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Objective: Dual‐antiplatelet therapy (DAPT) and proton pump inhibitor (PPI) are frequently prescribed after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) placement. However, studies that evaluate the optimal PPI when used as primary prevention in patients without a history of peptic ulcer disease or upper gastrointestinal bleeding (UGIB), particularly in the context of DAPT involving prasugrel, are lacking. This study aimed to assess the efficacy and safety of PPI use in preventing UGIB in this patient population. Methods: This study included patients who underwent PCI with coronary stent placement for acute coronary syndrome or stable angina at our institution from January 2015 to December 2020. Eligible patients started DAPT with aspirin and prasugrel and concomitantly received PPI therapy (lansoprazole or esomeprazole), with a follow-up period of two years. The primary endpoint was UGIB incidence, diagnosed during follow-up, serving as an efficacy measure. Secondary endpoints included the assessment of major bleeding (as defined by the Thrombolysis in Myocardial Infarction major bleeding criteria) and clinically relevant non-major bleeding events. Safety outcomes focused on adverse event incidence attributable to PPI use. Results: Among the 165 patients analyzed, 109 and 56 were included in the lansoprazole and esomeprazole groups, respectively, with cumulative incidence of UGIB at 96 weeks of 0.9% (1/109) and 3.6% (2/56). No significant differences in terms of major bleeding events or other bleeding outcomes were observed between the two groups. Adverse events related to PPI use were reported as diarrhea/soft stools in 7 (6%) cases and thrombocytopenia in 1 (1%) case in the lansoprazole group, whereas no such events were observed in the esomeprazole group. No clinically significant hematologic or biochemical abnormalities were reported. Conclusion: This study evaluated the efficacy and safety of PPIs in combination with DAPT, including prasugrel, following PCI, and suggests that lansoprazole and esomeprazole may offer comparable efficacy in preventing UGIB. [ABSTRACT FROM AUTHOR]

Background: Issues associated with proton pump inhibitor (PPI) usage have been documented. PPIs affect the gastrointestinal microbiome, as well as the saliva microbiota of healthy individuals. However, the alterations in the saliva microbiota of laryngopharyngeal reflux (LPR) patients remain unclear. This study aims to examine the composition of saliva microbiota in LPR patients before and after PPI usage through a self-controlled study. Methods: Thirty-two adult LPR patients participated in the study. Saliva samples were collected before and after an 8-week regimen of twice-daily administration of 20-mg esomeprazole. The impact of PPI administration on bacterial communities was assessed using 16 S rRNA gene sequencing. The functional and metabolic changes in saliva microbial communities after PPI usage were analyzed using PICRUSt2 based on our 16 S rRNA gene sequencing results. Results: The alpha diversity within the salivary microbiota, as measured by the PD-whole-tree index, exhibited a significant difference between samples collected before and after PPI application (P = 0.038). Additionally, PCoA analysis of unweighted UniFrac distances (beta diversity) revealed distinct separation of saliva sample microbiota structures before and after PPI application in LPR patients, with statistical significance (Adonis test, R2 = 0.063, P< 0.010). Taxon-based analysis indicated that PPI administration increased the abundance of Epsilonproteobacteria, Campylobacterales, Campylobacteraceae, Campylobacter, and Campylobacter_gracilis, while reducing the abundance of Lactobacillaceae and Lactobacillus in salivary samples (P< 0.050). Using LEfSe to compare bacterial abundances, Bacillaceae and Anoxybacillus were found to be enriched before PPI usage in LPR patients. Furthermore, the proportion of genes responsible for indole alkaloid biosynthesis in the salivary microbiota of LPR patients significantly increased after PPI therapy (P< 0.050). Conclusions: These findings indicate that PPIs induce alterations in the salivary microbiota of LPR patients. Chinese clinical trial registry: No. ChiCTR2300067507. Registered on January 10,2023 retrospectively. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Our understanding of the use of acid-suppressant drugs (ASDs) in companion animals is largely centered around the treatment of acid-related disorders including gastroesophageal reflux and gastrointestinal ulceration. The companion article by Grady et al, JAVMA, October 2024, summarizes our current knowledge of the efficacy of and indications for ASDs for the treatment of acid-related disorders. Far less is understood about both the benefits of and potential for adverse effects of ASDs outside of the parietal cell including those directed toward inflammation and immunomodulation, tumorigenesis, fibrosis, and oxidative stress. In this Currents in One Health article, we summarize the pH-independent properties of ASDs as demonstrated in studies conducted largely in humans and rodents. The objective of this review is to highlight and increase awareness of the pH-independent effects of ASDs to elucidate the need for further veterinary research in this area. [ABSTRACT FROM AUTHOR]

