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R T Jensen - One of the best experts on this subject based on the ideXlab platform.
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effect of long term gastric acid suppressive therapy on serum vitamin b12 levels in patients with zollinger ellison syndrome
The American Journal of Medicine, 1998Co-Authors: B Termanini, Fathia Gibril, V E Sutliff, Fang Yu, David Venzon, R T JensenAbstract:Abstract Background and aims: Long-term treatment with H + -K + -adenotriphosphatase (ATPase) inhibitors, such as omeprazole or lansoprazole, for severe gastroesophageal reflux disease is now widely used. Whether such treatment will result in vitamin B 12 deficiency is controversial. We studied whether long-term treatment with omeprazole alters serum vitamin B 12 levels in patients with Zollinger-Ellison syndrome. Methods: In 131 consecutive patients treated with either omeprazole (n = 111) or histamine H 2 -receptor antagonists (n = 20), serum vitamin B 12 and folate levels and complete blood counts were determined after acid secretion had been controlled for at least 6 months. These studies were repeated yearly. Serum vitamin B 12 and folate levels were correlated with the type of antisecretory drug and the extent of inhibition of acid secretion. Results: The mean duration of omeprazole treatment was 4.5 years, and for H 2 -receptor antagonists 10 years. Vitamin B 12 levels, but not serum folate levels or any hematological parameter, were significantly ( P = 0.03) lower in patients treated with omeprazole, especially those with omeprazole-induced sustained hyposecretion ( P = 0.0014) or complete Achlorhydria ( P 12 levels decreased significantly (30%; P = 0.001) only in patients rendered achlorhydric. The duration of omeprazole treatment was inversely correlated with vitamin B 12 levels ( P = 0.013), but not folate levels. Eight patients (6%) developed subnormal B 12 levels during follow-up. Conclusions: Long-term omeprazole treatment leads to significant decreases in serum vitamin B 12 but not folate levels. These results suggest patients with Zollinger-Ellison syndrome treated with H + -K + -ATPase inhibitors should have serum vitamin B 12 levels monitored. Furthermore, these results raise the possibility that other patients treated chronically with H + -K + -ATPase inhibitors may develop B 12 deficiency.
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gastric antisecretory drug induced Achlorhydria causes decreases in serum vitamin b12 levels in patients with zollinger ellison syndrome zes a prospective study
Gastroenterology, 1998Co-Authors: Jose Serrano, Fathia Gibril, Stephan U Goebel, R T JensenAbstract:Markedly decreased acid secretion is known to decrease vitamin B~2 absorption. However, it is controversial whether prolonged treatment with potent gastric antisecretory drugs will caused decreased serum vitamin Btz levels (Bt2 levels). This could be a potentially important problem in conditions such as GERD or ZES, requiring continuous long-term treatment. In a previous study we reported that B~z levels, but not serum folate levels, determined at one time correlated inversely with the length of omeprazole treatment in patients with ZES. In the present study to provide insights into the possible effects of long-term acid suppression on B~2 levels in a given patient, we have analyzed sequential results from 68 patients with ZES who were followed for at least 5 years. Patients had yearly B~ levels and determinations of acid secretory control taken one hour before the next dose of antisecretory drug. The mean age of the patients was 55 ± 1 yrs, there were 22 females and 46 males, and the total duration of gastric antisecretory treatment was 14 _+0.5 yrs. Fifty-two patients were being treated with omeprazole (mean time ± 1SEM=5 ± 1 yrs) and 17 patients with histamine Hz inhibitors. The mean initial B~2 level was 439 ± 21 pg/ml (normal=165-1000 pg/ml) and the last Ba2 level, a mean of 6.3 ± 1.2 yrs later, was 427 ± 21 pg/ml, was not significantly different. The patients had a mean basal acid output of 25 ± 2 mEq/h and M An of 54-+ 4 mEq/h. The patients' acid secretory rate on antisecretory drug for each of the last 5 years was reviewed and 21/68 (30%) had complete Achlorhydria defined as no basal acid secretion during each of the last 3 years. The B~ levels over the 6.3 ± 1.1 yrs from the first to the last Bl~ level in the achlorhydric patients showed a highly significant (p=0.001) decrease from 419 _+ 38 to 305 ± 24 pg/ml. In contrast, for the 47 patients without complete Achlorhydria over a 6.3 ± 1.2 year period of antisecretory drug treatment, the B~2 levels did not change significantly (447 ± 26 vs 480 ± 35 pg/ml). A significantly higher proportion (p=0.002) [18/21 (86%)] of patients with complete Achlorhydria had a decrease in their B~2 levels over this time period compared to the patients without Achlorhydria [22/47 (47%)]. These results demonstrate that profound acid inhibition, which occurs in 32% of patients with ZES, lead to a highly significant decrease in serum vitamin levels over a 6-year period. In other studies > 80% of patients with GERD treated long-term with potent antisecretory drugs also have such acid hyposecretion that hypergastrinemia develops. These results suggest that in patients with such conditions as ZES or GERD undergoing prolonged daily treatment with potent gastric acid suppressants such as omeprazole or lansoprazole, routine monitoring of B~2 levels should be considered.
