Colin Howden - Academia.edu (original) (raw)

Papers by Colin Howden

BMJ, Dec 11, 2019

Objective To determine the effectiveness of management strategies for uninvestigated dyspepsia. D... more Objective To determine the effectiveness of management strategies for uninvestigated dyspepsia. Design Systematic review and network meta-analysis. Data sOurces Medline, Embase, Embase Classic, the Cochrane Central Register of Controlled Trials, and clinicaltrials. gov from inception to September 2019, with no language restrictions. Conference proceedings between 2001 and 2019. cOnclusiOns "Test and treat" was ranked first, although it performed similarly to prompt endoscopy and was not superior to any of the other strategies. "Test and treat" led to fewer endoscopies than all other approaches, except symptom based management. However, participants showed a preference for prompt endoscopy as a management strategy for their symptoms. systematic review registratiOn PROSPERO registration number CRD42019132528.

Endoscopy International Open, Sep 22, 2020

Background Recently, underwater endoscopic mucosal resection (UEMR) has shown promising results i... more Background Recently, underwater endoscopic mucosal resection (UEMR) has shown promising results in the management of colorectal polyps. Some studies have shown better outcomes compared to conventional endoscopic mucosal resection (EMR). We conducted this systematic review and meta-analysis to compare UEMR and EMR in the management of colorectal polyps. Methods We searched several databases from inception to November 2019 to identify studies comparing UEMR and EMR. Outcomes assessed included rates of en bloc resection, complete macroscopic resection, recurrent/residual polyps on follow-up colonoscopy, complete resection confirmed by histology and adverse events. Pooled risk ratios (RR) with 95 % confidence interval were calculated using a fixed effect model. Heterogeneity was assessed by I 2 statistic. Funnel plots and Egger's test were used to assess publication bias. We used the Newcastle-Ottawa scale (NOS) for assessment of quality of observational studies, and the Cochrane tool for assessing risk of bias for RCTs Results Seven studies with 1291 patients were included; two were randomized controlled trials and five were observational. UEMR demonstrated statistically significantly better efficacy in rates of en bloc resection, pooled RR 1.16 (1.08, 1.26), complete macroscopic resection, pooled RR 1.28 (1.18, 1.39), recurrent/residual polyps; pooled RR 0.26 (0.12, 0.56) and complete resection confirmed by histology; pooled RR 0.75 (0.57, 0.98). There was no significant difference in adverse events (AEs); pooled RR 0.68 (0.44, 1.05). Conclusions This meta-analysis found statistically significantly better rates of en bloc resection, complete macroscopic resection, and lower risk of recurrent/residual polyps with UEMR compared to EMR. We found no significant difference in AEs between the two techniques. Supplementary material is available under

Contemporary Clinical Trials, May 1, 2012

Background-Functional dyspepsia (FD) is a common problem affecting up to 10-25% of individuals. F... more Background-Functional dyspepsia (FD) is a common problem affecting up to 10-25% of individuals. FD accounts for significant health care costs and affects quality of life but has no definitive treatment. Objectives-The Functional Dyspepsia Treatment Trial (FDTT) aims to test whether treatment with an antidepressant (amitriptyline or escitalopram) leads to improvement of symptoms in patients with moderate to severe FD. Design-The FDTT is an international multicenter, parallel group, randomized, double-blind, placebo-controlled trial to evaluate whether 12 weeks of treatment with escitalopram or amitriptyline improves FD symptoms compared to treatment with placebo. Secondly, it is hypothesized that acceleration of solid gastric emptying, reduction of postprandial satiation, and enhanced gastric volume change with a meal will be significant positive predictors of short-and long-term outcomes for those on antidepressants vs. placebo. The third aim is to examine whether polymorphisms of GNβ3 and serotonin reuptake transporter influence treatment outcomes in FD patients receiving a tricyclic antidepressant, selective serotonin reuptake inhibitor therapy, or placebo. Methods-The FDTT enrollment began in 2006 and is scheduled to randomize 400 patients by the end of 2012 to receive an antidepressant or placebo for 12 weeks, with a 6-month posttreatment follow-up. The study incorporates multiple validated questionnaires, physiological testing, and specific genetic evaluations. The protocol was approved by participating centers' Institutional Review Boards and an independent Data Safety Monitoring Board was established for monitoring to ensure patient safety and a single interim review of the data in December 2010 (ClinicalTrials.gov number NCT00248651).

