The Experts below are selected from a list of 42 Experts worldwide ranked by ideXlab platform
Scott H Stewart - One of the best experts on this subject based on the ideXlab platform.
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stress ulcer prophylaxis for general medical patients a review of the evidence
Journal of Hospital Medicine, 2007Co-Authors: Todd Janicki, Scott H StewartAbstract:BACKGROUND: Gastric stress ulceration and bleeding are common occurrences in the critically ill and prophylactic acid-suppression is used almost universally in this population. Evidence suggests that general medical patients hospitalized outside of the intensive care unit often receive similar therapy. PURPOSE: To determine how frequently general medical patients are prescribed stress ulcer prophylaxis and what evidence exists for doing so. DATA SOURCE: The MEDLINE database (1966 to October 2005), the Cochrane Central Register of Controlled Trials (4th Quarter 2005), and the bibliographies of selected articles. STUDY SELECTION: Studies that contained significant data about either the frequency of use of stress ulcer prophylaxis in general medical patients or gastrointestinal bleeding outcomes in patients given prophylaxis. DATA EXTRACTION: The primary author extracted prevalence and outcome data. DATA SYNTHESIS: Descriptive studies suggest that 20-25% of general medical patients receive acid suppression for stress ulcer prophylaxis in the absence of presumed (but not established) risk factors for bleeding. Only two randomized, controlled trials evaluated the effects of prophylaxis in this population. The first found a reduction in clinically significant gastrointestinal bleeding from 6% (3 of 48) with placebo to zero (n = 52) with Magaldrate. The second found a reduction in clinically significant bleeding from 3% (2 of 70) with sucralfate to zero (n = 74) with cimetidine. CONCLUSION: A significant number of general medical patients are prescribed acid-suppressive therapy for stress ulcer prophylaxis. The literature provides only sparse guidance on this issue with two randomized trials showing a possible benefit for prophylaxis. Further study is needed.
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stress ulcer prophylaxis for general medical patients a review of the evidence
Journal of Hospital Medicine, 2007Co-Authors: Todd Janicki, Scott H StewartAbstract:BACKGROUND: Gastric stress ulceration and bleeding are common occurrences in the critically ill and prophylactic acid-suppression is used almost universally in this population. Evidence suggests that general medical patients hospitalized outside of the intensive care unit often receive similar therapy. PURPOSE: To determine how frequently general medical patients are prescribed stress ulcer prophylaxis and what evidence exists for doing so. DATA SOURCE: The MEDLINE database (1966 to October 2005), the Cochrane Central Register of Controlled Trials (4th Quarter 2005), and the bibliographies of selected articles. STUDY SELECTION: Studies that contained significant data about either the frequency of use of stress ulcer prophylaxis in general medical patients or gastrointestinal bleeding outcomes in patients given prophylaxis. DATA EXTRACTION: The primary author extracted prevalence and outcome data. DATA SYNTHESIS: Descriptive studies suggest that 20-25% of general medical patients receive acid suppression for stress ulcer prophylaxis in the absence of presumed (but not established) risk factors for bleeding. Only two randomized, controlled trials evaluated the effects of prophylaxis in this population. The first found a reduction in clinically significant gastrointestinal bleeding from 6% (3 of 48) with placebo to zero (n = 52) with Magaldrate. The second found a reduction in clinically significant bleeding from 3% (2 of 70) with sucralfate to zero (n = 74) with cimetidine. CONCLUSION: A significant number of general medical patients are prescribed acid-suppressive therapy for stress ulcer prophylaxis. The literature provides only sparse guidance on this issue with two randomized trials showing a possible benefit for prophylaxis. Further study is needed.
Todd Janicki - One of the best experts on this subject based on the ideXlab platform.
