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| 1 | One fifth of hospitalizations for peptic ulcer-related bleeding are potentially preventable显示文摘AIM:To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease(PUD),erosive gastritis(EG)or duodenitis(ED).METHODS:Retrospective cohort study using ICD-10codes to identify all patients with upper gastrointestinal hemorrhage secondary to endoscopically proven PUD,EG or ED during the period from March 2007 to October 2010 in three major metropolitan hospitals in Melbourne,Australia.Patients were divided into'high risk'(those who would benefit from gastroprotection)and'not high risk'groups as defined by established guidelines.Mean Rockall score,transfusion requirement,length of stay,rebleeding rates,need for surgery and in-hospital mortality was compared between'high risk'and'not high risk'groups.Within the'high risk'group,those on gastroprotection and those with no gastroprotection were also compared.RESULTS:Five hundred and seven patients were included for analysis of which 174 were classified as high risk.Median values of complete Rockall Score(5vs 4,P=0.002)and length of stay(5 d vs 4 d,P=0.04)were higher in the high risk group but in-hospital mortality was lower(0.6%vs 3.9%,P=0.03).130out of the 174 patients in the high risk group were not taking recommended gastroprotective therapy prior to hospitalization.Past history of PUD(OR=3.7,P=0.006)and clopidogrel use(OR=3.2,P=0.007)significantly predicted prescription of gastroprotective therapy.Using proton pump inhibitor protection rates of 50%-85%from published studies,an estimation of13%to 22%of the total number of the hospitalizations due to PUD or EG/ED related bleeding may have been preventable.CONCLUSION:Up to one fifth of all hospitalizations for bleeding secondary to PUD or EG/ED are potentially preventable. | Ray Boyapati Sim Ye Ong Bei Ye Anuk Kruavit Nora Lee Rhys Vaughan Sanjay Nurkar Peter Gibson Mayur Garg | 2014 | World Journal of Gastroenterology2014，20，30： | 8 |
| 2 | Outcomes of a drug shortage requiring switching in patients with ulcerative colitis显示文摘BACKGROUND Drug shortages are common yet their impact on patient care and their commercial ramifications has not been adequately researched.In Australia a shortage of balsalazide(2012-2013)necessitated substitution with alternative 5-aminosalicylate(5-ASA)formulations for ulcerative colitis(UC).AIM To assess and compare the clinical and commercial sequelae of non-medical switching from balsalazide to another 5-ASA and/or return to balsalazide once supply resumed.METHODS A prospective cohort study of patients on balsalazide for mild-moderate UC was conducted where,strictly due to the national shortage(November 2012-January 2013),were switched to alternative 5-ASA and/or then returned to balsalazide once supply resumed.Clinical(Partial Mayo),endoscopic(Mayo score)activity,adverse effects(to alternative 5-ASA)and percentage market share(of continuous 5-ASA users)from baseline(i.e.,time of switching due to shortage)through to five years were assessed.RESULTS Of 31 patients switched due to the shortage,12(38.7%)resumed balsalazide immediately once supply resumed,8(25.8%)prompted by adverse effects to the alternative 5-ASA used.Three patients(9.7%)had documented symptomatic improvement,15(48.4%)were unchanged and 13(41.9%)had symptomatic worsening vs baseline(P<0.01),after switching to an alternative 5-ASA.At 3 and 5y post switch,overall 26/31(83.9%)and 23/31(74.2%)had remained continuously on any 5-ASA therapy respectively.Twelve(38.7%)and 11(35.5%)patients remained on balsalazide continuously at three and five years respectively after drug supply returned,equating to a loss of market share(within 5-ASA class)of 45.2%and 38.7%respectively.CONCLUSION This study of a balsalazide shortage in UC patients exemplifies the detrimental impact of a drug shortage on long term patient,disease and commercial outcomes. | Daniel R van Langenberg Richard Kai-Yuan Cheng Mayur Garg | 2020 | World Journal of Gastrointestinal Pathophysiology2020，11，2： | 0 |
| 3 | Dysphagia: Thinking outside the box显示文摘Dysphagia is a common symptom that is important to recognise and appropriately manage, given that causes include life threatening oesophageal neoplasia, oropharyngeal dysfunction, the risk of aspiration, as well as chronic disabling gastroesophageal reflux(GORD). The predominant causes of dysphagia varies between cohorts depending on the interplay between genetic predisposition and environmental risk factors, and is changing with time. Currently in white Caucasian societies adopting a western lifestyle, obesity is common and thus associated gastroesophageal reflux disease is increasingly diagnosed. Similarly, food allergies are increasing in the west, and eosinophilic oesophagitis is increasingly found as a cause. Other regions where cigarette smoking is still prevalent, or where access to medical care and antisecretory agents such as proton pump inhibitors are less available, benign oesophageal peptic strictures, Barrett's oesophagus, adeno-as well as squamous cell carcinoma are endemic. The evaluation should consider the severity of symptoms, as well as the pretest probability of a given condition. In young white Caucasian males who are atopic or describe heartburn, eosinophilic esophagitis and gastroesophageal reflux disease will predominate and a proton pump inhibitor could be commenced prior to further investigation. Upper gastrointestinal endoscopy remains a valid first line investigation for patients with suspected oesophageal dysphagia. Barium swallow is particularly useful for oropharyngeal dysphagia, and oesophageal manometry mandatory to diagnose motility disorders. | Hamish Philpott Mayur Garg Dunya Tomic Smrithya Balasubramanian Rami Sweis | 2017 | World Journal of Gastroenterology2017，23，38： | 0 |
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