Skip header and navigation

Refine By

15 records – page 1 of 2.

Association between spring season of birth and Crohn's disease.

https://arctichealth.org/en/permalink/ahliterature108177
Source
Clin Gastroenterol Hepatol. 2014 Feb;12(2):277-82
Publication Type
Article
Date
Feb-2014
Author
Souradet Y Shaw
Zoann Nugent
Laura E Targownik
Harminder Singh
James F Blanchard
Charles N Bernstein
Author Affiliation
Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Manitoba, Canada.
Source
Clin Gastroenterol Hepatol. 2014 Feb;12(2):277-82
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Anti-Bacterial Agents - therapeutic use
Case-Control Studies
Colitis, Ulcerative - epidemiology
Crohn Disease - epidemiology
Female
Humans
Incidence
Infant
Infant, Newborn
Logistic Models
Male
Manitoba - epidemiology
Odds Ratio
Risk factors
Seasons
Young Adult
Abstract
As for many complex diseases, the incidence of inflammatory bowel disease (IBD) is higher among individuals born during certain seasons. This difference could arise from seasonal variations in many factors, including exposure to sunlight, antibiotics, or infectious agents. We investigated the relationship between season of birth, early childhood exposure to antibiotics, and incidence of IBD.
We performed a nested case-control analysis using data from the University of Manitoba inflammatory bowel disease epidemiology database. We compared seasons of birth among 11,145 individuals with IBD (cases) and 108,633 controls using conditional logistic regression models. We collected data on use of antibiotics in the first year of life for cases and controls from the Manitoba Drug Program Information Network-a comprehensive database of all prescriptions given to residents of Manitoba since 1995.
Approximately 27.0% of cases were born from April through June, compared with 25.6% of controls (odds ratio, 1.07; 95% confidence interval, 1.02-1.12; P = .002). Comparisons made by sex (male vs female) and type of IBD (ulcerative colitis vs Crohn's disease) showed statistical significance only for men with Crohn's disease (odds ratio, 1.13; 95% confidence interval, 1.03-1.25; P = .009). At ages 6 months and older, cases and controls born from April through June received a significantly greater number of prescriptions for antibiotics than cases and controls born in other months.
Men with Crohn's disease are more likely to have been born in the months of April through June.
PubMed ID
23924874 View in PubMed
Less detail

Comparing resource utilization and gastrointestinal outcomes in patients treated with either standard-dose or high-dose proton pump inhibitors: a matched cohort study.

https://arctichealth.org/en/permalink/ahliterature160861
Source
Dig Dis Sci. 2008 Jun;53(6):1519-26
Publication Type
Article
Date
Jun-2008
Author
Laura E Targownik
Colleen Metge
Stella Leung
Author Affiliation
Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada. targowni@cc.umanitoba.ca
Source
Dig Dis Sci. 2008 Jun;53(6):1519-26
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Case-Control Studies
Chi-Square Distribution
Delivery of Health Care - economics - utilization
Drug Utilization
Female
Gastrointestinal Diseases - drug therapy - epidemiology
Humans
Male
Manitoba - epidemiology
Proton Pump Inhibitors - administration & dosage - economics
Statistics, nonparametric
Treatment Outcome
Abstract
The use of double-dose proton pump inhibitors (PPIs) for initial management of upper gastrointestinal (UGI) symptoms is common, though little evidence supports this practice. The aim of this study was to determine whether initial prescription of double-dose PPIs in outpatients with UGI complaints is superior to standard-dose PPIs prescription in reducing resource utilization. Patients in the Manitoba Health database prescribed double-dose PPIs were matched to individuals prescribed PPIs at standard doses. UGI-related inpatient and outpatient resource utilization and prescription drug usage were compared for both groups over the following year. Cases and controls had a similar duration of PPI use, and no difference in either UGI-related outpatient visits or UGI-related hospital admissions. Twelve-month UGI related costs were higher for double-dose PPI users. Initial therapy with double-dose PPIs does not reduce GI-related resource utilization. Prescription of double-dose PPIs as initial therapy for upper gastrointestinal symptoms should be discouraged.
PubMed ID
17932757 View in PubMed
Less detail

The cost-effectiveness of colonic stenting as a bridge to curative surgery in patients with acute left-sided malignant colonic obstruction: a Canadian perspective.

