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Braude M, Ratnam DT, Marsh L, Abasszade JH, Dev AT. Hepatitis C virus treatment with glecaprevir and pibrentasvir in patients co-prescribed carbamazepine: Three case reports. World J Gastrointest Pharmacol Ther 2023; 14:33-38. [PMID: 37484883 PMCID: PMC10359723 DOI: 10.4292/wjgpt.v14.i4.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/26/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023] [Imported: 07/04/2023] Open
Abstract
BACKGROUND Highly effective and well-tolerated direct-acting antiviral (DAA) therapies have revolutionised the management of hepatitis C virus (HCV); however, niche populations face treatment barriers. DAAs co-prescribed with several first-generation anti-epileptic drugs (AEDs) are contraindicated due to drug-drug interactions. A common example is carbamazepine whereby steady-state carbamazepine reduces the maximum concentration and area under the curve of velpatasvir, glecaprevir and pibrentasvir due to potent cytochrome P450 (CYP) 3A4 induction. Carbamazepine also induces P-glycoprotein which reduces glecaprevir and pibrentasvir’s area under curve to infinite time. Sofosbuvir-velpatasvir and glecaprevir-pibrentasvir are contraindicated in patients who are co-prescribed carbamazepine due to the risk of reduced DAA therapeutic effect and consequently, virological treatment failure. This presents a challenge for patients in whom carbamazepine substitution is medically unfeasible, impractical or unacceptable. However, the properties of current generation DAA therapies, including high-potency non-structural protein 5A inhibitory effect, may be sufficient to overcome reduced bioavailability arising from carbamazepine related CYP 3A4 and P-glycoprotein induction.
CASE SUMMARY We present a case series of three patients with non-cirrhotic, treatment-naïve, genotype 1a, 1b, and 3a HCV who were treated with a 12 wk course of glecaprevir-pibrentasvir, while co-prescribed carbamazepine for seizure disorders. Glecaprevir-pibrentasvir combination therapy was chosen due to its potent in vitro activity and low barrier to pan-genotypic resistance associated variants. DAA therapy was dose-separated from carbamazepine to maximise time to peak concentration, and taken with meals to improve absorption. Sustained virological response at 12 wk was achieved in each patient with no adverse outcomes.
CONCLUSION DAA therapies, including glecaprevir-pibrentasvir, warrant consideration as a therapeutic agent in people with HCV who are co-prescribed carbamazepine, particularly if AED substitution is not feasible.
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Affiliation(s)
- Michael Braude
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, VIC, Australia
| | - Dilip T Ratnam
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, VIC, Australia
| | - Louise Marsh
- General Practice, Margaret River Medical Centre, Margaret River 6285, Australia
| | - Joshua H Abasszade
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, VIC, Australia
| | - Anouk T Dev
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, VIC, Australia
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Yaowmaneerat T, Sirinawasatien A. Update on the strategy for intravenous fluid treatment in acute pancreatitis. World J Gastrointest Pharmacol Ther 2023; 14:22-32. [PMID: 37179816 PMCID: PMC10167805 DOI: 10.4292/wjgpt.v14.i3.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/21/2023] [Accepted: 04/18/2023] [Indexed: 04/27/2023] [Imported: 08/10/2023] Open
Abstract
Fluid therapy/resuscitation is mandatory in acute pancreatitis due to the pathophysiology of fluid loss as a consequence of the inflammatory process. For many years, without clear evidence, early and aggressive fluid resuscitation with crystalloid solutions (normal saline solution or Ringer lactate solution) was recommended. Recently, many randomized control trials and meta-analyses on fluid therapy have revealed that high fluid rate infusion is associated with increased mortality and severe adverse events compared to those resulting from moderate fluid rates, and this has triggered a paradigm shift in fluid management strategies. Meanwhile, there is evidence to show that Ringer lactate solution is superior to normal saline solutions in this context. The purpose of this review is to provide an update on the strategies for intravenous fluid treatment in acute pancreatitis, including the type, optimal amount, rate of infusion, and monitoring guides. Recommendations from recent guidelines are critically evaluated for this review in order to reach the authors' recommendations based on the available evidence.
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Affiliation(s)
- Thanapon Yaowmaneerat
- Nanthana-Kriangkrai Chotiwattanaphan Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai , Songkhla 90110, Thailand
| | - Apichet Sirinawasatien
- Department of Medicine, Division of Gastroenterology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok 10400, Thailand
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Jiang JG, Luo Q, Li SS, Tan TY, Xiong K, Yang T, Xiao TB. Cinnamic acid regulates the intestinal microbiome and short-chain fatty acids to treat slow transit constipation. World J Gastrointest Pharmacol Ther 2023; 14:4-21. [PMID: 36911598 PMCID: PMC9993904 DOI: 10.4292/wjgpt.v14.i2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/10/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] [Imported: 08/10/2023] Open
Abstract
BACKGROUND Slow transit constipation (STC) is a disorder with delayed colonic transit. Cinnamic acid (CA) is an organic acid in natural plants, such as Radix Scrophulariae (Xuan Shen), with low toxicity and biological activities to modulate the intestinal microbiome.
AIM To explore the potential effects of CA on the intestinal microbiome and the primary endogenous metabolites-short-chain fatty acids (SCFAs) and evaluate the therapeutic effects of CA in STC.
METHODS Loperamide was applied to induce STC in mice. The treatment effects of CA on STC mice were assessed from the 24 h defecations, fecal moisture and intestinal transit rate. The enteric neurotransmitters: 5-hydroxytryptamine (5-HT) and vasoactive intestinal peptide (VIP) were determined by the enzyme-linked immunosorbent assay. Hematoxylin-eosin and Alcian blue and Periodic acid Schiff staining were used to evaluate intestinal mucosa's histopathological performance and secretory function. 16S rDNA was employed to analyze the composition and abundance of the intestinal microbiome. The SCFAs in stool samples were quantitatively detected by gas chromatography-mass spectrometry.
RESULTS CA ameliorated the symptoms of STC and treated STC effectively. CA ameliorated the infiltration of neutrophils and lymphocytes, increased the number of goblet cells and acidic mucus secretion of the mucosa. In addition, CA significantly increased the concentration of 5-HT and reduced VIP. CA significantly improved the diversity and abundance of the beneficial microbiome. Furthermore, the production of SCFAs [including acetic acid (AA), butyric acid (BA), propionic acid (PA) and valeric acid (VA)] was significantly promoted by CA. The changed abundance of Firmicutes, Akkermansia, Lachnoclostridium, Monoglobus, UCG.005, Paenalcaligenes, Psychrobacter and Acinetobacter were involved in the production of AA, BA, PA and VA.
CONCLUSION CA could treat STC effectively by ameliorating the composition and abundance of the intestinal microbiome to regulate the production of SCFAs.
