3b:I[281230,["/_next/static/immutable/chunks/0l5c-zsrs2aic.js","/_next/static/immutable/chunks/3_n0rk2989-8h.js","/_next/static/immutable/chunks/3ofw495lt1gr1.js","/_next/static/immutable/chunks/3tofdpg99uc12.js","/_next/static/immutable/chunks/2rzojj6zgb9d9.js","/_next/static/immutable/chunks/42jxjvozn2thc.js","/_next/static/immutable/chunks/1jp6nkbajpbfs.js","/_next/static/immutable/chunks/3jn_lf7v27x-6.js","/_next/static/immutable/chunks/33qq2-hg37d0b.js","/_next/static/immutable/chunks/15isb0svrppbz.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/0asz50g5_lfq9.js","/_next/static/immutable/chunks/30ia-cxa0yoyc.js","/_next/static/immutable/chunks/3ghibkczd0agr.js","/_next/static/immutable/chunks/20mjl75wrar8n.js","/_next/static/immutable/chunks/3nxreg9fiyt2y.js","/_next/static/immutable/chunks/0c04lgvo3p78i.js","/_next/static/immutable/chunks/1u78gf_avpn77.js"],"PaperListPageClient"] 3e:I[70339,["/_next/static/immutable/chunks/355lxm8rh3fxr.js"],"IconMark"] 3c:T798,Background Prescribing patterns in primary care could demonstrate early clinical features of cancer and windows of opportunity for timely investigation. Aim Analyse primary care prescription patterns prior to a pancreatic cancer diagnosis. Design and Setting Retrospective cohort study using linked primary care and cancer registry data from patients diagnosed with pancreatic cancer in England between 2011-2018. Method Prescription records registered in the Clinical Practice Research Datalink were analysed in the five years pre-diagnosis. Eight categories of prescriptions which may be used to treat clinical features of pancreatic cancer were included (anti-emetics, anti-reflux medications, insulin, other hypoglycaemic agents, opioids, non-opioid analgesics, neuropathic analgesics and non-steroidal anti-inflammatories). Poisson regression was used to estimate the inflection points for increased prescribing above baseline. Results Among 12,990 patients, 669,287 prescriptions were analysed. Insulin was the least common prescription (7% patients), anti-reflux the most common (53% patients). Insulin prescribing increased 19 months pre-diagnosis (95% confidence interval [CI]=14.2-23.8), rising earlier in females (25 months; 95% CI=17.4-32.5) than males (11 months; 95% CI=5.8-16.2). Prescriptions for other hypoglycaemic agents increased 13 months (95% CI=7.7-18.5), anti-reflux and opioid analgesic prescribing 7 months (95% CI=5.4-8.6 and 4.4-9.6, respectively) and anti-emetics and non-opioid analgesics 5 months (95% CI=2.9-7.1 and 3.2-6.8, respectively) prior to diagnosis. Conclusion The early increase in insulin prescribing suggests tumour-induced type 3c diabetes, highlighting an opportunity for earlier diagnosis in a small proportion of patients. Opportunities for earlier diagnosis through investigation and referral also exist in patients prescribed anti-emetic, anti-reflux, and analgesic medications in primary care.3d:T7a9,Background Prescribing patterns in primary care could demonstrate early clinical features of cancer and windows of opportunity for timely investigation. Aim Analyse primary care prescription patterns prior to a pancreatic cancer diagnosis. Design and Setting Retrospective cohort study using linked primary care and cancer registry data from patients diagnosed with pancreatic cancer in England between 2011-2018. Method Prescription records registered in the Clinical Practice Research Datalink were analysed in the five years pre-diagnosis. Eight categories of prescriptions which may be used to treat clinical features of pancreatic cancer were included (anti-emetics, anti-reflux medications, insulin, other hypoglycaemic agents, opioids, non-opioid analgesics, neuropathic analgesics and non-steroidal anti-inflammatories). Poisson regression was used to estimate the inflection points for increased prescribing above baseline. Results Among 12,990 patients, 669,287 prescriptions were analysed. Insulin was the least common prescription (7% patients), anti-reflux the most common (53% patients). Insulin prescribing increased 19 months pre-diagnosis (95% confidence interval [CI]=14.2-23.8), rising earlier in females (25 months; 95% CI=17.4-32.5) than males (11 months; 95% CI=5.8-16.2). Prescriptions for other hypoglycaemic agents increased 13 months (95% CI=7.7-18.5), anti-reflux and opioid analgesic prescribing 7 months (95% CI=5.4-8.6 and 4.4-9.6, respectively) and anti-emetics and non-opioid analgesics 5 months (95% CI=2.9-7.1 and 3.2-6.8, respectively) prior to diagnosis. Conclusion The early increase in insulin prescribing suggests tumour-induced type 3c diabetes, highlighting an opportunity for earlier diagnosis in a small proportion of patients. Opportunities for earlier diagnosis through investigation and referral also exist in patients prescribed anti-emetic, anti-reflux, and analgesic medications in primary care.28:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Proton Pump Inhibitor: Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Proton Pump Inhibitor (modality). 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Rising antimicrobial resistance means H. pylori regimens should be selected based on local resistance patterns, and P-CABs represent a growing option worth considering in appropriate patients."}},{"doi":"10.1111/apt.70985","pmid":"42765157","title":"Medication Use and Risk of Microscopic Colitis: A Propensity‐Matched Analysis of US Adults ≥ 50 Years (2014–2024)","journal_title":"Alimentary Pharmacology & Therapeutics","journal_issn":"0269-2813","published_at":"2026-09-21T00:00:00.000Z","url":"https://doi.org/10.1111/apt.70985","source_score":9,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-26T13:50:03.054Z","updated_at":"2026-09-26T13:50:03.054Z","tags":[{"paper_doi":"10.1111/apt.70985","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"condition","value":"Microscopic Colitis","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"Angiotensin Receptor Blocker","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"Non-Steroidal Anti-Inflammatory Drug","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"modality","value":"Statin","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"sample_size","value":"n=907266","value_numeric":907266},{"paper_doi":"10.1111/apt.70985","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"warning","value":"Exposure was