Background: High-dose dual therapy (HDDT) using proton-pump inhibitors (PPI) and amoxicillin attracted attention for its simplicity and lower adverse event profile. Besides, vonoprazan is not available worldwide. This real-world study aims to compare the efficacy of esomeprazole-based and rabeprazole-based HDDT regimens and to identify clinical factors influencing outcomes. Methods: A retrospective study enrolled 346 Helicobacter pylori-infected naïve patients from January 2016 to August 2023. Patients were assigned to either a 14-day esomeprazole-based HDDT (EA-14; esomeprazole 40 mg t.i.d. and amoxicillin 750 mg q.i.d. for 14 days, n = 173) or a 14-day rabeprazole-based HDDT (RA-14; rabeprazole 20 mg and amoxicillin 750 mg q.i.d. for 14 days, n = 173). Results: Five patients from the EA-14 group and 10 from the RA-14 group were lost to follow-up, resulting in 168 and 163 patients for the per-protocol (PP) analysis, respectively. Eradication rates for the EA-14 and RA-14 groups were 90.2% and 80.9% (P = 0.014) in intention-to-treat (ITT) analysis; and 92.9% and 85.9% (P = 0.039) in PP analysis. Adverse event rates were similar between the two groups (11.9% vs 11.7%, P = 0.944). In multiple logistic regression analysis, age≧60 was associated with eradication failure (P = 0.046) and a trend of significance for smoking (P = 0.060) in the EA-14 group but not in the RA-14 group. A trend of significance was also observed for eradication regimens (EA-14 vs RA-14) (P = 0.071).The antibiotic resistance rates were amoxicillin (2.3%), clarithromycin (14.7%), metronidazole (40.3%), and dual resistance to clarithromycin and metronidazole (7.0%). Conclusions: Esomeprazole-based HDDT achieved over 90% eradication rates but rabeprazole-based HDDT, which failed.

Summary Recent studies report the use of a range of treatments for equine glandular gastric disease, but with all treatments, refractory disease is common. The evidence for some widely used treatments is very poor. Treatments may aim to suppress acid production (e.g. omeprazole), promote mucosal barrier function (e.g. misoprostol/sucralfate), or both. It is imperative that all treatments are combined with management to minimise known risk factors, primarily physiological and psychological stressors. [ABSTRACT FROM AUTHOR]

Background: Treatment with potassium‐competitive acid blockers has shown acceptable efficacy in Helicobacter pylori eradication. In regions like Korea, where the clarithromycin resistance rate is high, alternative combinations like non‐bismuth quadruple therapies have shown favorable results. This study compared the outcomes of sequential eradication therapy with new potassium‐competitive acid blocker tegoprazan and conventional esomeprazole‐containing sequential therapy. Materials and Methods: Patients with Helicobacter pylori (H. pylori) infection were consecutively recruited. Patients were allocated to either an esomeprazole‐containing sequential or a tegoprazan‐containing sequential therapy group. Sequential therapy comprised esomeprazole (40 mg) or tegoprazan (50 mg) plus amoxicillin (1000 mg) twice daily for the initial 5 days, followed by esomeprazole (40 mg) or tegoprazan (50 mg) with clarithromycin (500 mg) and metronidazole (500 mg) twice daily for the remaining 5 days. Eradication rate, compliance, and adverse events were recorded. Results: A total of 406 patients with H. pylori infection were enrolled in the trial and analyzed per protocol. Eradication rate by intention‐to‐treat and per‐protocol was 83.8% (95% confidence interval [CI]: 78.7–88.9) for esomeprazole‐containing sequential therapy, and 87.1% (95% CI: 82.5–91.8) for tegoprazan‐containing sequential therapy, with no statistical significance (p = 0.399). Additionally, there was no statistically significant difference in treatment compliance between the two groups. Nausea was more prevalent (23.3%, 27/202) with sequential tegoprazans than with esomeprazole‐containing sequential therapy (14.2%, 29/204; p = 0.022). Conclusion: Tegoprazan‐containing 10‐day sequential eradication treatment demonstrated similar eradication efficacy compared to esomeprazole‐containing treatment, even in regions with high antimicrobial resistance, such as Korea. Trial Registration: ClinicalTrials.gov: NCT06382493 [ABSTRACT FROM AUTHOR]