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Affiliation(s)
- Jin-Guang Jiang
- Department of Colorectal and Anal Surgery, Suqian Hospital of Traditional Chinese Medicine, Suqian 223800, Jiangsu Province, China
| | - Qian Luo
- Department of Colorectal and Anal Surgery, Suqian Hospital of Traditional Chinese Medicine, Suqian 223800, Jiangsu Province, China
| | - Shuang-Shuang Li
- College of Clinical Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang 550000, Guizhou Province, China
| | - Tian-Ying Tan
- College of Clinical Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang 550000, Guizhou Province, China
| | - Kai Xiong
- College of Clinical Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang 550000, Guizhou Province, China
| | - Tao Yang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 550000, Guizhou Province, China
| | - Tian-Bao Xiao
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 550000, Guizhou Province, China
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Willman J, Lucke-Wold B. “Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality, complications, or outcomes”: Commentary. World J Gastrointest Pharmacol Ther 2023; 14:1-3. [PMID: 36743219 PMCID: PMC9896468 DOI: 10.4292/wjgpt.v14.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/24/2022] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
In this commentary, we summarize some of the key points of the original paper “Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality, complications, or outcomes” and offer support for the proposed results. Specifically, we address how early percutaneous endoscopic gastrostomy (PEG) tube placement may reduce hospital length of stay and costs. We also discuss topics related to the article including PEG weaning and post-stroke nutritional formulation. However, we note that concerns purported by previous studies that early PEG placement may worsen outcomes are not fully addressed, and further research is needed.
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Affiliation(s)
- Jonathan Willman
- College of Medicine, University of Florida, Gainesville, FL 32610, United States
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, United States
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Mohan N, Jarrett S, Pop A, Rodriguez D, Dudnick R. Effect of small bowel transit time on accuracy of video capsule endoscopy in evaluating suspected small bowel bleeding. World J Gastrointest Pharmacol Ther 2022; 13:88-95. [PMID: 36405301 PMCID: PMC9669782 DOI: 10.4292/wjgpt.v13.i6.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/02/2022] [Accepted: 09/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Obscure small bowel bleeding is defined as gastrointestinal bleeding (GIB) that is unidentifiable with esophagogastroduodenoscopy and a colonoscopy with video capsule endoscopy (VCE) being the next gold standard step for evaluation. Small bowel transit time (SBTT) is a metric of a VCE study that is defined as the time the capsule takes to travel through the small intestine.
AIM To determine if SBTT within the VCE study, correlates to overall detection of obscure small bowel bleeds. Furthermore, we attempted to identify any existing correlation between SBTT and re-bleeding after a negative VCE study.
METHODS This is a single center retrospective analysis of VCE studies performed for overt and occult GIB at Einstein Medical Center, Philadelphia, between 2015 and 2019. Inclusion criteria primarily consisted of patients 18 years or older who had a VCE study done as part of the workup for a GIB. Patients with incomplete VCEs, poor preparation, or with less than 6 mo of follow up were excluded. A re-bleeding event was defined either as overt or occult within a 6-mo timeframe. Overt re-bleeding was defined as Visible melena or hematochezia with > 2 gm/dL drop in hemoglobin defined an overt re-bleeding event; whereas an unexplained > 2 gm/dL drop in hemoglobin with no visible bleeding defined an occult re-bleed.
RESULTS Results indicated that there was a significant and positive point biserial correlation between SBTT of 220 min and detection of a bleeding focus with a statistically significant p value of 0.008. However, the area under the curve was negligible when trying to identify a threshold time for SBTT to discriminate between risk of re-bleeding events after a negative VCE.
CONCLUSION In terms of SBTT and association with accuracy of VCE finding a bleeding focus, 220 min was found to be adequate transit time to accurately find a bleeding focus, when present. It was found that no threshold SBTT could be identified to help predict re-bleeding after a negative VCE.
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Affiliation(s)
- Nandakumar Mohan
- Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, United States
| | - Simone Jarrett
- Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, United States
| | - Alexander Pop
- Division of Gastrointestinal Diseases and Hepatology, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, United States
| | - Daniel Rodriguez
- Department of Urban Health and Nutrition, Lasalle University, Philadelphia, PA 19141, United States
| | - Robert Dudnick
- Division of Gastrointestinal Diseases and Hepatology, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, United States
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Saffo S, Nagar A. Impact of epinephrine volume on further bleeding due to high-risk peptic ulcer disease in the combination therapy era. World J Gastrointest Pharmacol Ther 2022; 13:67-76. [PMID: 36157267 PMCID: PMC9453442 DOI: 10.4292/wjgpt.v13.i5.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/22/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In monotherapy studies for bleeding peptic ulcers, large volumes of epinephrine were associated with a reduction in rebleeding. However, the impact of epinephrine volume in patients treated with combination endoscopic therapy remains unclear.
AIM To assess whether epinephrine volume was associated with bleeding outcomes in individuals who also received endoscopic thermal therapy and/or clipping.
METHODS Data from 132 patients with Forrest class Ia, Ib, and IIa peptic ulcers were reviewed. The primary outcome was further bleeding at 7 d; secondary outcomes included further bleeding at 30 d, need for additional therapeutic interventions, post-endoscopy blood transfusions, and 30-day mortality. Logistic and linear regression and Cox proportional hazards analyses were performed.
RESULTS There was no association between epinephrine volume and all primary and secondary outcomes in multivariable analyses. Increased odds for further bleeding at 7 d occurred in patients with elevated creatinine values (aOR 1.96, 95%CI 1.30-3.20; P < 0.01) or hypotension requiring vasopressors (aOR 6.34, 95%CI 1.87-25.52; P < 0.01). Both factors were also associated with all secondary outcomes.
CONCLUSION Epinephrine maintains an important role in the management of bleeding ulcers, but large volumes up to a range of 10-20 mL are not associated with improved bleeding outcomes among individuals receiving combination endoscopic therapy. Further bleeding is primarily associated with patient factors that likely cannot be overcome by increased volumes of epinephrine. However, in carefully-selected cases where ulcer location or size pose therapeutic challenges or when additional modalities are unavailable, it is conceivable that increased volumes of epinephrine may still be beneficial.
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Affiliation(s)
- Saad Saffo
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Anil Nagar
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT 06520, United States
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Reddy KM, Lee P, Gor PJ, Cheesman A, Al-Hammadi N, Westrich DJ, Taylor J. Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality, complications, or outcomes. World J Gastrointest Pharmacol Ther 2022; 13:77-87. [PMID: 36157266 PMCID: PMC9453443 DOI: 10.4292/wjgpt.v13.i5.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/22/2022] [Accepted: 08/18/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous Endoscopic Gastrostomy (PEG) tubes are often placed for dysphagia following a stroke in order to maintain sufficient caloric intake. The 2011 ASGE guidelines recommend delaying PEG tube placement for two weeks, as half of patients with dysphagia improve within 2 wk. There are few studies comparing outcomes based on timing of PEG tube placement, and there is increasing demand for early PEG tube placement to meet requirements for timely discharge to rehab and skilled nursing facilities.
AIM To assess the safety of early (≤ 7 d post stroke) vs late (> 7 d post stroke) PEG tube placement and evaluate whether pre-procedural risk factors could predict mortality or complications.