The American journal of gastroenterology, Jan 20, 2017

We have updated both the American College of Gastroenterology (ACG) and the Canadian Association ... more We have updated both the American College of Gastroenterology (ACG) and the Canadian Association of Gastroenterology (CAG) guidelines on dyspepsia in a joint ACG/CAG dyspepsia guideline. We suggest that patients ≥60 years of age presenting with dyspepsia are investigated with upper gastrointestinal endoscopy to exclude organic pathology. This is a conditional recommendation and patients at higher risk of malignancy (such as spending their childhood in a high risk gastric cancer country or having a positive family history) could be offered an endoscopy at a younger age. Alarm features should not automatically precipitate endoscopy in younger patients but this should be considered on a case-by-case basis. We recommend patients <60 years of age have a non-invasive test Helicobacter pylori and treatment if positive. Those that are negative or do not respond to this approach should be given a trial of proton pump inhibitor (PPI) therapy. If these are ineffective tricyclic antidepressa...

Polymorphisms of 5-HTT LPR and GNβ3 825C>T and Response to Antidepressant Treatment in Functional Dyspepsia: A Study from The Functional Dyspepsia Treatment Trial

The American journal of gastroenterology, Jan 14, 2017

The Functional Dyspepsia Treatment Trial reported that amitriptyline (AMI) was associated with ad... more The Functional Dyspepsia Treatment Trial reported that amitriptyline (AMI) was associated with adequate relief of functional dyspepsia (FD) symptoms, but the pharmacogenetics of antidepressant response in FD are not known. GNβ3 825C>T CC genotype has been previously linked to FD and TT genotype to antidepressant response in depression. The ss genotype of the 5-HTT LPR variant of the serotonin transporter gene (SLC6A4) has been linked to selective serotonin reuptake inhibitor (SSRI) response. We aimed to examine whether GNβ3 825C>T and 5-HTT LPR polymorphisms result in differential treatment effects in FD patients receiving antidepressant therapy. Participants were randomized to receive placebo, 50 mg AMI, or 10 mg escitalopram (ESC). The primary end point was adequate relief for ≥5 weeks of the last 10 weeks. Genotyping of GNβ3 825C>T and 5-HTT LPR was performed utilizing PCR-based methods. GNβ3 825C>T and 5-HTT LPR genotype data were available for 256 (88%) and 246 (84%...

Current Treatment Options in Gastroenterology, Jul 17, 2020

Purpose of review Our purpose was to provide an update on methods and indications for testing and... more Purpose of review Our purpose was to provide an update on methods and indications for testing and treatment selection focusing on novel modalities. Recent findings Increasing antibiotic resistance has reduced treatment effectiveness. Antibiotic resistance testing is not widely available in North America where there are insufficient resistance and susceptibility data. Quadruple regimens (bismuth-based or concomitant/non-bismuth-based) have been recommended first-line. A rifabutin-based combination product recently approved by the US Food and Drug Administration is highly effective and should simplify treatment. The potassium-competitive acid blocker vonoprazan is being evaluated as part of dual or triple combination regimens. Molecular-based genotypic testing for antibiotic resistance and an effective H. pylori vaccine remain under development. Summary Inability to test for antibiotic resistance renders treatment selection empiric. However, resistance to rifabutin and amoxicillin remains rare. Effective management continues to comprise appropriate diagnostic testing for active infection, utilization of an effective regimen, and post-treatment testing.