Background: We compared efficacy of vonoprazan‐dual or triple therapies and bismuth‐quadruple therapy for treatment‐naive Helicobacter pylori (HP) infection in Southern China, where primary resistance rates of clarithromycin and levofloxacin are >30%. Methods: This was an investigator‐initiated, three‐arm, randomized clinical trial in Southern China. Between March 2022 and August 2023, treatment‐naïve HP‐infected adults were randomly assigned to receive one of three 14‐day regimens (1:1:1 ratio): vonoprazan‐dual (VA‐dual; vonoprazan 20 mg twice daily and amoxicillin 1 g thrice daily), vonoprazan‐triple (VAC‐triple; vonoprazan 20 mg/amoxicillin 1 g/clarithromycin 500 mg twice daily), or bismuth‐quadruple therapy containing bismuth, esomeprazole, tetracycline, and metronidazole. Primary outcome was noninferiority in HP eradication, evaluated by UBT 4–6 weeks post‐treatment by intention‐to‐treat (ITT) and per‐protocol (PP) analysis (based on subjects who completed 14‐day treatment and rechecked UBT). Bonferroni‐adjusted p‐value of <0.017 was used to determine statistical significance. Results: A total of 298 subjects (mean age: 35.7 ± 8.4 years; male: 134 [45.0%]; VC‐dual: 100, VAC‐triple: 98, bismuth‐quadruple: 100) were enrolled, and 292 (98.0%) had UBT rechecked. ITT analysis showed that both VA‐dual (eradication rate of 96.0%) and VAC‐triple therapies (95.9%) were noninferior to bismuth‐quadruple therapy (92.0%) (difference: 4.0%, 95% CI: −2.9% to 11.5%, p < 0.001; and 3.9%, 95% CI: −3.1% to 11.5%, p < 0.001, respectively). PP analysis also revealed noninferiority (96.7% or 96.7% vs. 97.4%, with difference: −2.9% and −2.9%, p = 0.009 and 0.010, respectively). The frequency of adverse events was 39.0%, 56.1%, and 71.0% in VA‐dual, VAC‐triple, and bismuth‐quadruple therapies, respectively. Conclusions: VA‐dual and VA‐triple therapies are highly effective and noninferior to bismuth‐quadruple therapy in Southern China. Given the lower adverse effects and fewer antibiotic use, VA‐dual therapy is the preferred first‐line treatment for HP infection. Trial Registration: Chinese Clinical Trial Registry (No. ChiCTR2200056375). Registered on February 4, 2022, https://www.chictr.org.cn/showproj.aspx?proj=14131. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate prolonged esomeprazole use in Japanese pediatric patients for reflux esophagitis (RE) maintenance therapy and prevention of gastric (GU) and/or duodenal ulcers (DU) while using non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin (LDA). Methods: This multicenter, open-label, parallel-group, phase III study (NCT03553563) included patients who were administered esomeprazole according to body weight (10 mg/day [Groups 1 and 3] and up to 20 mg/day [Groups 2 and 4] for patients weighing 10-20 kg and ≥20 kg, respectively). Efficacy outcomes for Groups 1 and 2 (maintenance therapy for healed RE) and Groups 3 and 4 (prevention of long-term NSAID/LDA use-associated GU/DU) were the presence/absence of RE relapse and GU/DU recurrence, respectively. Results: Esomeprazole as maintenance therapy was associated with a low RE recurrence rate, independent of body weight or dosage. Recurrence rates of RE were 0.0% and 5.3% for Groups 1 and 2, respectively. In patients previously diagnosed with GU and/or DU due to long-term NSAID/LDA use, the recurrence rates of GU/DU during weeks 0-32 were 11.1% and 0.0% in Groups 3 and 4, respectively. Conclusion: Long-term use of 10- or 20-mg, once-daily esomeprazole demonstrated a favorable benefit-risk balance in preventing RE and suppressing recurrence of GU and/or DU secondary to NSAID or LDA therapy in Japanese pediatric patients. No new safety concerns were identified. Esomeprazole may be a viable option for managing RE and preventing GU and DU in Japanese pediatric patients. [ABSTRACT FROM AUTHOR]

