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Background and Aim: Since the first report of gastric adenocarcinoma of the fundic‐gland type in 2010, the clinicopathological characteristics of gastric neoplasm of the fundic‐gland type (GNFG) have become clearer; however, their risk factors remain unclear. This exploratory study aimed to identify the risk factors for GNFG. Methods: We conducted a single‐center, retrospective, matched case–control study using medical information recorded at our health management center from January 2014 to July 2023. During this period, 39 240 people underwent upper gastrointestinal endoscopy. GNFG were extracted as cases and matched to controls, according to age and sex, in a 1:8 ratio, excluding those with a history of gastrointestinal surgery and those with a history or comorbidity of cancer. Univariate analysis was used to compare patient background and endoscopic findings. Multivariable analysis was performed, adjusting for factors with P values < 0.1 and antacid use. Results: A total of 20 GNFG cases and 160 matched healthy controls were included. In the univariate analysis, only reflux esophagitis was significantly more common in GNFG (40.0% vs 18.1%; P = 0.036). Factors antacids and duodenitis had P values < 0.1. Logistic regression analysis was performed, adjusting for antacids, reflux esophagitis, and duodenitis. Antacids and reflux esophagitis were the independent risk factors for GNFG (odds ratio = 3.68 [95% confidence interval: 1.04–11.91] and 3.25 [95% confidence interval: 1.11–9.35]). Conclusions: Although the sample of patients with GNFG was small, antacids and reflux esophagitis were identified as a risk factor. The pathogenesis of antacids and reflux esophagitis may be involved in the development of GNFG. [ABSTRACT FROM AUTHOR]

The effect of food composition, tablet crushing, and antacid coadministration on maribavir pharmacokinetics was assessed in 2 Phase 1 studies in healthy adults. In the first, a single maribavir 400‐mg dose was administered under fasting conditions, with a low‐fat/low‐calorie or a high‐fat/high‐calorie meal. In the second, a single maribavir 100‐mg dose was administered under fasting conditions, as a crushed tablet, or as a whole tablet alone or with an antacid. The 90% confidence intervals of the geometric mean ratios were within 80%‐125% for area under the concentration‐time curve (AUC), but not for maximum plasma concentration (Cmax) for low‐fat/low‐calorie and high‐fat/high‐calorie meals versus fasting or for whole tablet with antacid versus whole tablet alone. The 90% confidence intervals of the geometric mean ratios for AUC and Cmax were within 80%‐125% for crushed versus whole tablet. Maribavir median time to Cmax value in plasma under fed conditions was delayed versus fasting conditions, but there was no statistical difference for crushed versus whole tablet or with versus without antacid. As the antiviral efficacy of maribavir is driven by AUC but not Cmax, findings suggest that maribavir can be administered with food or antacids or as a crushed tablet. [ABSTRACT FROM AUTHOR]

Abstract Agro-waste is the outcome of the under-utilization of bioresources and a lack of knowledge to re-use this waste in proper ways or a circular economy approach. In the Indian medicinal system, the root of Cyperus scariosus (CS) is used at a large scale due to their vital medicinal properties. Unfortunately, the aerial part of CS is treated as agro-waste and is an under-utilized bioresource. Due to a lack of knowledge, CS is treated as a weed. This present study is the first ever attempt to explore CS leaves as medicinally and a nutrient rich source. To determine the food and nutritional values of the neglected part of Cyperus scariosus R.Br. (CS), i.e. CS leaves, phytochemicals and metal ions of CS were quantified by newly developed HPLC and ICPOES-based methods. The content of the phytochemicals observed in HPLC analysis for caffeic acid, catechin, epicatechin, trans-p-coumaric acid, and trans-ferulic acid was 10.51, 276.15, 279.09, 70.53, and 36.83 µg/g, respectively. In GC–MS/MS analysis, fatty acids including linolenic acid, phytol, palmitic acid, etc. were identified. In ICPOES analysis, the significant content of Na, K, Ca, Cu, Fe, Mg, Mn, and Zn was observed. The TPC and TFC of the CS leaves was 17.933 mg GAE eq./g and 130.767 mg QCE eq./g along with an IC50 value of 2.78 mg/mL in the DPPH assay and better antacid activity was measured than the standard (CaCO3). The methanolic extract of CS leaves showed anti-microbial activity against Staphylococcus aureus (15 ± 2 mm), Pseudomonas aeruginosa (12 ± 2 mm) and Escherichia coli (10 ± 2 mm). In silico studies confirmed the in vitro results obtained from the antioxidant, antiacid, and anti-microbial studies. In addition, in silico studies revealed the anti-cancerous and anti-inflammatory potential of the CS leaves. This study, thus, demonstrated the medicinal significance of the under-utilized part of CS and the conversion of agro-waste into mankind activity as a pharmaceutical potent material. Consequently, the present study highlighted that CS leaves have medicinal importance with good nutritional utility and have a large potential in the pharmaceutical industry along with improving bio-valorization and the environment.

Agro-waste is the outcome of the under-utilization of bioresources and a lack of knowledge to re-use this waste in proper ways or a circular economy approach. In the Indian medicinal system, the root of Cyperus scariosus (CS) is used at a large scale due to their vital medicinal properties. Unfortunately, the aerial part of CS is treated as agro-waste and is an under-utilized bioresource. Due to a lack of knowledge, CS is treated as a weed. This present study is the first ever attempt to explore CS leaves as medicinally and a nutrient rich source. To determine the food and nutritional values of the neglected part of Cyperus scariosus R.Br. (CS), i.e. CS leaves, phytochemicals and metal ions of CS were quantified by newly developed HPLC and ICPOES-based methods. The content of the phytochemicals observed in HPLC analysis for caffeic acid, catechin, epicatechin, trans-p-coumaric acid, and trans-ferulic acid was 10.51, 276.15, 279.09, 70.53, and 36.83 µg/g, respectively. In GC–MS/MS analysis, fatty acids including linolenic acid, phytol, palmitic acid, etc. were identified. In ICPOES analysis, the significant content of Na, K, Ca, Cu, Fe, Mg, Mn, and Zn was observed. The TPC and TFC of the CS leaves was 17.933 mg GAE eq./g and 130.767 mg QCE eq./g along with an IC50 value of 2.78 mg/mL in the DPPH assay and better antacid activity was measured than the standard (CaCO3). The methanolic extract of CS leaves showed anti-microbial activity against Staphylococcus aureus (15 ± 2 mm), Pseudomonas aeruginosa (12 ± 2 mm) and Escherichia coli (10 ± 2 mm). In silico studies confirmed the in vitro results obtained from the antioxidant, antiacid, and anti-microbial studies. In addition, in silico studies revealed the anti-cancerous and anti-inflammatory potential of the CS leaves. This study, thus, demonstrated the medicinal significance of the under-utilized part of CS and the conversion of agro-waste into mankind activity as a pharmaceutical potent material. Consequently, the present study highlighted that CS leaves have medicinal importance with good nutritional utility and have a large potential in the pharmaceutical industry along with improving bio-valorization and the environment. [ABSTRACT FROM AUTHOR]

