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PubMed2000

Restorative proctocolectomy: operative safety and functional outcomes.

Restorative proctocolectomy (total proctocolectomy and ileal J pouch anal anastomosis) has been accepted as the operation of choice in the setting of chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess operative safety and functional outcome after restorative proctocolectomy. A total of sixteen patients underwent surgery between January 1996 and December 1999. Hand sewn anastomosis with diverting ileostomy was performed in 9 patients and double stapled anastomosis in 7 patients. The underlying disease was ulcerative colitis in 9 cases and familial adenomatous polyposis in 7. Postoperative complications developed in 8 cases (50%), and intestinal obstruction was found in 4 cases (2 cases were operated upon). Anastomosis related complications were stenosis (n=2), leak (n=1) and perianal abscess (n=1). All patients were followed up at the outpatient clinic using questionnaires, with a mean follow up period of 19.9 months. The frequency of bowel movement was 8.2 per day in hand sewn anastomosis (HS), and 12 per day in double stapled anastomosis (DS) 3 months after surgery (period 1). This frequency decreased to 5.5 per day in HS, and 4.6 per day in DS after one year (period 2). Day and night continence was shown in 12/15, and 5/15, respectively in period 1, but improved to 10/11, and 10/11, respectively in period 2. Night time incontinence was noted in 10 of 15 patients in period 1 (seepage 3/15, soiling 7/15). The need to take anti-diarrheal medication, and to use a pad was noted in 2/15, and 10/15, respectively in period 1, but no patient took antidiarrheal medication or wore a protective pad in period 2. Postoperative urinary function was satisfactory in 13/14 patients. Postoperative sexual function was analyzed in a total of 8 patients, who showed good erection (5/5), ejaculation (5/5) and satisfactory sexual life (5/5). In females, 3 patients showed a satisfactory sexual life. In conclusion, restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis can be performed safely with excellent functional outcomes, including bowel movement, urinary and sexual functions one year after surgery.

Adenomatous Polyposis Coli↗
PubMed1978

Further experience with mebendazole in the treatment of symptomatic trichuriasis in children.

Mebendazole (methyl-5-benzoylbenzimidazole-2-carbamate: Vermox), a broad spectrum anthelmintic, cured 22 (88%) children with symptomatic trichuriasis when given as a single 6-day course in a dosage of 100 mg twice daily. A further 3 (12%) were cured after a repeat 6-day course of therapy. Thus complete parasite eradication was achieved in all. The administration of an antidiarrheal agent, loperamide hydrochloride (Imodium), appeared to enhance the efficacy of mebendazole. Both drugs were well tolerated and completely free of any toxic effects.

Ascariasis↗
PubMed2004

Postoperative radiotherapy-induced morbidity in rectal cancer.

OBJECTIVES: We analyzed long-term morbidity and bowel function alteration after postoperative radiotherapy for rectal cancer following resection with anastomosis. PATIENTS AND METHODS: Thirty-seven patients who underwent surgery with intention to cure and a minimal follow-up period of 3 years were included. These patients were divided into two groups: in the first group, 14 patients received postoperative chemo-radiotherapy, 5-fluorouracil plus folinic acid, and 45 Gy plus 5 Gy boost. In the second group, there were 23 patients regarded as controls. We designed a questionnaire about their bowel function and analyzed the morbidity detected in their follow-up. RESULTS: The group that was treated with postoperative chemo-radiotherapy had more daily bowel movements (p = 0.03) and night-time movements (p = 0.04); incontinence (69.2 vs. 17.4% in the control group; p = 0.002), and perianal skin irritation (p = 0.04) versus the control group. Although without meaningful differences, the group under treatment wore a pad more often, had more defecatory urgency, could distinguish worse gas from stool, and needed more frequently antidiarrheal measures. Major complications were present in 28.6% of the under-treatment group: three intestinal resections were performed due to actinic stenosis; one patient had a residual stercoral fistula; another had several occlusive crises solved with medical treatment. CONCLUSIONS: Postoperative chemo-radiotherapy had a high morbidity rate, which determined a significant alteration in quality of life. Accuracy in indication is therefore necessary, as well as a consideration of other alternatives for treatment, such as preoperative chemo-radiotherapy and total mesorectal excision.