METHODS We performed a retrospective study of patients undergoing PEG tube placement for dysphagia following a stroke at two hospitals in Saint Louis, MO between January 2011 and December 2017. Patients were identified by keyword search of endoscopy reports. Mortality, peri-procedural complication rates, and post-procedural complication rates were compared in both groups. Predictors of morbidity and mortality such as protein-calorie malnutrition, presence of an independent cardiovascular risk equivalent, and presence of Systemic inflammatory response syndrome (SIRS) criteria or documented infection were evaluated by multivariate logistic regression.
RESULTS 154 patients had a PEG tube placed for dysphagia following a stroke, 92 in the late group and 62 in the early group. There were 32 observed deaths, with 8 occurring within 30 d of the procedure. There was an increase in peri-procedural and post-procedural complications with delayed PEG placement which was not statistically significant. Hospital length of stay was significantly less in patients with early PEG tube placement (12.9 vs 22.34 d, P < 0.001). Protein calorie malnutrition, presence of SIRS criteria and/or documented infection prior to procedure or having a cardiovascular disease risk equivalent did not significantly predict mortality or complications.
CONCLUSION Early PEG tube placement following a stroke did not result in a higher rate of mortality or complications and significantly decreased hospital length of stay. Given similar safety outcomes in both groups, early PEG tube placement should be considered in the appropriate patient to potentially reduce length of hospital stay and incurred costs.
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Affiliation(s)
- Kavya M Reddy
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Preston Lee
- Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, United States
| | - Parul J Gor
- Division of Gastroenterology and Hepatology, Mercy Hospital, Saint Louis, MO 63141, United States
| | - Antonio Cheesman
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO 63104, United States
| | - Noor Al-Hammadi
- Saint Louis University Center for Health Outcomes Research, Saint Louis University, Saint Louis, MO 63104, United States
| | - David John Westrich
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO 63104, United States
| | - Jason Taylor
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO 63104, United States
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Islek A, Tumgor G. Biliary atresia and congenital disorders of the extrahepatic bile ducts. World J Gastrointest Pharmacol Ther 2022; 13:33-46. [PMID: 36051179 PMCID: PMC9297290 DOI: 10.4292/wjgpt.v13.i4.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/10/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Biliary atresia (BA) and choledochal cysts are diseases of the intrahepatic and extrahepatic biliary tree. While their exact etiopathogeneses are not known, they should be treated promptly due to the potential for irreversible parenchymal liver disease. A diagnosis of BA may be easy or complicated, but should not be delayed. BA is always treated surgically, and performing the surgery before the age of 2 mo greatly increases its effectiveness and extends the time until the need for liver transplantation arises. While the more common types of choledochal cysts require surgical treatment, some can be treated with endoscopic retrograde cholangiopancreatography. Choledochal cysts may cause recurrent cholangitis and the potential for malignancy should not be ignored.
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Affiliation(s)
- Ali Islek
- Department of Pediatric Gastroenterology, Cukurova University School of Medicine, Adana 01320, Turkey
| | - Gokhan Tumgor
- Department of Pediatric Gastroenterology, Cukurova University School of Medicine, Adana 01320, Turkey
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Lopes MB, Lyra AC, Rocha R, Coqueiro FG, Lima CA, de Oliveira CC, Santana GO. Overweight and abdominal fat are associated with normal bone mineral density in patients with ulcerative colitis. World J Gastrointest Pharmacol Ther 2022; 13:57-66. [PMID: 36051180 PMCID: PMC9297289 DOI: 10.4292/wjgpt.v13.i4.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/27/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Low bone mineral density (BMD) is common in patients with inflammatory bowel disease. However, nutritional risk factors for low BMD in the ulcerative colitis (UC) population are still poorly understood.
AIM To investigate the association of anthropometric indicators and body composition with BMD in patients with UC.
METHODS This is a cross-sectional study on adult UC patients of both genders who were followed on an outpatient basis. A control group consisting of healthy volunteers, family members, and close people was also included. The nutritional indicators evaluated were body mass index (BMI), total body mass (TBM), waist circumference (WC), body fat in kg (BFkg), body fat in percentage (BF%), trunk BF (TBF), and also lean mass. Body composition and BMD assessments were performed by dual-energy X-ray absorptiometry.
RESULTS The sociodemographic characteristics of patients with UC (n = 68) were similar to those of healthy volunteers (n = 66) (P > 0.05). Most patients (97.0%) were in remission of the disease, 58.8% were eutrophic, 33.8% were overweight, 39.0% had high WC, and 67.6% had excess BF%. However, mean BMI, WC, BFkg, and TBF of UC patients were lower when compared to those of the control group (P < 0.05). Reduced BMD was present in 41.2% of patients with UC (38.2% with osteopenia and 2.9% with osteoporosis) and 3.0% in the control group (P < 0.001). UC patients with low BMD had lower BMI, TBM, and BFkg values than those with normal BMD (P < 0.05). Male patients were more likely to have low BMD (prevalence ratio [PR] = 1.86; 95% confidence interval [CI]: 1.07-3.26). Those with excess weight (PR = 0.43; 95%CI: 0.19-0.97) and high WC (PR = 0.44; 95%CI: 0.21-0.94) were less likely to have low BMD.
CONCLUSION Patients with UC in remission have a high prevalence of metabolic bone diseases. Body fat appears to protect against the development of low BMD in these patients.
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Affiliation(s)
- Mirella Brasil Lopes
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, Brazil
| | - Andre Castro Lyra
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, Brazil
| | - Raquel Rocha
- Departamento Ciências da Nutrição, Universidade Federal da Bahia, Salvador 40110-060, Brazil
| | - Fernanda Gomes Coqueiro
- Departamento Ciências da Nutrição, Universidade Federal da Bahia, Salvador 40110-060, Brazil
| | - Carla Andrade Lima
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, Brazil
| | | | - Genoile Oliveira Santana
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, Brazil
- Departamento Ciências da Vida, Universidade do Estado da Bahia, Salvador 41.150-000, Brazil
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Rashmi KG, Kamalanathan S, Sahoo J, Naik D, Mohan P, Pottakkat B, Kar SS, Palui R, Roy A. Primary hyperparathyroidism presenting as acute pancreatitis: An institutional experience with review of the literature. World J Gastrointest Pharmacol Ther 2022; 13:47-56. [PMID: 36051178 PMCID: PMC9297291 DOI: 10.4292/wjgpt.v13.i4.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/24/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) presenting as an initial manifestation of primary hyperparathyroidism (PHPT) is uncommon, and its timely diagnosis is crucial in preventing recurrent attacks of pancreatitis.
AIM To determine the clinical, biochemical, and radiological profile of PHPT patients presenting as AP.
METHODS This is a retrospective observational study, 51 consecutive patients admitted with the diagnosis of PHPT during January 2010 and October 2021 at a tertiary care hospital in Puducherry, India was included. The diagnosis of AP was established in the presence of at least two of the three following features: abdominal pain, levels of serum amylase or lipase greater than three times the normal, and characteristic features at abdominal imaging.