David C Metz - One of the best experts on this subject based on the ideXlab platform.
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risk of community acquired pneumonia in patients with a diagnosis of pernicious anemia a population based retrospective cohort study
European Journal of Gastroenterology & Hepatology, 2015Co-Authors: Christopher V Almario, David C Metz, Kevin Haynes, Yuxiao YangAbstract:Objective Pernicious anemia (PA) is an autoimmune disease that causes Achlorhydria or profound hypochlorhydria. We conducted a population-based study to determine whether individuals with PA are at an increased risk for community-acquired pneumonia (CAP). Methods We performed a retrospective cohort study using The Health Improvement Network (THIN) from the UK (1993-2009). The eligible study cohort included individuals 18 years of age or older, with at least 1 year of THIN follow-up. The exposed group consisted of individuals with a diagnosis code for PA. The unexposed group consisted of individuals without a diagnosis of PA and was frequency matched with the exposed group with respect to age, sex, and practice site. Cox regression analysis was used to determine the hazard ratio with the 95% confidence interval for CAP associated with PA, accounting for a comprehensive list of potential confounders. Results The study included 13,605 individuals with PA and 50,586 non-PA individuals. The crude incidence rate of CAP was 9.4/1000 person-years for those with PA, versus 6.4/1000 person-years for those without PA. The multivariable adjusted hazard ratio for CAP associated with PA was 1.18 (95% confidence interval 1.08-1.29). Conclusion In this large population-based cohort study, individuals with PA and presumed chronic Achlorhydria were at an increased risk for CAP.
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hypochlorhydria and Achlorhydria are associated with false positive secretin stimulation testing for zollinger ellison syndrome
Pancreas, 2013Co-Authors: Pari Shah, Yuxiao Yang, Maneesh H Singh, David C MetzAbstract:ObjectivesSecretin stimulation testing (SST) is used to evaluate patients with hypergastrinemia in the diagnosis of Zollinger-Ellison syndrome. Case series have documented false-positive SST in patients with Achlorhydria. This study reviews our experience with SST in hypochlorhydric and achlorhydric
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hip fracture risk in patients with a diagnosis of pernicious anemia
Gastroenterology, 2010Co-Authors: Nathan Merriman, Mary E Putt, David C Metz, Yuxiao YangAbstract:Background & Aims Pernicious anemia (PA) is characterized by vitamin B-12 deficiency and Achlorhydria, both of which have a detrimental effect on bone strength. The principle aim of this study was to determine the risk of hip fracture in patients with PA. Methods This is a retrospective cohort study using the General Practice Research Database (GPRD) from the United Kingdom. GPRD data from May 1987 until April 2002 were utilized to identify patients between 40 and 90 years of age at the time of GPRD enrollment. The exposed group contained patients with a diagnosis of PA being treated with vitamin B-12 therapy. We matched each patient having a diagnosis of PA with 4 randomly selected non-PA patients with respect to age (±1 year) and sex. Cox regression analysis was used to determine the hazard ratio (HR) for hip fracture associated with PA. Results Nine thousand five hundred six patients with a diagnosis of PA receiving vitamin B-12 injection therapy were identified and compared to 38,024 controls. Patients with PA had a greater risk of hip fracture than the controls (HR = 1.74; 95% CI: 1.45−2.08). The increase in hip fracture risk was even more pronounced among those patients newly diagnosed with PA during GPRD follow-up (HR = 2.63; 95% CI: 2.03−3.41). Conclusions Patients with a diagnosis of PA have an elevated risk of hip fracture. The increased hip fracture risk was persistent even years after vitamin B-12 therapy. Chronic Achlorhydria could be the mechanism contributing to the persistently elevated hip fracture risk.
Mark D Pritchard - One of the best experts on this subject based on the ideXlab platform.
