Interim results of a randomised controlled trial of homeopathic treatment for irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a chronic condition for which there is no consensus on the optimum treatment. Gastroenterology problems are some of the most common conditions treated by homeopaths, yet few trials have explored the effectiveness of individualised homeopathic treatment for IBS. A three-armed trial was conducted which compared: usual care, homeopathic treatment plus usual care and supportive listening plus usual care. The primary outcome was change in irritable bowel symptom severity score between baseline and 26 weeks, calculated using ANCOVA. An interim ANCOVA adjusted for baseline IBS severity, age and employment status found no statistically significant difference between the three arms. However, a post-hoc test comparing homeopathic treatment plus usual care to usual care alone found a statistically significant difference in favour of homeopathic treatment. In addition, 62.5 percent of patients in the homeopathic treatment arm (compared to 25.0 percent of those in the usual care arm), achieved a clinically relevant change in irritable bowel symptom severity score, which indicates a promising effect for homeopathic treatment, though these results should be interpreted with caution due to the low number of participants in the study.

An Unusual Case of Pyrexia of Unknown Origin.

A previously fit and well 29-year-old man with no significant recent travel or contact history presented to the hospital with 11 days of feeling unwell, intermittent diarrhea, abdominal pain and a skin rash that was consistent with folliculitis. Despite resolution of these index symptoms he continued with recurring fever of 38.5 degrees centigrade and weight loss of six Kilograms over the next three weeks. Extensive investigations to find a cause for the unexplained persistent fever failed to reveal an etiology, hence fulfilling pyrexia of unknown origin definition (PUO). None of the three main causes of PUO, namely infections, autoimmune diseases or underlying malignancy, were confidently found. Colonoscopy was suggested following a review of the abdominal CT scan to investigate possible thickening of the bowel wall. A diagnosis of atypically presenting Crohn's disease was eventually made and confirmed by colonoscopy and histology. The fever responded promptly to treatment of the Crohn's disease and he remained well at follow-up at six and 12 months after the initial presentation. In conclusion, it is important to keep in mind that PUO can be a rare initial presentation of inflammatory bowel disease in young adults with little or no gastrointestinal symptoms.

Percutaneous endoscopic colostomy: a useful technique when surgery is not an option.

Percutaneous endoscopic colostomy (PEC) is a minimally invasive endoscopic procedure that offers an alternative treatment for high-risk patients with sigmoid volvulus or intestinal pseudo-obstruction who have tried conventional treatment options without success or those who are unfit for surgery. The procedure acts as an irrigation or decompressing channel and provides colonic 'fixation' to the anterior abdominal wall. The risk of complications highlights the importance of informed consent for patients and relatives.

Soluble transferrin receptors and iron deficiency, a step beyond ferritin. A systematic review.

UNLABELLED: Iron deficiency is a common disorder; it can also be the first indicator of significant gastrointestinal pathology. Total iron stores are evaluated by ferritin measurement, but this is often difficult, as coexistent disease can obscure ferritin results. Bone marrow (BM) examination was previously felt to be superior to all known serological markers of iron status, but it has a number of disadvantages. The validity of measurement of soluble transferrin receptors (sTfR) as a surrogate marker of BM iron stores has been the subject of various studies so far. AIM: To critically review the use of sTfR as a marker for the evaluation of iron stores. METHODS: A systematic computerised literature search, in order to identify studies that compared sTfR measurement against BM iron stain. RESULTS: Twenty prospective studies were identified, of which nine fulfilled the inclusion criteria (sTfR measurement in anaemic adults alongside BM iron staining). For a total of 979 patients, a different sTfR reference range was used, but levels of 2.5 mg/L (29.5 nmol/L) were consistently used as the threshold for iron-deficiency anaemia resulting in good specificity and sensitivity. CONCLUSION: The use of sTfR improves the clinical diagnosis of iron deficiency anaemia, especially in the presence of coexisting chronic disease or gastrointestinal malignancies. The safety and cost-effectiveness of a ferritin/sTfR-based approach to exclude gastrointestinal cancer in the presence of iron deficiency has to be proven with a prospective, well standardised, multicentre trial or a meta-analysis.

A ferritin level >50 microg/L is frequently consistent with iron deficiency.

BACKGROUND: The British Society of Gastroenterology (BSG) suggests that a serum ferritin level or=2 and 17 had Index