Case Reports in Gastrointestinal Medicine, 2021

Acute herpes simplex esophagitis (HSE) is common in immunocompromised patients. Eosinophilic esop... more Acute herpes simplex esophagitis (HSE) is common in immunocompromised patients. Eosinophilic esophagitis (EoE) is characterized by immune-mediated eosinophil-predominant esophageal inflammation. We report a patient with human immunodeficiency virus infection who presented with dysphagia and odynophagia and was found to have HSE and EoE. The combination of these two relatively rare conditions suggests possible predisposition.

Alimentary Pharmacology & Therapeutics, 2021

S374 Patient Burden and Treatment Goals in the Management of Erosive Esophagitis in the United States: Results From the Study of Acid-Related Disorders (SOARD)

American Journal of Gastroenterology, 2021

oxyntic cells within the patch. These IPs rarely benefit from aggressive acid blocking therapy. I... more oxyntic cells within the patch. These IPs rarely benefit from aggressive acid blocking therapy. In our study we found that symptoms secondary to IPs improved in a vast majority of patients after RFA, APC or manual removal. Some further avenues of research could compare methods of removal as well as determining efficacy of removal when patients have other concomitant GI conditions. Although the study population was small, the magnitude of the number of patients with improvement of symptoms was significant. Our results suggest that further studies are necessary to select which symptomatic individuals could benefit from IP ablation.

S1451 Pitfalls of Physician-Directed Treatment of H. pylori Infection: Results From Two Phase 3 Clinical Trials and Real-World Prescribing Data

American Journal of Gastroenterology, 2021

injection, clipping, or thermal therapy for ulcers with pigmented spots or clean-based ulcers (Fo... more injection, clipping, or thermal therapy for ulcers with pigmented spots or clean-based ulcers (Forrest IIC, III). The secondary outcome was the performance of gastric biopsies for H. pylori assessment during the endoscopy. Continuous and categorical variables were analyzed using an unpaired t-test or Fisher’s exact test, respectively. Results: A total of 788 EGDs for GI bleeding were performed with findings of a gastric or duodenal ulcer. There were no significant differences in gender, fellow involvement, procedure location, or patient age between procedures performed by GI hospitalists and other gastroenterologists. Appropriate hemostatic therapy and H. pylori assessment via gastric biopsies occurred more often with GI hospitalists compared to non-GI hospitalists (Table 1). Conclusion: The GI hospitalist model improved adherence to PUD guidelines for H. pylori assessment and hemostatic interventions. As providers are experienced with management of PUD, they are uniquely positioned to standardize care. Future studies should assess the effect of the GI hospitalist model on rebleeding and other quality metrics.

S0388 High Prevalence of Opioid Use Among U.S. GERD Patients With and Without Refractory GERD Symptoms

American Journal of Gastroenterology, 2020

S0175 Bowel Perforation With Colonic Stents During Bevacizumab Therapy. Do We Need to Blame Bevacizumab? A Systemic Review and Meta-Analysis

American Journal of Gastroenterology, 2020

Placebo-Controlled Trial of 2 Doses of TAK-390MR, a PPI with Novel Dual Delayed Release Technology, as Maintenance Treatment for Patients with Healed Erosive Esophagitis (EE)