Esomeprazole (ESO) is one of the proton pump inhibitors (PPIs) that is commonly used to treat extreme acidity and gastrointestinal irritation. Since it is used at a high rate, it is now classified as a pollutant of emerging concern (CEC). ESO gravely jeopardizes the health of living beings because it persists in water and wastewater sources even after standard treatment. Studies on the effective removal of PPIs, especially ESO, are scarce. In the current study, esomeprazole is disintegrated in water using electrochemical oxidation (EO). Titanium cathode with sodium sulfate electrolyte and carbon coated titanium (C/Ti) anode were used to apply EO. Through optimization studies utilizing COD measurement, it was discovered that 93% of the COD could be removed at pH 3, 60 mM sodium sulfate concentration, 300 min treatment period, and 115 mA cm−2 current density. Whereas TOC research revealed only 44% mineralization, HPLC‐PDA experiments revealed 100% ESO transformation. High resolution mass spectrometry (HRMS) studies were used to propose a degradation mechanism and pathway. The primary processes of degradation included desulfurization, thioperoxole group formation, sulfinyl benzimidazole group breakage, and demethylation. More than 20 reuses of the anode and cathode materials were possible without significantly lowering their oxidation efficiency. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusions Helicobacter pylori infection is one of the most common bacterial infections affecting humans, causing gastroduodenal and extraintestinal diseases. Treatment of the infection remains challenging for the clinicians, and different factors are involved in the failure of the therapeutic approach. The importance of the intensity of acid secretion inhibition remains an unclear issue. The aim of this study is to assess whether 80 mg/day esomeprazole‐based 10‐day sequential therapy (esomeprazole‐ST) achieved different eradication rates when compared to 80 mg/day pantoprazole‐based analogous regimen (pantoprazole‐ST).This was a retrospective observational study where data of consecutive patients referred by their physicians to our unit to perform an upper gastrointestinal endoscopy were analyzed.Overall, 1,327 patients were available for the analysis: 599 and 728 patients received pantoprazole‐ST and esomeprazole‐ST, respectively. Eradication rate was significantly higher in patients receiving esomeprazole‐ST (92.6%, 95% CI: 91–94.5) than pantoprazole‐ST (89.3%, 95% CI: 86.7–91.7; difference: 3.3%; 95% CI: 0.2–6.5; P = 0.037). Even after a multivariate analysis, the esomeprazole‐ST achieved a significantly higher eradiation (OR: 1.44; 95% CI: 1.1–2.17).This study showed that esomeprazole‐ST achieved significantly higher H. pylori cure rates than pantoprazole‐ST. Prospective and well‐designed trials are demander to confirm this prelaminar finding. [ABSTRACT FROM AUTHOR]

