A Survey of Social Media Use and Preferences in Patients with Inflammatory Bowel Disease.

BACKGROUND: With the recent increase in the use of social media, patients with chronic illnesses are using the Internet as a resource for disease management. As the peak incidence of inflammatory bowel disease (IBD) occurs in patients between the ages of 15 and 30, IBD is a suitable condition to study social media use. The aim of this study was to assess social media usage and preferences in patients with IBD. METHODS: We administered a survey to 118 patients with IBD at our outpatient practice at the Boston Medical Center (BMC), Center for Digestive Disorders, and the University of Southern Alabama (USA) between November 1, 2015, and March 9, 2016. RESULTS: The most frequently used IBD-specific social media website was the CCFA (86%). High-frequency social media users were more likely to agree that "social media is useful for managing my IBD," compared with low-frequency social media users (OR 3.23, 0.3-10.1, P = 0.199). Fifty-five percent of respondents were interested in obtaining patient-with-IBD education through social media, or organizations such as the CCFA, whereas 45% did not express interest. Sixty-two percent of patients would be interested in following a social media account established by their gastroenterologist. Privacy and/or confidentiality issues were the primary barriers to social media use. Last, most patients were unsure of the quality of IBD information posted online. CONCLUSIONS: The results of this study suggest that patients who frequently use social media are highly interested in using social media in the management of their IBD. Most patients with IBD in our study were interested in receiving IBD information from their gastroenterologist and other patient-related organizations through social media. Most patients are unsure of the quality of IBD information posted on social media. Gastroenterologists should be aware that their patients may use social media to obtain disease education. Future studies should assess the quality of IBD information on social media and the effectiveness of communication through social media as a means to improve patient education and outcomes.

Comparative Proteomic Analysis of Whole-Gut Lavage Fluid and Pancreatic Juice Reveals a Less Invasive Method of Sampling Pancreatic Secretions.

OBJECTIVES: There are currently no reliable, non-invasive screening tests for pancreatic ductal adenocarcinoma. The fluid secreted from the pancreatic ductal system ("pancreatic juice") has been well-studied as a potential source of cancer biomarkers. However, it is invasive to collect. We recently observed that the proteomic profile of intestinal effluent from the bowel in response to administration of an oral bowel preparation solution (also known as whole-gut lavage fluid, WGLF) contains large amounts of pancreas-derived proteins. We therefore hypothesized that the proteomic profile is similar to that of pancreatic juice. In this study, we compared the proteomic profiles of 77 patients undergoing routine colonoscopy with the profiles of 19 samples of pure pancreatic juice collected during surgery. METHODS: WGLF was collected from patients undergoing routine colonoscopy, and pancreatic juice was collected from patients undergoing pancreatic surgery. Protein was isolated from both samples using an optimized method and analyzed by LC-MS/MS. Identified proteins were compared between samples and groups to determine similarity of the two fluids. We then compared our results with literature reports of pancreatic juice-based studies to determine similarity. RESULTS: We found 104 proteins in our pancreatic juice samples, of which 90% were also found in our WGLF samples. The majority (67%) of the total proteins found in the WGLF were common to pancreatic juice, with intestine-specific proteins making up a smaller proportion. CONCLUSIONS: WGLF and pancreatic juice appear to have similar proteomic profiles. This supports the notion that WGLF is a non-invasive, surrogate bio-fluid for pancreatic juice. Further studies are required to further elucidate its role in the diagnosis of pancreatic cancer.

Rectal effluent as a research tool.

