Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy in Newborn Infants

Neonatal hypoxic-ischemic encephalopathy (HIE) is an ongoing process, which may persist for weeks to years after an acute asphyxial insult, causing delayed programmed cell death. The typical clinical signs and the pathological findings of HIE manifest as the condition evolves in a step-wise manner, beginning with an acute phase, followed by a latent, a secondary energy failure phase, and eventually a tertiary brain injury phase. To date, therapeutic hypothermia (TH) is the only effective treatment strategy known to improve mortality and prevent neurodevelopmental disabilities, as has been proven by the results of several randomized controlled clinical trials. The current protocols describing the use of TH for newborns of gestational age ≥36 weeks with HIE, associated with clinical evidence of asphyxia along with neurological signs of moderate-to-severe encephalopathy, observed at ≤6 hours of age, are close to optimal. Most comorbid conditions observed during TH are related to asphyxia. TH is a safe treatment option—benign sinus bradycardia and thrombocytopenia are frequent hypothermia-related complications. Additional adjuvant agents, which may augment hypothermic neuroprotection are being investigated, and a few of them, such as erythropoietin and melatonin appear to be promising agents for use in this condition. Establishing our own nationwide cooling systems and guidelines for a standard treatment protocol to manage HIE are warranted in the future.

Current Issues on Irritable Bowel Syndrome: Diet and Irritable Bowel Syndrome / 대한소화기학회지

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multifactorial disorder with its pathogenesis attributed to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, communication in the gut-brain axis, and so on. Traditionally, IBS has been treated with diet and lifestyle modification, fiber supplementation, psychological therapy, and pharmacological treatment. Carbohydrates are intermingled with a wide range of regularly consumed food including grains such as rye and wheat, vegetables, fruits, and legumes. Short-chain carbohydrates that are poorly absorbed exert osmotic effects in the intestinal lumen increasing its water volume, and are rapidly fermented by bacteria with consequent gas production. These effects may be the basis for the induction of most of the gastrointestinal symptoms. This has led to the use of lactose-free diets in those with lactose intolerance and of fructose-reduced diets for fructose malabsorption. As all poorly absorbed short-chain carbohydrates have similar and additive effects in the intestine, a concept has been developed to regard them collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and to evaluate a dietary approach that restricts them all. Based on the observational and comparative studies, and randomized-controlled trials, FODMAPs have been shown to trigger gastrointestinal symptoms in patients with IBS. Food choice via the low FODMAPs and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for managing symptoms of IBS.

Classification and Treatment of Constipation / 대한소화기학회지

Constipation is a common symptom affecting 2-27% of general population in Western countries. According to a population-based study on bowel habits in a Korean community, the prevalence was 16.5% for self-reported constipation and 9.2% for functional constipation. There is a broad range of causes for constipation. There are three subtypes in functional constipation, although overlap is not uncommon. Physiologic studies such as colonic transit test, anorectal manometry, balloon expulsion test, and defecography can be helpful in further evaluating and classifying functional constipation. Slow transit constipation is characterized by prolongation of transit time through- out the colon, caused by either myopathy or neuropathy. Functional defecation disorder is characterized as an inability to initiate defecation following the urge to do so, a feeling of incomplete evacuation, tenesmus, excessive straining or manual evacuation. Normal transit constipation is the most common subtype and characterized by constipation occurring in the presence of normal colonic transit time and normal defecatory function. It is important for clinicians to choose appropriate treatment for constipation which are most efficacious for the individual patient. Most patients with functional constipation respond to laxatives, but a small proportion may be resistant to this treatment. In patients with functional defecation disorder, biofeedback is helpful. Sacral nerve stimulation may be helpful in some patients with slow transit constipation. Patients who are resistant to all the conservative modalities may require surgical intervention. Extensive clinical and physiological preoperative assessment of patients with slow colonic transit time is essential before considering surgery, including an assessment of small bowel motility and identification of coexistent defecatory disorder.

Effects of bovine colostrum in diclofenac induced gut injured rat model / 대한내과학회지

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed medicine but induce damage throughout the entire gastrointestinal tract including small intestine with protein and blood loss. Impaired epithelial barrier function, overgrowth of luminal bacteria and others have been implicated in the pathogenesis of NSAID induced enteropathy. Colostrum is a first milk produced after birth and is particularly rich in growth factors, immunoglobulins and antimicrobial peptides. The present study aimed to exam whether defatted bovine colostrum reduce small intestinal injury caused by diclofenac in the animals. METHODS: 64 rats were utilized in four groups; control group, diclofenac group, diclofenac with 5% colostrum group and diclofenac with 10% colostrum group. The animals with colostrum were fed with 5% or 10% colostral solution for 5 days before diclofenac administration. Small intestinal injury was induced by administering a single dose of diclofenac (50 mg/kg subcutaneously). Epithelial permeability, enteric aerobic bacterial counts, serum albumin and protein levels, and pathologic findings of distal ileum were measured. RESULTS: Diclofenac caused marked increase in intestinal permeability, enteric bacterial numbers and intestinal villous damage, and declines in serum levels of total protein and albumin. Co-administration of bovine colostrum reduced intestinal permeability and enteric bacterial numbers, declines in serum albumin and protein levels, and mucosal damage of small intestine induced by diclofenac. CONCLUSION: Bovine colostrums may have beneficial effects on preventing NSAID induced small intestinal injury and bacterial translocation.

The Immunoglobulins and Gastrin Concentrations in Human Colostrum and Mature Milk: Effects of Prematurity

No abstract available.