Background: PCSK9 inhibitors are a novel class of lipid-lowering medications, and numerous clinical studies have confirmed their significant role in improving the progression of chronic kidney disease. However, recent case reports have indicated new evidence regarding their association with acute kidney injury (AKI), with some patients experiencing acute tubular injury after PCSK9 inhibitors use. Objectives: To clarify the relationship between PCSK9 inhibitors and AKI, we conducted a pharmacovigilance study. Methods: Using the Food and Drug Administration Adverse Event Reporting System (FAERS) database from the third quarter of 2015 to the fourth quarter of 2022, a disproportionality analysis was employed to identify adverse events suggestive of AKI after PCSK9 inhibitors use. The drugs of interest included evolocumab and alirocumab. Results: A total of 144,341 adverse event reports related to PCSK9 inhibitors were analyzed, among which 444 cases were suspected of AKI for evolocumab, and 172 cases for alirocumab. Evolocumab had a greater impact on AKI in males (ROR 1.4, 95% CI 1.54-1.69). The ROR and 95% CI for evolocumab and Alirocumab were 0.13 (0.12-0.14) and 0.26 (0.23-0.30) respectively. Further analysis of AKI associated with the concomitant use of PCSK9 inhibitors with cephalosporins, furosemide, torsemide, pantoprazole, omeprazole, and esomeprazole revealed ROR and 95% CI of 0.38 (0.23-0.62), 0.38 (0.31-0.48), 0.18 (0.08-0.38), 0.23 (0.17-0.29), 0.20 (0.16-0.26), and 0.14 (0.10-0.20) respectively. Conclusion: Through the FAERS database, we analyzed the clinical characteristics of AKI associated with PCSK9 inhibitors, exploring its risks. Our findings suggest that PCSK9 inhibitors might have a potential protective effect against AKI and exhibit similar effects when co-administered with other nephrotoxic drugs. [ABSTRACT FROM AUTHOR]

Prednisolone (PDS) has recently been utilized to treat a variety of medical disorders, including autoimmune illnesses and cancer. It is also used to treat coronavirus disease 2019 infection-related respiratory problems. Because it may induce health problems including gastrointestinal lesions and ulceration, it has to be used alongside other drugs like esomeprazole (ESM), which acts as a proton pump antagonist to reduce the probability of ulceration. As a result, the goal of this research is to create an environmentally safe and sensitive high-performance liquid chromatography (HPLC) approach for determining PDS and ESM in their binary combination and spiked human plasma. C8 column (100 × 4.6 mm, 5 μm) and gradient mobile phase elution were used to separate the studied drugs with ultraviolet recognition at 290 nm. Caffeine was utilized as an internal standard to adjust the sample variance. Plasma, caffeine, ESM and PDS all had tR values of 1.4, 3.5, 6.3 and 7.3, respectively. The suggested method's greenness features were evaluated using three greenness evaluation tools: green analytical procedure index, analytical greenness metric approach and analytical eco-scale, and the findings were approved and satisfied. Validation parameters were evaluated in accordance with US-FDA recommendations in order to meet the global desires for biological analysis technique, acceptable limits were obtained. [ABSTRACT FROM AUTHOR]

Background: Current guidelines recommend bismuth‐containing quadruple therapy for patients newly diagnosed with Helicobacter pylori (H. pylori) infection. We aimed to compare the efficacy and safety of tetracycline administered three times daily versus four times daily in bismuth‐containing quadruple therapy for first‐line treatment of H. pylori infection. Methods: This multicenter, noninferiority, randomized controlled study, conducted in China, recruited treatment‐naïve adults with H. pylori infection, randomized 1:1 into two treatment groups to receive either of the following bismuth‐containing quadruple therapies: esomeprazole 20 mg twice‐daily; bismuth 220 mg twice‐daily; amoxicillin 1000 mg twice‐daily; and tetracycline 500 mg three times daily (TET‐T) versus 500 mg four times daily (TET‐F). At least 6 weeks post‐treatment, a 13C‐urea breath test was performed to evaluate H. pylori eradication. Results: In total, 406 patients were randomly assigned to the two treatment groups. Intention‐to‐treat eradication rates were 91.63% (186/203; 95% confidence interval [CI] 87.82%–95.44%) versus 90.15% (183/203; 95% CI 86.05%–94.25%) (p = 0.0005) and per‐protocol eradication rates were 95.34% (184/193; 95% CI 92.36%–98.31%) versus 95.72% (179/187; 95% CI 92.82%–98.62%) (p = 0.0002) for the TET‐T and TET‐F group, respectively. TET‐T‐treated patients had a lower incidence of adverse effects than TET‐F‐treated patients (21.61% vs. 31.63%, p = 0.024), with no significant differences in compliance to treatment between the groups. Conclusion: As a first‐line therapy for H. pylori infection, the eradication rate of the TET‐T therapy was noninferior to that of the TET‐F therapy while significantly reducing the incidence of adverse reactions. Trial Registration: ClinicalTrials.gov identifier: NCT05431075 [ABSTRACT FROM AUTHOR]