Commonly, most oral non-steroidal anti-inflammatory drugs (NSAIDs) have known gastric adverse reactions due to their long-term and high dose administration. In this study, a novel liquid sustained-release system based on multiple-unit in situ hydrogel beads was designed to address this issue. The system is composed of sodium alginate (SA), gellan gum (GG), zinc oxide (ZnO), and magnesium oxide (MgO). Furthermore, indobufen was loaded into the system to evaluate its gastric mucosal protection effect. This effect can be attributed to the topical antacid, pepsin inhibition, and sustained drug release properties of the system. It was proven that the stored solid gel system could undergo a "solid to liquid" transition after shaking. Once swallowed, the liquid gel could disperse well in the stomach as hydrogel beads. Then, the "liquid to solid" gelation occurred from the exterior to interior of each multiple-unit gel bead, triggered by the release of Zn2+ and Mg2+ from neutralization reactions. The formed gel demonstrated mild antacid effect that lasted for 3 hours and 66.3% pepsin inhibition in vivo. Moreover, the rats treated with the indobufen gel system showed a drug plasma concentration versus time curve with less fluctuation compared to the rats treated with the marketed preparation (YinDuo®) group. The gel system also exhibited an extended T max (6.50 hours) and reduced C max (52.87 μg/mL). Additionally, the gastric mucosal protection of the gel system was verified using three types of peptic gastric ulcer models. These findings suggested that this multiple-unit in situ gel could be a potential oral liquid sustained release delivery system for NSAIDs. [ABSTRACT FROM AUTHOR]

A accessible ultramodern life brings along with it a host of problems including acidity and Gastrointestinal issues. Poor eating habits, racy food and guzzling too numerous carbonated drinks Disrupts the pH balance and natural foliage of the stomach causing both bloating and acidity making Antacids the most common tone- specified specifics available over the counter. Common Dental Procedures and oral conditions requires dentists to define NSAIDs and antibiotics which alleviates Acidity. The antacids act by negativing the acid in the stomach and by inhibiting pepsin, which is a proteolytic enzyme. Each of These cationic mariners has a characteristic pharmacological property that determines its clinical use. In recent times, demands of identification and evaluation of new medicines conceivably of factory origin are gaining fashionability for the treatment of colorful gastrointestinal conditions. Hence, herbal drugs were considered a better cover for the treatment of acid influx/acidity with lower adverse side goods. The main ideal of the study was to elect sauces which were used as a home -- remedy having parcels for negativing the Acid of the stomach viz Cumin( Cuminum cyminum), Sprague (Trachyspermum ammi), and Peppermint (Mentha piperita) and incorporate in their excerpt forms in dividually into the new expression( Bouncy grains) developed by using wet granulation Method. Antacids are generally recommended for grown-ups and children at least 12 times old, and the FDA recommends antacids as the first-line treatment for heartburn in gestation. Herbal antacids are also one of the major classes of over the Counter drugs used by patient considering its safety. Hence, in present Study we attempted to prepare two formulations, one is aluminium Hydroxide suspension and second is combination of calcium carbonate and magnesium oxide suspension aswell as compares this by marketed Formulation through antacid activity using in vitro methods viz-acid-Neutralizing capacity and buffering capacity. [ABSTRACT FROM AUTHOR]

Abstract In the current study, Lactobacillus acidophilus was encapsulated in sodium alginate and whey protein isolate, with the addition of antacids CaCO3 or Mg(OH)2. The obtained microgels were observed by scanning electron microscopy. Encapsulated and free probiotics were subjected to vitality assay under stressed conditions. Furthermore, dried apple snack was evaluated as a carrier for probiotics for 28 days. A significant (p ≤ .05) effect of antacid with an encapsulating agent was observed under different stressed conditions. During exposure to simulated gastrointestinal conditions, there were observations of 1.24 log CFU and 2.17 log CFU, with corresponding 0.93 log CFU and 2.63 log CFU decrease in the case of SA + CaCO3 and WPI + CaCO3 respectively. Likewise, high viability was observed under thermal and refrigerated conditions for probiotics encapsulated with SA + CaCO3. In conclusion, the results indicated that alginate microgels with CaCO3 are effective in prolonging the viability of probiotics under stressed conditions.

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Hyperglycemia is a long-lasting syndrome that occurs either when the pancreas cannot produce enough insulin, or the body cannot effectively utilize that insulin to regulate blood sugar levels. Non-insulin-dependent hyperglycemia, also known as type II diabetes, causes a common consequence of severe damage to many of the body's organs mainly the blood vessels and nerves. The majority of people around the world are suffering from non-insulindependent diabetes. The present work showed a great effort to investigate any possible interaction between antacids and sitagliptin (anti-diabetic drug) in the treatment of type II diabetes with gastrointestinal tract problems. The in vitro studies were carried out in simulated gastric juice pH 2.0 and intestinal pH 7.4 at 37°C. MgCO3, NaHCO3, Mg(OH)2, Al(OH)3 and CaCO3 were used as antacids in these studies. It has been observed that % release of sitagliptin was significantly enhanced in the presence of calcium carbonate and magnesium carbonates. [ABSTRACT FROM AUTHOR]

In the current study, Lactobacillus acidophilus was encapsulated in sodium alginate and whey protein isolate, with the addition of antacids CaCO3 or Mg(OH)2. The obtained microgels were observed by scanning electron microscopy. Encapsulated and free probiotics were subjected to vitality assay under stressed conditions. Furthermore, dried apple snack was evaluated as a carrier for probiotics for 28 days. A significant (p ≤.05) effect of antacid with an encapsulating agent was observed under different stressed conditions. During exposure to simulated gastrointestinal conditions, there were observations of 1.24 log CFU and 2.17 log CFU, with corresponding 0.93 log CFU and 2.63 log CFU decrease in the case of SA + CaCO3 and WPI + CaCO3 respectively. Likewise, high viability was observed under thermal and refrigerated conditions for probiotics encapsulated with SA + CaCO3. In conclusion, the results indicated that alginate microgels with CaCO3 are effective in prolonging the viability of probiotics under stressed conditions. [ABSTRACT FROM AUTHOR]

Purpose: To compare Polygel Dual (PD) and four marketed alginate-antacid combination products, with respect to raft formation and antacid properties. Methods: The pharmacopeial tests used were selected based on demonstrable performance of raftforming potential, including speed and thickness, for all selected products. Evidence-based methods were used to determine the antacid effects in terms of acid-neutralizing capacity and increase in pH. Results: Raft-forming ability was demonstrated by three products, with AF-4 and PD outperforming in speed and thickness. PD, AF-1 and AF-2 exhibited superior antacid properties. However, PD was the only product that demonstrated superior performance with respect to raft-formation and antacid potential. Raft-forming capacity was exhibited by 3 out of 5 products, viz, PD, AF-1 and AF-4. Raft formation was faster in AF-4 (15 s), followed by in PD (25 s). Similarly, raft thickness (14.79 mm) was highest in AF-4, followed by (4.39 mm) in PD. Preliminary antacid test results showed that AF-4 failed to raise pH above 3.5, but PD raised pH to 5.86, while AF-1 raised pH to 5.88. Similarly, periodic test analysis revealed that PD maintained pH above 7 for the entire test duration of 210 min, whereas AF-4 failed to raise pH to 7 during the test period. Conclusion: Polygel dual (PD) demonstrates desirable raft-forming potential and antacid properties. Moreover, it effectively raises pH and maintains it for longer duration than any of the other antacid products. Thus, PD may be considered a potentially effective treatment for acid-reflux problems. However, this claim should be validated in suitable clinical trials. [ABSTRACT FROM AUTHOR]