https://arctichealth.org/en/permalink/ahliterature166057
Source
Can J Gastroenterol. 2006 Dec;20(12):779-85
Publication Type
Article
Date
Dec-2006
Author
Harminder Singh
Steven Latosinsky
Brennan M R Spiegel
Laura E Targownik
Author Affiliation
Department of Internal Medicine, University of Manitoba, Winnipeg.
Source
Can J Gastroenterol. 2006 Dec;20(12):779-85
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Aged
Canada
Colonic Neoplasms - complications - surgery
Cost-Benefit Analysis
Humans
Intestinal Obstruction - economics - etiology - surgery
Models, Economic
Prosthesis Implantation - economics - instrumentation
Retrospective Studies
Stents
Abstract
Over the past several years, colonic stenting has been advocated as an alternative to the traditional surgical approach for relieving acute malignant left-sided colonic obstruction. The aim of the present study was to determine the most cost-effective strategy in a Canadian setting. patients and
A decision analytical model was developed to compare three competing strategies: CS - emergent colonic stenting followed by elective resective surgery and reanastomosis; RS - emergent resective surgery followed by creation of either a diverting colostomy or primary reanastomosis; and DC - emergent diverting colostomy followed by elective resective surgery and reanastomosis. The costs were estimated from the perspective of the Manitoba provincial health plan.
The use of CS resulted in fewer total operative procedures per patient (mean CS 1.03, RS 1.32, DC 1.9), lower mortality rate (CS 5%, RS 11%, DC 13%) and lower likelihood of requiring a permanent stoma (CS 7%, RS 14%, DC 14%). CS is slightly more expensive than DC, but less costly than RS (DC 11,851 dollars, CS 13,164 dollars, RS 13,820 dollars). The incremental cost-effectiveness ratio associated with the use of CS versus DC is 1,415 dollars to prevent a temporary stoma, 1,516 dollars to prevent an additional operation and 15,734 dollars to prevent an additional death.
Colonic stenting for patients with acute colonic obstruction secondary to a resectable colonic tumour is comparable in cost with surgical options, and reduces the likelihood of requiring both temporary and permanent stomas. Colonic stenting should be offered as the initial therapeutic modality for Canadian colorectal cancer patients presenting with acute obstruction as a bridge to definitive RS.
Notes
Cites: Tech Coloproctol. 2004 Nov;8 Suppl 1:s226-915655630
Cites: Dis Colon Rectum. 1996 Jun;39(6):605-98646942
Cites: Aust N Z J Surg. 1996 Apr;66(4):218-218611128
Cites: Chirurg. 1995 Jun;66(6):597-6067664589
Cites: Int J Colorectal Dis. 1995;10(1):1-57745314
Cites: Dis Colon Rectum. 1995 May;38(5):480-6; discussion 486-77736878
Cites: Br J Surg. 1994 Sep;81(9):1270-67953385
Cites: Am J Surg. 1991 Dec;162(6):633-6; discussion 636-71670240
Cites: Surg Gynecol Obstet. 1993 Aug;177(2):203-88342105
Cites: Br J Surg. 1992 Aug;79(8):839-411393489
Cites: Br J Surg. 1992 Jul;79(7):685-81643487
Cites: Ann Chir. 1992;46(3):239-431605554
Cites: Arch Surg. 1991 Jun;126(6):748-512039362
Cites: Dis Colon Rectum. 1989 Apr;32(4):299-3032924670
Cites: Br J Surg. 1985 Sep;72(9):708-114041730
Cites: Am J Gastroenterol. 2004 Oct;99(10):2051-715447772
Cites: Ann Chir. 2004 Jul-Aug;129(6-7):353-815297225
Cites: Cochrane Database Syst Rev. 2004;(2):CD00210115106167
Cites: Best Pract Res Clin Gastroenterol. 2004 Feb;18(1):209-2915123093
Cites: Ann Surg. 2004 Jul;240(1):76-8115213621
Cites: Dis Colon Rectum. 2003 Jan;46(1):24-3012544518
Cites: Ann Surg Oncol. 2002 Jul;9(6):574-912095974
Cites: Dis Colon Rectum. 2002 Mar;45(3):401-612068202
Cites: Best Pract Res Clin Gastroenterol. 2002 Apr;16(2):253-6511969237
Cites: Dis Colon Rectum. 2000 Jan;43(1):50-410813123
Cites: Dis Colon Rectum. 1999 Dec;42(12):1575-8010613476
Cites: Dis Colon Rectum. 1999 Dec;42(12):1569-7410613475
Cites: Radiology. 1998 Jan;206(1):199-2049423673
Cites: Br J Surg. 1997 Dec;84(12):1731-69448628
Cites: Surg Oncol. 2004 Aug-Nov;13(2-3):149-5715572097
Cites: Gastrointest Endosc. 2004 Dec;60(6):865-7415604999
Cites: Dis Colon Rectum. 2004 Nov;47(11):1889-9715622582
PubMed ID
17171197 View in PubMed
Less detail

