Ann C. Logue

CHICAGO — Long-term use of proton-pump inhibitors, histamine₂-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and proton-pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” Dr. Yang said.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine₂-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use. The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang said. After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

Another hypothesis of the study, Dr. Yang said, is that men would be at greater risk because they do not take calcium supplements and do not talk about osteoporosis with their doctors. And, in fact, the data show just that: The relative risk of hip fracture associated with PPI use was much higher among men than among women.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — Long-term use of proton-pump inhibitors, histamine₂-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and proton-pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” Dr. Yang said.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine₂-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use. The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang said. After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

Another hypothesis of the study, Dr. Yang said, is that men would be at greater risk because they do not take calcium supplements and do not talk about osteoporosis with their doctors. And, in fact, the data show just that: The relative risk of hip fracture associated with PPI use was much higher among men than among women.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — Long-term use of proton-pump inhibitors, histamine₂-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and proton-pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” Dr. Yang said.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine₂-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use. The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang said. After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

Another hypothesis of the study, Dr. Yang said, is that men would be at greater risk because they do not take calcium supplements and do not talk about osteoporosis with their doctors. And, in fact, the data show just that: The relative risk of hip fracture associated with PPI use was much higher among men than among women.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — Ten patients with moderate Crohn's disease took supplements of fructooligosaccharide, a substance found in artichokes and asparagus, and showed an increase in fecal Bifidobacteria and production of mucosal dendritic cells, James Lindsay, Ph.D. said at the annual Digestive Disease Week.

Although the findings are preliminary, this is the first known study of “prebiotic” dietary therapies for Crohn's, and the strategy may offer a way to supplement traditional treatments or to manage patients who do not respond to them, he said.

Fructooligosaccharide is a carbohydrate that selectively alters the colonic microbiota, Dr. Lindsay explained. It is a prebiotic that may provide a substrate upon which healthy bacteria can grow, as opposed to probiotics, which are the healthy bacteria themselves.

The supplement given to the 10 patients in the open-label study was prepared by Nestlé UK, which provided financial support for the research. The patients took 15 g per day for 3 weeks.

Patients and doctors noted an improvement on the Harvey Bradshaw index, with the mean falling from 9.8 at the start of the study to 6.9 at the end. Remission of Crohn's disease was achieved by 40% of the patients. There was a 6.8% increase in the volume of Bifidobacteria found in dried fecal samples between the start and end of the study. In addition, the number of interleukin-10 dentridic cells increased, as did the number of cells expressing Toll-like receptors.

Patients in the study, 60% of whom were completely compliant with the study regimen, tolerated the supplement well. The most common complaints were rumbling and flatulence.

“Traditional therapies tend to increase effector pathways. The alternative is to increase regulatory pathways,” said Dr. Lindsay, consultant gastroenterologist at St Bartholomew's Hospital and the Royal London Hospital.

Balfour Sartor, M.D., a professor of medicine, microbiology, and immunology at the University of North Carolina at Chapel Hill, is familiar with the work of Dr. Lindsay and his colleagues because it overlaps with his own.

He said that Dr. Lindsay's study is not in the mainstream of Crohn's research, but that it is a legitimate area of investigation.

“The normal bacteria in the gut are probably the dominant antigenic stimulus driving immune mediation,” he said. “Altering the diet is a natural way of doing things that is presumed to have less toxicity and be less costly,” he said.

Dr. Lindsay emphasized the preliminary nature of the findings.

CHICAGO — Ten patients with moderate Crohn's disease took supplements of fructooligosaccharide, a substance found in artichokes and asparagus, and showed an increase in fecal Bifidobacteria and production of mucosal dendritic cells, James Lindsay, Ph.D. said at the annual Digestive Disease Week.

Although the findings are preliminary, this is the first known study of “prebiotic” dietary therapies for Crohn's, and the strategy may offer a way to supplement traditional treatments or to manage patients who do not respond to them, he said.

Fructooligosaccharide is a carbohydrate that selectively alters the colonic microbiota, Dr. Lindsay explained. It is a prebiotic that may provide a substrate upon which healthy bacteria can grow, as opposed to probiotics, which are the healthy bacteria themselves.

The supplement given to the 10 patients in the open-label study was prepared by Nestlé UK, which provided financial support for the research. The patients took 15 g per day for 3 weeks.

