Proton pump inhibitors and all-cause mortality risk among cancer patients

BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.

Prevalence of Helicobacter pylori infection among patients with esophageal carcinoma

BACKGROUND Helicobacter pylori(H.pylori)is a widespread microorganism related to gastric adenocarcinoma(AC).In contrast,it has been reported that an inverse association exists between H.pylori infection and esophageal carcinoma.The mechanisms underlying this supposedly protective effect remain controversial.AIM To determine the prevalence of H.pylori infection in esophageal carcinoma patients,we performed a retrospective observational study of esophageal tumors diagnosed in our hospital.METHODS We retrospectively reviewed the prevalence of H.pylori infection in a cohort of patients diagnosed with esophageal carcinoma.Concomitant or previous proton pump inhibitor(PPI)usage was also recorded.RESULTS A total of 89 patients with esophageal carcinoma(69 males,77.5%),with a mean age of 66 years(range,26-93 years)were included.AC was the most frequent pathological variant(n=47,52.8%),followed by squamous cell carcinoma(n=37,41.6%).Fourteen ACs(29.8%)originated in the gastroesophageal junction and 33(70.2%)in the esophageal body.Overall,54 patients(60.7%)presented at stages III and IV.Previous H.pylori infection occurred only in 4 patients(4.5%),3 with AC(6.3%of all ACs)and 1 with squamous cell carcinoma(2.7%of all squamous cell tumors).All patients with previous H.pylori infection had stage III-IV.Only one patient had received prior H.pylori eradication therapy,whereas 86(96.6%)had received previous or concomitant PPI treatment.CONCLUSION In our cohort of patients,and after histologic evaluation of paraffin-embedded primary tumors,we found a very low prevalence of previous H.pylori infection.We also reviewed the medical history of the patients,concluding that the majority had received or were on PPI treatment.The minimal prevalence of H.pylori infection found in this cohort of patients with esophageal carcinoma suggests a protective role.

Effects of proton pump inhibitors on inflammatory bowel disease:An updated review

Inflammatory bowel disease(IBD)is believed to be caused by various factors,including abnormalities in disease susceptibility genes,environmental factors,immune factors,and intestinal bacteria.Proton pump inhibitors(PPIs)are the primary drugs used to treat acid-related diseases.They are also commonly prescribed to patients with IBD.Recent studies have suggested a potential association between the use of certain medications,such as PPIs,and the occurrence and progression of IBD.In this review,we summarize the potential impact of PPIs on IBD and analyze the underlying mechanisms.Our findings may provide insights for conducting further investigations into the effects of PPIs on IBD and serve as an important reminder for physicians to exercise caution when prescribing PPIs to patients with IBD.

New Strategy for Boosting Cathodic Performance of Protonic Ceramic Fuel Cells Through Incorporating a Superior Hydronation Second Phase

For protonic ceramic fuel cells,it is key to develop material with high intrinsic activity for oxygen activation and bulk proton conductivity enabling water formation at entire electrode surface.However,a higher water content which benefitting for the increasing proton conductivity will not only dilute the oxygen in the gas,but also suppress the O_(2)adsorption on the electrode surface.Herein,a new electrode design concept is proposed,that may overcome this dilemma.By introducing a second phase with high-hydrating capability into a conventional cobalt-free perovskite to form a unique nanocomposite electrode,high proton conductivity/concentration can be reached at low water content in atmosphere.In addition,the hydronation creates additional fast proton transport channel along the two-phase interface.As a result,high protonic conductivity is reached,leading to a new breakthrough in performance for proton ceramic fuel cells and electrolysis cells devices among available air electrodes.

Rational Design of Ruddlesden-Popper Perovskite Ferrites as Air Electrode for Highly Active and Durable Reversible Protonic Ceramic Cells

Reversible protonic ceramic cells(RePCCs)hold promise for efficient energy storage,but their practicality is hindered by a lack of high-performance air electrode materials.Ruddlesden-Popper perovskite Sr_(3)Fe_(2)O_(7−δ)(SF)exhibits superior proton uptake and rapid ionic conduction,boosting activity.However,excessive proton uptake during RePCC operation degrades SF’s crystal structure,impacting durability.This study introduces a novel A/B-sites co-substitution strategy for modifying air electrodes,incorporating Sr-deficiency and Nb-substitution to create Sr_(2.8)Fe_(1.8)Nb_(0.2)O_(7−δ)(D-SFN).Nb stabilizes SF’s crystal,curbing excessive phase formation,and Sr-deficiency boosts oxygen vacancy concentration,optimizing oxygen transport.The D-SFN electrode demonstrates outstanding activity and durability,achieving a peak power density of 596 mW cm^(−2)in fuel cell mode and a current density of−1.19 A cm^(−2)in electrolysis mode at 1.3 V,650℃,with excellent cycling durability.This approach holds the potential for advancing robust and efficient air electrodes in RePCCs for renewable energy storage.

