Famotidine to prevent ASA-associated ulcers

In this manufacturer-funded trial, 404 patients starting ASA (dose range 75mg-325mg) underwent baseline and 12-week endoscopy, and were randomized to placebo or famotidine 20mg BID. At 12 weeks, the famotidine group had significantly fewer gastric ulcers (3% vs 15%), duodenal ulcers (1% vs 9%), and erosive esophagitis (4% vs 19%) compared to placebo. Famotidine is an effective strategy to prevent ASA-associated ulcers/esophagitis (abstract).

Capsule endoscopy versus colonoscopy

In this diagnostic trial of 328 patients who underwent both capsule endoscopy and colonoscopy, capsule endoscopy had a sens/spec for polys of 64% and 84%, and sens/spec for advanced adenomas of 73% and 70%. The capsule "slept" through the small bowel, and "awoke" in the colon, but was significantly limited by the adequacy of the prep. Although less invasive that colonoscopy, capsule endoscopy currently suffers from similar limitations as CT colonography (diagnostic only and significantly limited by prep adequacy). Although intriguing, it is not quite ready for prime time (abstract).

Rebound GERD after stopping PPIs

In thistrial of 120 healthy volunteers, they were randomized to 12 weeks of placebo or 8 weeks of PPI followed by 4 weeks of placebo. GERD symptoms were similar in the first 8 weeks, but in weeks 9-12, symptoms were significantly higher in the former PPI group (44% versus 15%) indicating significant post-PPI rebound. This is another reason to avoid unnecessary PPIs in inpatients, as many will experience rebound symptoms after cessation (abstract).

ND versus NG feeds in the ICU

In this trial of 121 MICU patients, they were randomized to ND versus NG feeds. The ND group experiencedfewer vomiting and VAP episodes, and achieved higher calories and earlier target rate, than the NG group. However, there were no significant differences in clinically significant outcome measures (bacteremia, ICU days, ventilator days, LOS, or death). The debate continues in determining the benefit of ND versus NG feeds, but ND does appear to be a better option in those at risk for vomiting (gastroparesis, dysmotility, GERD) (abstract).

Severe Cdiff? May try tigecycline

In this small case series of 4 patients in shock due to Cdiff (refractory to metronidazole and vancomycin), all had clinical and microbiologic cure (without recurrence) after treatment with tigecycline. Tigecycline does not induce proliferation of the Cdiff organism or the toxin production. Although premature for widespread use, it may be a reasonable alternative for septic patients that have failed traditional treatment options, and are headed for colectomy (abstract).