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Biomedical subjects

Nimish Vakil

Publications and source records attributed to Nimish Vakil.

51 records · Page 3Linked to original sources
PubMed2003

Are there geographical and regional differences in Helicobacter pylori eradication?

An important area of controversy in Helicobacter pylori eradication is the apparent difference in eradication rates seen in different countries and populations. A recent meta-analysis showed that several factors may affect the outcome of therapy. Individuals residing in northeast Asia had higher eradication rates than those residing in Europe or other areas of Asia. Triple and quadruple drug therapies had significantly higher eradication rates than did dual drug therapies. Treatment regimens that lasted longer than 14 days were better than those that lasted less than seven days, but there was no significant advantage for 10 day therapy over seven day therapy. A number of factors may play a role in determining the regional and geographical differences in H pylori eradication therapy. Included in these factors are genetic differences in the metabolism of the proton pump inhibitor, which can alter the availability of antimicrobials in the stomach. Regional differences in antimicrobial resistance also affect the outcome of therapy. Some studies suggest that the degree of gastritis and the nature of the underlying disease may affect the outcome of therapy, but the data are controversial. Understanding the regional and geographical differences in H pylori eradication can help physicians select the optimal treatment regimen in different regions.

Anti-Infective Agents↗
PubMed2003

Gastroesophageal reflux disease and Helicobacter pylori infection.

The prevalence of Helicobacter pylori infection has been decreasing while the prevalence of gastroesophageal reflux disease and esophageal adenocarcinoma has been increasing in developed countries since the 1930s. This has raised concerns that H. pylori infection may protect against esophageal disease and that the disappearance of H. pylori from the population might lead to a further increase in gastroesophageal reflux disease. Some studies have suggested that eradication of H. pylori in patients with duodenal ulcer disease results in an increase in the incidence of erosive esophagitis, whereas other studies have shown no such increase. Studies on gastric acid secretion have demonstrated that proton pump inhibitors are more effective in controlling gastric pH in individuals who are infected with H. pylori. Studies on the impact of therapy in patients with erosive esophagitis have been conflicting. This article reviews each of the issues in the debate separately and concludes that there is little evidence to suggest a major effect of H. pylori eradication on the outcome of gastroesophageal reflux disease.

Adult↗
PubMed2003

Epigastric pain in dyspepsia and reflux disease.

Epigastric pain may occur as a specific and localized symptom, as part of a group of symptoms that include heartburn, or in association with bloating or early satiety. The current classification (Rome II) characterizes ulcer-like dyspepsia by predominant pain centered in the upper abdomen and characterizes dysmotility-like dyspepsia by discomfort. The large number of patients presenting with epigastric pain has led to the development of empirical strategies.

Abdominal Pain↗
PubMed2002

The stool antigen test for detection of Helicobacter pylori after eradication therapy.

BACKGROUND: Current noninvasive tests to confirm the eradication of Helicobacter pylori must be performed 4 weeks or more after eradication therapy is completed. OBJECTIVE: To determine whether the stool antigen test, a relatively new noninvasive test for H. pylori, administered at various times after eradication therapy correctly identifies persons with persistent H. pylori infection. DESIGN: Prospective blinded study. SETTING: Six clinical centers in the United States and Europe. PATIENTS: 84 H. pylori --infected patients undergoing endoscopy for upper abdominal symptoms. MEASUREMENTS: At baseline and on day 35 after the completion of triple eradication therapy, all patients underwent endoscopy with histologic examination, rapid urease test and culture, urea breath test, and a stool antigen test. The stool antigen test was also performed on days 3, 7, 15, 21, 28, and 35 after completion of therapy. RESULTS: Compared with the gold-standard endoscopic tests on day 35 after antimicrobial therapy, the urea breath test had a sensitivity of 94% (95% CI, 71% to 100%) and a specificity of 100% (CI, 94% to 100%). The stool antigen test had a sensitivity of 94% (CI, 71% to 100%) and a specificity of 97% (CI, 89% to 100%). On day 7 after treatment, the stool antigen test was predictive of eradication (positive predictive value, 100% [CI, 69% to 100%]; negative predictive value, 91% [CI, 82% to 97%]). CONCLUSION: A positive result on the stool antigen test 7 days after completion of therapy identifies patients in whom eradication of H. pylori was unsuccessful.

Adult↗
PubMed2002

Nonulcer dyspepsia.

Nonulcer dyspepsia is a common condition in clinical practice. It is a heterogeneous disorder, and no single therapeutic agent is effective in all patients. The treatment of nonulcer dyspepsia is still dissatisfactory. Eradication of Helicobacter pylori organisms has a limited role and little effect. Antisecretory therapy has a modest effect in alleviating symptoms. Prokinetic agents may be effective, but selection bias in the trials performed to date may exaggerate their benefit. Partial 5-HT(4) agonists stimulate gastric emptying and may also affect gastric accommodation. They are promising but need further study. Data are limited on 5-HT(3) antagonists and hypnotherapy. New treatment approaches are necessary for this common and often chronic condition.

Antifoaming Agents↗
PubMed2002

Novel methods of using proton-pump inhibitors.

On-demand therapy with PPIs is a new strategy that has been shown to be effective in patients with nonerosive reflux disease or mild erosive reflux disease. This strategy can reduce the cost of maintenance therapy substantially and is particularly appealing in patients with no evidence of mucosal disease. The long-term efficacy and safety of this form of therapy have not been established. Nocturnal reflux may be important in patients with complicated reflux disease or Barrett's esophagus. Data on combining PPIs with H2RAs suggest that nocturnal gastric pH can be controlled by the administration of H2RAs at bedtime. There are few data on nocturnal symptoms, and some studies suggest that tachyphylaxis may develop with H2RA therapy. More data are required on the clinical effectiveness of combination therapy administered long-term.