Aged↗
PubMed1991

Treatment of travelers' diarrhea: ciprofloxacin plus loperamide compared with ciprofloxacin alone. A placebo-controlled, randomized trial.

OBJECTIVE: To compare the safety and efficacy of loperamide used in combination with ciprofloxacin or ciprofloxacin alone for the treatment of travelers' diarrhea. DESIGN: Double-blind, placebo-controlled, randomized clinical trial. SETTING: United States Army hospital in Egypt. PARTICIPANTS: United States military personnel with travelers' diarrhea (n = 104) during a military exercise in November 1989. Persons who were noncompliant, had bloody diarrhea, or had received antidiarrheal medications before entry into the study were excluded. INTERVENTIONS: All participants with travelers' diarrhea were treated with ciprofloxacin, 500 mg twice daily for 3 days. Fifty of these patients were randomly assigned to receive loperamide, a 4-mg first dose and 2 mg for every loose stool (as much as 16 mg/d), and 54 were randomly assigned to receive placebo. MEASUREMENTS: Enterotoxigenic Escherichia coli was isolated from 57% of patients; Shigella and Salmonella, seen in 4% and 2% of patients, respectively, were not common. MAIN RESULTS: After 24 hours, the symptoms of 82% of patients in the ciprofloxacin and loperamide group compared with 67% in the ciprofloxacin and placebo group had improved or fully recovered (odds ratio, 2.3; 95% CI, 0.8 to 6.3; P = 0.08). After 48 hours, the symptoms of 90% of both groups had improved or fully recovered. The mean number of stools for those receiving loperamide was not much lower than those who did not receive loperamide after 24 hours (1.9 +/- 0.2 [SE] compared with 2.6 +/- 0.2) or 48 hours (3.1 +/- 0.3 compared with 4.0 +/- 0.3) of treatment (P = 0.19). CONCLUSIONS: In a region where enterotoxigenic E. coli was the predominant cause of travelers' diarrhea, loperamide combined with ciprofloxacin was not better than treatment with ciprofloxacin alone. Loperamide appeared to have some benefit in the first 24 hours of treatment in patients infected with enterotoxigenic E. coli. Both regimens were safe.

Ciprofloxacin↗
PubMed1991

Effect of octreotide on refractory AIDS-associated diarrhea. A prospective, multicenter clinical trial.

OBJECTIVE: To determine the efficacy and safety of octreotide for treatment of refractory, profuse diarrhea in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: A prospective, open-label study. SETTING: Inpatient metabolic units of four university medical centers. PATIENTS: Fifty-one patients infected with human immunodeficiency virus (HIV) who had uncontrolled diarrhea (greater than or equal to 500-mL liquid stool per day) despite treatment with maximally tolerable doses of antidiarrheal medications. INTERVENTION: After initial baseline studies, patients received octreotide, 50 micrograms every 8 hours for 48 hours. If stool volume was not reduced to less than 250 mL/d, the dose of octreotide was increased stepwise to 100, 250, and 500 micrograms. MAIN RESULTS: Fifty men and one woman (mean age, 36.3 +/- 1.1 years) entered and completed the 28-day protocol (14 days of inpatient therapy and 14 days of outpatient therapy). Stool frequency and volume decreased significantly (6.5 +/- 0.5 stools per day on day 0 compared with 3.8 +/- 0.3 stools per day on day 21 [P less than 0.001] and 1604 +/- 180 mL/d on day 0 compared with 1084 +/- 162 mL/d on day 14 [P less than 0.001], respectively). Twenty-one patients (41.2%) were considered to be partial or complete responders (reduction in daily stool volume by greater than or equal to 50% of initial collections or reduction to less than or equal to 250 mL/d). Of the 21 responders, 14 (67%) had no identifiable pathogens at initial screening compared with 9 of 30 (30%) nonresponders (P less than 0.01). CONCLUSION: Patients with AIDS-associated refractory watery diarrhea, especially those without identifiable pathogens, may respond favorably to subcutaneously administered octreotide. This drug deserves further study in a randomized, placebo-controlled trial.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Gastrointestinal pharmacology.

