused by any pathogen OR 4.9 (CI: 3.9-6.1). Few studies exist on viral and parasitic gastroenteritis. Conclusions: Current literature show similar risks for bacterial pathogens. Studies are limited for viral and parasitic pathogens. The evaluated risk-factors for PI-IBS varied among the included studies and the existing evidence is insufficient to identify pathogen-specific risk factors.
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Affiliation(s)
- Anna Tølbøll Svendsen
- a Department of Gastroenterology , Zealand University Hospital , Køge , Denmark.,b Department of Clinical Medicine , Copenhagen University , Copenhagen N , Denmark
| | - Peter Bytzer
- a Department of Gastroenterology , Zealand University Hospital , Køge , Denmark.,b Department of Clinical Medicine , Copenhagen University , Copenhagen N , Denmark
| | - Anne Line Engsbro
- c Department of Clinical Microbiology , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
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12
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Rindom Krogsgaard L, Kristian Munck L, Bytzer P, Wildt S. An altered composition of the microbiome in microscopic colitis is driven towards the composition in healthy controls by treatment with budesonide. Scand J Gastroenterol 2019; 54:446-452. [PMID: 31009268 DOI: 10.1080/00365521.2019.1599064] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and aim: Microscopic colitis (MC) is an inflammatory disease of the bowel, hypothetically induced by an immunologic response to a luminal microbial agent. We aimed to characterize the microbiome composition in MC and subtypes collagenous colitis (CC) and lymphocytic colitis (LC) and to identify a possible microbial effect of treatment. Method: Stool samples were collected from MC patients prior to treatment, at 8 weeks (during treatment) and at 16 weeks (after treatment), and from healthy controls, not receiving treatment, at matched time-points. Microbiome composition was analyzed by sequencing of the 16S and 18S genes. Differences between patients and controls were analyzed by Shannon's diversity index (mean, standard deviation (SD)) and principal coordinate analysis (PCoA) complemented with a permanova test of UniFrac distances. Results: Ten LC patients, 10 CC patients and 10 controls were included. By PCoA, the bacterial composition in MC patients differed from controls at baseline (p = .02), but not during and after treatment (p = .09 and p = .33, respectively). At baseline, bacterial diversity was lower in MC patients compared to controls (2.5, SD: 0.5 vs 3.5, SD: 0.3, p < .05). Diversity in MC patients increased during (3.0, SD: 0.6) and after treatment and (2.9, SD: 0.5) compared with baseline (p < .01). Eukaryotes were detected in fewer samples from MC patients compared with controls (11/20 (55%) vs. 9/10 (90%), p = .06) with no effect of treatment. Conclusion: Microbiome composition is altered in MC patients. During and after treatment with budesonide the microbiome composition in MC patients was driven towards the composition in healthy controls.
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Affiliation(s)
- Laura Rindom Krogsgaard
- a Department of Medicine , Section of Gastroenterology, Zealand University Hospital , Køge , Denmark
| | - Lars Kristian Munck
- a Department of Medicine , Section of Gastroenterology, Zealand University Hospital , Køge , Denmark.,b Department of Clinical Medicine , University of Copenhagen , Køge , Denmark
| | - Peter Bytzer
- a Department of Medicine , Section of Gastroenterology, Zealand University Hospital , Køge , Denmark.,b Department of Clinical Medicine , University of Copenhagen , Køge , Denmark
| | - Signe Wildt
- a Department of Medicine , Section of Gastroenterology, Zealand University Hospital , Køge , Denmark.,b Department of Clinical Medicine , University of Copenhagen , Køge , Denmark
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13
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Zheng T, Li J, Ni Y, Kang K, Misiakou MA, Imamovic L, Chow BKC, Rode AA, Bytzer P, Sommer M, Panagiotou G. Mining, analyzing, and integrating viral signals from metagenomic data. Microbiome 2019; 7:42. [PMID: 30890181 PMCID: PMC6425642 DOI: 10.1186/s40168-019-0657-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/07/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Viruses are important components of microbial communities modulating community structure and function; however, only a couple of tools are currently available for phage identification and analysis from metagenomic sequencing data. Here we employed the random forest algorithm to develop VirMiner, a web-based phage contig prediction tool especially sensitive for high-abundances phage contigs, trained and validated by paired metagenomic and phagenomic sequencing data from the human gut flora. RESULTS VirMiner achieved 41.06% ± 17.51% sensitivity and 81.91% ± 4.04% specificity in the prediction of phage contigs. In particular, for the high-abundance phage contigs, VirMiner outperformed other tools (VirFinder and VirSorter) with much higher sensitivity (65.23% ± 16.94%) than VirFinder (34.63% ± 17.96%) and VirSorter (18.75% ± 15.23%) at almost the same specificity. Moreover, VirMiner provides the most comprehensive phage analysis pipeline which is comprised of metagenomic raw reads processing, functional annotation, phage contig identification, and phage-host relationship prediction (CRISPR-spacer recognition) and supports two-group comparison when the input (metagenomic sequence data) includes different conditions (e.g., case and control). Application of VirMiner to an independent cohort of human gut metagenomes obtained from individuals treated with antibiotics revealed that 122 KEGG orthology and 118 Pfam groups had significantly differential abundance in the pre-treatment samples compared to samples at the end of antibiotic administration, including clustered regularly interspaced short palindromic repeats (CRISPR), multidrug resistance, and protein transport. The VirMiner webserver is available at http://sbb.hku.hk/VirMiner/ . CONCLUSIONS We developed a comprehensive tool for phage prediction and analysis for metagenomic samples. Compared to VirSorter and VirFinder-the most widely used tools-VirMiner is able to capture more high-abundance phage contigs which could play key roles in infecting bacteria and modulating microbial community dynamics. TRIAL REGISTRATION The European Union Clinical Trials Register, EudraCT Number: 2013-003378-28 . Registered on 9 April 2014.
