NOD2/CARD15 gene polymorphisms and Crohn's disease in the Chinese population

BACKGROUND

Crohn's disease affects people world-wide, but the incidence in Asia is lower than in Western countries. This difference may be due to genetic and/or environmental factors. Three single nucleotide polymorphisms (SNPs) of the NOD2/CARD15 gene have been identified to be independently associated with the development of Crohn's disease in Caucasians. Whether these SNPs are involved in the pathogenesis of Crohn's disease in the Chinese population is unknown.

AIM

To determine if NOD2/CARD15 gene polymorphisms are found in Chinese patients with Crohn's disease.

METHODS

Sixty-five consecutive Chinese Crohn's disease patients had genotyping performed using sequence-specific PCR directed against the wild-type and the Arg702Trp, Gly908Arg and 3020insC variants of the NOD2/CARD15 gene. Controls consisted of 63 patients with ulcerative colitis and 70 patients with dyspepsia.

RESULTS

None of the patients with Crohn's disease had heterozygous or homozygous SNP variants. Similarly none of the ulcerative colitis or dyspeptic controls had these SNPs.

CONCLUSION

The three previously described SNPs associated with the development of Crohn's disease in Caucasians are not found in Chinese patients with Crohn's disease.

Review article: Ulcerative colitis, smoking and nicotine therapy

BACKGROUND

Smoking is the best-characterised environmental association of ulcerative colitis (UC). Smoking has been observed to exert protective effects on both the development and progression of UC.

AIMS

To examine the association between UC and smoking, possible pathogenic mechanisms and the potential of nicotine as a therapeutic agent in the treatment of UC.

METHODS

A literature search was conducted through MEDLINE, using the MeSH search terms 'ulcerative colitis' and 'smoking' or 'nicotine'. Relevant articles were identified through manual review. The reference lists of these articles were reviewed to include further appropriate articles.

RESULTS

Ulcerative colitis is less prevalent in smokers. Current smokers with a prior diagnosis of UC are more likely to exhibit milder disease than ex-smokers and nonsmokers. There is conflicting evidence for smokers having reduced rates of hospitalisation, colectomy and need for oral corticosteroids and immunosuppressants to manage their disease. Multiple potential active mediators in smoke may be responsible for these clinical effects, including nicotine and carbon monoxide, but the precise mechanism remains unknown. Nicotine has demonstrated variable efficacy in the induction of remission in UC when compared to placebo and conventional medicines. Despite this, the high frequency of adverse events limits its clinical significance.

CONCLUSIONS

Nicotine's application as a therapeutic treatment in ulcerative colitis is limited. Presently, it may be an option considered only in selected cases of acute ulcerative colitis refractory to conventional treatment options. This review also questions whether nicotine is the active component of smoking that modifies risk and inflammation in ulcerative colitis.

Patients' knowledge of pregnancy-related issues in inflammatory bowel disease and validation of a novel assessment tool ('CCPKnow')

BACKGROUND

Inflammatory bowel diseases (IBD) require complex therapeutic decisions and life choices concerning pregnancy, but little is known about patient's knowledge of IBD and its treatment before and during pregnancy.

AIM

To develop a novel tool (Crohn's and Colitis Pregnancy Knowledge Score 'CCPKnow') to assess knowledge of pregnancy-related issues in IBD. The validated tool was then applied to determine knowledge in patients.

METHOD

Discriminate ability of 'CCPKnow' was validated in four groups with different levels of IBD knowledge. Reliability and readability were tested by Cronbach-α and Flesch-Kencaid. Construct validity was subsequently assessed against general IBD knowledge (CCKnow) in 145 women with IBD. Associations between patient factors and knowledge were studied.

