AIM: To investigate the efficacy of lubiprostone compared to Senna on bowel symptoms and constipation in post-operative orthopedic patients treated with opioids.
AIM: To assess the additive effect of lubiprostone on the quality of colon preparation in diabetics given single-dosed polyethylene glycol electrolyte(PEG)for colonoscopy.METHODS:This was an investigator-initiated,sin...AIM: To assess the additive effect of lubiprostone on the quality of colon preparation in diabetics given single-dosed polyethylene glycol electrolyte(PEG)for colonoscopy.METHODS:This was an investigator-initiated,singlecenter,single-blinded prospective trial comparing the efficacy of L+PEG to PEG alone on colon preparation quality in diabetics undergoing screening colonoscopy.The study was approved by our institution’s IRB.The PEG was given as a single-dose to address patientcompliance concerns voiced by our IRB with splitdosing.All patients received only clear liquids the day prior to colonoscopy.Experimental group(Grp L)received PEG+1 dose L 2 h prior to and 2 h after PEG completion.Control group(Grp C)received only PEG the evening prior to the colonoscopy.Patients were randomly assigned to one of the 2 groups.The endoscopist was blinded to which colon prep was given and all colonoscopies were complete.Upon colonoscopy completion,the endoscopist rated the colon prep-quality by a validated 5-point Likert scale(1-excellent to 5-inadequate).RESULTS:Sixty patients were enrolled in the study;30 Grp L and 30 Grp C.Overall,patients were excluded due to study non-completion in 12(41%)Grp L and 5(17%) Grp C,P=0.04.Average colon preparation score Grp L =2.47 and Grp C=3.00,P=0.09.Although this was not statistically significant,there was a trend towards improved colon prep in Grp L.Statistical significance may have been achieved if completion rates had been similar between both study groups.CONCLUSION:Use of 2-L capsules with PEG resulted in a trend towards improved colon prep over PEG alone in diabetic patients when given as a single-dose regimen.展开更多
Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding.It is often multifactorial and more commonly encountered in the elderly.Several medications have been implicated in the devel...Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding.It is often multifactorial and more commonly encountered in the elderly.Several medications have been implicated in the development of colonic ischemia.We report a case of a 54-year old woman who presented with a two-hour history of nausea,vomiting,abdominal pain,and bloody stool.The patient had recently used lubiprostone with close temporal relationship between the increase in the dose and her symptoms of rectal bleeding.The radiologic,colonoscopic and histopathologic findings were all consistent with ischemic colitis.Her condition improved without any serious complications after the cessation of lubiprostone.This is the first reported case of ischemic colitis with a clear relationship with lubiprostone(Naranjo score of 10).Clinical vigilance for ischemic colitis is recommended for patients receiving lubiprostone who are presenting with abdominal pain and rectal bleeding.展开更多
In comparison to polyethylene glycol,lubiprostone offers other advantages and is increasingly being used as an adjunctive agent in diagnostic as well as management strategies not only in gastroenterology, but in other...In comparison to polyethylene glycol,lubiprostone offers other advantages and is increasingly being used as an adjunctive agent in diagnostic as well as management strategies not only in gastroenterology, but in other fields.For instance,lubiprostone exerts beneficial effects in cystic fibrosis tissues.It augmernts the chloride secretion in these cells by activating non-cystic fibrosis transmembrane regulator(CFTR) secretion of chloride by afflicted respiratory epithelia. Lubiprostone also seems to improve visualization of the gastrointestinal tract during procedures such as colonoscopy.This is especially true if the lubiprostone is administered prior to bowel cleansing with agents such as polyethylene glycol electrolyte(PEG-E). Lubiprostone also enhances and stimulates contraction in colonic as well as gastric muscles and may thus further contribute as a prokinetic agent.Besides these effects,lubiprostone also causes hyperpolarization in other tissues such as uterine muscle cells.This may prove to be of significant clinical benefit in the management of uterine pathologies in the near future.展开更多
Background: The efficacy of lubiprostone for chronic constipation has been established through phase III clinical trials. Nevertheless, the continuation of lubiprostone therapy is reportedly difficult due to the devel...Background: The efficacy of lubiprostone for chronic constipation has been established through phase III clinical trials. Nevertheless, the continuation of lubiprostone therapy is reportedly difficult due to the development of nausea. The objective of this study is to determine whether the administration of itopride hydrochloride can reduce lubiprostone-related nausea. Methods: Two hundred and thirty-five patients who were receiving lubiprostone (24 μg capsule twice daily) were enrolled. Seventy-one patients took a prophylactic dose of itopride (50 mg tablet twice daily) together with lubiprostone to prevent nausea. Thus, the patients were divided into 2 groups: lubiprostone alone (164;control group) and combination therapy with lubiprostone and itopride (71;itopride