• Humans
• Fibrinolytic Agents/therapeutic use
• Fibrinolytic Agents/adverse effects
• Cardiovascular Diseases/prevention & control
• Gastrointestinal Diseases/chemically induced
• Gastrointestinal Diseases/drug therapy
• Gastrointestinal Hemorrhage/chemically induced
• Gastrointestinal Hemorrhage/prevention & control
• Risk Assessment
• Risk Factors
• Comorbidity

• K23 HL150290 NHLBI NIH HHS

• Gastrointestinal hemorrhage
• Network meta-analysis
• Peptic ulcer
• Secondary prevention

• Humans
• Pantoprazole/therapeutic use
• Peptic Ulcer/prevention & control
• Peptic Ulcer/chemically induced
• Aspirin/adverse effects
• Aspirin/administration & dosage
• Aspirin/therapeutic use
• Proton Pump Inhibitors/therapeutic use
• Proton Pump Inhibitors/adverse effects
• Proton Pump Inhibitors/administration & dosage
• Recurrence
• Sulfonamides/therapeutic use
• Pyrroles/therapeutic use
• Pyrroles/administration & dosage
• Secondary Prevention/methods
• Gastrointestinal Hemorrhage/prevention & control
• Gastrointestinal Hemorrhage/chemically induced
• Network Meta-Analysis
• Randomized Controlled Trials as Topic

• Humans
• Helicobacter pylori
• Gastroenterology
• Peptic Ulcer/diagnosis
• Peptic Ulcer/therapy
• Metabolic Diseases
• Helicobacter Infections/diagnosis
• Helicobacter Infections/therapy

• Efficacy
• Etress response
• Pantoprazole
• Peptic ulcer
• Perforation repair

• Antiplatelet therapy
• Gastrointestinal bleeding
• Stable coronary artery disease

• deep learning
• early prediction of clinical risk
• importance-aware mechanism
• learnable feature fusion
• personalized medicine

• Helicobacter pylori eradication
• Idiopathic ulcer
• Low-dose aspirin
• Nonsteroidal anti-inflammatory drug
• Peptic ulcer

• Humans
• Anti-Bacterial Agents/therapeutic use
• Evidence-Based Practice/methods
• Japan
• Peptic Ulcer/complications
• Peptic Ulcer/therapy
• Proton Pump Inhibitors/therapeutic use

• Antiangiogenesis
• Aspirin
• Cancer therapy
• Cyclooxygenase

• Angiogenesis Inhibitors/adverse effects
• Angiogenesis Inhibitors/therapeutic use
• Animals
• Aspirin/adverse effects
• Aspirin/therapeutic use
• Humans
• Neoplasms/drug therapy
• Neoplasms/metabolism
• Neoplasms/pathology
• Neovascularization, Pathologic
• Signal Transduction

• Aged
• Aged, 80 and over
• Aspirin/adverse effects
• Famotidine/therapeutic use
• Female
• Gastric Mucosa/drug effects
• Gastrointestinal Hemorrhage/chemically induced
• Gastrointestinal Hemorrhage/prevention & control
• Humans
• Intestinal Mucosa/drug effects
• Male
• Middle Aged
• Omeprazole/therapeutic use
• Risk Factors

• UGI bleeding
• abdominal aortic aneurysm
• matrix metalloproteinases
• mortality
• peripheral arterial atherosclerosis
• proton pump inhibitors
• stable CAD
• thrombotic complications
• upper gastrointestinal bleeding

• citalopram
• drug‐drug interaction
• omeprazole
• sudden cardiac arrest

• Humans
• Peptic Ulcer

There is a reported association between proton pump inhibitor (PPI) exposure and increased risk of Clostridium difficile infection (CDI), but less is known about how this class of medications taken during treatment might influence mortality after CDI. Here we examine 180-day mortality rates in a cohort of CDI elders and its association with exposure to PPIs. We conducted a retrospective cohort study of elderly patients (> 65 years of age) diagnosed and treated for CDI in the years 2014–2016 (n = 874) in the Umass Memorial Health Care system, which represents both academic and community healthcare. Patient characteristics and medication use was extracted from the electronic medical record (EMR) and 6 month mortality data was obtained via the Center for Disease Control National Death Index. A Cox proportional hazards model was used to estimate hazard ratios associated with medication exposures and other relevant variables.

