Risks associated with long-term use of proton pump inhibitors

Proton pump inhibitors (PPIs) are widely used in the management of upper gastrointestinal disorders. In recent years, concerns have been raised on the potential adverse effects of long-term PPI use. This article reviews the published evidence of the effect of long-term PPI use on the absorption of minerals and vitamins, risk of infections, chronic kidney disease and dementia.peer-reviewe

The management of patients positive to hepatitis C virus antibody in Malta

Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease and hepatocellular carcinoma worldwide and is an important public health concern. A retrospective analysis of the demographics and management of patients who had a positive anti-HCV detected by enzyme immunoassay test done at Mater Dei Hospital was carried out to analyse the epidemiology of HCV infection in Malta and assess our management when compared to the European Association for the Study of the Liver (EASL) guidelines. 72% of patients were male. The majority of patients were aged 21-50 years. The main mode of infection was via intravenous drugs use, accounting for 68% of cases. Only 56% of patients found to be HCV Ab positive had a scheduled appointment with an infectious diseases specialist or gastroenterologist documented on the MDH online appointment system. 58% of patients had HCV RNA testing done and 45% had genotype testing. 7.3% with HCV infection were given treatment, of which 43% had a Sustained Virological Response (SVR).peer-reviewe

The Role of Serum Bio-Markers in Predicting Small Bowel Pathology in Crohn`s Disease Patients

Background: Computed tomography enterography (CTE) is a useful modality in the evaluation of small bowel (SB) crohn`s disease (CD) as it can provide assessment of disease activity, extramural abnormalities and SB complications. This procedure however utilises radiation exposure. The aim of this retrospective study was to determine the clinical indications and findings on CTE and to determine if serum bio-markers (CRP, ESR, platelet count and anaemia) can predict significant pathologies.Method: This was a retrospective analysis where 50 patients above the age of 18 with CD who had CTE between October 2013 and February 2015 were identified. The clinical indications, serum bio-markers and CTE findings in these patients were analysed.Results: The main indications for CTE were abdominal pain/discomfort and/or symptoms suggestive of SB obstruction. 26% of CD patients had active inflammation, 36% had a SB stricture and 4% had active inflammation with stricturing and fistulating disease. All the patients with a completely normal CTE did not have a raised bio-marker whist 76.9% of patients with active inflammation had one or more positive bio-markers. Additional findings were active colitis (8%), splenomegaly (4%), aortitis (2%) and had sacroileitis (2%). In these patients, 75% had a positive bio-marker. In patients with positive findings, the Erythrocyte Sedimentation Rate (ESR) was the most common marker of inflammation.Conclusion: CTE is an important tool in management of patients with CD however, in the presence of normal biomarkers, clinicians should question the need for CTE and thus decrease exposure of CD patients to ionising radiation