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Affiliation(s)
- Tingting Zheng
- Systems Biology & Bioinformatics Group, School of Biological Sciences, Faculty of Sciences, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Jun Li
- Department of Infectious Diseases and Public Health, The Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
- School of Data Science, City University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Yueqiong Ni
- Department of Systems Biology and Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Beutenbergstraße 11a, 07745 Jena, Germany
| | - Kang Kang
- Department of Systems Biology and Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Beutenbergstraße 11a, 07745 Jena, Germany
| | - Maria-Anna Misiakou
- Bacterial Synthetic Biology Section, Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Kemitorvet, 2800 Kongens Lyngby, Denmark
| | - Lejla Imamovic
- Bacterial Synthetic Biology Section, Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Kemitorvet, 2800 Kongens Lyngby, Denmark
| | - Billy K. C. Chow
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Anne A. Rode
- Department of Medicine, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Bytzer
- Department of Medicine, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Sommer
- Bacterial Synthetic Biology Section, Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Kemitorvet, 2800 Kongens Lyngby, Denmark
| | - Gianni Panagiotou
- Systems Biology & Bioinformatics Group, School of Biological Sciences, Faculty of Sciences, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
- Department of Systems Biology and Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Beutenbergstraße 11a, 07745 Jena, Germany
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
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15
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Abstract
INTRODUCTION The risk of venous thromboembolism (VTE) is increased by more than 100-fold among hospitalised medical patients compared to subjects in the community. The Danish Council for the Use of Expensive Hospital Medicines has published national guidelines on thromboprophylaxis (TP) in which the risks of VTE and bleeding are balanced. We wanted to investigate the proportion of acutely admitted medical patients for whom thromboprophylaxis was indicated and to what extent the guidelines were followed. METHODS Data from patients hospitalised at two medical wards were screened. We registered the proportion of patients for whom mechanical or pharmacologic TP (MTP and PTP, respectively) was indicated and whether national guidelines were followed. All data extraction and analyses were performed retrospectively. RESULTS After exclusion criteria were applied, 340 cases remained. PTP was indicated in 26 patients (7.6%) but only 4 patients were treated besides 12 patients who were already in anticoagulant treatment at submission. Conversely, 8/306 patients, in whom TP was not indicated, were started on PTP. MTP was indicated in 8/340 patients (2.4%) but therapy was not initiated in any of them. The majority (320/340, 94.1%) of cases was managed in accordance with existing guidelines. However, this high proportion was mainly explained by the large number of untreated patients, where TP was not indicated. CONCLUSION A large proportion of hospitalised medical patients was managed in conflict with national guidelines. A systematic approach to TP in patients with acute medical illness should be implemented. Plain language summary available for this article.
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Affiliation(s)
- Nanna Freund
- Department of Medicine, Zealand University Hospital Køge, Køge, Denmark.
| | - Jonas E Sabroe
- Department of Medicine, Zealand University Hospital Køge, Køge, Denmark
| | - Peter Bytzer
- Department of Medicine, Zealand University Hospital Køge, Køge, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Søren M Madsen
- Department of Medicine, Zealand University Hospital Køge, Køge, Denmark.
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16
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Abstract
OBJECTIVES Use of antibiotics affects the composition of the gut microbiome. The microbiome is thought to play a role in development of irritable bowel syndrome (IBS), but antibiotics as a possible risk factor for IBS has not been clarified. We aimed to explore if antibiotics is a risk factor for IBS by investigating use of antibiotics and development of IBS in a cohort from the Danish background population. MATERIALS AND METHODS An internet-based web panel representative of the Danish background population was invited to participate in a survey regarding the epidemiology of IBS in 2010, 2011 and 2013. A questionnaire based on the Rome III criteria for IBS were answered at all three occasions. In 2013, a question regarding use of antibiotics in the past year was included. RESULTS In 2013, use of antibiotics was reported by 22.4% (624/2781) of the population. A higher proportion of individuals with IBS reported use of antibiotics compared with asymptomatic controls [29.0% (155/534) vs. 17.9% (212/1,184), p < .01]. For asymptomatic respondents in 2010 and 2011 (n = 1004), the relative risk of IBS in 2013 related with use of antibiotics was 1.9 [95% confidence interval (CI): 1.1-3.1]. Adjusting for sex by logistic regression, development of IBS was predicted by use of antibiotics with an odds ratio of 1.8 (95% CI: 1.0-3.2). CONCLUSIONS Antibiotics is a risk factor for IBS in asymptomatic individuals. Possible mechanisms should be investigated in future studies.
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Affiliation(s)
| | - Anne Line Engsbro
- b Department of Clinical Microbiology , Hvidovre University Hospital , Hvidovre , Denmark
| | - Peter Bytzer
- a Department of Medicine , Zealand University Hospital , Køge , Denmark.,c Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark
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17
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Semb S, Helgstrand F, Hjørne F, Bytzer P. Persistent severe hypomagnesemia caused by proton pump inhibitor resolved after laparoscopic fundoplication. World J Gastroenterol 2017; 23:6907-6910. [PMID: 29085234 PMCID: PMC5645624 DOI: 10.3748/wjg.v23.i37.6907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/12/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
Magnesium deficiency can cause a variety of symptoms, including potentially life-threatening complications such as seizures, cardiac arrhythmias and secondary electrolyte disturbances. Hypomagnesemia can be a serious adverse effect to proton pump inhibitor (PPI) therapy, which is worrying due to the widespread use of PPIs. Current evidence suggest that the mechanism of PPI induced hypomagnesemia is impaired intestinal magnesium absorption. In this report, we present the case of a long-term PPI user with persistent hypomagnesemia with severe symptoms at presentation. He was unable to stop PPI treatment because of severe reflux symptoms, and was dependent on weekly intravenous magnesium infusions, until his magnesium levels finally normalized without the need for supplementation after a successful laparoscopic fundoplication.
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Affiliation(s)
- Synne Semb
- Department of Gastroenterology, Zealand University Hospital, 4600 Køge, Denmark
| | - Frederik Helgstrand
- Department of Surgery, Zealand University Hospital, 4600 Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Flemming Hjørne
- Department of Surgery, Zealand University Hospital, 4600 Køge, Denmark
| | - Peter Bytzer
- Department of Gastroenterology, Zealand University Hospital, 4600 Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark
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18
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Krogsgaard LR, Lyngesen M, Bytzer P. Letter: bias in clinical trials of the symptomatic effects of the low FODMAP diet for irritable bowel syndrome-getting the facts right. Authors' reply. Aliment Pharmacol Ther 2017; 46:386-387. [PMID: 28677288 DOI: 10.1111/apt.14165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- L R Krogsgaard
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Køge, Denmark
| | - M Lyngesen
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark
| | - P Bytzer
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Køge, Denmark
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19
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Rode AA, Chehri M, Petersen AM, Bytzer P. [Faecal microbiota transplantation for the treatment of bowel disease]. Ugeskr Laeger 2017; 179:V03170218. [PMID: 28869008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Faecal microbiota transplantation (FMT) is the transferral of faeces from a healthy donor to a patient with a disease linked to disturbances in the gut microbiota. The treatment has been implemented at several hospitals in Denmark, and banks with frozen donor stool material have been established. The effect of FMT for recurrent Clostridium difficile infection is well-documented. FMT cannot be recommended for routine clinical use for inflammatory bowel disease and irritable bowel syndrome because of lack of data from clinical trials.
