Acid suppressive medications are the second highest selling drugs in the world, reaching over $26 billion in 2005. The authors explained that medical literature has been looking more carefully at the impact popular drugs might have on public health.

Dr. Chun-Sick Eom, Dr. Sang Min Park and team carried out a systematic review of all studies related to acid suppressive drugs and pneumonia since August 2009 – they used three sources, MEDLIN E (PubMed), Embase and the Cochrane Library. They found that 1 in every 200 individuals taking an acid suppressive medication developed pneumonia.

The researchers revealed that:

Proton pump inhibitor use raised pneumonia risk overall by 27% compared with non-use
Histamine2 receptor blocker use raised pneumonia risk overall by 22% compared with non-use

The authors wrote:
“Several previous studies have shown that treatment with acid-suppressive drugs might be associated with an increased risk of respiratory tract infections and community-acquired pneumonia in adults and children. However, the association between use of acid-suppressive drugs and risk of pneumonia has been inconsistent. Given the widespread use of proton pump inhibitors and histamine2-receptor antagonists, clarifying the potential impact of acid-suppressive therapy on the risk of pneumonia is of great importance to public health.”
A considerable number of hospitalized patients, estimated to be between 40% and 70%, are given acid-suppressive drugs. The researchers suggest that they could contribute significantly towards the hospital-acquired pneumonia totals. Their impact on community-acquired pneumonia rates might be even larger.

Doctors should be cautious about prescribing acid suppressive drugs, the authors wrote, especially if the patient has an elevated risk of developing pneumonia.

Acid suppressive drugs might be prescribed for the following diseases and conditions:

Dyspepsia
Gastroesophageal reflux disease (GORD/GERD)
Laryngopharyngeal reflux
Peptic ulcer disease (PUD)
Barrett’s esophagus
To prevent stress gastritis
Gastrinomas and other conditions that cause hypersecretion of acid
Zollinger-Ellison syndrome.

“Use of acid-suppressive drugs and risk of pneumonia: systematic review and meta-analysis”
Chun-Sick Eom, Christie Y. Jeon, Ju-Won Lim, Eun-Geol Cho, Sang Min Park and Kang-Sook Lee
CMAJ 10.1503/cmaj.092129

An increasing number of obese adolescents have the metabolic syndrome, said a study co-author, Ilene Fennoy, MD, MPH, a pediatric endocrinologist at New York City’s Columbia University Medical Center.

The metabolic syndrome is a cluster of metabolic risk factors that increase the chance of later developing diabetes and cardiovascular disease. Weight loss can reduce the risk factors that are part of the syndrome: abdominal obesity as shown by a large waist circumference (waistline), low HDL (“good”) cholesterol, high triglycerides (fats in the blood), high blood pressure and high blood sugar.

“Few treatments, however, have succeeded in achieving major weight loss or greatly improving adolescents’ medical complications of obesity – until now,” Fennoy said.

In the new study, 24 morbidly obese teens between the ages of 14 and 17 years underwent laparoscopic gastric banding, also called the “Lap-Band” procedure. This minimally invasive weight loss surgery uses a band that can repeatedly be adjusted to make the stomach smaller.

Six months after the operation, patients had a statistically significant decrease in their body mass index (BMI, a measure of body fat) as well as their waist circumference and blood levels of C-reactive protein, a measure of inflammation that is linked to increased risk of cardiovascular disease. These improvements continued to 1 year in the 12 patients whose follow-up was that long.

Other features of the metabolic syndrome improved rapidly in the first 6 months and continued to a year, but with “less dramatic” changes, the authors reported in their abstract.

Five patients with 12-month follow-up met the criteria for a diagnosis of the metabolic syndrome before surgery. Only two still had this diagnosis a year later, a decrease in prevalence from 41.7 to 16.7 percent.

“Laparoscopic gastric banding surgery may be a useful intervention for morbidly obese teenagers to decrease the risk of early development of cardiovascular disease and other illnesses related to obesity,” Fennoy said.

Currently approved for use only in adults, the Lap-Band procedure is being studied in teenagers under age 18. Long-term studies are needed to confirm that this procedure effectively improves the metabolic syndrome in adolescents, Fennoy said.

Eun-Ju Lee, a fourth year medical student at Columbia University Medical Center, and a Doris Duke Fellow in the Division of Pediatric Endocrinology presented the study results.

