geoffrey modest medical blogs

gastroesophageal reflux disease (GERD) is a remarkably common problem in patients presenting to primary care clinicians. although there are an array of lifestyle interventions that have been suggested, there are somewhat limited data on their efficacy. a recent systematic review assessed the literature (see  gerd lifestlye interventions  jgastrohep2016  in dropbox, or Clinical Gastroenterology and Hepatology 2016;14:175). details: --background:     ​--prevalence of GERD in western populations is 30%; incidence is 5/1000 person-years     --GERD is associated with decreased quality-of-life and work productivity, and increased risk of esophageal carcinoma (for guidelines on Barretts esophagus management, see blog:  http://gmodestmedblogs.blogspot.com/2016/01/barretts-esophagus-guidelines.html  )     --reflux is associated with a variety of factors leading to relaxation of the lowe...

an article just came out looking at the relationship between  PPI  (proton-pump inhibitor) use and chronic kidney disease (CKD) (see   doi: 10.1001 / jamainternmed. 2015.7193). details: --10,482 patients in the ARIC study (Atherosclerosis Risk In Communities, in 4 US communities) who had baseline GFR of >60 ml/min/1.73 m 2  in 1996-9 were followed until 2011, mean 13.9 years     --mean age 63, 44% male, 80% white, 80% with education >=12th grade, mean eGFR 88, urinary albumin/creatinine ratio 4, 12% smokers, BMI 29, systolic BP 127, 50% hypertensive, 15% diabetic, 30% on NSAIDs, 15% on ACE inhibitors, 60% on aspirin --replication study in the Geisinger Health System database with 248,751 patients followed mean of 6.2 years      --mean age 50, 43% male, 95 % white ,   mean eGFR 95, 25% smokers, BMI 30, systolic BP 127, 33% hypertensive, 10% diabetic, 12% on NSAIDs, 30% on ...