Patients and doctors noted an improvement on the Harvey Bradshaw index, with the mean falling from 9.8 at the start of the study to 6.9 at the end. Remission of Crohn's disease was achieved by 40% of the patients. There was a 6.8% increase in the volume of Bifidobacteria found in dried fecal samples between the start and end of the study. In addition, the number of interleukin-10 dentridic cells increased, as did the number of cells expressing Toll-like receptors.

Patients in the study, 60% of whom were completely compliant with the study regimen, tolerated the supplement well. The most common complaints were rumbling and flatulence.

“Traditional therapies tend to increase effector pathways. The alternative is to increase regulatory pathways,” said Dr. Lindsay, consultant gastroenterologist at St Bartholomew's Hospital and the Royal London Hospital.

Balfour Sartor, M.D., a professor of medicine, microbiology, and immunology at the University of North Carolina at Chapel Hill, is familiar with the work of Dr. Lindsay and his colleagues because it overlaps with his own.

He said that Dr. Lindsay's study is not in the mainstream of Crohn's research, but that it is a legitimate area of investigation.

“The normal bacteria in the gut are probably the dominant antigenic stimulus driving immune mediation,” he said. “Altering the diet is a natural way of doing things that is presumed to have less toxicity and be less costly,” he said.

Dr. Lindsay emphasized the preliminary nature of the findings.

CHICAGO — Ten patients with moderate Crohn's disease took supplements of fructooligosaccharide, a substance found in artichokes and asparagus, and showed an increase in fecal Bifidobacteria and production of mucosal dendritic cells, James Lindsay, Ph.D. said at the annual Digestive Disease Week.

Although the findings are preliminary, this is the first known study of “prebiotic” dietary therapies for Crohn's, and the strategy may offer a way to supplement traditional treatments or to manage patients who do not respond to them, he said.

Fructooligosaccharide is a carbohydrate that selectively alters the colonic microbiota, Dr. Lindsay explained. It is a prebiotic that may provide a substrate upon which healthy bacteria can grow, as opposed to probiotics, which are the healthy bacteria themselves.

The supplement given to the 10 patients in the open-label study was prepared by Nestlé UK, which provided financial support for the research. The patients took 15 g per day for 3 weeks.

Patients and doctors noted an improvement on the Harvey Bradshaw index, with the mean falling from 9.8 at the start of the study to 6.9 at the end. Remission of Crohn's disease was achieved by 40% of the patients. There was a 6.8% increase in the volume of Bifidobacteria found in dried fecal samples between the start and end of the study. In addition, the number of interleukin-10 dentridic cells increased, as did the number of cells expressing Toll-like receptors.

Patients in the study, 60% of whom were completely compliant with the study regimen, tolerated the supplement well. The most common complaints were rumbling and flatulence.

“Traditional therapies tend to increase effector pathways. The alternative is to increase regulatory pathways,” said Dr. Lindsay, consultant gastroenterologist at St Bartholomew's Hospital and the Royal London Hospital.

Balfour Sartor, M.D., a professor of medicine, microbiology, and immunology at the University of North Carolina at Chapel Hill, is familiar with the work of Dr. Lindsay and his colleagues because it overlaps with his own.

He said that Dr. Lindsay's study is not in the mainstream of Crohn's research, but that it is a legitimate area of investigation.

“The normal bacteria in the gut are probably the dominant antigenic stimulus driving immune mediation,” he said. “Altering the diet is a natural way of doing things that is presumed to have less toxicity and be less costly,” he said.

Dr. Lindsay emphasized the preliminary nature of the findings.