Magaldrate is an antacid have been widely used in the treatment of various gastric and duodenal disorders such as heartburn, reflux esophagitis, acid indigestion, gastritis, sour stomach, upset stomach, irritable stomach, gastric and duodenal ulcers. The conventional antacids dosage forms have a short duration of action which is about 2-3 hours due to gastric emptying process. A gastroretentive dosage form of antacid is needed since the healing of gastric ulcers occurs when gastric pH is kept above 3-4 during 24 hours. The present study was aimed at developing Gastro retentive bilayer drug delivery systems containing Magaldrate to minimize the side effect, improve the prolongation of action, to reduce the frequency of drug administration. A wet granulation technique was used to formulate 9 batches. Superdisintegrants like Polyplasdone XL-10, Ac-Di-Sol, and sodium starch glycolate was used for immediate release layer and HPMC K4 M, Ac-Di-Sol and lactose like polymers were used in floating layer. Preformulation studies were carried out to optimize the ratios required for various grades of polymers. The prepared floating tablets were evaluated for hardness, weight variation, thickness, friability, drug content uniformity, buoyancy lag time, total floating time, water uptake (swelling index), and in vitro dissolution studies. Successful formulation was developed having floating lag time as low as 30 sec and drug release was sustained up to 12 hrs. A biphasic drug release can be obtained by using bilayer tableting technology which involved compression of immediate and sustained release layer together. Bilayered floating tablets with release characteristics offer critical advantages such as, site specificity with improved absorption and efficacy. This technology can be inculcated to various medicaments which have stomach as the major site of absorption. [ABSTRACT FROM AUTHOR]

Acidosis, such as respiratory acidosis and metabolic acidosis, can be induced by coronavirus disease 2019 (COVID‐19) infection and is associated with increased mortality in critically ill COVID‐19 patients. It remains unclear whether acidosis further promotes SARS‐CoV‐2 infection in patients, making virus removal difficult. For antacid therapy, sodium bicarbonate poses great risks caused by sodium overload, bicarbonate side effects, and hypocalcemia. Therefore, new antacid antidote is urgently needed. Our study showed that an acidosis‐related pH of 6.8 increases SARS‐CoV‐2 receptor angiotensin‐converting enzyme 2 (ACE2) expression on the cell membrane by regulating intracellular microfilament polymerization, promoting SARS‐CoV‐2 pseudovirus infection. Based on this, we synthesized polyglutamic acid‐PEG materials, used complexation of calcium ions and carboxyl groups to form the core, and adopted biomineralization methods to form a calcium carbonate nanoparticles (CaCO3‐NPs) nanoantidote to neutralize excess hydrogen ions (H+), and restored the pH from 6.8 to approximately 7.4 (normal blood pH). CaCO3‐NPs effectively prevented the heightened SARS‐CoV‐2 infection efficiency due to pH 6.8. Our study reveals that acidosis‐related pH promotes SARS‐CoV‐2 infection, which suggests the existence of a positive feedback loop in which SARS‐CoV‐2 infection‐induced acidosis enhances SARS‐CoV‐2 infection. Therefore, antacid therapy for acidosis COVID‐19 patients is necessary. CaCO3‐NPs may become an effective antacid nanoantidote superior to sodium bicarbonate. [ABSTRACT FROM AUTHOR]

Acid-suppressant drugs (ASDs) have revolutionized the treatment of acid-related disorders such as gastroesophageal reflux and gastrointestinal ulceration in both human and veterinary species. However, continued advancement in this field is dependent on a shared understanding of both human and veterinary research as well as an appreciation for species similarities and differences. In this Currents in One Health article, we will compare the efficacy of and indications for ASDs in humans and small animals, noting species differences and knowledge gaps when applicable. We will also highlight areas where further research is needed, specifically emphasizing the need for more feline research and a better understanding of which diseases may benefit from gastroprotection. Finally, given the rising overuse of ASDs in both human and veterinary medicine, we will explore the known adverse effects of these drugs in dogs and cats. This article is focused on our current understanding of these drugs in veterinary medicine and their clinical implications. The companion Currents in One Health article by Gould et al, AJVR, October 2024, will explore the future of ASD research and use by evaluating these drugs' pH-independent effects in humans and rodent models.

Practical Relevance: Acid-related disorders including esophagitis and gastroduodenal ulceration are uncommon in the cat. However, when they occur, they can have devastating consequences and require targeted intervention, including the use of gastroprotectants. Careful consideration of the causes of esophagitis and gastroduodenal ulceration can help the clinician to determine which gastroprotectant to use, and when to begin and end gastroprotective therapy., Clinical Challenges: Gastroprotectants remain one of the most misused classes of drugs in veterinary and human medicine. There are very few studies evaluating the efficacy of gastroprotective agents in cats. Furthermore, goals for the degree of gastric acid suppression are extrapolated from studies performed in dogs and humans., Aims: This review provides a foundation for the logical approach to the choice of gastroprotectant as indicated by the disease process, and is aimed at all veterinarians who prescribe gastroprotectants for use in cats., Evidence Base: The guidance provided in this review is supported by current literature, including consensus opinion from the American College of Veterinary Internal Medicine. Gaps in evidence for use of gastroprotectants in cats are filled by extrapolations from studies performed in dogs and humans., Competing Interests: Conflict of interestKatie Tolbert is a scientific advisor for TriviumVet, the manufacturer of omepraVet (although this product has only been studied in dogs). Eric Stubbs declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Disclosures K.S. received research funding and consultancy fees from Novartis; and is on the advisory board for Daiichi-Sankyo and Pfizer. G.C.I. received research funding from Celgene, Kura Oncology, Syndax and Novartis; and consultancy fees from Novartis and Kura Oncology. E.J. received research grants from Abbvie, adaptive biotechnologies, Amgen, Pfizer, and Takeda; and consultancy fees from Abbvie, adaptive biotechnologies, Amgen, BMS, Genentech, Incyte, Novartis, Pfizer, and Takeda. H.K. received research grants from AbbVie, Amgen, Ascentage, BMS, Daiichi-Sankyo, Immunogen, Jazz, Novartis, Pfizer; and honoraria from AbbVie, Amgen, Aptitude Health, Ascentage, Astellas Health, Astra Zeneca, Ipsen, Pharmaceuticals, KAHR Medical Ltd, NOVA Research, Novartis, Pfizer, Precision Biosciences, Taiho Pharmaceutical Canada. F.G.H., C.N., S.P., and C.R. have no conflicts of interest to disclose.

