scholarly journals Gastro-Cardiology: A Novel Perspective for the Gastrocardiac Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Robin Hofmann ◽  
Magnus Bäck
Keyword(s):  
Helicobacter Pylori ◽  
Gastrointestinal Bleeding ◽  
Large Scale ◽  
Bleeding Events ◽  
Gastrointestinal Infections ◽  
Inflammatory Conditions ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Ischemic Events ◽  
Cardiovascular Benefit

The gastrocardiac syndrome was coined originally at the beginning of the 19th century to describe an alleged gastric-cardiopathy with reflux heartburn mimicking cardiac chest pain. Today, a wider perspective of gastrocardiac syndrome has emerged. First, the cardiovascular risk factor chronic systemic inflammation may reflect gastroenterological inflammatory conditions, such as inflammatory bowel disease and gastrointestinal infections, in particular, chronic Helicobacter pylori infection. Furthermore, since contemporary treatment of cardiovascular disease commonly includes potent antithrombotic medications, the cardiovascular benefit in terms of a decrease in the incidence of recurrent ischemic events and death needs to be carefully balanced with an increased risk of gastrointestinal bleeding. Several strategies to target chronic gastrointestinal inflammation and to diagnose and treat Helicobacter pylori to reduce the risk of cardiovascular events and gastrointestinal bleeding are available but residual controversy remains and large-scale gastro-cardiology trials are needed to determine the optimal treatment approaches. In perspective, the centennial gastrocardiac syndrome is more relevant than ever in a contemporary gastroenterology and cardiology setting. A collaborative subspecialty, namely Gastro-cardiology, would introduce novel unique means to study, diagnose and treat gastrocardiac conditions with the aim to reduce the risk of cardiovascular and bleeding events to improve the prognosis for gastro-cardiology patients.

scholarly journals Genetic Variants in PTGS1 and NOS3 Genes Increase the Risk of Upper Gastrointestinal Bleeding: A Case–Control Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Marcela Forgerini ◽  
Gustavo Urbano ◽  
Tales Rubens de Nadai ◽  
Sabrina Setembre Batah ◽  
Alexandre Todorovic Fabro ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Gastrointestinal Bleeding ◽  
Genetic Variants ◽  
Case Control Study ◽  
Upper Gastrointestinal Bleeding ◽  
Case Control ◽  
Gastrointestinal Disorders ◽  
Increased Risk ◽  
Upper Gastrointestinal ◽  
Control Study

Objective: To assess the association between PTGS1 and NOS3 variant alleles and the risk to develop upper gastrointestinal bleeding (UGIB) secondary to complicated peptic disease.Methods: A case–control study was conducted in a Brazilian complex hospital from July 2016 to March 2020. Case: Patients with UGIB diagnosis. Control: Patients admitted for surgery not related to gastrointestinal disorders. Variables: UGIB (outcome), genetic variants in PTGS1 and NOS3 genes (independent), and sex, age, schooling, ethnicity, previous history of gastrointestinal disorders, Helicobacter pylori serology, comorbidity, drug therapy, and lifestyle (confounding). The single-nucleotide polymorphisms (SNPs) of the PTSG1 gene (rs1330344, rs3842787, rs10306114, and rs5788) and NOS3 gene (rs2070744 and rs1799983) were determined using the real-time polymerase chain reaction. Helicobacter pylori serology was determined through the chemiluminescence technique. Logistic regression models were built and deviations of allelic frequencies from Hardy–Weinberg equilibrium were verified.Results: 200 cases and 706 controls were recruited. Carriers of the AG genotype of rs10306114 (OR: 2.55, CI 95%: 1.13–5.76) and CA + AA genotypes of rs5788 (OR: 2.53, CI 95%: 1.14–5.59) were associated with an increased risk for the UGIB development. In nonsteroidal anti-inflammatory drugs (NSAIDs) users, the six variants evaluated modified the magnitude of the risk of UGIB, whereas in low-dose aspirin (LDA) users, an increased risk of UGIB was observed for four of them (rs1330344, rs10306114, rs2070744, and rs1799983). Personal ulcer history (p-value: < 0.001); Helicobacter pylori infection (p-value: < 0.011); NSAIDs, LDA, and oral anticoagulant use (p-value: < 0.001); and alcohol intake (p-value: < 0.001) were also identified as independent risk factors for UGIB.Conclusion: This study presents two unprecedented analyses within the scope of the UGIB (rs10306114 and rs2070744), and our findings showing an increased risk of UGIB in the presence of the genetic variants rs10306114 and rs5788, regardless of the drug exposure. Besides, the presence of the evaluated variants might modify the magnitude of the risk of UGIB in LDA/NSAIDs users. Therefore, our data suggest the need for a personalized therapy and drug use monitoring in order to promote patient safety.