Source:
Aaron Lohr

The Endocrine Society

“Researchers are working hard to try to understand how the environment of the digestive system relates to and affects other bodily functions, including a person’s immunity,” said Nicholas F. LaRusso, MD, AGAF, chair of the AGA Foundation. “The AGA Foundation is grateful for the support shown by the General Mills Bell Institute of Health and Nutrition in funding research that will help gastroenterologists continue to better understand and manage digestive health.”

“This award will allow me to continue to cultivate and expand growing research interests that align with my clinical interest in inflammatory disorders and malignancies of the luminal GI tract. This generous funding will also provide me with protected time necessary for continued focused research, afford me the opportunity to continue to generate meaningful data and ultimately, to be a competitive candidate for independent federal grant support,” said Dr. Shaker.

An assistant professor of medicine at Washington University School of Medicine, Dr. Shaker will focus her research on investigating epimorphin (Epim -/-) mice microbiota in colitis and colitis-associated cancer to understand gut microbial ecology during homeostasis and disease, delineate factors that modulate the intestinal microbiota, and uncover potential therapies to establish a luminal environment protective against colitis and colitis-associated cancer. (Mice that lack the protein Epim -/- are protected from the development of colitis and colitis-associated colon cancer.

Said Susan Crockett, PhD, RD, senior technology officer, General Mills Bell Institute of Health and Nutrition, “As part of General Mills’ mission of nourishing lives, the Bell Institute is committed to championing health innovation. We value the collaborative partnership with AGA and are committed to providing research funding to further elucidate the relationship between gut microbiota and health.”

Source:
Jennifer Chisholm
American Gastroenterological Association

The Agency’s Surrey and Sussex Health Protection Unit (HPU) is working with local environmental health officers, the Veterinary Laboratory Agency and Godstone Farm in response to 36 cases of gastrointestinal illness which have occurred following visits to the animal farm in Surrey.

Of the 36 cases, 12 children are currently in hospital with complications arising from the infection which causes diarrhoea and can lead to kidney failure, especially in young children.

Measures to reduce the risk of the infection spreading were put in place by the farm last week but as more cases have been reported, the farm has agreed to close to enable detailed investigations into the source of the infection. During the peak of the school holidays, the farm which allows people to see and pet a variety of farm animals, receives up to 2,000 visitors a day.

Dr Angela Iversen, Director of the Health Protection Unit, said: “This is a large outbreak of this infection. The farm owners are co-operating fully and we are working closely with them and with colleagues across health and local authorities to investigate the source. Our advice is that the farm should remain closed to visitors while this work goes on.”

It is believed the outbreak began around August 8th. Anyone who visited the farm since that date, or any member of their household, even if they did not personally visit the farm, who becomes unwell with the following symptoms should seek medical advice or contact NHS Direct on 0845 4647:

- diarrhoea (which can be bloodstained)
- vomiting
- fever
- abdominal pain and cramps
- feeling weak or lethargic
- passing less urine than usual
- pallor
- fits

Dr. Iversen added: “We are urging parents to follow strict hand washing with their families when visiting these farms. Although many parents may carry alcohol gels with them, this should be an adjunct to hand washing with soap and water and not a substitute.

“Eli 0157 is an infection that people can pick up when handling or stroking animals, unless hands are thoroughly washed afterwards to minimise the risk. It can also be spread easily from person to person so good hygiene is vital, especially in young children whose hand washing after using the toilet and before eating should be supervised. ”

Notes

- E coli 0157 bacteria usually cause diarrhoea which settles within seven days without treatment. The diarrhoea may contain blood. Occasionally, serious kidney and blood complications can occur. Good hygiene is very important in preventing person-to person spread and small children should be supervised with hand washing after using the toilet and before eating.

- Escherichia coli (commonly referred to as E. coli) is a species of bacteria commonly found in the intestines of humans and animals. There are many different types of E. coli, and while some live in the intestine quite harmlessly, others may cause a variety of diseases. The bacterium is found in faeces and can survive in the environment.

- To avoid getting strains capable of causing intestinal disease people should avoid eating undercooked meat, in particular inadequately cooked minced beef and avoid drinking unpasteurised milk. Individuals working with uncooked meats or on farms should pay close attention to good hygiene practices, as should visitors to farms.

- It is important to always wash your hands with soap after going to the toilet and before and after handling food.

- Hand washing in young children should be supervised, especially after handling animals or their surroundings, for instance on a visit to a farm.

