Effect of food and dosing regimen on safety and efficacy of proton pump inhibitors therapy : a literature review

Proton pump inhibitors (PPIs) are the first-choice drugs used to prevent and treat acid-related diseases. However, a lack of satisfactory response to the standard PPI dose (“PPI failure”) is often reported, especially in patients with gastroesophageal reflux disease. Poor compliance seems to be one of the main causes of PPI failure; hence, it is crucial to gain knowledge on how to properly administer PPIs. In this review, we aimed to evaluate the effect of food, beverages, and dosing regimen on pharmacokinetics and pharmacodynamics of PPIs and to frame recommendations for healthcare professionals to improve both patient’s counseling and compliance to treatment with PPIs. A total of 201 papers were identified following a literature search. After full-text evaluation, 64 studies were included in the review. Co-administration of PPIs with a meal may affect both their bioavailability and effectiveness; however, the influence of food depends on the type of drug and its formulation. Except for pantoprazole, PPIs can be administered in the morning or evening; however, morning intake generally provides better daytime control of gastric acidity. In most cases, the choice of the proper schedule of administration should be based on the patient’s symptoms and individual dosing preferences

Effect of selected personality traits and stress on symptoms of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder diagnosed on the basis of Rome IV criteria. Stress is an important contributor to the development of IBS symptoms, while personality, perceived self-efficacy, resilience, and coping strategies may be indirectly involved in the modulation of the body’s response to various stressors. The aim of this study was to assess the effect of selected personality traits and stress with IBS symptoms. We enrolled 129 participants (59 men and 70 women) aged from 18 to 61 years. The study group included 94 patients with IBS, while the control group comprised 35 participants without a diagnosed psychoso-matic disorder and chronic comorbidities. Participants were assessed using a self-designed questionnaire as well as the Coping Inventory for Stressful Situations, NEO-Five Factor Inventory, 25-item Resilience Coping Scale (Skala Pomiaru Prężności - SPP-25), and General Self-Efficacy Scale. We observed a significant effect of personality, perceived self-efficacy, resilience, and coping strategies in patients with IBS. Moreover, stress was shown to be associated with disease severity, while the type of a coping strategy was related to the frequency of symptoms. The groups differed in terms of personality traits such as resilience, self-efficacy, extraversion, and neuroticism. Our study confirms the significant effect of personality traits and coping strategies in patients with IBS

Zmiany w błonie śluzowej żołądka u dorosłych chorych na celiakię

Wstęp: Celiakia jest przewlekłą chorobą zapalną przewodu pokarmowego o podłożu autoimmunologicznym, występującą u osób predysponowanych genetycznie. Znaczenie zmian patologicznych w błonie śluzowej żołądka u chorych na celiakię i ich wpływ na przebieg kliniczny tej choroby nie zostały dotąd w pełni poznane. Cel: Ocena częstości występowania zmian histopatologicznych w błonie śluzowej żołądka u dorosłych osób z celiakią oraz wpływu tych zmian na obraz kliniczny choroby. Materiał i metody: Do badań włączono 90 pacjentów, w tym 35 chorych na celiakię i 55 osób z objawami dyspeptycznymi (grupa kontrolna). Obejmowały one wywiad chorobowy, badanie przedmiotowe, badania krwi oraz panendoskopię. Wycinki z błony śluzowej żołądka i części pozaopuszkowej dwunastnicy barwiono hematoksyliną i eozyną. Oceniano nasilenie zmian zapalnych oraz liczbę limfocytów śródnabłonkowych (intraepithelial lymphocytes - IEL). Za pomocą badania immunohistochemicznego z zastosowaniem przeciwciał monoklonalnych anty-CD3+ identyfikowano limfocyty CD3+. Ocenę bioptatów z dwunastnicy w kierunku celiakii wykonano zgodnie z klasyfikacją Marsha. Wyniki: U chorych na celiakię, zarówno nieleczonych, jak i leczonych dietą bezglutenową, obserwowano wzrost IEL, jednak ich liczba była znamiennie większa u chorych niestosujących diety bezglutenowej. Limfocytarne zapalenie żołądka rozpoznano u 8,6% chorych na celiakię. Osoby te podawały nasilone dolegliwości dyspeptyczne. W badaniu immunohistochemicznym wykazano obecność nacieków limfocytów T CD3+ zarówno w bioptatach błony śluzowej żołądka, jak i części pozaopuszkowej dwunastnicy.Introduction: Coeliac disease is a chronic inflammatory disorder of the gastrointestinal tract, of autoimmune etiology, in genetically predisposed persons. The role of the gastric lesions and their influence on the clinical course of that disease have not been explained. Aim: To evaluate the frequency of morphological lesions in the gastric mucosa in adults with coeliac disease and their effect on the clinical picture of gluten enteropathy. Material and methods: Ninety patients, including 35 patients with coeliac disease and 55 with dyspeptic symptoms (control group) were examined. Clinical studies comprised history of disease, physical examination, blood tests and gastroscopies. Biopsies from the gastric and distal part of the duodenal mucosa were stained with haematoxylin-eosin, for estimation of the intensity of mucosal changes and a count of the intraepithelial lymphocytes (IEL). Immunohistochemical studies with anti-CD3 antibodies were performed for the identification of CD3+ lymphocytes. Results: An increased number of IEL was observed in coeliac patients treated as well as not treated with gluten, compared with the control group. Lymphocytic gastritis (LG) was observed in 8.6% of coeliac patients. Patients with coeliac disease and LG presented intense dyspeptic symptoms. Presence of CD3+ T lymphocytes was revealed in the gastric and duodenal mucosa with immunohistochemical staining. Conclusions: Morphological lesions in the gastric mucosa belong to gastroenteropathy in the course of coeliac disease and may induce dyspeptic symptoms. Taking biopsies from the distal part of the duodenum in patients with dyspeptic symptoms should be considered