RESULTS Out of the 51 consecutive patients with PHPT, twelve (23.52%) had pancreatitis [5 (9.80%) AP, seven (13.72%) chronic pancreatitis (CP)]. PHPT with AP (PHPT-AP) was more common among males with the presentation at a younger age (35.20 ± 16.11 vs 49.23 ± 14.80 years, P = 0.05) and lower plasma intact parathyroid hormone (iPTH) levels [125 (80.55-178.65) vs 519.80 (149-1649.55, P = 0.01)] compared to PHPT without pancreatitis (PHPT-NP). The mean serum calcium levels were similar in both PHPT-AP and PHPT-NP groups [(11.66 ± 1.15 mg/dL) vs (12.46 ± 1.71 mg/dL), P = 0.32]. PHPT-AP also presented with more gastrointestinal symptoms like abdominal pain, nausea, and vomiting with lesser skeletal and renal manifestations as compared to patients with PHPT-NP.
CONCLUSION AP can be the only presenting feature of PHPT. Normal or higher serum calcium levels during AP should always draw attention towards endocrine causes like PHPT.
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Affiliation(s)
- K G Rashmi
- Department of Endocrinology, JIPMER, Puducherry 605006, India
| | | | | | | | - Pazhanivel Mohan
- Department of Medical Gastroenterology, JIPMER, Puducherry 605006, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, JIPMER, Puducherry 605006, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, JIPMER, Puducherry 605006, India
| | - Rajan Palui
- Department of Endocrinology, JIPMER, Puducherry 605006, India
| | - Ayan Roy
- Department of Endocrinology, JIPMER, Puducherry 605006, India
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Li ZP, Xu DH, He LP, Wang XJ. Fuzhuan brick tea affects obesity process by modulating gut microbiota. World J Gastrointest Pharmacol Ther 2022; 13:30-32. [PMID: 35646421 PMCID: PMC9124955 DOI: 10.4292/wjgpt.v13.i3.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/12/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
The effect of Fuzhuan brick tea (FBT) on metabolism in obese mice is mediated by regulation of N-methyltransferase by aryl hydrocarbon receptor. The expression of the phosphatidylethanolamine N-methyltransferase gene is regulated by many transcription factors, and those specific to this effect need further investigation. Experimental animal studies have been designed to observe the effects of a single drug or the sequential effects of drugs. A washout period should be included if different drugs (e.g., antibiotics and FBT) are given to avoid or reduce additive effects or synergy. Currently, most experimental studies performed in mice used only male animals. However, experience has revealed that the results of using only male mice are very likely to have sex differences.
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Affiliation(s)
- Zhi-Peng Li
- School of Medicine, Taizhou University, Taizhou 318000, Zhejiang Province, China
| | - Dong-Hui Xu
- School of Medicine, Taizhou University, Taizhou 318000, Zhejiang Province, China
| | - Lian-Ping He
- School of Medicine, Taizhou University, Taizhou 318000, Zhejiang Province, China
| | - Xin-Juan Wang
- School of Medicine, Taizhou University, Taizhou 318000, Zhejiang Province, China
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12
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Bhasi A, Patnaik I, Panda PK, Singh A. Hypereosinophilic syndrome presenting as eosinophilic gastroenteritis disorder and splinter hemorrhages: A case report. World J Gastrointest Pharmacol Ther 2022; 13:23-29. [PMID: 35433097 PMCID: PMC8968508 DOI: 10.4292/wjgpt.v13.i2.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/31/2021] [Accepted: 01/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Eosinophilia and related organ damage are extensively studied hot topics among rare disorders. Any addition to the cohort of available case reports of the same will be adding knowledge for better management of this less known entity.
CASE SUMMARY In this article, we describe a 27-year-old Indo-Aryan man who presented with abdominal pain, abdominal distension, and loose stools for variable days. He had splinter hemorrhages in the majority of fingernails. He was diagnosed with predominant eosinophilic gastrointestinal involvement with bowel obstruction and ascites, and was managed with intravenous immunoglobulin. He was subsequently treated with oral low dose steroid therapy and responded completely.
CONCLUSION Our experience is evidence that prompt management of this hypereosinophilic lethal gastrointestinal (all three layers) infiltrative disease provides a cure and avoids complications. Splinter nail hemorrhages may be seen in the same disease.
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Affiliation(s)
- Ankith Bhasi
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Itish Patnaik
- Department of Gastroenterology, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Prasan Kumar Panda
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Ashok Singh
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh 249203, India
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13
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Bona S, Fernandes SA, Moreira ACJ, Rodrigues G, Schemitt EG, Di Naso FC, Marroni CA, Marroni NP. Melatonin restores zinc levels, activates the Keap1/Nrf2 pathway, and modulates endoplasmic reticular stress and HSP in rats with chronic hepatotoxicity. World J Gastrointest Pharmacol Ther 2022; 13:11-22. [PMID: 35433098 PMCID: PMC8968507 DOI: 10.4292/wjgpt.v13.i2.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/18/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Melatonin (MLT) is a potent antioxidant molecule that is shown to have a beneficial effect in various pathological situations, due to its action against free radicals.
AIM To evaluate the effect of MLT on carbon tetrachloride (CCl4) induced liver injury in rats in terms of oxidative stress, reticular stress, and cell damage.
METHODS Twenty male Wistar rats (230-250 g) were divided into four groups: Control rats, rats treated with MLT alone, rats treated with CCl4 alone, and rats treated with CCl4 plus MLT. CCl4 was administered as follows: Ten doses every 5 d, ten every 4 d, and seven every 3 d. MLT was administered intraperitoneally at a dose of 20 mg/kg from the 10th wk to the end of the experiment (16th wk).
RESULTS MLT was able to reduce the release of liver enzymes in the bloodstream and to decrease oxidative stress in CCl4 treated rats by decreasing the level of thiobarbituric acid reactive substances and increasing superoxide dismutase activity, with a lower reduction in serum zinc levels, guaranteeing a reduction in liver damage; additionally, it increased the expression of nuclear factor (erythroid-derived 2)-like 2 and decreased the expression of Kelch-like ECH-associated protein 1. MLT also decreased the expression of the proteins associated with endoplasmic reticulum stress, i.e., glucose-regulated protein 78 and activating transcription factor 6, as well as of heat shock factor 1 and heat shock protein 70.
CONCLUSION MLT has a hepatoprotective effect in an experimental model of CCl4-induced liver injury, since it reduces oxidative stress, restores zinc levels, and modulates endoplasmic reticulum stress.
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Affiliation(s)
- Silvia Bona
- Medical Sciences Program, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Rio Grande do Sul, Brazil
| | - Sabrina Alves Fernandes
- Posgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90040-001, Rio Grande do Sul, Brazil
| | - Andrea C Janz Moreira
- Biological Sciences Program, Universidade Federal do Rio Grande do Sul, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Graziella Rodrigues
- Medical Sciences Program, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Rio Grande do Sul, Brazil
| | - Elizângela G Schemitt
- Medical Sciences Program, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Rio Grande do Sul, Brazil
| | - Fabio Cangeri Di Naso
- Postgraduate Program in Pneumological Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre 90000-000, Rio Grande do Sul, Brazil
| | - Cláudio A Marroni
- Posgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90040-001, Rio Grande do Sul, Brazil
| | - Norma P Marroni
- Medical Sciences Program, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Rio Grande do Sul, Brazil
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Guedes ALV, Lorentz AL, Rios LFDAR, Freitas BC, Dias AGN, Uhlein ALE, Vieira Neto FO, Jesus JFS, Torres TDSN, Rocha R, Andrade VD, Santana GO. Hospitalizations and in-hospital mortality for inflammatory bowel disease in Brazil. World J Gastrointest Pharmacol Ther 2022; 13:1-10. [PMID: 35116179 PMCID: PMC8788161 DOI: 10.4292/wjgpt.v13.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/28/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with complications, frequent hospitalizations, surgery and death. The introduction of biologic drugs into the therapeutic arsenal in the last two decades, combined with an expansion of immunosuppressant therapy, has changed IBD management and may have altered the profile of hospitalizations and in-hospital mortality (IHM) due to IBD.