RESULTS

Median CCPKnow scores differed significantly between the validation groups (P < 0.001). CCPKnow displayed excellent internal consistency, reliability (Cronbach-α 0.94), readability (reading age 9 years) and close correlation with CCKnow (Spearman's ρ 0.64; P < 0.001). Of 145 patients, 44.8% had poor, 27.6% adequate, 17.3% good and only 10.3% very good knowledge. Better knowledge was associated with Caucasian ethnicity, higher income, having a partner, having children, Crohn's and Colitis Association membership, longer disease duration and Crohn's disease.

CONCLUSIONS

Crohn's and Colitis Pregnancy Knowledge Score, a novel knowledge assessment tool of pregnancy and IBD, demonstrated excellent test characteristics. We found that nearly half of the women with IBD had poor knowledge, identifying a pressing need for better education.

Review article: Helicobacter species and hepatobiliary diseases

Helicobacter species, which may colonize the biliary tract, have been implicated as a possible cause of hepatobiliary diseases ranging from chronic cholecystitis and primary sclerosing cholangitis to gall-bladder carcinoma and primary hepatic carcinomas. Research in this area has been limited by the lack of a gold standard in the diagnosis of these organisms in bile. Most published data to date have been based on molecular techniques that detect the DNA of Helicobacter species in bile, rather than evidence of viable organisms in bile. Helicobacter species have not been shown to induce histological injury to the biliary epithelium or liver parenchyma. The strongest association of the presence of these organisms in bile is with cholestatic conditions. This article reviews the literature on this newly developing field as it has evolved historically, taking pertinent methodological issues into account.

Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis

BACKGROUND

Smoking demonstrates divergent effects in Crohn's disease (CD) and ulcerative colitis (UC). Smoking frequency is greater in CD and deleterious to its disease course. Conversely, UC is primarily a disease of nonsmokers and ex-smokers, with reports of disease amelioration in active smoking.

AIM

To determine the prevalence of smoking and its effects on disease progression and surgery in a well-characterised cohort of inflammatory bowel diseases (IBD) patients.

METHODS

Patients with smoking data of the Sydney IBD Cohort were included. Demographic, phenotypic, medical, surgical and hospitalisation data were analysed and reported on the basis of patient smoking status.

RESULTS

1203 IBD patients were identified comprising 626 CD and 557 UC with 6725 and 6672 patient-years of follow-up, respectively. CD patients were more likely to smoke than UC patients (19.2% vs. 10.2%, P < 0.001). A history of smoking in CD was associated with an increased proportional surgery rate (45.8% vs. 37.8%, P = 0.045), requirement for IBD-related hospitalisation (P = 0.009) and incidence of peripheral arthritis (29.8% vs. 22.0%, P = 0.027). Current smokers with UC demonstrated reduced corticosteroid utilisation (24.1% vs. 37.5%, P = 0.045), yet no reduction in the rates of colectomy (3.4% vs. 6.6%, P = 0.34) or hospital admission (P = 0.25) relative to nonsmokers. Ex-smokers with UC required proportionately greater immunosuppressive (36.2% vs. 26.3%, P = 0.041) and corticosteroid (43.7% vs. 34.5%, P = 0.078) therapies compared with current and never smokers.

CONCLUSIONS

This study confirms the detrimental effects of smoking in CD, yet failed to demonstrate substantial benefit from smoking in UC. These data should encourage all patients with IBD to quit smoking.

Effect of Helicobacter pylori eradication on treatment of gastro-oesophageal reflux disease: a double blind, placebo controlled, randomised trial

BACKGROUND

The role of Helicobacter pylori eradication in the management of gastro-oesophageal reflux disease (GORD) is controversial. We hypothesised that H pylori eradication leads to worsened control of reflux disease.

METHODS

Consecutive patients with weekly reflux symptoms were prospectively recruited for endoscopy and symptom evaluation. Patients were enrolled if they had H pylori infection and required long term acid suppressants. Eligible patients were randomly assigned to omeprazole triple therapy (HpE group) or omeprazole with placebo antibiotics (Hp+ group) for one week. Omeprazole 20 mg daily was given for eight weeks for healing of oesophagitis and symptom relief. This was followed by a maintenance dose of 10 mg daily for up to 12 months. The primary study end point was the probability of treatment failure within 12 months, which was defined as either incomplete resolution of symptoms or oesophagitis at the initial treatment phase, or relapse of symptoms and oesophagitis during the maintenance phase. Predictors of treatment failure were determined by Cox's proportional hazards model.