scholarly journals Role of Helicobacter pylori in Upper Gastrointestinal Bleeding Among Ischemic Stroke Hospitalizations: A Nationwide Study of Outcomes

2019 ◽  
Vol 1 (3) ◽  
pp. 358-371
Author(s):  
Urvish K. Patel ◽  
Mihir Dave ◽  
Anusha Lekshminarayanan ◽  
Nidhi Patel ◽  
Abhishek Lunagariya ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Ischemic Stroke ◽  
Risk Stratification ◽  
Gastrointestinal Bleeding ◽  
Health Care Cost ◽  
Upper Gastrointestinal Bleeding ◽  
Increased Risk ◽  
H Pylori ◽  
Upper Gastrointestinal

Introduction: Helicobacter pylori (H. pylori) is a well-recognized risk factor for upper gastrointestinal bleeding (UGIB). The exposure to tissue plasminogen activator (tPA), anti-platelets, and anticoagulants increases the risk of UGIB in acute ischemic stroke (AIS) patients, the risk stratification of H. pylori infection is not known. In this retrospective cross-sectional study, we aimed to evaluate the relationship between H. pylori and GIB in patients hospitalized with AIS. Methods: In the nationwide data, hospitalization for AIS was identified by primary diagnosis using International Classification of Diseases, clinical modification (ICD-9-CM) codes. Subgroup of patients with GIB and H. pylori were identified in AIS cohort. A stepwise multivariable logistic regression model was fitted to evaluate the outcome of upper GIB and role of H. Pylori in UGIB. Results: Overall 4,224,924 AIS hospitalizations were identified, out of which 18,629 (0.44%) had UGIB and 3122 (0.07%) had H. pylori. The prevalence of H. pylori-induced UGIB among UGIB in AIS was 3.05%. The prevalence of UGIB was markedly elevated among the H. pylori infection group (18.23% vs. 0.43%; p < 0.0001) compared to the non-H. pylori group. In multivariable regression analysis, H. pylori was associated with markedly elevated odds of UGIB (aOR:27.75; 95%CI: 21.07–36.55; p < 0.0001). Conclusion: H. pylori infection had increased risk-adjusted occurrence of UGIB amongst the AIS hospitalized patients. H. pylori testing may improve risk stratification for UGIB and lower the health care cost burden in stroke hospitalization.

Cost-effectiveness of Argatroban Versus Heparin Anticoagulation in Adult Extracorporeal Membrane Oxygenation Patients

2019 ◽  
pp. 001857871989009
Author(s):  
Angelina E. Cho ◽  
Kathleen Jerguson ◽  
Joy Peterson ◽  
Deepa V. Patel ◽  
Asif A. Saberi
Keyword(s):  
Cost Effectiveness ◽  
Extracorporeal Membrane Oxygenation ◽  
Average Cost ◽  
P Value ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Increased Risk ◽  
Heparin Anticoagulation ◽  
Ischemic Events ◽  
Ecmo Therapy

Purpose: The purpose of this study was to evaluate the cost effectiveness of argatroban compared to heparin during extracorporeal membrane oxygenation (ECMO) therapy. Methods: This was a retrospective study of patients who received argatroban or heparin infusions with ECMO therapy at a community hospital between January 1, 2017 and June 30, 2018. Adult patients who received heparin or argatroban for at least 48 hours while on venovenous (VV) or venoarterial (VA) ECMO were included. Patients with temporary mechanical circulatory assist devices were excluded. Each continuous course of anticoagulant exposure that met the inclusion criteria was evaluated. The primary endpoint was the total cost of anticoagulant therapy for heparin versus argatroban, including all administered study drugs, blood or factor products, and associated laboratory tests. Secondary endpoints included safety and efficacy of anticoagulation with each agent during ECMO. Documentation of bleeding events, circuit clotting, and ischemic events were noted. Partial thromboplastin time (PTT) values were evaluated for time to therapeutic range and percentage of therapeutic PTTs. Results: A total of 11 courses of argatroban and 24 courses of heparin anticoagulation were included in the study. The average cost per course of argatroban was less than the average cost per course of heparin ($7,091.98 vs $15,323.49, respectively; P value = 0.15). Furthermore, argatroban was not associated with an increased incidence of bleeding, thrombotic, or ischemic events. Conclusion: Argatroban may be more cost-effective during ECMO therapy in patients with low antithrombin III levels without increased risk of adverse events.

