Background/Aims: Previous studies have reported a possible relevance between proton pump inhibitor (PPI) use and 3 new gastric mucosal changes: black spots (BSs), white flat elevated mucosa (WFEM), and cobblestone-like mucosa (CLM). The aim of this study was to investigate the association between these mucosal changes and multiple factors including PPI use. Methods: All subjects who underwent a routine esophagogastroduodenoscopy (EGD) were successively enrolled. Endoscopists carried out the EGD after being blinded about information on patient PPI usage and determined the presence of these mucosal changes. The ratio of each factor was compared in cases with and without each gastric finding. Results: Out of 1,214 patients, BSs were recognized in 75 (6.2%) cases, WFEM in 59 (4.9%), and CLM in 41 (3.4%). In logistic regression analysis, PPI use was significantly correlated with all of these findings (BSs: OR 2.94; 95% CI 1.66–5.21), (WFEM: OR 3.58; 95% CI 1.94–6.61), and (CLM: OR 4.57; 95% CI 2.34–9.96), and Helicobacter pylori eradication was related to BSs (OR 3.01; 95% CI 1.73–5.24) and WFEM (OR 2.11; 95% CI 1.08–4.11). Decision-tree analyses showed that H. pylori eradication was associated with all findings. Conclusions: All of the considered findings were correlated with PPI and H. pylori eradication.
Earlier studies have shown that visit-to-visit blood pressure (BP) variability (VVV) served as a significant
independent risk factor of stroke, specifically, in the high-risk elderly of cardiovascular disease (CVD). Although
the mechanism is not clearly understood, arterial remodeling such as carotid artery, coronary artery and
large aortic artery would be a strong moderator in the relationship between VVV and CVD incidence. Recent
studies have provided evidence that VVV predicted the progression of arterial stiffness. While the class of
antihypertensive agents is suggested to be an important determinant of VVV, long-acting calcium channel
blockers use (CCBs) is associated with the reduction of VVV, and thus, is suggested to decrease the arterial
stiffness. Specifically, the relationship between VVV and coronary arterial remodeling has never been
reviewed until now. This article summarizes the recent literature on these topics. In the elderly hypertensives,
strict BP control using CCBs could play a pivotal role in suppressing arterial stiffening via VVV reduction.
Objective The long-term use of proton pump inhibitors (PPIs) may induce adverse events in many organs, including the stomach. The chronic use of PPIs has been associated with the growth of fundic gland polyps (FGPs) and of gastric black spots. This study assessed the incidence of gastric lesions with cobblestone-like appearance in PPI users. Methods The clinical characteristics and endoscopic findings of patients who underwent upper gastrointestinal endoscopy after using PPIs for at least six months were analyzed. The biopsy specimens from patients with gastric cobblestone-like lesions (GCLLs) were examined histopathologically. Patients This study analyzed 171 patients who underwent upper gastrointestinal endoscopy after more than 6 months of PPI use in Mitsugi Public General Hospital from January 1, 2015, to March 31, 2016. Results Of the 171 patients, 60 (35.1%) had GCLLs and 111 (64.9%) did not. There were no significant between-group differences in age, sex, duration of PPI use, and receipt of Helicobacter pylori eradication therapy. Atrophic gastritis of the corpus was significantly less frequent in the GCLL than in the non-GCLL group (55.0% vs. 47.8%, p=0.0097). Among the GCLL group, histological examinations of 24 patients revealed cystic dilation of the fundic gland in 19 (79.2%), parietal cell hyperplasia in 18 (75.0%), and cytoplasmic vacuolation in 7 (29.2%). Conclusion GCLLs occurred frequently in long-term PPI users, especially in patients without atrophic gastritis. The pathological findings of GCLLs included parietal cell hyperplasia and fundic gland cysts. The clinical importance of these new lesions remains uncertain, but they should be observed carefully.
Background:
The Japanese Ministry of Health, Labour and Welfare has tried to promote telemedicine since 2018, but faces difficulties in increasing the use of telemedicine partly due to a lack of clinical evidence. This study investigated the disease control status and safety of telemedicine, which, in Japan, is provided under the National Health Insurance system, for the treatment of lifestyle diseases under the present legal restraints.
Methods and Results:
This multicenter prospective observational study started in April 2018 and enrolled 34 patients with lifestyle diseases, including hypertension, dyslipidemia, and diabetes. Primary and secondary outcome measures included control status, serial changes in clinical indices, and the safety of telemedicine 6 months after implementation. Control status was assessed by the attending physician, and differences in blood pressure (BP), low density lipoprotein cholesterol (LDL-C), or HbA1c levels were evaluated. Of the 34 patients, 29 were successfully introduced to telemedicine and followed-up for 6 months. Median patient age was 77 years, 14 (48.3%) were men, 24 (82.8%) had hypertension, 17 (58.6%) had dyslipidemia, and 9 (31.0%) had diabetes. At the 6-month follow-up, no patients had experienced exacerbation of underlying diseases, with no significant changes in BP, LDL-C, or HbA1c. Moreover, no telemedicine-associated adverse events were observed.
Conclusions:
Telemedicine can be a safe and feasible option for managing lifestyle diseases under the present legal restraints.
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