Background: PPI prescriptions have consistently increased in hospitals and ambulatory care facilities. Because PPIs are widely used, readily available, highly effective, and heavily marketed, they are susceptible to over-prescription and misuse. This study aims to assess the PPI utilization pattern and prescribing appropriateness in terms of indication, dose, and route of administration in the ICU setting. Methods: A retrospective, cohort study performed from October 2020 - October 2022 in a tertiary care hospital in the UAE. All patients received a proton pump inhibitor in the ICU. Results: Only 20.3% had an appropriate indication for prophylaxis and matched either of the 1 major criteria of SUP or at least 2 minor criteria. The highest percentage of patients (66.2%) were receiving inappropriate prophylaxis therapy. Pantoprazole was the most commonly prescribed PPI followed by Esomeprazole and Lansoprazole. PPI dose was appropriate in 66.9% of the patients and PPI route of administration was appropriate in 87.8% of the patients. Total PPI appropriateness was achieved in only 17.6% of the patients. Patients with moderate GI bleeding risk and who are non-smokers are more likely to have total PPI inappropriateness. Conclusion: This study identified a significant number of inappropriate prescriptions of PPIs for critically ill patients, not in accordance with clinical guidelines. These findings underscore the necessity for educational interventions aimed at physicians to promote more rational prescribing practices. [ABSTRACT FROM AUTHOR]

Objective: To investigate the gastroprotective influence of 2,3-Dichloro-6-(trifluoromethoxy) quinoxaline in a rat model of indomethacininduced gastric ulcers. Methods: Thirty male Wistar rats were randomly divided into five groups (n = 6) as follows: Group 1 (control), Group 2 (indomethacin only, 30 mg/kg), Group 3 (indomethacin and 2,3-Dichloro-6-(trifluoromethoxy) quinoxaline, 30 mg/kg), Group 4 (indomethacin with 2,3-Dichloro-6-(trifluoromethoxy) quinoxaline, 60 mg/kg), and Group 5 (indomethacin with esomeprazole, 30 mg/kg). The efficacy of 2,3-Dichloro-6-(trifluoromethoxy) quinoxaline in mitigating gastric ulcers induced by indomethacin in rats was evaluated based on gastric morphology, histopathology, and inflammatory biomarkers. Results: Indomethacin-induced stomach ulcers resulted in epithelial damage and blood streaks on the gastric mucosa. However, treatment with indomethacin and 2,3-Dichloro-6-(trifluoromethoxy) quinoxaline (60 mg/kg) significantly (P < 0.05) reduced ulcers compared to the indomethacin-only group. Inflammatory cells were observed in the indomethacin group, while the 60 mg/kg 2,3-Dichloro-6- (trifluoromethoxy) quinoxaline-treated group exhibited the restoration of normal epithelial tissue and minimal inflammatory cells, similar to the control and esomeprazole-treated groups. Furthermore, 2,3-Dichloro-6-(trifluoromethoxy) quinoxaline significantly decreased inflammatory biomarkers (TNF-α, IL-6, INF-γ, and IL-β1) and increased gastroprotective mediator levels (PGE2 and mucin), both with P-values below 0.05, in contrast to the effects of indomethacin. Conclusion: This study provides clinical evidence highlighting the gastroprotective properties of 2,3-Dichloro-6-(trifluoromethoxy) quinoxaline. Its initial application reveals, for the first time, its efficacy in treating gastric ulcers induced by indomethacin. However, further tests are warranted to validate these findings. [ABSTRACT FROM AUTHOR]

The article examines abdominal pain in children, highlighting its frequent presentation in emergency settings and the need for accurate diagnosis. Topics include common self-limited causes of abdominal pain, such as constipation and gastroenteritis; the importance of identifying serious conditions that may require urgent treatment; and a specific case of a 17-year-old with epiploic appendagitis.