Rifaximin is a broad spectrum oral antibiotic with antimicrobial activity against Gram-positive and Gramnegative aerobic and anaerobic bacteria. It is poorly absorbed and thus has a highly favorable safety profile. Ri...Rifaximin is a broad spectrum oral antibiotic with antimicrobial activity against Gram-positive and Gramnegative aerobic and anaerobic bacteria. It is poorly absorbed and thus has a highly favorable safety profile. Rifaximin has been shown to be effective in the treatment of traveler's diarrhea, functional bloating and irritable bowel syndrome, small bowel bacterial overgrowth and in the prevention of recurrent overt hepatic encephalopathy. In addition, there is emerging evidence for a possible beneficial effect of rifaximin in the treatment of uncomplicated diverticular disease and in the prevention of recurrent diverticulitis. The use of rifaximin is associated with a low incidence of development, or persistence of spontaneous bacterial mutants. Moreover, the development of important drug resistance among extra-intestinal flora during rifaximin therapy is unlikely because of minimal systemic absorption and limited cross-resistance of rifaximin with other antimicrobials. This review addresses the current and emerging role of rifaximin in the treatment of gastrointestinal and liver disorders.展开更多
A tremendous amount of data from research was published over the past decades concerning the roles of different vitamins in various gastrointestinal diseases.For instance,most vitamins showed an inverse relationship w...A tremendous amount of data from research was published over the past decades concerning the roles of different vitamins in various gastrointestinal diseases.For instance,most vitamins showed an inverse relationship with the risk of colorectal carcinoma as well as other malignancies like gastric and esophageal cancer in observational trials,however interventional trials failed to prove a clear beneficial preventive role.On the other hand,more solid evidence was obtained from high quality studies for a role of certain vitamins in specific entities.Examples for this include the therapeutic role of vitamin E in patients with nonalcoholic steatohepatitis,the additive role of vitamins B12 and D to the standard therapy of chronic hepatitis C virus,the role of vitamin C in reducing the risk of gallstones,the positive outcome with vitamin B12 in patients with aphthous stomatitis,and the beneficial effect of vitamin D and B1 in patients with inflammatory bowel disease.Other potential uses are yet to be elaborated,like those on celiac disease,pancreatic cancer,pancreatitis,cholestasis and other potential fields.Data from several ongoing interventional trials are expected to add to the current knowledge over the coming few years.Given that vitamin supplementation is psychologically accepted by patients as a natural compound with relative safety and low cost,their use should be encouraged in the fields where positive data are available.展开更多
AIM: To study the efficacy of low-dose imipramine in relieving symptoms associated with the irritable bowel syndrome (IBS). METHODS: A randomized, double-blind trial of 25 mg imipramine vs matched placebo for 12 wk wa...AIM: To study the efficacy of low-dose imipramine in relieving symptoms associated with the irritable bowel syndrome (IBS). METHODS: A randomized, double-blind trial of 25 mg imipramine vs matched placebo for 12 wk was performed. Doubling the dose was allowed once at week 2 in case of an unsatisfactory early response. Primary efficacy variables were subjective global symptom relief and quality of life (QoL) using SF-36 at week 12. RESULTS: One hundred and seven patients were enrolled by advertisement or referral by general practitioners and 56 (31 imipramine: 25 placebo) completed the 16-wk study. Baseline characteristics were comparable. A high overall dropout rate was noted in the imipramine and placebo arms (47.5% vs 47.9%, P > 0.05), a mean of 25.0 and 37.4 d from enrollment, respectively (P < 0.05). At the end of 12 wk, there was a significant difference in global symptom relief with imipramine over placebo (per-protocol: 80.6% vs48.0%, P = 0.01) and a trend on intent-to-treat (ITT) analysis (42.4% vs 25.0%, P = 0.06). This improvement was evident early and persisted to week 16 (P = 0.024 and 0.053 by per-protocol and ITT analyses, respectively). Mean cumulative and componentspecific SF-36 scores improved in the imipramine group only (per-protocol, P < 0.01). Drug-related adverse events leading to patient dropout were more common in the imipramine group (25.4% vs 12.5%, P > 0.05). CONCLUSION: Imipramine may be effective in the treatment of IBS patients and is associated with improved QoL. Careful patient selection, initiation of a low dose with gradual escalation and monitoring for side effects may result in an improved therapeutic response.展开更多