defined as ≥3 prescriptions, which may not capture over-the-counter NSAID use, leading to possible exposure misclassification","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"warning","value":"MC diagnosis was based on administrative ICD codes, which may not reflect histologically confirmed cases — potentially inflating or diluting true associations","value_numeric":null},{"paper_doi":"10.1111/apt.70985","tag_type":"warning","value":"The study population is limited to U.S. adults ≥50 years with documented healthcare encounters, which may limit generalizability to younger patients or those with less healthcare access","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study used the TriNetX database (2014–2024) to evaluate whether NSAIDs, PPIs, SSRIs, ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and statins are associated with incident microscopic colitis (MC) in U.S. adults ≥ 50 years, using 1:1 propensity score matching and Cox proportional hazards models over a 2-year follow-up.","key_result":"NSAIDs (HR 1.15; 95% CI 1.02–1.30), PPIs (HR 1.36; 95% CI 1.19–1.54), and SSRIs (HR 1.52; 95% CI 1.27–1.83) were each associated with significantly increased MC risk, while ACEIs, ARBs, and statins showed no significant association.","limitations":"The retrospective design using administrative diagnostic codes risks misclassification of MC (which requires biopsy confirmation); confounding by indication cannot be fully excluded despite propensity matching; and the study cannot establish causality or capture over-the-counter NSAID use systematically.","practice_takeaway":"In patients aged ≥ 50 presenting with new-onset chronic diarrhoea, clinicians should review current medications — particularly NSAIDs, PPIs, and SSRIs — as a potential contributing cause of microscopic colitis and consider withdrawal where clinically feasible."}},{"doi":"10.1111/all.70517","pmid":"42744607","title":"Single‐Cell Profiling Links T‐Cell Accumulation and\n \n T\n _H\n 2\n \n /\n \n T\n _H\n 17\n \n Dynamics to Eosinophilic Esophagitis (\n EoE\n ) Activity in Children","journal_title":"Allergy","journal_issn":"0105-4538","published_at":"2026-09-15T00:00:00.000Z","url":"https://doi.org/10.1111/all.70517","source_score":5,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-21T23:14:47.663Z","updated_at":"2026-09-21T23:14:47.663Z","tags":[{"paper_doi":"10.1111/all.70517","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1111/all.70517","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1111/all.70517","tag_type":"condition","value":"Eosinophilic Esophagitis","value_numeric":null},{"paper_doi":"10.1111/all.70517","tag_type":"condition","value":"Gastroesophageal Reflux Disease","value_numeric":null},{"paper_doi":"10.1111/all.70517","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1111/all.70517","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/all.70517","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1111/all.70517","tag_type":"modality","value":"Single-Cell RNA Sequencing","value_numeric":null},{"paper_doi":"10.1111/all.70517","tag_type":"modality","value":"Topical Corticosteroid","value_numeric":null},{"paper_doi":"10.1111/all.70517","tag_type":"sample_size","value":"n=150","value_numeric":150},{"paper_doi":"10.1111/all.70517","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/all.70517","tag_type":"study_design","value":"Prospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/all.70517","tag_type":"warning","value":"Total sample size of 150 represents all three groups combined (EoE n=50, GERD n=33, FD n=67); subgroup analyses have smaller Ns. Study design is described as prospective with longitudinal biopsies but is not a randomized trial—treatment assignment was not randomized. Sex distribution was not explicitly reported in the abstract; 'mixed' is assumed.","value_numeric":null}],"summaries":{"what_studied":"Single-cell RNA sequencing and multiparametric immunofluorescence were used to profile esophageal T-cell infiltrates across disease activity states in pediatric EoE patients (n=50, up to 6 follow-up endoscopies), compared to GERD (n=33) and functional disorder (n=67) controls.","key_result":"TH2 cells and GNLY+ activated CD8+ T-cells positively correlated with esophageal eosinophilia (R=0.36, p=0.036; R=0.33, p=0.038), while IL-17+ CD4+ T-cells showed a negative correlation (R=−0.43, p=0.016). TH2 cells were enriched in active vs. inactive EoE (p=0.002), and topical steroid (TS) remission left significantly less residual CD8+ T-cell infiltration than PPI remission (p=0.0092).","limitations":"Low T-cell yields in biopsies after topical steroid treatment limited single-cell phenotyping of therapy-induced changes. The study is observational and pediatric-only, limiting generalizability to adults. Relatively small subgroups per treatment arm may reduce statistical power.","practice_takeaway":"In children with EoE, TH2 and activated CD8+ T-cell burden tracks with disease activity beyond eosinophil counts alone—suggesting these may be useful biomarkers of inflammation. Topical steroids appear to reduce residual T-cell infiltration more than PPIs during remission, which may inform treatment selection."}},{"doi":"10.1111/all.70466","pmid":"42618976","title":"Updated EAACI Statement on Drug Hypersensitivity Skin Testing: Methodology and Non‐Irritative Concentrations","journal_title":"Allergy","journal_issn":"0105-4538","published_at":"2026-08-19T00:00:00.000Z","url":"https://doi.org/10.1111/all.70466","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-30T06:19:56.216Z","updated_at":"2026-08-30T06:19:56.216Z","tags":[{"paper_doi":"10.1111/all.70466","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Acute Generalized Exanthematous Pustulosis","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Anaphylaxis","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Drug Hypersensitivity","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Drug Reaction with Eosinophilia and Systemic Symptoms","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Maculopapular Exanthema","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Stevens-Johnson Syndrome","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Toxic Epidermal