Gastroprotective strategies among NSAID users: guidelines for appropriate use in chronic illness.

https://arctichealth.org/en/permalink/ahliterature165296
Source
Can Fam Physician. 2006 Sep;52(9):1100-5
Publication Type
Article
Date
Sep-2006
Author
Laura E Targownik
Peter A Thomson
Author Affiliation
Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada. targowni@cc.umanitoba.ca
Source
Can Fam Physician. 2006 Sep;52(9):1100-5
Date
Sep-2006
Language
English
Publication Type
Article
Keywords
Anti-Inflammatory Agents, Non-Steroidal - adverse effects - therapeutic use
Canada
Chronic Disease
Cyclooxygenase 2 Inhibitors - therapeutic use
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Education, Medical, Continuing
Family Practice - standards - trends
Female
Gastrointestinal Diseases - chemically induced - prevention & control
Humans
Male
Practice Guidelines as Topic
Prognosis
Proton Pump Inhibitors
Proton Pumps - therapeutic use
Randomized Controlled Trials as Topic
Risk assessment
Treatment Outcome
Abstract
To review proper use of gastroprotective strategies in family medicine for patients requiring chronic nonsteroidal anti-inflammatory drug (NSAID) therapy.
Evidence of the efficacy and safety of strategies currently in use (prostaglandin analogues, cyclooxygenase-2 inhibitors, proton pump inhibitors) is derived from randomized controlled trials (level I evidence). The simultaneous use of multiple medications for very high-risk NSAID users is supported only by expert opinion (level III evidence).
Gastroprotective strategies should be reserved for NSAID users at substantially increased risk of gastrointestinal complications; low-risk patients can safely use NSAIDs alone. Cyclooxygenase-2 inhibitors, prostaglandin analogues, and proton pump inhibitors reduce the risk of NSAID-related gastointestinal complications by 40% to 90%. Cyclooxygenase-2 inhibitors should be avoided by patients who have or are at risk for cardiovascular disease.
Chronic NSAID use has been implicated in the development of severe and potentially life-threatening gastointestinal complications, though certain strategies are known to decrease the risk of these NSAID-related gastointestinal complications. Prescribing physicians must know which of their patients should be prescribed medications and which strategies are appropriate for particular patients.
Notes
Cites: Lancet. 2002 Jan 5;359(9300):14-2211809181
Cites: BMJ. 2005 Jun 11;330(7504):136615947398
Cites: N Engl J Med. 2002 Jun 27;346(26):2033-812087138
Cites: Lancet. 2002 Oct 5;360(9339):1071-312383990
Cites: N Engl J Med. 2002 Dec 26;347(26):2104-1012501222
Cites: Arch Intern Med. 2003 Jan 13;163(1):59-6412523917
Cites: Ann Intern Med. 2003 May 20;138(10):795-80612755551
Cites: Arthritis Rheum. 2003 Jun 15;49(3):283-9212794781
Cites: Ann Intern Med. 2003 Oct 7;139(7):539-4614530224
Cites: Circulation. 2004 May 4;109(17):2068-7315096449
Cites: CMAJ. 2004 Jul 6;171(1):33-815238493
Cites: Ann Rheum Dis. 2004 Sep;63(9):1028-3415308513
Cites: J Clin Pharmacol. 2005 Jul;45(7):742-5015951464
Cites: Arch Intern Med. 2000 May 22;160(10):1455-6110826458
Cites: Arch Intern Med. 2000 Jun 26;160(12):1781-710871971
Cites: N Engl J Med. 2000 Sep 21;343(12):834-910995862
Cites: JAMA. 2000 Sep 13;284(10):1247-5510979111
Cites: J Rheumatol. 2000 Sep;27(9):2203-1410990235
Cites: Am J Gastroenterol. 2000 Sep;95(9):2218-2411007221
Cites: N Engl J Med. 2000 Nov 23;343(21):1520-8, 2 p following 152811087881
Cites: JAMA. 2004 Oct 27;292(16):1955-6015507580
Cites: Gut. 1987 May;28(5):527-323596334
Cites: Am J Med. 1987 Jul 27;83(1A):2-83113241
Cites: Lancet. 1988 Dec 3;2(8623):1277-802904006
Cites: N Engl J Med. 2001 Mar 29;344(13):967-7311274623
Cites: Ann Intern Med. 1991 Feb 15;114(4):257-631987872
Cites: Pain. 1990 Dec;43(3):309-182293142
Cites: Ann Intern Med. 1991 May 1;114(9):735-402012355
Cites: N Engl J Med. 1991 Jul 11;325(2):87-912052056
Cites: Ann Intern Med. 1991 Aug 1;115(3):195-2001905501
Cites: Ann Intern Med. 1991 Nov 15;115(10):787-961834002
Cites: Arch Intern Med. 1993 Jul 26;153(14):1665-708333804
Cites: Lancet. 1994 Mar 26;343(8900):769-727907735
Cites: Lancet. 1994 Apr 30;343(8905):1075-87909103
Cites: Ann Intern Med. 1995 Aug 15;123(4):241-97611589
Cites: Ann Intern Med. 1995 Sep 1;123(5):344-507625622
Cites: BMJ. 1995 Jul 22;311(6999):222-67627034
Cites: Eur J Gastroenterol Hepatol. 1995 Jul;7(7):661-58590162
Cites: Cancer Surv. 1994;21:67-848565000
Cites: N Engl J Med. 1996 May 30;334(22):1435-98618582
Cites: Gastroenterology. 1997 Mar;112(3):683-99041228
Cites: N Engl J Med. 1998 Mar 12;338(11):719-269494148
Cites: N Engl J Med. 1998 Mar 12;338(11):727-349494149
Cites: Lancet. 2005 Feb 5-11;365(9458):475-8115705456
Cites: N Engl J Med. 2005 Mar 17;352(11):1092-10215713943
Cites: N Engl J Med. 2005 Mar 17;352(11):1071-8015713944
Cites: N Engl J Med. 2005 Mar 17;352(11):1081-9115713945
Cites: Ann Intern Med. 2005 Apr 5;142(7):481-915809459
Cites: Can J Gastroenterol. 2002 Apr;16(4):231-4011981576
PubMed ID
17279220 View in PubMed
Less detail