In-situ coating and surface partial protonation co-promoting performance of single-crystal nickel-rich cathode in all-solid-state batteries

The poor electrochemical performance of all-solid-state batteries(ASSBs),which is assemblied by Ni-rich cathode and poly(ethylene oxide)(PEO)-based electrolytes,can be attributed to unstable cathodic interface and poor crystal structure stability of Ni-rich cathode.Several coating strategies are previously employed to enhance the stability of the cathodic interface and crystal structure for Ni-rich cathode.However,these methods can hardly achieve simplicity and high efficiency simultaneously.In this work,polyacrylic acid(PAA)replaced traditional PVDF as a binder for cathode,which can achieve a uniform PAA-Li(LixPAA(0<x≤1))coating layer on the surface of single-crystal LiNi_(0.83)Co_(0.12)Mn_(0.05)O_(2)(SC-NCM83)due to H^(+)/Li^(+)exchange reaction during the initial charging-discharging process.The formation of PAA-Li coating layer on cathode can promote interfacial Li^(+)transport and enhance the stability of the cathodic interface.Furthermore,the partially-protonated surface of SC-NCM83 casued by H^(+)/Li^(+)exchange reaction can restrict Ni ions transport to enhance the crystal structure stability.The proposed SC-NCM83-PAA exhibits superior cycling performance with a retention of 92%compared with that(57.3%)of SC-NCM83-polyvinylidene difluoride(PVDF)after 200 cycles.This work provides a practical strategy to construct high-performance cathodes for ASSBs.

Performance Degradation Prediction of Proton Exchange Membrane Fuel Cell Based on CEEMDAN-KPCA and DA-GRU Networks

In order to improve the performance degradation prediction accuracy of proton exchange membrane fuel cell(PEMFC),a fusion prediction method(CKDG)based on adaptive noise complete ensemble empirical mode decomposition(CEEMDAN),kernel principal component analysis(KPCA)and dual attention mechanism gated recurrent unit neural network(DA-GRU)was proposed.CEEMDAN and KPCA were used to extract the input feature data sequence,reduce the influence of random factors,and capture essential feature components to reduce the model complexity.The DA-GRU network helps to learn the feature mapping relationship of data in long time series and predict the changing trend of performance degradation data more accurately.The actual aging experimental data verify the performance of the CKDG method.The results show that under the steady-state condition of 20%training data prediction,the CKDA method can reduce the root mean square error(RMSE)by 52.7%and 34.6%,respectively,compared with the traditional LSTM and GRU neural networks.Compared with the simple DA-GRU network,RMSE is reduced by 15%,and the degree of over-fitting is reduced,which has higher accuracy.It also shows excellent prediction performance under the dynamic condition data set and has good universality.

Tackling the proton limit under industrial electrochemical CO_(2)reduction by a local proton shuttle

Industrial CO_(2)electroreduction has received tremendous attentions for resolution of the current energy and environmental crisis,but its performance is greatly limited by mass transport at high current density.In this work,an ion‐polymer‐modified gas‐diffusion electrode is used to tackle this proton limit.It is found that gas diffusion electrode‐Nafion shows an impressive performance of 75.2%Faradaic efficiency in multicarbon products at an industrial current density of 1.16 A/cm^(2).Significantly,in‐depth electrochemical characterizations combined with in situ Raman have been used to determine the full workflow of protons,and it is found that HCO_(3)^(−)acts as a proton pool near the reaction environment,and HCO_(3)^(−)and H_(3)O^(+)are local proton donors that interact with the proton shuttle−SO_(3)^(−)from Nafion.With rich proton hopping sites that decrease the activation energy,a“Grotthuss”mechanism for proton transport in the above system has been identified rather than the“Vehicle”mechanism with a higher energy barrier.Therefore,this work could be very useful in terms of the achievement of industrial CO_(2)reduction fundamentally and practically.