Treatment of diseases affecting the gastrointestinal tract often focuses on resolution of clinical pharmacology of drugs used to treat the gastrointestinal tract, starting with appetite stimulants, followed by emetics and antiemetics, and antidiarrheals. Prokinetic agents and drugs used for the treatment of gastroduodenal ulceration are also discussed. Discussions include mechanisms of drug action, disposition of drugs as it relates to therapeutic use, drug interactions, adverse drug reactions, and clinical indications.

Animals↗
PubMed1999

Successful salvage treatment with irinotecan (CPT-11) of recurrent malignant lymphoma in an aged patient; and CPT-11 pharmacokinetics.

A 72-year-old patient with relapsed non-Hodgkin's lymphoma (diffuse large B-cell type) in the tongue was treated with irinotecan (CPT-11) as the 4th salvage therapy. A two-thirds reduced dose of 40 mg/m2 of CPT-11 was administered, as were granulocyte-colony stimulating factor and antidiarrheal agents. Complete remission was achieved. Although grade 3 leukopenia and grade 1 diarrhea were observed, these adverse reactions did not interrupt the treatment schedule and CPT-11 was administered without interruption for a total of 12 weeks. Despite the dose reduction, the area under the concentration-time curve of SN-38, the active metabolite of CPT-11, was nearly equal to the values reported in phase I and II studies of CPT-11. The patient's ratio of SN-38 to the SN-38 glucuronide (SN-38G) was low, suggesting a low risk of diarrhea. The optimal dose modification provided a sufficient amount of the active metabolite. Supportive therapy managed therapy-related toxicities and resulted in a stable treatment schedule. This is a rare case of a patient successfully treated with CPT-11 after a 4th relapse, in which the agent was administered at the total dose of 960 mg/m2, despite the patient's advanced age.

Aged↗
PubMed1999

Collagenous colitis in Spain: a report of nine new cases.

BACKGROUND: collagenous colitis is a clinicopathological entity that causes chronic watery diarrhea. The patients are predominantly women in the sixth or seventh decade of life. Radiological and endoscopic studies are usually normal or nonspecific. It is diagnosed by the presence in colonic biopsies of a thickened subepithelial band of collagen and an inflammatory infiltrate in the mucosa. METHODS: 9 cases diagnosed in our hospital and 18 previously described in Spain have been reviewed. RESULTS: all the cases showed chronic watery diarrhea. In 17 patients symptoms were present since at least one year before diagnosis. Five of the 27 patients had been taking nonsteroidal antiinflammatory drugs. Rheumatological and autoimmune diseases were found in 6 patients. Colonoscopy was normal or showed nonspecific findings except in one of our patients, in which aphthous ulcers and pseudomembranes were found. Different treatments had been employed, including antidiarrheal agents, sulfasalazine, 5-ASA and omeprazole. CONCLUSIONS: collagenous colitis is uncommon but should be considered in patients with long-standing chronic watery, nonbloody diarrhea. Collagenous colitis is probably more common than we think, as biopsies are not usually taken in cases of chronic diarrhea with normal endoscopic findings.

Adult↗
PubMedDate not supplied

Reduction of irrational drug duplication in geriatric nursing homes.

The reduction of irrational drug duplication by rigorous drug regimen review, in-service education, and physician acceptance of consultant pharmacist recommendations in a 72-bed geriatric long-term-care facility is described. In decreasing order of frequency of duplication, laxatives, analgesics, NSAIDs, diuretics, hypnotics, antipsychotics, KC1 supplements, hematinics/vitamins, antacids, and antinauseants and antidiarrheals were the drug classes most often duplicated. Apparent reasons for the duplications were confusion over the term "of choice," physician convenience, failure to review medication orders actively, and individual nurse preferences for different agents in each duplicated drug class.

