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Potassium-competitive acid blockers-are they the next generation of proton pump inhibitors?

World Journal of Gastrointestinal Pharmacology and Therapeutics 2018年第7期9卷 63-68页

作者： Prashanth Rawla Tagore Sunkara Andrew Ofosu vinaya gaduputi Department of Internal Medicine SOVAH Health Division of Gastroenterology and Hepatology The BrooklynHospital CenterClinical Affiliate of The Mount Sinai Hospital Division of Gastroenterology SBH Health System

The modern lifestyle caters to an increase in the incidence of peptic ulcer disease,gastroesophageal reflux disease and several other acid-related conditions of the gut. The drugs to prevent these conditions work either through H2 receptor blockade or inhibition of the H^+, K^+ ATPase enzyme. Although proton pump inhibitors have been proven to be efficacious, they have a slow onset of action with limited resolution of symptoms in most patients. Potassium-competitive acid blockers(P-CABs) are novel drugs that bind reversibly to K^+ ions and block the H^+, K^+ ATPase enzyme, thus preventing acid production. P-CABs have a fast onset of action and have dose-dependent effects on acid production. Animal studies exist that differentiate the better results of P-CABs from proton pump inhibitors; further human trials will give a comprehensive picture of the results and will help to elucidate the therapeutic benefits of this new group of drugs.

关键词： Potassium-competitive acid blockers Gastroesophageal reflux disease Proton pump inhibitors Peptic ulcer disease Vonoprazan

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A fascinating presentation of hepatic hydrothorax

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World Journal of Hepatology 2013年第10期5卷 589-591页

作者： vinaya gaduputi Hassan Tariq Kalyan Kanneganti Department of Medicine Bronx Lebanon Hospital Center

We report this case of a 43-year-old woman with hepatitis-C cirrhosis who presented with a large right sided pleural effusion complicated by hypoxic respiratory failure and altered mentation necessitating dependence on mechanical ventilation. The pleural effusion spontaneously resolved upon initiation of mechanical positive pressure ventilation and recurred almost immediately after weaning the patient off the ventilator. The preventilation, ventilation and post-ventilation chest X-ray films in chronological order present a striking visual demonstration of fluid dynamics and pathophysiology of hepatic hydrothorax, thereby obviating the need for a dedicated diagnostic test. We also report this case to highlight the treatment strategies for this often intractable complication.

关键词： Hepatic hydrothorax Hydrothorax Cirrhotic pleural effusions Refractory pleural effusions Pleural effusions in cirrhosis

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Gallstone ileus with multiple stones:Where Rigler triad meets Bouveret's syndrome

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World Journal of Gastrointestinal Surgery 2015年第12期7卷 394-397页

作者： vinaya gaduputi Hassan Tariq Amir A Rahnemai-Azar Anil Dev Daniel T Farkas Department of Medicine Bronx Lebanon Hospital Center Department of Surgery Bronx Lebanon Hospital Center

A 53-year-old man with multiple medical conditions presented to the emergency department with complaints of vomiting, anorexia and diffuse colicky abdominal pain for 3 d. A computed tomography scan of the abdomen and pelvis showed radiographic findings consistent with Rigler triad seen in small proportion of patients with small bowel obstruction secondary to gallstone impaction. In addition there was a gastric outlet obstruction, consistent with Bouveret's syndrome. The patient underwent an exploratory laparotomy and enterotomy with multiple stones extracted. The patient had an uneventful post-surgical clinical course and was discharged home.

关键词： Rigler triad Gallstone ileus Bouveret'ssyndrome Small bowel obstruction

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Carcinoma in situ in a 7 mm gallbladder polyp: Time to change current practice?

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World Journal of Gastrointestinal Endoscopy 2015年第9期7卷 912-915页

作者： David Kasle Amir A Rahnemai-Azar Shahida Bibi vinaya gaduputi Brian F Gilchrist Daniel T Farkas Department of Surgery BronxLebanon Hospital CenterAlbert Einstein College of Medicine Department of Medicine Bronx-Lebanon Hospital CenterAlbert Einstein College of Medicine

Detection of polypoid lesions of the gallbladder is increasing in conjunction with better imaging modalities. Accepted management of these lesions depends on their size and symptomatology. Polyps that are symptomatic and/or greater than 10 mm are generally removed, while smaller, asymptomatic polyps simply monitored. Here, a case of carcinoma-in-situ is presented in a 7 mm gallbladder polyp. A 25-year-old woman, who had undergone a routine cholecystectomy, was found to have an incidental 7 mm polyp containing carcinoma in situ. She had few to no risk factors to alert to her condition. There are few reported cases of cancer transformation in gallbladder polyps smaller than 10 mm reported in the literature. The overwhelming consensus, barring significant risk factors for cancer being present, is that such lesions should be monitored until they become symptomatic or develop signs suspicious for malignancy. In our patient's case this could have led to the possibility of missing a neoplastic lesion, which could then have gone on to develop invasive cancer. As gallbladder carcinoma is an aggressive cancer, this may have led to a tragic outcome.

关键词： Gallbladder Polyp Cholecystectomy Size Carcinoma

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