Background and objective: Antacids are basic substances that can neutralize hydrochloric acid and reduce gastric acidity. They are over the counter drugs used to treat dyspepsia. The most commonly used antacids are sodium bicarbonate, magnesium hydroxide, aluminum hydroxide, and calcium carbonate. This study aimed to evaluate the effectiveness of antacids that are commonly used in Erbil city by finding their acid-neutralizing capacity. Methods: The method for acid-neutralizing capacity was adapted from pharmacopeia. The samples were prepared by dissolving the antacid in an excess amount of hydrochloric acid, then neutralizing the excess acid with sodium hydroxide solution by doing back titration. The number of milliequivalents that are neutralized by the antacid is the acid-neutralizing capacity of the antacid. Results: Rennie® chewable tablet showed the highest acid-neutralizing capacity, followed by AntacidAwa and Maalux® plus. The lowest acid-neutralizing capacity was for the suspensions Gaviscon® and Enoxon®. Conclusion: Acid-neutralizing capacity is an easy and quick method to evaluate the efficacy of antacids. Different combinations of salts and concentrations can affect the acid-neutralizing capacity of the antacid. The higher the neutralizing effect of the antacid, the more effective the antacid is.

Abstract Acidosis, such as respiratory acidosis and metabolic acidosis, can be induced by coronavirus disease 2019 (COVID‐19) infection and is associated with increased mortality in critically ill COVID‐19 patients. It remains unclear whether acidosis further promotes SARS‐CoV‐2 infection in patients, making virus removal difficult. For antacid therapy, sodium bicarbonate poses great risks caused by sodium overload, bicarbonate side effects, and hypocalcemia. Therefore, new antacid antidote is urgently needed. Our study showed that an acidosis‐related pH of 6.8 increases SARS‐CoV‐2 receptor angiotensin‐converting enzyme 2 (ACE2) expression on the cell membrane by regulating intracellular microfilament polymerization, promoting SARS‐CoV‐2 pseudovirus infection. Based on this, we synthesized polyglutamic acid‐PEG materials, used complexation of calcium ions and carboxyl groups to form the core, and adopted biomineralization methods to form a calcium carbonate nanoparticles (CaCO3‐NPs) nanoantidote to neutralize excess hydrogen ions (H+), and restored the pH from 6.8 to approximately 7.4 (normal blood pH). CaCO3‐NPs effectively prevented the heightened SARS‐CoV‐2 infection efficiency due to pH 6.8. Our study reveals that acidosis‐related pH promotes SARS‐CoV‐2 infection, which suggests the existence of a positive feedback loop in which SARS‐CoV‐2 infection‐induced acidosis enhances SARS‐CoV‐2 infection. Therefore, antacid therapy for acidosis COVID‐19 patients is necessary. CaCO3‐NPs may become an effective antacid nanoantidote superior to sodium bicarbonate.

Summary: This population-based study demonstrates a strong link between Mg-containing antacid exposure and hip fracture risk in nondialysis CKD and dialysis patients. As an Mg-containing antacid, MgO is also commonly used as a stool softener, which can be effortlessly replaced by other laxatives in CKD patients to maintain bone health. Purpose: Bone fracture is a severe complication in chronic kidney disease (CKD) patients, leading to disability and reduced survival. In CKD patients, blood magnesium (Mg) concentrations are usually above the normal range due to reduced kidney excretion of Mg. The present study examines the association between Mg-containing antacid exposure and the risk of hip fracture of CKD patients. Methods: In this nationwide nested case–control study, we enrolled 44,062 CKD patients with hip fracture and 44,062 CKD matched controls, among which the mean age was 77.1 years old, and 87.9% was nondialysis CKD. Results: As compared to non-users, Mg-containing antacid users were significantly more likely to experience hip fracture (adjusted odds ratio (OR) 1.36, 95% CI, 1.32 to 1.41; p < 0.001). Subgroup analysis showed that such risk exists in both nondialysis CKD patients and long-term dialysis patients. In contrast, aluminum or calcium-containing-antacid use did not reveal such association. Next, we examined the influence of Mg-containing antacid dosage on hip fracture risk, the adjusted ORs in the first quartile (Q1), Q2, Q3, and Q4 were 1.20 (95% CI, 1.15 to 1.25; p < 0.001), 1.35 (95% CI, 1.30 to 1.41; p < 0.001), 1.49 (95% CI, 1.43 to 1.56; p < 0.001), and 1.54 (95% CI, 1.47 to 1.61; p < 0.001), respectively, showing that such risk exists regardless of the antacid dosage. A receiver operating characteristic curve analysis demonstrated that the best cutoff value of the exposed Mg dose to discriminate the hip fracture is 532 mEq during the follow-up period. Conclusion: This population-based study demonstrates a strong link between Mg-containing antacid exposure and the hip fracture risk in both nondialysis CKD and dialysis patients. [ABSTRACT FROM AUTHOR]

Abstract Background Calcium carbonate antacids are potent over-the-counter antacids, made more effective by adding magnesium carbonate (as in Rennie, Bayer). However, published studies on their onset of action are scarce. Therefore, we carried out an in vitro study comparing Rennie and placebo under simulated conditions of the human stomach (artificial stomach model) to reconfirm the onset of action of Rennie. Methods The validated Simulator of the Human Intestinal Microbial Ecosystem apparatus (SHIME, ProDigest, Belgium) was used, comprising five reactors simulating different parts of the human gastrointestinal tract. Both Rennie and placebo were dosed at two tablets per incubation over six independent, 2-h stomach incubations each. Primary objectives: to evaluate the time required to achieve pH 3.0, 3.5, 4.0 and 4.5, as well as the maximum pH reached. Secondary objective: to evaluate pepsin activity over the entire 2-h gastric incubation. Results After addition of Rennie, the gastric medium reached a pH of 3.0 within 40 s. The maximum pH of 5.24 was maintained for almost 10 min. In contrast, the maximum pH with placebo was 1.28 during the entire gastric simulation. Furthermore, Rennie strongly reduced the activity of mucosa-damaging pepsin during the period of increased pH. With placebo, the lower pH resulted in consistently high loads of digested peptides, reflecting the high cumulative and instantaneous pepsin activity. Conclusions New data is a critical component in informed decision making. Our data confirm the high efficacy and fast onset of acid-neutralizing action of Rennie, which begins to work within seconds.

Premedication is an important part of preoperative management of all patients. It involves the optimization of underlying medical conditions and implementation of risk reduction therapies. Anxiolytic medications still have a place, particularly in certain patient populations. Important classes of drugs to consider in the perioperative period are cardiovascular drugs, anticoagulants and antiplatelets. Aspiration prophylaxis is the main risk-reduction therapy used. Benzodiazepines are still the mainstay of anxiolysis treatment, while topical anaesthesia can be used to aid cannula insertion. The most important aspect is thorough assessment of each patient, and tailoring the premedication to their specific needs. [ABSTRACT FROM AUTHOR]