AIM To describe hospitalizations from 2008 to 2018 and to analyze IHM from 1998 to 2017 for IBD in Brazil.
METHODS This observational, retrospective, ecological study used secondary data on hospitalizations for IBD in Brazil for 2008-2018 to describe hospitalizations and for 1998-2017 to analyze IHM. Hospitalization data were obtained from the Hospital Information System of the Brazilian Unified Health System and population data from demographic censuses. The following variables were analyzed: Number of deaths and hospitalizations, length of hospital stay, financial costs of hospitalization, sex, age, ethnicity and type of hospital admission.
RESULTS There was a reduction in the number of IBD hospitalizations, from 6975 admissions in 1998 to 4113 in 2017 (trend: y = -0.1682x + 342.8; R2 = 0.8197; P < 0.0001). The hospitalization rate also decreased, from 3.60/100000 in 2000 to 2.17 in 2010. IHM rates varied during the 20-year period, between 2.06 in 2017 and 3.64 in 2007, and did not follow a linear trend (y = -0.0005049x + 2.617; R2 = 0,00006; P = 0.9741). IHM rates also varied between regions, increasing in all but the southeast, which showed a decreasing trend (y = -0.1122x + 4.427; R2 = 0,728; P < 0.0001). The Southeast region accounted for 44.29% of all hospitalizations. The Northeast region had the highest IHM rate (2.86 deaths/100 admissions), with an increasing trend (y = 0.1105x + 1.110; R2 = 0.6265; P < 0.0001), but the lowest hospitalization rate (1.15). The Midwest and South regions had the highest hospitalization rates (3.27 and 3.17, respectively). A higher IHM rate was observed for nonelective admissions (2.88), which accounted for 81% of IBD hospitalizations. The total cost of IBD hospitalizations in 2017 exhibited an increase of 37.5% compared to 2008.
CONCLUSION There has been a notable reduction in the number of hospitalizations for IBD in Brazil over 20 years. IHM rates varied and did not follow a linear trend.
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Affiliation(s)
| | - Amanda Lopes Lorentz
- Life Sciences Department, State University of Bahia, Salvador 41150-000, Bahia, Brazil
| | | | | | | | | | | | | | | | - Raquel Rocha
- Sciences of Nutrition, Federal University of Bahia, Salvador 40110-060, Bahia, Brazil
| | - Vitor D Andrade
- Medicine Department, Universidade Salvador (UNIFACS), Salvador 41820-021, Bahia, Brazil
| | - Genoile Oliveira Santana
- Life Sciences Department, State University of Bahia, Salvador 41150-000, Bahia, Brazil
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador 40110-060, Bahia, Brazil
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Semenov S, Ismail MS, O'Hara F, Sihag S, Ryan B, O'Connor A, O'Donnell S, McNamara D. Addition of castor oil as a booster in colon capsule regimens significantly improves completion rates and polyp detection. World J Gastrointest Pharmacol Ther 2021; 12:103-112. [PMID: 34877028 PMCID: PMC8611183 DOI: 10.4292/wjgpt.v12.i6.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/02/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incomplete excretion rates are problematic for colon capsule endoscopy (CCE). Widely available booster regimens are suboptimal. Recently published data on one day preparation CCE protocol using castor oil appeared effective.
AIM To assess the impact of adding castor oil to a standard split-dose (2-d) preparation in an unselected Western patient cohort.
METHODS All patients aged 18 or more referred to our unit for a CCE over a 5-mo period were prospectively recruited. Controls were retrospectively identified from our CCE database. All patients received split bowel preparation with Moviprep® [polyethylene glycol (PEG)-3350, sodium sulphate, sodium chloride, potassium chloride, sodium ascorbate and ascorbic acid for oral solution; Norgine B. V, United States], a PEG-based solution used predominantly in our colonoscopy practice. Control booster regimen included Moviprep® with 750 mL of water (booster 1) on reaching the small bowel. A further dose of Moviprep® with 250 mL of water was given 3 h later and a bisacodyl suppository (Dulcolax®) 10 mg after 8 h, if the capsule was not excreted. In addition to our standard booster regimen, cases received an additional 15 mL of castor oil given at the time of booster 1. A nested case control design with 2:1 ratio (control:case) was employed. Basic demographics, completion rates, image quality, colonic transit time, diagnostic yield and polyp detection were compared between groups, using a student t or chi-square tests as appropriate.
RESULTS One hundred and eighty-six CCEs [mean age 60 years (18-97), 56% females, n = 104], including 62 cases have been analysed. Indication breakdown included 96 polyp surveillance (51.6%), 42 lower gastrointestinal symptoms (22.6%), 28 due to incomplete colonoscopy (15%), 18 anaemia (9.7%) and 2 inflammatory bowel disease surveillance (1.1%). Overall, CCE completion was 77% (144/186), image quality was adequate/diagnostic in 91% (170/186), mean colonic transit time was 3.5 h (0.25-13), and the polyp detection rate was 57% (106/186). Completion rates were significantly higher with castor oil, 87% cases (54/62) vs 73% controls (90/124), P = 0.01. The number needed to treat with castor oil to result in an additional complete CCE study was 7, absolute risk reduction = 14.52%, 95% confidence interval (CI): 3.06- 25.97. This effect of castor oil on excretion rates was more significant in the over 60 s, P < 0.03, and in females, P < 0.025. Similarly, polyp detection rates were higher in cases 82% (51/62) vs controls 44% (55/124), P = 0.0001, odds ratio 5.8, 95%CI: 2.77-12.21. Colonic transit times were similar, 3.2 h and 3.8 h, respectively. Image quality was similar, reported as adequate/ diagnostic in 90% (56/62) vs 92% (114/124).
CONCLUSION In our capsule endoscopy centre, castor oil addition as a CCE booster significantly improved completion rates and polyp detection in an unselected Western cohort.
