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At least 703 records · Page 39Linked to original sources
PubMed2002

Serotonergic modulating drugs for functional gastrointestinal diseases.

After many years of basic research we have now begun to learn how to manipulate the serotonergic mechanisms within the gut. This has lead to a number of significant advances including 5HT3 antagonists for the treatment of functional diarrhoea, 5HT4 agonists for the treatment of constipation and 5HT1 agonists for the treatment of impaired fundal relaxation. Initial enthusiasm has been somewhat dented by the withdrawal of alosetron because of ischaemic colitis, but it remains to be seen whether this adverse event will be seen with other 5HT3 antagonists. Finally it should be recognized that, in a substantial proportion of patients attending clinics complaining of functional symptoms, anxiety is a major component. The drugs so far described are by and large devoid of CNS effects. It remains possible therefore that a drug which combines both peripheral and central effects would likely to be beneficial.

Colon↗
PubMed1995

Common gastrointestinal syndromes diseases.

Gastrointestinal syndromes are an important contributory cause of morbidity for women, although in many cases, the gynecologist may primarily diagnose and treat uncomplicated disease. The role of endoscopy in the management of more difficult cases requires referral. The role of flexible sigmoidoscopy performed by the gynecologist for colorectal screening is intriguing.

Antacids↗
PubMedDate not supplied

Reactive oxygen metabolites and upper gastrointestinal diseases.

Reactive oxygen metabolites play an important role in the pathogenesis of gastroduodenal mucosal inflammation (mucosal ischemic injury and other models of mucosal damage induced by nonsteroidal anti-inflammatory drugs, ethanol, or H. pylori), peptic ulcer disease, and gastric cancer. H. pylori achieves its pathogenetic role by triggering an intense leukocyte infiltration of the gastric mucosa, and neutrophil activation provides a major source of reactive oxygen metabolites which can cause tissue damage mainly in the absence of antioxidants. H. pylori virulence factors promote release of a variety of chemoattractants/inflammatory mediators. Circulating leukocytes are recruited to sites of inflammation by a well-regulated and coordinated process that largely occurs in postcapillary venules. Adhesion molecules are expressed on the surface of endothelial cells and leukocytes serve to ensure an orderly sequence of cell-to-cell interactions that sustain leukocyte adherence to vascular endothelium and the subsequent transendothelial migration into inflamed tissue. Transcriptional factors are involved in the expression of endothelial adhesion molecules, and regulation of activity of these factors (i.e., NF-kappa B) is a very attractive target for therapeutic interventions. Longstanding H. pylori-associated gastritis predisposes to gastric cancer development and reactive oxygen metabolites play a part in H. pylori-related gastric carcinogenesis. Various regimens of reactive oxygen metabolite scavengers appear to be new treatment strategies for upper gastrointestinal diseases.

Animals↗
PubMed2003

Gastrointestinal disease control after histamine2-receptor antagonist dose modification for renal impairment in frail chronically ill elderly patients.

OBJECTIVES: To determine whether histamine2-receptor antagonist (H2RA) dose modified for renal impairment affects gastrointestinal (GI) disease control. DESIGN: Concurrent medical record review. SETTING: One hundred forty-six nursing facilities throughout the United States. PARTICIPANTS: Three hundred thirty-six patients aged 65 and older receiving H2RAs for GI disorders. INTERVENTION: H2RA dose modified for renal impairment or no dose change. MEASUREMENTS: Disease control (no H2RA dose increase for 6 months or longer, additional GI medication, hospitalizations, emergency room visits, and unscheduled physician visits for GI symptoms) was evaluated using chart review at 3, 6, 9, and 12 months in nursing home patients aged 65 and older with H2RA dose modified for decreased creatinine clearance (ClCr) according to manufacturer. RESULTS: Three hundred thirty-six patients, mean age +/- standard deviation 85.9 +/- 7.9, with mean ClCr of 33.6 +/- 10.4 mL/min, were recommended to receive lower H2RA doses based upon estimated renal function. Patients were analyzed in two groups: H2RA dose reduced (Group 1) and dose reduction not adopted or implemented (Group 2). There was no difference in baseline characteristics (age, weight, ClCr, or starting H2RA dose and indication) between the two groups. One hundred ninety-eight patients in Group 1 were taking 195.5 +/- 71.0 mg per day of nizatidine or equivalent, compared with 183.7 +/- 66.6 mg for 138 patients in Group 2. For patients with 90 days of follow-up, the mean H2RA dose in Group 1 was 100.2 +/- 44.3 mg, compared with 187.8 +/- 69.9 for Group 2 (P <.0001) The mean decrease in daily dose for Groups 1 and 2 after 365 days were 98.9 +/- 72.9 mg and 22.2 +/- 68.2 mg, respectively (P <.0001). Except for more physician visits in Group 2, disease control was similar for all groups. Major and minor GI bleeding events were similar across both groups and over time. The 12-month mortality rate was 12.1% and 21.7% for Groups 1 and 2, respectively. This difference was statistically significant (P =.02). CONCLUSION: The findings suggest that the dose of H2RAs may be decreased based upon renal function in frail elderly patients without compromising GI disease control.