Medicinal plants have been representing a rich source of antimicrobial agent as well as can be used as antacid in various ayurvedic preparations. Hence the present study was undertaken to evaluate the antibacterial potential and antacid properties of selected six plant extracts. The plant extracts such as Methanolic extracts of Cassia tora (MECT), Methanolic extracts of Pithecellobium dulce (MEPD), Chloroform extracts of Butea monosperma (CEBM), Butanolic extracts of Pongamia pinnata (BEPP), Water extracts of Tephrosia purpurea (WETP), Methanolic extracts of Mucuna pruriens (MEMP) were selected for the study. The neutralization capacity in vitro was performed using the titration method of Fordtran’s model. The antimicrobial activity was performed by using the disc diffusion method and minimum inhibitory concentration was determined by broth dilution method. The consumed volumes of artificial gastric juices to titrate to pH 3.0 for water, Sodium bicarbonate, MECT, MEPD, CEBM, BEPP, WETP and MEMP extracts solutions were found to be 1.3±0.02, 34.22±0.59*, 8.26±0.08*, 10.58±0.09*, 9.6±0.1*, 7.35±0.05, 9.36±0.09* and 9.88±0.06* respectively. The highest activity of plant extract has been shown in MECT and was found to be 25.00 mm diameter of zone of inhibition against E. coli at the concentration of 250 µg/disc followed by 24.00 mm diameter of zone of inhibition against P. aeruginosa at concentration of 250 µg/disc. Against Gram positive organism, the MECT and MEPD possess 21.00 mm and 20.00 mm diameter of zone of inhibition respectively against M. Lutues at concentration of 250µg/disc. The MIC values were found in the range of 50-500μg/ml against the tested organisms. The acid neutralizing capacity was found to be higher in MEPD and MEMP extracts among all the selected extract. The highest in vitro antimicrobial activity was found in MECT extract against gram-negative and gram-positive bacteria. [ABSTRACT FROM AUTHOR]

Gaia Pellegatta,1 Marco Spadaccini,1 Laura Lamonaca,1 Vincenzo Craviotto,1 Ferdinando D’Amico,1 Laura Ceriotti,2 Marisa Meloni,2 Alessandro Repici1 1Humanitas Clinical and Research Center and Humanitas University, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, MI, Italy; 2VitroScreen, Milano, ItalyCorrespondence: Gaia PellegattaDigestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI 20089, ItalyTel +390282247091Email gaia.pellegatta@humanitas.itPurpose: New medical devices that contain hyaluronic acid (HA) and chondroitin sulphate (CS), with or without antacid components, have been developed for the treatment of gastroesophageal reflux disease (GERD) with the aim of improving oesophageal mucosal defences by creating a film on the oesophageal mucosa and acting as a mechanical barrier against the noxious components of refluxate, both acidic and basic.Methods: The film-forming and protective efficacy of medical device A based on HA and CS plus aluminium hydroxide, device B combining HA and CS with magnesium trisilicate and device C with only the combination of HA and CS was tested on a reconstructed human oesophageal epithelium (HO2E/S/5) as a biological model in 2 different pH environments, neutral and acidic, to mimic realistic conditions. Caffeine penetration kinetics and Lucifer yellow (LY) permeability modifications induced by these products were compared to those induced by a negative control series (saline solution, code NC) and positive control series (white Vaseline, code V) under neutral and acidic pH conditions.Results: Under neutral and acidic pH conditions, compared to the negative control, all the products tested reduced (> 80% and 85– 90%, respectively) the caffeine passage, and no significant difference was observed among the products tested. Under neutral and acidic conditions, the LY permeabilities registered with device A and device C were not different from that registered with the negative control, while an LY flux% increase was calculated after 2 hrs of treatment (21.1%) with device B under acidic conditions.Conclusion: These results confirm the ability of the products tested to interact with the oesophageal epithelium in order to adhere and create a stable protective film for at least 2 hours after their homogeneous distribution on the epithelium surface. Further clinical studies are needed to test these devices in the topical treatment of gastroesophageal reflux symptoms.Keywords: hyaluronic acid, chondroitin sulphate, gastroesophageal reflux disease, antacid, caffeine, Lucifer yellow

OBJECTIVE We assessed the impact of acid suppression therapy (i.e., ranitidine or proton pump inhibitors) on iron supplementation and its ability to maintain or alter laboratory values that are commonly associated with anemia. METHODS This was a prospective, observational trial. The primary outcome was changes in serum iron levels from baseline. Secondary outcomes were changes in hemoglobin (Hgb) and hematocrit (Hct), transfusions, and maintenance of an alkalotic gastric pH. RESULTS Thirty-four patients (mean 24 ± 43 months) met inclusion criteria. The serum iron levels increased to 50.9 ± 24.6 mcg/dL by day 3. The mean difference from baseline was 1.5 mcg/dL (95% CI, 1.14-1.98, p = 0.0056). Gastric pH increased to 4.68 ± 1.49 on day 5. The mean Hgb and Hct increased on day 5 to 10 ± 1.06 g/dL and 29.6% ± 3.27%, respectively. The mean difference of Hgb was 1.15 g/dL (95% CI, 0.51-1.78, p = 0.0009). The mean difference of Hct was 3.04% (95% CI, 1.11-4.97, p = 0.0032). CONCLUSIONS The use of antacids along with oral ferrous sulfate supplementation did not affect the absorption of iron. Serum iron, Hgb, and Hct all showed statistically significant increases despite combined antacid and iron therapy. Thus, despite use of antacids, combination use showed increases in iron absorption. [ABSTRACT FROM AUTHOR]

Background: Antibiotic exposure has been associated with worse outcomes with immune checkpoint inhibitors (ICIs) in cancer patients, likely due to disruption of the gut microbiome. Other commonly prescribed medications, such as proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H2RAs), are also known to disrupt the microbiome, but data on their association with ICI outcomes are conflicting. Methods: We conducted a retrospective, multicenter, international cohort study including 314 hepatocellular carcinoma (HCC) patients treated with ICIs from 2017 to 2019 to assess the association between PPI or H2RA exposure (up to 30 days before ICI) and overall survival. Secondary outcomes included overall response rate (ORR) and development of any treatment-related adverse events (AEs). Results: Baseline PPI/H2RA exposure was not associated with overall survival in univariable (HR 1.01, 95% CI 0.75–1.35) or multivariable analysis (HR 0.98, 95% CI 0.71–1.36). Baseline PPI/H2RA exposure was not associated with either ORR (OR 1.32, 95% CI 0.66–2.65) or AEs (OR 1.07, 95% CI 0.54–2.12) in multivariable analysis. Conclusions: Our results suggest that exposure to PPI/H2RA prior to ICIs does not adversely affect outcomes in HCC patients. [ABSTRACT FROM AUTHOR]

In this study, a composite hydrogel consisting of pea protein and konjac glucomannan (KG) was fabricated using three approaches, namely neutral, salt-set, and alkaline gelation. Hydrogels made from pea protein were brittle and weak. The addition of KG improved the elasticity and water holding capacity of the pea protein hydrogels. Concomitantly, a decrease in syneresis rate and swelling of the composite hydrogels was observed. The alkaline-set hydrogels exhibited the highest resilience to strain. Thixotropicity was found to be less pronounced for salt-set hydrogels. Sulphate had a greater positive effect on the structural recovery and negative effect on hysteresis area than chloride due to the greater salting-out effect of the sulphates. The addition of KG facilitated the formation of an interconnected structure with limited mobility of biopolymer chains. A sharp increase in G' and G" during the temperature ramp indicated the predominance of hydrophobic interactions towards the aggregation of biopolymers. The infrared spectra of the hydrogels revealed a change in secondary structure of proteins on addition of KG. A controlled in vitro release of riboflavin was observed in neutral and salt-set hydrogels. The alkaline-set hydrogels exhibited a prolonged gastric retention time, thereby establishing in vitro antacid activity in the gastric environment. • Konjac glucomannan (KG) improved the structural resilience of composite pea protein (PP) hydrogels. • Alkaline-set hydrogels were more stable than neutral and salt-set hydrogels. • Alteration in secondary structure of the protein due to the addition of KG. • Controlled in-vitro release of riboflavin from the salt-set hydrogels. • Prolonged in-vitro antacid activity of alkaline-set hydrogel, compared to unencapsulated Na 2 CO 3. [ABSTRACT FROM AUTHOR]