Source
Health Protection Agency

Prof. Eugene Rosenberg, Prof. Daniel Segel and doctoral student Gil Sharon of Tel Aviv University’s Department of Molecular Microbiology and Biotechnology recently demonstrated that the symbiotic bacteria inside a fruit fly greatly influence its choice of mates.

The research was done in cooperation with Prof. John Ringo of the University of Maine, and was recently published in the Proceedings of the National Academy of Sciences (PNAS).

Love, marriage and fruit flies

Based on a theory developed by Prof. Rosenberg and Dr. Ilana Zilber-Rosenberg, the scientists propose that the basic unit of natural selection is not the individual living organism, plant or animal, but rather a larger biological milieu called a holobiont. This milieu can include plant or animal life as well as their symbiotic partners. In the case of animals, these partners tend to be microorganisms like intestinal bacteria.

“Up to now, it was assumed that the host organism undergoes evolution on its own, while its symbiotic bacteria undergo their own evolution,” Prof. Rosenberg says. “The mechanism that we discovered enables evolution to occur more rapidly in response to environmental changes. Since a generation is shorter for bacteria than for multicellular organisms, they genetically adjust more quickly to changes in the holobiont,” says Prof. Rosenberg.

Conducting their experiments on the rapidly-reproducing fruit fly, the scientists were able to test this new theory. The first experiment repeated a study carried out two decades ago by a Yale University researcher, in which a fly population was divided in half and fed different diets – malt sugar versus starch. A year later, when the flies were re-integrated as one group, those who had been fed starch preferred starch-fed mates, while the sugar-fed flies preferred mates of a similar nutritional background. The repeat experiment carried out by the Tel Aviv University researchers shows that this dietary influence takes effect within just a generation or two rather than over an entire year.

In their second experiment, the Tel Aviv University team repeated the first, but with the addition of an antibiotic, which killed the bacteria and eliminated the specific mate preference. The mating process became random, with no dietary influence.

In subsequent experiments, the researchers successfully isolated the bacterial species responsible for reproductive isolation in flies with diet-related mating preferences, and found the bacteria Lactobacillus plantarum to be present in greater numbers in starch-fed fruit flies than in sugar-fed flies. When L. plantarum was reintroduced into the antibiotic-treated flies, the preferential mating behavior resumed – proving that this bacterial species is at least partly responsible for the mating preference.

Rewriting Darwin?

Finally, in cooperation with Prof. Avraham Hefetz of Tel Aviv University’s Department of Zoology, the team analyzed the sexual pheromones produced by the fruit flies. There turned out to be differences in pheromone levels between the two groups of flies – differences that again disappeared after administering antibiotics.

“The finding indicates that pheromone alterations are a mechanism by which we can identify mating preferences. We therefore hypothesize that it is the bacteria that are driving this change,” Prof. Rosenberg says. He adds that these discoveries have implications for our entire understanding of natural selection – something which may even lead to the development of a new theory of evolution.

Source:
George Hunka

American Friends of Tel Aviv University

The GORE EXCLUDER AAA Endoprosthesis is an implantable device indicated for the endovascular treatment of AAA, a condition caused by the degenerative weakening and dilation of the abdominal aorta. If left untreated, it can rupture and result in fatality. The GORE TAG Thoracic Endoprosthesis is an implantable device used to treat TAA, or an aneurysm of the descending thoracic aorta, the body’s main circulatory vessel. TAA is a life-threatening condition generally believed to be significantly under-diagnosed, and patients with TAA are at risk of death due to internal bleeding resulting from a ruptured aorta.

Until recently, treatment for AAA and TAA required invasive, large incision surgery and a lengthened hospital stay to repair the diseased or damaged artery. With the GORE EXCLUDER AAA Endoprosthesis and the GORE TAG Thoracic Endoprosthesis, aneurysms can be prevented from rupturing through a minimally invasive procedure, thereby reducing the hospital stay, morbidity and mortality associated with surgery.

“Gore is pleased to expand its international efforts to improve patient care for both AAA and TAA, with less invasive treatment alternatives for the Canadian patient population,” said John Sininger, Leader of the Gore Medical Products Division. “The GORE EXCLUDER Device and the GORE TAG Device have already proven to be valuable alternatives to invasive open surgery elsewhere, and Gore welcomes the opportunity to advance less invasive endovascular therapies for aortic diseases in Canada.”