CHICAGO — Long-term use of proton-pump inhibitors, histamine₂-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and proton-pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” Dr. Yang said.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine2-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use. The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang said. After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

Another hypothesis of the study, Dr. Yang said, is that men would be at greater risk because they do not take calcium supplements and do not talk about osteoporosis with their doctors. And, in fact, the data show just that: The relative risk of hip fracture associated with PPI use was much higher among men than among women.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — Long-term use of proton-pump inhibitors, histamine₂-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and proton-pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” Dr. Yang said.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine2-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use. The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang said. After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

Another hypothesis of the study, Dr. Yang said, is that men would be at greater risk because they do not take calcium supplements and do not talk about osteoporosis with their doctors. And, in fact, the data show just that: The relative risk of hip fracture associated with PPI use was much higher among men than among women.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — Long-term use of proton-pump inhibitors, histamine₂-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and proton-pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” Dr. Yang said.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine2-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use. The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang said. After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

Another hypothesis of the study, Dr. Yang said, is that men would be at greater risk because they do not take calcium supplements and do not talk about osteoporosis with their doctors. And, in fact, the data show just that: The relative risk of hip fracture associated with PPI use was much higher among men than among women.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — There is a significant gap between expert opinion regarding Barrett's esophagus treatment and the opinions of gastroenterologists in general practice, indicating a need for ongoing physician education, Colin Howden, M.D., said at the annual Digestive Disease Week.

To test how much recent research has filtered into the general practice community, Dr. Howden and his team queried 275 gastroenterologists attending three regional conferences in 2004. The surveyed physicians were attending conferences sponsored by TAP Pharmaceutical Products Inc., but the company provided no financial support for the study and had no role in the analysis or reporting of results.

The gastroenterologists used hand-held response devices to indicate how much they agreed or disagreed with statements about the treatment of Barrett's esophagus. Their answers were compared with opinions gleaned by the American Gastroenterological Association from a panel of 18 experts in the field.

There was a high level of agreement about the definition of Barrett's esophagus and the need for multiple systematic biopsies. However, the two groups differed in their approaches to surveillance and treatment.

None of the expert panel members accepted short-segment and long-segment Barrett's esophagus as distinct clinical entities, but 41% of the gastroenterologists surveyed did. None of the expert panel members accepted that screening reduced mortality or was cost effective, but 25% of the gastroenterologists though it reduced mortality, and 13% thought it was cost effective. Also, none of the expert panel members accepted that surveillance was cost effective, but 69% of the gastroenterologists believed that it was.

“There is not complete agreement about managing Barrett's esophagus, even among the experts,” said Dr. Howden of Northwestern University, Chicago. “General gastroenterologists do a pretty good job at managing the condition, but their knowledge and understanding is a few years behind those of the experts.”

In a related presentation, Hashem El-Serag, M.D., of Baylor College of Medicine, Houston, reported on research about the incidence of Barrett's esophagus in children and adolescents.

In a group of 8,038 patients under age 18 years who had an upper endoscopy between 1999 and 2002 in the United States, only 37 had suspected Barrett's, indicating that the incidence in children is extremely low.

Community hospitals were more likely to report suspected Barrett's in children and adolescents than were pediatric hospitals. The difference was not statistically significant, but the data may indicate that the condition is so rare in children that pediatric gastroenterologists don't see it enough to recognize it, Dr. El-Serag said.

CHICAGO — There is a significant gap between expert opinion regarding Barrett's esophagus treatment and the opinions of gastroenterologists in general practice, indicating a need for ongoing physician education, Colin Howden, M.D., said at the annual Digestive Disease Week.

To test how much recent research has filtered into the general practice community, Dr. Howden and his team queried 275 gastroenterologists attending three regional conferences in 2004. The surveyed physicians were attending conferences sponsored by TAP Pharmaceutical Products Inc., but the company provided no financial support for the study and had no role in the analysis or reporting of results.

The gastroenterologists used hand-held response devices to indicate how much they agreed or disagreed with statements about the treatment of Barrett's esophagus. Their answers were compared with opinions gleaned by the American Gastroenterological Association from a panel of 18 experts in the field.

There was a high level of agreement about the definition of Barrett's esophagus and the need for multiple systematic biopsies. However, the two groups differed in their approaches to surveillance and treatment.

None of the expert panel members accepted short-segment and long-segment Barrett's esophagus as distinct clinical entities, but 41% of the gastroenterologists surveyed did. None of the expert panel members accepted that screening reduced mortality or was cost effective, but 25% of the gastroenterologists though it reduced mortality, and 13% thought it was cost effective. Also, none of the expert panel members accepted that surveillance was cost effective, but 69% of the gastroenterologists believed that it was.

“There is not complete agreement about managing Barrett's esophagus, even among the experts,” said Dr. Howden of Northwestern University, Chicago. “General gastroenterologists do a pretty good job at managing the condition, but their knowledge and understanding is a few years behind those of the experts.”