Studies of localized secretions are generally superior to those of blood because they contain higher concentrations of molecules specific to the organ of interest. A common method used to analyze localized secretions is lavage. The flow of fluid over the lining of a cavity picks up both cells and soluble factors, and the effluent can be collected for study. Gastrointestinal (GI) lavage is easily and noninvasively performed by the administration of gut lavage solutions such as those routinely given to patients prior to colonoscopy, with GI lavage fluid being the copious, watery rectal effluent subsequently induced. Residual effluent is currently suctioned from the colon and discarded during colonoscopy. With millions of routine colonoscopies performed per year, GI lavage fluid is a rich and largely untapped resource for basic and clinical research. Rectal effluent can also be easily collected in a toilet receptacle without need for a colonoscopy. Rectal effluent generated in this manner has been used to study diarrheal disease, mucosal immunology, inflammatory bowel disease, celiac disease, and cancer. It is often referred to as gut lavage, colon lavage, GI lavage, or whole gut lavage fluid, which makes it challenging to locate previous studies in the literature and there are currently no comprehensive reviews of its use as a research tool. This review attempts to fill this void by discussing previous applications of rectal effluent in research and the methods that have been developed for its collection, stabilization, and analysis.

A comparison of oral sulfate solution with sodium picosulfate: magnesium citrate in split doses as bowel preparation for colonoscopy.

BACKGROUND: There are few data comparing U.S. Food and Drug Administration-approved low-volume bowel preparations for colonoscopy. OBJECTIVE: To compare oral sulfate solution (OSS) with sodium picosulfate plus magnesium citrate (SP+MC) for bowel cleansing efficacy. DESIGN: Single-blind, randomized, controlled trial. SETTING: Ten U.S. centers. PATIENTS: Outpatients undergoing colonoscopy for routine indications. INTERVENTIONS: Patients were randomized to undergo bowel preparation with OSS or SP+MC. Both preparations were given in split doses. MAIN OUTCOME MEASUREMENTS: Cleansing efficacy on a 4-point scale from excellent (4) to poor (1). RESULTS: Among 338 randomized patients who took preparation, OSS resulted in a higher rate of successful (excellent or good) preparation (94.7% vs 85.7%; P = .006) and more excellent preparations (54% vs 26%; P < .001) compared with SP+MC. There was no difference between OSS and SP+MC in treatment-emergent adverse events. SP+MC had better scores for nausea, but the differences were small. LIMITATIONS: The preparation grading scale has been used in previous studies and has regulatory acceptance but has not been formally validated. CONCLUSION: The U.S. Food and Drug Administration-approved split-dose regimen of OSS provides superior bowel cleansing compared with the approved split-dose regimen of SP+MC. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01786629.).

Diagnosing irritable bowel syndrome: a changing clinical paradigm.

Rather than being a diagnosis of exclusion, irritable bowel syndrome (IBS) is a diagnosis that can be identified by symptom-based criteria. The collection of these criteria by a meticulous history can be enhanced by using various tools. Once a positive diagnosis is made, using clinical criteria for diagnosis, one should look for alarm or warning symptoms or signs, and should characterize the type of bowel habit. Determining whether the condition is a diarrhea-predominant or a constipation-predominant IBS will direct further diagnostic evaluation and management.

A comparison of polyethylene glycol laxative and placebo for relief of constipation from constipating medications.

OBJECTIVES: Medications often cause constipation and little data are available concerning treatment interventions. This study was designed to evaluate the safety and efficacy of polyethylene glycol (PEG) 3350 laxative (MiraLax) for relief of constipation from medicines associated with symptoms of constipation. METHODS: Study subjects were enrolled who met defined criteria for chronic constipation and were also taking medications that were associated with a reported side effect incidence of more than 3% constipation. Subjects were randomized into a double-blind, parallel, multicenter study where they received 17 g per day of PEG laxative or placebo for 28 days. The primary efficacy variable, "Treatment Success," was defined as relief of ROME II criteria for constipation over the last 7 days of the treatment period. Various secondary measures were also assessed. Daily bowel movement experience, patient perception of efficacy, and safety information were recorded in a diary. Laboratory testing was performed at baseline and at end of study for hematology and blood chemistry, including BUN, calcium, electrolytes, and TSH. RESULTS: One hundred patients were enrolled at 4 study centers. Successful treatment according to the primary efficacy variable was seen in 78.3% of PEG and 39.1% of placebo subjects (P < 0.001). Similar results were observed in a subgroup of 28 elderly subjects. Secondary measures of number of bowel movements, complete bowel movements, satisfactory bowel movements, straining at stool and stool consistency also showed statistically significant results in favor of PEG compared with placebo (P < or = 0.01) after the first week of treatment. There were no differences inpatient reported scores for gas, cramping, or bloating between PEG and placebo. No significant differences in laboratory findings or adverse events, including the gastrointestinal category, were observed. Diarrhea and flatulence occurred more frequently with PEG treatment, although they were not individually statistically different from placebo. Similar results were observed when these symptoms were analyzed for differences due to gender, race, or age. CONCLUSIONS: PEG laxative is safe and effective for use in treating constipation in patients taking constipating medications.