RESULTS

A total of 236 GORD patients were screened and 113 (47.9%) were positive for H pylori; 104 (92%) patients were included in the intention to treat analysis (53 in the HpE group and 51 in the Hp+ group). Thirty one patients (30%) had erosive oesophagitis at baseline. H pylori was eradicated in 98% of the HpE group and in 3.9% of the Hp+ group. Overall, 15 patients (28.3%) in the HpE group and eight patients (15.7%) in the Hp+ group had treatment failure. The 12 month probability of treatment failure was 43.2% (95% confidence interval (CI) 29.9-56.5%) in the HpE group and 21.1% (95% CI 9.9-32.3%) in the Hp+ group (log rank test, p = 0.043). In the Cox proportional hazards model, after adjustment for the covariates age, sex, erosive oesophagitis, hiatus hernia, degree of gastritis, and severity of symptoms at baseline, H pylori eradication was the only predictor of treatment failure (adjusted hazard ratio 2.47 (95% CI 1.05-5.85)).

CONCLUSION

H pylori eradication leads to more resilient GORD.

A model for signal transmission in an ear having hair cells with free-standing stereocilia. IV. Mechanoelectric transduction stage

A model is described for mechanoelectric transduction in hair cells with free-standing stereocilia in the alligator lizard cochlea. The model relates the angular displacement of the stereocilia to the receptor potential in the absence of the hair cell's membrane capacitance whose effect is considered elsewhere (Leong and Weiss, 1985, in preparation). The model consists of two parts: a population of membrane ionic channels and an electric network that relates the channel conductance to the equivalent resistance of the hair cell. The membrane ionic channels tend to open when the stereociliary tuft is displaced toward the kinocilium (or basal body) and tend to close when the tuft is oppositely displaced. The fraction of channels that is open for a given tuft displacement is governed by Boltzmann statistics and the energies of open and closed configurations of the channels are separated by a single energy barrier whose height depends on the angular displacement of the stereociliary tuft. The resulting channel conductance is a hyperbolic-tangent type function of the angular displacement of the stereociliary tuft. The channel conductance is coupled to the rest of the hair cell by an equivalent electric network containing constant resistance and a capacitance. The Thévenin equivalent resistance change across the basolateral membrane of the hair cell, called the transducer function, is also a hyperbolic-tangent type function of angular displacement. The parameters of the channel conductance and the values of resistances in the hair-cell electric model determine the scale factors and the location of the operating point of this hyperbolic-tangent type function. The hyperbolic-tangent type function is a specific example of a class of monotonically decreasing and saturating, or sigmoidal, transducer functions. The spectral properties of sigmoidal transducer functions are examined for sinusoidal angular displacements of amplitude theta. General results are obtained for arbitrary sigmoidal transducer functions; particular results are obtained for the hyperbolic-tangent type function. General conclusions concerning spectral components of the resistance change include: all spectral components are independent of the frequency of the angular displacement; the constant or DC component can be positive or negative; the fundamental component is 180 degrees out of phase with the angular displacement, i.e. the resistance decreases when the stereocilia are displaced towards the kinocilium; for small values of theta, the magnitude of the nth harmonic tends to grow as theta n for n greater than 0; the zeroth harmonic or DC component grows as theta 2.(ABSTRACT TRUNCATED AT 400 WORDS)

A model for signal transmission in an ear having hair cells with free-standing stereocilia. III. Micromechanical stage

