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At least 1,027 records · Page 57Linked to original sources
PubMed2005

CT colonography with fecal tagging after incomplete colonoscopy.

The objective of this study was to evaluate dietary fecal tagging (FT) as a cleansing method prior to CT colonography (CTC) in patients with incomplete conventional colonoscopy (CC). After written informed consent was obtained, 24 patients had standard colonoscopic preparation (ScCl), and 25 patients had FT as cleansing method. Segmental distention, fluid levels, fecal residues, tagged appearance of fluid levels, and residual stool were evaluated. Mann-Whitney U test was used to test for significant differences between FT and ScCl groups. Compared with ScCl, FT improved distention (p=0.001), reduced the amount of fluid (p=0.043), but suffered from residual stool (p=0.046). A clear correlation was found between distention and fluid. No differences were found in stool size between FT and ScCl. FT showed a good labeling of fecal residues, and acceptable labeling of fluid levels. Compared with ScCl, FT reduces fluid, favors distention, but suffers from fecal residues. The tagged nature of these residues, however, allows differentiation from polyps.

Adult↗
PubMed1999

Do magnesium ions influence barium mucosal coating of the large bowel?

The aim of the present study was to verify whether the presence of magnesium in the colon lumen at the time of the double-contrast barium enema (DCBE) examination changes the quality of barium mucosal coating. The two members of 38 pairs of patients undergoing DCBE with a standardised technique were randomly subjected to bowel preparation with sennosides and magnesium sulphate, or sennosides and sodium sulphate. Mucosal coating, residual fluid and colon cleansing were assessed independently by three radiologists. The null hypothesis was tested by means of Wilcoxon's signed-rank test. Barium mucosal coating was judged to be better in the members to whom magnesium sulphate was administered (p = 0.0007). There was no difference in the amount of residual fluids (p = 0.3198). Colon cleansing was judged to be better in the members to whom sodium sulphate was administered (p = 0.0166). These results demonstrate, in a simple way, that magnesium ions increase barium coating of the colon mucosa in vivo. The underlying mechanisms (increase in viscosity of barium suspension through water subtraction owing to the hydrophilism of magnesium ions, or interactions with the polysaccharide additives) need further investigation. A first clinical application could be the integration of magnesium ions in a newly designed isotonic electrolyte solution containing polyethylene glycol for the oral colon wash-out.

Adult↗
PubMed2004

A prospective comparison of two regimes of bowel preparation for pediatric colorectal procedures: normal saline with added potassium vs. polyethylene glycol.

We prospectively evaluated the safety and efficacy of total gut irrigation (TGI) using normal saline with added potassium (NS) and polyethylene glycol (PG) in patients undergoing a variety of colorectal procedures including single-stage pull-through for Hirschsprung's disease (HD). Fifty-four patients were randomly assigned into one of the two groups (NS or PG). Pre- and post-TGI weight, abdominal girth, and serum electrolytes were assessed. Patients were also evaluated for vomiting and abdominal discomfort. At surgery, bowel preparation was evaluated, and postoperative complications were recorded. Both NS and PG are safe and effective agents for TGI. No patient in either group had any clinical or statistically significant change in the evaluated parameters. The amount of NS required for TGI was significantly higher than PG, and PG was better tolerated than NS. All patients with HD completed TGI, although one patient with long segment HD had abdominal distension.

Cathartics↗
PubMed2006

Long-term outcome of patients with enterocolitis complicating Hirschsprung's disease.