What is known and objectiveBaking soda is a common household product promoted by the manufacturer as an antacid. It contains sodium bicarbonate and has the potential for significant toxicity when ingested in excessive amounts. Characterizing the patterns and outcomes from the misuse of baking soda as a home remedy can guide the clinical assessment and preventative counselling of patients at risk for use of this product.MethodsWe conducted a retrospective review of all symptomatic cases involving ingestion and misuse of a baking soda powder product that were reported to the California Poison Control System between the years 2000 and 2012.Results and discussionOf the 192 cases we identified, 55·8% were female, ages ranged 2 months to 79 years, and the most common reasons for misuse included antacid (60·4%), 'beat a urine drug test' (11·5%) and treat a UTI (4·7%). Most cases (55·2%) had significant symptoms warranting a medical evaluation, whereas 12 patients required hospital admission developed either electrolyte imbalances, metabolic alkalosis or respiratory depression.What is new and conclusionMisuse of baking soda can result in serious electrolyte and acid/base imbalances. Patients at highest risk of toxicity may include those who chronically use an antacid, those who use the method to 'beat' urine drug screens, pregnant women and young children. Self-treatment with baking soda as a home remedy may also mask or delay medical care thereby complicating or exacerbating an existing medical problem. We suggest that healthcare providers counsel high-risk patients about the potential complications of misuse of baking soda as a home remedy.

Abstract Background and objective Gastroesophageal reflux disease (GORD) is highly prevalent in idiopathic pulmonary fibrosis (IPF) and may play a role in its pathogenesis. Recent IPF treatment guidelines suggest that all patients with IPF be considered for antacid therapy. However, emerging evidence suggests that antacid therapy does not improve IPF patient outcomes and may increase the risk of pulmonary infection. Methods Using prospectively collected data from the Australian IPF Registry including use of antacid therapy, GORD diagnosis and GORD symptoms, the relationship of these GORD variables to survival and disease progression was assessed. The severity of GORD symptoms using the frequency scale for symptoms of GORD (FSSG) and its relationships to outcomes was also assessed for the first time in an IPF cohort. Results Five hundred eighty-seven (86%) of the 684 patients in the Australian IPF Registry were eligible for inclusion. Patients were mostly male (69%), aged 71.0 ± 8.5 years with moderate disease (FVC 81.7 ± 21.5%; DLco 48.5 ± 16.4%). Most patients were taking antacids (n = 384; 65%), though fewer had a diagnosis of GORD (n = 243, 41.4%) and typical GORD symptoms were even less common (n = 171, 29.1%). The mean FSSG score was 8.39 ± 7.45 with 43% (n = 251) having a score > 8. Overall, there was no difference in survival or disease progression, regardless of antacid treatment, GORD diagnosis or GORD symptoms. Conclusions Neither the use of antacid therapy nor the presence of GORD symptoms affects longer term outcomes in IPF patients. This contributes to the increasing evidence that antacid therapy may not be beneficial in IPF patients and that GORD directed therapy should be considered on an individual basis to treat the symptoms of reflux.

Intoduction: Self-medication is the selection and use of modern drugs, herbs, and traditional medicines by individuals to overcome diseases or symptoms of disease. One mild disease that can be treated with self-medication is gastritis. The over-the-counter medication which is frequently used in treating gastritis in self- medication is antacid. Objective: To determine the correlation between attitudes and antacid rational use in self-medication among health students at the Universitas Muhammadiyah Malang. Methods: observational analytic method using questionnaire was used for this study. The sample consist of 97 people who met inclusion criteria. Sampling was done by purposive sampling method, then the data were analyzed using Rank Spearman analysis using SPSS. This research was conducted at the campus II, Universitas Muhammadiyah Malang. Results: The results showed that 97 students of health had negative attitudes of 42% (41) and positive attitude of 58 % (56). The rational use of antacid drugs as much as 60% (58), the irrational use of drugs is 40% (39). Results of analysis using Spearman rank correlation test values were rcount 0.680 > rtable 0.202. Conclusion: The results of this study indicated that there is a significant correlation between a positive attitude to the antacid rational use in self-medication on Health Students of Universitas Muhammadiyah Malang

Background: Calcium carbonate antacids are potent over-the-counter antacids, made more effective by adding magnesium carbonate (as in Rennie, Bayer). However, published studies on their onset of action are scarce. Therefore, we carried out an in vitro study comparing Rennie and placebo under simulated conditions of the human stomach (artificial stomach model) to reconfirm the onset of action of Rennie.Methods: The validated Simulator of the Human Intestinal Microbial Ecosystem apparatus (SHIME, ProDigest, Belgium) was used, comprising five reactors simulating different parts of the human gastrointestinal tract. Both Rennie and placebo were dosed at two tablets per incubation over six independent, 2-h stomach incubations each.Primary Objectives: to evaluate the time required to achieve pH 3.0, 3.5, 4.0 and 4.5, as well as the maximum pH reached.Secondary Objective: to evaluate pepsin activity over the entire 2-h gastric incubation.Results: After addition of Rennie, the gastric medium reached a pH of 3.0 within 40 s. The maximum pH of 5.24 was maintained for almost 10 min. In contrast, the maximum pH with placebo was 1.28 during the entire gastric simulation. Furthermore, Rennie strongly reduced the activity of mucosa-damaging pepsin during the period of increased pH. With placebo, the lower pH resulted in consistently high loads of digested peptides, reflecting the high cumulative and instantaneous pepsin activity.Conclusions: New data is a critical component in informed decision making. Our data confirm the high efficacy and fast onset of acid-neutralizing action of Rennie, which begins to work within seconds. [ABSTRACT FROM AUTHOR]

Introduction: Laryngopharyngeal reflux (LPR) is highly prevalent in the general population and its impact on health systems is growing dramatically by the day. The term reflux means back flow. The contents of the stomach flowing back into the esophagus, pharynx, and larynx because of a transient relaxation of the lower esophageal sphincter cause of a spectrum of symptoms diagnosed with LPR and gastroesophageal reflux disease. Aims and Objectives: To study in detail the symptoms caused in LPR and to ascertain if and how they hamper the routine of an individual by using the reflux symptom index (RSI). Materials and Methods: The RSI is a self-administered nine-item outcomes instrument for LPR. Ninety-one patients with clinically diagnosed LPR were taken up for this study and were issued the RSI (translated into the local language for better results) before and after treatment. Data were assessed at the end of 3 months and 6 months. Observations and Results: The tabulated data showed significant improvement in the symptomatic index after treatment. Conclusion: It can thus be concluded that RSI is still highly valid in the follow-up for patients with LPR because of it can be easily administered and gives excellent validation for accurate results. [ABSTRACT FROM AUTHOR]

