Can Simvastatin Reduce the Need for Immunomodulatory Drugs to Treat Uveitis?: A Prospective, Randomized, Placebo-Controlled Trial.

Objective: To assess the efficacy of simvastatin 80 mg/day versus placebo in patients with noninfectious nonanterior uveitis receiving prednisolone ≥ 10 mg/day. Design: Randomized, double-masked, controlled trial. Subjects: Adult patients with noninfectious nonanterior uveitis on oral prednisolone dose of ≥ 10 mg/day. Methods: Patients were randomly assigned at a 1:1 ratio to receive either simvastatin 80 mg/day or placebo. A total of 32 patients were enrolled (16 in each arm), all of whom completed the primary end point, and 21 reached the 2-year visit (secondary end points). Main Outcome Measures: The primary end point was mean reduction in the daily prednisolone dose at 12 months follow-up. Secondary end points were mean reduction in prednisolone dose at 24 months, percent of patients with a reduction in second-line immunomodulatory agents, time to disease relapse, and adverse events. Results: Our results show that simvastatin 80 mg/day did not have a significant corticosteroid-sparing effect at 12 months (estimate: 3.62; 95% confidence interval [CI]: -8.15 to 15.38; P = 0.54). There was no significant difference between the groups with regard to prednisolone dose or change in dose at 12 and 24 months. There was no difference between the 2 groups in percent of patients with reduction in second-line agent by 24 months. Among patients who achieved disease quiescence, the median time to first relapse was longer for those receiving simvastatin (38 weeks, 95% CI: 14-54) than placebo (14 weeks, 95% CI: 12-52), although this was not statistically significant. There was no significant difference in adverse events or serious adverse events between the 2 groups. Conclusions: Simvastatin 80 mg/day did not have an effect on the dose reduction of corticosteroids or conventional immunomodulatory drugs at 1 and 2 years. The results suggest that it may extend the time to disease relapse among those who achieve disease quiescence. Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Quality of small bowel preparation for video-capsule endoscopy. Prospective comparison of two different preparations.

BACKGROUND/AIM: The best preparation for successful small bowel video-capsule endoscopy (VCE) is still unknown. The primary aim of our study was to compare sodium phosphate (PS) and polyethylene glycol (PEG) purge on the quality of small bowel preparation. METHODOLOGY: In this prospective, non-randomized, two centers study, we evaluated 47 and 48 consecutive outpatients who received PS and PEG preparations, respectively. Two independent investigators measured the proportion of small bowel transit time (SBTT) without clean mucosa. Two other investigators assessed bowel preparation independently, using a visual analogue scale (VAS). RESULTS: The proportion of SBTT without clean mucosa was similar for both preparations, in the proximal [3.8 (2.1-8.7) % vs. 4.85 (2.7-9.7) %, p = 0.24)] and in the distal half [31.9 (10.7-52.5) % vs. 22.9 (6.9-57.7) %, p = 0.48] of VCE recording. There was moderate - good correlation of VAS assessment of bowel preparation with the proportion of SBTT without clean mucosa in the proximal (r = 0.69, p < 0.001) and in the distal half (r = 0.76, p < 0.001) of the recording. The outcome measures of the studies were similar for both preparations. CONCLUSIONS: PS and PEG preparations result in similar quality of small bowel preparation and similar outcome measures of VCE studies. VAS assessment could be an alternative measure of bowel preparation in clinical practice.

Effects of ageing on small bowel video-capsule endoscopy examination.

OBJECTIVES: The effects of ageing on small bowel video-capsule endoscopy (VCE) studies have not been studied prospectively yet. METHODS: We prospectively investigated 120 consecutive VCE studies. Patients were divided into three age groups: <40, 40-64, and > or =65 yr. Two independent investigators examined the completion of the examination and measured the VCE gastric transit time (GTT), small bowel transit time (SBTT), and the proportion of VCE SBTT without clean intestinal mucosa. They also recorded study findings. RESULTS: We examined the videos of 32 (26.7%), 36 (30%), and 52 (43.3%) patients aged under 40, 40-64, and over 64 yr, respectively. VCE completion (cecum visualized) rate was similar in the three groups (81.2%, 77.8%, and 78.8%, respectively, P= 0.96). There was no difference in GTT (P= 0.22) and in SBTT (P= 0.8) among the three age groups. Although in univariate analysis, there was a trend (P= 0.057) for higher proportion of SBTT without clean mucosa in patients over 64 yr (22.65 [12.42-32.22]%) versus patients under 40 (12.65 [4.57-30.7]%) and patients aged 40-64 yr (12.55 [6.12-31.32]%), multivariate linear regression analysis has not confirmed this difference. Older patients had significantly less erosions and normal studies, but they had more angiodysplasias (P < 0.05). All four tumors were detected in the elderly. CONCLUSIONS: Ageing does not affect the completion rate and the quality of bowel preparation for VCE. However, elderly patients have fewer normal studies and more angiodysplasias and tumors in the small bowel.

Hospitalization rates for cholelithiasis and acute cholecystitis doubled for the aged population in Greece over the past 30 years.

OBJECTIVE: Gallbladder disease is becoming increasingly prevalent in Western countries and is a common cause of hospitalization. The objective of this study was to determine time trends in cholelithiasis and acute cholecystitis for hospitalization and disease case fatality in Greece between 1970 and 1998. MATERIAL AND METHODS: Data were obtained from the Annual Bulletin for the Social Welfare and Health Statistics of the National Statistics Service of Greece. Percentage changes in time trends were estimated by comparing the median values of the initial (1970-78) to the last (1989-98) 10-year study period for cholelithiasis and acute cholecystitis at discharge and for all deaths attributed to the disease. RESULTS: Over the study period, age-standardized hospitalization rates for cholelithiasis increased. The median hospitalization rate between the initial and last (178 and 258 per 100,000 of the population, respectively) 10-year study period increased by 44.7%, but peaked to 70.1% and 208.3% for the 70-79 and >80 years age groups, respectively. Case fatality rate declined by 56.8% and the median value was 0.24 per 100 patients hospitalized during the last 10-year period. CONCLUSIONS: Hospitalization rates for cholelithiasis and/or acute cholecystitis increased by 45%, and doubled for elderly patients, while the case fatality rate of the disease halved in Greece over the past 30 years.