Inflammatory bowel disease has a small effect on bone mineral density and risk for osteoporosis.

https://arctichealth.org/en/permalink/ahliterature119422
Source
Clin Gastroenterol Hepatol. 2013 Mar;11(3):278-85
Publication Type
Article
Date
Mar-2013
Author
Laura E Targownik
Charles N Bernstein
Zoann Nugent
William D Leslie
Author Affiliation
Section of Gastroenterology, University of Manitoba, Winnipeg, Canada. Laura.Targownik@med.unanitoba.ca
Source
Clin Gastroenterol Hepatol. 2013 Mar;11(3):278-85
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Bone Density
Female
Femur - pathology - radiography
Hip - pathology - radiography
Humans
Inflammatory Bowel Diseases - complications
Lumbar Vertebrae - pathology - radiography
Male
Manitoba - epidemiology
Middle Aged
Osteoporosis - epidemiology
Risk assessment
Abstract
A high prevalence of osteoporosis has been reported among individuals with inflammatory bowel disease (IBD). We performed a population-based analysis to determine whether IBD is itself a risk factor for low bone mineral density (BMD) or whether low BMD results from other factors associated with IBD.
We identified 1230 subjects with IBD in the Manitoba BMD Database, which contains results of BMD tests performed on all Manitobans since 1997 (n = 45,714). BMD was assessed at the lumbar spine (mean value, L1-L4), hip (total), femoral neck, and trochanter. Multivariate linear and logistic regression analyses were performed to determine the independent effects of IBD, Crohn's disease (CD), or ulcerative colitis (UC) on T score and the presence of osteoporosis (a low T score was equal to or less than -2.5) at any site; we controlled for age, sex, body mass index, hormone replacement therapy, osteoprotective medications, and corticosteroid use. We also performed regression analysis within the IBD population to determine the effect of IBD-specific factors on T score and osteoporosis.
IBD was associated with a statistically significant but small effect on T score; IBD did not increase the risk for osteoporosis at any site measured. CD was associated with an increased risk of osteoporosis at the lumbar spine and trochanter, but UC was not associated with an increased risk of osteoporosis or low T score. No IBD-specific variables were associated with increased risk of osteoporosis or low T score.
IBD has a small effect on BMD; CD poses a greater risk than UC. The risk of osteoporosis in patients with IBD appears to be related to other known osteoporosis risk factors.
PubMed ID
23103821 View in PubMed
Less detail