In a related presentation, Hashem El-Serag, M.D., of Baylor College of Medicine, Houston, reported on research about the incidence of Barrett's esophagus in children and adolescents.

In a group of 8,038 patients under age 18 years who had an upper endoscopy between 1999 and 2002 in the United States, only 37 had suspected Barrett's, indicating that the incidence in children is extremely low.

Community hospitals were more likely to report suspected Barrett's in children and adolescents than were pediatric hospitals. The difference was not statistically significant, but the data may indicate that the condition is so rare in children that pediatric gastroenterologists don't see it enough to recognize it, Dr. El-Serag said.

CHICAGO — There is a significant gap between expert opinion regarding Barrett's esophagus treatment and the opinions of gastroenterologists in general practice, indicating a need for ongoing physician education, Colin Howden, M.D., said at the annual Digestive Disease Week.

To test how much recent research has filtered into the general practice community, Dr. Howden and his team queried 275 gastroenterologists attending three regional conferences in 2004. The surveyed physicians were attending conferences sponsored by TAP Pharmaceutical Products Inc., but the company provided no financial support for the study and had no role in the analysis or reporting of results.

The gastroenterologists used hand-held response devices to indicate how much they agreed or disagreed with statements about the treatment of Barrett's esophagus. Their answers were compared with opinions gleaned by the American Gastroenterological Association from a panel of 18 experts in the field.

There was a high level of agreement about the definition of Barrett's esophagus and the need for multiple systematic biopsies. However, the two groups differed in their approaches to surveillance and treatment.

None of the expert panel members accepted short-segment and long-segment Barrett's esophagus as distinct clinical entities, but 41% of the gastroenterologists surveyed did. None of the expert panel members accepted that screening reduced mortality or was cost effective, but 25% of the gastroenterologists though it reduced mortality, and 13% thought it was cost effective. Also, none of the expert panel members accepted that surveillance was cost effective, but 69% of the gastroenterologists believed that it was.

“There is not complete agreement about managing Barrett's esophagus, even among the experts,” said Dr. Howden of Northwestern University, Chicago. “General gastroenterologists do a pretty good job at managing the condition, but their knowledge and understanding is a few years behind those of the experts.”

In a related presentation, Hashem El-Serag, M.D., of Baylor College of Medicine, Houston, reported on research about the incidence of Barrett's esophagus in children and adolescents.

In a group of 8,038 patients under age 18 years who had an upper endoscopy between 1999 and 2002 in the United States, only 37 had suspected Barrett's, indicating that the incidence in children is extremely low.

Community hospitals were more likely to report suspected Barrett's in children and adolescents than were pediatric hospitals. The difference was not statistically significant, but the data may indicate that the condition is so rare in children that pediatric gastroenterologists don't see it enough to recognize it, Dr. El-Serag said.

CHICAGO — Long-term use of proton-pump inhibitors, histamine₂-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and proton-pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” Dr. Yang said.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine₂-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use. The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang said. After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

Another hypothesis of the study, Dr. Yang said, is that men would be at greater risk because they do not take calcium supplements and do not talk about osteoporosis with their doctors. And, in fact, the data show just that: The relative risk of hip fracture associated with PPI use was much higher among men than among women.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — Long-term use of proton-pump inhibitors, histamine₂-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and proton-pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” Dr. Yang said.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine₂-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use. The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang said. After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

Another hypothesis of the study, Dr. Yang said, is that men would be at greater risk because they do not take calcium supplements and do not talk about osteoporosis with their doctors. And, in fact, the data show just that: The relative risk of hip fracture associated with PPI use was much higher among men than among women.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — Long-term use of proton-pump inhibitors, histamine₂-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and proton-pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” Dr. Yang said.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine₂-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use. The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang said. After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

Another hypothesis of the study, Dr. Yang said, is that men would be at greater risk because they do not take calcium supplements and do not talk about osteoporosis with their doctors. And, in fact, the data show just that: The relative risk of hip fracture associated with PPI use was much higher among men than among women.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — Long-term use of proton pump inhibitors, histamine2-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and protein pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” said Dr. Yang.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine2-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use.

The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent, Dr. Yang noted.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang noted in his presentation.