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Affiliation(s)
- Serhiy Semenov
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
- Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin D 2, Ireland
| | - Mohd Syafiq Ismail
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
- Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin D 2, Ireland
| | - Fintan O'Hara
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
- Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin D 2, Ireland
| | - Sandeep Sihag
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
- Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin D 2, Ireland
| | - Barbara Ryan
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
| | - Anthony O'Connor
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
| | - Sarah O'Donnell
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
| | - Deirdre McNamara
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
- Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin D 2, Ireland
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Bessone F. Overview on drug-induced liver injury in Brazil. World J Gastrointest Pharmacol Ther 2021; 12:100-102. [PMID: 34616586 PMCID: PMC8465396 DOI: 10.4292/wjgpt.v12.i5.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/06/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
Drug-induced liver injury (DILI) is an uncommon event in clinical practice, which makes knowing its true incidence difficult. Prospective, retrospective and registry-based studies are the most important methods to obtain epidemiological data on DILI. Latin America (LA) has a historical lack of prospective studies on this topic. New definitions and the creation of hepatotoxicity registries have significantly improved the epidemiological understanding of hepatic drug reactions in several regions of the world. The Latin American DILI network, referred to as LATINDILI, has been created in 2011, and recently published its own DILI recommendations describing the most relevant issues on the management of hepatotoxicity in general, and those based on findings from our own LA experience in particular. Although most of the registries do not carry out population-based studies, they may provide important data related to the prevalence of DILI. The joint work among researchers and the corresponding health and regulatory authorities should be stimulated due to the high impact that hepatotoxicity represents for public health.
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Affiliation(s)
- Fernando Bessone
- Department of Gastroenterology and Hepatology, Hospital Provincial del Centenario, Facultad de Ciencias Médicas, University of Rosario School of Medicine, Rosario 2000, Santa Fe, Argentina
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17
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Rocha R, de J Santos G, Santana G. Influence of nutritional status in the postoperative period of patients with inflammatory bowel disease. World J Gastrointest Pharmacol Ther 2021; 12:90-99. [PMID: 34616585 PMCID: PMC8465395 DOI: 10.4292/wjgpt.v12.i5.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/21/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBDs) are a group of chronic inflammatory diseases that affect the gastrointestinal tract, including Crohn's disease (CD) and ulcerative colitis. Surgery is a treatment option, and more than half of the patients with CD will undergo surgical interventions over the course of the disease. Postoperative complications are common in IBD patients, the most frequent being intra-abdominal sepsis, infection of the surgical site, and adynamic ileum, and nutritional status is a factor that can influence postoperative outcome. Recent studies have shown that malnutrition, obesity, sarcopenia, and myosteatosis are predictors of surgical complications. However, most were retrospective studies with small patient samples and heterogeneity of clinical and nutritional assessment methods, which limit the extrapolation of data. Therefore, knowing the pathophysiological mechanisms of IBD and identifying the best parameters for assessing nutritional status are essential for prompt implementation of adequate nutritional interventions.
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Affiliation(s)
- Raquel Rocha
- Department of Sciences of Nutrition, School of Nutrition, Federal University of Bahia, Salvador 40110-150, Bahia, Brazil
| | - Geisa de J Santos
- Department of Sciences of Nutrition, School of Nutrition, Federal University of Bahia, Salvador 40110-150, Bahia, Brazil
| | - Genoile Santana
- Department of Life Sciences, State University of Bahia, Salvador 40110060, Bahia, Brazil
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Takashima K, Komeda Y, Sakurai T, Masaki S, Nagai T, Matsui S, Hagiwara S, Takenaka M, Nishida N, Kashida H, Nakaji K, Watanabe T, Kudo M. Castor oil as booster for colon capsule endoscopy preparation reduction: A prospective pilot study and patient questionnaire. World J Gastrointest Pharmacol Ther 2021; 12:79-89. [PMID: 34316385 PMCID: PMC8290927 DOI: 10.4292/wjgpt.v12.i4.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/22/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Preparation for colon capsule endoscopy (CCE) requires a large liquid laxative volume for capsule excretion, which compromises the procedure's tolerability.
AIM To assess the safety and utility of castor oil-boosted bowel preparation.
METHODS This prospective cohort study including 20 patients (age range, 16-80 years; six men and 14 women) suspected of having colorectal disease was conducted at Kindai University Hospital from September 2017 to August 2019. All patients underwent CCE because of the following inclusion criteria: previous incomplete colonoscopy in other facility (n = 20), history of abdominal surgery (n = 7), or organ abnormalities such as multiple diverticulum (n = 4) and adhesion after surgery (n = 6). The exclusion criteria were as follows: Dysphagia, history of allergic reactions to the drugs used in this study (magnesium citrate, polyethylene glycol, metoclopramide, and castor oil), possibility of pregnancy, possibility of bowel obstruction or stenosis based on symptoms, or scheduled magnetic resonance imaging within 2 wk after CCE. The primary outcome was the capsule excretion rate within the battery life, as evaluated by the total large bowel observation rate, large bowel transit time, and bowel creasing level using a five-grade scale in different colorectal segments. The secondary outcomes were complications, colorectal lesion detection rates, and patients’ tolerability.
RESULTS The castor oil-based regimen was implemented in 17 patients. Three patients cancelled CCE because they could tolerate castor oil, but not liquid laxatives. The capsule excretion rate within the battery life was 88% (15/17). The mean large bowel transit time was 236 min. Approximately 70% of patients had satisfactory colon cleansing levels. CCE detected colon polyps (14/17, 82%) and colonic diverticulum (4/12, 33%). The sensitivity, specificity, and diagnostic accuracy rates for detecting colorectal polyps (size ≥ 6 mm) were 76.9%, 75.0%, and 76.4%, respectively. The sensitivity, specificity, and diagnostic accuracy rates for detection of diverticulum were 100% each. Twelve patients (71%) rated CCE as more than “good”, confirming the new regimen’s tolerability. No serious adverse events occurred during this study.
CONCLUSION The castor oil-based regimen could reduce bowel preparation dose and improve CCE tolerability.
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Affiliation(s)
- Kota Takashima
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Sho Masaki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Tomoyuki Nagai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Shigenaga Matsui
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Satoru Hagiwara
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Konosuke Nakaji
- Division of Gastroenterology, Department of Internal Medicine, Endoscopy Center, Aishinkai Nakae Hospital, Wakayama-Shi 640-8461, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
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Shah NJ, Aloysius MM, Sharma NR, Pallav K. Advances in treatment and prevention of hepatitis B. World J Gastrointest Pharmacol Ther 2021; 12:56-78. [PMID: 34316384 PMCID: PMC8290928 DOI: 10.4292/wjgpt.v12.i4.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/22/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis B (CHB) continues to contribute to worldwide morbidity and mortality significantly. Scientists, clinicians, pharmaceutical companies, and health organizations have dedicated substantial Intellectual and monetary resources to finding a cure, increasing immunization rates, and reducing the global burden of CHB. National and international health-related organizations including the center for disease control, the national institute of health, the American Association for the study of liver disease (AASLD), The European association for the study of the Liver (EASL), The Asia Pacific association for the study of the Liver (APASL) and the world health organization release periodic recommendations for disease prevention and treatment. Our review of the most recent guidelines by EASL, AASLD, APASL, and Taiwan Association for the Study of the Liver revealed that an overwhelming majority of cited studies were published before 2018. We reviewed Hepatitis B-related literature published 2018 onwards to identify recent developments and current barriers that will likely direct future efforts towards eradicating hepatitis B. The breakthrough in our understanding of the hepatitis B virus life cycle and resulting drug development is encouraging with significant room for further progress. Data from high-risk populations, most vulnerable to the devastating effects of hepatitis B infection and reactivation remain sparse. Utilization of systems approach, optimization of experimental models, identification and validation of next-generation biomarkers, and precise modulation of the human immune response will be critical for future innovation. Within the foreseeable future, new treatments will likely complement conventional therapies rather than replace them. Most Importantly, pragmatic management of CHB related population health challenges must be prioritized to produce real-world results.
