ABSTRACT
Bleeding from the small intestine remains a clinically challenging diagnostic and therapeutic problem. It may be minor, requiring only supplemental iron treatment, to patients who have severe overt bleeding that requires multimodal intervention. This article provides an up-to-date review of the state-of-the-art of diagnosis and treatment of small intestinal bleeding.
Subject(s)
Capsule Endoscopy/methods , Gastrointestinal Hemorrhage/diagnosis , Intestinal Diseases/diagnosis , Melena/diagnosis , Adult , Aged , Diagnosis, Differential , Female , Gastrointestinal Hemorrhage/complications , Humans , Intestinal Diseases/complications , Intestine, Small/diagnostic imaging , Male , Melena/etiology , Middle AgedABSTRACT
Medicinal plants may be effective against helminthic infestation in animals, but to date few studies have investigated the real impact of anthelminthic medicinal plants in veterinary ethnopharmacology. The aim of this study was to assess the geographical use of anthelminthic medicinal plants in livestock in European Union (EU), and to quantify the anthelminthic efficacy of medicinal plants in comparison with anthelminthic drugs. Surveys on the use of anthelminthic traditional medicinal plants in livestock in the EU were included in the qualitative synthesis. Studies that investigated the efficacy of anthelminthic traditional medicinal plants in animals, compared with negative control and/or anthelminthic drugs, were included in the quantitative synthesis (network meta-analysis). Twelve surveys (9 in Italy, 2 in Spain, 1 in Austria) reported the use of anthelminthic medicinal plants in livestock living in EU Countries. Data obtained from 256 animals and extracted from 6 studies were included in the network meta-analysis. Medicinal plants and drugs were more effective than negative control (standardized mean difference [SMD]: -0.60 95%CrI -0.88 to -0.31, -0.73 95%CrI -1.08 to -0.38, respectively, P < 0.001). Overall, no difference was detected between anthelminthic medicinal plants and anthelminthic drugs, namely albendazole, ivermectin, fenbendazole, and doramectin (SMD: 0.26 95%CrI -0.02 to 0.55, P > 0.05). The most effective anthelminthic medicinal plants were Artemisia absintihium, Allium sativum, and Duranta erecta. There is the strong medical need of performing adequately powered randomized controlled trials in different livestock species aimed to improve the quality of the current evidence concerning the anthelminthic efficacy of medicinal plants compared to that of the currently available antiparasitic drugs.
ABSTRACT
BACKGROUND AND OBJECTIVE: Helicobacter pylori infects the mucus layer of the human stomach and causes peptic ulcers and adenocarcinoma. We have previously shown that H. pylori accumulates photoactive porphyrins making the organism susceptible to inactivation by light, and that small spot endoscopic illumination with violet light reduced bacterial load in human stomachs. This study assessed the feasibility and safety of whole-stomach intra-gastric violet phototherapy for the treatment of H. pylori infection. STUDY DESIGN/MATERIALS AND METHODS: A controlled, prospective pilot trial was conducted using a novel light source consisting of laser diodes and diffusing fibers to deliver 408-nm illumination at escalating total fluences to the whole stomach. Eighteen adults (10 female) with H. pylori infection were treated at three U.S. academic endoscopy centers. Quantitative bacterial counts were obtained from biopsies taken from the antrum, body, and fundus, and serial urea breath tests. RESULTS: The largest reduction in bacterial load was in the antrum (>97%), followed by body (>95%) and fundus (>86%). There was a correlation between log reduction and initial bacterial load in the antrum. There was no dose-response seen with increasing illumination times. The urea breath test results indicated that the bacteria repopulated in days following illumination. CONCLUSION: Intra-gastric violet light phototherapy is feasible and safe and may represent a novel approach to eradication of H. pylori, particularly in patients who have failed standard antibiotic treatment. This was a pilot study involving a small number of patients. Further research is needed to determine if phototherapy can be effective for eradicating H. pylori.