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Open access

Gastroenterology

Efficacy and safety of stress ulcer prophylaxis in critically ill patients: a network meta-analysis of randomized trials – Intensive Care Medicine (free)

“PPIs are the most effective agents in preventing CIB, but they may increase the risk of pneumonia”.

 


Glucocorticosteroids for people with alcoholic hepatitis – Cochrane Library (free)

Original article: Glucocorticosteroids for people with alcoholic hepatitis – Cochrane Library (link to abstract – $ for full-text)

“We found no evidence of a difference between glucocorticosteroids and placebo or no intervention on all-cause mortality, health-related quality of life, and serious adverse events during treatment”.

 


Maintenance therapy with proton pump inhibitors and risk of gastric cancer: a nationwide population-based cohort study in Sweden – BMJ Open (free)

“Among 797 067 individuals on maintenance PPI therapy, the SIR of gastric cancer was over threefold increased (SIR=3.38, 95% CI 3.23 to 3.53)”.

 


Incidence, Demographics, and Clinical Characteristics of Diabetes of the Exocrine Pancreas (Type 3c): A Retrospective Cohort Study – Diabetes Care (link to abstract – $ for full-text)

Commentary: Newly-identified third type of diabetes is being wrongly diagnosed as type 2 – The Conversation (free)

“Diabetes of the exocrine pancreas is frequently labeled type 2 diabetes but has worse glycemic control and a markedly greater requirement for insulin”.

 


Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis – Antibiotics (free)

Antibiotic-associated diarrhea ocurred in 8.0% of the probiotic group compared to 17.7% in the control group. The number needed to treat (NNT) to prevent one case of diarrhea was 11 (95% CI 6 to 13).

 


Medical News & Perspectives: Study Questions Use of Acid Suppressors To Curb Mild Infant Reflux – JAMA (free) (RT @DeeMangin see Tweet)

Study abstract presented at the Pediatric Academic Societies meeting: Infants prescribed antacids for reflux have increased risk of bone fractures (free)

 


Incidence, Demographics, and Clinical Characteristics of Diabetes of the Exocrine Pancreas (Type 3c): A Retrospective Cohort Study – Diabetes Care (link to abstract – $ for full-text)

Commentary: Glycemic control poor, insulin use high in diabetes after pancreatic disease – Haelio (free registration required)

“Diabetes following pancreatic disease associated with poor glycemic control compared with T2 diabetes” (RT @kamleshkhunti see Tweet)

 


Gastrointestinal Safety of Direct Oral Anticoagulants: A Large Population-Based Study – Gastroenterology (free)

Commentary: Which NOACS are riskiest for gastrointestinal bleeding? – Pharmacy News (free)

Source: ACP Journal Club ($)

Observational study suggests Apixaban may be associated with a more favorable gastrointestinal safety profile. Further randomized trials are needed to confirm these findings.

 


Gastrointestinal safety of celecoxib versus naproxen in patients with cardiothrombotic diseases and arthritis after upper gastrointestinal bleeding (CONCERN): an industry-independent, double-blind, double-dummy, randomised trial – The Lancet (link to abstract – $ for full-text)

Source: ACP Journal Club

In this study, patients at high risk of both cardiovascular and gastrointestinal events who required concomitant aspirin and NSAID, celecoxib associated with a proton pump inhibitor led to less recurrent gastrointestinal bleeding when compared to naproxen associated with a proton pump inhibitor (5.6% vs 12.3%).

 


New 8-Week Treatment Approved for All Hepatitis C Genotypes – Physician’s First Watch (free)

See also: FDA News Release

Standard treatment length was previously 12 weeks or more.

 


Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial – Gastrointestinal Endoscopy (link to abstract – $ for full-text)

Source: No Benefit of Second-Look Endoscopy After Endoscopic Hemostasis – Journal Watch ($)

“A single EGD with endoscopic hemostasis is not inferior to scheduled second-look endoscopy in terms of reduction in rebleeding rate of peptic ulcer bleeding. Repeat endoscopy would be helpful in the patients with unsatisfactory initial endoscopic hemostasis, use of NSAIDs, and larger amounts of transfused blood”

 


What carcinoembryonic antigen level should trigger further investigation during colorectal cancer follow-up? A systematic review and secondary analysis of a randomised controlled trial – Health Technology Assessment (free)

Source: ACP Journal Wise ($)

“The results suggest that (1) CEA testing should not be used alone as a triage test; (2) in year 1, testing frequency should be increased (to monthly for 3 months and then every 2 months); (3) the threshold for investigating a single test result should be raised to 10 µg/l; (4) after the second CEA test, decisions to investigate further should be made on the basis of the trend in CEA levels; (5) the optimal threshold for investigating the CEA trend falls over time; and (6) continuing smokers should not be monitored with CEA testing”.

 


Head To Head: Should we screen for cirrhosis? – The BMJ (free)

Pros and cons of screening high risk patients for liver cirrhosis.

 


Post-Surgical Complications – emDocs (free)

Practical review of this common problem in the emergency department.

 


The relationship between eosinophilic esophagitis and esophageal cancer – Diseases of The Esophagus (free)

An analysis of a large database of de-identified electronic medical records (EMRs) with over 40.000.000 patients found no association.

 


Complications of Proton Pump Inhibitor Therapy – Gastroenterology (free)

Commentary: Complications of Proton Pump Inhibitor Therapy – PracticeUpdate (free registration required)

Related: Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline – Canadian Family Physician (free) AND Proton Pump Inhibitors and Risk of Incident CKD and Progression to ESRD – Journal of the American Society of Nephrology (link to abstract – registration required for full text) AND Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis – Jama Neurology (link to abstract – subscription required for full text)

The authors of this review argue that the observational studies that brought up the safety issues associated with PPIs (above studies, for example) are insufficient to establish causation and suggest a more balanced approach to PPI prescribing.

 


Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta-Regression Analysis – Gastroenterology (free)

Source: EvidenceAlerts (free resource to find articles of interest)

In this meta-analysis including 19 randomized trials, probiotics given within 2 days of the first antibiotic dose (more effective than if started later) reduced the risk of Clostridium difficile infection (CDI) by >50% in hospitalized adults. 1 case of CDI would be prevented for every 23−144 patients treated with probiotics when antibiotics are started. “There was no convincing evidence of superior efficacy for any of the tested probiotic formulations, delivery methods (drink or capsule), or probiotic doses”.

 


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