The GORE EXCLUDER AAA Endoprosthesis is an endovascular graft and stent combination that seals off the aneurysm and creates a new path for the blood to flow. The GORE EXCLUDER AAA Endoprosthesis is inserted through a small incision in the patient’s leg using a catheter-based delivery technique. Once the graft is correctly positioned in the diseased aorta, the device self-expands using radial force and metal anchors to permanently secure it to the walls of the aorta.

The GORE TAG Thoracic Endoprosthesis is a thoracic endoprosthesis that internally relines the thoracic aorta and isolates the diseased segment from blood circulation. The GORE TAG Thoracic Endoprosthesis is comprised of an ePTFE graft with an outer self-expanding nitinol support structure to combine both device flexibility and material durability. The device is inserted by a catheter delivery technique through a small incision in the patient’s groin.

About Veithsymposium™

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Gore & Associates

Professor van Heel and his team, including collaborators from Ireland, the Netherlands, and the Wellcome Trust Sanger Institute, first performed a genome wide association study in coeliac disease. Genetic markers across the genome were compared in coeliac disease subjects versus healthy controls. They then assessed around 1,000 of the strongest markers in a further ~ 5,000 samples. Their results identified seven new risk regions, six of which harbour important genes critical in the control of immune responses, highlighting their significance in the development of the disease.

Coeliac disease is common in the West, afflicting around 1 per cent of the population. It is an immune-mediated disease, triggered by intolerance to gluten (a protein found in wheat, barley and rye containing foods), that prevents normal digestion and absorption of nutrients. If undetected it can lead to a number of often severe problems among them anaemia, poor bone health, fatigue and weight loss. Currently only a restricted diet can diminish symptoms.

Professor van Heel said: “So far our findings explain nearly half of the heritability of coeliac disease – now studies with many more samples from individuals with coeliac disease are needed to identify the precise causal genetic variants from each region, and understand how these influence biological processes.”

The research was funded by Coeliac UK and The Wellcome Trust.

The paper, ‘Newly identified genetic risk variant for celiac disease related to the immune response’ is published online, on 2 March 2008, in Nature Genetics.

Barts and The London School of Medicine and Dentistry offers international levels of excellence in research and teaching while serving a population of unrivalled diversity amongst which cases of diabetes, hypertension, heart disease, TB, oral disease and cancers are prevalent, within east London and the wider Thames Gateway. Through partnership with our linked trusts, notably Barts and The London NHS Trust, and our associated University Hospital trusts – Homerton, Newham, Whipps Cross and Queen’s – the School’s research and teaching is informed by an exceptionally wide ranging and stimulating clinical environment.

At the heart of the School’s mission lies world class research, the result of a focused programme of recruitment of leading research groups from the UK and abroad and a ??100 million investment in state-of-the-art facilities. Research is focused on translational research, cancer, cardiology, clinical pharmacology, inflammation, infectious diseases, stem cells, dermatology, gastroenterology, haematology, diabetes, neuroscience, surgery and dentistry.

The School is nationally and internationally recognised for research in these areas, reflected in the ??40 million it attracts annually in research income. Its fundamental mission, with its partner NHS Trusts, and other partner organisations such as CRUK, is to ensure that that the best possible clinical service is underpinned by the very latest developments in scientific and clinical teaching, training and research.

Websites
coeliac/
wellcome.ac/

icms.qmul.ac/

icms.qmul.ac/Profiles/Gastro/van%20Heel%20David.htm

nature/ng/index.html

Source: Sally Webster

Queen Mary, University of London

Gastro-oesophageal reflux disease (GORD) affects between 20% and 40% of the population in the western world and 32 million prescriptions for proton pump inhibitors (PPIs) were issued in 2008 in the UK at a cost of ??220 million a year.

Researchers from Bucks New University in Middlesex and Kings College London are suggesting that an educational programme for GORD sufferers, perhaps offered by nurses in primary care, might make a difference in reducing the amount of medication used.

The study gave 42 people being prescribed medication for GORD symptoms a 1.5 hour educational session each week over four weeks, then interviewed them on their symptoms and their affect on their lives after three months. Participants were encouraged to record their symptoms, look at their diet, learn about managing stress, set goals for themselves and identify their three biggest problems relating to GORD.

The authors write: “Following the intervention, patients felt more in control, believed that their treatment could help them, experienced fewer symptoms, were less concerned about their illness and had a greater understanding of and were less affected by their reflux than before the intervention.

“The intervention improved patients’ perception of their illness at three months, and improved their illness experience in many areas including testing patients’ sense of control, perception and understanding of their condition, and also symptom severity.

