Vonoprazan vs proton pump inhibitors in treating post-endoscopic submucosal dissection ulcers and preventing bleeding: A meta-analysis of randomized controlled trials and observational studies

Background: Vonoprazan is a potassium-competitive acid blocker (P-CAB) that is frequently used in Japan for Helicobacter pylori (H. pylori) eradication, treatment of gastroesophageal reflux disease, and treatment of post endoscopic submucosal dissection (ESD) complications. We sought to determine if vonoprazan was superior to proton pump inhibitors (PPIs) for treating ESD-induced ulcers (as assessed by ulcer healing and shrinkage ratios) and preventing delayed bleeding over various treatment durations (2, 4, and 8 weeks). Methods: We collected randomized controlled trials (RCTs) and observational studies that discussed the effectiveness of vonoprazan and PPIs on ESD-induced ulcers and bleeding from PubMed, Cochrane Library, ClinicalTrials.gov, and Google Scholar. Studies were selected according to pre-established eligibility criteria and data were extracted separately by 2 researchers with double-check. We used the Cochrane risk of bias tool to assess RCTs and the Newcastle–Ottawa Quality Assessment Scale to assess observational studies. Meta-analyses, based on the random-effects model, were conducted to compare differences in ulcer shrinkage ratios (%) and odds ratios (ORs) for ulcer healing and delayed bleeding. Publication bias was evaluated using funnel plots and Egger regression test. Heterogeneity was assessed using I2 statistics. A sensitivity analysis was conducted to check the robustness of results. The evidential quality of the findings was assessed using...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

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This study, for instance, attributes a patient’s waitlist/transplant outcome to the very last dialysis facility the patient was associated with.  In epidemiology speak, this means the causal inference authors are trying to draw between for-profit status and good transplant outcomes is subject to time-varying confounding. As an example, if one is seeking an association between testosterone levels and risk of a heart attack, using the last testosterone level available would be a poor way of doing this study because testosterone levels are known to vary over time. The same applies to dialysis facilities. Patie...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Medical Practice Physicians Eric Weinhandl JAMA medical research public health Public Policy public policy research Source Type: blogs
Japanese Prime Minister Shinzo Abe is lifting a coronavirus state of emergency in Tokyo and four other remaining areas, ending the restrictions nationwide as businesses begin to reopen
Source: ABC News: Health - Category: Consumer Health News Tags: Health Source Type: news
Source: ABC News: Health - Category: Consumer Health News Tags: Health Source Type: news
Discussion: The findings of the present systematic review will be critical for physicians, patients, and policymakers regarding the use of vonoprazan in ESD-induced ulcers. Study registration: PROSPERO registration number: CRD42018116855.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Study Protocol Systematic Review Source Type: research
AbstractPurpose of the reviewAcid suppression treatment has revolutionized the management of the acid-related disorders since the introduction of the H2-receptor antagonists (H2-RAs) and the proton pump inhibitors (PPIs). However, there has been increasing identification of needs for improvement in antisecretory therapy, especially in gastroesophageal reflux disease (GERD), the eradication ofHelicobacter pylori (H. pylori), protection from aspirin (ASA) and non-steroidal inflammatory drug (NSAID) injury and the management of upper gastrointestinal (UGI) bleeding. There have also been increasing publications addressing safe...
Source: Current Treatment Options in Gastroenterology - Category: Gastroenterology Source Type: research
Abstract INTRODUCTION: The introduction of proton pump inhibitors (PPIs) into clinical practice has greatly improved our therapeutic approach to acid-related diseases for their efficacy and safety. Areas Covered:The following evidence-based indications for PPI use are acknowledged by many scientific societies: treatment of the various forms and complications of gastroesophageal reflux disease, eradication of H. pylori infection in combination with two or more antibiotics, short- and long-term therapy of H. pylori-negative peptic ulcers, healing and prevention of NSAID/COXIB-associated gastric ulcers, co-therapy wi...
Source: Pharmacological Reviews - Category: Drugs & Pharmacology Authors: Tags: Expert Rev Clin Pharmacol Source Type: research
Abstract A substantial decrease in Helicobacter pylori‐associated peptic ulcer disease has been observed during the last decades. Drug‐related ulcers as well as idiopathic ulcers are becoming predominant and are more refractory to treatment; however, H. pylori infection still plays an important role in ulcer bleeding and recurrence after therapy. The effect of H. pylori eradication upon functional dyspepsia symptoms has been reviewed in this article and generally confirms the results of previous meta‐analyses. Additional evidence suggests a lack of impact upon the quality of life, in spite of improvement in symptoms....
Source: Helicobacter - Category: Gastroenterology Authors: Tags: REVIEW ARTICLE Source Type: research
The postoperative marginal ulcer at the gastrojejunal (GJ) anastomosis is not uncommonly encountered post Roux-en-Y gastric bypass (RYGB). Reported incidence varies widely 0.6 to 16%. Most marginal ulcerations occur between 2 and 6 months postoperatively, with 95% occurring within 12 months. Ulcers can be due to reaction to foreign body such as non-absorbable sutures, staples, and implanted bands or mesh, local ischemia, micro insufficiency, bile acid reflux, tension on the Roux limb and Helicobacter pylori infection.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Oral abstract Source Type: research
In 1982, two Australian scientists discovered that a certain bacterium, Helicobacter pylori, was a common cause of persistent stomach inflammation and stomach ulcers. This realization revolutionized ulcer treatment. While fairly common, this infection usually causes no symptoms, but it can sometimes lead to ulcers in the stomach or the very first part of the small intestine (duodenum), and to certain types of stomach cancer. There is also evidence linking H. pylori infection to other conditions like iron-deficiency anemia and vitamin B12 deficiency. The bacteria are thought to spread through contaminated water, vomit, or f...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Digestive Disorders Health Infectious diseases Tests and procedures Source Type: blogs
CONCLUSION: Prevalence of UGIB risk factors was high in elderly population, but was also considerable in younger population. Patient with osteoarthritis was at higher UGIB risk than those without osteoarthritis. Physicians should consider individualized risk assessment regardless of age when prescribing drugs or performing procedures that may increase the risk of UGIB, and take necessary measures to reduce modifiable risk factors such as H. pylori eradication or lifestyle counseling. PMID: 28082817 [PubMed - in process]
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
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