After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — Long-term use of proton pump inhibitors, histamine2-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and protein pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” said Dr. Yang.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine2-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use.

The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent, Dr. Yang noted.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang noted in his presentation.

After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — Long-term use of proton pump inhibitors, histamine2-receptor antagonists, and other acid suppressors increases the risk of hip fracture, Yu-Xiao Yang, M.D., reported at the annual Digestive Disease Week.

Physicians turning to a combination of NSAIDs and protein pump inhibitors (PPIs) in place of cyclooxygenase-2 (COX-2) inhibitors should be aware of this effect in patients who are at increased risk of osteoporosis, but they should not deny this therapy to patients with appropriate indications, said Dr. Yang of the division of gastroenterology at the University of Pennsylvania, Philadelphia.

PPIs interfere with calcium absorption, leading to an increased risk of hip fracture.

“Do patients with more than 1 year of PPI therapy have more hip fractures? Up until now, there has been no epidemiological study to address this,” said Dr. Yang.

His conclusions came from a retrospective cohort study of 518,096 patients older than 40 years who were included in the U.K. General Practice Research Database between May 1987 and April 2002. Of these, 47,631 had more than 1 year of exposure to a PPI; the remaining 470,465 patients had no exposure to either a PPI or histamine2-receptor antagonist (H2RA).

By looking at complete prescription information and validated hip fracture reports, the researchers discovered that taking a PPI long term was associated with an increased risk of hip fracture, with a relative risk of 1.9 associated with at least 1 year of PPI use.

The relationship had both a dose-response effect and a duration-response effect. H2RA use also increased the relative risk of hip fracture, but to a lesser extent, Dr. Yang noted.

In general, the PPI-exposed patients were sicker and took more medications, so potential confounders were considered and adjusted for if they represented markers of comorbidity status or if they had an effect on the central nervous system that would increase the risk of falling, Dr. Yang noted in his presentation.

After adjustment for potential confounders, there was still a significantly increased risk of hip fracture among long-term PPI users. Significant confounders included antidepressant use and an increased number of office visits.

The study was limited by the assumption of 100% compliance with therapy and the lack of information on use of over-the-counter drugs, Dr. Yang said.

CHICAGO — Ten patients with moderate Crohn's disease took supplements of fructooligosaccharide, a substance found in artichokes and asparagus, and showed an increase in fecal Bifidobacteria and production of mucosal dendritic cells, James Lindsay, Ph.D. reported at the Digestive Disease Week.

Although the findings are preliminary, this is the first known study of “prebiotic” dietary therapies for Crohn's, and the strategy may offer a way to supplement traditional treatments or to manage patients who do not respond to them, he said.

Fructooligosaccharide is a carbohydrate that selectively alters the colonic microbiota, Dr. Lindsay explained. It is a prebiotic that may provide a substrate upon which healthy bacteria can grow, as opposed to probiotics, which are the healthy bacteria themselves.

The supplement given to the 10 patients in the open-label study was prepared by Nestlé UK, which provided financial support for the research. The patients took 15 g per day for 3 weeks.

Patients and doctors noted an improvement on the Harvey Bradshaw index, with the mean falling from 9.8 at the start of the study to 6.9 at the end. Remission of Crohn's disease was achieved by 40% of the patients. There was a 6.8% increase in the volume of Bifidobacteria found in dried fecal samples between the start and end of the study. In addition, the number of interleukin-10 dentridic cells increased, as did the number of cells expressing Toll-like receptors.

Patients in the study, 60% of whom were completely compliant with the study regimen, tolerated the supplement well. The most common complaints were rumbling and flatulence.

“Traditional therapies tend to increase effector pathways. The alternative is to increase regulatory pathways,” said Dr. Lindsay, consultant gastroenterologist at St Bartholomew's Hospital and the Royal London Hospital.

Balfour Sartor, M.D., a professor of medicine, microbiology, and immunology at University of North Carolina at Chapel Hill, is familiar with the work of Dr. Lindsay and his colleagues because it overlaps with his own. He said that Dr. Lindsay's study is not in the mainstream of Crohn's research, but that it is a legitimate area of investigation.

Dr. Lindsay emphasized the preliminary nature of the findings. “One would have to be quite cautious in interpreting the results until we have performed a controlled trial,” he said.