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20
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Coyle C, Bytzer P. Editorial: refractory GERD-good drug, wrong patients? Authors' reply. Aliment Pharmacol Ther 2017. [PMID: 28621071 DOI: 10.1111/apt.14151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
| | - P Bytzer
- Zealand University Hospital and University of Copenhagen, Copenhagen, Denmark
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21
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Coyle C, Crawford G, Wilkinson J, Thomas SJ, Bytzer P. Randomised clinical trial: addition of alginate-antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms. Aliment Pharmacol Ther 2017; 45:1524-1533. [PMID: 28464343 DOI: 10.1111/apt.14064] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/09/2017] [Accepted: 03/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Symptomatic breakthrough in proton pump inhibitor (PPI)-treated gastro-oesophageal reflux disease (GERD) patients is a common problem with a range of underlying causes. The nonsystemic, raft-forming action of alginates may help resolve symptoms. AIM To assess alginate-antacid (Gaviscon Double Action, RB, Slough, UK) as add-on therapy to once-daily PPI for suppression of breakthrough reflux symptoms. METHODS In two randomised, double-blind studies (exploratory, n=52; confirmatory, n=262), patients taking standard-dose PPI who had breakthrough symptoms, assessed by Heartburn Reflux Dyspepsia Questionnaire (HRDQ), were randomised to add-on Gaviscon or placebo (20 mL after meals and bedtime). The exploratory study endpoint was change in HRDQ score during treatment vs run-in. The confirmatory study endpoint was "response" defined as ≥3 days reduction in the number of "bad" days (HRDQ [heartburn/regurgitation] >0.70) during treatment vs run-in. RESULTS In the exploratory study, significantly greater reductions in HRDQ scores (heartburn/regurgitation) were observed in the Gaviscon vs placebo (least squares mean difference [95% CI] -2.10 [-3.71 to -0.48]; P=.012). Post hoc "responder" analysis of the exploratory study also revealed significantly more Gaviscon patients (75%) achieved ≥3 days reduction in "bad" days vs placebo patients (36%), P=.005. In the confirmatory study, symptomatic improvement was observed with add-on Gaviscon (51%) but there was no significant difference in response vs placebo (48%) (OR (95% CI) 1.15 (0.69-1.91), P=.5939). CONCLUSIONS Adding Gaviscon to PPI reduced breakthrough GERD symptoms but a nearly equal response was observed for placebo. Response to intervention may vary according to whether symptoms are functional in origin.
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Affiliation(s)
| | | | | | | | - P Bytzer
- Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
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22
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Krogsgaard LR, Lyngesen M, Bytzer P. Systematic review: quality of trials on the symptomatic effects of the low FODMAP diet for irritable bowel syndrome. Aliment Pharmacol Ther 2017; 45:1506-1513. [PMID: 28440580 DOI: 10.1111/apt.14065] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/04/2016] [Accepted: 03/06/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The low Fermentable Oligo-, Di- Monosaccharides, and Polyoles (FODMAP) diet is a new treatment option for irritable bowel syndrome (IBS). Experts refer to the diet as supported by high level of evidence, but an evaluation of the quality of trials is lacking. AIM To provide a systematic review of the quality of trials on the symptomatic effects of the low FODMAP diet for IBS. METHODS Pubmed and EMBASE were searched for randomised controlled trials (RCTs) reporting effect of the low FODMAP diet on IBS symptoms. The quality of trials was evaluated by estimating risk of bias and assessing trial methodology. RESULTS Nine RCTs were eligible, including 542 patients. The intervention period was from 2 days to 6 weeks and one trial included a 6-month follow-up. Three trials intervened by providing meals, controlling with a diet high in FODMAP content. In six trials, the intervention was instruction by a dietician and a variety of control interventions were used, all with limited established efficacy. Domains with a high risk of bias were identified for all the trials. High risk of bias dominated domains regarding blinding, with only one trial double-blinded. CONCLUSIONS The RCTs on the low FODMAP diet are characterized by high risk of bias. The diet has not been studied in a randomised, controlled setting for more than 6 weeks and trials examining the effect of the important reintroduction period are lacking. There is a risk that the symptomatic effects reported in the trials are driven primarily by a placebo response.
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Affiliation(s)
- L R Krogsgaard
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Denmark
| | - M Lyngesen
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark
| | - P Bytzer
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Denmark
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23
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Krarup AL, Engsbro ALØ, Fassov J, Fynne L, Christensen AB, Bytzer P. Danish national guideline: Diagnosis and treatment of Irritable Bowel Syndrome. Dan Med J 2017; 64:C5382. [PMID: 28566121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
National Danish guidelines for the diagnosis and treatment of irritable bowel syndrome (IBS) in adult patients in secondary and tertiary care have been approved by the Danish Society for Gastroenterology and Hepatology. IBS can be a positive diagnosis in patients fulfilling the Rome III criteria for IBS with no alarm signals, a normal physical examination and a normal CRP and hemoglobin. In patients < 40 years with IBS and diarrhea, a normal fecal calprotectin excludes inflammatory bowel disease with a high probability. Patients with IBS and diarrhea should be tested for celiac disease. Endoscopy is not routinely recommended. The therapeutic gain of various treatment modalities is small and most likely overestimated in older studies. However, side effects are usually mild which may justify empirical treatment. The choice of therapy based on IBS subtyping is pragmatic and there are only few trials as guidance. The significance of previous failure with another treatment modality is unclear. There is a lack of long-term treatment trials. The generalizability of the trials is poor, mainly due to selection bias.
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Krogsgaard LR, Engsbro AL, Jones MP, Bytzer P. The epidemiology of irritable bowel syndrome: Symptom development over a 3-year period in Denmark. A prospective, population-based cohort study. Neurogastroenterol Motil 2017; 29. [PMID: 27865035 DOI: 10.1111/nmo.12986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND We aimed to explore the natural history of irritable bowel syndrome (IBS) in Denmark over 3 years by studying development of IBS symptoms and associated factors. METHODS A cohort study was carried out using a web panel representative of the Danish general population 18-50 years. The survey, including a questionnaire based on the Rome III criteria for IBS, was conducted in January 2010, January 2011, and March 2013. KEY RESULTS The prevalence of IBS was 15.4% (920/5986). The incidence was 10.3%, and was three times higher for persons with unspecific gastrointestinal (GI) symptoms compared to asymptomatic persons. Of respondents with IBS symptoms in both 2010 and 2011, 69% (131/191) also reported symptoms of IBS in 2013, which was significantly more compared to respondents with IBS symptoms in 2010 reporting to be asymptomatic or having unspecific GI symptoms in 2011 (20% and 39%, respectively, P<.001). Being diagnosed with IBS predicted fulfilling the criteria for IBS 3 years later (OR: 2.59, 95% CI: 1.11-6.10). Fulfilling criteria for IBS after 1 year also led to a high risk of IBS symptoms 3 years later in asymptomatic persons and persons with unspecific symptoms at baseline. CONCLUSIONS & INFERENCES The vast majority of persons fulfilling criteria for IBS report GI symptoms after one and 3 years. Fulfilling IBS criteria after 1 year led to a high risk of reporting IBS symptoms after 3 years. In the general population having an IBS diagnosis predicts persistently fulfilling the Rome III criteria for IBS 3 years later.