Enterocolitis remains the most serious complication of Hirschsprung's disease (HD). The purpose of this study was to evaluate the risk factors in the development of enterocolitis and the long-term outcome in these patients. The hospital records of 259 consecutive patients with HD during 1975-2003 were examined. The data was analysed for age at presentation, associated anomalies, level of aganglionosis, clinical features, number of episodes of enterocolitis, type of pullthrough, necessity for post-pullthrough sphincterectomy. Follow up was carried out by personal interviews and interviews over the telephone with patients/parents. Enterocolitis was diagnosed on the basis of clinical features of diarrhoea, pyrexia, abdominal distention and vomiting. Of the 259 patients with HD, 74 patients (28.5%) were found to have enterocolitis. Out of 39 patients with Down's syndrome and HD, 19 (48%) had enterocolitis. Fifteen (20%) patients had other associated anomalies. Fifty-six patients (75.6%) were male and 18 (24.3%) were female. In 30 patients enterocolitis was the presenting feature in the neonatal period, 22 of which presented in the first 2 weeks of life. Fifty-six patients (75.6%) had rectosigmoid disease and 18 (24.3%) had long segment disease or total colonic aganglionosis. Eighteen (24.3%) had only preoperative enterocolitis and 31(41.8%) had only postoperative enterocolitis. Twenty-five (33.7%) had both pre- and post-operative enterocolitis. Twenty (27%) patients had more than 2 episodes of enterocolitis. Various pullthrough procedures were performed. Twenty-six patients (35.1%) required internal sphinctermyectomy to treat the enterocolitis. At the time of follow-up, 16 patients were lost to follow-up. Of the remaining 58 patients, 3 patients died, 2 due to enterocolitis and 1 due to sepsis. Six patients remained with a stoma. Twenty-two patients were continent and were stooling normally, but 14 of these were on laxatives for several years after pullthrough procedure. The mean age at achieving full continence was 4.95 years in the 22 patients with normal bowel function. Nineteen patients are still on laxatives and 8 patients are soiling. Eight patients continue to have multiple recurrent episodes of enterocolitis at follow-up. Down's syndrome is an important risk factor in the development of enterocolitis. The majority of patients with enterocolitis complicating HD continue to have disturbances of bowel function many years after surgery for HD.

Cathartics↗
PubMed2002

Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon.

BACKGROUND AND AIMS: We examined the efficacy of cyclic long-term administration of rifaximin, a broad spectrum, poorly absorbable antibiotic, in obtaining symptom relief in a large series of patients with uncomplicated diverticular disease, and compared the incidence of episodes of diverticulitis in the group treated with rifaximin to that in a group receiving fiber supplementation only. PATIENTS AND METHODS: In a multicenter, prospective, open trial, 968 outpatients with uncomplicated symptomatic diverticular disease were randomized to either fiber supplementation with 4 g/day glucomannan plus 400 mg rifaximin twice daily for 7 days every month ( n=558) or 4 g/day glucomannan alone ( n=346). Clinical evaluation was performed on admission and at 4-month intervals for 12 months. RESULTS: After 12 months the group treated with glucomannan + rifaximin showed fewer symptoms (abdominal pain/discomfort, bloating, tenesmus, diarrhea, abdominal tenderness) and a lower global symptomatic score. Overall 56.5% of the patients treated with glucomannan + rifaximin and 29.2% of those treated with glucomannan alone were asymptomatic at 12 months ( P<0.001). The rate of complications (diverticulitis and rectal bleeding) was 1.34% in the rifaximin + glucomannan group and 3.22% in the glucomannan alone group ( P<0.05). CONCLUSION: Cyclic administration of rifaximin is effective in obtaining symptom relief in uncomplicated diverticular disease of the colon. The incidence of episodes of diverticulitis in the group treated with rifaximin was lower than that in the group treated with glucomannan alone.

Adult↗
PubMed2002

Helicoidal suture: alternative treatment for complete rectal prolapse in high-risk patients.

BACKGROUND AND AIMS: Optimal treatment for rectal prolapse is controversial. We describe a novel alternative treatment for high-risk patients with complete rectal prolapse. PATIENTS AND METHODS: Sixteen high-risk patients over 60 years old with complete rectal prolapse were examined. All patients had significant past medical history and were classified as grade III (ASA) surgical risk. The helicoidal suture technique is described. Postoperative parameters evaluated were morbidity, mortality, postoperative symptoms, recurrence and anal incontinence score. Median follow-up was 60 months. RESULTS: There were no operative complications or mortality in the series; one patient experienced recurrence. Median postoperative anal incontinence score was 6.06 (range 1-30; preoperative 23.6). CONCLUSION: This technique provides adequate functional outcomes and could be an effective therapeutic strategy against rectal prolapse in high-risk patients.

Aged↗
PubMed2006

Polyethylene glycol enhances colonic barrier function and ameliorates experimental colitis in rats.

OBJECTIVE: Polyethylene glycol (PEG) has been suggested to protect against pathogen colonization by improving colonic barrier function. We aimed to establish whether PEG 4000 affects colonic barrier function and the development of colitis induced by 2,4,6-trinitrobenzenesulfonic acid (TNBS) in rats. MATERIALS AND METHODS: PEG was included in the drinking water for a period of 48 h before intracolonic administration of TNBS. RESULTS AND DISCUSSION: PEG increased colonic surface hydrophobicity and diminished luminal bacterial load. Moreover, PEG markedly reduced mucosal damage and inflammation induced by TNBS. This protection effect appeared to be independent of its laxative properties since the laxatives mannitol or senna extracts had no effect on TNBS colitis. Using everted colonic sacs, pretreatment with PEG produced a lasting reduction in epithelial permeability to mannitol and dextran-70 K that correlated with decreased surface hydrophobicity. CONCLUSION: Our results suggest that the protective effect of PEG on TNBS colitis is associated with reinforcement of the epithelial barrier.