American Journal of Gastroenterology, 2008

Facts and Fantasies Concerning Aspirin

American Journal of Gastroenterology, 2004

European Journal of Gastroenterology & Hepatology, 2015

Background Observational studies have presented conflicting results with regard to an association... more Background Observational studies have presented conflicting results with regard to an association between gastric acid suppression and spontaneous bacterial peritonitis (SBP). Our aim was to carry out a meta-analysis investigating the possible association between the use of proton pump inhibitors or H 2-receptor antagonists and SBP. Methods We searched several databases from inception through 15 December 2014 to identify observational studies that provided data on the association of gastric acid suppression with SBP as their primary outcome, and carried out random effects meta-analyses. Results Fourteen observational studies (six case-control and eight cohort) evaluating the association between proton pump inhibitors and SBP revealed a pooled odds ratio (OR) of 2.32 [95% confidence interval (CI) 1.57-3.42, I 2 = 82%]. The subgroup analysis based on study design revealed a pooled OR of 2.52 (95% CI 1.71-3.71, I 2 = 16%) for case-control studies, and a pooled OR of 2.18 (95% CI 1.24-3.82, I 2 = 89%) for cohort studies. Sensitivity analysis including only the peer-reviewed publications in the cohort subgroup revealed a pooled OR of 1.49 (95% CI 1.15-1.95, I 2 = 27%). The subgroup analysis for highquality studies revealed a pooled OR of 1.49 (95% CI 1.19-1.88, I 2 = 21%). The pooled OR for H 2-receptor antagonists and SBP was 1.93 (95% CI 1.15-3.24, I 2 = 0%). Conclusions There appear to be statistically significant, but quantitatively small, associations between gastric acid suppression and SBP. However, the magnitude of the possible association diminished when analysis focused on higher quality data that were more robust. Furthermore, the quality evidence in support of the association, as per the GRADE framework, was very low.

Gastroenterology & hepatology, 2012

Helicobacter pylori infection is highly prevalent, affecting approximately half of the world'... more Helicobacter pylori infection is highly prevalent, affecting approximately half of the world's population. While the majority of infected individuals are asymptomatic, H. pylori infection is associated with certain diseases, including peptic ulcers (either duodenal or gastric), gastritis, and 2 malignancies-gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma. Many of the epidemiologic associations between these diseases and H. pylori infection have been further validated by treatment studies, which show that effective eradication therapy correlates with a decreased risk of disease. A variety of testing strategies are used to detect H. pylori infection. Serologic techniques are widely available and inexpensive, but they are no longer preferred as they have low sensitivities and specificities, and they may show a positive result for a long period following effective therapy. The remaining testing methods are divided into 2 categories: invasive tests (which requir...

Proton Pump Inhibitor Therapy for Suspected GERD‐Related Chronic Laryngitis: A Meta‐Analysis of Randomized Controlled Trials

Clinical Otolaryngology, 2008

British Journal of Clinical Pharmacology, 1985

The effects of single and repeated doses of omeprazole 10 mg on gastric secretion were studied in... more The effects of single and repeated doses of omeprazole 10 mg on gastric secretion were studied in a group of six healthy subjects. Single doses had no significant effect on basal or stimulated acid output. After 7 days of treatment, there was a 93.1% reduction in basal acid output (P < 0.02) and a 66.5% reduction in stimulated output (P < 0.01). Pepsin output was not affected. Systemic availability of omeprazole, as reflected in the AUC, increased significantly (P < 0.05) with repeated dosing. Low doses of omeprazole can produce substantial reductions in acid output after repeated dosing.

Gut, 1988

The effects of a specific H2 receptor agonist impromidine, on gastric acid secretion were measure... more The effects of a specific H2 receptor agonist impromidine, on gastric acid secretion were measured in six patients with duodenal ulcer in clinical remission before and after three months treatment with ranitidine 150 mg nocte. After treatment basal acid output increased from 1 2 to 2-8 mmol/h and after maximal impromidine stimulation from 36-9 (4 7) to 44-2 (6 2) mmol/h (p<002). Intravenous ranitidine 50 mg was given at the end of the impromidine infusion on each study day; the antisecretory effect of intravenous ranitidine was accentuated after the treatment with ranitidine from a trough acid output of 8 5 (1-2) mmol/h before, to 3-8 (1-5) mmol/h (p<0 05) after, treatment. The increased response to the H2 agonist impromidine and the H2 antagonist ranitidine after treatment with ranitidine suggests an enhanced sensitivity of the H2 receptor. This might be explained on the basis of an increase in the number of H2 receptors ('up-regulation').

