ABSTRACT
Background/Aims@#Although proton pump inhibitors (PPIs) remain a mainstay for the suppression of gastric acid secretion, long-term PPI use is associated with side effects. However, the genotoxicity associated with long-term PPI use is unclear. @*Materials and Methods@#This prospective observational pilot study enrolled patients who had been on PPIs for >1 year and healthy controls from July 2015 to August 2016. The subjects completed self-report questionnaires pertaining to their drug and medical history, and only those with no medical history and a ≥2-year wash-out period (for drugs other than PPIs) were included. We collected peripheral-blood lymphocytes from long-term PPI users and healthy controls and analyzed the genotoxicity by using the cytokinesis-block micronucleus cytome assay; we also determined the fasting serum levels of pyridoxine, folate, cobalamin, and homocysteine. @*Results@#Ten long-term PPI users and 40 healthy control subjects were enrolled. The median serum pyridoxine, folate, cobalamin, and homocysteine levels were not significantly different between the groups. The median frequencies of micronuclei (MNi), nucleoplasmic bridges (NPBs), and nuclear buds (Nbuds) per 1,000 binucleated cells, in long-term PPI users and healthy controls, were 30.3 and 16.3 (P<0.005), 2.5 and 1.8 (P<0.005), and 9.3 and 5.0 (P<0.005), respectively. Even after adjustment for confounding factors, the OR of the MNi, NPBs, and Nbuds for long-term PPI users compared with healthy control subjects were 14.1 (P<0.001), 2.0 (P=0.001), and 1.3 (P=0.3), respectively. @*Conclusions@#Long-term PPI use was significantly associated with an increased risk of genotoxicity after adjustment for age, sex, body mass index, medical history, drug history, and the serum levels of vitamins.
ABSTRACT
Multi-drug resistant tuberculosis is an emerging threat to humans. Despite steady efforts of the national tuberculosis control program, current prevalence of multi-drug resistant tuberculosis rate is increasing in Korea. In Korea, it is effective to both improve the medical transfer system on tuberculosis, and also to make a new tuberculosis patient control system with integrated public-private sector. Improvement focused on the new medical transfer system is a suitable model considering current situation of the Korean medical system. This model can be achieved by replacing the traditional drug susceptibility test method, which requires a long turnaround time, with rapid molecular biological method, and improving the overall process of specimen transport system, report system, and guidelines for tuberculosis, as well. Using such model, doctors can discover multi-drug resistant tuberculosis patients at an earlier stage, prescribe appropriate drugs at the right time, and effectively support directly observed treatment short course strategy. Therefore, this new model for improvement of multi-drug resistant tuberculosis control program, medical transfer system-focused public-private integrated system, can present an effective tool for enhancing and modifying functions of the current national tuberculosis programme in Korea.