Comparing mortality of colorectal cancer and gastrointestinal bleeding among patients with long-term use of low dose aspirin: A population-based study of 689,209 patients.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 527-527
Author(s):  
Joseph Sung ◽  
Kelvin Kf Tsoi
Keyword(s):  
Colorectal Cancer ◽  
Gastrointestinal Bleeding ◽  
Large Scale ◽  
Low Dose ◽  
Population Based ◽  
Dose Aspirin ◽  
Increased Risk ◽  
Incidence And Mortality ◽  
Low Dose Aspirin

527 Background: Aspirin, commonly used for prevention of cardiovascular and cerebrovascular diseases, is well-known to protect against colorectal cancer (CRC) development but increase risk of gastrointestinal bleeding (GIB). Few large-scale studies have compared the benefit and risk of long-term aspirin usage. This cohort study aims to evaluate the use of low-dose aspirin to prevent CRC and the risk of GIB associated with the aspirin use. Methods: A population-based clinical dataset was used to compare incidence and mortality of CRC and GIB patients receiving low-dose aspirin with sex-and-age matched controls (in 1:2 ratio). Patients with aspirin≤6 months were excluded. Clinical data of 206,243 aspirin users (mean dose 80 mg/day, mean duration 7.7 years) and 482,966 non-users were included. All patients must have at least 10-year follow up on clinical outcome. Results: Among aspirin users 5,776 (2.80%) were diagnosed with CRC; 2,097 (1.02%) died of the malignancy. 16,483 (3.41%) non-users were diagnosed with CRC; 7,963 (1.65%) died of CRC. Using the cox-proportional hazard regression, aspirin usage showed a modest but significant reduction in CRC mortality (HR = 0.65; 95% CI = 0.62 to 0.69). On the other hand, 11,187 (5.42%) aspirin users developed GIB, and 841 (0.41%) died. 15,186 (3.14%) non-users developed GIB, and 1,682 patients (0.35%) died. Aspirin users showed modest but significant increased risk of GIB-related mortality (HR = 1.24; 95% CI = 1.14 to 1.35). Conclusions: The long-term use of low dose aspirin shows preventive effect on CRC, but also increases the associated GIB risk. Considerations of prophylactic use of aspirin should balance the benefit and the risk of this treatment to the target population. [Table: see text]

scholarly journals Occult Blood in Feces Is Associated with Increased Risk of Psoriasis

Dermatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Hyun Jung Lee ◽  
Kyungdo Han ◽  
Hosim Soh ◽  
Seong-Joon Koh ◽  
Jong Pil Im ◽  
...  
Keyword(s):  
Intestinal Inflammation ◽  
Surrogate Marker ◽  
Occult Blood ◽  
National Health Insurance System ◽  
Inflammatory Conditions ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Using Data ◽  
Adjusted Model

<b><i>Background:</i></b> The fecal immunochemistry test (FIT) has been proposed as a surrogate marker of intestinal inflammation. Psoriasis is a chronic inflammatory skin disease that is linked to underlying systemic inflammatory conditions, including inflammatory bowel disease. <b><i>Methods:</i></b> We investigated the association between occult blood in feces and the risk of psoriasis using data from the National Health Insurance System. This study was conducted involving 1,395,147 individuals who underwent health examinations from January 2009 to December 2012 and were followed up until the end of 2017. <b><i>Results:</i></b> The incidence of psoriasis (per 1,000 person-years) was 3.76 versus 4.14 (FIT-negative versus FIT-positive group) during a median follow-up of 6.68 years. In the multivariable-adjusted model, the hazard ratios for psoriasis were 1.03 for one positive FIT result, 1.12 for two positive FIT results, and 1.34 for three positive FIT results compared with negative FIT results. <b><i>Conclusion:</i></b> The risk of psoriasis was significantly increased in patients with positive FIT results compared to the FIT-negative population.

scholarly journals The Risk of Endoscopic Mucosal Resection in the Setting of Clopidogrel Use