Correlation between hydration properties and electrochemical performances on Ln cation size effect in layered perovskite for protonic ceramic fuel cells

PrBa_(0.5)Sr_(0.5)Co_(1.5)Fe_(0.5)O_(5+δ)(PrBSCF) has attracted much research interest as a potential triple ionic and electronic conductor(TIEC) electrode for protonic ceramic fuel cells(PCFCs). The chemical formula for Pr BSCF is AA'B_(2)O_(5+δ), with Pr(A-site) and Ba/Sr(A'-site) alternately stacked along the c-axis. Due to these structural features, the bulk oxygen ion diffusivity is significantly enhanced through the disorder-free channels in the PrO layer;thus, the A site cations(lanthanide ions) play a pivotal role in determining the overall electrochemical properties of layered perovskites. Consequently, previous research has predominantly focused on the electrical properties and oxygen bulk/surface kinetics of Ln cation effects,whereas the hydration properties for PCFC systems remain unidentified. Here, we thoroughly examined the proton uptake behavior and thermodynamic parameters for the hydration reaction to conclusively determine the changes in the electrochemical performances depending on LnBa_(0.5)Sr_(0.5)Co_(1.5)Fe_(0.5)O_(5+δ)(LnBSCF,Ln=Pr, Nd, and Gd) cathodes. At 500 ℃, the quantitative proton concentration of PrBSCF was 2.04 mol% and progressively decreased as the Ln cation size decreased. Similarly, the Gibbs free energy indicated that less energy was required for the formation of protonic defects in the order of Pr BSCF < Nd BSCF < Gd BSCF. To elucidate the close relationship between hydration properties and electrochemical performances in LnBSCF cathodes, PCFC single cell measurements and analysis of the distribution of relaxation time were further investigated.

Highly efficient vanadium redox flow batteries enabled by a trilayer polybenzimidazole membrane assembly

A novel polybenzimidazole(PBI)-based trilayer membrane assembly is developed for application in vanadium redox flow battery(VRFB).The membrane comprises a 1μm thin cross-linked poly[2,2′-(p-oxydiphenylene)−5,5′-bibenzimidazole](OPBI)sandwiched between two 20μm thick porous OPBI membranes(p-OPBI)without further lamination steps.The trilayer membrane demonstrates exceptional properties,such as high conductivity and low area-specific resistance(ASR)of 51 mS cm^(−1) and 81mΩ cm^(2),respectively.Contact with vanadium electrolyte increases the ASR of trilayer membrane only to 158mΩ cm^(2),while that of Nafion is 193mΩ cm^(2).VO^(2+) permeability is 2.73×10^(-9) cm^(2) min^(−1),about 150 times lower than that of Nafion NR212.In addition,the membrane has high mechanical strength and high chemical stability against VO^(2+).In VRFB,the combination of low resistance and low vanadium permeability results in excellent performance,revealing high Coulombic efficiency(>99%),high energy efficiency(EE;90.8% at current density of 80mA cm^(−2)),and long-term durability.The EE is one of the best reported to date.

Electromagnetic pulses produced by a picosecond laser interacting with solid targets

A high-power laser ablating solid targets induces giant electromagnetic pulses(EMPs),which are intimately pertinent to laser parameters,such as energy and pulse width.In this study,we reveal the features of EMPs generated from a picosecond(ps)laser irradiating solid targets at the SG-Ⅱpicosecond petawatt(PSPW)laser facility.The laser energy and pulse,as well as target material and thickness,show determinative effects on the EMPs’amplitude.More intense EMPs are detected behind targets compared to those at the other three positions,and the EMP amplitude decreases from 90.09 kV/m to 17.8 kV/m with the gold target thickness increasing from 10μm to 20μm,which is suppressed when the laser pulse width is enlarged.The results are expected to provide more insight into EMPs produced by ps lasers coupling with targets and lay the foundation for an effective EMP shielding design in high-power laser infrastructures.