The dynamics of emotional reactions in patients with inflammatory bowel disease

W niniejszej pracy omówiono czynniki psychologiczne wpływające na funkcjonalny stan chorych na nieswoiste zapalenia jelit (NZJ). W tej grupie wielu ludzi doświadcza różnego rodzaju trudności emocjonalnych z powodu choroby i leczenia. Najczęstszymi występującymi wówczas reakcjami są lęk, nastrój depresyjny, brak satysfakcji z życia oraz negatywna postawa wobec efektów leczenia. Istotną rolę odgrywają tu mechanizmy patofizjologiczne. Przedstawiono indywidualne cechy osobowości pacjenta mogące mieć wpływ na jego stan psychiczny i fizyczny, a tym samym proces zdrowienia. Zaprezentowano również dynamikę zmian reakcji emocjonalnych u chorych, pozwalających im na przystosowanie się do przewlekłej choroby. Opracowanie przedstawionych zagadnień ma na celu zrozumienie charakterystycznych reakcji psychologicznych chorych na NZJ i późniejsze adekwatne do tej wiedzy podejście do nich i zapewnienie lepszych efektów leczenia.We intended to assess psychological factors influencing functional status of patients with inflammatory bowel disease (IBD). These patients experience different emotional difficulties, which may interfere with the course of the disease by influencing the pathophysiological mechanisms. The most frequent reactions observed in IBD patients are: anxiety, depressive mood, life dissatisfaction, and negative attitude to the results of treatment. We discuss individual features of patient personality which may be important for their psychological or physical status and in consequence their health status. The article also presents the dynamics of emotional reaction changes in IBD patients, which allow them to adapt to chronic disease. We hope that an understanding of the characteristic psychological reactions of IBD patients will be helpful to achieve better therapeutic results for this disease

Variability in Prevalence of Helicobacter pylori Strains Resistant to Clarithromycin and Levofloxacin in Southern Poland

Background. An increasing resistance of Helicobacter pylori strains to antimicrobial agents is the serious therapeutic problem. The aim of this study was to compare the primary and secondary resistance of H. pylori strains isolated between 2006–2008 (data published) and 2009–2011 to clarithromycin and levofloxacin. Material and Methods. 220 dyspeptic patients (153 before treatment, 67 after), were enrolled in the study. 51 H. pylori strains were isolated. MIC values of clarithromycin and levofloxacin were determined by the E-test method. The statistical analysis was conducted with the χ2 test with Yates correction at the 0.05 significance level (P ≤ 0.05). Results. Between 2006 and 2008, 34% (39/115) of H. pylori strains were resistant to clarithromycin (primary 21% (19/90), secondary 80% (20/25)). 5% (6/115) of strains were resistant to levofloxacin (primary 2% (2/90), secondary 16% ((4/25); data published) Between 2009–2011, 22% (11/51) of H. pylori strains were resistant to clarithromycin (primary 19% (8/43), secondary 38% (3/8)). 16% (8/51) of strains were resistant to levofloxacin (primary 12% (5/43), secondary 38% (3/8)). Conclusion. The present study has shown the increasing amount of resistant H. pylori strains isolated from patients in Southern Poland to levofloxacin and decreasing number of resistant strains to clarithromycin