Of the 874 elderly adults treated for CDI, 180-day all-cause mortality was 12.4%. Exposure to a PPI was associated with a 55% reduced risk of mortality (adjusted hazard ratio (aHR) 0.45; 95% confidence interval (CI) 0.28–0.72). In our Cox model, increasing age (aHR 1.45; 95% CI 1.14–1.84), those with severe CDI infections (aHR 1.87; 95% CI 1.22–2.88), and those with hospital acquired CDI (aHR 3.01; 95% CI 1.81–4.99) also had increased 180 day mortality risk. There were similar associations noted with both 90 day and 1-year mortality.

Use of PPIs during CDI treatment in elderly patients is associated with decreased 180-day mortality. Although use of PPIs has been associated with an increased risk of CDI, it appears to be protective against mortality when used during the treatment phase.

• Clostridium difficile
• Enteric pathogens
• Infectious disease
• Medication safety
• Proton pump inhibitors

Acute upper gastrointestinal haemorrhage due to peptic ulcer bleeding remains an important cause of emergency presentation and hospital admission. Despite advances in many aspects of management, peptic ulcer bleeding is still associated with significant morbidity, mortality, and healthcare costs. Comprehensive international guidelines have been published, but advances as well as controversies continue to evolve. Important recent advances include the evidence supporting a more restrictive transfusion strategy aiming for a target haemoglobin of 70–90 g/l. Comparative studies have confirmed that the Glasgow–Blatchford score remains the most useful score for predicting the need for intervention as well as for identifying the lowest-risk patients suitable for outpatient management. New scores, including the AIMS65 and Progetto Nazionale Emorragia Digestiva score, may be more accurate in predicting mortality. Pre-endoscopy erythromycin appears to improve outcomes and is probably underused. High-dose oral proton pump inhibition (PPI) for 11 days after PPI infusion is advantageous in those with a Rockall score of 6 or more. Oral is as effective as parenteral iron at restoring haemoglobin levels after a peptic ulcer bleed and both are superior to placebo in this respect. Within endoscopic techniques, haemostatic powders and over-the-scope clips can be used when other methods have failed. A disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Non- Helicobacter pylori, non-aspirin/non-steroidal anti-inflammatory drug ulcers contribute an increasing percentage of bleeding peptic ulcers and are associated with a poor prognosis and high rebleeding rate. The optimal management of these ulcers remains to be determined.

• H pylori
• anticoagulant drugs
• endoscopic hemostasis
• gastrointestinal hemorrhage
• non-steroidal anti-inflammatory drugs
• peptic ulcer hemorrhage

• Algorithms
• Anti-Bacterial Agents/therapeutic use
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Drug Therapy, Combination
• Gastrointestinal Hemorrhage/therapy
• Helicobacter Infections/complications
• Helicobacter Infections/drug therapy
• Helicobacter pylori
• Humans
• Peptic Ulcer/diagnosis
• Peptic Ulcer/drug therapy
• Peptic Ulcer/epidemiology
• Peptic Ulcer/etiology

• Gastric ulcers
• low dose aspirin
• omeprazole
• proton pump inhibitors
• secondary cardiovascular prevention