group). Efficacy measures included changes in constipation scoring system scores, the incidence of treatment-related adverse events including nausea, and the percentage of patients who discontinued treatment within two weeks after administration. Results: Of the 235 patients who were enrolled, 196 were available for analysis. Both treatment groups experienced statistically significant improvements in constipation scoring system scores. The percentage of patients who reported ≥1 adverse event was significantly higher in the control group (40.9%) than in the itopride group (21.9%). The percentage of patients experiencing nausea was statistically and significantly lower in the itopride group than in the control group (9.4% versus 22.7%). The itopride regimen was also statistically superior compared to the control regimen in terms of treatment discontinuation. Conclusion: The prophylactic administration of itopride can decrease the risk of nausea in patients receiving lubiprostone and consequently reduce the risk of treatment discontinuation.展开更多
A number of new, novel strategies for managing constipation in the elderly have emerged over the past few years. Prucalopride is one such new agent that is highly effi cacious in managing chronic constipation. In fact...A number of new, novel strategies for managing constipation in the elderly have emerged over the past few years. Prucalopride is one such new agent that is highly effi cacious in managing chronic constipation. In fact, Camilleri et al in a recent study reported that the average number of bowel movements increased by at least one in nearly 47% of the patients who were administered a dose of 4 mg. Lubiprostone is another new agent recently approved by the FDA that shows efficacy in managing the symptoms of constipation. Neostigmine has also been successfully used for the management of recalcitrant constipation. Most of these studies have used subcutaneous neostigmine. Symbiotic yogurt containig components, such as Bifidobacterium and fructoligosaccharide, have also been recently shown to be highly effective in improving symptoms of constipation. Elderly patients especially those in hospices and nursing homes are often on opiods for pain management. Constipation secondary to opioid use is extremely common in nursing homes. Subcutaneous methylnaltrexone has recently been shown to be highly effective in the management of opioid-related constipation, and was recently approved by the FDA. Sacral nerve stimulation is another emerging strategy. A recent analysis by Mowatt et al supports the eff icacy of this technique. Botulinum toxin is another agent that has already been successfully used for the management of chronic, refractory constipation in children and may be very effective for elderly constipation. Further larger studies are needed to confi rm the fi ndings noted in these studies. Constipation is clearly a major issue in the elderly and these new, emerging strategies will hopefully improve the quality of life and relieve the symptoms of constipation in this population.展开更多
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders causing patients to seek medical treatment. It is relatively resource intensive and the source of significant morbidity. Recent insig...Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders causing patients to seek medical treatment. It is relatively resource intensive and the source of significant morbidity. Recent insights into the pathophysiology and treatment of IBS has given clinicians more options than ever to contend with this disorder. The purpose of our paper is to review older, “classic” treatments for IBS as well as newer agents and “alternative” therapies. We discuss the evidence base of these drugs and provide context to help develop appropriate treatment plans for IBS patients.展开更多
AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxative...AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxatives in elderly with constipation,which were conducted between January1990 and January 2013 using the specified keywords.Controlled studies that enrolled geriatric patients with a diagnosis of constipation and addressed the efficacy and/or the safety of pharmacological treatments were included.Studies were excluded from this review if they were non-controlled trials,case series,or case reports.RESULTS:Out of twenty three studies we initially retrieved in our search,only nine studies met the eligibility criteria of being controlled trials within geriatrics.The laxatives examined in the nine studies were senna,lactulose,sorbital,polyethylene glycol(PEG),lubiprostone,linaclotide,and prucalopride.In those studies,senna combinations had a higher efficacy than sorbitol or lactulose as well as,a very good adverse effect profile.PEG was also shown to be safe and effective in geriatric population.Furthermore,it has been shown that PEG is as safe in geriatrics as in general population.New agents like lubiprostone and prucalopride show promising results but the data about these agents in geriatrics are still limited which warrant further investigation.CONCLUSION:Senna combinations and PEG appear to have a more favorable profile over the other traditionally used laxatives in elderly patients with constipation.展开更多
基金Supported by A grant from Takeda Pharmaceuticals North America,Inc
文摘AIM: To investigate the efficacy of lubiprostone compared to Senna on bowel symptoms and constipation in post-operative orthopedic patients treated with opioids.