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Vikneswaran Namasivayam ◽  
Ganapathy A. Prasad ◽  
Lori S. Lutzke ◽  
Kelly T. Dunagan ◽  
Lynn S. Borkenhagen ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Endoscopic Mucosal Resection ◽  
Average Risk ◽  
Limited Evidence ◽  
Single Centre ◽  
Mucosal Resection ◽  
Antiplatelet Medication ◽  
Increased Risk ◽  
Risk Patients ◽  
Ischemic Events

Objective. Guidelines on antiplatelet medication use during endoscopy are based on limited evidence. We investigate the risk of bleeding and ischemic events in patients undergoing endoscopic mucosal resection (EMR) of esophageal lesions in the setting of scheduled cessation and prompt resumption of clopidogrel. Design. Single centre retrospective review. Patients. Patients undergoing EMR of esophageal lesions. Interventions. Use of clopidogrel before EMR and resumption after EMR. Patients cease antiplatelets and anticoagulants 7 days before EMR and resume clopidogrel 2 days after EMR in average risk patients. Main Outcomes. Gastrointestinal bleeding (GIB) and ischemic events (IE) within 30 days of EMR. Results. 798 patients underwent 1716 EMR. 776 EMR were performed on patients on at least 1 antiplatelet/anticoagulant (APAC). 17 EMR were performed following clopidogrel cessation. There were 14 GIB and 2 IE. GIB risk in the setting of recent clopidogrel alone (0%) was comparable to those not on APAC (1.1%) (P=1.0). IE risk on clopidogrel (6.3%) was higher than those not on APAC (0.1%) (P=0.03). Limitations. Retrospective study. Conclusions. Temporary cessation of clopidogrel before EMR and prompt resumption is not associated with an increased risk of gastrointestinal bleeding but may be associated with increased ischemic events.

scholarly journals Dentists Are at a Higher Risk for Oral Helicobacter pylori Infection

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Qian Liu ◽  
Yunhan Zhang ◽  
Chunmei Xu ◽  
Boran Chen ◽  
Hao Xu ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Large Scale ◽  
Healthy Lifestyle ◽  
Cross Sectional Study ◽  
Gastric Disease ◽  
Nested Polymerase Chain Reaction ◽  
Cross Sectional ◽  
Increased Risk ◽  
H Pylori ◽  
Good Individual

Oral cavity has been taken as one of the major reservoirs for Helicobacter pylori, the bacteria responsible for gastric infection and cancers. Dentists are frequently exposed to saliva; thus, theoretically, they are at a higher risk for oral H. pylori infection. In the present study, to test this hypothesis and to find out the potential factors associated with the increased risk, a cross-sectional study was carried out on a large scale of dentists (N=90) and nondentist controls (N=110). By using nested polymerase chain reaction to amplify a specific DNA fragment of H. pylori, we found 7.27% of saliva samples from the nondentist group and 16.67% of saliva samples from the dentist group were oral H. pylori positive, and the difference between groups was statistically significant (χ2=4.292, p=0.038). Importantly, however, after stratifying enrolled subjects with factors which might interfere with the comparison of H. pylori detection rate between groups, we still observed a higher H. pylori frequency in the dentists than that in the controls in subgroups, including those with good individual hygiene, healthy lifestyle, and physical condition, as well as those living with families to be gastric disease free and not sharing meals with H. pylori-positive persons, respectively. Moreover, the frequency of clinical practice per week of the investigated dentists was closely associated with an oral H. pylori infection risk. Our data indicates that dentists are at a higher risk for H. pylori infection, and intensive attention needs to be paid on this issue.

scholarly journals P097 Raised inflammatory markers with unclear cause; what do they tell us? An audit of patients presenting to rheumatology service at RNHRD, Bath

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Muhammad Safwan Jamal ◽  
Rachel Peck ◽  
Raj Sengupta
Keyword(s):  
Inflammatory Response ◽  
Inflammatory Markers ◽  
Large Scale ◽  
Plasma Viscosity ◽  
Inflammatory Conditions ◽  
Risk Of Mortality ◽  
Included Patient ◽  
Increased Risk ◽  
Made In