BMJ, Dec 11, 2019

Objective To determine the effectiveness of management strategies for uninvestigated dyspepsia. D... more Objective To determine the effectiveness of management strategies for uninvestigated dyspepsia. Design Systematic review and network meta-analysis. Data sOurces Medline, Embase, Embase Classic, the Cochrane Central Register of Controlled Trials, and clinicaltrials. gov from inception to September 2019, with no language restrictions. Conference proceedings between 2001 and 2019. cOnclusiOns "Test and treat" was ranked first, although it performed similarly to prompt endoscopy and was not superior to any of the other strategies. "Test and treat" led to fewer endoscopies than all other approaches, except symptom based management. However, participants showed a preference for prompt endoscopy as a management strategy for their symptoms. systematic review registratiOn PROSPERO registration number CRD42019132528.

Endoscopy International Open, Sep 22, 2020

Background Recently, underwater endoscopic mucosal resection (UEMR) has shown promising results i... more Background Recently, underwater endoscopic mucosal resection (UEMR) has shown promising results in the management of colorectal polyps. Some studies have shown better outcomes compared to conventional endoscopic mucosal resection (EMR). We conducted this systematic review and meta-analysis to compare UEMR and EMR in the management of colorectal polyps. Methods We searched several databases from inception to November 2019 to identify studies comparing UEMR and EMR. Outcomes assessed included rates of en bloc resection, complete macroscopic resection, recurrent/residual polyps on follow-up colonoscopy, complete resection confirmed by histology and adverse events. Pooled risk ratios (RR) with 95 % confidence interval were calculated using a fixed effect model. Heterogeneity was assessed by I 2 statistic. Funnel plots and Egger's test were used to assess publication bias. We used the Newcastle-Ottawa scale (NOS) for assessment of quality of observational studies, and the Cochrane tool for assessing risk of bias for RCTs Results Seven studies with 1291 patients were included; two were randomized controlled trials and five were observational. UEMR demonstrated statistically significantly better efficacy in rates of en bloc resection, pooled RR 1.16 (1.08, 1.26), complete macroscopic resection, pooled RR 1.28 (1.18, 1.39), recurrent/residual polyps; pooled RR 0.26 (0.12, 0.56) and complete resection confirmed by histology; pooled RR 0.75 (0.57, 0.98). There was no significant difference in adverse events (AEs); pooled RR 0.68 (0.44, 1.05). Conclusions This meta-analysis found statistically significantly better rates of en bloc resection, complete macroscopic resection, and lower risk of recurrent/residual polyps with UEMR compared to EMR. We found no significant difference in AEs between the two techniques. Supplementary material is available under

Contemporary Clinical Trials, May 1, 2012

Background-Functional dyspepsia (FD) is a common problem affecting up to 10-25% of individuals. F... more Background-Functional dyspepsia (FD) is a common problem affecting up to 10-25% of individuals. FD accounts for significant health care costs and affects quality of life but has no definitive treatment. Objectives-The Functional Dyspepsia Treatment Trial (FDTT) aims to test whether treatment with an antidepressant (amitriptyline or escitalopram) leads to improvement of symptoms in patients with moderate to severe FD. Design-The FDTT is an international multicenter, parallel group, randomized, double-blind, placebo-controlled trial to evaluate whether 12 weeks of treatment with escitalopram or amitriptyline improves FD symptoms compared to treatment with placebo. Secondly, it is hypothesized that acceleration of solid gastric emptying, reduction of postprandial satiation, and enhanced gastric volume change with a meal will be significant positive predictors of short-and long-term outcomes for those on antidepressants vs. placebo. The third aim is to examine whether polymorphisms of GNβ3 and serotonin reuptake transporter influence treatment outcomes in FD patients receiving a tricyclic antidepressant, selective serotonin reuptake inhibitor therapy, or placebo. Methods-The FDTT enrollment began in 2006 and is scheduled to randomize 400 patients by the end of 2012 to receive an antidepressant or placebo for 12 weeks, with a 6-month posttreatment follow-up. The study incorporates multiple validated questionnaires, physiological testing, and specific genetic evaluations. The protocol was approved by participating centers' Institutional Review Boards and an independent Data Safety Monitoring Board was established for monitoring to ensure patient safety and a single interim review of the data in December 2010 (ClinicalTrials.gov number NCT00248651).