A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation.

OBJECTIVES: Polyethylene glycol (PEG) 3350 (MiraLAX) is currently approved for the short-term treatment of occasional constipation. This study was designed to compare the safety and efficacy of PEG laxative versus placebo over a 6-month treatment period in patients with chronic constipation. METHODS: Study subjects who met defined criteria for chronic constipation were randomized in this double-blind, placebo-controlled, parallel, multicenter study to receive PEG laxative as a single daily dose of 17 g or placebo for 6 months. Baseline constipation status was confirmed during a 14-day observation period. As a primary efficacy variable, treatment success was defined as relief of modified ROME criteria for constipation for 50% or more of their treatment weeks. Various secondary measures were assessed. An Interactive Voice Response System (IVRS) recorded daily bowel movement experience and study efficacy and safety information. Laboratory testing at baseline and monthly for the study duration was analyzed for hematology, blood chemistry including amylase, GGT, uric acid, lipids, and urinalysis. RESULTS: A total of 304 patients were enrolled and received treatment at one of 50 centers. Successful treatment according to the primary efficacy variable was seen in 52.0% of PEG and 11% of placebo subjects (P < 0.001). Similar efficacy was seen in a subgroup of 75 elderly subjects. According to the primary efficacy definition (based on individual treatment weeks), 61% of PEG treatment weeks versus 22% of the placebo weeks were successful (P < 0.001). There were no significant differences in laboratory findings or adverse events except for the gastrointestinal category where diarrhea, flatulence, and nausea were the most frequent with PEG although they were not individually statistically significant compared with placebo. Similar results were observed when analyzed for differences due to gender, race, or age. CONCLUSIONS: PEG laxative is safe and effective for use in patients with chronic constipation for 6 months.

Capsule endoscopy: impact on patient management.

Capsule endoscopy (CE) is an emerging technology in the diagnosis of a variety of gastrointestinal (GI) disorders. However, for CE to play a significant role in the care of GI disease, changes in patient management and positive patient outcomes must be seen. The objective of this study was to determine the impact of CE findings in the management of patients referred for CE. The study was a retrospective chart review of all patients who underwent CE at the University of South Alabama College of Medicine from April 2002 to May 2005. Demographic data was collected, as well as indications for CE. Findings included active bleeding (some within reach of a therapeutic endoscope), masses or polyps potentially missed by prior evaluation, and ulcers or lesions that would require a change in medical or surgical management (eg, the discontinuation of medications such as nonsteroidal anti-inflammatory drugs [NSAIDs] or a change in inflammatory bowel disease [IBD] treatment regimen, based on evidence of active disease from CE). A total of 210 cases were reviewed in this study. Overall, CE findings would lead to a change in patient management in 81 of 210 patients (38.6%). When the sample was restricted to the 93 patients with obscure-occult bleeding, 34 patients (36.6%) would have a change in patient management. Of the 79 obscure-overt bleeding patients, 33 patients (41.8%) would experience a change in patient management. Of the 36 patients who had CE for known or suspected IBD, 13 patients (36%) would have a patient management change based on capsule findings. This study demonstrates that CE meets a reasonable criteria for clinical utility in its ability to change patient management. In our study, 36-41.8% of patients with suspected small-bowel disorders would experience a change in patient management as a result of CE. Also of importance is the ability of CE to provide information that reassures patients and eliminates the need for further testing.

