Medical News You May Have Missed - Week of February 25th

March 4, 2013

GERD and magnets; calcium, vit D, and fractures; GLP-1 agonists and pancreatitis; hip replacement and women; acupuntcure and Bell palsy

Acid Reflux Eased in 92% of Patients with Implanted Magnetic Device

Sixty-four percent of patients with gastroesophageal acid reflux had a normalization of esophageal acid exposure or a 50% or greater reduction in acid exposure at one year after implantation of a magnetic device that augments the esophageal sphincter. It is estimated that about 1 in 3 people in the United States has gastric reflux disease. Proton-pump inhibitors (PPIs) are effective but for many provide incomplete control of reflux.

The beaded bracelet-like device augments resistance of the esophageal sphincter to abnormal opening associated with reflux.

In the analysis, more than 90% of patients who were given the device had a reduction of 50% or more in the use of PPIs used to control their disease, and 92% of patients had a more than 50% improvement in quality of life.

The study, published on February 21st in the New England Journal of Medicine, examined outcomes with the device in a group of 100 patients. No control arm was used in the study.

An abstract of the study is available here.

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USPSTF: Calcium, Vitamin D Not Recommended to Prevent Fractures

The United States Preventive Services Task Force has issued a recommendation advising against daily supplementation with 400 IU or less of vitamin D and 1,000 mg or less of calcium for the primary prevention of fractures in postmenopausal women. The USPSTF, on the other hand, could not assess on the strength of evidence available the balance of benefits and harms for taking vitamin D and calcium supplements at higher doses for fracture prevention in this population. The statement was published online today in the Annals of Internal Medicine.

In addition, the task force stated that there is not enough evidence to support the use of these two supplements combined for the prevention of fractures in men and premenopausal women.

Although the Institute of Medicine and the World Health Organization have both issued recommendations for adequate daily intake of calcium and vitamin D, these organizations addressed them in the setting of overall health, and not one specific to fracture prevention, the researchers explained.

The USPSTF statement emphasized that the recommendations apply only to the population studied: community-dwelling adults with no history of fractures, and that includes adults, ages 65 and older, who are at increased risk for falls. The panel also notes that the recommendation against supplementation with vitamin D and calcium does not apply to adults with osteoporosis or vitamin D deficiency.

The full study is available here.

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GLP-1 Agonists Linked to Higher Pancreatitis Risk

Both current and recent use of the glucagon-like peptide 1 (GLP-1) agonists exenatide and sitagliptin were associated with a more than twofold increased risk for acute pancreatitis among a group of adults with type 2 diabetes. These findings were published online February 25 in JAMA: Internal Medicine.

Patients who had used either drug within 30 days had an increased adjusted odds ratio (OR) of 2.24 (95% CI, 1.36-3.69, P=.01) for acute pancreatitis. Recent use, defined as past 30 days but within 2 years, resulted in an adjusted OR of 2.01 (95% CI, 1.37-3.18, P=.01) for emergent pancreatitis. Both current use (OR=2.01) and recent use (OR=1.95) were associated with a statistically significant increase in hospitalization rate for the condition.

The scientific and medical communities have known that pancreatitis could be a side effect of GLP-1 drugs, a pre-approval risk that was noted in animal studies. The researchers said their study is the first to accurately assess the degree of risk in humans.

The study abstract is available here.

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Hip Implant Failure Found One-Third Higher in Women

Women who underwent total hip replacement were at an almost 30% increased risk for all-cause revision of the surgery compared with men who had undergone the same procedure (HR=1.29; 95% CI, 1.11-1.51) even after adjustment for a multitude of risk factors including those associated with the patient, surgeon and surgery.

Risk for aseptic revision of the surgery was also increased in women vs. men (HR=1.32; 95% CI, 1.10-1.58); however, there was no increased risk for septic revision between sexes.

The researchers looked at a prospective cohort of patients between 2001 and 2010 who underwent primary, unilateral hip replacement.

“The differences in prosthesis choices in men and women, as well as the follow-up of the presented study and non-measured possible confounders, are important considerations when interpreting these results,” the researchers wrote.

Read the abstract here.

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Acupuncture to Treat Bell Palsy: The Stronger, the Better

Patients with Bell palsy who received acupuncture treatment that achieved a state of de qi, or intense stimulation, experienced a four times greater improvement in facial function (OR=4.16; 95% CI, 2.23-7.78) than patients who underwent less intense acupuncture. Results of the prospective multicentre randomized controlled trial were published February 25 in the Canadian Medical Association Journal.

De qi is a combination of sensations stimulated by manipulation of acupuncture needles - soreness, tingling, coolness, warmth and others radiating at the insertion points - but has not been validated by randomized controlled trials. Intensity of each sensation was rated by patients using a visual analog scale.

Achieving de qi also resulted in significant improvements in disability assessment (differences of least squares means 9.80, 95% CI, 6.29-13.30) and quality of life (differences of least squares means 29.86, 95% CI, 22.33–37.38).

Find the full text of the study here.

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