Author Interviews, Gastrointestinal Disease, Heart Disease, Pharmacology / 31.05.2019

MedicalResearch.com Interview with: Ziyad Al-Aly, MD, FASN Assistant Professor of Medicine Director of the Clinical Epidemiology Center Chief of Research and Education Department of Veterans Affairs Health Care System Saint Louis  MedicalResearch.com: What is the background for this study?   Response: In 2017, we published a paper showing increased risk of death associated with Proton-pump inhibitors (PPI) use. Following the publication of that 2017 paper, several key stakeholders including patients, doctors, research scientists, medical media folks, mainstream media folks, and others asked us: what do these people die from? Did you study causes of death attributable to PPI use? In the study published today, we developed a causal inference framework to answer this question. (more…)
Author Interviews, BMJ, Cancer Research / 07.11.2017

MedicalResearch.com Interview with: Dr. Wai Keung Leung Professor, Division of Gastroenterology & Hepatology Department of Medicine Assistant Dean, LKS Faculty of Medicine University of Hong Kong Hong Kong MedicalResearch.com: What is the background for this study? What are the main findings? Response: It remains controversial whether proton pump inhibitors will increase the risk of gastric cancer. Although previous studies have shown a possible increase in risk in patients taking long-term proton pump inhibitors (PPI), these studies are confounded by the presence of H. pylori infection. In this population-based study from Hong Kong, we have determined the risk of gastric cancer development in more than 63,000 H. pylori-infected subjects who had the bacterium eradicated by a course of  clarithromycin-based triple therapy and continued to take PPI or H2-receptor antagonist (H2RA). After adjusting for various baseline differences among those PPI and non-PPI users, we found that the risk of gastric cancer was increased by 2.4-fold in those who used long-term PPI. The risk was in tandem with the frequency and duration of PPIs treatment. The risk increased from 5-fold to 8-fold for more than 1-year and 3-year use of PPI, respectively. Similar increase in risk was not observed among those who took H2RA, a weaker acid suppressive agent. (more…)
Author Interviews, Gastrointestinal Disease, Kidney Disease / 06.11.2017

MedicalResearch.com Interview with: Charat Thongprayoon, MD Bassett Medical Center Cooperstown, NY 13326 MedicalResearch.com: What is the background for this study? What are the main findings? Response: We conducted a meta-analysis including 5 observational studies with 536,902 patients to assess the risks of chronic kidney disease (CKD) and/or end-stage kidney disease (ESRD) in patients who are taking proton pump inhibitors (PPIs) and/or H2 receptor antagonists (H2RAs). We found a statistically significant association between the use of PPI and 1.3-fold increased risk of CKD or ESRD development. Compared with H2Ras, the use of proton pump inhibitors was significantly associated with 1.3-fold higher risk for CKD development. Conversely, there was no significant association between the use of H2RAs and chronic kidney disease. (more…)
Author Interviews, BMJ, Gastrointestinal Disease / 09.07.2017

MedicalResearch.com Interview with: Ziyad Al-Aly MD FASN Assistant Professor of Medicine Co-director for Clinical Epidemiology Center Department of Medicine, Washington University School of Medicine Saint Louis, Missouri Associate Chief of Staff for Research and Education Veterans Affairs Saint Louis Health Care System MedicalResearch.com: What is the background for this study? What are the main findings? Response: Proton Pump Inhibitors (PPI) are commonly used, and they are associated with adverse events including kidney disease, dementia, fractures, cardiovascular disease, and pneumonia. We asked the question of whether this translates to increased risk of death. We conducted this large cohort study to specifically examine the association between PPI use and risk of death. The results consistently showed an association between use of PPI and increased mortality risk. Moreover, there was a graded relationship between duration of PPI use and risk of death in that longer duration of use was associated with incrementally higher risk of death. (more…)
Author Interviews, Geriatrics, Mineral Metabolism / 22.10.2015

MedicalResearch.com Interview with: Andrew M Hinson, MD UAMS Postdoctoral Research Fellow Thyroid/Parathyroid Diseases & Surgery and Donald L. Bodenner, MD, PhD Department of Otolaryngology-Head and Neck Surgery Department of Geriatrics University of Arkansas for Medical Sciences, Little Rock, Arkansas. Medical Research: What is the background for this study? Response: Proton pump inhibitors (PPIs)​ are widely prescribed, highly effective and generally safe for the treatment of acid-related gastrointestinal disorders. However, there are risks that may be elevated for some older people when PPIs are used in high doses over long periods of time. There is also evidence that fracture risk may even be higher in older patients who are being treated with concurrent oral bisphosphonate medications, which are used to prevent fractures in patients with osteoporosis. While the mechanism remains unknown, PPIs may increase fracture risk by decreasing gastrointestinal absorption (e.g., calcium, vitamin B12, and/or bisphosphonates) or by inhibiting a major mechanism by which bisphosphonates work. To learn more about this process, we studied patients 60 years or older with normal renal function and vitamin D levels to see how PPIs (with and without concurrent bisphosphonate administration) impacted measurements in parathyroid hormone (PTH) and calcium. Medical Research: What are the main findings? Response: We found that chronic PPI exposure in elderly adults is associated with mild secondary hyperparathyroidism regardless of concurrent oral blood pressure administration. Secondary hyperparathyroidism refers to the excessive secretion of PTH by the parathyroid glands in response to low blood calcium levels. This is often associated with renal failure; however, all of our patients had normal renal function. (more…)
Author Interviews, Pediatrics, Pharmacology / 07.01.2015

