Role of vitamins in gastrointestinal diseases

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.

Split-dose menthol-enhanced PEG vs PEG-ascorbic acid for colonoscopy preparation

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.