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Affiliation(s)
- L R Krogsgaard
- Department of Medical Gastroenterology, Køge University Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - A L Engsbro
- Department of Medical Gastroenterology, Køge University Hospital, Køge, Denmark.,Department of Clinical Microbiology, Hvidovre Hospital, Hvidovre, Denmark
| | - M P Jones
- Psychology Department, Macquarie University, North Ryde, NSW, Australia
| | - P Bytzer
- Department of Medical Gastroenterology, Køge University Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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25
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Bytzer P, Reimer C, Smith G, Anatchkova MD, Hsieh R, Wilkinson J, Thomas SJ, Lenderking WR. Psychometric evaluation of a daily gastro-oesophageal reflux disease symptom measure. Scand J Gastroenterol 2017; 52:276-283. [PMID: 27826993 DOI: 10.1080/00365521.2016.1250282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the validity of the Heartburn Reflux Dyspepsia Questionnaire (HRDQ), a newly developed measure of gastro-oesophageal reflux disease (GORD) symptoms. Specifically, the HRDQ was developed for patients, who still experience symptoms with proton pump inhibitor (PPI) treatment. MATERIAL AND METHODS The psychometric properties of HRDQ were evaluated based on data from two clinical trials of patients with GORD with a partial response to PPIs, one from the UK and one from Denmark and Germany. RESULTS The HRDQ had good internal consistency (Cronbach's alpha range .83-.88) and test-retest reliability (intraclass correlation coefficient range .71-.90). Convergent and discriminant validity were supported by high correlations with ReQuest™ and ability to differentiate between groups based on ReQuest™ cut-off values. Responsiveness of HRDQ was demonstrated by moderate to high correlations with ReQuest™ change scores and time with symptoms. An HRDQ cut-off value of 0.70 for definition of 'bad day' was also evaluated. CONCLUSIONS Based on existing evidence, the HRDQ is a valid and reliable measure of GORD symptoms that can be used as a study outcome in clinical trials.
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Affiliation(s)
- Peter Bytzer
- a Department of Gastroenterology , Zealand University Hospital , Køge , Denmark.,b Department of Clinical Medicine , Copenhagen University , Copenhagen N , Denmark
| | - Christina Reimer
- c Department of Gastroenterology , Hvidovre Hospital , Hvidovre , Denmark
| | - Gary Smith
- d Reckitt Benckiser Brands , Slough , UK
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26
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Bytzer P, Reimer C. Letter: add-on alginate therapy for reflux patients with inadequate response to a once daily proton pump inhibitor - more questions than answers. Authors' reply. Aliment Pharmacol Ther 2016; 44:208. [PMID: 27296689 DOI: 10.1111/apt.13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- P Bytzer
- Department of Gastroenterology, Køge Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - C Reimer
- Department of Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.
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27
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Reimer C, Bytzer P. Editorial: alginates for inadequate response to a proton pump inhibitor in gastro-oesophageal reflux disease--authors' reply. Aliment Pharmacol Ther 2016; 43:1104. [PMID: 27072319 DOI: 10.1111/apt.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- C Reimer
- Department of Medical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.
| | - P Bytzer
- Department of Medical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.,Department of Medical Gastroenterology, Copenhagen University, Copenhagen, Denmark.,Institute for Internal Medicine, Copenhagen University, Copenhagen, Denmark
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28
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Reimer C, Lødrup AB, Smith G, Wilkinson J, Bytzer P. Randomised clinical trial: alginate (Gaviscon Advance) vs. placebo as add-on therapy in reflux patients with inadequate response to a once daily proton pump inhibitor. Aliment Pharmacol Ther 2016; 43:899-909. [PMID: 26909885 DOI: 10.1111/apt.13567] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 12/29/2015] [Accepted: 02/01/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many reflux patients remain symptomatic on a standard dose of proton pump inhibitor (PPI). Alginates decrease the number of reflux events by forming a raft on top of the stomach content and thus offer a supplemental mechanism of action to acid suppression. AIM To assess the efficacy of an alginate (Gaviscon Advance, Reckitt Benckiser, Slough, UK) on reflux symptoms in patients with persistent symptoms despite once daily PPI. METHODS This was a multicentre, randomised, placebo-controlled, 7-day double-blind trial preceded by a 7-day run-in period. Reflux symptoms were assessed using the Heartburn Reflux Dyspepsia Questionnaire (HRDQ). Based on symptom score during run-in, eligible patients were randomised to Gaviscon Advance 10 mL four times a day or placebo in addition to a once daily PPI. The primary endpoint was change in HRDQ score post-treatment compared to baseline. RESULTS One hundred and thirty-six patients were randomised. Change in HRDQ reflux score was significantly greater for Gaviscon Advance (mean: -5.0, s.d.: 4.7) than for placebo (mean: -3.5, s.d.: 5.5) with an LS mean difference of 1.6 [95% CI -3.1 to -0.1], P = 0.03. A decrease in the mean (s.d.) number of nights with symptoms was observed from 3.6 (2.8) to 3.0 (3.0) in the placebo group and from 3.9 (2.8) to 2.2 (2.7) for the Gaviscon Advance group. This reduction was significantly greater in the Gaviscon Advance group than in the placebo group [LS mean difference = -0.9, 95% CI (-1.6 to -0.2), P < 0.01]. CONCLUSION In patients with residual reflux symptoms despite PPI treatment, adding an alginate offers additional decrease in the burden of reflux symptoms (EudraCT/IND Number: 2011-005486-21).
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Affiliation(s)
- C Reimer
- Department of Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - A B Lødrup
- Department of Gastroenterology, Køge Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - G Smith
- Reckitt Benckiser Brands, Slough, UK
| | | | - P Bytzer
- Department of Gastroenterology, Køge Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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29
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Lødrup A, Pottegård A, Hallas J, Bytzer P. Editorial: anti-secretory therapy prior to anti-reflux surgery. Does dose matter? Authors' reply. Aliment Pharmacol Ther 2015; 42:627. [PMID: 26238578 DOI: 10.1111/apt.13314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- A Lødrup
- Department of Medicine, Køge University Hospital, Køge, Denmark. .,Diagnostic Center, Silkeborg Hospital, Silkeborg, Denmark.
| | - A Pottegård
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - J Hallas
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark
| | - P Bytzer
- Department of Medicine, Køge University Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Lødrup A, Pottegård A, Hallas J, Bytzer P. Use of acid-suppressive therapy before anti-reflux surgery in 2922 patients: a nationwide register-based study in Denmark. Aliment Pharmacol Ther 2015; 42:84-90. [PMID: 25939580 DOI: 10.1111/apt.13230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 03/24/2015] [Accepted: 04/16/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Guidelines recommend that patients with gastro-oesophageal reflux disease are adequately treated with acid-suppressive therapy before undergoing anti-reflux surgery. Little is known of the use of acid-suppressive drugs before anti-reflux surgery. AIM To determine the use of proton pump inhibitors and H2 -receptor antagonists in the year before anti-reflux surgery. METHODS A nationwide retrospective study of all patients aged ≥18 undergoing first-time anti-reflux surgery in Denmark during 2000-2012 using data from three different sources: the Danish National Register of Patients, the Danish National Prescription Register, and the Danish Person Register. RESULTS The study population thus included 2922 patients (median age: 48 years, 55.7% male). The annual proportion of patients redeeming ≥180 DDD of acid-suppressive therapy increased from 17.0% 5 years before anti-reflux surgery to 64.9% 1 year before. The probability for inadequate dosing 1 year before surgery (<180 DDD) was significantly increased for younger patients, patients operated in the period 2000-2003, patients who had not undergone pre-surgical manometry, pH- or impedance monitoring, and patients who had not redeemed prescriptions on NSAID or anti-platelet drugs. CONCLUSION Compliance with medical therapy should be evaluated thoroughly before planning anti-reflux surgery, as a high proportion of patients receive inadequate dosing of acid-suppressive therapy prior to the operation.