As the global incidence of idiopathic pulmonary fibrosis (IPF) is on the rise, there is a need for better diagnostic criteria, better treatment options, early and appropriate diagnosis, adequate care, and a multidisciplinary approach to the management of patients. This systematic review explores the role of proton pump inhibitors (PPIs) in IPF and answers the question, "Does proton pump inhibitor improve only the prognosis of gastroesophageal associated idiopathic pulmonary fibrosis or for other types of idiopathic pulmonary fibrosis too?" We used PubMed (PMC) and Google Scholar for data collection for this systematic review and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting this review. After in-depth literature screening and quality appraisal, 12 articles were selected for this systematic review. On the one hand, the efficacy of PPI therapy is supported by research such as the CAPACITY and ASCEND trials, a pilot randomized control trial (RCT) investigating the role of omeprazole in IPF and a bidirectional two-sample Mendelian randomization (MR) study, respectively. On the other hand, a systematic review and meta-analysis on antacid and antireflux surgery in IPF negate these results and show no statistical significance. Questions regarding the efficacy of PPI therapy must be dealt with in an adequately powered multicenter and double-blinded randomized control trial. The anti-inflammatory properties of antacids can serve as the cornerstone for future trials. In the following systematic review, antacid, antireflux therapy, omeprazole, and proton pump therapy are synonymous with stomach acid suppression therapy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Iftikhar et al.)

Antacids are usually alkaline substances that are used to neutralise excess acid in the stomach. Antacids were developed based on the hydroxides and carbonates of the group II and III metals, as well as the bicarbonates of the alkali metals. Antacids can be classified into two main classes being non-absorbable or absorbable antacids. Non-absorbable antacids have fewer side effects and further advantageous properties. Each antacid has a specific active ingredient which has a different effect on the gastric acid. Antacids act similar to when an acid reacts with a hydroxide; a salt and water are produced. Antacids are more effective in the form of suspension. The average therapeutic dose of an antacid is 10-15 ml of liquid or one to two tablets three to four times a day. These drugs have small volumes of distribution, undergo minimal hepatic metabolism and are excreted in faeces. Antacids that contain calcium, magnesium and aluminium ions are chelators. To avoid undesirable interactions, antacids are usually used two hours before or after taking any medication. Stress ulcerations are common in intensive care unit (ICU) patients. The pathophysiology of the ulceration probably results from an imbalance between mucosal protection and gastric acid hypersecretion. Whilst prophylaxis was provided to every patient previously, it is wise to individualise the decision and to only provide it to high risk patients. For critically ill patients who are able to receive enteral medications and in whom prophylaxis is indicated, an oral proton pump inhibitor (PPI) is preferred rather than an alternative prophylactic agent. For critically ill patients who cannot receive enteral medications, an intravenous (IV) histamine 2 (H2) receptor blocker or IV PPI can be administered. Where PPIs or H2 blockers cannot be administered, sucralfate is a suitable oral alternative. [ABSTRACT FROM AUTHOR]

Background: Reflux occurs in 50% of healthy infants at some point. This is most often a physiological condition and does not require drug treatment. Various studies have shown that the use of drugs affecting gastric acidity (DAGAs) in infants is increasing. This entails disadvantages such as unnecessary exposure of infants to medication and their side effects and a higher cost to society. Objective: To get an image of the current practice in Flanders regarding diagnosis and treatment of gastro-oesophageal reflux disease (GORD) in infants and the associated use of DAGAs. To this end, we determined both parents’ and health care providers’ experiences and perceptions about these treatments. Method: An observational cross-sectional study was conducted in April and May 2019. We developed a questionnaire for parents and three different questionnaires for health care providers (HCPs), including midwives, general practitioners, paediatricians and community pharmacists (CPs). The questionnaire for parents was only available through an online platform. HCPs were questioned face-to-face and through an online platform. Results: This study made clear that the counselling of children with GORD is multidisciplinary as the median number of counselling HCPs is 3 (interquartile range (IQR) = 2–4). 63% of the included 251 parents also seek support through online forums and groups. 60% of parents report that no physical tests were performed before DAGAs were prescribed and 39% of parents additionally state they perceived no effect of the prescribed DAGAs. Although parents reported to understand HCPs well (average score 7.4/10), satisfaction with care and information provision was scored lower (between 4.8 and 6.1/10). On the other hand, 234 HCPs answered the questionnaire, of which 89 midwives, 78 community pharmacists and 67 physicians. Only 45 HCPs indicate that guidelines to diagnose or treat GORD are clear. Physicians confirm they perform very little physical testing before starting DAGAs. Provided nonmedical measures to patients are largely in line with the European guidelines, however perceived effectiveness is moderate. Conclusion: Parents are in need for more information about tests, nutrition and (non)medical measures. HCPs on the other hand are in need for clear guidelines on diagnosing and treating GORD. [ABSTRACT FROM AUTHOR]

Background: Antacids are the most commonly used medications for fast symptomatic relief of gastric disorders. Because of adverse effects, low efficiency and the high cost of some chemical antacids, identifying a natural medicine with high efficiency and low cost seems useful. Therefore, the aim of the present study was to prepare antacid tablets from Cuttlefish bone and assessment of its antacid properties. Methods: 24 different formulations of cuttlefish bone were prepared by direct compression using different fillers (starch, cellulose, lactose, and mixture of those) in different ratios of the drug. Characterization of powders and tablets was done on all formulations and marketed dosage forms (calcium carbonate and Al-Mg). Results: Weight uniformity, hardness, and friability of all formulations were in acceptable range. Tablets prepared by calcined cuttlebone disintegrated in longer time due to their higher hardness which were mostly higher than 5 Kg. Also, disintegration time of formulations 50-50 (lower dose of cuttlebone) was less than other tablets (2 minutes or less). Results of antacid capacity showed that formulations 90-10 and 80-20 raise the acidic pH of the medium above 7.5, which were the same as or more than the capacity of the marketed tablets. Conclusion: Tablets were prepared by 90 or 80% of either calcined or non-calcined cuttlebone showed the highest antacid capacity.

Sugar free chewable tablets are considered to be desired medication for diabetic population having acid reflex problems. The main objective of this study is to develop a patient complaint tablet dosage form which is sugar free, chewable and easy to use. The formulation is designed for hyperglycemic and dysphasic patients along acidity or stomach ulcer. For manufacturing Aluminum Hydroxide (Kyowa Japan), Magnesium Hydroxide (Taurus chemicals India) Simethicone, Povidone (JRS Pharma) Sorbitol powder, Magnesium stearate, Dilcalcium phosphate anhydrous, SSG (JRS Pharma) and Aspartame were used. The granules are formed by wet granulation method and tablets are compressed by rotary compression machine. The pre-formulation studies of granules (Angle of repose, Bulk/Tapped density, Carr's compressibility index and Hausner's ratio), uniformity of content (assay), acid neutralizing capacity, Identification by FTIR spectroscopy all are found within the limits as per USP specifications. All three formulation batches are stable under accelerated and ambient stability conditions for 6 months and 24 months respectively. The formulation development of sugar free oral chewable antacid tablet is pharmaceutically stable and can further analyze for safety and efficacy studies. [ABSTRACT FROM AUTHOR]

Calcium carbonate (CaCO3)-based materials have received notable attention for biomedical applications owing to their safety and beneficial characteristics, such as pH sensitivity, carbon dioxide (CO2) gas generation, and antacid properties. Herein, to additionally incorporate antioxidant and anti-inflammatory functions, we prepared tannylated CaCO3 (TA-CaCO3) materials using a simple reaction between tannic acid (TA), calcium (Ca2+), and carbonate (CO32−) ions. TA-CaCO3 synthesized at a molar ratio of 1:75 (TA:calcium chloride (CaCl2)/sodium carbonate (Na2CO3)) showed 3–6 μm particles, comprising small nanoparticles in a size range of 17–41 nm. The TA-CaCO3 materials could efficiently neutralize the acid solution and scavenge free radicals. In addition, these materials could significantly reduce the mRNA levels of pro-inflammatory factors and intracellular reactive oxygen species, and protect chondrocytes from toxic hydrogen peroxide conditions. Thus, in addition to their antacid property, the prepared TA-CaCO3 materials exert excellent antioxidant and anti-inflammatory effects through the introduction of TA molecules. Therefore, TA-CaCO3 materials can potentially be used to treat inflammatory cells or diseases.

