A trial-based economic evaluation of peppermint oil for the treatment of irritable bowel syndrome

Background

Irritable Bowel Syndrome (IBS) is a prevalent, chronic gastrointestinal disorder that imposes a substantial socioeconomic burden. Peppermint oil is a frequently used treatment for IBS, but evidence about cost‐effectiveness is lacking.

Objective

We aimed to assess cost‐effectiveness of small‐intestinal release peppermint oil versus placebo in IBS patients.

Methods

In a multicenter randomized placebo‐controlled trial, cost‐effectiveness was evaluated from a societal perspective. The incremental cost‐effectiveness ratios (ICERs) were expressed as (1) incremental costs per Quality Adjusted Life Years (QALY), and (2) incremental costs per successfully treated patient, that is per abdominal pain responder (according to FDA definitions), both after an eight‐week treatment period with placebo versus peppermint oil. Cost‐utility and uncertainty were estimated using non‐parametric bootstrapping. Sensitivity analyses were performed.

Results

The analysis comprised 126 patients (N = 64 placebo, N = 62 small‐intestinal release peppermint oil). Peppermint oil was a dominant treatment compared to placebo in 46% of bootstrap replications. Peppermint oil was also more effective but at higher cost in 31% of replications. The net‐benefit acceptability curve showed that peppermint oil has a 56% probability of being cost‐effective at a conservative willingness‐to‐pay threshold of €10.000/QALY. Peppermint oil was also a dominant treatment per additional successfully treated patient according to FDA definitions, that is in 51% of replications. In this case, the acceptability curve showed an 89% probability of being cost‐effective.

Conclusions

In patients with IBS, small‐intestinal release peppermint oil appears to be a cost‐effective treatment although there is uncertainty surrounding the ICER. When using abdominal pain responder as outcome measure for the ICER, peppermint oil has a high probability of being cost‐effective. The use of peppermint oil, which is a low‐cost treatment, can be justified by the modest QALY gains and slightly higher proportion of abdominal pain responders. More research and long‐term data are necessary to confirm the cost‐effectiveness of peppermint oil. NCT02716285.

Microorganisms and complaints in outpatients with a percutaneous endoscopic gastrostomy catheter

BACKGROUND

We analyzed the presence of microorganisms at the insertion site of percutaneous endoscopic gastrostomy (PEG) catheters of 100 patients to investigate the microbiologic flora and its possible relation with complaints.

MATERIALS AND METHODS

Outpatients visiting our hospital PEG-catheter team were included. Symptoms and the local aspect of the skin at the insertion site were described systematically and swabs were taken to analyze the presence of pathogenic microorganisms.

RESULTS

The mean age of these 100 patients (55 men) was 62 ± 14 years (range, 3-89 years). Oropharyngeal carcinoma (n = 59) and neurologic disorders (n = 27) were the most frequent indications for a PEG catheter. The mean insertion time was 17 ± 20 months (range, 3-99 months). In 15 patients no microorganisms were found. In 85 patients we found Candida albicans (n = 37; 44%), Staphylococcus aureus (n = 28; 33%), Escherichia coli, Klebsiella, Enterobacter, and enterococci (5%-20%). None of the patients reported discomfort. Pain or itching was reported by 24 patients. We did not find any statistically significant relationship between colonization, microorganisms, complaints, and aspect of skin.

CONCLUSIONS

The insertion sites of PEG catheters in outpatients are frequently colonized, especially with C albicans, S aureus, and E coli, without clinical consequences. We did not find a relationship between microorganisms at the insertion sites of PEG catheters and signs and symptoms.

Benefits of placental biopsies for rapid karyotyping in the second and third trimesters (late chorionic villus sampling) in high-risk pregnancies

In a total of 301 placental biopsies in the second and third trimesters, 225 were performed because of suspicious ultrasonographic findings. In this group there was a high rate of aneuploidies (20%). As opposed to the alternative methods for rapid karyotyping, placental biopsies can easily be performed even in pregnancies with abnormal amounts of amniotic fluid. Oligohydramnios and polyhydramnios were key ultrasonographic findings in 38% of cases and were found to be associated with 22% of abnormal chromosomal findings. Suggestive ultrasonographic findings seem to justify the exclusive use of direct preparation.

Validity of cytogenetic analyses from trophoblast tissue throughout gestation

Cytogenetic findings in the Münster Chorionic Villi Sampling (CVS) program are presented after 1,184 first trimester transcervical samplings and 131 second and third trimester placentacenteses. In the first trimester series the abnormality rate is low (2.4%) in patients with only an age-dependent aneuploidy risk. In this group terminations were performed in only 1.6% because of aneuploidy. True mosaicism was found more frequently after CVS, and the risk of maternal cell contamination seems higher as compared to amniocentesis. There are no obvious differences in the overall rate of diagnostic errors after both procedures, when metaphases after direct preparation and chorionic cell cultures are analysed and doubtful findings such as mosaicism are adequately followed up by amniocentesis. The cytogenetic techniques also offer a very rapid approach to karyotyping in the second and third trimester. We found a high rate of aneuploidy (15%) when placentacentesis was performed after sonographic diagnosis of fetal abnormalities. We conclude that cytogenetic analysis from trophoblast tissue is an accurate diagnostic tool applicable from first to third trimester of pregnancy.

[Difficulties in interpreting the cardiotocogram in atrioventricular arrhythmia of the fetal heart]

During a routine screening examination of a pregnancy during the 28th gestational week, a pericardial effusion and ascites were recognized in the fetus. Ultrasound B- and M-mode evaluation (echocardiography) revealed an atrio-ventricular block grade III with commencing cardiac insufficiency. Cardiac monitoring (CTG) by ultrasound (HP 8040A Fetal Monitor) documented primarily the fetal atrial activity when the logic switch was turned off, but after it was turned on there was no continuous recording. When fetal heart action was recorded by abdominal electrocardiogram (AFEKG) the cardiotocography showed simultaneously a ventricular frequency of 50/min. and a maternal frequency of 70-80/min. This case confirms that the registration of fetal heart action without real-time imaging is only of limited value in cases of cardiac-conduction anomalies. It is important that during ultrasound screening examination, the cardiac heart action is carefully evaluated.