CHICAGO — Ten patients with moderate Crohn's disease took supplements of fructooligosaccharide, a substance found in artichokes and asparagus, and showed an increase in fecal Bifidobacteria and production of mucosal dendritic cells, James Lindsay, Ph.D. reported at the Digestive Disease Week.

Although the findings are preliminary, this is the first known study of “prebiotic” dietary therapies for Crohn's, and the strategy may offer a way to supplement traditional treatments or to manage patients who do not respond to them, he said.

Fructooligosaccharide is a carbohydrate that selectively alters the colonic microbiota, Dr. Lindsay explained. It is a prebiotic that may provide a substrate upon which healthy bacteria can grow, as opposed to probiotics, which are the healthy bacteria themselves.

The supplement given to the 10 patients in the open-label study was prepared by Nestlé UK, which provided financial support for the research. The patients took 15 g per day for 3 weeks.

Patients and doctors noted an improvement on the Harvey Bradshaw index, with the mean falling from 9.8 at the start of the study to 6.9 at the end. Remission of Crohn's disease was achieved by 40% of the patients. There was a 6.8% increase in the volume of Bifidobacteria found in dried fecal samples between the start and end of the study. In addition, the number of interleukin-10 dentridic cells increased, as did the number of cells expressing Toll-like receptors.

Patients in the study, 60% of whom were completely compliant with the study regimen, tolerated the supplement well. The most common complaints were rumbling and flatulence.

“Traditional therapies tend to increase effector pathways. The alternative is to increase regulatory pathways,” said Dr. Lindsay, consultant gastroenterologist at St Bartholomew's Hospital and the Royal London Hospital.

Balfour Sartor, M.D., a professor of medicine, microbiology, and immunology at University of North Carolina at Chapel Hill, is familiar with the work of Dr. Lindsay and his colleagues because it overlaps with his own. He said that Dr. Lindsay's study is not in the mainstream of Crohn's research, but that it is a legitimate area of investigation.

Dr. Lindsay emphasized the preliminary nature of the findings. “One would have to be quite cautious in interpreting the results until we have performed a controlled trial,” he said.

CHICAGO — Ten patients with moderate Crohn's disease took supplements of fructooligosaccharide, a substance found in artichokes and asparagus, and showed an increase in fecal Bifidobacteria and production of mucosal dendritic cells, James Lindsay, Ph.D. reported at the Digestive Disease Week.

Although the findings are preliminary, this is the first known study of “prebiotic” dietary therapies for Crohn's, and the strategy may offer a way to supplement traditional treatments or to manage patients who do not respond to them, he said.

Fructooligosaccharide is a carbohydrate that selectively alters the colonic microbiota, Dr. Lindsay explained. It is a prebiotic that may provide a substrate upon which healthy bacteria can grow, as opposed to probiotics, which are the healthy bacteria themselves.

The supplement given to the 10 patients in the open-label study was prepared by Nestlé UK, which provided financial support for the research. The patients took 15 g per day for 3 weeks.

Patients and doctors noted an improvement on the Harvey Bradshaw index, with the mean falling from 9.8 at the start of the study to 6.9 at the end. Remission of Crohn's disease was achieved by 40% of the patients. There was a 6.8% increase in the volume of Bifidobacteria found in dried fecal samples between the start and end of the study. In addition, the number of interleukin-10 dentridic cells increased, as did the number of cells expressing Toll-like receptors.

Patients in the study, 60% of whom were completely compliant with the study regimen, tolerated the supplement well. The most common complaints were rumbling and flatulence.

“Traditional therapies tend to increase effector pathways. The alternative is to increase regulatory pathways,” said Dr. Lindsay, consultant gastroenterologist at St Bartholomew's Hospital and the Royal London Hospital.

Balfour Sartor, M.D., a professor of medicine, microbiology, and immunology at University of North Carolina at Chapel Hill, is familiar with the work of Dr. Lindsay and his colleagues because it overlaps with his own. He said that Dr. Lindsay's study is not in the mainstream of Crohn's research, but that it is a legitimate area of investigation.

Dr. Lindsay emphasized the preliminary nature of the findings. “One would have to be quite cautious in interpreting the results until we have performed a controlled trial,” he said.