Obesity is a global health epidemic with considerable economic burden.Surgical solutions have become increasingly popular following technical advances leading to sustained efficacy and reduced risk.Sleeve gastrectomy ...Obesity is a global health epidemic with considerable economic burden.Surgical solutions have become increasingly popular following technical advances leading to sustained efficacy and reduced risk.Sleeve gastrectomy accounts for almost half of all bariatric surgeries worldwide but concerns regarding its relationship with gastroesophageal reflux disease(GERD)has been a topic of debate.GERD,including erosive esophagitis,is highly prevalent in the obese population.The role of pre-operative endoscopy in bariatric surgery has been controversial.Two schools of thought exist on the matter,one that believes routine upper endoscopy before bariatric surgery is not warranted in the absence of symptoms and another that believes that symptoms are poor predictors of underlying esophageal pathology.This debate is particularly important considering the evidence for the association of laparoscopic sleeve gastrectomy(LSG)with de novo and/or worsening GERD compared to the less popular Roux-en-Y gastric bypass procedure.In this paper,we try to address 3 burning questions regarding the inter-relationship of obesity,GERD,and LSG:(1)What is the prevalence of GERD and erosive esophagitis in obese patients considered for bariatric surgery?(2)Is it necessary to perform an upper endoscopy in obese patients considered for bariatric surgery?And(3)What are the long-term effects of sleeve gastrectomy on GERD and should LSG be done in patients with pre-existing GERD?展开更多
AIM:To compare the efficacy and palatability of 4L polyethylene glycol electrolyte(PEG)plus sugar-free menthol candy(PEG+M)vs reduced-volume 2 L ascorbic acid-supplemented PEG(Asc PEG).METHODS:In a randomized controll...AIM:To compare the efficacy and palatability of 4L polyethylene glycol electrolyte(PEG)plus sugar-free menthol candy(PEG+M)vs reduced-volume 2 L ascorbic acid-supplemented PEG(Asc PEG).METHODS:In a randomized controlled trial setting,ambulatory patients scheduled for elective colonoscopy were prospectively enrolled.Patients were randomized to receive either PEG+M or Asc PEG,both splitdosed with minimal dietary restriction.Palatability was assessed on a linear scale of 1 to 5(1=disgusting;5=tasty).Quality of preparation was scored by assignment-blinded endoscopists using the modified Aronchick and Ottawa scales.The main outcomes were the palatability and efficacy of the preparation.Secondary outcomes included patient willingness to retake the same preparation again in the future and completion of the prescribed preparation.RESULTS:Overall,200 patients were enrolled(100patients per arm).PEG+M was more palatable than Asc PEG(76%vs 62%,P=0.03).Completing the preparation was not different between study groups(91%PEG+M vs 86%Asc PEG,P=0.38)but more patients were willing to retake PEG+M(54%vs 40%respectively,P=0.047).There was no significant difference between PEG+M vs Asc PEG in adequate cleansing on both the modified Aronchick(82%vs77%,P=0.31)and the Ottawa scale(85%vs 74%,P=0.054).However,PEG+M was superior in the left colon on the Ottawa subsegmental score(score0-2:94%for PEG+M vs 81%for Asc PEG,P=0.005)and received significantly more excellent ratings than Asc PEG on the modified Aronchick scale(61%vs 43%,P=0.009).Both preparations performed less well in afternoon vs morning examinations(inadequate:29%vs 15.2%,P=0.02).CONCLUSION:4 L PEG plus menthol has better palatability and acceptability than 2 L ascorbic acidPEG and is associated with a higher rate of excellentpreparations;Clinicaltrial.gov identifier:NCT01788709.展开更多
AIM: To evaluate the sensory characteristics of commercial bowel cleansing preparations.METHODS: Samples of 4 commercially available bowel cleansing preparations, namely polyethylene glycol electrolyte solution(PEG), ...AIM: To evaluate the sensory characteristics of commercial bowel cleansing preparations.METHODS: Samples of 4 commercially available bowel cleansing preparations, namely polyethylene glycol electrolyte solution(PEG), PEG + ascorbic acid(PEG-Asc), sodium picosulfate(SPS), and oral sodium sulfate(OSS) were prepared according to the manufacturer's instructions. Descriptive analysis was conducted(n = 14) using a 15-cm line scale with the Compusense at-hand? sensory evaluation software. Acceptability testing(n = 80) was conducted using the 9-point hedonic scale. In addition, a Just-About-Right(JAR) scale was included for the four basic tastes to determine their intensity compatibility with acceptability levels in the products.RESULTS: Samples were significantly different, in descriptive analysis, for all attributes(P < 0.05) except for sweetness. SPS received the highest ratings for turbidity, viscosity appearance, orange odor and orange flavor; PEG-Asc for citrus odor and citrus flavor; OSS for sweetener taste, sweet aftertaste, bitterness, astringency, mouthcoating, bitter aftertaste and throatburn, and along with PEG-Asc, the highest ratings for saltiness, sourness and adhesiveness. Acceptability results showedsignificant differences between the various samples(P < 0.05). SPS received significantly higher ratings for overall acceptability, acceptability of taste, odor and mouthfeel(P < 0.05). JAR ratings showed that PEG and PEG-Asc were perceived as slightly too salty; SPS and OSS were slightly too sweet, while SPS, PEG-Asc and OSS were slightly too sour and OSS slightly too bitter. While using small sample volumes was necessary to avoid unwanted purgative effects, acceptability ratings do not reflect the true effect of large volumes intake thus limiting the generalization of the results.CONCLUSION: Further improvements are needed to enhance the sensory profile and to optimize the acceptability for better compliance with these bowel cleansing solutions.展开更多