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stress ulcer prophylaxis for general medical patients a review of the evidence
Journal of Hospital Medicine, 2007Co-Authors: Todd Janicki, Scott H StewartAbstract:BACKGROUND: Gastric stress ulceration and bleeding are common occurrences in the critically ill and prophylactic acid-suppression is used almost universally in this population. Evidence suggests that general medical patients hospitalized outside of the intensive care unit often receive similar therapy. PURPOSE: To determine how frequently general medical patients are prescribed stress ulcer prophylaxis and what evidence exists for doing so. DATA SOURCE: The MEDLINE database (1966 to October 2005), the Cochrane Central Register of Controlled Trials (4th Quarter 2005), and the bibliographies of selected articles. STUDY SELECTION: Studies that contained significant data about either the frequency of use of stress ulcer prophylaxis in general medical patients or gastrointestinal bleeding outcomes in patients given prophylaxis. DATA EXTRACTION: The primary author extracted prevalence and outcome data. DATA SYNTHESIS: Descriptive studies suggest that 20-25% of general medical patients receive acid suppression for stress ulcer prophylaxis in the absence of presumed (but not established) risk factors for bleeding. Only two randomized, controlled trials evaluated the effects of prophylaxis in this population. The first found a reduction in clinically significant gastrointestinal bleeding from 6% (3 of 48) with placebo to zero (n = 52) with Magaldrate. The second found a reduction in clinically significant bleeding from 3% (2 of 70) with sucralfate to zero (n = 74) with cimetidine. CONCLUSION: A significant number of general medical patients are prescribed acid-suppressive therapy for stress ulcer prophylaxis. The literature provides only sparse guidance on this issue with two randomized trials showing a possible benefit for prophylaxis. Further study is needed.
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stress ulcer prophylaxis for general medical patients a review of the evidence
Journal of Hospital Medicine, 2007Co-Authors: Todd Janicki, Scott H StewartAbstract:BACKGROUND: Gastric stress ulceration and bleeding are common occurrences in the critically ill and prophylactic acid-suppression is used almost universally in this population. Evidence suggests that general medical patients hospitalized outside of the intensive care unit often receive similar therapy. PURPOSE: To determine how frequently general medical patients are prescribed stress ulcer prophylaxis and what evidence exists for doing so. DATA SOURCE: The MEDLINE database (1966 to October 2005), the Cochrane Central Register of Controlled Trials (4th Quarter 2005), and the bibliographies of selected articles. STUDY SELECTION: Studies that contained significant data about either the frequency of use of stress ulcer prophylaxis in general medical patients or gastrointestinal bleeding outcomes in patients given prophylaxis. DATA EXTRACTION: The primary author extracted prevalence and outcome data. DATA SYNTHESIS: Descriptive studies suggest that 20-25% of general medical patients receive acid suppression for stress ulcer prophylaxis in the absence of presumed (but not established) risk factors for bleeding. Only two randomized, controlled trials evaluated the effects of prophylaxis in this population. The first found a reduction in clinically significant gastrointestinal bleeding from 6% (3 of 48) with placebo to zero (n = 52) with Magaldrate. The second found a reduction in clinically significant bleeding from 3% (2 of 70) with sucralfate to zero (n = 74) with cimetidine. CONCLUSION: A significant number of general medical patients are prescribed acid-suppressive therapy for stress ulcer prophylaxis. The literature provides only sparse guidance on this issue with two randomized trials showing a possible benefit for prophylaxis. Further study is needed.
Camille Finck - One of the best experts on this subject based on the ideXlab platform.