Necrolysis","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Anesthetic","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Antibiotic","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Biologic","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Chemotherapy","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Contrast Media","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"study_design","value":"Clinical Practice Guideline","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"warning","value":"Chemotherapy-specific guidance (testing within 2 weeks) differs from the general 4–6 week window; clinicians should apply the correct algorithm per drug class.","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"warning","value":"Level of evidence assigned as '3' (consensus guideline/expert panel); the paper does not report an original trial with a defined sample size, so no sample_size tag was applied.","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"warning","value":"Many drug-class recommendations are 'conditional' due to sparse negative-control data, meaning specificity for those agents is not firmly established.","value_numeric":null}],"summaries":{"what_studied":"Updated EAACI guidelines standardizing skin testing methodology (prick, intradermal, patch) for immediate and non-immediate drug hypersensitivity reactions, including validated non-irritant concentrations for major drug classes and risk-stratified algorithms for drug provocation testing.","key_result":"The optimal testing window is 4–6 weeks post-reaction for immediate reactions (false negatives rise beyond 6 months); the validated intradermal test threshold is a wheal ≥ initial wheal +3 mm at 20 min after injecting exactly 0.02 mL. Risk algorithms now allow direct drug provocation for mild maculopapular exanthema, while anaphylaxis requires prior skin testing; skin tests are deemed safe and useful for DRESS/AGEP/SJS/TEN.","limitations":"Conditional recommendations are provided for many drug classes where few or no negative controls are available, limiting specificity data. Crushing tablets and diluting at 30% in petrolatum introduces significant variability in final active-ingredient concentrations.","practice_takeaway":"Test patients for immediate drug hypersensitivity 4–6 weeks post-reaction using the standardized 0.02 mL intradermal technique (wheal ≥ initial +3 mm = positive). For mild maculopapular exanthema, skin tests can be bypassed in favor of direct drug provocation, but anaphylaxis or severe cutaneous reactions (DRESS/AGEP/SJS/TEN) require skin testing first."}},{"doi":"10.1111/nmo.70413","pmid":"42547873","title":"Beyond the Snapshot: Overcoming\n GES\n Limitations to Characterize Gastric Phenotypes and Therapeutic Responses Using a 6‐Day Ambulatory Wearable Monitor","journal_title":"Neurogastroenterology & Motility","journal_issn":"1350-1925","published_at":"2026-08-03T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13433792/","source_score":4,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-09T13:25:13.850Z","updated_at":"2026-08-09T13:25:13.850Z","tags":[{"paper_doi":"10.1111/nmo.70413","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"condition","value":"Functional Dyspepsia","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"condition","value":"Gastroparesis","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"condition","value":"Nausea and Vomiting","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"modality","value":"Antiemetic","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"modality","value":"Wearable Biosensor / Wireless Patch","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"sample_size","value":"n=48","value_numeric":48},{"paper_doi":"10.1111/nmo.70413","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"study_design","value":"Prospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"warning","value":"The 'impact_flag' of practice_changing is applied provisionally; the finding challenges GES utility, but larger validation studies are needed before changing standard-of-care protocols.","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"warning","value":"The 'retesting cohort' is described as a subset of the 48 patients, but its exact size is not reported in the abstract or results — effect size estimates for treatment comparisons should be interpreted cautiously.","value_numeric":null},{"paper_doi":"10.1111/nmo.70413","tag_type":"warning","value":"The study is single-center with a small, predominantly female sample (79%), which may limit generalizability across sexes and clinical settings.","value_numeric":null}],"summaries":{"what_studied":"A prospective study enrolled 48 adults referred for gastric emptying scintigraphy (GES) who wore a non-invasive wireless patch system (WPS) for up to 6 days to characterize multiday gastric myoelectrical activity, compare it with GES results, and assess physiologic changes after individualized therapeutic interventions (anti-emetics, PPIs, lifestyle changes).","key_result":"GES results showed no correlation with multiday myoelectric recordings. Gastric activity was lowest on Day 1 (GES test day) and rose significantly on subsequent days, stabilizing by Day 4 (p < 0.001) — a 'Test-Day' dip not seen in healthy controls. Anti-emetics produced robust increases in gastric amplitude; PPIs showed minimal impact.","limitations":"Small sample size (n=48, single center); the retesting cohort was a subset with no reported sample size breakdown; GES-to-WPS correlation analysis may be underpowered given the non-significant trend for delayed emptying (p = 0.08).","practice_takeaway":"A single 4-hour GES may not reflect a patient's true day-to-day gastric function — activity is systematically suppressed on the test day and only stabilizes by Day 4. Consider multiday ambulatory monitoring when GES results seem discordant with ongoing symptoms, and note that anti-emetics — not PPIs — appear to meaningfully improve gastric myoelectrical amplitude."