Clopidogrel, Proton-Pump Inhibitors, and Cardiovascular Events

A careful analysis of drug exposure after coronary stent implantation found no significant association between major cardiovascular events and concomitant use of clopidogrel and PPIs.

Concerns about the combined use of clopidogrel and proton-pump inhibitors (PPIs) began when studies suggested that PPIs impaired the intended antiplatelet activity of clopidogrel. This effect was attributed to a competitive interaction at the cytochrome P450 pathway, which is required for the biotransformation of the prodrug clopidogrel to its active metabolite. These studies led to a rapid onslaught of retrospective observational database analyses that reported an increased likelihood of clinical adverse cardiovascular events in patients taking this drug combination. However, a fundamental problem with these retrospective analyses has been their reliance on discharge prescription data, without accounting for varying medication exposures after discharge.

Computerized Prediction of Mortality from Upper Gastrointestinal Bleeding

An artificial neural-network program that used pre-endoscopy data was superior to the Rockall scoring system.

Venous Thromboembolism and Inflammatory Bowel Disease

Risk for VTE was two times higher in patients with IBD than in sex- and age-matched controls.

Patients with inflammatory bowel disease (IBD) have elevated risk for venous thromboembolism (VTE) — including deep venous thrombosis (DVT) and pulmonary embolism (PE) — and possibly arterial thrombosis.

Low Risk for Colorectal Cancer in Patients with Inflammatory Bowel Disease

Hospital-based data from the Netherlands confirm low risk and reveal protective effects of immunosuppressive thiopurines and antitumor necrosis factor.

Esophageal Adenocarcinoma in Populations with Gastroesophageal Reflux Disease

Incidence of EAC in patients with GERD was very low overall, especially among men younger than 50 and women at any age.

The incidence of esophageal adenocarcinoma (EAC) has increased rapidly during the past few decades. National society guidelines recommend endoscopic screening for Barrett esophagus in patients with long-standing gastroesophageal reflux disease (GERD). However, the incidence for EAC in demographic subpopulations with GERD is unknown.

Colorectal Tumor Development and Lynch Syndrome

Progression from adenoma to carcinoma occurred rapidly in patients with Lynch syndrome.

Because mutations responsible for Lynch syndrome can cause colorectal adenomas to pass rapidly through the polyp–cancer sequence, interval cancers are common in patients with Lynch syndrome. As such, current U.S. screening guidelines recommend that adults with Lynch syndrome undergo colonoscopy every 2 years until age 40 and then annually thereafter (JW Gastroenterol Jul 9 2010).

Predicting Poor Outcomes in Nonvariceal Upper Gastrointestinal Bleeding

Comorbidity, age >65 years, history of bleeding ulcers, and source and setting of bleeding contributed to risk for continued or recurrent bleeding, or death within 30 days.

Advances in endoscopic and pharmacologic therapy have reduced the risk for rebleeding in patients with nonvariceal upper gastrointestinal bleeding (UGIB); however, mortality remains relatively unchanged.

Fecal Occult Blood Tests Can Do More Harm Than Good in the Elderly

Among elderly men, 87% with the worst life expectancy and 65% with the best life expectancy experienced more burden than benefit from fecal occult blood testing.