Abstract Background/Aims  Unexplained persistently raised inflammatory response in patients’ leads to concern for clinicians. Different studies have demonstrated increased risk of mortality in patients with persistently raised inflammatory response. Rheumatology input is often sought in these cases when cause of inflammatory response is unclear. We conducted this project in our department to see the progress of new patients with raised inflammatory markers presenting to the rheumatology service. Methods  Patients referred to the rheumatology outpatients with raised inflammatory markers (Plasma viscosity &gt;1.85 or CRP&gt;100) from April to November 2018 were included. Patient demographic information was gathered through patient’s records and imaging information was gathered through PACS system. Information about investigative modalities was included. Treatment recommendations were also included. Patients were followed up for 6 months and any change in their diagnosis was also incorporated into the data. Results  169 patients satisfied the inclusion criteria. Median age was 58 years. Majority were females (72%). Mean referral to seen time was 3.43 weeks. Mean elevation in CRP and PV was 10 and 1.93 respectively. A diagnosis of mechanical/non rheumatological cause was made in 36% patients of those 11% were Fibromyalgia. Inflammatory arthritis diagnosis made in 34% patients. Autoimmune testing and radiological tests were performed in 97% and 90% patients respectively. 67% patients had malignancy or infection work up. Diagnosis was changed in 25% patients on follow up with investigation. With PV &gt; 2.0 (44 patients), only 20% had non inflammatory conditions. There were 6 deaths in this cohort of patients (13% mortality). 3 new cases of malignancy were diagnosed. P097 Table 1:Investigative modalitiesInflammatory disorders N=number of scansNon-inflammatory conditionsCT100MRI1812PET CT71NM scan14 Conclusion  Patients with persistently elevated inflammatory markers had a higher mortality rate than the other group over 6 months. Three quarters of patients with raised inflammatory markers remain under follow up of Rheumatology team for surveillance. Patients were reviewed in Rheumatology clinics in reasonable time. Appropriate investigative modalities were considered while investigating for inflammatory disorders. Further large scale studies are required to find an association between raised inflammatory response with mortality in rheumatology patients. Disclosure  M. Jamal: None. R. Peck: None. R. Sengupta: None.

Influence of CYP2C19 genetic polymorphisms on clinical outcomes of intracranial aneurysms treated with stent-assisted coiling

2016 ◽  
Vol 9 (10) ◽  
pp. 958-962 ◽  
Author(s):  
Huijian Ge ◽  
Xianli Lv ◽  
Hui Ren ◽  
Hengwei Jin ◽  
Yuhua Jiang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Genetic Polymorphisms ◽  
Intracranial Aneurysms ◽  
Loss Of Function ◽  
Bleeding Events ◽  
Clopidogrel Resistance ◽  
Increased Risk ◽  
Posterior Circulation Aneurysms ◽  
Cerebral Ischemic ◽  
Ischemic Events

ObjectiveTo investigate the influence of CYP2C19 genetic polymorphisms on clinical outcomes of intracranial aneurysms treated with stent-assisted coiling.MethodsBetween September 2014 and October 2015, we prospectively recruited 215 patients with intracranial aneurysms who were treated with stent-assisted coiling. CYP2C19 genotypes were determined and clopidogrel response was tested. The primary endpoints included symptomatic or silent ischemic events, and bleeding events. The secondary endpoint was clinical outcome at 3 months.ResultsOf the 215 patients, 108 (50.2%) were classified as intermediate metabolizers (IMs, CYP2C19*1/*2, *1/*3), 76 (35.3%) as extensive metabolizers (EMs, CYP2C19*1/*1) and 31 (14.4%) as poor metabolizers (PMs, CYP2C19*2/*2, *2/*3, *3/*3). Carriers of CYP2C19 loss-of-function (LOF) alleles (*2 or *3, p=0.001), especially PMs (p=0.004), had an increased risk for clopidogrel resistance. After the procedures, cerebral ischemic events occurred in 69 patients (32.1%) and bleeding was seen in 20 patients (9.3%). In comparison with IMs and PMs, EMs had a lower risk for ischemic events (21.1% vs 37.0% and 41.9%, p=0.02 and 0.027, respectively) and a relatively higher risk for bleeding events (18.4% vs 5.6% and 0%, p=0.006 and 0.01, respectively). Based on multivariate analysis, the carriage of CYP2C19 LOF alleles (p=0.032) and clopidogrel resistance (p=0.047) were considered as predictors of cerebral ischemic events, and EMs were significantly associated with bleeding (p=0.002). Posterior circulation aneurysms (p=0.038), hemorrhagic history (p=0.001) and poor metabolic genotypes (p=0.001) could result in poor clinical outcomes (modified Rankin Scale >2).ConclusionsCYP2C19 genetic polymorphisms had significant influence on the antiplatelet effect of clopidogrel, and could be considered as risk factors of ischemic or bleeding events and even clinical outcomes of patients with intracranial aneurysms treated with stent-assisted coiling.

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