}},{"doi":"10.1016/j.ekir.2026.106991","pmid":null,"title":"Peritonitis and Mortality Risks of Gastric Acid Suppressants in Patients Undergoing Peritoneal Dialysis","journal_title":"Kidney International Reports","journal_issn":"2468-0249","published_at":"2026-07-29T00:00:00.000Z","url":"https://doi.org/10.1016/j.ekir.2026.106991","source_score":15,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-08-27T06:17:02.977Z","updated_at":"2026-08-27T06:17:02.977Z","tags":[{"paper_doi":"10.1016/j.ekir.2026.106991","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106991","tag_type":"condition","value":"End-Stage Kidney Disease","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106991","tag_type":"condition","value":"Peritoneal Dialysis","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106991","tag_type":"condition","value":"Peritonitis","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106991","tag_type":"modality","value":"H2 Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106991","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106991","tag_type":"study_design","value":"Observational Study","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106991","tag_type":"warning","value":"Only bibliographic metadata was provided — no abstract, methods, results, or discussion text was included. All tags, summary fields, and the study design label are based solely on the paper title and journal. Numerical outcomes, sample size, follow-up duration, and level of evidence could not be determined. Key result and practice takeaway fields were set to null due to insufficient source data.","value_numeric":null}],"summaries":{"what_studied":"This study evaluated the association between gastric acid suppressant use (proton pump inhibitors and/or H2 receptor antagonists) and risks of peritonitis and mortality in patients undergoing peritoneal dialysis.","limitations":"The paper abstract provided contains insufficient detail to extract specific numerical outcomes, comparators, sample size, or follow-up duration."}},{"doi":"10.1111/pai.70417","pmid":"42430571","title":"Gastrointestinal manifestations during oral immunotherapy: A guide for pediatric allergists","journal_title":"Pediatric Allergy and Immunology","journal_issn":"0905-6157","published_at":"2026-07-10T00:00:00.000Z","url":"https://doi.org/10.1111/pai.70417","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-20T13:36:03.227Z","updated_at":"2026-07-20T13:36:03.227Z","tags":[{"paper_doi":"10.1111/pai.70417","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"condition","value":"Anaphylaxis","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"condition","value":"Eosinophilic Esophagitis","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"condition","value":"Food Allergy","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"modality","value":"Oral Immunotherapy","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"modality","value":"Topical Corticosteroid","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"warning","value":"EoE incidence figures are pooled from multiple systematic reviews with differing allergen types and study populations; heterogeneity may affect generalizability.","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"warning","value":"No sample size tag was applied as this is a narrative review without a single primary study population.","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"warning","value":"The ELORS prevalence of 13.7% derives from a single peanut OIT cohort (n=270) and may not apply to other allergens.","value_numeric":null},{"paper_doi":"10.1111/pai.70417","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the review's structured clinical guidance and synthesis of EoE prevalence data, but the underlying evidence base is largely observational; clinicians should weigh recommendations accordingly.","value_numeric":null}],"summaries":{"what_studied":"This narrative review examined the full spectrum of gastrointestinal (GI) adverse events during oral immunotherapy (OIT) for IgE-mediated food allergy in pediatric patients, covering clinical presentation, pathophysiology, and management of both immediate IgE-mediated and delayed eosinophil-associated GI reactions (including OITIGER, ELORS, and EoE).","key_result":"GI manifestations cause OIT discontinuation in 10–20% of patients overall; biopsy-confirmed EoE occurs in approximately 2.3–5.3% of OIT patients (pooled incidence 2.31%, 95% CI 1.45–3.36). OITIGER affects ~8.2% and ELORS ~13.7% of treated patients. Over 90% of patients who dose-reduce for OITIGER/ELORS can resume OIT without symptom recurrence.","limitations":"- All management evidence comes from observational cohorts and case series; no high-quality RCTs compare OIT continuation vs. discontinuation or PPIs vs. topical steroids for EoE.\n- EGD with biopsy is rarely performed in OITIGER/ELORS cases, so true rates of esophageal eosinophilia are likely underestimated.\n- Narrative review methodology introduces selection bias and limits formal quality appraisal of included studies.","practice_takeaway":"Screen all pediatric OIT patients for EoE-suggestive symptoms (dysphagia, slow eating, food refusal) before and throughout treatment using structured age-appropriate questions. For delayed GI symptoms with peripheral eosinophilia >900 cells/mm³ unresponsive to dose reduction and 8–12 weeks of PPI therapy, refer for endoscopic evaluation; use a shared decision-making approach to weigh continuing OIT with pharmacotherapy against discontinuation."}},{"doi":"10.1001/jamaoto.2026.0577","pmid":"42390846","title":"Comparison of Diet and Lifestyle Program With 3 Medication Approaches for Laryngopharyngeal Reflux Disease Management","journal_title":"JAMA Otolaryngology–Head & Neck Surgery","journal_issn":"2168-6181","published_at":"2026-07-02T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13329737/","source_score":24,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-08T13:26:23.886Z","updated_at":"2026-07-08T13:26:23.886Z","tags":[{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"condition","value":"Laryngopharyngeal Reflux Disease","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"generic","value":"magaldrate","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"modality","value":"Alginate","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"modality","value":"Antacid","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"modality","value":"Dietary Intervention","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"sample_size","value":"n=145","value_numeric":145},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"warning","value":"Diet adherence and stress-reduction activity compliance were not objectively measured, making it difficult to assess dose-response or distinguish truly adherent patients.","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"warning","value":"The full text is under embargo until July 2027; this analysis is based solely on the abstract and results sections provided.","value_numeric":null},{"paper_doi":"10.1001/jamaoto.2026.0577","tag_type":"warning","value":"Treatment allocation was not randomized; patients may have self-selected or been clinician-selected into diet vs. medication groups, which could confound results.