Aged↗
PubMed1976

Loperamide binding to opiate receptor sites of brain and myenteric plexus.

Loperamide, a new antidiarrheal agent, was tested to determine whether its biological activity involves binding to opiate receptor sites. Loperamide and morphine competitively inhibited 3H-naloxone binding to homogenates a guinea-pig brain and myenteric plexus. The Kp values obtain in the presence of Na+ were: morphine, 9.60-10(-9) M (brain), 1.66-10(-7) M (myenteric plexus); loperamide, 7.20-10(-9) M (brain), 1.33-10(-7) M (myenteric plexus); naloxone, 4.78-10(-10) M (brain), 1.27-10(-9) M (myenteric plexus. In the absence of Na+, binding a loperamide and morphine to brain homogenate was enhanced while the binding of naloxone was reduced. Morphine (IC50 = 7.5-10(-8) M) and loperamide (IC50 = 6.9-10(-9) M) inhibited the electrically induced contractions of longitudinal muscle from guinea-pig ileum, and naloxone competitively antagonized these effects. The Kd value calculated for the interaction of naloxone with binding sites associated with the contracting muscle was between 0.98-10(-9) M and 1.85-10(-9) M. In the mouse hot plate test, subcutaneous administration of morphine (minimal effective dose = 6.6 mugmol/kg) and loperamide (minimal effective dose = 78 mugmol/kg) delayed the response to heat stimuli and this effect was completely blocked by prior administration of naloxone. In the anesthetixed dog, intravenous administration of morphine (100 mug/kg) and loperamide (100 mug/kg) enhanced the contractile activity of circular muscle in proximal and distal duodenum, distal ileum and proximal colon but duodenal longitudinal muscle was relaxed; these effects were completely reversed by subsequent administration of naloxone. It is concluded that loperamide binds to opiate receptor sites and possesses opiate agonist activity both in vivo and in vitro.

Analgesics, Opioid↗
PubMed1999

Management of acute gastroenteritis in children.

Acute gastroenteritis is a common and costly clinical problem in children. It is a largely self-limited disease with many etiologies. The evaluation of the child with acute gastroenteritis requires a careful history and a complete physical examination to uncover other illnesses with similar presentations. Minimal laboratory testing is generally required. Treatment is primarily supportive and is directed at preventing or treating dehydration. When possible, an age-appropriate diet and fluids should be continued. Oral rehydration therapy using a commercial pediatric oral rehydration solution is the preferred approach to mild or moderate dehydration. The traditional approach using "clear liquids" is inadequate. Severe dehydration requires the prompt restoration of intravascular volume through the intravenous administration of fluids followed by oral rehydration therapy. When rehydration is achieved, an age-appropriate diet should be promptly resumed. Antiemetic and antidiarrheal medications are generally not indicated and may contribute to complications. The use of antibiotics remains controversial.

Acute Disease↗
PubMed1999

[Toxic megacolon presenting as Crohn's disease].

We introduce a young patient, without history of inflammatory bowel disease (I.B.D.) who started with an acute gastroenteritis, which in the following days progressed to a toxic megacolon. The patient had come to hospital with nausea, vomiting, fever and liquid, explosive diarrhoea without pathologic products. There was no clinical remission with astringent diet, hydroelectrolitic reposition and antidiarrheic opiates. The patient was admitted in hospital when he had blood in the diarrhoea. This progressed to a toxic megacolon in three days and the patient had to be operated on urgently. The surgeons found perforations in the colon and the pathologists diagnosed Crohn disease. Even without previous E.B.D. history we reached the diagnosis from the clinical and analytical data and the plain abdominal radiology. It was impossible to confirm the diagnosis with a colonoscopy because of the high risk of perforation. In cases like this, early surgery may save the life of the patient.

Adult↗
PubMed2000

[Pharmacotherapy of inflammatory bowel disease].

