ABSTRACT
Background@#This study aimed to identify the effect of histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) use on the positivity rate and clinical outcomes of coronavirus disease 2019 (COVID-19). @*Methods@#We performed a nationwide cohort study with propensity score matching using medical claims data and general health examination results from the Korean National Health Insurance Service. Individuals aged ≥ 20 years who were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 1 January and 4 June 2020 were included.Patients who were prescribed H2RA or PPI within 1 year of the test date were defined as H2RA and PPI users, respectively. The primary outcome was SARS-CoV-2 test positivity, and the secondary outcome was the instance of severe clinical outcomes of COVID-19, including death, intensive care unit admission, and mechanical ventilation administration. @*Results@#Among 59,094 patients tested for SARS-CoV-2, 21,711 were H2RA users, 12,426 were PPI users, and 24,957 were non-users. After propensity score matching, risk of SARS-CoV-2 infection was significantly lower in H2RA users (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.74–0.98) and PPI users (OR, 0.62; 95% CI, 0.52–0.74) compared to non-users. In patients with comorbidities including diabetes, dyslipidemia, and hypertension, the effect of H2RA and PPI against SARS-CoV-2 infection was not significant, whereas the protective effect was maintained in patients without such comorbidities. Risk of severe clinical outcomes in COVID-19 patients showed no difference between users and non-users after propensity score matching either in H2RA users (OR, 0.89; 95% CI, 0.52–1.54) or PPI users (OR, 1.22; 95% CI, 0.60–2.51). @*Conclusion@#H2RA and PPI use is associated with a decreased risk for SARS-CoV-2 infection but does not affect clinical outcome. Comorbidities including diabetes, hypertension, and dyslipidemia seem to offset the protective effect of H2RA and PPI.
ABSTRACT
Purpose@#As the rate of endoscopic resection for early gastric cancer (EGC) has increased in patients with comorbid diseases, it is necessary to elucidate the efficacy of endoscopic submucosal dissection (ESD) for EGC in patients with comorbidities. This study aimed to analyze the clinical outcomes of ESD for EGC in patients with comorbidities. @*Materials and Methods@#A total of 969 patients with 1,015 lesions who underwent ESD for EGC at Seoul National University Hospital between 2010 and 2014 were analyzed. The shortand long-term clinical outcomes were evaluated according to the comorbidity status. @*Results@#Comorbidities were observed in 558 patients (57.6%). The comorbidity group had a higher proportion of patients using antithrombotic agents (29.5% vs. 0.9%; P<0.0001).Although procedure-related complications (bleeding and perforation) were not significantly different between the two groups, the length of hospital stay was significantly longer (1.8 vs.1.4 days, P=0.023), while survival was significantly shorter in the comorbidity group (5-year overall survival rate: 90.5% vs. 97.2%, P<0.0001; 5-year disease-specific survival rate: 97.9% vs. 100%, P=0.018; 5-year disease-free survival rate: 83.4% vs. 89.2%, P=0.007). @*Conclusions@#Gastric ESD can be performed in patients with comorbidities without increasing the risk of complications.
ABSTRACT
We are now in the middle of an unprecedented coronavirus disease 2019 (COVID-19) pandemic, and efforts to prevent the spread of infections are more important than ever. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, is transmitted through respiratory droplets or contaminated surfaces, and air transmission may be possible during some aerosol-generating procedures, requiring systematic infection control of the surrounding environment. Prior to endoscopy, suspected COVID-19 patients need to be screened, and all workers in the endoscopy room need to wear appropriate personal protective equipment. Isolate and move with a distance of 1-1.8 m or more between patients, and prevent close contact and cross-infection by limiting parental visits and minimizing latency in the waiting room or recovery room. If a COVID-19 infection is suspected or confirmed, it is recommended to postpone the endoscopic examination as much as possible, but if emergency endoscopy is necessary, a minimum number of people shall perform it in the negative pressure room. It is recommended to clean and sterilize the endoscope and accessories based on the current disinfection guidelines, and the treatment room should resume the procedure after a certain period of time after disinfection. In the endoscopy room, thorough infection control will be important for the safety of patients and medical staff, and as new information on SARS-CoV-2 is updated, continuous efforts will be needed to ensure the quality and safety of endoscopy until the end of COVID-19.
ABSTRACT
We are now in the middle of an unprecedented coronavirus disease 2019 (COVID-19) pandemic, and efforts to prevent the spread of infections are more important than ever. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, is transmitted through respiratory droplets or contaminated surfaces, and air transmission may be possible during some aerosol-generating procedures, requiring systematic infection control of the surrounding environment. Prior to endoscopy, suspected COVID-19 patients need to be screened, and all workers in the endoscopy room need to wear appropriate personal protective equipment. Isolate and move with a distance of 1-1.8 m or more between patients, and prevent close contact and cross-infection by limiting parental visits and minimizing latency in the waiting room or recovery room. If a COVID-19 infection is suspected or confirmed, it is recommended to postpone the endoscopic examination as much as possible, but if emergency endoscopy is necessary, a minimum number of people shall perform it in the negative pressure room. It is recommended to clean and sterilize the endoscope and accessories based on the current disinfection guidelines, and the treatment room should resume the procedure after a certain period of time after disinfection. In the endoscopy room, thorough infection control will be important for the safety of patients and medical staff, and as new information on SARS-CoV-2 is updated, continuous efforts will be needed to ensure the quality and safety of endoscopy until the end of COVID-19.