• Acute Coronary Syndrome/chemically induced
• Acute Coronary Syndrome/etiology
• Acute Coronary Syndrome/mortality
• Aged
• Case-Control Studies
• Coronary Disease/complications
• Coronary Disease/drug therapy
• Coronary Disease/mortality
• Female
• Heart Failure/chemically induced
• Heart Failure/etiology
• Heart Failure/mortality
• Humans
• Ischemic Attack, Transient/chemically induced
• Ischemic Attack, Transient/etiology
• Ischemic Attack, Transient/mortality
• Male
• Middle Aged
• Proton Pump Inhibitors/adverse effects
• Proton Pump Inhibitors/therapeutic use
• Risk Factors
• ST Elevation Myocardial Infarction/chemically induced
• ST Elevation Myocardial Infarction/etiology
• ST Elevation Myocardial Infarction/mortality
• Stroke/chemically induced
• Stroke/etiology
• Stroke/mortality

• Fondo de Investigaciones Sanitarias
• ISCIII-RETIC REDinREN
• Comunidad de Madrid
• Spanish Society of Cardiology
• Spanish Heart Foundation
• RECAVA
• Instituto de Salud Carlos III FEDER

• ASA
• Acid-Suppressive Drugs
• Antiplatelet
• Hemorrhage

• Cyclooxygenase-2
• Duodenal ulcer
• Gastric ulcer
• Helicobacter pylori eradication
• Low-dose aspirin
• Nonsteroidal anti-inflammatory drug
• Peptic ulcer
• Stomach ulcer

• Anti-Bacterial Agents/therapeutic use
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Anti-Ulcer Agents/therapeutic use
• Cyclooxygenase 2 Inhibitors/adverse effects
• Cyclooxygenase 2 Inhibitors/therapeutic use
• Drug Therapy, Combination
• Endoscopy, Gastrointestinal/methods
• Evidence-Based Medicine/methods
• Helicobacter Infections/complications
• Helicobacter Infections/drug therapy
• Helicobacter pylori
• Hemostasis, Endoscopic/methods
• Humans
• Peptic Ulcer/etiology
• Peptic Ulcer/therapy
• Peptic Ulcer Hemorrhage/therapy
• Proton Pump Inhibitors/therapeutic use
• Recurrence

• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Anti-Ulcer Agents/therapeutic use
• Aspirin/adverse effects
• Gastrointestinal Diseases/chemically induced
• Gastrointestinal Diseases/prevention & control
• Hemorrhage/chemically induced
• Hemorrhage/prevention & control
• Histamine H2 Antagonists/therapeutic use
• Humans
• Proton Pump Inhibitors/therapeutic use
• Randomized Controlled Trials as Topic
• Upper Gastrointestinal Tract/drug effects

AIM: To determine the preventive effect and safety of proton pump inhibitors (PPIs) in low-dose aspirin (LDA)-associated gastrointestinal (GI) ulcers and bleeding.

METHODS: We searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register from inception to December 2013, and checked conference abstracts of randomized controlled trials (RCTs) on the effect of PPIs in reducing adverse GI events (hemorrhage, ulcer, perforation, or obstruction) in patients taking LDA. The preventive effects of PPIs were compared with the control group [taking placebo, a cytoprotective agent, or an H₂ receptor antagonist (H₂RA)] in LDA-associated upper GI injuries. The meta-analysis was performed using RevMan 5.1 software.

RESULTS: We evaluated 8780 participants in 10 RCTs. The meta-analysis showed that PPIs decreased the risk of LDA-associated upper GI ulcers (OR = 0.16; 95%CI: 0.12-0.23) and bleeding (OR = 0.27; 95%CI: 0.16-0.43) compared with control. For patients treated with dual anti-platelet therapy of LDA and clopidogrel, PPIs were able to prevent the LDA-associated GI bleeding (OR = 0.36; 95%CI: 0.15-0.87) without increasing the risk of major adverse cardiovascular events (MACE) (OR = 1.00; 95%CI: 0.76-1.31). PPIs were superior to H₂RA in prevention of LDA-associated GI ulcers (OR = 0.12; 95%CI: 0.02-0.65) and bleeding (OR = 0.32; 95%CI: 0.13-0.79).

CONCLUSION: PPIs are effective in preventing LDA-associated upper GI ulcers and bleeding. Concomitant use of PPI, LDA and clopidogrel did not increase the risk of MACE.