Measurements have shown that the sound-induced motion of free-standing stereocilia of hair cells in the alligator lizard cochlea exhibits tonotopically organized frequency selectivity that is correlated with the geometry of the stereociliary tuft. We propose a model in which basilar-membrane motion causes vibration of the receptor organ which drags the stereocilia back and forth through the endolymph. The stereociliary tuft is represented as a rigid rod attached to the cuticular plate by a compliant hinge. Viscous and inertial forces exerted by the endolymph on the rod are computed approximately. A transfer function, H mu(f), is derived that relates rod angular displacement to basilar-membrane velocity. H mu(f) has low- and high-frequency slopes of 10 and -20 dB/decade, respectively. The resonant frequency of H mu(f) depends on the dimensions of the rod because this frequency is inversely proportional to the square root of the product of the moment of inertia of the rod, which depends on rod dimensions, and the compliance of the hinge, which does not. In most respects, measurements of frequency selectivity and tonotopic organization of hair cells and cochlear neurons in the alligator lizard, can be accounted for by an input transfer function, HI(f) = Hm(f)H mu(f)Ha(f), where Hm(f) is the macromechanical transfer function that relates sound pressure at the tympanic membrane to basilar-membrane velocity (Rosowski et al., 1985, Hearing Res. 20, 139-155), and Ha(f) is a first-order lowpass filter. Mechanisms that could produce the additional lowpass filter process are discussed.

Absence of cyclin D2 expression is associated with promoter hypermethylation in gastric cancer

Expression of cyclin D2 is absent in 30-70% of gastric cancers. We investigated the role of promoter hypermethylation in the transcriptional silencing of cyclin D2 in five gastric cell lines and 47 primary gastric carcinomas. CpG island methylation status of the cyclin D2 gene was studied by methylation-specific polymerase chain reaction and bisulphite sequencing. RNA and protein expression was analysed by reverse transcription-PCR and Western blot, respectively. Dense methylation of cyclin D2 was detected in three cell lines (KATOIII, AGS and NCI-N87), which also lacked cyclin D2 mRNA and protein expression. Bisulphite DNA sequencing revealed that loss of cyclin D2 expression was closely associated with the density of methylation in the promoter region. Treatment with DNA methyltransferase inhibitor, 5-aza-2'-deoxycytidine, restored the cyclin D2 expression level in methylated gastric cells. Among the 47 primary gastric cancers, cyclin D2 hypermethylation was detected in 23 (48.9%) cases. None of the 23 normal gastric biopsies from noncancer patients showed hypermethylation. Hypermethylation was associated with loss of mRNA (P&<0.001) and protein (P=0.006) expressions. Our study showed that cyclin D2 hypermethylation is associated with loss of cyclin D2 expression in a subset of gastric cancers, which may suggest an alternative gastric carcinogenesis pathway in the absence of cyclin D2 expression.

Quality of life in Chinese patients with inflammatory bowel disease: validation of the Chinese translation of the Inflammatory Bowel Disease Questionnaire

BACKGROUND

Health-related quality of life is an important outcome measure in inflammatory bowel disease. The Inflammatory Bowel Disease Questionnaire is a quality of life questionnaire that has not been validated previously in Chinese patients with inflammatory bowel disease.

AIM

To develop and validate a Chinese translation of the Inflammatory Bowel Disease Questionnaire, specifically determining its construct validity, discriminant ability, reliability and sensitivity to change.

METHODS

We developed a Chinese version of the Inflammatory Bowel Disease Questionnaire. Chinese patients with Crohn's disease and ulcerative colitis completed the Chinese Inflammatory Bowel Disease Questionnaire and visual analogue scales measuring systemic, social, bowel and emotional well-being. Patients also completed a validated Chinese SF-36 generic quality of life questionnaire, the Crohn's disease activity index or the clinical activity index for ulcerative colitis.