Inflammatory bowel disease (IBD) encompasses ulcerative colitis and Crohn's disease. Since the etiology of both diseases, is undetermined the causal therapy do not exist. Medical treatment has focused on nonspecific suppressions of the inflammatory process. There are four groups of IBD drugs: anti-inflammatory medicaments, immunomodulators, antidiarrheal agents, and biologic therapy. In a last year immunosuppressives become the very essential IBD drugs. Azathioprine is drug of choice for chronically active Crohn's disease; methotrexate become the second line immunosuppressive drug. It appears that anti-TNG monoclonal antibodies, cA2 (infliximab) may produce rapid control of active Crohn's disease and achieve tissue healing. Topically acting glucocorticosteroids are a safer than standard glicocorticosteroids in ileocolonic Crohn's disease. Cyclosporin is becoming a drug of choice in severely active ulcerative colitis. Anti-inflammatory agents, sulfasalazine and 5-ASA drugs are recommended in treatment mild and moderately active IBD and as maintenance treatment in ulcerative colitis. Corticosteroids still have the main role in the treatment of active IBD. There is no convincing data for efficacy of corticosteroids as maintenance therapy.

Humans↗
PubMed2000

Diarrhea-associated over-anticoagulation in a patient taking warfarin: therapeutic role of cholestyramine.

We present a case of significant over-anticoagulation temporally associated with a bout of protracted diarrhea in a patient on warfarin therapy. Cholestyramine was utilized to interrupt the enterohepatic recycling of warfarin and for its antidiarrheal effects to prevent gastrointestinal vitamin K wasting. Cholestyramine enabled the use of very low doses of sc vitamin K1 (2 mg total) with subsequent attainment of a therapeutic International Normalized Ratio in 39 h.

Aged↗
PubMed2001

Pharmacological evidence for a 7-benzylidenenaltrexone-preferring opioid receptor mediating the inhibitory actions of peptidic delta- and mu-opioid agonists on neurogenic ion transport in porcine ileal mucosa.

The antidiarrheal and constipating effects of opiates are partly attributed to reductions in active anion secretion across the intestinal mucosa that are modulated by submucosal neurons. In this study, the opioid receptor mediating the actions of opioids on ion transport was characterized in mucosa-submucosa sheets from porcine ileum. Electrical transmural stimulation evoked transient increases in short-circuit current, an electrical measure of neurogenic ion transport, in this preparation. After serosal addition, the peptidic delta-opioid agonists [D-Ala(2)]-deltorphin II (pIC(50) = 8.4 +/- 0.7), [D-Ala(2),D-Leu(5)]-enkephalin (DADLE), [D-Pen(2),D-Pen(5)]-enkephalin (DPDPE), and [D-Ser(2),Leu(5),Thr(6)]-enkephalin (DSLET), and the mu-opioid agonists [D-Ala(2),N-methyl-Phe(4),Gly(5)-ol]-enkephalin (DAMGO) (pIC(50) = 8.0 +/- 0.1), endomorphin I, and PL-017 inhibited short-circuit current elevations. Nonpeptidic mu- or delta-opioid agonists (morphine, loperamide, and SNC80) and kappa-opioid agonists (U-50,488H and U-69,593) were <360-fold less potent than deltorphin II. At 100 nM, the delta(1)-opioid antagonist 7-benzylidenenaltrexone reduced the potencies of DPDPE and DAMGO by 13.5- and 15.5-fold, respectively; at an identical concentration naltriben, a delta(2)-opioid antagonist, or the mu-opioid antagonist D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH(2) (CTOP) reduced DPDPE potency by 4.1- and 3.4-fold, respectively, but had no significant effect on DAMGO potency. Using primary antisera directed toward cloned opioid receptors, delta-opioid receptor immunoreactivity was immunohistochemically localized in submucosal neurons and nerve fibers, but immunoreactivities to kappa- or mu-opioid receptors were not detected in the mucosa-submucosa. These results suggest that a novel 7-benzylidenenaltrexone-sensitive opioid receptor is expressed in submucosal neurons of the porcine ileum, which mediates the inhibitory effects of peptidic mu- and delta-opioid agonists on neurogenic ion transport.