The American journal of gastroenterology, Jan 20, 2017

We have updated both the American College of Gastroenterology (ACG) and the Canadian Association ... more We have updated both the American College of Gastroenterology (ACG) and the Canadian Association of Gastroenterology (CAG) guidelines on dyspepsia in a joint ACG/CAG dyspepsia guideline. We suggest that patients ≥60 years of age presenting with dyspepsia are investigated with upper gastrointestinal endoscopy to exclude organic pathology. This is a conditional recommendation and patients at higher risk of malignancy (such as spending their childhood in a high risk gastric cancer country or having a positive family history) could be offered an endoscopy at a younger age. Alarm features should not automatically precipitate endoscopy in younger patients but this should be considered on a case-by-case basis. We recommend patients <60 years of age have a non-invasive test Helicobacter pylori and treatment if positive. Those that are negative or do not respond to this approach should be given a trial of proton pump inhibitor (PPI) therapy. If these are ineffective tricyclic antidepressa...

Polymorphisms of 5-HTT LPR and GNβ3 825C>T and Response to Antidepressant Treatment in Functional Dyspepsia: A Study from The Functional Dyspepsia Treatment Trial

The American journal of gastroenterology, Jan 14, 2017

The Functional Dyspepsia Treatment Trial reported that amitriptyline (AMI) was associated with ad... more The Functional Dyspepsia Treatment Trial reported that amitriptyline (AMI) was associated with adequate relief of functional dyspepsia (FD) symptoms, but the pharmacogenetics of antidepressant response in FD are not known. GNβ3 825C>T CC genotype has been previously linked to FD and TT genotype to antidepressant response in depression. The ss genotype of the 5-HTT LPR variant of the serotonin transporter gene (SLC6A4) has been linked to selective serotonin reuptake inhibitor (SSRI) response. We aimed to examine whether GNβ3 825C>T and 5-HTT LPR polymorphisms result in differential treatment effects in FD patients receiving antidepressant therapy. Participants were randomized to receive placebo, 50 mg AMI, or 10 mg escitalopram (ESC). The primary end point was adequate relief for ≥5 weeks of the last 10 weeks. Genotyping of GNβ3 825C>T and 5-HTT LPR was performed utilizing PCR-based methods. GNβ3 825C>T and 5-HTT LPR genotype data were available for 256 (88%) and 246 (84%...

Current Treatment Options in Gastroenterology, Jul 17, 2020

Purpose of review Our purpose was to provide an update on methods and indications for testing and... more Purpose of review Our purpose was to provide an update on methods and indications for testing and treatment selection focusing on novel modalities. Recent findings Increasing antibiotic resistance has reduced treatment effectiveness. Antibiotic resistance testing is not widely available in North America where there are insufficient resistance and susceptibility data. Quadruple regimens (bismuth-based or concomitant/non-bismuth-based) have been recommended first-line. A rifabutin-based combination product recently approved by the US Food and Drug Administration is highly effective and should simplify treatment. The potassium-competitive acid blocker vonoprazan is being evaluated as part of dual or triple combination regimens. Molecular-based genotypic testing for antibiotic resistance and an effective H. pylori vaccine remain under development. Summary Inability to test for antibiotic resistance renders treatment selection empiric. However, resistance to rifabutin and amoxicillin remains rare. Effective management continues to comprise appropriate diagnostic testing for active infection, utilization of an effective regimen, and post-treatment testing.