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Affiliation(s)
- Niraj James Shah
- Department of Internal Medicine, Digestive Disease, University of Mississippi Medical Center, Jackson, MS 39216, United States
| | - Mark M Aloysius
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18505, United States
| | - Neil Rohit Sharma
- Department of Internal Medicine, Interventional Oncology and Surgical Endoscopy, Parkview Regional Medical Center, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
| | - Kumar Pallav
- Department of Internal Medicine, Interventional Oncology and Surgical Endoscopy, Parkview Regional Medical Center, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
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Becker MW, Schwambach KH, Lunardelli M, Blatt CR. Overview of drug induced liver injury in Brazil: What is the role of public health policy on the evidence? World J Gastrointest Pharmacol Ther 2021; 12:40-55. [PMID: 34046243 PMCID: PMC8134851 DOI: 10.4292/wjgpt.v12.i3.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/20/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adverse drug reactions are responsible for increased costs and morbidity in the health system. Hepatotoxicity can be induced both by non-prescription drugs and by those used for chronic diseases. It is the main cause of safety-related drug marketing withdrawals and could be responsible for irreversible and fatal injuries. AIM To identify and to summarize Brazilian studies reporting the drug-induced liver injury. METHODS A systematic review of Brazilian studies was carried out until June 2020. It was found 32 studies, being 10 retrospective cohorts, 12 prospective cohorts, 5 cross-sectional, 3 case-control, one case series and one randomized clinical trial. In most studies were investigated tuberculosis patients followed by other infectious conditions like human immunodeficiency virus (HIV) and hepatitis C virus. The hepatotoxicity ranged from one to 57%, led by isoniazid, rifampicin, and pyrazinamide. Few studies reported algorithm to assess causality. In most studies, there were moderate outcomes and it was necessary drug interruption. However, few severe outcomes, such as chronic liver damage and liver transplantation were reported. RESULTS Twenty-two different criteria for hepatotoxicity were found. The great heterogeneity did not allow a meta-analysis. Standardization of parameter of drug-induced liver injury and greater effort in pharmacovigilance could contribute to learn more about drug-induced liver injury (DILI)'s epidemiology in Brazil. CONCLUSION The development of strategic public health policies seems to have an influence on the DILI scientific evidence in Brazil due to main studies are in HIV and tuberculosis line care, two strategic health policies in Brazil.
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Affiliation(s)
- Matheus William Becker
- Graduate Program in Medicine-Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, RS, Brazil
| | - Karin Hepp Schwambach
- Graduate Program in Medicine-Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, RS, Brazil
| | - Michele Lunardelli
- Graduate Program in Medicine-Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, RS, Brazil
| | - Carine Raquel Blatt
- Graduate Program in Medicine-Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, RS, Brazil
- Pharmacoscience Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, RS, Brazil
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Abayli B, Abaylı C, Gencdal G. Histopathological evaluation of long-term tenofovir disoproxil fumarate treatment in patients with hepatitis be antigen-negative chronic hepatitis B. World J Gastrointest Pharmacol Ther 2021; 12:32-39. [PMID: 33815864 PMCID: PMC8008959 DOI: 10.4292/wjgpt.v12.i2.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/10/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis B virus is a universal health problem. There are approximately 250 million people living with hepatitis B worldwide, and approximately 600000 of these people die every year due to the virus.
AIM To compare the pretreatment and post-treatment histopathological results of patients with hepatitis be antigen (HBeAg)-negative chronic hepatitis B (CHB) who had been receiving tenofovir disoproxil fumarate (TDF) treatment at our clinic for at least 5 years.
METHODS Patients with HBeAg-negative CHB who were being treated with TDF (245 mg/d) were included in the study. Liver biopsies of patients before TDF treatment and liver biopsies after 5 years of TDF treatment were retrospectively compared.
RESULTS A total of 50 HBeAg-negative CHB patients were included in the study (mean age: 47.9 ± 10.4 years, men: 27.54%). Histological improvement was observed in 78% (39) of the patients after 5 years of treatment. After the 5 years of treatment, the mean Ishak score of the patients was 1.3 ± 1.3, and the mean histologic activity index score was 4.1 ± 2.8. A 1.53 point reduction in Ishak fibrosis score was detected after long-term TDF treatment.
CONCLUSION Liver biopsies after 5 years of TDF treatment revealed a significant histological response and a regression of the necroinflammatory score compared to pretreatment liver biopsies. To better understand the effects of antiviral treatments on the improvement of liver histology, long-term studies involving larger numbers of patients are needed.
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Affiliation(s)
| | | | - Genco Gencdal
- Department of Gastroenterology, Hepatology and Liver Transplantation, Koc University, School of Medicine, İstanbul 34300, Turkey
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Henz AC, Marroni CA, Silva DMD, Teixeira JM, Silveira TT, Ferreira S, Silveira AT, Schmidt NP, Stein JT, Rayn RG, Fernandes SA. Resting energy expenditure in cirrhotic patients with and without hepatocellular carcinoma. World J Gastrointest Pharmacol Ther 2021; 12:1-12. [PMID: 33564492 PMCID: PMC7844573 DOI: 10.4292/wjgpt.v12.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/26/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The diagnosis of malnutrition in patients with independent hepatocellular carcinoma (HCC) varies from 20% to 50%, is related to important complications and has a direct impact on the prognosis. Determination of the resting energy expenditure (REE) has become an important parameter in this population, as it allows therapeutic adjustments to recover their nutritional status. The REE in cirrhosis, with and without HCC, is not clearly defined, and requires the identification and definition of the best nutritional approach.
AIM To evaluate the REE of patients with cirrhosis, with and without HCC.
METHODS This is a prospective observational study evaluating the REE of 118 patients, 33 with cirrhosis and hepatocellular carcinoma and a control group of 85 patients with cirrhosis without HCC, using indirect calorimetry (IC), bioimpedance, and predictive formulas.
RESULTS The REE determined by IC in cirrhotic patients with HCC was 1643 ± 364 and in those without HCC was 1526 ± 277 (P = 0.064). The REE value as assessed by bioimpedance was 1529 ± 501 for those with HCC and 1660 ± 385 for those without HCC (P = 0.136). When comparing the values of REE determined by IC and predictive formulas in cirrhotics with HCC, it was observed that only the formulas of the Food and Agriculture Organization (FAO)/World Health Organization (WHO) (1985) and Cunningham (1980) presented values similar to those determined by IC. When comparing the REE values determined by IC and predictive formulas in cirrhotics without HCC, it was observed that the formulas of Schofield (1985), FAO/WHO (1985), WHO (2000), Institute of Medicine (IOM) (2005) and Katch and McArdie (1996) presented values similar to those determined by IC.
CONCLUSION The FAO/WHO formula (1985) could be used for cirrhotic patients with or without HCC; as it is the one with the values closest to those obtained by IC in these cirrhotic patients.