BACKGROUND In resource-limited countries,risk stratification can be used to optimize colorectal cancer screening.Few prospective risk prediction models exist for advanced neoplasia(AN)in true average-risk individuals....BACKGROUND In resource-limited countries,risk stratification can be used to optimize colorectal cancer screening.Few prospective risk prediction models exist for advanced neoplasia(AN)in true average-risk individuals.AIM To create and internally validate a risk prediction model for detection of AN in METHODS Prospective study of asymptomatic individuals undergoing first screening colonoscopy.Detailed characteristics including diet,exercise and medications were collected.Multivariate logistic regression was used to elucidate risk factors for AN(adenoma≥1 cm,villous histology,high-grade dysplasia or carcinoma).The model was validated through bootstrapping,and discrimination and calibration of the model were assessed.RESULTS 980 consecutive individuals(51%F;49%M)were enrolled.Adenoma and AN detection rates were 36.6%(F 29%:M 45%;P<0.001)and 5.1%(F 3.8%;M 6.5%)respectively.On multivariate analysis,predictors of AN[OR(95%CI)]were age[1.036(1.00-1.07);P=0.048],BMI[overweight 2.21(0.98-5.00);obese 3.54(1.48-8.50);P=0.018],smoking[<40 pack-years 2.01(1.01-4.01);≥40 pack-years 3.96(1.86-8.42);P=0.002],and daily red meat consumption[2.02(0.92-4.42)P=0.079].Nomograms of AN risk were developed in terms of risk factors and age separately for normal,overweight and obese individuals.The model had good discrimination and calibration.CONCLUSION The prevalence of adenoma and AN in average-risk Lebanese individuals is similar to the West.Age,smoking,and BMI are important predictors of AN,with obesity being particularly powerful.Though external validation is needed,this model provides an important platform for improved risk-stratification for screening programs in regions where universal screening is not currently employed.展开更多
文摘Rifaximin is a broad spectrum oral antibiotic with antimicrobial activity against Gram-positive and Gramnegative aerobic and anaerobic bacteria. It is poorly absorbed and thus has a highly favorable safety profile. Rifaximin has been shown to be effective in the treatment of traveler's diarrhea, functional bloating and irritable bowel syndrome, small bowel bacterial overgrowth and in the prevention of recurrent overt hepatic encephalopathy. In addition, there is emerging evidence for a possible beneficial effect of rifaximin in the treatment of uncomplicated diverticular disease and in the prevention of recurrent diverticulitis. The use of rifaximin is associated with a low incidence of development, or persistence of spontaneous bacterial mutants. Moreover, the development of important drug resistance among extra-intestinal flora during rifaximin therapy is unlikely because of minimal systemic absorption and limited cross-resistance of rifaximin with other antimicrobials. This review addresses the current and emerging role of rifaximin in the treatment of gastrointestinal and liver disorders.
文摘A tremendous amount of data from research was published over the past decades concerning the roles of different vitamins in various gastrointestinal diseases.For instance,most vitamins showed an inverse relationship with the risk of colorectal carcinoma as well as other malignancies like gastric and esophageal cancer in observational trials,however interventional trials failed to prove a clear beneficial preventive role.On the other hand,more solid evidence was obtained from high quality studies for a role of certain vitamins in specific entities.Examples for this include the therapeutic role of vitamin E in patients with nonalcoholic steatohepatitis,the additive role of vitamins B12 and D to the standard therapy of chronic hepatitis C virus,the role of vitamin C in reducing the risk of gallstones,the positive outcome with vitamin B12 in patients with aphthous stomatitis,and the beneficial effect of vitamin D and B1 in patients with inflammatory bowel disease.Other potential uses are yet to be elaborated,like those on celiac disease,pancreatic cancer,pancreatitis,cholestasis and other potential fields.Data from several ongoing interventional trials are expected to add to the current knowledge over the coming few years.Given that vitamin supplementation is psychologically accepted by patients as a natural compound with relative safety and low cost,their use should be encouraged in the fields where positive data are available.