Prof. H. Szajewska The Medical University of Warsaw Department of Paediatrics Warsaw, PolandMedicalResearch.com Interview with: Prof. H. Szajewska The Medical University of Warsaw Department of Paediatrics Warsaw, Poland   Medical Research: What is the background for this study? Dr. Szajewska: Proton pump inhibitors (PPIs) are increasingly being used in the management of irritability and excessive crying in young infants. For example, a 7-fold increase in PPI prescriptions for infants was demonstrated in one US-based study. While differences among countries may occur, over-prescription of PPIs for infants remains a problem. The use of PPIs is mainly based on the assumption that these symptoms are attributable to gastroesophageal reflux or gastroesophageal reflux disease. Indeed, in infants, common symptoms of both conditions include regurgitation or vomiting associated with irritability or crying. However, there is still uncertainty with regard to the role of proton pump inhibitors for the management of excessive crying and irritability. Dr. Szajewska: What are the main findings? We aimed to examine whether proton pump inhibitors are effective in the management of excessive crying and irritability in infants. Only 5 randomized controlled trials fulfilled the inclusion criteria, so the evidence remains limited. There was variability in how crying/irritability outcomes were reported, but all trials used reliable methods. Some trials showed a decrease in crying/irritability from baseline to the end of the intervention; a similar effect was observed in the control group. However, no significant differences between the treatment groups were observed. (more…)
Author Interviews, C. difficile, Gastrointestinal Disease, Mayo Clinic / 26.11.2014

Dr. John K. DiBaise MD Gastroenterology and Hepatology Mayo Clinic, Scottsdale ArizonaMedicalResearch.com Interview with: Dr. John K. DiBaise MD Gastroenterology and Hepatology Mayo Clinic, Scottsdale Arizona Medical Research: What is the background for this study? What are the main findings? Dr. DiBaise: Despite nearly 25 years of safe and effective use of proton pump inhibitors (PPI), in recent years there have been an increasing number of reports suggesting potentially harmful effects and harmful associations with their use.  One such association with PPI use has been Clostridium difficile infection (CDI) which can cause severe and recurrent episodes of diarrhea.  Previous reports evaluating the microbes present within the gastrointestinal tract (ie, gut microbiome) of individuals with CDI have shown a reduction in overall microbial community diversity.  We studied the gut microbiome in healthy individuals both before and after using a proton pump inhibitors for one month and found a similar reduction in microbial diversity while taking the PPI that did not entirely revert back to the ‘normal’ baseline after being off the medication for a month.  While this does not demonstrate a causal association between proton pump inhibitors use and CDI, it demonstrates that PPI use creates a situation in the gut microbial environment that may increase the individual’s susceptibility to CDI. (more…)
Author Interviews, Gastrointestinal Disease, Heart Disease / 20.08.2013

MedicalResearch.com Interview with: John P. Cooke MD PhD Chair, Department of Cardiovascular Sciences Director, Center for Cardiovascular Regeneration Houston Methodist Research Institute 6670 Bertner St MS: R6-414, Houston, TX 77030John P. Cooke MD PhD Chair, Department of Cardiovascular Sciences Director, Center for Cardiovascular Regeneration Houston Methodist Research Institute 6670 Bertner St MS:  R6-414, Houston, TX 77030   MedicalResearch.com: What are the main findings of the study? Answer: We discovered that the proton pump inhibitors PPIs), as a class, impair vascular relaxation.  The PPIs have this effect by suppressing the activity of a key enzyme required for cardiovascular health. The enzyme is known as DDAH (for dimethylarginine dimethylaminohydrolase).  This enzyme is critical in clearing ADMA (asymmetric dimethylarginine) from tissues and the circulation.  Because ADMA is an endogenous inhibitor of nitric oxide synthase, accumulation of ADMA impairs vascular relaxation and vascular homeostasis.   Previously, we and others have found that, by inhibiting endothelium-derived nitric oxide, ADMA accelerates vascular disease in preclinical models.  In humans, ADMA is linked to the severity of vascular disease, and is an independent risk factor for major adverse cardiovascular events (MACE).  Thus, the effect of PPIs to inhibit DDAH would be anticipated to impair cardiovascular health, and to increase the risk of MACE. (more…)