Cost-Benefit Analysis↗
PubMed2002

Usage of supplemental alternative medicine by community-based patients with gastroesophageal reflux disease (GERD).

There is an increasing trend towards alternative medicine usage by the general US population. However, the extent and type of supplemental alternative medicine used specifically by community-based patients with GERD is unknown. A previously validated questionnaire that included questions about patient demographics, 18 types of alternative medicine, and attitudes towards alternative and conventional medicine was utilized. Consecutive patients seen by community-based physicians in Arizona (Tucson, Phoenix, and Flagstaff) and Wisconsin (Milwaukee) for GERD received the questionnaire during the years 1999 and 2000. Patients completed the questionnaire and returned it to the Tucson VA Medical Center by mail. A total of 185 patients were surveyed (82 men, mean age 55.8 years). Of those, 61.6% used alternative medicine for any reason. However, only 3.8% of patients used supplemental alternative medicine for GERD. Females were twice as likely (95% CI, 1.10-3.67) to use alternative medicines for any reason (including GERD). Patients with daily acid regurgitation were 5.75 times (95% CI, 1.03-32.17) more likely than patients with less frequent acid regurgitation to use alternative medicines specifically for GERD. None of the other demographics, health characteristics, or attitudes were predictive of supplemental alternative medicine use for any reason (or specifically for GERD). In conclusion, only a small percentage of GERD patients seen by community-based practitioners use supplemental alternative medicine specifically for GERD symptoms, despite a higher usage of supplemental alternative medicine for non-GERD-related illness. Being female and having acid regurgitation daily were positively associated with alternative medicine usage for GERD.

Adult↗
PubMed2002

Esophageal cancer.

Despite advances in our knowledge of esophageal cancer, 50% of patients present with incurable disease, and the overall survival after diagnosis is poor. The incidence of esophageal adenocarcinoma of the distal esophagus is rising at a rapid rate in developed countries. Recent advances in the epidemiology of esophageal cancer offer insights into preventive strategies in patients who are at risk. New developments in diagnosis may help detect the disease at an early stage. New diagnostic modalities permit more accurate staging procedures and allow appropriate selection of therapy. New studies provide more information on multimodality therapy for esophageal cancer, and new endoscopic techniques allow resection of small lesions without surgery. New stent designs provide better palliation by providing tumor ingrowth. These developments in the treatment of esophageal cancer are the focus of this review.

Journal Article↗
PubMed2002

Upper GI malignancy, uncomplicated dyspepsia, and the age threshold for early endoscopy.

OBJECTIVES: We sought to determine the frequency with which patients with upper GI malignancies present with uncomplicated dyspepsia and to determine the impact of changing the threshold for early endoscopy from 45 to 55 yr, as has recently been recommended in European studies. METHODS: Three hundred forty-one patients with upper GI malignancies at two Milwaukee teaching hospitals were identified from electronic databases. Trained physician-investigators reviewed the charts using a specifically designed questionnaire. Staging of GI cancers was performed using the TNM classification to determine operability. Uncomplicated dyspepsia was defined as dyspepsia without alarm symptoms/signs (dysphagia, vomiting, weight loss, early satiety, GI bleeding, or anemia). RESULTS: There were 341 patients with upper GI malignancies with a mean age of 68 yr (range = 22-94). Twenty-one patients were younger than 45 and 65 were under 55. Uncomplicated dyspepsia was the presenting symptom in five of 65 (7.7%) patients younger than 55 and one of 21 (4.8%) patients under 45 (p = 0.99). Five patients 55 or younger presented with uncomplicated dyspepsia. All had advanced, inoperable disease (stage III or higher). CONCLUSIONS: 1) In a racially diverse United States population, upper GI malignancy presenting without alarm symptoms is uncommon. 2) Raising the threshold for immediate endoscopy in uncomplicated dyspepsia from age 45 to 55 increases the risk of missing an underlying malignancy but may not affect outcome, as incurable disease was present at diagnosis within a few weeks of the onset of symptoms.

Adult↗
PubMedDate not supplied

The benefit of negative tests in non-ulcer dyspepsia.

OBJECTIVES: Negative diagnostic tests are usually evaluated by their ability to advance a diagnostic search, or they are considered redundant expenditures in establishing a definitive diagnosis. It has remained difficult to assess their benefit in terms of their own merit and the reassurance that they provide to a patient. The aim of the present study is to develop a mathematical model for quantifying the impact of diagnostic tests on a patient's health-related quality of life (HRQL). METHODS: An influence diagram is used to model how non-ulcer dyspepsia (NUD) and its medical care affect HRQL. Diagnostic tests and medical therapy benefit HRQL by alleviating fear of disease and NUD symptoms. Medical care can also adversely affect HRQL, lead to expenses in time and money, and compromise a patient's sense of autonomy. HRQL is modeled as the focal point of multiple influences detracting from its value. RESULTS: Negative diagnostic tests can improve HRQL in NUD. The improvement of HRQL by diagnostic tests depends on a multitude of individual influences and the interactions between them, such as the severity of NUD symptoms andfear of disease, as well as the impact of medical care itself on HRQL. If a patient harbors a strong fear of serious disease or cancer, more extensive testing is likely to improve the patient's well-being and appears a worthwhile endeavor. Other patients, however, would be served perfectly well by empirical therapy only. For the vast majority of subjects with NUD who never seek medical advice, the unpleasantness of the disease itself does not outweigh the anticipated downside of obtaining medical care. CONCLUSION: The analysis illustrates the applicability of the influence diagram in modeling disease behavior. This method helps to assess the benefit of negative tests beyond their means of generating information.

Attitude to Health↗