Management of acute nonvariceal upper gastrointestinal hemorrhage: comparison of an American and a Canadian medical centre.

https://arctichealth.org/en/permalink/ahliterature183853
Source
Can J Gastroenterol. 2003 Aug;17(8):489-95
Publication Type
Article
Date
Aug-2003
Author
Laura E Targownik
Ian M Gralnek
Gareth S Dulai
Brennan M R Spiegel
Tommy Oei
Charles N Bernstein
Author Affiliation
Veterans Affairs Greater Los Angeles Health Care System, California, USA. lauraellyn@yahoo.com
Source
Can J Gastroenterol. 2003 Aug;17(8):489-95
Date
Aug-2003
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Aged
Aged, 80 and over
Canada
Esophageal and Gastric Varices
Female
Gastrointestinal Hemorrhage - diagnosis - therapy
Hospitals, University - organization & administration
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care) - organization & administration
United States
Upper Gastrointestinal Tract
Abstract
Acute nonvariceal upper gastrointestinal hemorrhage (UGIH) remains a common indication for hospital admission. Differences in the structure, process and outcomes of care in the management of acute nonvariceal UGIH between providers in Canada and the United States have not been previously characterized. The aim of the present study was to compare the structure, process and outcomes of care between a Canadian and an American tertiary care medical centre in the management of acute nonvariceal UGIH.
Data were collected from identified cases of acute non-variceal UGIH at the two medical centres over two years. Process measures analyzed included the level of care (intensive care unit [ICU] monitored bed versus unmonitored bed) and hospital length of stay (HLOS). Outcomes assessed included rebleeding, inhospital mortality and readmission and/or death within 30 days of admission.
One hundred seventy-five and 83 cases of acute non-variceal UGIH were identified at the American and Canadian centres, respectively. Cases at the American centre had a lower median HLOS, (2.6 versus 3.9 days, P
PubMed ID
12945010 View in PubMed
Less detail

The prevalence of and the clinical and demographic characteristics associated with high-intensity proton pump inhibitor use.

https://arctichealth.org/en/permalink/ahliterature165043
Source
Am J Gastroenterol. 2007 May;102(5):942-50
Publication Type
Article
Date
May-2007
Author
Laura E Targownik
Colleen Metge
Leslie Roos
Stella Leung
Author Affiliation
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Source
Am J Gastroenterol. 2007 May;102(5):942-50
Date
May-2007
Language
English
Publication Type
Article
Keywords
Adult
Anti-Ulcer Agents - administration & dosage - therapeutic use
Demography
Female
Gastroesophageal Reflux - drug therapy
Humans
Logistic Models
Male
Manitoba
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Proton Pump Inhibitors
Abstract
High-intensity proton pump inhibitor (PPI) use is often recommended by physicians, though there is little proven benefit over standard PPI dosing in many clinical situations. We therefore sought to calculate the prevalence and predictors of high-intensity PPI use.
We used a Canadian provincial administrative database to capture all PPI prescriptions between 1996 and 2004. A person was defined as a high-intensity user if he used PPIs at more than 1.5 times the standard PPI dose for greater than 45 of 90 days before the index date. The prevalence of high-intensity use was calculated at four index dates annually. Stepwise logistic regression was performed to determine clinical and demographic factors associated with high-intensity PPI use.
The prevalence of high-intensity PPI use increased from 9.7% in 1997 to 14.2% in 2004. Polypharmacy, concomitant use of antispasmodic/promotility agents, and recent endoscopy were most strongly predictive of high-intensity PPI use. Severity of gastroesophageal reflux disease (GERD) (as assessed by the number of GERD-related physician visits) was relatively weakly predictive of high-intensity PPI use.
High-intensity PPI use is becoming more prevalent over time, and its use is strongly associated with factors suggestive of a high degree of comorbidity and treatment failure. Further research into factors that drive high-intensity PPI prescription and use are required.
PubMed ID
17313495 View in PubMed
Less detail

Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss.

https://arctichealth.org/en/permalink/ahliterature147222
Source
Gastroenterology. 2010 Mar;138(3):896-904
Publication Type
Article
Date
Mar-2010
Author
Laura E Targownik
Lisa M Lix
Stella Leung
William D Leslie
Author Affiliation
Section of Gastroenterology, Division of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. targowni@cc.umanitoba.ca
Source
Gastroenterology. 2010 Mar;138(3):896-904
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Aged
Aged, 80 and over
Bone Density - drug effects
Cross-Sectional Studies
Databases as Topic
Evidence-Based Medicine
Female
Hip Fractures - chemically induced - radiography
Hip Joint - drug effects - radiography
Humans
Linear Models
Logistic Models
Longitudinal Studies
Lumbar Vertebrae - drug effects - radiography
Male
Manitoba
Middle Aged
Odds Ratio
Osteoporosis - chemically induced - radiography
Proton Pump Inhibitors - adverse effects
Risk assessment
Risk factors
Abstract
Recent studies have shown an association between proton-pump inhibitor use (PPI) and hip fracture. The mechanism by which PPI use promotes the development of hip fracture is uncharacterized. Therefore, we sought to determine whether PPI use is associated with osteoporosis or accelerated bone mineral density (BMD) loss.
We used the Manitoba Bone Mineral Density Database to determine the relationship between chronic PPI use and osteoporosis on an initial assessment of BMD and on BMD loss between successive assessments of BMD. In the cross-sectional study, cases with osteoporosis at the hip or lumbar vertebrae (T-score or =-1.0). In the longitudinal analysis, the change in BMD among PPI users and nonusers between successive BMD assessments was assessed. Conditional logistic regression and multivariate linear regression were used to obtain estimates of the association between PPI use and osteoporosis and of the annualized change in BMD associated with PPI use.
PPI use was not associated with having osteoporosis at either the hip (OR, 0.84; 95% CI, 0.55-1.34) or the lumbar spine (OR, 0.79; 95% CI, 0.59-1.06) for PPI use >1500 doses over the previous 5 years. In the longitudinal study no significant decrease was observed in BMD at either site attributable to PPI use.
PPI use does not appear to be associated with either the presence of osteoporosis or accelerated BMD loss. The association between PPI use and hip fracture is probably related to factors independent of osteoporosis.
PubMed ID
19931262 View in PubMed
Less detail

The relationship between proton pump inhibitor use and longitudinal change in bone mineral density: a population-based study [corrected] from the Canadian Multicentre Osteoporosis Study (CaMos).