Animals↗
PubMed2000

Rectal tone in response to bisacodyl in women with obstructed defecation.

This study investigated the tonic response of the rectum to topical application of bisacodyl in women with obstructed defecation. Forty-five women with obstructed defecation, and 15 female controls were studied. Total colonic transit time was normal in 35 patients, and prolonged in 10. For the purpose of this study an "infinitely compliant" polyethylene bag was inserted into the rectum. Rectal tone was assessed by measuring variations in bag volume with a computerized electromechanical "barostat" system. After an adaptation period of 30 min, a suppository containing 10 mg bisacodyl was inserted into the rectum. Recording was continued for 90 min. In a second recording session rectal tone in response to an evoked urge to defecate was assessed. In a third session we investigated rectal sensory perception. After a mean time interval of 30 +/- 15 min following intrarectal application of bisacodyl, all controls showed a significant increase in rectal tone (mean value: 68.2 +/- 12%). In patients with a normal transit time, a similar increase was observed. In patients with prolonged transit time, the tonic response of the rectum to bisacodyl was significantly lower (mean 21.1 +/- 11%; P < 0.001). Five of these patients showed no response at all. In the second recording session, all controls showed an increase in rectal tone during an evoked urge to defecate (mean 36.3 +/- 7%). In both patient groups this tonic response was absent or significantly blunted (mean 19.2 +/- 6%) (P < 0.001). In both patient groups rectal sensory perception was impaired significantly. In conclusion, rectal tone increases significantly after topical application of bisacodyl in controls as well as in patients with obstructed defecation in whom transit time is normal. This tonic response is absent or significantly blunted in patients with a prolonged transit time. Both the tonic response of the rectum to an evoked urge to defecate and rectal sensory perception are significantly impaired in patients with a normal and those with a prolonged transit time.

Adolescent↗
PubMed1998

Small intestinal transit and digestibility of lactitol in Wistar rats.

The study was conducted to evaluate if the recovery of lactitol and its cleavage products varied when different doses of this disaccharide sugar alcohol (150 and 1,200 mg/kg body weight, respectively) were given by gastric gavage to unadapted male rats. Phenol red added to the test solution as marker dye served to determine the intestinal transit and distribution areas. Marker transit revealed that the test substance did not reach the cecum in all series. Gastric emptying was more retarded after the high dose. Administration of low doses did not alter intestinal transit and luminal volume as compared to control animals. But a much larger luminal volume was found in the third intestinal quarter after the high doses, although the marker transit through this segment was equal under all experimental conditions. The total gastrointestinal recovery of lactitol at 63.2 (+/- 3.9) and 75.5 (+/- 4.5)% was significantly different (p < 0.001) 1 hour after administration of 150 mg and 1200 mg/kg body weight, respectively. Only free sorbitol was detected in the gastrointestinal contents in both dosage groups. Based on these results and correcting the values for marker recovery (85% in both groups), it is reasonable to assume that the maximum amount of lactitol that can be hydrolyzed and absorbed by the small intestine is 11.2 and 25.2%, respectively, and not zero. In conclusion, the caloric availability of lactitol is dose-dependent and should be determined under normal conditions in which the laxative threshold is not exceeded.

Animals↗
PubMed1998

Structural and functional changes in skeletal muscle in anorexia nervosa.

Protein-energy malnutrition in anorexia nervosa is an under-recognised cause of muscle dysfunction. To characterise the skeletal myopathy that occurs in patients with severe anorexia nervosa, muscle function and structure were comprehensively examined in eight young adult female patients with severe (40%) self-induced weight loss. All of the patients showed impaired muscle function on strength and exercise measurement. The maximum voluntary contraction force for the patient group was significantly less than predicted values. Electromyography revealed myopathy in five of the patients, four of whom also had electro-physiological evidence of neuropathy. However, muscle biopsy specimens consistently showed myopathic changes with severe type 2 fibre atrophy but with no evidence of neuropathic changes. Ultrastructurally, there was separation and segmental loss of myofibrils and most biopsy samples contained abundant glycogen granules; we have previously reported that one of the most consistent biochemical abnormalities in these patients is impaired ischaemic lactate responses to forearm exercise. The result of severe protein-energy malnutrition on the musculo-skeletal system is a metabolic myopathy. Although the patients admitted to a variety of abnormal dieting behaviours, such as over-exercising and self-induced vomiting, no association was found between any of these and quantitative histological changes in the muscle biopsy samples. It is recommended that myopathy in anorexia nervosa be treated by instituting an appropriate refeeding programme.

