News from DDW 2018: GERD is appearing in younger patients; PPI first use linked to many adverse events; and, new test for bile salts in saliva.
Trends in GERD Diagnosis and Questions about PPIs 3 Studies At-a-Glance based on presentations at Digestive Disease Week 2018, June 2-5, 2018 Washington, DC
The changing epidemiology of gastroesophageal reflux disease (GERD) - Are we seeing younger patients?
Is Age at GERD Diagnosis Decreasing? National (Explorys) and local (Epic) medical record database study of over 54 million patients; evaluated GERD prevalence, age, gender, race and PPI therapy over 11 years.
Increased GERD Diagnosis, PPI Use in 30-39-year-olds. From 2006-2016 GERD prevalence increased across all ages except older individuals and the greatest increase was seen in the age range of 30-39 years; GERD was found more significantly more common in whites and in women.
PPI Use: Decrease in Elders, Increase in aged 30-39 years. Conclusions: GERD still predominantly diagnosed in middle aged and older adults; GERD and PPI use increasingly common in younger age groups. Abstract from DDW 2018.
Epidemiology of first-time proton pump inhibitor users in the United States between 2012 to 2017: a population based national study
Largest Study to Evaluate Adverse Events with First-Time PPI Use. National medical record database study (Explorys) included ~36 million individuals, approximately 3.5 million with first-time PPI use (prevalence 9.79%). compared frequency of adverse events.
First-Time PPI Use Linked to Many Adverse Events. Odds of many adverse events significantly linked to first-time PPI use: CKD, dementia, hypomagnesemia, C. diff, hip fracture, spine fracture, CAP, cardiovascular events (p<.001 for all).
Odds Adverse Events Linked to First-Time PPI Use. Conclusion: Further studies needed to evaluate temporal relationshipbetween PPI use and these adverse events in order to understand cause and effect. Abstract from DDW 2018.
Presence of bile acids detected in human saliva using a novel sensitive bioanalytical method: a comparative study in patients with persistent or controlled GERD symptoms and healthy subjects
New Method to Measure Bile Acids in GERD. New method: high-performance liquid chromatography-mass spectrometry (HPLC/MS/MS) Simultaneously monitors 10 bile acids in saliva; high sensitivity ≥1 nM.
Potential Non-Invasive Method to Dx Persistent GERD. Conclusion: HPLC/MS/MS is highly sensitive and can measure very low amounts of bile acids in human saliva. Abstract from DDW 2018.
GERD Trends and PPI Use--Take Home Points
National medical record database study found increasing GERD diagnosis and PPI use in ages 30-39 from 2006-2016
Largest study of its kind found odds of first-time PPI use linked to myriad adverse events; more studies needed to understand cause and effect
Study suggests a new highly sensitive method of measuring bile acids in saliva may be an alternative, noninvasive way to assess persistent GERD
References Perez N, Shao JZ, Mittleman R, et al. Presence of Bile Acids Detected in Human Saliva using a Novel Sensitive Bioanalytical Method: A Comparative Study in Patients with Persistent or Controlled Gerd Symptoms and Healthy Subjects. Gastroenterology. 2018;154:S-484Elchert JA, Mansoor E, Saleh MA, Cooper GS. Epidemiology of First Time Proton Pump Inhibitor Users in the United States Between 2012 to 2017: A Population Based National Study. Gastroenterology. 2018; 154:S-232.Yamasaki T, Hemond C, Fass, R. The Changing Epidemiology of Gastroesophageal Reflux Disease (GERD)- are We Seeing Younger Patients? Gastroenterology. 2018;154: S-233.