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Affiliation(s)
- Ana Cristhina Henz
- Department of Nutrition, Centro Universitário Metodista (IPA), Porto Alegre 90420-060, RS, Brazil
| | - Claudio Augusto Marroni
- Department of Gastroenterology and Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 91760470, RS, Brazil
| | - Daniella Miranda da Silva
- Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Joise Munari Teixeira
- Postgraduate Program in Medicine, Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Thiago Thomé Silveira
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Shaiane Ferreira
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Andresa Thomé Silveira
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Natalia Perin Schmidt
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Jessica Taina Stein
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Roberta Goulart Rayn
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Sabrina Alves Fernandes
- Department of Nutrition, Centro Universitário Metodista (IPA), Porto Alegre 90420-060, RS, Brazil
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Sun BH, Wang T, Li NY, Wu Q, Qiao J. Clinical features and relative factors of constipation in a cohort of Chinese patients with Parkinson's disease. World J Gastrointest Pharmacol Ther 2021; 12:21-31. [PMID: 33564494 PMCID: PMC7844575 DOI: 10.4292/wjgpt.v12.i1.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/28/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Constipation as a most common non-motor symptom of Parkinson's disease (PD), has a higher prevalence compared to the general population. The etiologies of constipation in PD are diverse. In addition to physical weakness and other factors of disease, the lifestyles and eating habits are also important factors. Therefore, the prevalence and influencing factors of constipation may vary among different populations.
AIM To determine the prevalence of constipation and analyze relative factors in a cohort of Chinese patients with PD.
METHODS All the patients diagnosed with PD according to the movement disorders society criteria were consecutively collected by a self-developed questionnaire. Rome III diagnostic criteria were used to assess functional constipation and Wexner score was used to estimate the severity of constipation. Non-motor symptoms (NMS) were assessed with the non-motor symptoms assessment scale (NMSS). Unified Parkinson's disease Rating Scale III (UPDRS III) was used to evaluate the severity of motor symptoms. The modified Hoehn-Yahr stage was used to evaluate the severity of PD. Cognitive function was assessed using Montreal cognitive assessment (MoCA). Depression and anxiety were rated with the Hamilton depression scale (HAMD) and the Hamilton anxiety scale (HAMA). Quality of life was assessed using the Parkinson’s disease Questionnaire-39 items (PDQ-39).
RESULTS Of 166 patients enrolled, 87 (52.41%) were accompanied with constipation, and 30 (34.48%) experienced constipation for 6.30 ± 5.06 years before motor symptoms occurred. Age, Hoehn-Yahr stage, disease duration, levodopa medication times, incidence of motor complications, the scores of UPDRS total, UPDRS III, NMSS, HAMD, HAMA, and PDQ-39 in the constipation group were higher than those in the non-constipation group (P < 0.05), but there was no difference in the scores of MoCA, clinical types, or medications between the two groups (P > 0.05). There was a higher incidence of depression in patients with constipation (P < 0.05), but there were no difference in the incidence of anxiety and cognitive impairment between the two groups (P > 0.05). As Hoehn-Yahr stages increased, the severity of constipation increased (P < 0.05), but not the incidence of constipation (P > 0.05). Pearson correlation analysis showed that constipation was moderately positively correlated with age, Hoehn-Yahr stage, and scores of NMSS, UPDRS III, UPDRS total, PDQ-39, HAMD, and HAMA (r = 0.255, 0.172, 0.361, 0.194, 0.221, 0.237, 0.238, and 0.207, P < 0.05). Logistic regression analysis showed that only NMSS score was an independent risk factor for constipation (P < 0.001).
CONCLUSION Our findings confirm that constipation has a relatively high frequency in patients with PD. PD patients with constipation have a higher incidence of depression, which leads to worse quality of life.
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Affiliation(s)
- Bai-Hua Sun
- Department ofNeurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
- Department of Neurology, Xi'an Third Hospital, Xi'an 710021, Shaanxi Province, China
| | - Tao Wang
- Department ofNeurology, the Shaanxi Sengong Hospital, Xi'an 710300, Shaanxi Province, China
| | - Nian-Ying Li
- Department ofNeurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Qiong Wu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Jin Qiao
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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Raahave D, Jensen AK. Increased colon transit time and faecal load in irritable bowel syndrome. World J Gastrointest Pharmacol Ther 2021; 12:13-20. [PMID: 33564493 PMCID: PMC7844574 DOI: 10.4292/wjgpt.v12.i1.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a bowel disorder involving abdominal pain or discomfort along with irregularity of stool form and passage frequency. The pathophysiology is poorly understood and seems to be multifactorial. Investigations of possible causes of IBS have included only a few colonic transit studies and no simultaneous determination of the colonic faecal content.
AIM To compare colon transit time and faecal load between IBS-patients and healthy control subjects.
METHODS The study included 140 patients with IBS, with a mean age of 50.0 years. The control group comprised 44 healthy persons with a mean age of 43.4 years, who were selected at random from the National Civil Register. Both the patient group and the control group underwent a marker study to measure colon transit time (CTT) and to calculate a faecal loading score. The patient group underwent treatment with a combined prokinetic regime, after which their CTT and faecal loading were reassessed. Analyses were performed to compare measurements between the control group and the patient group before and after treatment.
RESULTS Compared to healthy controls, IBS-patients exhibited a significantly prolonged mean CTT (45.48 h vs 24.75 h, P = 0.0002) and significantly greater mean faecal loading scores in all colonic segments (P < 0.001). Among IBS patients, we found no significant differences between the 48 h and 96 h radiographs. Among patients exhibiting increased CTT and faecal loading, approximately half exhibited a palpable mass in the right iliac fossa. After intervention with a prokinetic treatment, the mean CTT among IBS patients was reduced from 45.48 h to 34.50 h (P = 0.091), with the post-treatment CTT not significantly differing from the CTT among control subjects (P = 0.095). The faecal loading score among IBS patients did not significantly differ before and after treatment (P = 0.442). The post-treatment faecal loading score in IBS patients remained significantly higher compared to that in controls (5.3 vs 4.3, P = 0.014). After treatment, half of the IBS-patients were relieved of bloating, while the majority no longer experienced abdominal pain and achieved a daily consistent stool.
CONCLUSION IBS-patients exhibited prolonged CTT and heavier faecal loading. These assessments may aid in diagnosis. Faecal retention may contribute to IBS symptoms, which can be treated using a prokinetic regime.
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Affiliation(s)
- Dennis Raahave
- Department of Gastroenterology and Surgery, Copenhagen University North Sealand Hospital, Hilleroed 3400, Denmark
| | - Andreas K Jensen
- Faculty of Health Sciences, Section of Biostatistics, University of Copenhagen, Hilleroed 3400, Denmark
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Yazawa T, Hori T, Yamamoto H, Harada H, Yamamoto M, Yamada M, Tani M, Sato A, Kamada Y, Tani R, Aoyama R, Sasaki Y, Zaima M. Do liver metastases from gastric cancer contraindicate aggressive surgical resection? A 14-year single-center experience. World J Gastrointest Pharmacol Ther 2020; 11:110-122. [PMID: 33251035 PMCID: PMC7667407 DOI: |