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Affiliation(s)
- A Lødrup
- Department of Medicine, Køge University Hospital, Køge, Denmark.,Diagnostic Center, Silkeborg Hospital, Silkeborg, Denmark
| | - A Pottegård
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - J Hallas
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark
| | - P Bytzer
- Department of Medicine, Køge University Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Krogsgaard LR, Bytzer P. [Irritable bowel syndrome – another example of everything that we do not yet know]. Ugeskr Laeger 2015; 177:1245. [PMID: 26099180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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32
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Krogsgaard LR, Lyngesen M, Bytzer P. [Insufficient evidence of the effect of the low FODMAP diet on irritable bowel syndrome]. Ugeskr Laeger 2015; 177:1503-1507. [PMID: 25922242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The low FODMAP (Fermentable Oligo-, Di- and Monosaccharides and Polyoles) diet (LFD) allegedly reduces symptoms of irritable bowel syndrome (IBS). Eleven studies have examined the effects of LFD on IBS. Most studies reported a symptomatic effect, but methodological weaknesses such as lack of relevant control group and of proper blinding means that a placebo response cannot be excluded. No studies have examined the effect of the important reintroduction phase nor the effects of LFD on IBS patients in primary care. Evidence suggests that intake of high dose FODMAP can induce gastrointestinal symptoms, but the clinical relevance of this is doubtful.
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Bremholm L, Gadsbøll N, Poulsen JH, Bytzer P. [A targeted effort can secure a good and educating clinical stay for medical students]. Ugeskr Laeger 2014; 176:V02140125. [PMID: 25353673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The medical education at the University of Copenhagen introduces the student to clinical life through a number of clinical courses. In this article we describe measures taken to secure a good and educating stay on the department during a five-week course. We describe the process, procedures, planning, executing and evaluation of the five-week clinical course. The evaluation through direct feedback and subsequent electronic form is commented and essential learning points are discussed.
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Affiliation(s)
- Lasse Bremholm
- Medicinsk Afdeling, Køge Sygehus, Lykkebækvej 1, 4600 Køge.
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Abstract
OBJECTIVE Antireflux surgery (ARS) has been suggested as an alternative to lifelong use of proton pump inhibitors (PPI) in reflux disease. Data from clinical trials on PPI use after ARS have been conflicting. We investigated PPI use after ARS in the general Danish population using nationwide healthcare registries. DESIGN A nationwide retrospective follow-up study of all patients aged ≥18 and undergoing first-time ARS in Denmark during 1996-2010. Two outcome measures were used: redemption of first PPI prescription after ARS (index prescription) and a marker of long-term use, defined by an average PPI use of ≥180 defined daily doses (DDDs) per year. Kaplan-Meier curves and Cox proportional hazards model were used for statistics. RESULTS 3465 patients entered the analysis. 12.7% used no PPI in the year before surgery, while 14.2%, 13.4% and 59.7% used 1-89 DDD, 90-179 DDD and ≥180 DDD, respectively. Five-, 10- and 15-year risks of redeeming index PPI prescription were 57.5%, 72.4% and 82.6%, respectively. Similarly, 5-, 10- and 15-year risks of taking up long-term PPI use were 29.4%, 41.1% and 56.6%. Female gender, high age, ARS performed in most recent years, previous use of PPI and use of nonsteroidal anti-inflammatory drugs or antiplatelet therapy significantly increased the risk of PPI use. CONCLUSIONS Risk of PPI use after ARS was higher than previously reported, and more than 50% of patients became long-term PPI users 10-15 years postsurgery. Patients should be made aware that long-term PPI therapy is often necessary after ARS.
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Affiliation(s)
- Anders Lødrup
- Department of Medicine, Køge University Hospital, University of Copenhagen, Køge, Denmark
| | - Anton Pottegård
- Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark,Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark,Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark
| | - Peter Bytzer
- Department of Medicine, Køge University Hospital, University of Copenhagen, Køge, Denmark
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Bytzer P. [Not Available]. Ugeskr Laeger 2014; 176:V66505. [PMID: 25294194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Peter Bytzer
- Medicinsk Afdeling, Køge Sygehus, Lykkebækvej 1, 4600 Køge.
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Abstract
OBJECTIVE Both over-the-counter medicine, such as antacids or alginates, and proton pump inhibitors (PPI) are used for treating acid-related disorders. We sought to describe what characterizes users of these different medicines, including long-term PPI users within the general population. METHOD A cross-sectional survey was conducted in an internet panel representative of the Danish adult population in 2012. Data queried included antacid/alginate and PPI use, reason for therapy, co-medication, and presence of upper gastrointestinal symptoms. Long-term PPI use was defined as using PPI ≥1/3 of the last year (∼120 days). Risk of long-term PPI use was estimated by logistic regression. RESULTS A total of 18,223 people received the questionnaire, of which 52% (9390) responded. Antacid/alginate use was reported by 23%; 16% reported use of only antacid/alginate. PPI use was reported by 13.6%; 6.2% were defined as long-term PPI users. Antacid/alginate users were younger, used less co-medication, had most often started on therapy because of reflux symptoms, and had less often ongoing symptoms. Risk of long-term PPI use appeared to be increased in male gender, by renewing PPI prescription by phone/e-mail, using co-medication, and having started on PPI for several reasons. Combination of antacid/alginate and PPI was reported by approximately 50% of those on therapy with weekly or daily symptoms. CONCLUSION 23% of Danish adults were using antacids or alginates and 14% were using PPI, of which one-half were on long-term therapy. Prescription renewal by phone or e-mail and use of other prescription medication were associated with long-term PPI use, indicating a behavioral pattern, in which unnecessary PPI therapy may be maintained.
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Affiliation(s)
- Anders Lødrup
- Department of Medicine, Køge Hospital , Koege , Denmark
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Röser D, Simonsen J, Stensvold CR, Olsen KEP, Bytzer P, Nielsen HV, Mølbak K. Metronidazole therapy for treating dientamoebiasis in children is not associated with better clinical outcomes: a randomized, double-blinded and placebo-controlled clinical trial. Clin Infect Dis 2014; 58:1692-9. [PMID: 24647023 DOI: 10.1093/cid/ciu188] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a paucity of evidence documenting the pathogenicity of Dientamoeba fragilis, an intestinal protozoan common in children. As case reports on successful treatment are numerous, many authors advocate treatment, despite no placebo-controlled trials being available. Metronidazole is often used for treatment, though eradication rates are relatively low (60%-80%). In the present study we determined the clinical and microbiological efficacy of metronidazole in Danish children. METHODS In this parallel placebo-controlled double-blinded trial, children aged 3-12 years with >4 weeks of gastrointestinal symptoms were allocated using block randomization in a 1:1 ratio to a 10-day course of oral metronidazole or placebo. Primary outcome was change in level of gastrointestinal symptoms, measured on a visual-analog-scale (VAS), and secondary outcome was eradication of D. fragilis infection. Participants, caregivers, investigators, and sponsor were all blinded to group assignment. The trial was registered with clinicaltrials.gov (NCT01314976) prior to start. RESULTS Of 96 participants, 48 were allocated to the metronidazole and placebo group each. Mean VAS change from pre- to post-treatment did not differ significantly (P = .8) between the metronidazole (-1.8 CI, [-2.5, -1.1]) and the placebo group (-1.6 CI, [-2.3, -.9]). Eradication of D. fragilis was significantly greater in the metronidazole group, although it declined rapidly from 62.5% 2 weeks after end of treatment to 24.9% 8 weeks after end of treatment. CONCLUSIONS These findings do not provide evidence to support routine metronidazole treatment of D. fragilis positive children with chronic gastrointestinal symptoms. Study funded by Statens Serum Institut. CLINICAL TRIALS REGISTRATION Trial was registered with clinicaltrials.gov (NCT01314976).
