Introduction: the Scientific and clinical rationale for extended acid suppression
Bibliographic record
Abstract
The management of acid-related disorders has been transformed by the proton pump inhibitors (PPIs). Patients with gastro-oesophageal reflux disease (GERD) now have the opportunity for excellent overall symptom relief and long-term remission. PPIs have also contributed to a reduction in NSAID-related gastrointestinal (GI) injury, in combination with antibiotics allowed eradication of Helicobacter pylori and may reduce recurrent bleeding in high risk patients with non-variceal upper GI bleeding. However, the available PPIs are chemically similar, and exhibit similar pharmacokinetics and pharmacodynamics. In particular, the PPIs have a relatively short half-life which compromises their ability to fully control acid over a 24-h period from a single dose. Although novel formulations, including immediate release omeprazole may offer some advantages over existing formulations this new formulation does not address many of the potential unmet needs of patients with these disorders. Other alternative strategies include formulating a PPI with a longer half-life, which might then allow additional acid suppression with a once-daily administration. Tenatoprazole, which has an imidazopyridine ring in place of the benzimidazole moiety has a greatly extended half-life and pharmacodynamic data have indicated a prolonged (24-h) effect on gastric acidity with a single morning dose. To consider the potential benefits of a PPI with improved pharmacokinetics and pharmacodynamics, a ‘Montreal Clinical Initiative’ was supported as part of the World Congress of Gastroenterology (WCOG). A group of experts considered the clinical pharmacology of the PPIs, current unmet medical needs, and finally how extended acid suppression could address these needs. After several discussion sessions we reached consensus regarding these issues and our conclusions were presented at the WCOG. We have developed this supplement to capture the key information we considered when reaching our consensus. I hope these manuscripts will provide insight into our thought processes and the issues we all face in managing patients with acid related disorders in clinical practice.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".