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study (n=145) compared 4 treatments for laryngopharyngeal reflux disease (LPRD) over 3 months: strict antireflux diet plus stress reduction, proton pump inhibitors (PPIs), alginates, and magaldrate antacids. Diagnosis was confirmed by 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing.","key_result":"All 4 groups showed significant symptom and sign improvement. The diet group had the highest responder rate (81.2%, 39/48) vs PPIs (56.3%, 18/32), alginates (57.9%, 22/38), and antacids (74.1%, 20/27). Diet was associated with 24.9 percentage points more responders than PPIs (95% CI, 4.6–45.4) and 23.4 points more than alginates (95% CI, 4.2–42.5). Diet also had significantly lower RSS scores than the antacid group (mean difference 38.73; 95% CI, 4.24–73.23), though the rate of change over time did not differ between groups.","limitations":"- Retrospective design with non-random treatment allocation introduces selection bias.\n- Diet adherence was not objectively verified, and stress-reduction activities were self-reported.\n- Single-author study from 2 centers in Belgium and France limits generalizability.","practice_takeaway":"For patients with confirmed LPRD, a strict antireflux diet combined with stress reduction may outperform PPIs and alginates in symptom response at 3 months — consider it as a first-line or adjunct option. Randomized trials are still needed before definitive practice change."}},{"doi":"10.1002/ppul.71715","pmid":"42360697","title":"Early Use of Proton Pump Inhibitors Increases Risk of Upper Respiratory Tract Infections in Children: A Birth Cohort Study","journal_title":"Pediatric Pulmonology","journal_issn":"8755-6863","published_at":"2026-06-26T00:00:00.000Z","url":"https://doi.org/10.1002/ppul.71715","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-01T13:27:08.498Z","updated_at":"2026-07-01T13:27:08.498Z","tags":[{"paper_doi":"10.1002/ppul.71715","tag_type":"age_group","value":"infant","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"condition","value":"Bronchiolitis","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"condition","value":"Gastroesophageal Reflux","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"condition","value":"Otitis Media","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"condition","value":"Upper Respiratory Tract Infection","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"condition","value":"Viral Croup","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"sample_size","value":"n=200","value_numeric":200},{"paper_doi":"10.1002/ppul.71715","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"study_design","value":"Birth Cohort Study","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"warning","value":"Confounding by indication is a material concern: infants prescribed PPIs may have been sicker at baseline, which could partly explain higher infection rates.","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"warning","value":"No specific PPI agents or doses were reported, so drug-level conclusions cannot be drawn.","value_numeric":null},{"paper_doi":"10.1002/ppul.71715","tag_type":"warning","value":"The exposed group is very small (n=16 early PPI, n=22 any PPI), so confidence intervals are extremely wide — especially for hospitalization. Results should be interpreted with caution.","value_numeric":null}],"summaries":{"what_studied":"This birth cohort study (ARIES, Santiago, Chile) followed 200 infants from birth to 24 months to assess whether early PPI exposure (first 6 months) or any PPI exposure (first 24 months) was associated with respiratory tract infections (RTIs), hospitalizations, and antibiotic use.","key_result":"Early PPI use (8% of infants) was independently linked to otitis media (aOR 9.5), viral croup (aOR 4.8), RTI-related hospitalization (aOR 19.3), and antibiotic use (aOR 9.9). No significant association was found with lower RTIs (bronchiolitis, pneumonia).","limitations":"- Small sample (n=200) with only 16 early PPI-exposed infants, producing very wide CIs (e.g., hospitalization aOR 19.3, 95% CI 1.6–225.8).\n- Single-center cohort in Chile limits generalizability.\n- Observational design cannot exclude confounding by indication (PPIs prescribed for sicker infants).","practice_takeaway":"Avoid routine PPI prescribing in infants with functional GI complaints (colic, reflux) given the lack of proven benefit and this signal of meaningfully increased upper RTI risk. Reserve PPIs for infants with clear evidence-based indications and reassess promptly."}},{"doi":"10.14309/ajg.0000000000004075","pmid":"42262519","title":"The effect of prior proton pump inhibitor use on gastric cancer survival: A population-based cohort study in the five Nordic countries","journal_title":"American Journal of Gastroenterology","journal_issn":"0002-9270","published_at":"2026-06-09T00:00:00.000Z","url":"https://doi.org/10.14309/ajg.0000000000004075","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-19T13:23:30.798Z","updated_at":"2026-06-19T13:23:30.798Z","tags":[{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"condition","value":"Gastric Non-Cardia Adenocarcinoma","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"generic","value":"proton pump inhibitor (class)","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"sample_size","value":"n=21433","value_numeric":21433},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"study_design","value":"Population-Based Cohort Study","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"warning","value":"Indication bias is a key concern: PPI users may receive closer GI surveillance, which could partly explain the observed lower mortality and earlier-stage findings.","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"warning","value":"The full text PDF was not accessible — the extracted text contained only publisher