Adult↗
PubMedDate not supplied

Primary infantile hypomagnesaemia: outcome after 21 years and treatment with continuous nocturnal nasogastric magnesium infusion.

UNLABELLED: Primary infantile hypomagnesaemia is an infrequent cause of neonatal hypocalcaemic seizures but one that responds well to magnesium supplementation. We describe a 22-year-old male, first reported at 4 months of age, who is currently free of neurological deficit but has suffered from intermittent hypomagnesaemic tetany and chronic diarrhoea due to large oral magnesium supplements. Hypothesizing that modest hypercalcaemia might prevent the tetany, we conducted a trial of 5 microg/day 1,25(OH)2D3 over 5 days. Despite the resultant increase in calcium, he developed tetany with the reduction of magnesium intake and decline of serum magnesium from 0.63 to 0.39 mmol/l (normal >0.65 mmol/l). After 1,25(OH)2D3 was stopped and the parenteral magnesium injections suspended, 33% of his usual oral supplement was given instead by continuous nasogastric infusion and serum magnesium rose to 0.60 mmol/l. This regimen was better tolerated because of decreased gastrointestinal side-effects and freedom from parenteral injections. We observed that 1,25(OH)2D3 supplements do not promote magnesium retention nor does the resultant hypercalcaemia prevent hypomagnesaemic tetany. CONCLUSION: Continuous nocturnal nasogastric infusion may be considered in lieu of parenteral therapy in primary infantile hypomagnesaemia.

Administration, Oral↗
PubMed2006

A prospective randomized single-blind comparison of three methods of bowel preparation for outpatient flexible sigmoidoscopy.

BACKGROUND: Preparation for outpatient flexible sigmoidoscopy using a self-administered phosphate enema is the standard practice in our unit, but it provides acceptable bowel preparation in only 80% of patients. This study compared two methods of bowel preparation with the current standard in an attempt to improve efficacy and acceptability. METHODS: From January to September 2003, patients scheduled for out-patient flexible sigmoidoscopy were prospectively randomized to 3 groups: group 1: one Fleet enema 2 h pre-procedure; group 2: two Fleet enemas, one on the evening prior to sigmoidoscopy and one 2 h pre-procedure; group 3: lactulose 30 ml orally 48 and 24 h prior to sigmoidoscopy, plus a single Fleet enema 2 h pre-procedure. A patient questionnaire was used to assess side effects and tolerance. The endoscopists questionnaire assessed the indication for the procedure, quality of preparation, depth of insertion, and pathological findings identified. Power calculations were based on the 80% acceptable preparation rate obtained using a single enema. RESULTS: For this study, 305 patients were randomized to the three groups. Patient data were available for 261 patients (group 1 = 105; group 2 = 81; group 3 = 75), and endoscopist data were available for 251 patients (group 1 = 97; group 2 = 79; group 3 = 75). No difference was noted between the groups with regard to age, gender, procedure indication, grade of endoscopist, or patient acceptability variables (ease of use: p = 0.09; assistance required: p = 0.11; cramps experienced: p = 0.84; alternative method: p = 0.25). There was no significant difference between the groups in terms of depth of insertion (p = 0.42-chi-squared test) or abnormalities noted (p = 0.34-chi-squared test). Nor was there any difference in the quality of preparation of patients in group 1 versus group 2 (p = 0.39-Fishers exact test) or group 1 versus group 3 (p = 0.13-Fishers exact). However, lactulose + Fleet resulted in significantly fewer patients with acceptable preparation compared with those who administered two Fleet enemas (p = 0.02- Fishers exact test). CONCLUSIONS: The addition of a Fleet enema or oral lactulose over and above a single Fleet enema gives no significant improvement in the acceptability or efficacy of bowel preparation.

Adult↗
PubMed2003

[Laxative use and efficacy in palliative care of patients with cancer pain and morphine therapy. A retrospective study with special regard to polyethylene glycol].

GOAL: Goal of this study was the assessment of the frequency of constipation in patients of palliative care medicine and the efficacy of the use of laxatives. METHODS: In a retrospective study the computerized data of 206 patients were analysed by descriptive statistics. RESULTS: Constipation occurred in 42.7% of patients. Constipation appeared in 34% of 159 patients, who were treated with morphine. There was no correlation to gastrointestinal tumors. Laxatives were given to 74.3% of patients. Laxative use was uncomplicated in 78.4%. For therapy of constipation combined administration of polyethylene glycol, sodium picosulphate and paraffin was most effective. CONCLUSION: In palliative care patients the use of polyethylene glycol is recommended for treating morphine-related-constipation.

