PPI’s and Gastric Cancer Risk

Objective The association between proton pump inhibitor (PPI) use and gastric cancer related to Helicobacter pylori eradication has not been fully investigated in geographical regions with high risk of gastric cancer. We aimed to evaluate the association between PPIs and gastric cancer in Korea.

Design This study analysed the original and common data model versions of the Korean National Health Insurance Service database from 2002 to 2013. We compared the incidence rates of gastric cancer after 1-year drug exposure, between new users of PPIs and other drugs excluding PPIs, by Cox proportional hazards model. We also analysed the incidence of gastric cancer among PPI users after H. pylori eradication.

Results The analysis included 11 741 patients in matched PPI and non-PPI cohorts after large-scale propensity score matching. During a median follow-up of 4.3 years, PPI use was associated with a 2.37-fold increased incidence of gastric cancer (PPI≥30 days vs non-PPI; 118/51 813 person-years vs 40/49 729 person-years; HR 2.37, 95% CI 1.56 to 3.68, p=0.001). The incidence rates of gastric cancer showed an increasing trend parallel to the duration of PPI use. In H. pylori-eradicated subjects, the incidence of gastric cancer was significantly associated with PPI use over 180 days compared with the non-PPI group (PPI≥180 days vs non-PPI; 30/12 470 person-years vs 9/7814 person-years; HR 2.22, 95% CI 1.05 to 4.67, p=0.036).

Conclusion PPI use was associated with gastric cancer, regardless of H. pylori eradication status. Long-term PPIs should be used with caution in high-risk regions for gastric cancer.

Association between proton pump inhibitor use and gastric cancer: a population-based cohort study using two different types of nationwide databases in Korea — https://gut.bmj.com/content/early/2021/05/11/gutjnl-2020-323845?rss=1
  • Prevacid 24HR
  • Nexium 24HR
  • Prilosec OTC
  • Zegerid OTC

OTC PPIs are only intended for a 14-day course of treatment and can be used up to three times per year.

Over-The-Counter (OTC) Heartburn Treatment — https://www.fda.gov/drugs/information-consumers-and-patients-drugs/over-counter-otc-heartburn-treatment

I was thinking of a snarky comment but decided against posting any snark.

But if you routinely pop a PPI before and/or after chowing down on a meat lover’s pizza you can’t say you weren’t advised that maybe it might be a better idea to give up the pizza.

The Other Pandemic

Even under the best circumstances, however, addiction is a disease prone to relapse. An estimated 40-60% of people who misuse drugs will return to using them at some point during recovery—and it’s this time that leaves them most vulnerable to overdose, since their tolerance has dropped, often dramatically, during their period of abstinence.

The US covid pandemic has a sinister shadow—drug overdoses — BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4751 (Published 17 December 2020)

Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020

MentalHealthCOVID19_IMAGE_14Aug20_1200x675-medium

The survey results are in line with recent data from Mental Health America, which indicate dramatic increases in depression, anxiety, and suicidality since the start of the COVID-19 pandemic.

Citation: Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1external icon.

 

 

More Drugs Please

 

According to Ginger, an organization that provides mental health services to companies, compared to January and February of this year, prescriptions for psychotropics, most of which were antidepressants, were up 86% for the months of March and April.

The stress of unemployment, social isolation and health concerns are all cited by Americans who say the lock down is having a serious impact on their mental health.

Pharmacy group Express Scripts also revealed that prescriptions for anti-anxiety medications were up 34.1% between mid-February and mid-March, while prescriptions for antidepressants increased 18.6%.

Link to the source article.

Wow.

Goodbye Benadryl

Link to the full article here.

Benadryl isn’t safe

Benadryl causes significant sedation. One study in a driving simulator showed an ordinary adult dose of Benadryl caused worse driving than a blood alcohol level of 0.1 percent (that’s between buzzed-drunk and frat-party drunk). Ordinary doses of Benadryl can also cause urinary retention, dizziness, trouble with coordination, dry mouth, blurry vision, and constipation. Especially in older individuals, diphenhydramine can cause delirium and contribute to long term dementia.

You be the judge.

Got DM1? Don’t do Pot

Abstract

OBJECTIVE We examined the frequency of diabetic ketoacidosis (DKA) in cannabis users compared with nonusers in the T1D Exchange clinic registry (T1DX).

RESEARCH DESIGN AND METHODS The association between cannabis use by total substance score for cannabis (TSC) and DKA in the past 12 months was examined using a logistic regression model adjusted for potential confounders among adults in the T1DX.

RESULTS Of 932 adults with type 1 diabetes, 61 had a TSC >4, which classified them as moderate cannabis users. Adjusting for sex, age at study visit, and HbA1c, cannabis use was associated with a twofold increase in risk for DKA among adults with type 1 diabetes (odds ratio 2.5 [95% CI 1.0–5.9]).

CONCLUSIONS Cannabis use was associated with an increased risk for DKA among adults in the T1DX. Providers should inform their patients of the potential risk of DKA with cannabis use.

© 2019 by the American Diabetes Association.

Cannabis Use Is Associated With Increased Risk for Diabetic Ketoacidosis in Adults With Type 1 Diabetes: Findings From the T1D Exchange Clinic Registry