Conceptual design of a 714-MHz RFQ for compact proton injectors and development of a new tuning algorithm on its aluminium prototype

Radio frequency quadrupoles(RFQs),which are crucial components of proton injectors,significantly affect the performance of proton accelerator facilities.An RFQ with a high frequency of 714 MHz dedicated to compact proton injectors for medi-cal applications is designed in this study.The RFQ is designed to accelerate proton beams from 50 keV to 4 MeV within a short length of 2 m and can be matched closely with the downstream drift tube linac to capture more particles through a preliminary optimization.To develop an advanced RFQ,challenging techniques,including fabrication and tuning method,must be evaluated and verified using a prototype.An aluminium prototype is derived from the conceptual design of the RFQ and then redesigned to confirm the radio frequency performance,fabrication procedure,and feasibility of the tuning algorithm.Eventually,a new tuning algorithm based on the response matrix and least-squares method is developed,which yields favorable results based on the prototype,i.e.,the errors of the dipole and quadrupole components reduced to a low level after several tuning iterations.Benefiting from the conceptual design and techniques obtained from the prototype,the formal mechanical design of the 2-m RFQ is ready for the next manufacturing step.

Proton conductivity performance and its correlation with physiochemical properties of proton exchange membrane(PEM)

Graphene oxide(GO)filler containing diversified Nafion-based proton exchange membrane(PEM)is studied to know the unique physical and chemical properties and performances of PEM.Nafion-SPEEK 1%-GO 0.75%(NSG-0.75%)composite shows the highest proton conductivity of 0.327 S·cm^(-1) at 90℃ and 100%RH(relative humidity)among all the PEM investigated.The descending order of significant proton conductivity is found as;Nafion-sPGO(1%)0.306 S·cm^(-1)>Nafion/ZIF-8@GO 0.280 S·cm^(-1)>Nafion/PGO(2%)0.277 S·cm^(-1)>Nafion/GO-sulfur(3%)0.232 S·cm^(-1)>Nafion/GO-poly-SPM-co-PEGMEMA(1%)0.229 S·cm^(-1)>Nafion/Ce-sPGO(1%)0.215 S·cm^(-1).The proton conductivity,water uptake capacity and ion exchange capacity,hydration number,thermal and oxidative stability,mechanical integrity(tensile strength),maximum power,and current density are found to be increased while activation energy and fuel crossover show a decrement as GO or modified GO is incorporated in the Nafion matrix.Principal component analysis(PCA)predicted a significant correlation between the proton conductivity and the properties;the water uptake capacity,ion exchange capacity,hydration number,maximum power density,and maximum current density are 0.598%,0.688%,0.894%,0.980%,and 0.852%accordingly.A multiple linear model equation of proton conductivity is defined with the parameters of water uptake capacity,ion exchange capacity,hydration number,maximum power density,and maximum current density whereas the regression coefficient is 0.9923.

Molecular-level proton acceptor boosts oxygen evolution catalysis to enable efficient industrial-scale water splitting

Industrial water splitting has long been suppressed by the sluggish kinetics of the oxygen evolution reaction(OER),which requires a catalyst to be efficient.Herein,we propose a molecular-level proton acceptor strategy to produce an efficient OER catalyst that can boost industrial-scale water splitting.Molecular-level phosphate(-PO_(4))group is introduced to modify the surface of PrBa_(0.5)Ca_(0.5)Co_(2)O_(5)+δ(PBCC).The achieved catalyst(PO_(4)-PBCC)exhibits significantly enhanced catalytic performance in alkaline media.Based on the X-ray absorption spectroscopy results and density functional theory(DFT)calculations,the PO_(4)on the surface,which is regarded as the Lewis base,is the key factor to overcome the kinetic limitation of the proton transfer process during the OER.The use of the catalyst in a membrane electrode assembly(MEA)is further evaluated for industrial-scale water splitting,and it only needs a low voltage of 1.66 V to achieve a large current density of 1 A cm^(-2).This work provides a new molecular-level strategy to develop highly efficient OER electrocatalysts for industrial applications.

A dual redox-active and robust polymer enables ultrafast and durable proton-storage capability

Aqueous proton batteries(APBs) offer a viable and attractive option in the field of affordable and sustainable energy solutions.Organic polymers are highly favored due to their environmentally friendly manufacturability and malleable molecular configurations,making them suitable materials for constructing APB electrodes.Nonetheless,their currently limited capacity for proton-associated redox reactions poses a challenge to the widespread usage.Herein,we have developed a highly redox-active organic polymer(PTA) tailored for APB applications.The inclusion of dual redox-active moieties in the extended nconjugated frameworks not only enhances the redox activity and refines the electronic properties,but also ensures the high structural integrity of the PTA polymer.When used as an electrode,the PTA polymer has a notable ability to store protons,with a large capacity of 213.99 mA h g^(-1) at 1 A g^(-1) and exceptional long-term stability,as evidenced by retaining 94.6% of its initial capacity after 20,000 cycles.In situ techniques alongside theoretical calculations have unveiled efficient redox processes occurring at C=N and C=O redox-active sites within the PTA electrode upon proton uptake/removal.Furthermore,a softpackage APB device has been assembled with impressive electrochemical behaviors and excellent operational lifespan,accentuating its significant promise for real-world deployment.