Aged↗
PubMed2000

[Polyethylene glycol (Macrogol)--an overview of its use in diagnosis and therapy of gastrointestinal diseases].

The pharmacological rationale for the use of polyethylene glycol (PEG) in gastroenterology is its inverse relation between molecular mass and intestinal absorbability, with practically no intestinal absorption at molecular masses exceeding 3000, its lack of intestinal enzymatic degradation or bacterial metabolism, and its water binding capacity. PEG is used as a nonabsorbable marker in the evaluation of small intestinal and colonic absorption and secretion, as a marker for intestinal permeability studies, as an essential component of colonic lavage solutions used for the preparation of the colon for diagnostic and therapeutic interventions, and for the treatment of fecal impaction or chronic constipation. Since PEG has been used for decades, there is extensive data documenting its safety in short term use. Although animal experiments have also proved the safety of chronic PEG administration, the increasing use of PEG for the treatment of chronic constipation in the long term requires further surveillance to establish its safety.

Constipation↗
PubMed1996

Review article: safety of bismuth in the treatment of gastrointestinal diseases.

Bismuth preparations are commonly used to treat a variety of gastrointestinal disorders, including peptic ulcers and dyspepsia. The safety profile of currently approved bismuth preparations, such as tripotassium dicitrato bismuthate (De-Nol), bismuth subsalicylate (Pepto-Bismol) and ranitidine bismuth citrate (Pylorid, Tritec), is excellent. Adverse reactions to these agents are mild, transient and infrequent, and reports of serious adverse reactions are rare. This, in part, reflects the low systemic bioavailability of bismuth from these medicines: less than 1% of the bismuth dose administered is absorbed. During repeated dosing with ranitidine bismuth citrate 200, 400 or 800 mg b.d. trough plasma bismuth concentrations remain well below 50 micrograms/L. After 4 weeks of treatment median concentrations of 3.4 micrograms/L or less were reported amongst 1210 duodenal ulcer patients receiving this new chemical entity, while mean concentrations of 5.1 micrograms/L (plasma) and 12.3 micrograms/L (blood) have been reported in two studies of patients receiving tripotassium dicitrato bismuthate 120 mg q.d.s. for 4 weeks. Transient peak plasma bismuth concentrations greater than 50 micrograms/L are observed 30-60 min after dosing with tripotassium dicitrato bismuthate in some patients, but are not associated with any toxic effects. After discontinuation of treatment with bismuth preparations its excretion in urine may continue for up to 3 months, by which time blood bismuth concentrations have declined to pretreatment values.

Bismuth↗
PubMed1989

Dietary and nutritional management of gastrointestinal diseases.

The value of proper diet in the management of the gastrointestinal patient has been demonstrated. As experience and knowledge increase, diets will become more refined to address specific diet-related abnormalities. There is an increasing awareness in veterinary medicine, and justifiably so, of the benefit of nutritional support, administered enterally or parenterally. Aggressive, early, and adequate nutritional support may be the most important factor responsible for a successful response to other aspects of therapy and recovery, and has to represent an improvement in veterinary medicine.

Animal Feed↗
PubMed2002

Mechanisms of epithelial injury and inflammation in gastrointestinal diseases.

Using Barrett's esophagus and Crohn's disease as models of gastrointestinal disorders, a number of key mechanisms of cell injury and death and chronic inflammation are reviewed. Among them are the roles of impaired osmoregulation, elevated cytosolic calcium, activation of the mitochondrial permeability transition and levels of cytosolic adenosine triphosphate as determinates of cell death as well as the role of inflammatory cells, cytokines, NOD2 gene products, and reactive oxygen species in chronic inflammation. Further, the basis for the link between inflammation and cancer risk in Barrett's esophagus and Crohn's disease is described.

Adenocarcinoma↗
PubMed2002

Malnutrition and gastrointestinal disease.

The recognition of several disease processes that cause or are associated with gastrointestinal malabsorption has led to extensive investigation into their pathogenesis, diagnosis, and treatment. This review of selected articles covers a range of subjects related to some of the more common malabsorptive disease. Selected topics including celiac disease, disaccharidase deficiencies, short bowel syndrome, and Crohn disease are discussed.

Celiac Disease↗
PubMed1975

A critical review of periodic health screening using specific screening criteria. Part 2: Selected endocrine, metabolic and gastrointestinal diseases.

Despite the increasing interest in recent years in prevention and early recognition of asymptomatic disease, there has been a lag in development of a sound scientific basis for efforts in this area. No objectively based program for periodic health screening of asymptomatic adults has yet been proposed for the primary care physician. This is the second in a series of four articles which will critically examine the feasibility of screening procedures for 36 selected diseases. Six basic criteria are adopted as necessary to justify periodic screening. Specific screening recommendations are made for each disease, and a longitudinal screening program for asymptomatic adults will be proposed in the concluding article of this series.

Adult↗