• Proton pump inhibitor
• Low dose aspirin
• Peptic ulcer
• Gastrointestinal bleeding
• Meta-analyses
• Randomized controlled trial

• Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Aspirin/administration & dosage
• Aspirin/adverse effects
• Chi-Square Distribution
• Cytoprotection
• Humans
• Odds Ratio
• Peptic Ulcer/chemically induced
• Peptic Ulcer/diagnosis
• Peptic Ulcer/prevention & control
• Peptic Ulcer Hemorrhage/chemically induced
• Peptic Ulcer Hemorrhage/diagnosis
• Peptic Ulcer Hemorrhage/prevention & control
• Proton Pump Inhibitors/adverse effects
• Proton Pump Inhibitors/therapeutic use
• Risk Factors
• Treatment Outcome

• famotidine
• gastroduodenal injury
• low-dose aspirin
• teprenone

• Duodenal ulcer
• Endoscopy
• Gastric ulcer
• Nonvariceal upper gastrointestinal hemorrhage
• Peptic ulcer bleeding
• Upper gastrointestinal bleeding

Background. Proton pump inhibitor and histamine-2 receptor antagonist can prevent aspirin-related ulcers/erosions but few studies compare the efficacy of these two agents. Aims. We evaluated the efficacy of omeprazole and famotidine in preventing recurrent ulcers/erosions in low-dose aspirin users. Methods. The 24-week clinical outcomes of the patients using low-dose aspirin for cardiovascular protection with a history of ulcers/erosions and cotherapy of omeprazole or famotidine were retrospectively reviewed. The incidence of gastrointestinal symptoms, recurrent ulcers/erosions, erosive esophagitis, gastrointestinal bleeding, and thromboembolic events was analyzed. Results. A total of 104 patients (famotidine group, 49 patients; omeprazole group, 55 patients) were evaluated. Famotidine group had more gastrointestinal symptoms episodes than omeprazole group (46.9% versus 23.6%, P = 0.01). Fifteen famotidine group patients and 5 omeprazole group patients had recurrent ulcers/erosions (30.6% versus 9.1%, P = 0.005). Lanza scale was significantly lower in omeprazole group than in famotidine group (1.2 ± 0.7 versus 1.7 ± 1.1, P = 0.008). Only 1 famotidine group patient had ulcer bleeding. The incidences of erosive esophagitis and thromboembolic events were comparable between both groups. Conclusions. Omeprazole was superior to famotidine with less gastrointestinal symptoms and recurrent ulcers/erosions in patients using 24-week low-dose aspirin. The risk of erosive esophagitis, gastrointestinal bleeding, and thromboembolic events was similar between both groups.

AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).

METHODS: Retrospective cohort study using ICD-10 codes to identify all patients with upper gastrointestinal hemorrhage secondary to endoscopically proven PUD, EG or ED during the period from March 2007 to October 2010 in three major metropolitan hospitals in Melbourne, Australia. Patients were divided into “high risk” (those who would benefit from gastroprotection) and “not high risk” groups as defined by established guidelines. Mean Rockall score, transfusion requirement, length of stay, rebleeding rates, need for surgery and in-hospital mortality was compared between “high risk” and “not high risk” groups. Within the “high risk” group, those on gastroprotection and those with no gastroprotection were also compared.

RESULTS: Five hundred and seven patients were included for analysis of which 174 were classified as high risk. Median values of complete Rockall Score (5 vs 4, P = 0.002) and length of stay (5 d vs 4 d, P = 0.04) were higher in the high risk group but in-hospital mortality was lower (0.6% vs 3.9%, P = 0.03). 130 out of the 174 patients in the high risk group were not taking recommended gastroprotective therapy prior to hospitalization. Past history of PUD (OR = 3.7, P = 0.006) and clopidogrel use (OR = 3.2, P = 0.007) significantly predicted prescription of gastroprotective therapy. Using proton pump inhibitor protection rates of 50%-85% from published studies, an estimation of 13% to 22% of the total number of the hospitalizations due to PUD or EG/ED related bleeding may have been preventable.