Case Reports in Gastrointestinal Medicine, 2021

Acute herpes simplex esophagitis (HSE) is common in immunocompromised patients. Eosinophilic esop... more Acute herpes simplex esophagitis (HSE) is common in immunocompromised patients. Eosinophilic esophagitis (EoE) is characterized by immune-mediated eosinophil-predominant esophageal inflammation. We report a patient with human immunodeficiency virus infection who presented with dysphagia and odynophagia and was found to have HSE and EoE. The combination of these two relatively rare conditions suggests possible predisposition.

Alimentary Pharmacology & Therapeutics, 2021

S374 Patient Burden and Treatment Goals in the Management of Erosive Esophagitis in the United States: Results From the Study of Acid-Related Disorders (SOARD)

American Journal of Gastroenterology, 2021

oxyntic cells within the patch. These IPs rarely benefit from aggressive acid blocking therapy. I... more oxyntic cells within the patch. These IPs rarely benefit from aggressive acid blocking therapy. In our study we found that symptoms secondary to IPs improved in a vast majority of patients after RFA, APC or manual removal. Some further avenues of research could compare methods of removal as well as determining efficacy of removal when patients have other concomitant GI conditions. Although the study population was small, the magnitude of the number of patients with improvement of symptoms was significant. Our results suggest that further studies are necessary to select which symptomatic individuals could benefit from IP ablation.

S1451 Pitfalls of Physician-Directed Treatment of H. pylori Infection: Results From Two Phase 3 Clinical Trials and Real-World Prescribing Data

American Journal of Gastroenterology, 2021

injection, clipping, or thermal therapy for ulcers with pigmented spots or clean-based ulcers (Fo... more injection, clipping, or thermal therapy for ulcers with pigmented spots or clean-based ulcers (Forrest IIC, III). The secondary outcome was the performance of gastric biopsies for H. pylori assessment during the endoscopy. Continuous and categorical variables were analyzed using an unpaired t-test or Fisher’s exact test, respectively. Results: A total of 788 EGDs for GI bleeding were performed with findings of a gastric or duodenal ulcer. There were no significant differences in gender, fellow involvement, procedure location, or patient age between procedures performed by GI hospitalists and other gastroenterologists. Appropriate hemostatic therapy and H. pylori assessment via gastric biopsies occurred more often with GI hospitalists compared to non-GI hospitalists (Table 1). Conclusion: The GI hospitalist model improved adherence to PUD guidelines for H. pylori assessment and hemostatic interventions. As providers are experienced with management of PUD, they are uniquely positioned to standardize care. Future studies should assess the effect of the GI hospitalist model on rebleeding and other quality metrics.

S0388 High Prevalence of Opioid Use Among U.S. GERD Patients With and Without Refractory GERD Symptoms

American Journal of Gastroenterology, 2020

S0175 Bowel Perforation With Colonic Stents During Bevacizumab Therapy. Do We Need to Blame Bevacizumab? A Systemic Review and Meta-Analysis

American Journal of Gastroenterology, 2020

Placebo-Controlled Trial of 2 Doses of TAK-390MR, a PPI with Novel Dual Delayed Release Technology, as Maintenance Treatment for Patients with Healed Erosive Esophagitis (EE)

