Pre-procedural proton pump inhibition is associated with fewer peri-oesophageal lesions after cryoballoon pulmonary vein isolation

Pulmonary vein isolation (PVI) using cryoenergy is safe and efficient for treatment of atrial fibrillation (AF). Pre-existing upper gastrointestinal (GI) pathologies have been shown to increase the risk for AF. Therefore, this study aimed at assessing incidental pathologies of the upper GI tract in patients scheduled for PVI and to analyse the impact of patients’ characteristics on PVI safety outcome. In 71 AF patients, who participated in the MADE-PVI trial, oesophagogastroduodenoscopy and endosonography were prospectively performed directly before and the day after PVI to assess pre-existing upper GI pathologies and post-interventional occurrence of PVI-associated lesions. Subgroup analysis of the MADE-PVI trial identified clinically relevant incidental findings in 53 patients (74.6%) with age > 50 years being a significant risk factor. Pre-existing reflux oesophagitis increased risk for PVI-associated mediastinal oedema, while patients already treated with proton pump inhibitors (PPI) had significantly fewer mediastinal oedema. Our results suggest that AF patients with pre-existing reflux oesophagitis are at higher risk for PVI-associated mediastinal lesions, which is decreased in patients with constant PPI-treatment prior to PVI. Since PVI-associated mediastinal lesions are regarded as surrogate parameter for an increased risk of the fatal complication of an oesophago-atrial fistula, our findings hint at a beneficial effect of pre-interventional prophylactic PPI-treatment to reduce risk for PVI-associated complications.German Clinical Trials Register (DRKS00016006; date of registration: 17/12/2018).

Chrysophyllum Albidum Accelerates Delayed Gastric Ulcer Healing in Rats Through Oxidative Stress Reversal and Proton Pump Inhibition

Background: Chrysophyllum albidum has been documented to exert its gastric ulcer (GU) healing activities by modulating blood inflammatory mediators, however, other probable in-vivo underlying mechanisms are still vague which this study sought to investigate.Materials and Methods: Male Wistar rats (120-130g) divided into 9 groups (n=15 for groups I-VII; n=5 for groups VIII & IX) viz: Groups I- positive control (DUnA); II and III–250 and 500mg/kg methanolic extract of C. albidum (MeCaB) bark respectively; IV, V and VI-100mg/kg fractions A, B and C respectively; VII–30mg/kg omeprazole; VIII-ulcerated untreated (baseline), IX-negative control. Chronic GU was induced experimentally and delayed using indomethacin with 14 days simultaneous drug treatment. Gastric ulcer score, mucin content, antioxidant and proton pump activities were evaluated by days 3, 7 and 14 of treatment. Data were expressed as Mean+SEM and P<0.05 was significant.Results: C. albidum and fractions treated groups significantly decreased gastric ulcer scores and lipid peroxidation compared with DUnA. Negative control, C. albidum and fraction treated groups significantly increased superoxide dismutase, catalase, glutathione levels and mucin content compared with DUnA group by days 3 and 7. C. albidum, Negative and baseline control groups significantly decreased H+K+ATPase activities compared with DUnA by day14.Conclusion: C. albidum and its fractions facilitated the healing of gastric ulcer, probably by enhanced antioxidant levels, mucin content and decreased gastric H+K+ATPase activity. Keywords: C. albidum and chromatographic fractions, gastric ulcer healing, mucin , antioxidant, H+/K+ATPase pump.

Low Blood Pressure

A brisk upper gastrointestinal bleed is a medical emergency that requires prompt recognition and early initiation of therapy. Patients may present with a variety of signs and symptoms including presyncope, syncope, tachycardia, hypotension, hematochezia, or hematemesis. An important distinction in the differential diagnosis is whether the source is variceal or nonvariceal. The initial goals of management include fluid resuscitation and stabilization. Intravenous proton pump inhibition should be initiated, and octreotide should be considered when liver disease is suspected. Initial investigations include complete blood count, type and screen, coagulation studies, and liver function. Early endoscopy is essential to management.