CONCLUSION: Up to one fifth of all hospitalizations for bleeding secondary to PUD or EG/ED are potentially preventable.

• Peptic ulcer
• Gastrointestinal hemorrhage
• Prevention
• Non-steroidal anti-inflammatory drug
• Proton pump inhibitor
• Gastroprotection

• Chi-Square Distribution
• Duodenitis/complications
• Duodenitis/diagnosis
• Duodenitis/drug therapy
• Duodenitis/mortality
• Endoscopy, Gastrointestinal
• Female
• Gastritis/complications
• Gastritis/diagnosis
• Gastritis/drug therapy
• Gastritis/mortality
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/mortality
• Gastrointestinal Hemorrhage/prevention & control
• Hospital Mortality
• Hospitalization
• Humans
• Length of Stay
• Logistic Models
• Male
• Middle Aged
• Odds Ratio
• Peptic Ulcer Hemorrhage/diagnosis
• Peptic Ulcer Hemorrhage/mortality
• Peptic Ulcer Hemorrhage/prevention & control
• Predictive Value of Tests
• Proton Pump Inhibitors/therapeutic use
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Victoria

• H. pylori
• clopidogrel
• famotidine
• low-dose aspirin
• rabeprazole

• Adult
• Anti-Ulcer Agents/administration & dosage
• Asian People/genetics
• Aspirin/administration & dosage
• Aspirin/adverse effects
• Clopidogrel
• Cytochrome P-450 CYP2C19/genetics
• Drug Therapy, Combination
• Famotidine/administration & dosage
• Female
• Gastric Acidity Determination
• Gastric Mucosa/drug effects
• Gastric Mucosa/pathology
• Genotype
• Helicobacter Infections/drug therapy
• Helicobacter Infections/genetics
• Helicobacter Infections/pathology
• Helicobacter pylori
• Histamine H2 Antagonists/administration & dosage
• Humans
• Hydrogen-Ion Concentration
• Male
• Platelet Aggregation/drug effects
• Platelet Aggregation Inhibitors/administration & dosage
• Platelet Aggregation Inhibitors/adverse effects
• Ticlopidine/administration & dosage
• Ticlopidine/adverse effects
• Ticlopidine/analogs & derivatives
• Young Adult

• Acute Coronary Syndrome/drug therapy
• Clopidogrel
• Cytochrome P-450 CYP2C19/metabolism
• Drug Interactions
• Humans
• Lansoprazole/pharmacology
• Monitoring, Physiologic
• Omeprazole/pharmacology
• Platelet Aggregation Inhibitors/metabolism
• Platelet Aggregation Inhibitors/pharmacology
• Proton Pump Inhibitors/pharmacology
• Ticlopidine/analogs & derivatives
• Ticlopidine/metabolism
• Ticlopidine/pharmacology

• Adverse event
• Anti-inflamatorios no esteroideos
• Cardiovascular
• Efecto adverso
• Gastrointestinal hemorrhage
• Hemorragia gastrointestinal
• Non steroidal anti-inflammatory drugs
• Peptic ulcer
• Úlcera péptica

• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Delphi Technique
• Humans
• Musculoskeletal Diseases/drug therapy

The aim of this study was to describe the use of gastrointestinal (GI) protection before, during and after hospitalisation for elderly patients using NSAID or low-dose ASA.

This study included all elderly patients (75+) admitted to hospital in the period of 1^st April 2010 to 31^st March 2011 at Odense University Hospital, Denmark, who were regular users of NSAID or low-dose ASA before hospital admission, or had one of these drugs initiated during hospital stay. By using pharmacy dispensing data and a hospital-based pharmacoepidemiological database, the treatment strategy for the individual patients was followed across hospital stay.