American Journal of Gastroenterology, 2008

Facts and Fantasies Concerning Aspirin

American Journal of Gastroenterology, 2004

European Journal of Gastroenterology & Hepatology, 2015

Background Observational studies have presented conflicting results with regard to an association... more Background Observational studies have presented conflicting results with regard to an association between gastric acid suppression and spontaneous bacterial peritonitis (SBP). Our aim was to carry out a meta-analysis investigating the possible association between the use of proton pump inhibitors or H 2-receptor antagonists and SBP. Methods We searched several databases from inception through 15 December 2014 to identify observational studies that provided data on the association of gastric acid suppression with SBP as their primary outcome, and carried out random effects meta-analyses. Results Fourteen observational studies (six case-control and eight cohort) evaluating the association between proton pump inhibitors and SBP revealed a pooled odds ratio (OR) of 2.32 [95% confidence interval (CI) 1.57-3.42, I 2 = 82%]. The subgroup analysis based on study design revealed a pooled OR of 2.52 (95% CI 1.71-3.71, I 2 = 16%) for case-control studies, and a pooled OR of 2.18 (95% CI 1.24-3.82, I 2 = 89%) for cohort studies. Sensitivity analysis including only the peer-reviewed publications in the cohort subgroup revealed a pooled OR of 1.49 (95% CI 1.15-1.95, I 2 = 27%). The subgroup analysis for highquality studies revealed a pooled OR of 1.49 (95% CI 1.19-1.88, I 2 = 21%). The pooled OR for H 2-receptor antagonists and SBP was 1.93 (95% CI 1.15-3.24, I 2 = 0%). Conclusions There appear to be statistically significant, but quantitatively small, associations between gastric acid suppression and SBP. However, the magnitude of the possible association diminished when analysis focused on higher quality data that were more robust. Furthermore, the quality evidence in support of the association, as per the GRADE framework, was very low.

Gastroenterology & hepatology, 2012

Helicobacter pylori infection is highly prevalent, affecting approximately half of the world'... more Helicobacter pylori infection is highly prevalent, affecting approximately half of the world's population. While the majority of infected individuals are asymptomatic, H. pylori infection is associated with certain diseases, including peptic ulcers (either duodenal or gastric), gastritis, and 2 malignancies-gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma. Many of the epidemiologic associations between these diseases and H. pylori infection have been further validated by treatment studies, which show that effective eradication therapy correlates with a decreased risk of disease. A variety of testing strategies are used to detect H. pylori infection. Serologic techniques are widely available and inexpensive, but they are no longer preferred as they have low sensitivities and specificities, and they may show a positive result for a long period following effective therapy. The remaining testing methods are divided into 2 categories: invasive tests (which requir...

Proton Pump Inhibitor Therapy for Suspected GERD‐Related Chronic Laryngitis: A Meta‐Analysis of Randomized Controlled Trials

Clinical Otolaryngology, 2008

British Journal of Clinical Pharmacology, 1985

The effects of single and repeated doses of omeprazole 10 mg on gastric secretion were studied in... more The effects of single and repeated doses of omeprazole 10 mg on gastric secretion were studied in a group of six healthy subjects. Single doses had no significant effect on basal or stimulated acid output. After 7 days of treatment, there was a 93.1% reduction in basal acid output (P < 0.02) and a 66.5% reduction in stimulated output (P < 0.01). Pepsin output was not affected. Systemic availability of omeprazole, as reflected in the AUC, increased significantly (P < 0.05) with repeated dosing. Low doses of omeprazole can produce substantial reductions in acid output after repeated dosing.

Gut, 1988

The effects of a specific H2 receptor agonist impromidine, on gastric acid secretion were measure... more The effects of a specific H2 receptor agonist impromidine, on gastric acid secretion were measured in six patients with duodenal ulcer in clinical remission before and after three months treatment with ranitidine 150 mg nocte. After treatment basal acid output increased from 1 2 to 2-8 mmol/h and after maximal impromidine stimulation from 36-9 (4 7) to 44-2 (6 2) mmol/h (p<002). Intravenous ranitidine 50 mg was given at the end of the impromidine infusion on each study day; the antisecretory effect of intravenous ranitidine was accentuated after the treatment with ranitidine from a trough acid output of 8 5 (1-2) mmol/h before, to 3-8 (1-5) mmol/h (p<0 05) after, treatment. The increased response to the H2 agonist impromidine and the H2 antagonist ranitidine after treatment with ranitidine suggests an enhanced sensitivity of the H2 receptor. This might be explained on the basis of an increase in the number of H2 receptors ('up-regulation').