https://arctichealth.org/en/permalink/ahliterature122758
Source
Am J Gastroenterol. 2012 Sep;107(9):1361-9
Publication Type
Article
Date
Sep-2012
Author
Laura E Targownik
William D Leslie
K Shawn Davison
David Goltzman
Sophie A Jamal
Nancy Kreiger
Robert G Josse
Stephanie M Kaiser
Christopher S Kovacs
Jerilynn C Prior
Wei Zhou
Author Affiliation
University of Manitoba, Winnipeg, Manitoba, Canada. targowni@cc.umanitoba.ca
Source
Am J Gastroenterol. 2012 Sep;107(9):1361-9
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Bone Density - drug effects
Canada
Female
Femur Neck - drug effects
Follow-Up Studies
Hip Fractures - etiology
Humans
Male
Middle Aged
Osteoporosis - chemically induced
Proton Pump Inhibitors - adverse effects
Risk factors
Spinal Fractures - etiology
Spine - drug effects
Abstract
Proton pump inhibitor (PPI) use has been identified as a risk factor for hip and vertebral fractures. Evidence supporting a relationship between PPI use and osteoporosis remains scant. Demonstrating that PPIs are associated with accelerated bone mineral density (BMD) loss would provide supportive evidence for a mechanism through which PPIs could increase fracture risk.
We used the Canadian Multicentre Osteoporosis Study data set, which enrolled a population-based sample of Canadians who underwent BMD testing of the femoral neck, total hip, and lumbar spine (L1-L4) at baseline, and then again at 5 and 10 years. Participants also reported drug use and exposure to risk factors for osteoporosis and fracture. Multivariate linear regression was used to determine the independent association of PPI exposure and baseline BMD, and on change in BMD at 5 and 10 years.
In all, 8,340 subjects were included in the baseline analysis, with 4,512 (55%) undergoing year 10 BMD testing. After adjusting for potential confounders, PPI use was associated with significantly lower baseline BMD at the femoral neck and total hip. PPI use was not associated with a significant acceleration in covariate-adjusted BMD loss at any measurement site after 5 and 10 years of follow-up.
PPI users had lower BMD at baseline than PPI non-users, but PPI use over 10 years did not appear to be associated with accelerated BMD loss. The reasons for discordant findings between PPI use at baseline and during follow-up require further study.
Notes
Comment In: Evid Based Med. 2013 Oct;18(5):192-323220469
Comment In: Gastroenterology. 2013 Mar;144(3):650-223380947
Erratum In: Am J Gastroenterol. 2013 Jan;108(1):157
PubMed ID
22777336 View in PubMed
Less detail

The relative efficacies of gastroprotective strategies in chronic users of nonsteroidal anti-inflammatory drugs.

https://arctichealth.org/en/permalink/ahliterature158653
Source
Gastroenterology. 2008 Apr;134(4):937-44
Publication Type
Article
Date
Apr-2008
Author
Laura E Targownik
Colleen J Metge
Stella Leung
Daniel G Chateau
Author Affiliation
Section of Gastroenterology, Division of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. targowni@cc.umanitoba.ca
Source
Gastroenterology. 2008 Apr;134(4):937-44
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Age Distribution
Anti-Inflammatory Agents, Non-Steroidal - adverse effects
Anti-Ulcer Agents - therapeutic use
Cardiovascular Diseases - drug therapy
Cyclooxygenase 2 Inhibitors - therapeutic use
Drug Therapy, Combination
Gastrointestinal Diseases - chemically induced - epidemiology - prevention & control
Humans
Incidence
Manitoba - epidemiology
Misoprostol - therapeutic use
Prognosis
Proton Pump Inhibitors - therapeutic use
Pyrazoles - therapeutic use
Retrospective Studies
Risk factors
Sex Distribution
Sulfonamides - therapeutic use
Abstract
There are numerous gastroprotective strategies recommended for reducing the risk of upper gastrointestinal (GI) complications in long-term users of nonsteroidal anti-inflammatory drugs (NSAIDs). The relative efficacy of the different strategies alone or in combination is uncertain.
We used the Manitoba Population Health Research Data Repository to perform a population-based matched case-control analysis. All NSAID users (nonselective and cyclooxygenase [COX]-2-specific) users admitted to the hospital with a primary diagnosis for an upper gastrointestinal complication were matched to NSAID-using controls in the community. We used conditional logistic regression analysis to determine the relative efficacy of different gastroprotective strategies (proton pump inhibitors [PPIs], COX-2 inhibitors, and low-dose/high-dose misoprostol) either alone or in combination and to adjust for multiple pertinent covariates.
A total of 1382 NSAID/COX-2 users with upper GI complications were matched to 33,957 age- and sex-matched controls. Cotherapy with PPIs or misoprostol or use of a COX-2 inhibitor all significantly reduced the risk of upper GI complications. COX-2 inhibitors were not statistically more likely to prevent upper GI complications than PPIs, although they were superior to low-dose misoprostol. The combination of COX-2 inhibitors with a PPI was associated with the greatest degree of upper GI complication risk reduction.
All of the commonly accepted gastroprotective strategies reduce the risk of upper GI complications in NSAID users, although the combination of COX-2 inhibitors with PPIs promotes the greatest risk reduction for NSAID-related upper GI complications. Celecoxib use specifically may be superior to the combination of nonselective NSAIDs with a PPI.
Notes
Comment In: Gastroenterology. 2008 Apr;134(4):1240-618395101
PubMed ID
18294634 View in PubMed
Less detail

15 records – page 1 of 2.