In total, 3,587 patients were included. Before hospital admission, 93 of 245 NSAID users (38.0%) and 597 of 1994 user of low-dose ASA (29.9%) had used GI protection. During hospital stay, use of GI protection increased to 75% and 33.9%, respectively. When hospital physicians initiated new treatment with NSAID or with low-dose ASA, 305 of 555 (55.0%) and 647 of 961 (67.3%) were initiated without concomitant use of GI protection. When hospital physicians initiated GI protection, 26.8–51.0% were continued in primary care after discharge.

During hospital stay, the use of GI protection increases, but when new treatment with NSAIDs or low-dose ASA is initiated in hospital, the use of gastrointestinal protection is low. The low use of GI protection is carried on in primary care after discharge.

• Aged
• Aged, 80 and over
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Aspirin/therapeutic use
• Denmark
• Drug Administration Schedule
• Female
• Gastrointestinal Tract/drug effects
• Hospitalization
• Humans
• Male
• Physicians
• Practice Patterns, Physicians'/statistics & numerical data
• Prescription Drugs/therapeutic use
• Primary Health Care/statistics & numerical data

• Helicobacter pylori
• cyclooxygenase
• gastrointestinal haemorrhage
• nonsteroidal anti-inflammatory agents
• oesophageal and gastric varices
• peptic ulcer

Increased risk due to nonsteroidal anti-inflammatory drugs (NSAIDs) therapy has been observed in patients. Although diaphragm-like stricture in the small bowel and colon induced by NSAIDs therapy has been rarely reported, gastric body diaphragm-like stricture has not been reported. We describe the first case of gastric body diaphragm-like stricture due to NSAIDs in a 44-year-old male patient who was successfully treated by an endoscopic approach to avoid complicated surgery. This case highlights new insight into the disadvantages of NSAIDs and provides new data for future clinical studies.

• Gastric
• Gastroscopy
• Diaphragm
• Stricture
• Nonsteroidal anti-inflammatory drug

• Adult
• Aminopyrine/adverse effects
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Biopsy
• Constriction, Pathologic
• Dilatation
• Drug Overdose
• Gastroscopy/instrumentation
• Humans
• Male
• Stents
• Stomach/drug effects
• Stomach/pathology
• Stomach/surgery
• Stomach Ulcer/chemically induced
• Stomach Ulcer/diagnosis
• Stomach Ulcer/surgery
• Treatment Outcome

The preventive effects of histamine 2 receptor antagonists vs. proton pump inhibitors on low-dose aspirin (LDA)-related gastroduodenal mucosal injury have not been fully investigated. We conducted a cross-sectional study to compare the prevalence of gastroduodenal ulcers or erosions in patients taking LDA with either 40 mg/day of famotidine or 15 mg/day of lansoprazole for at least three months.

Of 84 eligible patients, two taking 40 mg/day of famotidine and four taking 15 mg/day of lansoprazole refused to undergo upper gastrointestinal endoscopy. Ultimately, we performed upper gastrointestinal endoscopy in 78 patients taking either 40 mg/day of famotidine (group F, n = 31) or 15 mg/day of lansoprazole (group L, n = 47). The prevalence of gastroduodenal ulcers or erosions and the magnitude of gastric mucosal injury evaluated using modified Lanza scores were compared between the two groups.

No patients in either group had gastroduodenal ulcers. Gastroduodenal erosions were more prevalent in group F than in group L (48.4% vs. 17.0%, p = 0.005). The modified Lanza scores (mean ± SD) were significantly higher in group F than in group L (0.9 ± 1.3 vs. 0.3 ± 0.7, p = 0.007). A multivariate logistic regression analysis showed that the use of lansoprazole was negatively associated with gastroduodenal erosions.

This study suggests that 15 mg/day of lansoprazole may be more effective in preventing the development of LDA-related gastroduodenal erosions than 40 mg/day of famotidine. The preventive effects of these two regimens on the development of LDA-related gastroduodenal ulcers require further investigation.