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the management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms a contemporary review
Clinical Otolaryngology, 2019Co-Authors: Jerome R Lechien, Vinciane Muls, Pierre Eisendrath, Giovanni Dapri, Francois Mouawad, Antonio Schindler, A Nacci, Maria Rosaria Barillari, Camille FinckAbstract:Objective To summarise current knowledge about the prevalence, aetiology and management of recalcitrant laryngopharyngeal reflux (LPR) patients-those who do not respond to anti-reflux medical treatment. Methods A literature search was conducted following the PRISMA guidelines to identify studies that reported success of anti-reflux medical treatment with emphasis on studies that attempted to be rigorous in defining a population of LPR patients and which subsequently explored the characteristics of non-responder patients (ie aetiology of resistance; differential diagnoses; management and treatment). Three investigators screened publications for eligibility from PubMED, Cochrane Library and Scopus and excluded studies based on predetermined criteria. Design, diagnostic method, exclusion criteria, treatment characteristics, follow-up and quality of outcome assessment were evaluated. Results Of the 139 articles screened, 45 met the inclusion criteria. The definition of non-responder patients varied substantially from one study to another and often did not include laryngopharyngeal signs. The reported success rate of conventional therapeutic trials ranged from 17% to 87% and depended on diagnostic criteria, treatment scheme, definition of treatment failure and treatment outcomes that varied substantially between studies. The management of non-responders differed between studies with a few differential diagnoses reported. No study considered the profile of reflux (acidic, weakly acid, non-acid or mixed) or addressed personalised treatment with the addition of alginate or Magaldrate, low acid diet, or other interventions that have emerging evidence of efficacy. Conclusion To date, there is no standardised management of LPR patients who do not respond to traditional treatment approached. A diagnostic and therapeutic algorithm is proposed to improve the management of these patients. Future studies will be necessary to confirm the efficacy of this algorithm through large cohort studies of non-responder LPR patients. Level of evidence 2a.
Jerome R Lechien - One of the best experts on this subject based on the ideXlab platform.
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gastroesophageal reflux in laryngopharyngeal reflux patients clinical features and therapeutic response
Laryngoscope, 2020Co-Authors: Jerome R Lechien, Francois Bobin, Vinciane Muls, Pierre Eisendrath, Mihaela Horoi, Marie Paule Thill, Didier Dequanter, Jeanpierre Durdurez, Alexandra Rodriguez, Sven SaussezAbstract:OBJECTIVE To investigate the clinical features and the therapeutic response of laryngopharyngeal reflux (LPR) patients with or without gastroesophageal reflux disease (GERD). METHODS Patients with LPR symptoms were enrolled from three European Hospitals. The diagnosis of LPR and GERD was made through impedance-pH monitoring (MII-pH). A gastrointestinal endoscopy was realized in patients with digestive complaints or ≥60 years old. The 3- to 6-month treatment was based on the association of diet, pantoprazole, alginate, and Magaldrate regarding the MII-pH characteristics. Reflux Symptom Score (RSS) and Reflux Sign Assessment (RSA) were used to evaluate the clinical evolution throughout treatment. The gastrointestinal endoscopy findings, clinical features, and therapeutic response were compared between patients with LPR and GERD (LPR/GERD) and patients with LPR. RESULTS One hundred and eleven LPR patients were included, 54 being LPR/GERD. LPR/GERD patients had a higher number of proximal reflux episodes compared with LPR patients. The prevalence of esophagitis, hernia hiatal, and lower esophageal sphincter insufficiency did not differ between groups. The presence of GERD was strongly associated with acid LPR. Patients without GERD had a higher proportion of nonacid and mixed LPR compared with LPR/GERD patients. The pre- to posttreatment evolutions of RSS and RSA were quite similar in both groups, with the exception of the 3- to 6-month improvement of digestive symptoms, which was better in LPR/GERD group. The therapeutic success rates were 79.6% and 77.2% in GERD/LPR and LPR group, respectively. CONCLUSION GERD is predictive of acid LPR. The clinical evolution and the therapeutic response rates were quite similar in both groups. LEVEL OF EVIDENCE 4 Laryngoscope, 130: E479-E489, 2020.