基金Supported by Sucampo Pharmaceuticals,Inc.,Bethesda,Maryland and Takeda PharmaceuticalsAmerica,Inc.,Deerfield,Illinois
文摘AIM: To assess the additive effect of lubiprostone on the quality of colon preparation in diabetics given single-dosed polyethylene glycol electrolyte(PEG)for colonoscopy.METHODS:This was an investigator-initiated,singlecenter,single-blinded prospective trial comparing the efficacy of L+PEG to PEG alone on colon preparation quality in diabetics undergoing screening colonoscopy.The study was approved by our institution’s IRB.The PEG was given as a single-dose to address patientcompliance concerns voiced by our IRB with splitdosing.All patients received only clear liquids the day prior to colonoscopy.Experimental group(Grp L)received PEG+1 dose L 2 h prior to and 2 h after PEG completion.Control group(Grp C)received only PEG the evening prior to the colonoscopy.Patients were randomly assigned to one of the 2 groups.The endoscopist was blinded to which colon prep was given and all colonoscopies were complete.Upon colonoscopy completion,the endoscopist rated the colon prep-quality by a validated 5-point Likert scale(1-excellent to 5-inadequate).RESULTS:Sixty patients were enrolled in the study;30 Grp L and 30 Grp C.Overall,patients were excluded due to study non-completion in 12(41%)Grp L and 5(17%) Grp C,P=0.04.Average colon preparation score Grp L =2.47 and Grp C=3.00,P=0.09.Although this was not statistically significant,there was a trend towards improved colon prep in Grp L.Statistical significance may have been achieved if completion rates had been similar between both study groups.CONCLUSION:Use of 2-L capsules with PEG resulted in a trend towards improved colon prep over PEG alone in diabetic patients when given as a single-dose regimen.
文摘Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding.It is often multifactorial and more commonly encountered in the elderly.Several medications have been implicated in the development of colonic ischemia.We report a case of a 54-year old woman who presented with a two-hour history of nausea,vomiting,abdominal pain,and bloody stool.The patient had recently used lubiprostone with close temporal relationship between the increase in the dose and her symptoms of rectal bleeding.The radiologic,colonoscopic and histopathologic findings were all consistent with ischemic colitis.Her condition improved without any serious complications after the cessation of lubiprostone.This is the first reported case of ischemic colitis with a clear relationship with lubiprostone(Naranjo score of 10).Clinical vigilance for ischemic colitis is recommended for patients receiving lubiprostone who are presenting with abdominal pain and rectal bleeding.
文摘In comparison to polyethylene glycol,lubiprostone offers other advantages and is increasingly being used as an adjunctive agent in diagnostic as well as management strategies not only in gastroenterology, but in other fields.For instance,lubiprostone exerts beneficial effects in cystic fibrosis tissues.It augmernts the chloride secretion in these cells by activating non-cystic fibrosis transmembrane regulator(CFTR) secretion of chloride by afflicted respiratory epithelia. Lubiprostone also seems to improve visualization of the gastrointestinal tract during procedures such as colonoscopy.This is especially true if the lubiprostone is administered prior to bowel cleansing with agents such as polyethylene glycol electrolyte(PEG-E). Lubiprostone also enhances and stimulates contraction in colonic as well as gastric muscles and may thus further contribute as a prokinetic agent.Besides these effects,lubiprostone also causes hyperpolarization in other tissues such as uterine muscle cells.This may prove to be of significant clinical benefit in the management of uterine pathologies in the near future.