permissions guidelines, not the study body. All structured data were derived exclusively from the abstract and results sections provided.","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004075","tag_type":"warning","value":"The individual PPI agents used were not specified in the available text; the modality tag reflects the drug class only.","value_numeric":null}],"summaries":{"what_studied":"This population-based cohort study examined whether prior PPI use (light or heavy, in the 2 years before diagnosis) affects 5-year disease-specific mortality, all-cause mortality, and stage at presentation in 21,433 patients with gastric non-cardia adenocarcinoma across five Nordic countries.","key_result":"Both heavy and light PPI use were associated with *lower* 5-year disease-specific mortality (adjusted HR 0.90, 95% CI 0.86–0.94 and HR 0.87, 95% CI 0.84–0.91, respectively). Heavy PPI use was also linked to lower odds of metastatic disease (OR 0.70, 95% CI 0.64–0.76) and advanced tumor stage (OR 0.71, 95% CI 0.56–0.89) at diagnosis.","limitations":"- Observational design limits causal inference; residual confounding (e.g., indication bias — PPI users may be more medically surveilled) cannot be excluded.\n- Full text was unavailable for review; conclusions rely solely on the abstract and results sections.\n- Stage data completeness and consistency across five national registries is not described.","practice_takeaway":"Prior PPI use does not appear to delay gastric cancer diagnosis or worsen survival — clinicians need not avoid PPIs out of concern for masking gastric cancer symptoms, though appropriate alarm-symptom investigation remains essential."}},{"doi":"10.1016/j.cgh.2026.05.028","pmid":"42264337","title":"Anxiety severity and PPI non-response association across GERD phenotypes defined by the Lyon 2.0 classification","journal_title":"Clinical Gastroenterology and Hepatology","journal_issn":"1542-3565","published_at":"2026-06-08T00:00:00.000Z","url":"https://doi.org/10.1016/j.cgh.2026.05.028","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-18T13:24:16.949Z","updated_at":"2026-06-18T13:24:16.949Z","tags":[{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"condition","value":"Anxiety","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"condition","value":"Gastroesophageal Reflux Disease","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"condition","value":"Refractory GERD","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"sample_size","value":"n=204","value_numeric":204},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"study_design","value":"Prospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"warning","value":"Study design is described as 'consecutive patients' which may reflect a prospective cohort or retrospective chart review — the abstract is ambiguous; classified as cohort study but causal directionality cannot be confirmed.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied cautiously — authors themselves note prospective confirmation is required before integrating anxiety evaluation into routine clinical algorithms.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.05.028","tag_type":"warning","value":"The paper's DOI and publication date (June 2026) are future-dated relative to standard indexing; content reflects the abstract as provided.","value_numeric":null}],"summaries":{"what_studied":"This study evaluated whether anxiety severity (measured by the Hamilton Anxiety Rating Scale, HAM-A) is associated with PPI non-response across GERD phenotypes defined by the Lyon Consensus 2.0 classification in 204 consecutive patients undergoing off-therapy impedance-pH monitoring.","key_result":"PPI response declined stepwise from conclusive GERD (70.2%) to no GERD (30.8%). Non-responders had higher anxiety scores than responders (20.9±9.8 vs 13.4±6.3; p<0.001). Anxiety independently predicted PPI non-response in inconclusive GERD with supportive evidence (OR 1.14/HAM-A point; p=0.004) and no GERD (OR 1.22; p<0.001), but not in conclusive GERD. Response rates fell sharply with anxiety severity: 59.0% (mild), 20.5% (moderate), and 7.7% (severe). HAM-A AUC was 0.73 overall and 0.78 in no-GERD patients.","limitations":"- Retrospective, consecutive-cohort design limits causal inference; prospective validation is needed.\n- Anxiety was assessed at a single timepoint; it is unclear whether anxiety preceded or followed PPI failure.\n- The study does not address whether treating anxiety improves PPI response or reduces inappropriate PPI use.","practice_takeaway":"Consider formal anxiety screening (e.g., HAM-A) in patients with refractory reflux symptoms, especially those with inconclusive or no GERD on impedance-pH testing — high anxiety strongly predicts PPI failure in these groups. Routine anxiety assessment alongside Lyon 2.0 classification may help avoid escalating PPI therapy when psychological factors are likely driving symptoms."}},{"doi":"10.1016/j.jaci.2026.04.026","pmid":"42140395","title":"Emerging Insights into the Presentation, Pathophysiology, and Management of Eosinophilic Esophagitis","journal_title":"Journal of Allergy and Clinical Immunology","journal_issn":"0091-6749","published_at":"2026-05-15T00:00:00.000Z","url":"https://doi.org/10.1016/j.jaci.2026.04.026","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-19T13:22:49.771Z","updated_at":"2026-05-19T13:22:49.771Z","tags":[{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"condition","value":"Eosinophilic Esophagitis","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"condition","value":"Eosinophilic Gastrointestinal Diseases","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"modality","value":"Biologic Agent","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"modality","value":"Dietary Elimination Therapy","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"modality","value":"Topical Corticosteroid","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"warning","value":"DOI publication date (2026-05-15) is very recent; some cited findings may not yet have been independently replicated.","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"warning","value":"No original patient data or sample size reported — this is a narrative review without meta-analytic methods.","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.04.026","tag_type":"warning","value":"The