RESULTS

One hundred and thirty-five patients (59 with Crohn's disease and 76 with ulcerative colitis) were enrolled, 99 of whom also completed the Chinese Inflammatory Bowel Disease Questionnaire for a second time. The Chinese Inflammatory Bowel Disease Questionnaire correlated well with the SF-36 for all four domains (Spearman: r = 0.55-0.80), the Crohn's disease activity index (r = -0.62-0.72) and the clinical activity index for ulcerative colitis (r = -0.44-0.68), as well as with the visual analogue scales. The Chinese Inflammatory Bowel Disease Questionnaire accurately distinguished between active and inactive disease. Test-re-test reliability showed excellent intra-class correlation (0.76-0.92; all P < 0.001). The Chinese Inflammatory Bowel Disease Questionnaire was also sensitive to changes in disease activity (P < 0.05).

CONCLUSION

The Chinese Inflammatory Bowel Disease Questionnaire is a valid and reliable test that correlates well with the patients' subjective well-being and clinical disease activity.

A model for signal transmission in an ear having hair cells with free-standing stereocilia. II. Macromechanical stage

A model of the signal-processing properties of the macromechanical system of the alligator-lizard middle and inner ear is developed. The model is based on measurements (as a function of tone frequency) of ossicular and basilar-membrane motion and of acoustic input-admittance at the tympanic membrane before and after alterations of middle-ear and inner-ear structures. From the structure of the ear, we formulate an equivalent electric network consisting of six admittance blocks and two transformers. The admittance blocks represent the mechanical properties of particular structures, e.g. the tympanic membrane (TM), the ossicle, the TM-ossicular joint, the vestibule, the basilar membrane and the helicotrema. The transformers represent the conversions from acoustical to mechanical variables performed by the TM-ossicular system and by the columella footplate. The block admittances and transformer ratios are inferred from the measurements, and each admittance is approximated by a network with a few simple elements. The resulting model fits the experimental results satisfactorily, allows correlations between specific structures and response behavior, and predicts the macromechanical transfer function. This transfer function acts as the first stage of a model of the alligator-lizard auditory periphery (Weiss et al., Weiss and Leong, 1985, Hearing Res. 20, 131-138, 157-174, 175-195). In the model the frequency dependence of basilar-membrane motion (1) is determined primarily by the tympanic membrane and extracolumella in the middle frequencies and (2) is affected by the helicotrema at low frequencies and the TM-ossicular joint at high frequencies.

Impaired motility in Barrett's esophagus: A study using high-resolution manometry with physiologic challenge

BACKGROUND

Esophageal dysmotility may predispose to Barrett's esophagus (BE). We hypothesized that high-resolution manometry (HRM) performed with additional physiologic challenge would better delineate dysmotility in BE.

METHODS

Included patients had typical reflux symptoms and underwent endoscopy, HRM with single water swallows and adjunctive testing with solids and rapid drink challenge (RDC) before ambulatory pH-impedance monitoring. BE and endoscopy-negative reflux disease (ENRD) subjects were compared against functional heartburn patient-controls (FHC). Primary outcome was incidence of HRM contractile abnormalities with standard and adjunctive swallows. Secondary outcomes included clearance measures and symptom association on pH-impedance.

KEY RESULTS

Seventy-eight patients (BE 25, ENRD 27, FHC 26) were included. Water swallow contractility was reduced in both BE (median DCI 87 mm Hg/cm/s) and ENRD (442 mm Hg/cm/s) compared to FHC (602 mm Hg/cm/s; P < .001 and .04, respectively). With the challenge of solid swallows and RDC, these parameters improved in ENRD (solids = 1732 mm Hg/cm/s), becoming similar to FHC (1242 mm Hg/cm/s; P = .93), whereas abnormalities persisted in BE (818 mm Hg/cm/s; P < .01 c.f. FHC). In BE and ENRD, reflux events (67 vs 57 events/24 hour) and symptom frequency were similar; yet symptom correlation was significantly better in ENRD compared to BE, which was comparable to FHC (symptom index 30% vs 4% vs 0%, respectively). Furthermore, bolus clearance and exposure times were more pronounced in BE (P < .01).

