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Schubert M.L.,Virginia Commonwealth University | Schubert M.L.,Hunter Holmes ire Veterans Affairs Medical Center
Current Opinion in Gastroenterology | Year: 2015

Purpose of review This review summarizes the past year's literature regarding the neuroendocrine and intracellular regulation of gastric acid secretion, discussing both basic and clinical aspects. Recent findings Gastric acid facilitates the digestion of protein as well as the absorption of iron, calcium, vitamin B12, and certain medications. High acidity kills ingested microorganisms and limits bacterial overgrowth, enteric infection, and possibly spontaneous bacterial peritonitis. The main stimulants of acid secretion are gastrin, released from antral gastrin cells; histamine, released from oxyntic enterochromaffin-like cells; and acetylcholine, released from antral and oxyntic intramural neurons. Ghrelin and coffee also stimulate acid secretion whereas somatostatin, cholecystokinin, glucagon-like peptide-1, and atrial natriuretic peptide inhibit acid secretion. Although 95% of parietal cells are contained within the oxyntic mucosa (fundus and body), 50% of human antral glands contain parietal cells. Proton pump inhibitors are considered well tolerated drugs, but concerns have been raised regarding dysbiosis, atrophic gastritis, hypergastrinemia, hypomagnesemia, and enteritis/colitis. Summary Our understanding of the functional anatomy and physiology of gastric secretion continues to advance. Such knowledge is crucial for improved management of acid-peptic disorders, prevention and management of neoplasia, and the development of novel medications. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Desilets A.R.,Manchester College | Asal N.J.,Hunter Holmes ire Veterans Affairs Medical Center | Dunican K.C.,Manchester College
Consultant Pharmacist | Year: 2012

Objective: To investigate current concerns regarding the use of proton-pump inhibitors (PPIs) in older adults. Data Sources: A literature search was conducted in MEDLINE (1948 to April week 3 2011) to identify relevant publications. Key words searched included proton-pump inhibitor, safety, adverse events, elderly, and older adults. Additional data sources were obtained through a bibliographic review of selected articles. Data Selection: Relevant studies conducted in older adults published in English that examined risks associated with the use of PPIs were included in this review. Data Synthesis: The older adult population in the United States is growing at an astounding rate. With the increase in age, there are many factors that make the elderly susceptible to acid-related gastrointestinal disorders that require treatment with PPIs. However, PPI use in the elderly has been shown to lead to a number of health concerns. Recent data have shown that PPI use is associated with an increased risk of fractures, Clostridium difficile infection, community-acquired pneumonia, vitamin and mineral deficiencies, and drug interactions. These concerns will be further investigated and weighed against the benefits of PPI use in this population. Conclusions: Patient-specific characteristics must be taken into consideration when recommending and/or prescribing PPIs to older adults. © 2012 American Society of Consultant Pharmacists, Inc. All rights reserved.


Fatouros P.P.,Virginia Commonwealth University | Shultz M.D.,Hunter Holmes ire Veterans Affairs Medical Center | Shultz M.D.,Virginia Commonwealth University
Nanomedicine | Year: 2013

Metallofullerenes have incited research endeavors across many disciplines owing to their wide range of properties obtainable by altering the metal component inside the fullerene cage or by a variety of surface functionalities. With a metal component of gadolinium, gadofullerenes have particularly shown promise in MRI applications owing to their high proton relaxivity and isolation of the metal from the biological environment. This article aims to give a perspective on the development of metallofullerenes as MRI contrast agents and further applications that distinguish them as a new class of imaging agent. © 2013 Future Medicine Ltd.


Schubert M.L.,Virginia Commonwealth University | Schubert M.L.,Hunter Holmes ire Veterans Affairs Medical Center
Current Opinion in Gastroenterology | Year: 2014

Purpose of review: This review summarizes the past year's literature regarding the neural, paracrine, hormonal, and intracellular regulation of gastric acid secretion. Recent findings: Gastric acid facilitates the digestion of protein as well as the absorption of iron, calcium, vitamin B12, and certain medications. High gastric acidity, in combination with pepsin and lipase, kills ingested microorganisms and may play a role in preventing bacterial overgrowth, enteric infection, and possibly spontaneous bacterial peritonitis, community-acquired pneumonia, and infection with Mycobacterium tuberculosis. Stimulants of acid secretion include histamine, gastrin, acetylcholine, and ghrelin. Inhibitors include somatostatin, gastric inhibitory polypeptide, calcitonin gene-related peptide, and adrenomedullin. Helicobacter pylori stimulates or inhibits depending upon the time course of infection and the area of the stomach predominantly infected. Proteins implicated in H-K-ATPase membrane trafficking include myosin IIB, F-actin, ezrin, and Rab GTPases. Summary: Our understanding of the regulation of gastric acid secretion continues to advance. Such knowledge is crucial for the management of acid-peptic disorders and the development of novel medications, such as cholecystokinin-2 receptor antagonists. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Hasnain M.,Sir Thomas Roddick Hospital | Fredrickson S.K.,Hunter Holmes ire Veterans Affairs Medical Center | Vieweg W.V.R.,Virginia Commonwealth University | Pandurangi A.K.,Virginia Commonwealth University
Current Diabetes Reports | Year: 2010

Patients with schizophrenia are at increased risk for developing the metabolic syndrome or its individual components due to their lifestyle, suspected genetic predisposition, and exposure to antipsychotic medications that can cause weight gain and other metabolic side effects. Despite the availability of clinical guidelines, screening for and monitoring of metabolic problems in this patient population continue to be suboptimal. We provide an overview specifically addressing 1) why patients with schizophrenia are at increased risk for metabolic problems; 2) how commonly used antipsychotic medications vary in terms of their metabolic liability; 3) how to effectively screen for and monitor metabolic problems in patients receiving antipsychotic medications; 4) what interventions can prevent, limit, or reverse the metabolic side effects of antipsychotic drug treatment; and 5) what are the barriers to the care of these patients. © Springer Science+Business Media, LLC 2010.

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