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Tumor necrosis factor alpha (TNF-alpha) plays a major role in the pathogenesis of psoriasis. Anti-TNF-alpha therapy is a standard treatment for moderate-to-severe psoriasis, especially in patients who are resistant or intolerant to conventional systemic therapies. However, the development of anti-TNF-alpha agents was largely influenced by European trials of severe psoriasis, which emphasized the use of biologic agents over systemic agents in the management of severe psoriasis. Currently, the cost of biologic agents is a significant consideration in the decision to use them for psoriasis. In this review, we highlight data from the limited experience with anti-TNF-alpha therapy for psoriasis in the United States and focus on whether it is time to reconsider their use for severe psoriasis.The relationship between feeding-stimulated gastric acid secretion and esophageal acid exposure in children with gastroesophageal reflux disease: a randomized double-blind study.
The nature of the association between feeding-stimulated gastric acid secretion and esophageal acid exposure is unclear. To study this issue, 10 children (5 boys, 5 girls, aged 3-15 years) with symptomatic gastroesophageal reflux disease and abnormal acid exposure on esophageal pH testing were enrolled in a randomized double-blind study. Each patient had at least 2 consecutive 24-hour esophageal pH-metry recordings, one during a baseline period and one during a test period after placebo or ranitidine therapy. Each pH recording was analyzed for average esophageal acid exposure (percentage time with pH < 4) and percent of time that pH was < 4. Basal gastric acid secretion was measured with the 24-hour pattern in response to a standard meal on the a77f14ba26
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