Introduction

Treatment response in patients with severe erosive gastroesophageal reflux disease (eGERD) is often inadequate using regular doses of proton pump inhibitors (PPIs), thus necessitating escalation of dosing. High-dose PPIs improve compliance in such patients, leading to better outcomes. However, comparative data on effectiveness of high-dose PPIs is limited.

Aims & Methods

This interim analysis assessed symptomatic improvement of regurgitation in an ongoing, prospective, real-world, observational study to compare the effectiveness of rabeprazole 40mg to pantoprazole 80mg and omeprazole 40mg/esomeprazole 80mg. Adult patients with endoscopically confirmed severe eGERD were enrolled. Patients shifted from low-dose PPIs or started on high-dose PPIs were included; those with complications of GERD were excluded.

Results

A total of 260 patients (rabeprazole, 130; omeprazole/esomeprazole, 65; pantoprazole, 65) from 37 sites in India were analyzed. Although symptomatic improvement of diurnal and nocturnal regurgitation based on patient-reported severity scores was observed among the three arms after 4±1 weeks of treatment, the complete-resolution rate of diurnal regurgitation was significantly higher with rabeprazole (17.97%) compared to omeprazole/esomeprazole (5.08%; p=0.018) and higher than pantoprazole (8.20%; p=0.077). Similarly, complete resolution of nocturnal regurgitation was significantly higher with rabeprazole (14.06%) compared to omeprazole/esomeprazole (1.59%; p=0.007) and higher than pantoprazole (7.94%; p=0.221). Among patients with associated work-related stress (n=132), one-fifth in the rabeprazole arm experienced complete resolution of diurnal regurgitation compared to none in the omeprazole/esomeprazole (p=0.013) or pantoprazole (p=0.030) arms. Patients with lack of regular physical exercise (83.08%) exhibited higher rate of complete resolution of nocturnal regurgitation with rabeprazole (13.73%) compared to the other PPIs. Overall, elderly patients >60 years of age (mean±SD, 68.82±6.54 years) treated with rabeprazole showed significantly higher complete-resolution rates of diurnal regurgitation compared to pantoprazole (36.67% vs. 0%; p=0.003). For complete resolution of nocturnal regurgitation, rabeprazole proved to be significantly better when compared to omeprazole/esomeprazole (31.25% vs. 0%; p=0.015) in elderly patients (Table 1).

Conclusion

The interim results showed that rabeprazole led to significantly higher complete-resolution rates of diurnal and nocturnal regurgitation at 4±1 weeks of treatment than omeprazole/esomeprazole in adults with severe eGERD. In elderly patients, rabeprazole showed significant resolution over pantoprazole.

Disclosure

Study funded by: Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India

Introduction

Hypergastrinemia, caused by chronic atrophic gastritis or Helicobacter pylori (H. pylori) associated pangastritis, is associated with an increased risk of non-cardia gastric cancer. Recent studies have also found an increased risk of gastric cancer in long-term proton pump inhibitor (PPI) users. Patients with chronic atrophic gastritis also have an increased risk of neuroendocrine neoplasms (NEN) due to hypergastrinemia. However, whether long-term PPI use increases the risk of gastric NEN has not been assessed in the general population.

Aims & Methods

The aim of the present study was to assess the risk of gastric NEN among long-term PPI users in a multinational population-based study from the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden). The study was based on the Nordic Gastric and Esophageal Tumor Study (NordGETS), which is a population-based multinational sex, age, calendar year, and country matched case-control study including all adults (≥18 years of age) with a diagnosis of gastric or esophageal tumor in the Nordic countries. In the present study, the cases were incident gastric NEN identified in the cancer registries and the exposure was long-term use of PPI categorised into three equal-sized groups (tertiles) of defined daily doses (DDDs) from the medication registries of the Nordic countries between 1996 and 2020. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for chronic atrophic gastritis, NEN in the duodenum or pancreas, and H. pylori infection identified in the patient registries and medication registries.

Results

In total, 1,790 gastric NEN case patients were compared to 17,897 control participants. After a one-year run-in period, the median follow-up was 11.8 years. The risk of incident gastric NEN increased in PPI users compared to non-users in a dose-dependent manner. The adjusted OR for incident gastric NEN was 1.83 (95% CI 1.56 to 2.15) in the highest tertile of PPI use (>385 DDDs, entire drug history) compared to no PPI use (Table). The risk was higher in the younger age group (<65 years) than the older age group (≥65 years) and the estimates were consistent when excluding individuals with chronic atrophic gastritis, other NENs, and H. pylori.

Conclusion

In this population-based study from the five Nordic countries the risk of gastric NEN was increased in PPI users compared to non-users of PPI in a seemingly dose-dependent manner. The risk was higher in younger age groups of PPI users compared to older age groups.

Disclosure

No conflicts of interest

Introduction

Constipation is one the most common gastrointestinal disorders among women. Causing factors are various. We aimed to assess the role of colonoscopy in evaluation young women with constipation.

Aims & Methods

A multi-center, large cohort, cross-sectional, retrospective study included all colonoscopies performed between 2016 and 2021 in seven endoscopy departments. The indications and findings of the procedures were collected, findings of young women aged 40y and younger with constipation as indication were compared to older women.

Results

A total cohort of 377,795 patients, 198,629 (52.6%) females and 179,166 (47.4%) males. 7872 females underwent colonoscopy for constipation and other indications (Cohort 1). 6852 women referred to colonoscopy for constipation only (Cohort 2). Women younger than 50y had more associated symptoms than older women. 75% of colonoscopies in women < 40y were normal in both cohorts. In Cohort 1, Inflammatory bowel diseases (IBD) was significantly higher in young women <40y, Ulcerative Colitis (UC) 12(1.2%) and Crohn's 7(0.7%) p<0.001. In Cohort 2, among women <40y, UC was found in 6(0.7%) p= 0.01, Crohn's in 2(0.2%) p=0.05. In both cohorts, diverticulosis and polyps rates exponentially increased with age. The increase was remarkably noticed at ages >40y in comparison to younger subjects 18-39y, p<0.001. In Cohort 1, diverticulosis and polyps rates among young women <40y was 0.5% and 7.4% respectively. In Cohort 2 diverticulosis rate 0.4% and polyps 8%. One case (0.1%) of Colorectal cancer (CRC) in <40 y women and 0.3% in women aged 40-49y. In Comparison between two genders: Cohort 1 Similar prevalence of IBD found in males and females in all ages, (UC p=0.94, Crohn's p=0.67). Higher rate of diverticulosis among males in all ages p<0.05. Higher rate of polyps in all ages including young males <40y, p=0.001. In Cohort 2 no significant difference in the prevalence of IBD (p>0.05), diverticulosis rate (p=0.15), polyps rate (p= 0.34) and CRC rate (p=0.5) among young pts<40y of both genders.

Conclusion

The yield of colonoscopy in investigation isolated constipation in young females < 40y is not of a considerable diagnostic value. Clinical understanding should guide each case manager by using the correct beneficial diagnostic tools avoiding unnecessary invasive procedures.