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Affiliation(s)
- Dennis Röser
- Department of Microbiology and Infection Control
| | - Jacob Simonsen
- Division of Health Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | | | | | - Peter Bytzer
- Faculty of Health Sciences, Department of Medicine, Copenhagen University, Køge University Hospital, Denmark
| | | | - Kåre Mølbak
- Division of Health Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
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Engsbro ALØ, Bytzer P. [Diagnostic strategy in patients suspected of irritable bowel syndrome]. Ugeskr Laeger 2014; 176:V08130528. [PMID: 25347436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Irritable bowel syndrome, a very common condition with a high use of health-care costs especially related to diagnostic testing, is traditionally approached by a diagnostic strategy of exclusion. However, data from clinical studies support a positive diagnostic strategy based on symptom-based criteria, absence of alarm signals and, if needed, a few simple blood tests in young patients presenting in primary care. For older patients, and for patients not fulfilling symptom-based criteria or presenting with alarm signals, more thorough investigations are needed, directed by the symptomatology.
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Larsen AR, Engsbro AL, Bytzer P. Screening instruments for anxiety and depression in patients with irritable bowel syndrome are ambiguous. Dan Med J 2014; 61:A4785. [PMID: 24495890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Psychiatric disorders are common among patients with irritable bowel syndrome (IBS) which may make a psychiatric evaluation appropriate. The Hospital Anxiety and Depression Scale (HADS) has been recommended internationally for screening. The Common Mental Disorder Questionnaire (CMDQ) is a novel Danish instrument recommended for use in general practice, but it lacks validation. The objective of this study was to test the reliability and the convergent validity of the anxiety and depression subscales of the CMDQ and the HADS in patients with IBS. MATERIAL AND METHODS A total of 149 patients with IBS completed the CMDQ and the HADS twice in a year. Data were analysed with respect to internal consistency (Cronbach's alpha), agreement on case identification (κ) and correlation between scores (Spearman's rank correlation coefficient). RESULTS All subscales showed satisfactory internal consistency. Cases identified by the CMDQ's anxiety and depressions subscales differed considerably from those identified with the HADS with only fair-moderate agreement, while the correlation between the scores on the CMDQ and the HADS was only moderate for both anxiety and depressions. CONCLUSION The subscales for anxiety disorder and depression on the CMDQ showed internal consistency, but only fair to moderate agreement and correlation, which yielded an unsatisfying convergent validity compared to the HADS. More studies in different populations and research on the cut-off values for possible cases could make the CMDQ more useful. FUNDING Danish Council for Independent Research; Region Zealand's Health Sciences Research Foundation; Councils for Quality Assurance in Primary Care in Region Zealand. TRIAL REGISTRATION NCT00659763.
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Affiliation(s)
- Anne Rode Larsen
- Medicinsk Afdeling, Køge Sygehus, Lykkebækvej 1, 4600 Køge, Denmark.
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Christoffersen MW, Rosenberg J, Jorgensen LN, Bytzer P, Bisgaard T. Health-related Quality of Life Scores Changes Significantly within the First Three Months After Hernia Mesh Repair. World J Surg 2013; 38:1852-9. [DOI: 10.1007/s00268-013-2411-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Engsbro AL, Stensvold CR, Vedel Nielsen H, Bytzer P. Prevalence, incidence, and risk factors of intestinal parasites in Danish primary care patients with irritable bowel syndrome. ACTA ACUST UNITED AC 2013; 46:204-9. [PMID: 24344761 DOI: 10.3109/00365548.2013.861609] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The gut microbiota may be involved in the aetiopathogenesis of irritable bowel syndrome (IBS). We studied the role of intestinal parasites by describing the epidemiology and risk factors for infection in primary care patients aged 18-50 y with IBS. One hundred and thirty-eight patients at baseline and 78/116 patients returning 1 y later, submitted faecal samples that were examined by microscopy, culture for Blastocystis, and real-time PCR for Dientamoeba fragilis, Entamoeba (dispar and histolytica), Cryptosporidium spp., and Giardia intestinalis. Overall, 42-45% of patients harboured intestinal parasites (baseline and follow-up, respectively): D. fragilis carriage was 35-41%; Blastocystis 14-20%. Incidence rates for D. fragilis and Blastocystis were 10 and 4 per 100 person-y, respectively. Blastocystis carriage increased the odds for carrying D. fragilis. Clinical comparisons showed D. fragilis to be associated with a low frequency of defecation. Further, D. fragilis was associated with having children aged 5-18 y and Blastocystis with increasing age.
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Begtrup LM, Engsbro AL, Kjeldsen J, Larsen PV, Schaffalitzky de Muckadell O, Bytzer P, Jarbøl DE. A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2013; 11:956-62.e1. [PMID: 23357491 DOI: 10.1016/j.cgh.2012.12.038] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Guidelines recommend a positive strategy based on symptom criteria to diagnose patients with irritable bowel syndrome (IBS). We conducted a randomized noninferiority trial to determine whether a positive diagnostic strategy is noninferior to a strategy of exclusion, with regard to patients' health-related quality of life (HRQOL). METHODS We studied 302 patients (18-50 years old) from primary care who were suspected of having IBS and referred by general practitioners. Patients who fulfilled the Rome III criteria for IBS with no alarm signals were randomly assigned to groups assessed by a strategy of exclusion (analyses of blood, stool samples for intestinal parasites, and sigmoidoscopies with biopsies) or a positive strategy (analyses of blood cell count and C-reactive protein). Patients were followed for 1 year. The primary end point was difference in change of HRQOL from baseline to 1 year between groups (on the basis of the Short Form 36 health survey, physical component summary, and noninferiority margin of 3 points). Secondary outcomes were change in gastrointestinal symptoms, satisfaction with management, and use of resources. Findings of diagnostic misclassification were registered. RESULTS A positive strategy was noninferior to a strategy of exclusion (difference, 0.64; 95% confidence interval, -2.74 to 1.45). The positive diagnostic strategy had lower direct costs. Each approach had similar effects on symptoms, satisfaction, and subsequent use of health resources. No cases of inflammatory bowel disease, colorectal cancer, or celiac disease were found. CONCLUSIONS In diagnosing IBS in primary care, use of a positive diagnostic strategy is noninferior to using a strategy of exclusion with regard to the patients' HRQOL. Our findings support the current guideline recommendations.