Do gastroenterologists notify polyp patients that family members should have screening?

OBJECTIVE: The objective of this study was to determine whether patients found to have adenomatous polyps or cancer were notified that their relatives should have screening, due to an increased risk of developing colorectal cancer. METHODS: Consecutive (n = 121) colonoscopy patients from December of 1999 to October of 2001 found to have adenomatous colon polyps or colon cancer formed the study group. Charts were reviewed for documentation of relative notification, and when documentation was not present, study subjects were contacted by telephone. RESULTS: Overall, 71% had data that were able to be evaluated; the remaining 29% were unable to be contacted because of changes of address or phone numbers. Adenomatous polyps were seen in 95%, and cancer seen in 5%. Overall, 30% of the patients were notified: 23 of 82 (28%) in the polyp group and 3 of 4 (75%) in the cancer group. Advanced adenomas or multiple adenomas were noted in 28 of the 82 (34%). Of those, 8 of 28 (29%) were notified. CONCLUSIONS: Gastroenterologists should be aware of the need for increased attention to family notification, especially in those with advanced adenomas or multiple adenomas. Template notification letters may complement the polyp surveillance programs that many colonoscopists use.

U.S. practices for colon cancer screening.

As the prevalence of gastric carcinoma decreases in Japan, the prevalence of colon cancer has been increasing. Examination of the screening practices for colon cancer in the United States can offer insight into practices that may be useful in Japan. This paper will review the epidemiology and risk factors for colon cancer, the genetics of colon cancer, prevention issues, screening modalities, and current recommendations in U.S. practice.

Safety issues regarding colonic cleansing for diagnostic and surgical procedures.

There are various methods available to cleanse the colon in preparation for diagnostic and surgical procedures. The popular options are diet and cathartic regimens, gut lavage and phosphate preparations. Each method has its own unique characteristics and safety profile. Diet and cathartic regimens are based on traditional methods of colonoscopy preparation and remain an acceptable and safe alternative for patients unwilling or unable to tolerate other bowel preparations. Gut lavage methods involve ingestion of 2-4L of osmotically balanced solutions containing polyethylene glycol, which have been shown to be safe and effective for colon cleansing, including for special patient populations with cardiac, renal or hepatic dysfunction. Phosphate preparations have also been shown to be safe and effective for colon cleansing and are generally better tolerated than counterpart gut lavage solutions. However, this method has safety concerns for some patients with cardiac, renal and hepatic dysfunctions.

Brachial blood pressure monitoring versus ankle monitoring during colonoscopy.

OBJECTIVES: To compare ankle and brachial blood pressure monitoring before and during colonoscopy using automated noninvasive blood pressure (NIBP) monitors. METHODS: Forty-five consecutive patients who presented for outpatient colonoscopy had both ankle and brachial blood pressure monitoring with automated NIBP using an appropriately sized cuff for arm or leg size. Three baseline measurements were obtained, and then measurements were taken at 5-minute intervals during conscious sedation, with brachial blood pressure being the standard. RESULTS: The average of all of the ankle blood pressures was significantly higher for all systolic and mean arterial blood pressure readings. Diastolic blood pressure readings were higher at baseline, but not significantly different during the procedure. CONCLUSIONS: Ankle systolic and mean arterial blood pressures using automated NIBP monitoring for conscious sedation are significantly higher than brachial blood pressures. Ankle NIBP monitoring should only be used if brachial NIBP monitoring is not feasible, taking into consideration that ankle NIBP pressures are generally higher than brachial.

Bowel preparation for gastrointestinal procedures.

Adequate colonic cleansing is essential for accurate and safe colonic procedures. Common preparations for cleansing include diet in combination with a cathartic agent, gut lavage, and phosphate preparations. The diet used with a cathartic consists of clear liquids or is designed to leave a minimal colonic fecal residue with laxatives. Gut lavage solutions wash out the colon in a safe and effective manner. Phosphate preparations offer an attractive alternative due to smaller volumes required for ingestion; however, electrolyte disturbances can occur. This review discusses the development and clinical experience with various colon cleansing regimens and efforts to improve the tolerability and safety of preparation for colonoscopy, virtual colonoscopy, colon surgery, barium enema, and flexible sigmoidoscopy.

