2023年9月21日,上海交通大学医学院附属第九人民医院介入团队杨西涛医师在《英国医学杂志》(The British Medical Journal)发表题目为An unusual abdominal distension的临床病例报道。该文章介绍了1例常染色体显性多囊肾病(autosomal d...2023年9月21日,上海交通大学医学院附属第九人民医院介入团队杨西涛医师在《英国医学杂志》(The British Medical Journal)发表题目为An unusual abdominal distension的临床病例报道。该文章介绍了1例常染色体显性多囊肾病(autosomal dominant polycystic kidney disease,ADPKD)女性病例。该患者因严重腹胀,活动后即胸闷气促,严重影响日常生活,多处就医均未获得可行的药物治疗或外科手术方案。针对该疑难病例,上海交通大学医学院附属第九人民医院介入团队定制个性化方案,最终确认采用靶向动脉栓塞联合局部抽吸无水乙醇硬化双途径治疗,以达到快速去血管化、缩小囊性病灶的治疗效果。该方法具有创伤小、无瘢痕、恢复快等优点。术后即刻患者腹胀症状显著改善,日常生活逐渐恢复到正常,重返工作岗位。展开更多
Introduction:Selective serotonin reuptake inhibitors(SSRIs) are frequently used in the treatment of irritable bowel syndrome(IBS) although evidence of their efficacy is scarce.Aim:Twenty three non-depressed IBS patien...Introduction:Selective serotonin reuptake inhibitors(SSRIs) are frequently used in the treatment of irritable bowel syndrome(IBS) although evidence of their efficacy is scarce.Aim:Twenty three non-depressed IBS patients were recruited from a tertiary care centre and included in a crossover trial comparing six weeks of treatment with the SSRI citalopram(20 mg for three weeks,40 mg for three weeks) with placebo.IBS symptom severity was the primary outcome measure,and depression and anxiety scores were also measured.The effect of acute administration of citalopram on colonic sensitivity and on colonic response to feeding was investigated as a putative predictor of symptomatic response to the drug.Results:After three and six weeks of treatment,citalopram significantly improved abdominal pain,bloating,impact of symptoms on daily life,and overall well being compared with placebo.There was only a modest effect on stool pattern.Changes in depression or anxiety scores were not related to symptom improvement.The effect of acute administration of citalopram during a colonic barostat study did not predict clinical outcome.Analysis of the first treatment period as a double blind parallel arm study confirmed the benefit of citalopram over placebo.Conclusions:The SSRI citalopram significantly improves IBS symptoms,including abdominal pain,compared with placebo.The therapeutic effect is independent of effects on anxiety,depression,and colonic sensorimotor function.展开更多
Background: Tegaserod, a prokinetic 5-HT4 receptor agonist, has demonstrated efficacy and tolerability in irritable bowel syndrome (IBS) patients with constipation (IBS- C) in controlled clinical trials. Its use in pr...Background: Tegaserod, a prokinetic 5-HT4 receptor agonist, has demonstrated efficacy and tolerability in irritable bowel syndrome (IBS) patients with constipation (IBS- C) in controlled clinical trials. Its use in primary care has not been investigated. Aim: To determine whether tegaserod is effective and well tolerated by primary care IBS- C patients. Methods: Patients received tegaserod 6 mg b.i.d. for 12 weeks and were assessed for response, abdominal pain/discomfort, bloating, stool consistency/frequency and straining at weeks 4 and 12. Previous successful treatment with the withdrawn drug, cisapride, was noted. A 9- month study extension was offered to patients completing 12 weeks of tegaserod treatment. Results: 212 patients entered the 12- week treatment period; 166 completed as planned. Response rates were 64.2% at week 4 and 70.3% at week 12. After 12weeks, abdominal pain/discomfort and bloating were reduced from baseline (p< 0.0001; mean change - 1.02 and - 0.91 points, respectively), stool frequency increased (0.78- 0.97 stools/day) and stool consistency improved (2.45- 3.42; lumpy stools became softer). Tegaserod was well tolerated; the most common adverse events were headache (13.2% ) and diarrhea (9.4% ). One hundred and twenty patients entered the 9- month extension study, 85 completed and tegaserod continued to be well tolerated. Conclusions: In ambulatory primary care IBS- C patients, tegaserod is an effective and well- tolerated long- term treatment.展开更多
BACKGROUND: We hypothesized that functional anal incontinence with no structur al explanation comprises distinct pathophysiologic subgroups that could be ident ified on the basis of the predominant presenting bowel pa...BACKGROUND: We hypothesized that functional anal incontinence with no structur al explanation comprises distinct pathophysiologic subgroups that could be ident ified on the basis of the predominant presenting bowel pattern. METHODS: Consecu tive patients (n = 80) were prospectively grouped by bowel symptoms as 1) incont inence only, 2) incontinence +constipation, 3) incontinence +diarrhea, and 4) incontinence +alternating bowel symptoms. The Hopkins Bowel Symptom Questionnai re, the Symptom Checklist 90-R, and anorectal manometry were completed. RESULTS : Significant group differences were found between subcategories of incontinent patients on the basis of symptoms. Abdominal pain was more frequent in patients with altered bowel patterns. Patients with alternating symptoms reported the hig hest prevalence of abdominal pain, rectal pain, and bloating. Basal anal pressur es were significantly higher in alternating patients (P = 0.03). Contractile pre ssures in the distal anal canal were diminished in the incontinent only and dia rrhea groups (P = 0.004). Constipated patients with incontinence exhibited eleva ted thresholds for the urge to defecate (P = 0.027). Dyssynergia was significant ly more frequent in patients with incontinence and constipation or alternating b owel patterns. CONCLUSIONS: Distinct patterns of pelvic floor dysfunction were i dentified in patient subgroups with anal incontinence, based on the presence or absence of altered bowel patterns. Physiologic assessments suggested different p athophysiologic mechanisms among the subgroups. The evaluation of patients with fecal incontinence should consider altered bowel function.展开更多