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Affiliation(s)
- Luise M Begtrup
- Department of Gastroenterology, Odense University Hospital, Odense, Denmark
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Engsbro AL, Begtrup LM, Kjeldsen J, Larsen PV, de Muckadell OS, Jarbøl DE, Bytzer P. Patients suspected of irritable bowel syndrome--cross-sectional study exploring the sensitivity of Rome III criteria in primary care. Am J Gastroenterol 2013; 108:972-80. [PMID: 23419383 DOI: 10.1038/ajg.2013.15] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The Rome III criteria for irritable bowel syndrome (IBS) are recommended by guidelines to help identify the syndrome. The majority of IBS patients are managed in primary care, where a pragmatic approach to diagnosis is usually adopted, using clinical judgment and knowledge about the patient. Many general practitioners (GPs) have no or limited knowledge of the diagnostic criteria, few use them, and many consider IBS a diagnosis of exclusion. The aim of this study is to explore the sensitivity of the Rome III criteria in relation to a GP-based clinical diagnosis of IBS, to identify differences between Rome III-positive and -negative patients, and to describe the agreement between the various symptom-based criteria. METHODS Patients aged 18-50 years, presenting in primary care with gastrointestinal complaints and identified as IBS patients by their GP, were referred for enrollment. The Manning and Rome I-III criteria were evaluated through interviews and patients completed the questionnaires The Gastrointestinal Symptom Rating Scale (GSRS)/The Gastrointestinal Symptom Rating Scale modified for use in patients with IBS (GSRS-IBS), Short Form 36, Irritable Bowel Syndrome Quality of Life measurement, Work Productivity and Activity Impairment questionnaire-irritable bowel version, and a questionnaire on use of health-care resources. RESULTS A total of 604 patients were referred and 499 were included (mean age 32.8 (s.d. 9.5) years, 75% were female). The Rome III criteria were fulfilled by 376 patients (sensitivity 0.75, 95% CI 71-79%). Rome III-positive patients more frequently reported disturbed defecation, had a higher symptom burden, and lower disease-specific health-related quality of life compared with Rome III-negative patients. The various symptom-based criteria identified slightly different subpopulations with the highest agreement between the Rome II and III criteria. CONCLUSIONS The Rome III criteria identified three in four patients labeled with IBS in primary care. The relevance of the Rome III for IBS in primary care is supported.
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Reimer C, Bytzer P. Gastroesophageal reflux disease: current state-of-the-art management. Best Pract Res Clin Gastroenterol 2013; 27:323. [PMID: 23998971 DOI: 10.1016/j.bpg.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 07/02/2013] [Indexed: 01/31/2023]
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Abstract
OBJECTIVE Our aims were to investigate the prevalence and subtype distribution of irritable bowel syndrome (IBS) according to the Rome III criteria in Denmark, to describe the difference in symptom reporting between those with gastrointestinal (GI) symptoms not fulfilling Rome III for IBS compared to those classified as IBS, and furthermore to describe the proportion of consulters and formally diagnosed subjects. MATERIAL AND METHODS A web-based survey was carried out in January 2010. Questionnaires were emailed to a web panel (n = 19,567) representative of the general Danish population aged 18-50 years on gender, age, and geography. IBS and subtypes were estimated by the Rome III criteria. RESULTS Of 6112 responders, 979 (16%) fulfilled the Rome III criteria for IBS and had no organic diagnosis likely to explain their symptoms. Subtypes were: mixed IBS 36%, IBS with diarrhea 33%, IBS with constipation 18%, and unsubtyped IBS 11%. Those with GI symptoms, not fulfilling Rome III for IBS, had symptoms very similar to those classified as IBS, but symptoms were less frequent and of shorter duration. Of IBS subjects, 180/978 (18.4%) had consulted a doctor for GI symptoms within the past 3 months, but only 7.9% were diagnosed with IBS. CONCLUSION Symptoms compatible with IBS according to Rome III are highly prevalent in Denmark. A high proportion of sufferers are undiagnosed.
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Affiliation(s)
- Laura Rindom Krogsgaard
- Department of Medical Gastroenterology, Køge University Hospital, Lykkebœkvej 1, Køge, Denmark.
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Abstract
INTRODUCTION While the physiological existence of rebound acid hypersecretion (RAHS) after withdrawal of proton pump inhibitors (PPI) therapy is established, the clinical implications are less certain. It has been speculated that a clinical relevant rebound phenomenon may be responsible for difficulties in getting off acid-suppressive medication and partly explain the increase in long-term use of PPI. A number of studies addressing this issue have been published recently. The authors aimed to systematically review the existing evidence of clinically relevant symptoms caused by acid rebound following PPI treatment. MATERIAL AND METHODS PubMed was searched using the terms "rebound acid hypersecretion" and generic names of PPIs. RESULTS Five studies were included. Two studies on asymptomatic volunteers found that 44% experienced acid-related symptoms up to 4 weeks after treatment was withdrawn. Symptoms were generally mild to moderate and mainly heartburn and regurgitation. Three studies, using patients with reflux disease, found no signs of symptoms caused by acid rebound. CONCLUSION Gastric acid rebound hypersecretion following PPI therapy induces reflux-like symptoms post-treatment in asymptomatic volunteers, but the significance of this in patient populations is not clear. The studies in patients with reflux disease found no evidence of symptomatic RAHS, but these studies were hampered by severe methodological weaknesses.
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Affiliation(s)
- Anders Bergh Lødrup
- Department of Medicine, Køge Hospital, Copenhagen University, Køge, Denmark.
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Bytzer P, Connolly SJ, Yang S, Ezekowitz M, Formella S, Reilly PA, Aisenberg J. Analysis of upper gastrointestinal adverse events among patients given dabigatran in the RE-LY trial. Clin Gastroenterol Hepatol 2013; 11:246-52.e1-5. [PMID: 23103906 DOI: 10.1016/j.cgh.2012.10.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 09/21/2012] [Accepted: 10/15/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Dabigatran is an oral and direct inhibitor of thrombin. In a study of patients with atrial fibrillation (the RE-LY trial), twice as many subjects given dabigatran reported dyspepsia-like symptoms compared with those given warfarin (controls). We analyzed data from this trial to quantify upper gastrointestinal nonbleeding adverse events (NB-UGI AEs). METHODS We analyzed the AE database from the RE-LY trial (18,113 subjects) and assigned NB-UGI AEs to 4 groups: those associated with gastroesophageal reflux (GERD), upper abdominal pain and dyspepsia, dysmotility, or gastroduodenal injury. We analyzed frequency, timing, and severity, and clinical variables associated with NB-UGI AEs. RESULTS NB-UGI AEs occurred in 16.9% of subjects given dabigatran and in 9.4% of controls (relative risk [RR], 1.81; 95% confidence interval [CI], 1.66%-1.97%; P < .001). Rates of AEs were not associated with the dose of dabigatran. Among subjects with any UGI symptom who were given dabigatran (n = 2045), symptoms were rated as mild in 46.3%, moderate in 44.8%, and severe in 8.9%; these values were similar to those of controls. GERD-associated NB-UGI AEs were most frequent among the 4 groups (compared with controls, RR, 3.71; 95% CI, 2.98%-4.62%; P < .001). Four percent of subjects stopped taking dabigatran because of NB-UGI AEs (most within 3 months of starting therapy), compared with 1.7% of controls (RR, 2.34; 95% CI, 1.90%-2.88%; P < .001). NB-UGI AEs slightly increased risk of major GI bleeding among subjects given dabigatran and controls (6.8% vs 2.3%, P < .001). CONCLUSIONS Among patients given dabigatran for atrial fibrillation, NB-UGI AEs are generally mild or moderate; 4% stopped taking the drug over a median of 21.7 months. The greatest increase was in GERD-type NB-UGI AEs. These observations should guide management and prevention strategies.