abstract does not specify which specific biologics are discussed; drug-level tags could not be assigned.","value_numeric":null}],"summaries":{"what_studied":"This narrative review covers recent advances in the epidemiology, pathophysiology, diagnosis, and treatment of eosinophilic esophagitis (EoE), including its relationship to broader eosinophilic gastrointestinal diseases (EGIDs).","key_result":"EoE pathogenesis centers on impaired epithelial barrier function, epithelial alarmin signaling, and antigen-driven Type 2 inflammation; notably, depletion of eosinophils and mast cells alone does not improve patient symptoms. Evolving therapies include dietary elimination, topical corticosteroids, PPIs, and anti-type 2 biologics, alongside new clinical scoring tools for diagnosis and disease monitoring.","limitations":"As a narrative review, it does not provide pooled effect sizes or systematic quality appraisal of included studies. No original patient data are presented.","practice_takeaway":"Clinicians managing EoE should be aware that eosinophil/mast cell depletion alone may not resolve symptoms, pointing to broader epithelial and alarmin-driven mechanisms. An expanding toolkit — including anti-type 2 biologics and new scoring tools — is now available to guide treatment and monitoring."}},{"doi":"10.3399/bjgp.2025.0780","pmid":"41991223","title":"Pre-diagnostic prescription patterns in pancreatic cancer: a retrospective cohort study","journal_title":"British Journal of General Practice","journal_issn":"0960-1643","published_at":"2026-04-17T00:00:00.000Z","url":"https://doi.org/10.3399/bjgp.2025.0780","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-04-16","doi":"10.3399/bjgp.2025.0780","days":"30","issn":"0960-1643","rank":"5","field":"Clinical Medicine","score":"7","category":"Primary Health Care","categories":["Primary Health Care"],"_categories":["Primary Health Care"]},"pubmed":{"doi":"10.3399/BJGP.2025.0780","title":"Pre-diagnostic prescription patterns in pancreatic cancer: a retrospective cohort study.","journal":"The British journal of general practice : the journal of the Royal College of General Practitioners","methods":"","results":"","abstract":"$3c","keywords":["Cancer < Clinical (physical)","Large database research < Research methods","Prescribing < Clinical (general)","Primary health care","diabetes mellitus","diagnosis","early","insulin","pancreatic cancer","prescriptions"],"pubmed_id":"41991223","conclusions":"","publication_date":"2026-04-17T00:00:00"},"crossref":{"DOI":"10.3399/bjgp.2025.0780","URL":"https://doi.org/10.3399/bjgp.2025.0780","ISSN":["0960-1643","1478-5242"],"link":[{"URL":"https://syndication.highwire.org/content/doi/10.3399/BJGP.2025.0780","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"BJGP.2025.0780","type":"journal-article","issue":null,"score":1,"title":["Pre-diagnostic prescription patterns in pancreatic cancer: a retrospective cohort study"],"author":[{"given":"Cecilia H","family":"Morel","sequence":"first","affiliation":[]},{"given":"Fiona M","family":"Walter","sequence":"additional","affiliation":[]},{"given":"Pawandeep","family":"Virpal","sequence":"additional","affiliation":[]},{"given":"Kirsten Deanne","family":"Arendse","sequence":"additional","affiliation":[]},{"given":"Garth","family":"Funston","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,4,16]]},"member":"1987","prefix":"10.3399","source":"Crossref","volume":null,"created":{"date-time":"2026-04-16T12:50:19Z","timestamp":1776343819000,"date-parts":[[2026,4,16]]},"indexed":{"date-time":"2026-04-16T13:44:18Z","timestamp":1776347058505,"date-parts":[[2026,4,16]]},"subject":[],"abstract":"$3d","accepted":{"date-parts":[[2026,3,11]]},"language":"en","relation":{},"resource":{"primary":{"URL":"http://bjgp.org/lookup/doi/10.3399/BJGP.2025.0780"}},"subtitle":[],"deposited":{"date-time":"2026-04-16T12:50:19Z","timestamp":1776343819000,"date-parts":[[2026,4,16]]},"issn-type":[{"type":"print","value":"0960-1643"},{"type":"electronic","value":"1478-5242"}],"published":{"date-parts":[[2026,4,16]]},"publisher":"Royal College of General Practitioners","reference":null,"short-title":[],"alternative-id":["10.3399/BJGP.2025.0780"],"content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["British Journal of General Practice"],"reference-count":0,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,4,16]]},"references-count":0,"short-container-title":["Br J Gen Pract"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.3399/bjgp.2025.0780","is_oa":true,"title":"Pre-diagnostic prescription patterns in pancreatic cancer: a retrospective cohort study","updated":"2026-04-18T08:12:42+00:00","published_date":"2026-04-16","best_oa_location":{"url":"https://bjgp.org/content/bjgp/early/2026/04/16/BJGP.2025.0780.full.pdf","pmh_id":null,"url_for_pdf":"https://bjgp.org/content/bjgp/early/2026/04/16/BJGP.2025.0780.full.pdf","url_for_landing_page":"https://doi.org/10.3399/bjgp.2025.0780"}}},"created_at":"2026-05-07T22:51:30.442Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"category","value":"Primary Health Care","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"condition","value":"Pancreatic Cancer","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"condition","value":"Type 3c Diabetes Mellitus","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"modality","value":"Anti-emetic","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"modality","value":"Hypoglycaemic Agent","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"modality","value":"Insulin","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"modality","value":"Opioid Analgesic","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"sample_size","value":"n=12,990","value_numeric":12990},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"warning","value":"Sex-specific inflection point differences for insulin were based on subgroup analyses with broad CIs, particularly for females; the finding is suggestive but not definitive.","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"warning","value":"The inflection point for neuropathic analgesics (35 months) had very wide CIs (15–55 months) and should be interpreted cautiously — it is not a reliable early signal.","value_numeric":null},{"paper_doi":"10.3399/bjgp.2025.0780","tag_type":"warning","value":"The study is restricted to