Cone-beam computed tomography noise reduction method based on U-Net with convolutional block attention module in proton therapy

Cone-beam computed tomography(CBCT) is mostly used for position verification during the treatment process. However,severe image artifacts in CBCT hinder its direct use in dose calculation and adaptive radiation therapy re-planning for proton therapy. In this study, an improved U-Net neural network named CBAM-U-Net was proposed for CBCT noise reduction in proton therapy, which is a CBCT denoised U-Net network with convolutional block attention modules. The datasets contained 20 groups of head and neck images. The CT images were registered to CBCT images as ground truth. The original CBCT denoised U-Net network, sCTU-Net, was trained for model performance comparison. The synthetic CT(SCT) images generated by CBAM-U-Net and the original sCTU-Net are called CBAM-SCT and U-Net-SCT images, respectively. The HU accuracies of the CT, CBCT, and SCT images were compared using four metrics: mean absolute error(MAE), root mean square error(RMSE), peak signal-to-noise ratio(PSNR), and structure similarity index measure(SSIM). The mean values of the MAE, RMSE, PSNR, and SSIM of CBAM-SCT images were 23.80 HU, 64.63 HU, 52.27 dB, and 0.9919, respectively,which were superior to those of the U-Net-SCT images. To evaluate dosimetric accuracy, the range accuracy was compared for a single-energy proton beam. The γ-index pass rates of a 4 cm × 4 cm scanned field and simple plan were calculated to compare the effects of the noise reduction capabilities of the original U-Net and CBAM-U-Net on the dose calculation results. CBAM-U-Net reduced noise more effectively than sCTU-Net, particularly in high-density tissues. We proposed a CBAM-U-Net model for CBCT noise reduction in proton therapy. Owing to the excellent noise reduction capabilities of CBAM-U-Net, the proposed model provided relatively explicit information regarding patient tissues. Moreover, it maybe be used in dose calculation and adaptive treatment planning in the future.

The role of titanium at the interface of hematite photoanode in multisite mechanism:Reactive site or cocatalyst site?

Hematite(α-Fe_(2)O_(3))constitutes one of the most promising photoanode materials for oxygen evolution reaction(OER).Recent research on Fe_(2)O_(3) have found a fast OER rate dependence on surface hole density,suggesting a multisite reaction pathway.However,the effect of heteroatom in Fe_(2)O_(3) on the multisite mechanism is still poorly understood.Herein we synthesized Fe_(2)O_(3) on Ti substrates(Fe_(2)O_(3)/Ti)to study the oxygen intermediates of OER by light-dark electrochemical scans.We identified the Fe-OH species disappeared and Ti-OH intermediates appeared on Fe_(2)O_(3)/Ti when pH=11‒14,which significantly improved the OER performance of Fe_(2)O_(3)/Ti.Combined with the density functional theory calculations,we propose that Ti atom acts as cocatalyst site and captures proton from neighboring Fe-OH species under highly alkaline condition,thereby promoting the coupling of Fe=O and reducing the energy barrier of the non-electrochemical step.Our work provides a new insight into the role of heteroatom in OER multisite mechanism based on clarifying the reaction intermediates.