文摘Background: The efficacy of lubiprostone for chronic constipation has been established through phase III clinical trials. Nevertheless, the continuation of lubiprostone therapy is reportedly difficult due to the development of nausea. The objective of this study is to determine whether the administration of itopride hydrochloride can reduce lubiprostone-related nausea. Methods: Two hundred and thirty-five patients who were receiving lubiprostone (24 μg capsule twice daily) were enrolled. Seventy-one patients took a prophylactic dose of itopride (50 mg tablet twice daily) together with lubiprostone to prevent nausea. Thus, the patients were divided into 2 groups: lubiprostone alone (164;control group) and combination therapy with lubiprostone and itopride (71;itopride group). Efficacy measures included changes in constipation scoring system scores, the incidence of treatment-related adverse events including nausea, and the percentage of patients who discontinued treatment within two weeks after administration. Results: Of the 235 patients who were enrolled, 196 were available for analysis. Both treatment groups experienced statistically significant improvements in constipation scoring system scores. The percentage of patients who reported ≥1 adverse event was significantly higher in the control group (40.9%) than in the itopride group (21.9%). The percentage of patients experiencing nausea was statistically and significantly lower in the itopride group than in the control group (9.4% versus 22.7%). The itopride regimen was also statistically superior compared to the control regimen in terms of treatment discontinuation. Conclusion: The prophylactic administration of itopride can decrease the risk of nausea in patients receiving lubiprostone and consequently reduce the risk of treatment discontinuation.
文摘A number of new, novel strategies for managing constipation in the elderly have emerged over the past few years. Prucalopride is one such new agent that is highly effi cacious in managing chronic constipation. In fact, Camilleri et al in a recent study reported that the average number of bowel movements increased by at least one in nearly 47% of the patients who were administered a dose of 4 mg. Lubiprostone is another new agent recently approved by the FDA that shows efficacy in managing the symptoms of constipation. Neostigmine has also been successfully used for the management of recalcitrant constipation. Most of these studies have used subcutaneous neostigmine. Symbiotic yogurt containig components, such as Bifidobacterium and fructoligosaccharide, have also been recently shown to be highly effective in improving symptoms of constipation. Elderly patients especially those in hospices and nursing homes are often on opiods for pain management. Constipation secondary to opioid use is extremely common in nursing homes. Subcutaneous methylnaltrexone has recently been shown to be highly effective in the management of opioid-related constipation, and was recently approved by the FDA. Sacral nerve stimulation is another emerging strategy. A recent analysis by Mowatt et al supports the eff icacy of this technique. Botulinum toxin is another agent that has already been successfully used for the management of chronic, refractory constipation in children and may be very effective for elderly constipation. Further larger studies are needed to confi rm the fi ndings noted in these studies. Constipation is clearly a major issue in the elderly and these new, emerging strategies will hopefully improve the quality of life and relieve the symptoms of constipation in this population.
文摘Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders causing patients to seek medical treatment. It is relatively resource intensive and the source of significant morbidity. Recent insights into the pathophysiology and treatment of IBS has given clinicians more options than ever to contend with this disorder. The purpose of our paper is to review older, “classic” treatments for IBS as well as newer agents and “alternative” therapies. We discuss the evidence base of these drugs and provide context to help develop appropriate treatment plans for IBS patients.
文摘AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxatives in elderly with constipation,which were conducted between January1990 and January 2013 using the specified keywords.Controlled studies that enrolled geriatric patients with a diagnosis of constipation and addressed the efficacy and/or the safety of pharmacological treatments were included.Studies were excluded from this review if they were non-controlled trials,case series,or case reports.RESULTS:Out of twenty three studies we initially retrieved in our search,only nine studies met the eligibility criteria of being controlled trials within geriatrics.The laxatives examined in the nine studies were senna,lactulose,sorbital,polyethylene glycol(PEG),lubiprostone,linaclotide,and prucalopride.In those studies,senna combinations had a higher efficacy than sorbitol or lactulose as well as,a very good adverse effect profile.PEG was also shown to be safe and effective in geriatric population.Furthermore,it has been shown that PEG is as safe in geriatrics as in general population.New agents like lubiprostone and prucalopride show promising results but the data about these agents in geriatrics are still limited which warrant further investigation.CONCLUSION:Senna combinations and PEG appear to have a more favorable profile over the other traditionally used laxatives in elderly patients with constipation.