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netazepide a gastrin cholecystokinin 2 receptor antagonist can eradicate gastric neuroendocrine tumours in patients with autoimmune chronic atrophic gastritis
British Journal of Clinical Pharmacology, 2017Co-Authors: Malcolm Boyce, H L Waldum, Andrea Varro, Andrew R Moore, Liv Sagatun, Bryony N Parsons, Fiona Campbell, Reidar Fossmark, Mark D PritchardAbstract:Netazepide, a gastrin/CCK2 receptor antagonist, once daily for 12 weeks reduced the number of tumours and size of the largest one in 16 patients with autoimmune chronic atrophic gastritis (CAG), Achlorhydria, hypergastrinaemia and multiple gastric neuroendocrine tumours (type 1 gastric NETs), and normalised circulating chromogranin A (CgA) produced by enterochromaffin-like cells, the source of the tumours. The aim was to assess whether longer-term netazepide treatment can eradicate type 1 gastric NETs.After a mean 14 months off netazepide, 13 of the 16 patients took it for another 52 weeks. Assessments were: gastroscopy; gene-transcript expression in corpus biopsies using qPCR; blood CgA and gastrin concentrations; and safety assessments.While off-treatment, the number of tumours, the size of the largest one, and CgA all increased again. Netazepide for 52 weeks: cleared all tumours in 5 patients; cleared all but one tumour in one patient; reduced the number of tumours and size of the largest one in the other patients; normalised CgA in all patients; and reduced mRNA abundances of CgA and histidine decarboxylase in biopsies. Gastrin did not increase further, confirming that the patients had Achlorhydria. Netazepide was safe and well tolerated.A gastrin/CCK2 receptor antagonist is a potential medical and targeted treatment for type 1 gastric NETs, and an alternative to regular gastroscopy or surgery. Treatment should be continuous because the tumours will regrow if it is stopped. Progress can be monitored by CgA in blood or biomarkers in mucosal biopsies. This article is protected by copyright. All rights reserved.
Naoki Yamanaka - One of the best experts on this subject based on the ideXlab platform.
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watery diarrhea hypokalemia and Achlorhydria syndrome due to an adrenal pheochromocytoma
World Journal of Gastroenterology, 2007Co-Authors: Shinichi Ikuta, Chiaki Yasui, Masahiro Kawanaka, Tsukasa Aihara, Hidenori Yoshie, Hidenori Yanagi, Masao Mitsunobu, Ayako Sugihara, Naoki YamanakaAbstract:Watery diarrhea, hypokalemia and Achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP) -producing tumor only rarely occurs in patients with nonpancreatic disease. A 49-year-old woman was referred for evaluation of a right adrenal tumor incidentally diagnosed by abdominal ultrasound during the investigation of chronic watery diarrhea. Laboratory findings showed hypokalemia and excessive production of VIP and catecholamines. After surgical resection of the tumor, diarrhea subsided and both electrolytes and affected hormone levels normalized. Immunohistochemical examination confirmed a diagnosis of pheochromocytoma, which contained VIP-positive ganglion-like cells. We herein present the clinical and histogenetic implications of this rare clinical entity, with literature review.
Basil I Hirschowitz - One of the best experts on this subject based on the ideXlab platform.
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rapid regression of enterochromaffinlike cell gastric carcinoids in pernicious anemia after antrectomy
Gastroenterology, 1992Co-Authors: Basil I Hirschowitz, James L Griffith, David Pellegrin, Oscar W CummingsAbstract:In rats, hypergastrinemia due to Achlorhydria produced by antisecretory drugs or resection of the gastric fundus leads to enterochromaffinlike (ECL) cell hyperplasia and gastric carcinoids. In humans, Achlorhydria due to pernicious anemia may also lead to ECL cell hyperplasia and multicentric gastric carcinoids in as many as 5% of cases. To examine the apparent gastrin dependence of gastric ECL carcinoids, three patients were studied (2 men aged 59 and 73 years; 1 woman aged 45 years) who had pernicious anemia, serum gastrin concentrations of greater than 1000 ng/L (greater than 1000 pg/mL), and multicentric gastric carcinoids. Antrectomy resulted in normalization of serum gastrin levels within 8 hours and disappearance of carcinoids in 6-16 weeks. In each of the three patients, a focus of microcarcinoid was found at 12-18 months. Further follow-up in each of the three patients 21-30 months after antrectomy again showed no carcinoids or ECL cell hyperplasia. It is concluded that multicentric ECL gastric carcinoids in patients with pernicious anemia and Achlorhydria appear to be gastrin dependent and disappear after normalization of serum gastrin by antrectomy. Antrectomy rather than total gastrectomy may be the most appropriate treatment for this condition.
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development of sustained Achlorhydria in a patient with the zollinger ellison syndrome treated with omeprazole
Gastroenterology, 1991Co-Authors: James L Griffith, Oscar W Cummings, Basil I HirschowitzAbstract:Abstract Spontaneous remission of gastric acid hypersecretion in the Zollinger-Ellison syndrome occurs rarely. This study shows the development of gastric secretory mucosal atrophy resulting in Achlorhydria and loss of pepsin secretion in a 63-year-old woman with the Zollinger-Ellison syndrome. Reduced secretion began soon after starting treatment with omeprazole, and Achlorhydria became complete 6 months later. The patient remains well with normal endoscopy results and is achlorhydric 4 years after the start of treatment and 34 months after stopping omeprazole. She was not colonized with Helicobacter pylori until 36 months after developing Achlorhydria. Serum gastrin has increased from 1000 to between 5000 and 12,500 ng/L (pg/mL), was not suppressible by gastric acidification, and was not associated with G-cell hyperplasia. She also has a normal Schilling test and normal immunoglobulins, and lacks antibodies to parietal cells or H + ,K + -ATPase. Moderate enterochromaffinlike cell hyperplasia is apparent for the first time on the latest biopsy sample.