CONCLUSIONS & INFERENCES

Reduced contractile effectiveness persisted in BE with the more representative esophageal challenge of swallowing solids and free drinking; while in ENRD and FHC peristalsis usually improved, demonstrating peristaltic reserve. Furthermore, symptom association and refluxate clearance were reduced in BE. These factors may underlie BE pathogenesis.

Predictors of corticosteroid-dependent and corticosteroid-refractory inflammatory bowel disease: analysis of a Chinese cohort study

BACKGROUND

Patients with inflammatory bowel disease (IBD) who are corticosteroid-dependent or -refractory are at higher risk of developing disease- and treatment-related complications.

AIMS

To identify retrospectively clinical factors present at diagnosis that predict the occurrence of corticosteroid dependency and refractoriness in Crohn's disease (CD) and ulcerative colitis (UC) patients.

METHODS

A total of 310 IBD patients (134 CD, 176 UC) were observed for 2140 person years and their use of systemic corticosteroids was determined. Outcomes of corticosteroid dependency and refractoriness were recorded. Univariate and multivariate analyses were performed to determine the clinical factors associated with outcomes.

RESULTS

Seventy-seven (57.5%) CD and 95 (54.0%) UC patients had received corticosteroids during study period. In CD, thrombocytosis [Hazard ratio (HR):3.0] predicted, whereas colonic CD (HR:0.3) negatively predicted corticosteroid dependency. Stricturing phenotype (HR:4.5) predicted corticosteroid-refractory CD. For UC, thrombocytosis (HR:3.9) and extensive colitis (HR:1.7) predicted corticosteroid dependency. Presence of anaemia (HR:10.8) at diagnosis and initial requirement of total parenteral nutrition (TPN) (HR:18.8) predicted corticosteroid-refractory UC. The cumulative risks of surgery were 17.8% and 5.4% for CD and UC patients respectively at 1 year after starting corticosteroids.

CONCLUSIONS

Thrombocytosis at diagnosis predicted corticosteroid-dependency in IBD. Stricturing phenotype of CD and the presence of anaemia in UC predicted subsequent course of corticosteroid refractoriness.

Semiautomatic detection of villi in confocal endoscopy for the evaluation of celiac disease

Celiac Disease (CD) is an immune-mediated enteropathy, diagnosed in the clinical practice by intestinal biopsy and the concomitant presence of a positive celiac serology. Confocal Laser Endomicroscopy (CLE) allows skilled and trained experts to potentially perform in vivo virtual histology of small-bowel mucosa. In particular, it allows the qualitative evaluation of mucosa alteration such as a decrease in goblet cells density, presence of villous atrophy or crypt hypertrophy. We present a semi-automatic method for villi detection from confocal endoscopy images, whose appearance change in case of villous atrophy. Starting from a set of manual seeds, a first rough segmentation of the villi is obtained by means of mathematical morphology operations. A merge and split procedure is then performed, to ensure that each seed originates a different region in the final segmentation. A border refinement process is finally performed, evolving the shape of each region according to local gradient intensities. Mean and median Dice coefficients for 290 villi originating from 66 images when compared to manually obtained ground truth are 80.71% and 87.96% respectively.

Aciclovir or ganciclovir universal prophylaxis of cytomegalovirus infection in liver transplantation: an economic analysis

BACKGROUND

Cytomegalovirus (CMV) following orthotopic liver transplantation can result in significant morbidity and mortality. Prophylaxis with oral aciclovir (ACV) or ganciclovir (GCV) for all transplant recipients (universal prophylaxis) may be beneficial, but which agent is more cost-effective is unknown.

METHODS

A single centre, retrospective study of all patients who had OLT at the Western Australian Liver Transplantation Service was performed. Patients received ACV from 1992 to 1998, and GCV from 1999 to 2001. A comparative cost-effectiveness analysis for the two groups was performed based on the mean total cost of the number of cases of CMV infection and disease as the clinical end-point.