Food is an important source of human aluminium (Al) exposure and regular consumption of foods containing Al-based food additives may result in high Al intakes above health-based tolerable intakes. However, some additives are Al salts with low solubility, and little is known about bioavailability of Al in these additives. We investigated urine Al concentrations in healthy adult volunteers (N = 18, women/men) before (base-line) and after 7 days of ingestion of pancakes with a low Al content (median: <0.5 mg Al/kg) and high Al content (median: 860 mg/kg). The high-Al pancakes contained the common additive sodium aluminium phosphate (SALP). The participants did not know if the pancakes contained SALP or not during the experiment. After adjusting for creatinine content of the urine samples, median base-line Al concentrations before pancake ingestion were in the range 30–40 µmol Al/mol creatinine. Urine Al concentrations after ingestion of low-Al pancakes (average intake: <0.042 Al mg/day) did not differ significantly from the base-line levels. After ingestion of high-Al pancakes (72 mg Al/day) the median Al concentration in urine was more than 2-fold higher than at the base-line sampling before the high-Al pancake ingestion. At the end of the experiment the volunteers ingested an Al-containing antacid (Al-OH, 1800 mg Al/day) for 7 days as a positive control of Al absorption. This caused a 10-fold increase in median urine Al concentration compared to base-line. Our results strongly suggest that Al in the form of SALP in a pancake mix is bioavailable for absorption in humans, which should be taken into account in risk assessment of Al in food in countries with a high use of SALP as a food additive. [ABSTRACT FROM AUTHOR]

Objective: To investigate the intragastric acid neutralization activity of a combined alginate-antacid formulation. Significance: Published studies have investigated the reflux-suppressing alginate component of Gaviscon Double Action (Gaviscon DA; RB, UK) but intragastric acid neutralization activity of the antacid component has not been evaluated in vivo. Methods: Intragastric pH monitoring, using a custom-made 10-electrode catheter, was evaluated in a two-part exploratory study in healthy subjects; Part I (n = 6) tested suitability of the catheter using antacid tablets (Rennie; Bayer, Germany); Part II (n = 12) evaluated gastric acid neutralization activity of Gaviscon DA liquid (20 ml) versus placebo in fasted subjects using a randomized, open-label, crossover design. The primary endpoint was the percentage of time that intragastric pH ≥4 was measured during 30 min post-treatment. A confirmatory study of identical design was subsequently conducted (n = 20). Results: Monitoring pH using the multielectrode catheter was a viable approach, directly detecting changes in intragastric pH following a single dose of antacid tablets. In the exploratory study, the percentage of time that pH ≥4 during 30 minutes post-treatment was 46.8% with Gaviscon DA liquid versus 4.7% with placebo (p = 0.0004). These findings were supported by the confirmatory study, where pH ≥4 was recorded 50.8% of the time with Gaviscon DA versus 3.5% with placebo (p = 0.0051). In this study, Gaviscon DA was safe and well tolerated. Conclusions: These studies demonstrate the effective acid neutralizing capacity of Gaviscon DA versus placebo in healthy, fasted subjects. This adds to the evidence base for the combination of alginates and antacids. [ABSTRACT FROM AUTHOR]

Abstract Premedication is an important part of preoperative management of all patients. It involves the optimization of underlying medical conditions and implementation of risk reduction therapies. Anxiolytic medications still have a place, particularly in certain patient populations. Important classes of drugs to consider in the perioperative period are cardiovascular drugs, anticoagulants and antiplatelets. Aspiration prophylaxis is the main risk-reduction therapy used. Benzodiazepines are still the mainstay of anxiolysis treatment, while topical anaesthesia can be used to aid cannula insertion. The most important aspect is thorough assessment of each patient, and tailoring the premedication to their specific needs. [ABSTRACT FROM AUTHOR]

Background: Reflux occurs in 50% of healthy infants at some point. This is most often a physiological condition and does not require drug treatment. Various studies have shown that the use of drugs affecting gastric acidity (DAGAs) in infants is increasing. This entails disadvantages such as unnecessary exposure of infants to medication and their side effects and a higher cost to society. Objective: To get an image of the current practice in Flanders regarding diagnosis and treatment of gastro-oesophageal reflux disease (GORD) in infants and the associated use of DAGAs. To this end, we determined both parents’ and health care providers’ experiences and perceptions about these treatments. Method: An observational cross-sectional study was conducted in April and May 2019. We developed a questionnaire for parents and three different questionnaires for health care providers (HCPs), including midwives, general practitioners, paediatricians and community pharmacists (CPs). The questionnaire for parents was only available through an online platform. HCPs were questioned face-to-face and through an online platform. Results: This study made clear that the counselling of children with GORD is multidisciplinary as the median number of counselling HCPs is 3 (interquartile range (IQR) = 2–4). 63% of the included 251 parents also seek support through online forums and groups. 60% of parents report that no physical tests were performed before DAGAs were prescribed and 39% of parents additionally state they perceived no effect of the prescribed DAGAs. Although parents reported to understand HCPs well (average score 7.4/10), satisfaction with care and information provision was scored lower (between 4.8 and 6.1/10). On the other hand, 234 HCPs answered the questionnaire, of which 89 midwives, 78 community pharmacists and 67 physicians. Only 45 HCPs indicate that guidelines to diagnose or treat GORD are clear. Physicians confirm they perform very little physical testing before starting DAGAs. Provided nonmedical measures to patients are largely in line with the European guidelines, however perceived effectiveness is moderate. Conclusion: Parents are in need for more information about tests, nutrition and (non)medical measures. HCPs on the other hand are in need for clear guidelines on diagnosing and treating GORD.

This study investigated the quantitative polyphenolic constituents and gastroprotective effects of aqueous leaf extracts of Spondias mombin and Ficus exasperata against indomethacin-induced gastric ulcer in rats. Ulceration was induced by a single oral administration of indomethacin (30 mg/kg body weight). Wistar rats were pretreated with esomeprazole (reference drug) at a dose of 20 mg/kg body weight, S. mombin or F. exasperata at 100 and 200 mg/kg body weight once daily for 21 days prior to ulcer induction. At the end of the experiment, gastric secretions and antioxidant parameters were evaluated. We observed that the significantly increased (p