基金Supported by A Private Research Fund From the Division of Gastroenterology at the American University of Beirut Medical Center, Beirut, Lebanon
文摘AIM: To study the efficacy of low-dose imipramine in relieving symptoms associated with the irritable bowel syndrome (IBS). METHODS: A randomized, double-blind trial of 25 mg imipramine vs matched placebo for 12 wk was performed. Doubling the dose was allowed once at week 2 in case of an unsatisfactory early response. Primary efficacy variables were subjective global symptom relief and quality of life (QoL) using SF-36 at week 12. RESULTS: One hundred and seven patients were enrolled by advertisement or referral by general practitioners and 56 (31 imipramine: 25 placebo) completed the 16-wk study. Baseline characteristics were comparable. A high overall dropout rate was noted in the imipramine and placebo arms (47.5% vs 47.9%, P > 0.05), a mean of 25.0 and 37.4 d from enrollment, respectively (P < 0.05). At the end of 12 wk, there was a significant difference in global symptom relief with imipramine over placebo (per-protocol: 80.6% vs48.0%, P = 0.01) and a trend on intent-to-treat (ITT) analysis (42.4% vs 25.0%, P = 0.06). This improvement was evident early and persisted to week 16 (P = 0.024 and 0.053 by per-protocol and ITT analyses, respectively). Mean cumulative and componentspecific SF-36 scores improved in the imipramine group only (per-protocol, P < 0.01). Drug-related adverse events leading to patient dropout were more common in the imipramine group (25.4% vs 12.5%, P > 0.05). CONCLUSION: Imipramine may be effective in the treatment of IBS patients and is associated with improved QoL. Careful patient selection, initiation of a low dose with gradual escalation and monitoring for side effects may result in an improved therapeutic response.
文摘Obesity is a global health epidemic with considerable economic burden.Surgical solutions have become increasingly popular following technical advances leading to sustained efficacy and reduced risk.Sleeve gastrectomy accounts for almost half of all bariatric surgeries worldwide but concerns regarding its relationship with gastroesophageal reflux disease(GERD)has been a topic of debate.GERD,including erosive esophagitis,is highly prevalent in the obese population.The role of pre-operative endoscopy in bariatric surgery has been controversial.Two schools of thought exist on the matter,one that believes routine upper endoscopy before bariatric surgery is not warranted in the absence of symptoms and another that believes that symptoms are poor predictors of underlying esophageal pathology.This debate is particularly important considering the evidence for the association of laparoscopic sleeve gastrectomy(LSG)with de novo and/or worsening GERD compared to the less popular Roux-en-Y gastric bypass procedure.In this paper,we try to address 3 burning questions regarding the inter-relationship of obesity,GERD,and LSG:(1)What is the prevalence of GERD and erosive esophagitis in obese patients considered for bariatric surgery?(2)Is it necessary to perform an upper endoscopy in obese patients considered for bariatric surgery?And(3)What are the long-term effects of sleeve gastrectomy on GERD and should LSG be done in patients with pre-existing GERD?