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patients with acid high fat and low protein diet have higher laryngopharyngeal reflux episodes at the impedance ph monitoring
European Archives of Oto-rhino-laryngology, 2020Co-Authors: Jerome R Lechien, Francois Bobin, Vinciane Muls, Mihaela Horoi, Marie Paule Thill, Didier Dequanter, Alexandra Rodriguez, Sven SaussezAbstract:Objective To assess the impact of diet on the occurrence of proximal reflux episodes at the multichannel intraluminal impedance-pH monitoring (MII-pH) in patients with laryngopharyngeal reflux (LPR). Methods Patients with LPR symptoms and findings were recruited from three European hospitals. The LPR diagnostic was confirmed through MII-pH and patients were benefited from gastrointestinal (GI) endoscopy. Regarding the types of reflux at the MII-pH (acid, nonacid, mixed), patients received a 3 month-therapy based on the association of alkaline, low-fat and high-protein diet, proton pump inhibitors, alginate or Magaldrate. Reflux symptom score (RSS) and reflux sign assessment (RSA) were used to evaluate laryngeal and extra-laryngeal symptoms and findings from pretreatment to posttreatment. The Global Refluxogenic Score (GRES) was used to assess the refluxogenic potential of the diet of the patients at baseline and posttreatment. The relationship between GRES severity; the MII-pH findings; GI endoscopy; and the therapeutic response was explored through multiple linear regression. Results Eighty-five LPR patients were included. The mean GRES significantly improved from pretreatment (50.7 ± 23.8) to posttreatment (27.3 ± 23.2; P = 0.001). Similarly, RSS and RSA significantly improved from baseline to posttreatment. The baseline GRES was significantly associated with the occurrence of proximal reflux episodes at the MII-pH (P = 0.001). Trends were found regarding the association between GRES and the occurrence of esophagitis (P = 0.06) and between hiatal hernia and DeMeester score (P = 0.06). There was a significant and strong association between the concomitant respect of diet and medication and the improvement of RSS (P = 0.001). Conclusion The consumption of high-fat, low-protein, high-sugar, acid foods, and beverages is associated with a higher number of proximal reflux episodes at the MII-pH, according to the global refluxogenic score of LPR patients.
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the management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms a contemporary review
Clinical Otolaryngology, 2019Co-Authors: Jerome R Lechien, Vinciane Muls, Pierre Eisendrath, Giovanni Dapri, Francois Mouawad, Antonio Schindler, A Nacci, Maria Rosaria Barillari, Camille FinckAbstract:Objective To summarise current knowledge about the prevalence, aetiology and management of recalcitrant laryngopharyngeal reflux (LPR) patients-those who do not respond to anti-reflux medical treatment. Methods A literature search was conducted following the PRISMA guidelines to identify studies that reported success of anti-reflux medical treatment with emphasis on studies that attempted to be rigorous in defining a population of LPR patients and which subsequently explored the characteristics of non-responder patients (ie aetiology of resistance; differential diagnoses; management and treatment). Three investigators screened publications for eligibility from PubMED, Cochrane Library and Scopus and excluded studies based on predetermined criteria. Design, diagnostic method, exclusion criteria, treatment characteristics, follow-up and quality of outcome assessment were evaluated. Results Of the 139 articles screened, 45 met the inclusion criteria. The definition of non-responder patients varied substantially from one study to another and often did not include laryngopharyngeal signs. The reported success rate of conventional therapeutic trials ranged from 17% to 87% and depended on diagnostic criteria, treatment scheme, definition of treatment failure and treatment outcomes that varied substantially between studies. The management of non-responders differed between studies with a few differential diagnoses reported. No study considered the profile of reflux (acidic, weakly acid, non-acid or mixed) or addressed personalised treatment with the addition of alginate or Magaldrate, low acid diet, or other interventions that have emerging evidence of efficacy. Conclusion To date, there is no standardised management of LPR patients who do not respond to traditional treatment approached. A diagnostic and therapeutic algorithm is proposed to improve the management of these patients. Future studies will be necessary to confirm the efficacy of this algorithm through large cohort studies of non-responder LPR patients. Level of evidence 2a.
Sven Saussez - One of the best experts on this subject based on the ideXlab platform.
