Gastric acid-related disorders and drugs: An epidemiological perspective

Gastroesophageal reflux disease (GERD) is an important health problem for several reasons. First, GERD is highly prevalent. GERD symptoms are experienced by more than 25% of the general population on at least a monthly basis. Secondly, GERD has a substantial impact on quality of life. Thirdly, GERD may lead to complications, such as esophageal strictures, Barrett’s esophagus and ultimately to esophageal adenocarcinoma (EAC). The primary goals of treatment of GERD are to achieve relief of symptoms as well as to prevent complications. The most common pharmacological treatment consists of proton pump inhibitors (PPIs). With this thesis we aimed to give insight into the epidemiology of and risk factors for GERD and associated diseases, and on usage patterns, efficacy and safety of proton pump inhibitors in daily clinical practice. We made use of the Integrated Primary Care Information (IPCI) database which is a general practitioner research database, containing the complete longitudinal electronic medical records of more than 800,000 patients in the Netherlands. The main findings of the studies described in this thesis include that the incidence of Barrett’s esophagus is increasing, mainly among men under 60 years of age. The incidence of EAC is increasing as well. Furthermore we showed that the use of tricyclic antidepressants, with the exception of clomipramine, does not increase the risk of reflux esophagitis. Also for other anticholinergic drugs there is no solid evidence for such an association. With regard to PPIs, we described usage patterns in daily clincial practice and concluded that the risk of NSAID-related gastrointestinal complications is increased 4-fold in patients who are not adherent to PPI therapy. PPIs were not associated with an increased risk of colorectal cancer

Suboptimal gastroprotective coverage of NSAID use and the risk of upper gastrointestinal bleeding and ulcers: An observational study using three European databases

Background: Gastro-protective agents (GPA) are co-prescribed with non-steroidal anti-inflammatory drugs (NSAID) to lower the risk of upper gastrointestinal (UGI) events. It is unknown to what extent the protective effect is influenced by therapy adherence. Aim: To study the association between GPA adherence and UGI events among non-selective (ns) NSAID users. Methods: The General Practice Research Database (UK 1998e2008), the Integrated Primary Care Information database (the Netherlands 1996-2007) and the Health Search/CSD Longitudinal Patient Database (Italy 2000-2007) were used. A nested case-control design was employed within a cohort of nsNSAID users aged ≥50 years, who also used a GPA. UGI event cases (UGI bleeding and/or symptomatic ulcer with/without obstruction/perforation) were matched to event-free members of the cohort for age, sex, database and calendar time. Adherence to GPA was calculated as the proportion of nsNSAID treatment days covered by a GPA prescription. Adjusted OR with 95% CI were calculated. Results: The cohort consisted of 618 684 NSAID users, generating 1 107 266 nsNSAID episodes. Of these, 117 307 (10.6%) were (partly) covered by GPA, 4.9% of which with a GPA coverage 80% (full adherence). 339 patients experienced an event. Among non-adherers, the OR was 2.39 (95% CI 1.66 to 3.44) for all UGI events and 1.89 (95% CI 1.09 to 3.28) for UGI bleeding alone, compared to full adherers. Conclusions: The risk of UGI events was significantly higher in nsNSAID users with GPA non-adherence. This underlines the importance of strategies to improve GPA adherence. Copyright Article author (or their employer) 2011

In situ degradability of corn stover and elephant-grass harvested at four stages of maturity

Among tropical forages, corn silage is largely used by farmers trying to explore the maximum genetic potential from the animals. However, other tropical forages, such as elephant-grass (Pennisetum purpureum), are more productive and therefore cheaper to use than corn silage. Our objective was to compare the in situ degradability of elephant-grass with that from corn hybrids, all harvested at four stages of maturity. The experimental design followed a randomized block design with nested subplots. Two corn hybrids: AG5011, ZN8392 were harvested with 25, 30, 35, and 40% dry matter (DM) in the whole plant, and separated in stem + leaf sheath + leaf blade (stover), and cobs. Elephant-grass was harvested with 30, 40, 50 and 60 days after a leveling cut. Dried and ground samples were incubated in nylon bags inside the rumen for 0, 6, 12, 24, 48 and 72 h to estimate the kinetics of ruminal DM and neutral detergent fiber (NDF) degradation. The advance of maturity increased the NDF and acid detergent fiber (ADF) content in elephant-grass, and reduced its DM degradability. However, maturity had little or no effect on fiber content and DM degradability of corn stover. Elephant-grass had a higher NDF degradability than corn stover, and there was no effect of maturity on NDF degradability of either elephant-grass or corn stover. Fiber degradability of elephant-grass was not worse than that of corn stover, and therefore the choice of forage should be made on economical analysis rather than assuming an intrinsic low production potential for elephant-grass based diets.Dentre as forragens, a silagem de milho é amplamente utilizada pelos fazendeiros que visam explorar o máximo do potencial genético dos animais. No entanto, outros volumosos tropicais como o capim-elefante (Pennisetum purpureum) são mais produtivos e, portanto, mais baratos do que a silagem de milho. Nosso objetivo foi comparar a degradabilidade in situ do capim-elefante com a degradabilidade de híbridos de milho, colhidos em quatro estágios de maturidade. O experimento seguiu um delineamento de blocos ao acaso com sub-parcelas. Dois híbridos de milho: AG5011 e ZN8392 foram colhidos com 25, 30, 35 e 40% matéria seca (MS) na planta toda e separados na fração colmo + bainha + folhas e espigas. Capim elefante foi colhido 30, 40, 50 e 60 dias após o corte de nivelamento. As amostras secas e trituradas foram incubadas no rúmen por 0, 6, 12, 24, 48 e 72 h para cálculo da cinética da degradação ruminal da MS e da fibra em detergente neutro (FDN). O avanço da maturidade aumentou os teores de FDN e fibra em detergente ácido (FDA) do capim elefante e reduziu a degradabilidade da MS. Entretanto, a maturidade teve pouco efeito sobre os teores de fibra e a degradabilidade da MS da fração planta dos híbridos de milho. O capim elefante apresentou maior degradabilidade da FDN do que híbridos de milho, e não houve efeito da maturidade sobre a degradabilidade da FDN das duas espécies. A degradabilidade da fibra de capim-elefante não é pior do que a de híbridos de milho e, portanto a escolha da forragem deve ser feita com base em análises econômicas ao invés de assumir um menor potencial de produção em dietas a base de capim elefante