Simadibrata, Daniel Martin

ABSTRACT Background and Aim Determining the location of gastrointestinal (GI) bleeding is critical for guiding diagnostic and therapeutic strategies but often results in patients receiving pan‐endoscopy with upper endoscopy, colonoscopy, and small bowel capsule endoscopy, which can be unnecessary, costly, and waste limited healthcare resources. The blood urea nitrogen‐to‐creatinine ratio (BUN/Cr) may help discriminate between upper GI bleeding (UGIB) and lower GI bleeding (LGIB). This study aims to assess the diagnostic performance of the BUN/Cr in distinguishing UGIB from LGIB. Methods A literature search was conducted in MEDLINE, EMBASE, and Cochrane Library to identify diagnostic test accuracy studies published from inception through January 31, 2025, which evaluated BUN/Cr in patients with UGIB versus LGIB. A linear mixed‐effects model meta‐analysis was conducted using the “diagmeta” package. The pooled sensitivity, specificity, diagnostic odds ratio, and area under the summary receiver operating characteristic curve (AUC) were estimated, and optimal threshold was determined using the Youden index. Results Seventeen studies were included in this meta‐analysis. The pooled mean difference in BUN/Cr between UGIB and LGIB patients was 11.44 (95% confidence interval [95% CI] 8.35–14.52). At a threshold of > 30, pooled sensitivity was 38.8% (95% CI 28.1%–50.8%) and specificity was 89.3% (95% CI 81.0%–94.2%). At the optimal cut‐off of 22, sensitivity was 66.2% (95% CI 57.8%–73.7%), specificity was 71.0% (95% CI 58.5%–81.0%), and AUC was 0.740 (95% CI 0.683–0.794). Conclusion BUN/Cr demonstrates moderate diagnostic accuracy for distinguishing UGIB from LGIB, particularly at a threshold of ≥ 22. This readily accessible and inexpensive blood test may assist in early clinical triage and assessment of the location of GI bleeding, particularly in those patients where the clinical presentation is obscure.

Background/Objective: Clostridioides difficile infection (CDI) is a common healthcare-associated ailment, presenting major health and economic challenges, especially for the elderly. Despite its prevalence, comprehensive data about CDI’s impact on the elderly are limited. Methods: This study used the Global Burden of Disease Study 2019 data to analyze CDI trends from 2000 to 2019, considering factors like sex, region, and sociodemographic index (SDI). Results: This study revealed that CDI caused approximately 18,181 deaths and 252,709 disability-adjusted life years (DALYs) among the elderly worldwide. The Americas showed the highest CDI burden, while the Eastern Mediterranean saw the steepest rate increase from 2000 to 2019. Regions with a high SDI also displayed substantial CDI impact. Conclusions: The escalating burden of CDI in the elderly, especially in high-SDI areas and the Americas, emphasizes an urgent need for targeted public health strategies.

AbstractBackground and AimIn recent years, there has been a growing incidence of gastrointestinal cancer in young individuals. Despite its significant morbidity and mortality, research on upper gastrointestinal (UGI) cancer in young populations has been relatively limited. Therefore, studies on the epidemiological changes of this cancer are needed.MethodsUsing data from the Global Burden of Disease Study 2019, we examined the incidence, death, and disability‐adjusted life years (DALYs) from UGI cancers in the young, namely, early‐onset esophageal cancer (EOEC) and early‐onset gastric cancer (EOGC). These results were stratified by sex, geographical region, country, and sociodemographic index.ResultsThere was a total of 185 140 cases, 120 289 deaths, and 5.70 million DALYs attributable to early‐onset UGI cancers globally. From 2010 to 2019, the global incidence, death, and DALYs rates of early‐onset UGI cancers decreased. In contrast, the incidence rates increased in both EOEC (+1.15%) and EOGC (+0.21%) in the Eastern Mediterranean region.ConclusionsOver the past decade, the burden of UGI cancer in the young has decreased. However, it has increased in the Eastern Mediterranean region. Further research to elucidate the attributable risk factors in this population is warranted.