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gastroesophageal reflux in laryngopharyngeal reflux patients clinical features and therapeutic response
Laryngoscope, 2020Co-Authors: Jerome R Lechien, Francois Bobin, Vinciane Muls, Pierre Eisendrath, Mihaela Horoi, Marie Paule Thill, Didier Dequanter, Jeanpierre Durdurez, Alexandra Rodriguez, Sven SaussezAbstract:OBJECTIVE To investigate the clinical features and the therapeutic response of laryngopharyngeal reflux (LPR) patients with or without gastroesophageal reflux disease (GERD). METHODS Patients with LPR symptoms were enrolled from three European Hospitals. The diagnosis of LPR and GERD was made through impedance-pH monitoring (MII-pH). A gastrointestinal endoscopy was realized in patients with digestive complaints or ≥60 years old. The 3- to 6-month treatment was based on the association of diet, pantoprazole, alginate, and Magaldrate regarding the MII-pH characteristics. Reflux Symptom Score (RSS) and Reflux Sign Assessment (RSA) were used to evaluate the clinical evolution throughout treatment. The gastrointestinal endoscopy findings, clinical features, and therapeutic response were compared between patients with LPR and GERD (LPR/GERD) and patients with LPR. RESULTS One hundred and eleven LPR patients were included, 54 being LPR/GERD. LPR/GERD patients had a higher number of proximal reflux episodes compared with LPR patients. The prevalence of esophagitis, hernia hiatal, and lower esophageal sphincter insufficiency did not differ between groups. The presence of GERD was strongly associated with acid LPR. Patients without GERD had a higher proportion of nonacid and mixed LPR compared with LPR/GERD patients. The pre- to posttreatment evolutions of RSS and RSA were quite similar in both groups, with the exception of the 3- to 6-month improvement of digestive symptoms, which was better in LPR/GERD group. The therapeutic success rates were 79.6% and 77.2% in GERD/LPR and LPR group, respectively. CONCLUSION GERD is predictive of acid LPR. The clinical evolution and the therapeutic response rates were quite similar in both groups. LEVEL OF EVIDENCE 4 Laryngoscope, 130: E479-E489, 2020.
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patients with acid high fat and low protein diet have higher laryngopharyngeal reflux episodes at the impedance ph monitoring
European Archives of Oto-rhino-laryngology, 2020Co-Authors: Jerome R Lechien, Francois Bobin, Vinciane Muls, Mihaela Horoi, Marie Paule Thill, Didier Dequanter, Alexandra Rodriguez, Sven SaussezAbstract:Objective To assess the impact of diet on the occurrence of proximal reflux episodes at the multichannel intraluminal impedance-pH monitoring (MII-pH) in patients with laryngopharyngeal reflux (LPR). Methods Patients with LPR symptoms and findings were recruited from three European hospitals. The LPR diagnostic was confirmed through MII-pH and patients were benefited from gastrointestinal (GI) endoscopy. Regarding the types of reflux at the MII-pH (acid, nonacid, mixed), patients received a 3 month-therapy based on the association of alkaline, low-fat and high-protein diet, proton pump inhibitors, alginate or Magaldrate. Reflux symptom score (RSS) and reflux sign assessment (RSA) were used to evaluate laryngeal and extra-laryngeal symptoms and findings from pretreatment to posttreatment. The Global Refluxogenic Score (GRES) was used to assess the refluxogenic potential of the diet of the patients at baseline and posttreatment. The relationship between GRES severity; the MII-pH findings; GI endoscopy; and the therapeutic response was explored through multiple linear regression. Results Eighty-five LPR patients were included. The mean GRES significantly improved from pretreatment (50.7 ± 23.8) to posttreatment (27.3 ± 23.2; P = 0.001). Similarly, RSS and RSA significantly improved from baseline to posttreatment. The baseline GRES was significantly associated with the occurrence of proximal reflux episodes at the MII-pH (P = 0.001). Trends were found regarding the association between GRES and the occurrence of esophagitis (P = 0.06) and between hiatal hernia and DeMeester score (P = 0.06). There was a significant and strong association between the concomitant respect of diet and medication and the improvement of RSS (P = 0.001). Conclusion The consumption of high-fat, low-protein, high-sugar, acid foods, and beverages is associated with a higher number of proximal reflux episodes at the MII-pH, according to the global refluxogenic score of LPR patients.
