What is the best strategy for successful bowel preparation under special conditions?

Adequate bowel preparation is important for successful colonoscopic examination.Several effective colonic cleansing agents are available and routinely prescribed,but each carries its own limitations and benefits from particular dosing regimens.The most frequently prescribed colonic cleansing agent,the polyethylene glycol(PEG)cathartic solution,suffers from low patient compliance in general,due to its unpalatable taste and smell coupled with the large ingested volumes required.However,PEG is preferred over other cathartics for use in individuals of advanced age,sufferers of chronic kidney disease,heart failure and inflammatory bowel disease,and women who are pregnant or lactating.The laxative agents sodium phosphate(NaP)and sodium picosulfate plus magnesium citrate have been applied and have improved patient compliance and tolerance.NaP,however,should be avoided in individuals with impaired renal function or plasma clearance,such as those with chronic kidney disease,who are taking drugs that affect renal function,or who suffer from heart failure.Other special conditions that may affect an individual’s tolerance of the cathartic agent or ability to complete the administration routine include stroke,severe constipation,hematochezia,suspicious lower gastrointestinal bleeding,and mental disorders such as dementia.All ingestible bowel preparation solutions can be instilled into the stomach and duodenum through nasogastric tube or esophagogastroduodenoscope with the aid of a water irrigation pump for patients with difficulties swallowing or ingesting the large volumes of fluid required.In addition,dietary regimens based on clear liquids and low-residue foods for 1-4 d prior to the colonoscopy may be supplemental bowel preparation strategies.Achieving an effective and safe cleansing of the bowel is important for successful colonoscopy in all patients,so full knowledge of the individual’s condition and capabilities is necessary to select the most appropriate colonic cleansing agent and delivery regimen.

Adjuncts to colonic cleansing before colonoscopy

Pre-procedural cleansing of the bowel can maximize the effectiveness and efficiency of colonoscopy.Yet,efficacy of the current gold standard colonic preparation method-high-volume oral administration of purgative agents 12-24 h prior to the procedure-is limited by several factors,such as patient compliance(due to poor palatability and inconvenience of the dosing regimen)and risks of complications(due to drug interactions or intolerance).Attempts to resolve these limitations have included providing adjunctive agents and methods to promote the colonic cleansing ability of the principal purgative agent,with the aim of lessening unpleasant side effects(such as bloating)and reducing the large ingested volume requirement.Several promising adjunctive agents are bisacodyl,magnesium citrate,senna,simethicone,metoclopramide,and prokinetics,and each are being investigated for their potential.This review provides an up to date summary of the reported investigations into the potencies and weaknesses of the key adjuncts currently being applied in clinic as supplements to the traditional bowel preparation agents.While the comparative analysis ofthese adjuncts showed that no single agent or method has yet achieved the goal of completely overcoming the limitations of the current gold standard preparation method,they at least provide endoscopists with an array of alternatives to help improve the suboptimal efficacy of the main cleansing solutions when used alone.To aid in this clinical endeavor,a subjective grade was assigned to each adjunct to indicate its practical value.In addition,the systematic review of the currently available agents and methods provides insight into the features of each that may be overcome or exploited to create novel drugs and strategies that may become adopted as effective bowel cleansing adjuncts or alternatives.

Filiform polyposis in the sigmoid colon: A case series

Filiform polyposis is a rare condition of uncertain patho-genesis that is usually found in association with Crohn’s disease, ulcerative colitis, intestinal tuberculosis or histiocytosis X. We report seven interesting cases of polyposis with various pathologic components, mainly located in the left side of the colon with no associated inflammatory bowel disease, intestinal tuberculosis or histiocytosis X. Multiple finger-like polypoid lesions with the appearance of stalactites were noted on the left side of the colon, especially in the sigmoid area, at the time of colonoscopy. The polyps had a variety of sizes and shapes and were shown to have various histopathologic components among the different patients. Although filiform polyposis localized in the sigmoid colon appears not to have high oncogenic potential, periodic follow-up seems to be needed.

Risk factor analysis for meta plastic gastritis in Koreans

瞄准：进行回顾的研究在朝鲜人口为遇见的无形的胃炎的开发决定风险因素。方法：为常规检查的目的经历了一个 gastros 拷贝在的 113449 个题目的数据库为健康集中提升，三星医学中心在 5 年期间镇定、回顾地分析。在他们之中，有内视镜的联盟者的 5847 个题目作为遇见的无形的胃炎或 10076 正常诊断了以及回答了到问询表为现在的学习被包括。这些题目被划分成 2 个组；组我，正常和组 II，遇见的无形的胃炎。年龄，性， Helicobacter pylori ( H pylori ) seropositivity ，身体团索引( BMI )，癌症的家庭历史，吸烟，白酒消费，全部的每日的卡，folate 和盐吸入和饮食的习惯(多，吃得过多，不规则的吃)从问询表或电子医药记录被检索并且在组之间比较了我和组 II 。结果：组 II 的流行是 11%(13578/113449 ) 与年龄增加它的流行(P = 0.000 ) 。但是，在在 BMI，癌症的家庭历史，白酒消费，全部的每日的卡， folate 和盐吸入和饮食的习惯的 2 个组之间没有重要协会(多，吃得过多，不规则的吃) 。老年(P=0.000 ) ，男性(P = 0.000 ) ， H pylori seropositivity (P = 0.010 ) 并且当前的吸烟者(P = 0.000 ) 显著地，在在多重逻辑回归的组 II 普通的更多当模特儿。结论：我们的数据建议了那老年，男性， H pylori seropositivity 并且吸烟是为遇见的无形的胃炎的风险因素，胃的癌症的癌前期损害。

Celecoxib attenuates 5-fluorouracil-induced apoptosis in HCT-15 and HT-29 human colon cancer cells

AIM: To investigate the combined chemotherapeutic effects of celecoxib when used with 5-FU in vitro. METHODS: Two human colon cancer cell lines (HCT-15 and HT-29) were treated with 5-FU and celecoxib, alone and in combination. The effects of each drug were evaluated using the MTT [3- (4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide] assay, flow cytometry, and western blotting. RESULTS: 5-FU and celecoxib showed a dose- dependent cytotoxic effect. When treated with 10-3 mol/L 5-FU (IC50) and celecoxib with its concentration ranging from 10-8 mol/L to 10-4 mol/L of celecoxib, cells showed reduced cytotoxic effect than 5-FU (10-3 mol/L) alone. Flow cytometry showed that celecoxib attenuated 5-FU induced accumulation of cells at subG1 phase. Western blot analyses for caspase-3 and poly (ADP-ribose) polymerase (PARP) cleavage showed that celecoxib attenuated 5-FU induced apoptosis. Western blot analyses for cell cycle molecules showed that G2/M arrest might be possible cause of 5-FU induced apoptosis and celecoxib attenuated 5-FU induced apoptosis via blocking of cell cycle progression to the G2/M phase, causing an accumulation of cells at the G1/S phase. CONCLUSION: We found that celecoxib attenuated cytotoxic effect of 5-FU. Celecoxib might act via inhibition of cell cycle progression, thus preventing apoptosis induced by 5-FU.