English primary care (CPRD Aurum); findings may not generalize to other health systems or more ethnically diverse populations (92.7% White in this cohort).","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study analyzed primary care prescription patterns in the 5 years before pancreatic cancer diagnosis among 12,990 patients in England (diagnosed 2011–2018), using linked CPRD Aurum and cancer registry data. Eight medication categories were examined, with Poisson regression used to identify inflection points where prescribing rates rose above baseline.","key_result":"Insulin prescribing rose earliest — 19 months pre-diagnosis overall (95% CI 14.2–23.8), at 25 months in females (95% CI 17.4–32.5) vs. 11 months in males (95% CI 5.8–16.2). Other hypoglycaemic agents increased at 13 months, anti-reflux and opioids at 7 months, and anti-emetics and non-opioid analgesics at 5 months pre-diagnosis. NSAIDs showed no meaningful inflection point. Only ~7% of patients received insulin and ~20% received other hypoglycaemic agents during the 5-year period.","limitations":"- Population-level analysis cannot determine PPVs for individual prescriptions or identify which patients are driving the trends — a minority of atypical cases could explain observed patterns.\n- Indications for prescriptions and whether medications were actually taken could not be verified; secondary care, private, and over-the-counter prescriptions were not captured.\n- Multiple comparisons across 8 medication categories stratified by sex raise risk of type I error; residual confounding from BMI, alcohol use, and comorbidities may remain.","practice_takeaway":"New insulin initiation in older adults — especially women — should prompt consideration of pancreatic cancer, consistent with NICE guidance recommending urgent CT for patients over 60 with new-onset diabetes and unexplained weight loss. Anti-emetic, anti-reflux, and analgesic prescribing rises closer to diagnosis and likely reflects late disease; these are less useful as early detection triggers on their own."}},{"doi":"10.1016/j.ekir.2026.106524","pmid":"42088029","title":"Renal Outcomes With Potassium-Competitive Acid Blockers Versus Proton Pump Inhibitors in CKD","journal_title":"Kidney International Reports","journal_issn":"2468-0249","published_at":"2026-04-01T00:00:00.000Z","url":"https://doi.org/10.1016/j.ekir.2026.106524","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-08T13:23:45.606Z","updated_at":"2026-05-08T13:23:45.606Z","tags":[{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"condition","value":"Gastroesophageal Reflux Disease","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"generic","value":"esomeprazole","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"generic","value":"fexuprazan","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"generic","value":"rabeprazole","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"generic","value":"revaprazan","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"generic","value":"tegoprazan","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"modality","value":"Potassium-Competitive Acid Blocker","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"sample_size","value":"n=20,535 (matched)","value_numeric":20535},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"study_design","value":"Target Trial Emulation Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"warning","value":"CKD severity (stage, GFR, proteinuria) was not captured in claims data, which is a notable unmeasured confounder.","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"warning","value":"The matched sample size (n=20,535) is used for the primary analysis; the pre-match total was 34,077, but only 4,107 P-CAB and 16,428 PPI users were retained after 1:4 PS matching — the sample_size tag reflects the matched cohort used in main analyses.","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"warning","value":"The study population is Korean; ethnic and healthcare-system differences may limit broader applicability.","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.106524","tag_type":"warning","value":"Vonoprazan, the most widely used P-CAB globally, was not available in South Korea during the study period and was excluded; results may not generalize to vonoprazan users.","value_numeric":null}],"summaries":{"what_studied":"This target trial–emulated cohort study compared renal safety of P-CABs (tegoprazan, fexuprazan, revaprazan) versus PPIs in Korean CKD patients newly starting acid suppression therapy for GERD between 2019 and 2022, using national insurance claims data. The primary outcome was first initiation of renal replacement therapy (RRT).","key_result":"After 1:4 propensity score matching (4,107 P-CAB vs. 16,428 PPI users), P-CAB use was associated with a 37% lower risk of composite RRT initiation (HR 0.63, 95% CI 0.45–0.88). The intention-to-treat analysis also favored P-CABs (HR 0.90, 95% CI 0.82–0.99). Individual RRT components (hemodialysis, peritoneal dialysis, transplant) trended toward benefit but did not reach statistical significance.","limitations":"- Observational design using claims data limits causal inference; unmeasured confounders (e.g., CKD stage, proteinuria, lab values) could not be controlled.\n- GERD diagnosis code accuracy was reported at only ~74%, introducing potential misclassification.\n- Vonoprazan (a major global P-CAB) was unavailable in South Korea and excluded, limiting generalizability.","practice_takeaway":"For CKD patients requiring acid suppression for GERD, P-CABs may carry lower renal risk than PPIs and could be considered a preferential option in this high-risk group. These findings warrant confirmation in prospective studies before routine clinical adoption."}}],"initialOffset":14,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Proton Pump Inhibitor"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Proton Pump Inhibitor"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Proton Pump Inhibitor"}}}]] 2b:null 2f:[["$","title","0",{"children":"Proton Pump Inhibitor: Research & Clinical Takeaways | ReachRx"}],["$","meta","1",{"name":"description","content":"Explore peer-reviewed papers on Proton Pump Inhibitor (modality). Clinician-written summaries and actionable practice insights. 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