文摘Introduction:Selective serotonin reuptake inhibitors(SSRIs) are frequently used in the treatment of irritable bowel syndrome(IBS) although evidence of their efficacy is scarce.Aim:Twenty three non-depressed IBS patients were recruited from a tertiary care centre and included in a crossover trial comparing six weeks of treatment with the SSRI citalopram(20 mg for three weeks,40 mg for three weeks) with placebo.IBS symptom severity was the primary outcome measure,and depression and anxiety scores were also measured.The effect of acute administration of citalopram on colonic sensitivity and on colonic response to feeding was investigated as a putative predictor of symptomatic response to the drug.Results:After three and six weeks of treatment,citalopram significantly improved abdominal pain,bloating,impact of symptoms on daily life,and overall well being compared with placebo.There was only a modest effect on stool pattern.Changes in depression or anxiety scores were not related to symptom improvement.The effect of acute administration of citalopram during a colonic barostat study did not predict clinical outcome.Analysis of the first treatment period as a double blind parallel arm study confirmed the benefit of citalopram over placebo.Conclusions:The SSRI citalopram significantly improves IBS symptoms,including abdominal pain,compared with placebo.The therapeutic effect is independent of effects on anxiety,depression,and colonic sensorimotor function.
文摘Background: Tegaserod, a prokinetic 5-HT4 receptor agonist, has demonstrated efficacy and tolerability in irritable bowel syndrome (IBS) patients with constipation (IBS- C) in controlled clinical trials. Its use in primary care has not been investigated. Aim: To determine whether tegaserod is effective and well tolerated by primary care IBS- C patients. Methods: Patients received tegaserod 6 mg b.i.d. for 12 weeks and were assessed for response, abdominal pain/discomfort, bloating, stool consistency/frequency and straining at weeks 4 and 12. Previous successful treatment with the withdrawn drug, cisapride, was noted. A 9- month study extension was offered to patients completing 12 weeks of tegaserod treatment. Results: 212 patients entered the 12- week treatment period; 166 completed as planned. Response rates were 64.2% at week 4 and 70.3% at week 12. After 12weeks, abdominal pain/discomfort and bloating were reduced from baseline (p< 0.0001; mean change - 1.02 and - 0.91 points, respectively), stool frequency increased (0.78- 0.97 stools/day) and stool consistency improved (2.45- 3.42; lumpy stools became softer). Tegaserod was well tolerated; the most common adverse events were headache (13.2% ) and diarrhea (9.4% ). One hundred and twenty patients entered the 9- month extension study, 85 completed and tegaserod continued to be well tolerated. Conclusions: In ambulatory primary care IBS- C patients, tegaserod is an effective and well- tolerated long- term treatment.
文摘BACKGROUND: We hypothesized that functional anal incontinence with no structur al explanation comprises distinct pathophysiologic subgroups that could be ident ified on the basis of the predominant presenting bowel pattern. METHODS: Consecu tive patients (n = 80) were prospectively grouped by bowel symptoms as 1) incont inence only, 2) incontinence +constipation, 3) incontinence +diarrhea, and 4) incontinence +alternating bowel symptoms. The Hopkins Bowel Symptom Questionnai re, the Symptom Checklist 90-R, and anorectal manometry were completed. RESULTS : Significant group differences were found between subcategories of incontinent patients on the basis of symptoms. Abdominal pain was more frequent in patients with altered bowel patterns. Patients with alternating symptoms reported the hig hest prevalence of abdominal pain, rectal pain, and bloating. Basal anal pressur es were significantly higher in alternating patients (P = 0.03). Contractile pre ssures in the distal anal canal were diminished in the incontinent only and dia rrhea groups (P = 0.004). Constipated patients with incontinence exhibited eleva ted thresholds for the urge to defecate (P = 0.027). Dyssynergia was significant ly more frequent in patients with incontinence and constipation or alternating b owel patterns. CONCLUSIONS: Distinct patterns of pelvic floor dysfunction were i dentified in patient subgroups with anal incontinence, based on the presence or absence of altered bowel patterns. Physiologic assessments suggested different p athophysiologic mechanisms among the subgroups. The evaluation of patients with fecal incontinence should consider altered bowel function.
