What is the truth about proton pump inhibitors?

PURPOSE OF REVIEW: This review explores the recent evidence and established scientific literature surrounding proton pump inhibitors in the context of laryngology. RECENT FINDINGS: Proton pump inhibitors are often associated with gastroenterology; however, they also have a place in laryngology. Several laryngopharyngeal disorders are treated with proton pump inhibitors, though limited evidence regarding effectiveness, dosing and length of treatment exists. With the recent influx of articles reporting possible adverse effects of proton pump inhibitors, the appropriate prescribing of them has come under scrutiny. These reported risks include cancer, stroke, myocardial infarction, kidney disease and cognitive decline. It should be noted though that many of these studies by nature, are fraught with potential confounding. Regardless, clinicians ought to be aware of any risks associated with treatment regimens and prescribe the optimal dosage and duration. SUMMARY: Proton pump inhibitor treatment should be dose-appropriate and for a limited duration. Concerning potential adverse effects, the limitations of retrospective cohort studies must be taken into consideration when reviewing the evidence.

Primary malignant melanoma of the oesophagus: two case reports.

Primary malignant melanoma of the oesophagus is a rare and aggressive malignancy. This tumour entity accounts for 0.1-0.2% of all oesophageal malignancies and risk factors are yet to be established, although melanosis of the oesophagus may reflect its precursor form. Dysphagia is the commonest symptom. On gastroscopy, it appears as an elevated pigmented mass with satellite lesions in some cases. Unfortunately, most patients present late with metastatic disease. The prognosis is poor with a mean survival time post-operatively of 10-14 months and a 5-year survival rate of 4.5%. Although adjuvant therapy offers some loco-regional control, complete surgical resection offers the best hope for survival.

Enteropathy associated T-cell lymphoma presenting with multiple episodes of small bowel haemorrhage and perforation.

Enteropathy-associated T cell lymphoma (EATCL) is an intestinal neoplasm of intra-epithelial T lymphocytes associated with coeliac disease. Although the incidence is rare, EATCL runs an aggressive disease course and produces multi-focal ulcerative lesions most commonly in the proximal small bowel. As such, patients may present with intestinal perforation, obstruction or haemorrhage. Management of EATCL requires a combination of early diagnosis and treatment by surgical resection followed by chemotherapy to achieve treatment success. Overall however, the treatment completion rate remains at 50% and EATCL carries a poor prognosis with a 5-year survival rate of <20%.

Cervical spine in Treacher Collins syndrome.

Treacher Collins syndrome is a congenital syndrome with characteristic craniofacial malformations, which are well described in the literature. However, the presence of cervical spine dysmorphology in this syndrome has been minimally described. This study reviews cervical spine radiographs of 40 patients with Treacher Collins syndrome. In this sample, 7 of 40 patients displayed cervical spine anomalies, with 3 of these patients displaying multiple cervical spine anomalies. The patterns of spinal anomalies were variable, suggesting that the underlying genetic mutation has variable expressivity in cervical spine development as it does elsewhere in the craniofacial skeleton.