Effects of baffle position in serpentine flow channel on the performance of proton exchange membrane fuel cells

This study used a three-dimensional numerical model of a proton exchange membrane fuel cell with five types of channels:a smooth channel(Case 1);eight rectangular baffles were arranged in the upstream(Case 2),midstream(Case 3),downstream(Case 4),and the entire cathode flow channel(Case 5)to study the effects of baffle position on mass transport,power density,net power,etc.Moreover,the effects of back pressure and humidity on the voltage were investigated.Results showed that compared to smooth channels,the oxygen and water transport facilitation at the diffusion layer-channel interface were added 11.53%-20.60%and 7.81%-9.80%at 1.68 A·cm^(-2)by adding baffles.The closer the baffles were to upstream,the higher the total oxygen flux,but the lower the flux uniformity the worse the water removal.The oxygen flux of upstream baffles was 8.14%higher than that of downstream baffles,but oxygen flux uniformity decreased by 18.96%at 1.68 A·cm^(-2).The order of water removal and voltage improvement was Case 4>Case 5>Case 3>Case 2>Case 1.Net power of Case 4 was 9.87%higher than that of the smooth channel.To the Case 4,when the cell worked under low back pressure or high humidity,the voltage increments were higher.The potential increment for the back pressure of 0 atm was 0.9%higher than that of 2 atm(1 atm=101.325 kPa).The potential increment for the humidity of 100%was 7.89%higher than that of 50%.

Overlapping approach Proton Pump Inhibitors/Nux vomica-Heel as new intervention for gastro-esophageal reflux management:Delphi consensus study

BACKGROUND Gastro-esophageal reflux disease(GERD)may affect the upper digestive tract;up to 20%of population in Western nations are affected by GERD.Antacids,histamine H2-receptor antagonists,and Proton Pump Inhibitors(PPIs)are considered the referring medications for GERD.Nevertheless,PPIs must be managed carefully because their use,especially chronic,could be linked with some adverse effects.An effective and safe alternative pharmacological tool for GERD is needed.After the identification of potentially new medications to flank PPIs,it is mandatory to revise and improve good clinical practices even through a consensus process.AIM To optimize diagnosis and treatment guidelines for GERD through a consensus based on Delphi method.METHODS The availability of clinical studies describing the action of the multicomponent/multitarget medication Nux vomica-Heel,subject of the consensus,is the basic prerequisite for the consensus itself.A modified Delphi process was used to reach a consensus among a panel of Italian GERD specialists on the overlapping approach PPIs/Nux vomica-Heel as a new intervention model for the management of GERD.The Voting Consensus group was composed of 49 Italian Medical Doctors with different specializations:Gastroenterology,otolaryngology,geriatrics,and general medicine.A scientific committee analyzed the literature,determined areas that required investigation(in agreement with the multiple-choice questionnaire results),and identified two topics of interest:(1)GERD disease;and(2)GERD treatment.Statements for each of these topics were then formulated and validated.The Delphi process involved two rounds of questioning submitted to the panel experts using an online platform.RESULTS According to their routinary GERD practice and current clinical evidence,the panel members provided feedback to each questionnaire statement.The experts evaluated 15 statements and reached consensus on all 15.The statements regarding the GERD disease showed high levels of agreement,with consensus ranging from 70%to 92%.The statements regarding the GERD treatment also showed very high levels of agreement,with consensus ranging from 90%to 100%.This Delphi process was able to reach consensus among physicians in relevant aspects of GERD management,such as the adoption of a new approach to treat patients with GERD based on the overlapping between PPIs and Nux vomica-Heel.The consensus was unanimous among the physicians with different specializations,underlying the uniqueness of the agreement reached to identify in the overlapping approach between PPIs and Nux vomica-Heel a new intervention model for GERD management.The results support that an effective approach to deprescribe PPIs through a progressive decalage timetable(reducing PPIs administration to as-needed use),should be considered.CONCLUSION Nux vomica-Heel appears to be a valid opportunity for GERD treatment to favor the deprescription of PPIs and to maintain low disease activity together with the symptomatology remission.

Should we pay more attention to the potential link between Helicobacter pylori and esophageal cancer in Asian countries

The presence of Helicobacter pylori(H.pylori)infection has been indicated to have a protective influence on esophageal cancer(EC)in some studies,but its specific impact on the risk of esophageal squamous cell carcinoma and esophageal adenocarcinoma remains inconclusive.This manuscript comment addresses the recent study by López-Gómez et al.Despite it was a retrospective observational study without a control group,this study revealed a notably low prevalence of H.pylori infection among EC patients,indicating a potential association between H.pylori and EC in Spain.It is important to note that the relationship between H.pylori and the risk of EC varies geographically.We also conducted a metaanalysis focusing on this association in Asian populations to offer precise clinical insights.However,no significant correlation between H.pylori infection and EC was identified,suggesting that the perceived protective effect of H.pylori against EC may have been overestimated in the Asian population.