RESULTS

The ACV group comprised of 55 patients and there were 24 in the GCV group. The incidence of CMV disease was 7% and 4% for the ACV and GCV groups, respectively (P > 0.05). For CMV infection it was 16% and 8%, respectively (P > 0.05). GCV prevented more cases of CMV infection and disease than ACV but at an incremental cost of dollars A20,000 (dollars US10,172) per case prevented. Overall, ACV was more cost-effective than GCV by dollars A2200 (dollars US1119) per person. The cost benefit of ACV was derived principally through a reduced pharmaceutical cost. Both agents were well tolerated without development of antiviral resistance.

CONCLUSIONS

Universal prophylaxis of CMV infection-following liver transplantation with aciclovir is more cost-effective than with ganciclovir.

Detection and density estimation of goblet cells in confocal endoscopy for the evaluation of celiac disease

Celiac Disease (CD) is an immune-mediated enteropathy, diagnosed in the clinical practice by intestinal biopsy and the concomitant presence of a positive celiac serology. Confocal Laser Endomicroscopy (CLE) allows skilled and trained experts to potentially perform in vivo virtual histology of small-bowel mucosa. In particular, it allows the qualitative evaluation of mucosa alteration such as a decrease in goblet cells density, presence of villous atrophy or crypt hypertrophy. We present a semi-automatic computer-based method for the detection of goblet cells from confocal endoscopy images, whose density changes in case of pathological tissue. After a manual selection of a suitable region of interest, the candidate columnar and goblet cells' centers are first detected and the cellular architecture is estimated from their position using a Voronoi diagram. The region within each Voronoi cell is then analyzed and classified as goblet cell or other. The results suggest that our method is able to detect and label goblet cells immersed in a columnar epithelium in a fast, reliable and automatic way. Accepting 0.44 false positives per image, we obtain a sensitivity value of 90.3%. Furthermore, estimated and real goblet cell densities are comparable (error: 9.7 ± 16.9%, correlation: 87.2%, R(2) = 76%).

A241 KIWIFRUIT AND KIWIFRUIT EXTRACTS FOR TREATMENT OF CONSTIPATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Aims

This systematic review and meta-analysis aimed to determine the effectiveness of kiwifruit or kiwifruit extracts in thetreatment of constipation.

Methods

Electronic databases were searched from inception until January 2021. Eligible studies enrolled participants with functional constipation (FC) or irritable bowel syndrome with constipation (IBS-C) with randomization to receive kiwifruit or kiwifruit extracts vs. any non-kiwifruit control. Standardized meandifference (SMD) or mean difference (MD) with confidence intervals (CI) were determined for the following outcomes: weekly frequency of spontaneous bowel movements (SBM) and Bristol Stool Scale (BSS). GRADE approach was used to rate the certainty of evidence. PROSPERO registration number CRD42020207365.

Results

Seven randomized controlled trials including 399 participants (82% female; mean age 42 years [Standard Deviation 14.6]) were included. Compared with placebo, kiwifruit extract might increase weekly frequency of SBM (MD 1.36; 95% CI -0.44 to 3.16) with low certainty evidence. Kiwifruit had an uncertain effecton BSS (SMD 1.54; 95% CI -1.33 to 4.41) with very low certainty evidence. Compared with psyllium, kiwifruitmay increase weekly SBM (MD 1.1; 95% CI -0.02 to 2.04) and may increase BSS (softer stools) (MD 0.63;95% CI 0.01 to 1.25) both with low certainty evidence. Compared to placebo, kiwifruit encapsulated extracts may result in an increase in minor adverse events (Relative Risk 4.58; 95% CI 0.79 to 26.4).

Conclusions

Among individuals with constipation, overall low certainty of evidence indicate that kiwifruit may increase SBM when compared to placebo or psyllium. Although overall results are promising, establishing therole of kiwifruit in FC or IBS-C requires large, methodologically rigorous trials.