“There was no improvement in symptoms that prevent patients from eating or drinking what they like, which may reflect the fact that, despite reporting symptoms, patients did not let these interfere with what they wanted to consume anyway.”

Br J Gen Pract 2010; 60: 891-896).

Also in this month’s BJGP

Stanton and colleagues provide a valuable overview of the evidence guiding clinical decision making in patients with respiratory tract symptoms and infections, and offer a series of practical suggestions aimed at improving their management

In their study from Oslo, Hoye and co-workers discovered that deferred prescribing was not always endorsed by GPs, and emphasise the need for careful negotiation and the provision of information to patients when issuing wait-and-see prescriptions.

A non-drug approach to the management of hypertension is also explored in a systematic review from Ireland suggesting that patients have an important role to play in the effective management of this condition

The BJGP’s golden anniversary is marked in the Back Pages by a series of short pieces by all but one of its editors, tracing the development of one of the world’s oldest and most influential primary care publications.

Source: Royal College of General Practitioners

NEC is a serious disease that causes infection and inflammation of the intestines in infants, primarily those that are premature. Its cause is unknown however it is one of the leading causes of surgical intervention in preemies and has a death rate of 25 percent.

“The DAAS provides a standardized 10-point radiographic scale that increases with disease severity,” said Caroline L. Hollingsworth, M.D., lead author of the study. For every 1-point increase in the DAAS score, patients are more likely to have severe disease and more likely to need a surgical intervention,” she said.

Researchers performed a case-control study of 43 infants to assess whether the DAAS could serve as a clinically useful tool for predicting disease severity in neonates and infants with clinically suspected NEC. “We found that the use of a standardized scale like the DAAS may enable earlier detection of patients at risk for developing severe NEC by creating a clear, concise radiology report that provides the clinician with a consistent measure of concern by the radiologist. We also found that improved communication through standardized reporting using an accurate scale like the DAAS may affect medical decision making in a positive way and hasten the accurate identification of patients in need of intense medical surveillance or surgical intervention,” said Dr. Hollingsworth.

“Our study suggests that using the DAAS score when interpreting abdominal X-rays in neonates and infants with clinically suspected NEC may help guide increased level of clinical concern and monitoring for advanced NEC. Radiographic monitoring of disease progression and heightened clinical awareness through improved communication via the DAAS system has been a tremendous help to our clinicians at Duke,” she said.

Source:
Heather Curry

American Roentgen Ray Society

Over one billion people around the world have some type of intestinal
worm infection (or intestinal helminth infection). Often they lead to
problems in child and maternal
health, nutritional status, physical performance, and cognitive
development.
If people had access to safe water and sanitation, many of these
intestinal worm infections would become less prevalent. In reality,
infections are usually handled using drugs that reduce morbidity.
Currently there are four drugs that the World Health Organization
recommends for treating helminth infections transmitted by soil. This
small pool of medications means that there is a great concern that the
worms will develop resistance to the drugs.

The drug tribendimidine
is a member of a chemical class that is different than current
treatments for worm infections. Developed at IPD and Shandong Xinhua
Pharmaceutical in Zibo,
China, the drug was approved by the China State Food and Drug
Administration in 2004.

The safety and efficacy study consisted of 123 patients who were tested
for intestinal helminth infections. Researchers randomly assigned some
patients to take
tribendimidine and others to take the common albendazole treatment.
Doses were set at 200 mg for children aged 5 to 14 years and 400 mg for
individuals 15 years old and higher.

In humans situated in a highly endemic setting in China, administration
of a single oral dose of tribendimidine
cured up to 92% of the common soil-transmitted helminth infections. The
researchers also noted that the drug more effectively fought threadworm
and tapeworm infections – 55% of threadworm infections and 67% of
tapeworm infections were cured after treatment with tribendimidine.
Further, the medication reduced the infection intensity of large
roundworms and hookworms. Among the final study cohort, the researchers
did not find any adverse treatment-related events.

Repeated dosing should be tested, and results should be validated with
larger samples in various epidemiological settings in order to further
improve treatment outcomes, note the authors.

Tribendimidine and Albendazole for Treating Soil-Transmitted
Helminths, Strongyloides stercoralis and Taenia
spp.: Open-Label Randomized Trial
Steinmann P, Zhou X-N, Du Z-W, Jiang J-Y, Xiao S-H, et al.
PLoS Neglected Tropical Disease (2008). 2(10): e322.
doi:10.1371/journal.pntd.
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Here to View Article

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: Peter M Crosta