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Affiliation(s)
- Peter Bytzer
- Køge University Hospital and Copenhagen University, Copenhagen, Denmark.
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Bytzer P, Pratt S, Elkin E, Næsdal J, Sörstadius E. Burden of upper gastrointestinal symptoms in patients receiving low-dose acetylsalicylic acid for cardiovascular risk management: a prospective observational study. Am J Cardiovasc Drugs 2013; 13:27-35. [PMID: 23315343 DOI: 10.1007/s40256-012-0001-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Continuous low-dose acetylsalicylic acid (aspirin; ASA) is a mainstay of cardiovascular (CV) risk management. It is well established, however, that troublesome upper gastrointestinal (GI) symptoms are commonly experienced among low-dose ASA users. OBJECTIVE The objective of this study was to investigate the occurrence of upper GI symptoms, and their impact on well-being, among patients taking low-dose ASA for CV risk management. STUDY DESIGN This was a multicenter, non-interventional, 12-week study carried out in primary-care, cardiology, and practice group centers in the USA, Canada, and France. PATIENTS Eligible patients were adults (age ≥18 years) at risk of or with confirmed CV disease, with physician-prescribed/-recommended low-dose ASA (75-325 mg) use. MAIN OUTCOME MEASURES An electronic device (eDiary) was used to collect patient-reported outcome data three times per day (morning, afternoon, and evening; regular reports), including upper GI (gastroesophageal disease [GERD]-like or dyspepsia-like) symptoms and the impact of such symptoms on sleep quality, perceived stress, and emotions. In addition to regular reports, patients were able to self-initiate a report of upper GI symptoms (spontaneous reports). RESULTS Overall, 81,282 eDiary reports (including 4,407 spontaneous reports of upper GI symptoms) were collected from 340 patients. Upper GI symptoms (most commonly GERD-like) were commonly blamed on food/drink (39 %), and around one-third of patients (37 %) used medication to relieve their symptoms. Analysis showed that upper GI symptoms had a negative impact on sleep quality, perceived stress, and emotions (all p < 0.01). Overall, GI medication use was infrequent, but was more common among low-dose ASA-experienced patients (41 % vs. 12 % of evening reports in patients naïve to low-dose ASA at baseline; p < 0.01); adherence to prescribed daily proton pump inhibitors (PPIs) was poor (47 %). CONCLUSION Upper GI symptoms impact negatively on well-being among low-dose ASA users, in terms of decreased quality of sleep, increases in perceived stress, and negative impact on emotions. Despite this, patients may not necessarily associate these symptoms with their low-dose ASA therapy and do not readily take steps to manage such symptoms, which extends to poor adherence to prescribed daily PPIs.
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Affiliation(s)
- Peter Bytzer
- Department of Gastroenterology, Køge University Hospital, Copenhagen University, Lykkebækvej 1, 4600 Køge, Denmark.
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Bytzer P, Jones R, Vakil N, Junghard O, Lind T, Wernersson B, Dent J. Limited ability of the proton-pump inhibitor test to identify patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2012; 10:1360-6. [PMID: 22813439 DOI: 10.1016/j.cgh.2012.06.030] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/26/2012] [Accepted: 06/28/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The efficacy of proton-pump inhibitor (PPI) therapy often is assessed to determine whether patients' symptoms are acid-related and if patients have gastroesophageal reflux disease (GERD), although the accuracy of this approach is questionable. We evaluated the diagnostic performance of the PPI test, in conjunction with other tests, for the diagnosis of GERD. METHODS We analyzed data from the DIAMOND study, a multinational trial that compared the ability of the reflux disease questionnaire with that of symptom-based clinical diagnosis to identify GERD in primary care patients with frequent upper-gastrointestinal symptoms. Patients (n = 308) were given placebo and further evaluated by endoscopy, wireless esophageal pH-metry, and symptom association monitoring. Those with GERD (n = 197) were identified based on the presence of reflux esophagitis, esophageal pH level less than 4 for more than 5.5% of 24 hours, or positive results from symptom association monitoring (or a positive result from the PPI test in patients with borderline levels of esophageal acidity). All patients then were given single-blind therapy with esomeprazole (40 mg once daily) for 2 weeks and symptoms were recorded daily. RESULTS A positive response to the PPI test was observed in 69% of patients with GERD and in 51% of those without GERD. Response to placebo did not influence the diagnostic ability of the subsequent PPI test. More patients with reflux esophagitis had a positive result from the PPI test than patients without GERD (57% vs 35%; P = .002) or patients with GERD but no esophagitis. A clinical diagnosis by the primary care physician of an acid-related disease was not associated with response to PPIs. CONCLUSIONS In a well-characterized population of primary care patients with frequent upper-gastrointestinal symptoms of any type, the PPI test has limited ability to identify patients with GERD, diagnosed by current standard tests. (ClinicalTrials.gov Number, NCT00291746.).
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Affiliation(s)
- Peter Bytzer
- Department of Medicine, Køge University Hospital, Køge, Denmark.
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Abstract
The role of Dientamoeba fragilis in irritable bowel syndrome (IBS) is incompletely known. We aimed to investigate whether eradication of D. fragilis alleviates symptoms in IBS. Twenty-five D. fragilis-positive IBS patients were treated with Metronidazole (MZ) or Tetracycline. The patients were mostly female (89%), and mean age (SD) was 35.1 (8.2) years. Microbiological response, evaluated 2 weeks post-treatment, was observed in 15 of 25 patients (60%), all by MZ. Clinical response, defined as adequate relief of symptoms, was observed in 7 of 22 patients (32%), all by MZ. In a logistic regression analysis, we found no significant association between clinical and microbiological response. This case study did not support our hypothesis of a simple association between D. fragilis and IBS. Some D. fragilis-infections were insufficiently treated by MZ. Further studies into the prevalence and effect of eradication of D. fragilis in IBS and into efficient treatments of D. fragilis are warranted.
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Affiliation(s)
- Anne Line Engsbro
- Department of Medicine, Køge Hospital, Lykkebækvej 1, Køge, Denmark.
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