Funding Agencies

None

A246 GASTROINTESTINAL ADVERSE EVENTS OF CANNABINOIDS IN PEDIATRIC POPULATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Use of therapeutic cannabinoids in the pediatric population has increased in recent years within areas of epilepsy, palliative care, and cancer. Given the endocannabinoid system plays a crucial role in gastrointestinal (GI) homeostasis, exogenous cannabinoids have the potential to develop GI related side effects. While some GI adverse events have been reported with the use of therapeutic cannabinoids, the full profile of GI adverse events in the pediatric population is still unknown.

Aims

To understand the impact of therapeutic cannabinoids on the GI system of pediatric patients, we performed a systematic review and meta-analysis to assess the prevalence of various GI-related adverse events arising from cannabinoid usage within pediatric populations.

Methods

Searches were conducted from OVID MEDLINE, EMBASE, CINAHL, Web of Science, and The Cochrane Library for study screening. The included studies were quantitatively assessed for GI adverse events including nausea, diarrhea, increased appetite, decreased appetite, weight gain, weight loss, constipation, abdominal pain, and unspecified events. The prevalence along with their relation towards diagnosis, type of cannabinoid, dosage, duration of treatment, and study type were also assessed.

Results

Among a total of 1201 patients across 25 included studies, an overall prevalence of 33.91% GI adverse events was observed in patients. The statistical analysis of the pediatric population displayed no relation between therapeutic cannabinoid usage and GI adverse events, bearing a large heterogeneity (I² = 91%, P < 0.01). Upon analysis based on study type, a significant difference was observed between prospective and retrospective studies in categories of all GI adverse events, diarrhea, and decreased appetite, with prospective studies displaying a higher prevalence in all three categories. Nausea symptoms showed a significant negative correlation with maximum dosage of cannabinoid used. In addition, diarrhea was found to have a higher prevalence in Dravet syndrome related to an ion channel gene mutation (SCN1A) compared to other epilepsy patients.

Conclusions

While the meta-analysis did not identify any significant associations between therapeutic cannabinoid usage and GI adverse events, there remains the potential for interactions of cannabinoids on GI symptoms depending on dosage and underlying patient factors.

Funding Agencies

Farncombe Family Digestive Health Research Institute

A68 THERAPEUTIC EFFECTS OF MEDICINAL CANNABINOIDS ON THE GASTROINTESTINAL SYSTEM IN PEDIATRIC PATIENTS: A SYSTEMATIC REVIEW

Background

Changes in cannabis legalization in recent years have led to an increasing interest in medicinal cannabinoids for a variety of therapeutic uses, including those which target the gastrointestinal tract. These effects are mediated by interactions with the endocannabinoid system. As this system is present in early life, it is important to ensure pediatric representation in clinical studies regarding cannabinoid use.

Aims

We conducted a systematic review to assess the efficacy of medicinal cannabinoids in treating gastrointestinal symptoms in pediatric patients.

Methods

A literature search of Medline, Embase, CINAHL, Web of Science and the Cochrane Library was conducted from inception. Study design, patient characteristics, type, dose and duration of medicinal cannabinoid therapy, and gastrointestinal outcomes were extracted.

Results

From 7,303 records identified, five studies met all inclusion criteria. The focus of the included studies ranged from chemotherapy-induced nausea, inflammatory bowel disease and gastrointestinal symptoms associated with severe complex motor disorders. Results varied based on the symptom being treated, the type of cannabinoid, and the patient population, however, the most consistently improved symptom was chemotherapy-induced nausea.

Conclusions

Medicinal cannabinoids may have a potential role in treating specific gastrointestinal symptoms in specific patient populations. The limited number and heterogenicity of included studies highlight the requirement for future research to distinguish the effects amongst different cannabinoid types, patient populations and examine drug-interactions. In addition, the molecular interplay between disease processes, the endocannabinoid system and medicinal cannabinoids require investigation to further understand the mechanisms behind this intervention.

Funding Agencies

Natural Sciences and Engineering Research Council of Canada; Farncombe Family Digestive Health Research Institute