文摘AIM:To compare the efficacy and palatability of 4L polyethylene glycol electrolyte(PEG)plus sugar-free menthol candy(PEG+M)vs reduced-volume 2 L ascorbic acid-supplemented PEG(Asc PEG).METHODS:In a randomized controlled trial setting,ambulatory patients scheduled for elective colonoscopy were prospectively enrolled.Patients were randomized to receive either PEG+M or Asc PEG,both splitdosed with minimal dietary restriction.Palatability was assessed on a linear scale of 1 to 5(1=disgusting;5=tasty).Quality of preparation was scored by assignment-blinded endoscopists using the modified Aronchick and Ottawa scales.The main outcomes were the palatability and efficacy of the preparation.Secondary outcomes included patient willingness to retake the same preparation again in the future and completion of the prescribed preparation.RESULTS:Overall,200 patients were enrolled(100patients per arm).PEG+M was more palatable than Asc PEG(76%vs 62%,P=0.03).Completing the preparation was not different between study groups(91%PEG+M vs 86%Asc PEG,P=0.38)but more patients were willing to retake PEG+M(54%vs 40%respectively,P=0.047).There was no significant difference between PEG+M vs Asc PEG in adequate cleansing on both the modified Aronchick(82%vs77%,P=0.31)and the Ottawa scale(85%vs 74%,P=0.054).However,PEG+M was superior in the left colon on the Ottawa subsegmental score(score0-2:94%for PEG+M vs 81%for Asc PEG,P=0.005)and received significantly more excellent ratings than Asc PEG on the modified Aronchick scale(61%vs 43%,P=0.009).Both preparations performed less well in afternoon vs morning examinations(inadequate:29%vs 15.2%,P=0.02).CONCLUSION:4 L PEG plus menthol has better palatability and acceptability than 2 L ascorbic acidPEG and is associated with a higher rate of excellentpreparations;Clinicaltrial.gov identifier:NCT01788709.
文摘AIM: To evaluate the sensory characteristics of commercial bowel cleansing preparations.METHODS: Samples of 4 commercially available bowel cleansing preparations, namely polyethylene glycol electrolyte solution(PEG), PEG + ascorbic acid(PEG-Asc), sodium picosulfate(SPS), and oral sodium sulfate(OSS) were prepared according to the manufacturer's instructions. Descriptive analysis was conducted(n = 14) using a 15-cm line scale with the Compusense at-hand? sensory evaluation software. Acceptability testing(n = 80) was conducted using the 9-point hedonic scale. In addition, a Just-About-Right(JAR) scale was included for the four basic tastes to determine their intensity compatibility with acceptability levels in the products.RESULTS: Samples were significantly different, in descriptive analysis, for all attributes(P < 0.05) except for sweetness. SPS received the highest ratings for turbidity, viscosity appearance, orange odor and orange flavor; PEG-Asc for citrus odor and citrus flavor; OSS for sweetener taste, sweet aftertaste, bitterness, astringency, mouthcoating, bitter aftertaste and throatburn, and along with PEG-Asc, the highest ratings for saltiness, sourness and adhesiveness. Acceptability results showedsignificant differences between the various samples(P < 0.05). SPS received significantly higher ratings for overall acceptability, acceptability of taste, odor and mouthfeel(P < 0.05). JAR ratings showed that PEG and PEG-Asc were perceived as slightly too salty; SPS and OSS were slightly too sweet, while SPS, PEG-Asc and OSS were slightly too sour and OSS slightly too bitter. While using small sample volumes was necessary to avoid unwanted purgative effects, acceptability ratings do not reflect the true effect of large volumes intake thus limiting the generalization of the results.CONCLUSION: Further improvements are needed to enhance the sensory profile and to optimize the acceptability for better compliance with these bowel cleansing solutions.
文摘BACKGROUND In resource-limited countries,risk stratification can be used to optimize colorectal cancer screening.Few prospective risk prediction models exist for advanced neoplasia(AN)in true average-risk individuals.AIM To create and internally validate a risk prediction model for detection of AN in METHODS Prospective study of asymptomatic individuals undergoing first screening colonoscopy.Detailed characteristics including diet,exercise and medications were collected.Multivariate logistic regression was used to elucidate risk factors for AN(adenoma≥1 cm,villous histology,high-grade dysplasia or carcinoma).The model was validated through bootstrapping,and discrimination and calibration of the model were assessed.RESULTS 980 consecutive individuals(51%F;49%M)were enrolled.Adenoma and AN detection rates were 36.6%(F 29%:M 45%;P<0.001)and 5.1%(F 3.8%;M 6.5%)respectively.On multivariate analysis,predictors of AN[OR(95%CI)]were age[1.036(1.00-1.07);P=0.048],BMI[overweight 2.21(0.98-5.00);obese 3.54(1.48-8.50);P=0.018],smoking[<40 pack-years 2.01(1.01-4.01);≥40 pack-years 3.96(1.86-8.42);P=0.002],and daily red meat consumption[2.02(0.92-4.42)P=0.079].Nomograms of AN risk were developed in terms of risk factors and age separately for normal,overweight and obese individuals.The model had good discrimination and calibration.CONCLUSION The prevalence of adenoma and AN in average-risk Lebanese individuals is similar to the West.Age,smoking,and BMI are important predictors of AN,with obesity being particularly powerful.Though external validation is needed,this model provides an important platform for improved risk-stratification for screening programs in regions where universal screening is not currently employed.