Animals↗
PubMed2001

[Concurrent chemoradiation therapy with nedaplatin for high-risk cervical cancer--clinical investigation of adverse events].

A clinical investigation of adverse events was conducted to confirm the safety of concurrent chemotherapy using nedaplatin (cisplatin derivative) and radiotherapy in the high-risk carcinoma of the uterine cervix. Seven patients who were treated with radical radiotherapy and 5 patients who were treated with adjunctive radiotherapy after radical hysterectomy and pelvic lymphadenectomy were eligible for the study. Nedaplatin was given intravenously at 70 mg/m2 on day 1 and day 29, and a total of 24 courses of nedaplatin administration were observed. None of the planned radiotherapy was postponed or discontinued due to side effects. Major adverse effects observed were gastrointestinal effects such as anorexia (66.7%), nausea and vomiting (33.3%) and diarrhea (66.7%). Grade 3 (in the 2nd course) and Grade 4 (in the 1st course) diarrhea was observed in one patient, which was easily relieved by antidiarrheal. Hematologic side effects were also major, including leukopenia (62.5%), neutropenia (75.0%), anemia (75.0%), and thrombocytopenia (33.3%). Hematologic effects were generally moderate; no Grade 4 (severe) effects were observed. Although these hematologic effects were lasting longer compared with radiation therapy alone, there were no significant differences in the seriousness of these side effects. Concurrent chemoradiation therapy with nedaplatin 70 mg/m2 every 4 weeks was safe and adverse effects were self-limited or resolved with medical management. Dose escalation in the phase III clinical study may be considered.

Adenocarcinoma↗
PubMedDate not supplied

Subtotal colectomy for colonic inertia.

The aim of this study was to assess the outcome of subtotal colectomy for colonic inertia (idiopathic slow transit constipation) that was resistant to laxative treatment. Twenty-four patients, 19 women and 5 men, with a mean age of 37 years, underwent subtotal colectomy with ileorectal or ascendo-rectal anastomosis. All patients were available for follow-up, with a mean follow-up of 23 months. Bowel frequency was significantly increased from 1.4+/-0.9 times per week to 22.8+/-9 times per week (average 3.2/day) after surgery (P <0.0001). The incidence of abdominal pain was decreased from 75% to 17%, as well as the severity (P <0.0001). Two patients who underwent ascendo-rectal anastomosis developed recurrent constipation. Two patients used antidiarrheal medication regularly. There was no major postoperative morbidity. Five patients were re-admitted due to small bowel obstruction; four received successful conservative management, and one required enterolysis. 'Excellent' or 'good' outcomes were reported by 21 patients (87.5%). Subtotal colectomy with ileorectal anastomosis produces satisfactory results in the majority of patients with proven colonic inertia.

Adult↗
PubMed1999

[Clinical and experimental study on treatment of retention enema for chronic non-specific ulcerative colitis with quick-acting kuijie powder].

OBJECTIVE: To study the clinical effect and mechanism of retention enema with quick-acting Kuijie powder (QAKJP) in treating chronic non-specific ulcerative colitis (CUC). METHODS: A treatment group of 156 patients treated with QAKJP and a control group of 78 patients treated with sulfasalazine orally were established randomly and their scores of main symptoms and signs were measured and compared before and after treatment. Animal experiments were conducted at the same time. RESULTS: The total effective rate in the treatment and the control group was 98.7% and 70.5% respectively, the clinical cure rate was 78.2% and 6.4% and the recurrence rate was 5.3% and 20.0% respectively. The effect of the treatment group was markedly superior to that of the control group, P < 0.01. Experimental study showed QAKJP could rapidly alleviate the congestion and edema of intestinal mucosa, promote the healing of ulcer, inhibit spasm of colon and had significant antidiarrheal action and antagonist effect against allergic mediator histamine. CONCLUSION: Retention enema with QAKJP has good effect on CUC, low recurrence rate and no toxic and side effect.

Administration, Rectal↗