Aged↗
PubMed2003

Constipation--modern laxative therapy.

It is estimated that one third of the population in Western industrial countries suffers from constipation at least from time to time. Constipation may have somatopathic or functional causes. Furthermore, a great number of substances are known to cause medication-induced constipation, i.e. opioid-induced constipation is caused by linkage of the opioid to opioid receptors in the bowel and the central nerve system. Whenever possible, causal therapy should be undertaken. Patients in palliative care mostly suffer from chronic functional constipation. The treatment consists of basic measures and the application of laxatives. According to their mode of action, they are divided into bulk-forming laxatives, osmotic laxatives, stimulant laxatives, lubricating agents and others. Bulk-forming laxatives are not recommended for use in palliative care patients, for such patients are normally not able to take in the required amount of fluids. Osmotic laxatives are divided into (magnesium) salts, saccharine, alcohols and macrogols. Lactulose is the most popular saccharine laxative. Because of its side effects (flatulence, bloating and abdominal cramping), lactulose is not a laxative of our choice; instead, we prefer to give macrogol. Orally administered, macrogol is not metabolised and pH value and bowel flora remain unchanged. Macrogol hydrates hardened stools, increases stool volume, decreases the duration of colon passage and dilates the bowel wall that then triggers the defecation reflex. Even when given for some time, the effectiveness of macrogol will not decrease. Because of its high effectiveness and commonly good tolerance, macrogol has become the laxative of first choice in palliative care patients with all kinds of chronic constipation, if these patients are able to take in the necessary amount of fluids. From the general medical point of view, lubricating agents have become obsolete. In palliative care patients, however, they are still important laxatives for prophylactic treatment or therapy of constipation. Due to clinical experience, in palliative care a laxative ladder has proven successful.

Aged↗
PubMed2004

Management of opioid-induced bowel dysfunction in cancer patients.

The gastrointestinal (GI) effects of morphine and other opioids may result in opioid-induced bowel dysfunction (OBD) and the need for treatment. Although OBD is very common in morphine-treated patients, it is usually under-diagnosed. Opioids deliver their GI effect through central and peripheral mechanisms. Laxatives are the pharmaceuticals prescribed most in this area. Prokinetics as well as cholinergic agonists have been used satisfactorily. One-third of patients with OBD have to be treated rectally. The use of opioid antagonists has been favored, but the bioavailability of oral forms is poor. Opioid antagonists with a quaternary structure have a high affinity for peripheral opioid receptors and therefore do not interfere with the analgesia, nor do they generate alkaloid withdrawal syndrome. Opioid rotation is another strategy for maintaining or improving analgesic quality directed toward decreasing the effects of previous opiates on the GI tract.

Analgesics, Opioid↗
PubMed2005

Anterior resection of rectal cancer without bowel preparation and diverting stoma.

PURPOSE: Since the introduction of total mesorectal excision (TME) as the standard operation technique for rectal cancer, anastomotic leakage percentages of up to 18% have been reported. To prevent such leakage, the use of mechanical bowel preparation and also the construction of a diverting ileostoma or colostomy have been standard procedures for years. In our institute, however, all patients undergoing colorectal surgery are operated upon without these measures. The present study was undertaken to investigate the results of this strategy in terms of the occurrence of postoperative anastomotic leakage. METHODS: All patients who underwent an elective (low) anterior resection between January 1996 and December 2001 (n = 144) entered the study. The clinical and pathological records of these patients were reviewed retrospectively. The exclusion criteria were patients with fixed rectal carcinoma who received preoperative radiotherapy and/or a stoma only at operation, emergency operations, abdominoperoneal resections, and Hartmann's procedures. RESULTS: Anastomotic leakage occurred in 7 out of 144 patients (4.9%). There was a trend toward a higher leakage frequency in men, in patients with a distal anastomosis, in patients with a stapled anastomosis, and in patients with a T3-T4 tumor or with positive lymph nodes. None of these factors, however, had a significant prognostic value based on a univariate or multivariate analysis. Those who died after leakage tended to be older than those who did not (P < 0.05). CONCLUSION: A (low) anterior resection can be performed safely without mechanical bowel preparation or a diverting stoma, and results in an anastomotic leakage percentage of less than 5%. Appropriate selection of patients may be important, but none of the investigated patient- or tumor-related factors could be identified as decisive.

Adult↗