Current treatment options for chronic constipation.

Various agents are used for the medical management of chronic constipation but few have been carefully studied. This review examines available data concerning several bulk and fiber products, lubricating agents, stimulants, and osmotic laxatives, alone and in combination. Popular therapeutic options for initial treatment of chronic constipation are dietary fiber and medicinal bulk. Subsequent treatments if fiber is not successful or tolerated would include saline osmotic laxatives, lactulose, or stimulants like senna or bisacodyl. Recent data demonstrate polyethylene glycol laxative to be safe and effective as an initial or second-line agent for chronic constipation. Indications and use of surgery and biofeedback are also discussed.

Comparison of reduced volume versus four liters sulfate-free electrolyte lavage solutions for colonoscopy colon cleansing.

OBJECTIVE: In an attempt to improve patient tolerance for colonoscopy cleansing, a reduced volume lavage regimen with 2 L sulfate-free electrolyte lavage solution (SF-ELS, NuLYTELY, Braintree Laboratories, Braintree, MA) plus 20 mg p.o. bisacodyl (Half Lytely, Braintree Laboratories) was compared with standard 4 L SF-ELS lavage for safety and efficacy. METHODS: At two centers, 200 patients undergoing colonoscopy for routine indications were randomized to receive the reduced volume or standard 4 L method. The day before scheduled colonoscopy, study subjects were allowed a normal breakfast and clear liquids for lunch and dinner. Those randomized to receive the reduced volume method received four 5-mg bisacodyl tablets p.o. at noon. Six hours later, they received 2 L SF-ELS given as 10 oz every 10 min. Subjects randomized to receive 4 L SF-ELS also drank their solution at 6:00 PM in a similar fashion. Colonoscopists, unaware as to the randomized preparation received, rated efficacy of cleansing. Patient tolerance and various hematological and biochemical parameters were assessed. RESULTS: Physician assessment of colon cleansing showed no differences between those patients randomized to receive reduced volume (n = 93) or 4 L (n = 93) SF-ELS cleansing (p = 0.16). There was a profound reduction in preparation side effects. The reduced volume preparation had less fullness (p < 0.01), nausea (p < 0.01), vomiting (p = 0.01), and overall discomfort (p < 0.01). There were no clinically significant changes in hematology or blood chemistry associated with either preparation. CONCLUSIONS: Reduced volume preparation with 2 L SF-ELS and bisacodyl is safe and effective. Clinical symptoms from the reduced volume preparation are significantly reduced compared with traditional 4 L gut lavage.

Abdominal pain associated with lactose ingestion in children with lactose intolerance.

The causal relationship between lactose ingestion and gastrointestinal symptoms is questionable. The aim of this study was to assess symptoms associated with milk ingestion in children with lactose maldigestion. Thirty children (11 males) age 3 to 17 years with lactose maldigestion were studied. In a double-blind, crossover design, subjects ingested 240 mL daily of either lactose-hydrolyzed or lactose-containing milk for 14 days. Diaries were kept daily that recorded diet, medication use, and symptoms. There was a significant increase in abdominal pain experienced by study participants during the lactose ingestion period when compared to the lactose-free period. We conclude that ingestion of 12 g of lactose daily is associated with increased abdominal pain in susceptible children with lactose maldigestion. A trial of dietary lactose restriction may be beneficial in reducing abdominal pain in children with lactose maldigestion.

Women's colonic digestive health.

Digestive problems in women are common and sometimes debilitating. Twenty percent of women suffer from irritable bowel syndrome, 20% have constipation, and all American women will need screening for colon cancer, the number two cause of cancer death in women. This article reviews management of these disorders as well as lower gastrointestinal symptoms associated with menses, hysterectomy, fecal incontinence, and rectal bleeding.