AbstractBackground and AimHealing rates of severe erosive esophagitis (EE; Los Angeles [LA] Grade C/D) in patients treated with a proton pump inhibitor (PPI) is suboptimal (~60–70%). Vonoprazan, a potassium‐competitive acid blocker, is suggested to have better healing rates in patients with severe EE. This meta‐analysis compares the efficacy and safety of vonoprazan 20 mg versus lansoprazole 30 mg daily in healing EE, specifically in those with LA Grade C/D.MethodsWe searched MEDLINE, Embase, and CENTRAL on May 24, 2023. Studies that randomized EE patients to vonoprazan 20 mg daily or lansoprazole 30 mg daily and compared healing rates were included. The risk of bias was assessed using Cochrane's Risk of Bias 2 tool. The fixed‐effect model was used to obtain the pooled efficacy and safety outcomes. Subgroup analysis was done to compare healing rates in mild (LA Grade A/B) versus severe EE and based on study location.ResultsFour randomized controlled trials (RCTs) with low risks of bias comprising 2208 participants were included. Vonoprazan 20 mg was superior to lansoprazole 30 mg daily in healing severe EE at all weeks (Week 2 RR 1.294 [95% CI 1.169–1.433], Week 4 1.160 [1.059–1.270], and Week 8 1.175 [95% CI 1.107–1.247]), but was similar for mild EE at all weeks (P‐interaction < 0.01). Vonoprazan 20 mg was more efficacious than lansoprazole 30 mg at Week 8 in Western versus Asian studies (P‐interaction < 0.01). Any, serious, and drug‐related treatment‐emergent adverse events were comparable between groups.ConclusionVonoprazan 20 mg is superior to lansoprazole 30 mg for healing severe EE but not mild EE. Vonoprazan 20 mg daily has a similar safety profile to lansoprazole 30 mg daily.

AbstractBackground and AimUp to 40% of gastroesophageal reflux disease (GERD) patients experience inadequate symptom relief with a proton pump inhibitor (PPI), termed PPI‐resistant or refractory GERD. Vonoprazan, a potassium‐competitive acid blocker, has better efficacy than PPI in suppressing gastric acid secretion. This meta‐analysis summarizes the efficacy and safety of vonoprazan for treating PPI‐resistant GERD (both erosive esophagitis [EE] and non‐erosive reflux disease [NERD]).MethodsFour electronic databases (Medline, Embase, SCOPUS, and CENTRAL) were searched for studies indexed until August 1, 2023. Both observational studies and clinical trials assessing the efficacy and safety of vonoprazan in PPI‐resistant GERD were included. Efficacy outcomes included healing and maintenance rates of EE and improvement of the Frequency Scale for Symptoms of GERD (FSSG) scores. Serious adverse events (SAEs) were considered a safety outcome. The modified Newcastle‐Ottawa Scale (NOS) was used to assess study quality.ResultsTwelve studies were included in this meta‐analysis. Healing rates of PPI‐resistant EE with vonoprazan 20 mg were 91.7% (95% CI 86.8–94.8%) and 88.5% (95% CI 69.7–96.2%) at weeks 4 and 8, respectively. For healed PPI‐resistant EE, the overall maintenance rates with vonoprazan 10 mg were 82.6% (95% 61.2–95.0%) at week 8, 86.0% (95% CI 72.1–94.7%) at week 24, and 93.8% (95% CI 69.8–99.8%) at week 48. FSSG scores were improved in 74.6% (95% CI 65.8–81.7%) and 51.9% (95% CI 37.8–65.7%) of patients at weeks 4 and 8. Overall, no SAE was reported.ConclusionVonoprazan demonstrated high efficacy in the healing and maintenance of PPI‐resistant EE and moderate efficacy for the improvement of FSSG score. Vonoprazan was well tolerated in PPI‐resistant GERD patients.