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1.
Medicine (Baltimore) ; 99(8): e19044, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080079

RESUMO

INTRODUCTION: The purpose of this study is to evaluate the efficacy and safety of acupuncture on relieving abdominal pain and distension in acute pancreatitis. METHODS AND ANALYSIS: We will electronically search PubMed, MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wanfang Database from their inception. Furthermore, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and gray literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to acupuncture treating acute pancreatitis will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data will be synthesized using a fixed effects model or random effects model depending on the heterogeneity test. The overall response rate and the visual analog scale score will be the primary outcomes. The time of first bowel sound, the time of first defecation, the length of hospitalization, acute physiology and chronic health evaluation II score, and the adverse events will also be assessed as secondary outcomes. RevMan 5 (version 5.3) statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation. Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals, whereas dichotomous data will be expressed in the form of risk ratios with 95% confidence intervals. ETHICS AND DISSEMINATION: The protocol of this systematic review does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and present at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42019147503.


Assuntos
Dor Abdominal/terapia , Terapia por Acupuntura/métodos , Pancreatite/terapia , Terapia por Acupuntura/efeitos adversos , China/epidemiologia , Defecação/efeitos dos fármacos , Defecação/fisiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Metanálise como Assunto , Pancreatite/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Escala Visual Analógica
2.
J Evid Based Integr Med ; 24: 2515690X19891952, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31840545

RESUMO

Traditionally people used Dodonaea viscosa for the treatment of various ailments, including diarrhea. Therefore, this study was aimed to evaluate the antidiarrheal activity of the 80% methanolic leaf extract of D viscosa against castor oil-induced diarrhea in mice models. Different doses of 80% methanolic leaf extract of D viscosa (100, 200, and 400 mg/kg) were evaluated for their antidiarrheal activities using castor oil-induced diarrhea, gastrointestinal transit, and enteropooling models in Swiss albino mice. At all test doses, the plant extract showed significant (P < .05) inhibition in the frequency of defecation of wet feces and total fecal output as compared to the control group. Similarly, at all dose ranges used the plant extract demonstrated significant (P < .05) reduction in an intraluminal fluid accumulation as compared to the untreated group. Besides, at higher doses, the plant extract also indicated significant (P < .05) antimotility activity in comparison with the control. In conclusion, these findings illustrated that the 80% methanolic leaf extract of D viscosa supported the traditional claim of antidiarrheal activity of the plant though further investigations are warranted.


Assuntos
Antidiarreicos/administração & dosagem , Diarreia/tratamento farmacológico , Extratos Vegetais/administração & dosagem , Sapindaceae/química , Animais , Antidiarreicos/isolamento & purificação , Óleo de Rícino/efeitos adversos , Defecação/efeitos dos fármacos , Diarreia/induzido quimicamente , Diarreia/fisiopatologia , Avaliação Pré-Clínica de Medicamentos , Feminino , Motilidade Gastrointestinal/efeitos dos fármacos , Trânsito Gastrointestinal/efeitos dos fármacos , Humanos , Camundongos , Extratos Vegetais/isolamento & purificação
3.
BMC Complement Altern Med ; 19(1): 311, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727037

RESUMO

BACKGROUND: To provide evidence for medical management of chronic idiopathic constipation (CIC) in China based on comparisons of all clinical practical interventions using Bayesian network meta-analysis. METHODS: We conducted a systematic literature review by searching PubMed, Embase, Cochrane Central, the China National Knowledge Infrastructure (CNKI), and the Wanfang Database (inception to May 2019) for randomized controlled trials (RCTs) for CIC in Chinese people. Only RCTs that recruited participants aged over 18 and diagnosed with CIC by the Rome II, III or IV criteria were included. We used three outcomes to examine efficacy. The risk ratio (RR) of the responder rate, based on ≥3 spontaneous bowel movements (SBMs) per week after treatment, was the primary outcome, and the SBM count per week and the Bristol score (BS) were secondary outcomes. In addition, adverse effects (AEs) were also considered a secondary outcome to evaluate safety. We conducted Bayesian network meta-analysis with random effects, and the RR or mean difference with its 95% credible interval was calculated. In addition, we ranked all treatments via their cumulative curves (SUCRA) and assessed the quality of evidence according to the GRADE criteria. RESULTS: We included a total of 42 trials (6820 participants) of 20 grouped interventions that included pharmacological and nonpharmacological treatments. For the primary outcome, fourteen interventions were significantly better than placebo, and Probiotics plus Mosapride (PB + MP) appeared superior to others (GRADE quality of evidence: Moderate to Low), followed by Prucalopride (PP) (High to Low) and Electroacupuncture (EA) (High to Low). For SBM, Compound sodium bicarbonate suppository (CSBS) appeared to be best, with an SUCRA value of 90% (High to Low). For BS, Lactulose plus Probiotics (LT + PB) was superior to others (Moderate to Low), followed by Polyethylene glycol (PEG) (High to Moderate). Although all interventions appeared non-significant when compared with placebo in terms of adverse effects, Lactulose plus Mosapride showed greater risk than others on ranking probability. CONCLUSIONS: Given the GRADE assessment, PB + MP, PP and EA may be the priory options with moderate certainty in the quality of evidence for the primary outcome. For SBM, a CSBS may be the best option with moderate certainty in the quality of evidence. For BS, PEG may be the priory option with high certainty in the quality of evidence. However, due to a lack of high certainty in the quality of evidence, caution is needed when recommending the interventions. Because of the limitations, an increased number of trials are required for more accurate results.


Assuntos
Constipação Intestinal/tratamento farmacológico , Teorema de Bayes , China , Constipação Intestinal/fisiopatologia , Defecação/efeitos dos fármacos , Humanos , Polietilenoglicóis/uso terapêutico , Probióticos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Supositórios/uso terapêutico
4.
Dis Colon Rectum ; 62(12): 1518-1527, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31567921

RESUMO

BACKGROUND: Split-dose bowel preparation is recommended for morning colonoscopy, although a same-day dose regimen is an alternative for afternoon colonoscopy. Same-day preparation for morning colonoscopy has rarely been evaluated. OBJECTIVE: We compared the bowel cleansing efficacy, bowel movement kinetics, safety profile, and patient tolerability of split-dose and same-day preparation using 4-L polyethylene glycol. DESIGN: This was a prospective, randomized, assessor-blinded study. SETTINGS: This study was performed at a tertiary center in Korea. PATIENTS: Study subjects were randomly assigned to the same-day or split-dose groups. For the same-day dose group, 4 L of polyethylene glycol were ingested on the day of colonoscopy starting at 5:00 AM for morning colonoscopy or 7:00 AM for afternoon colonoscopy. In the split-dose group, 2 L of polyethylene glycol were ingested at 9:00 PM the day before colonoscopy, and the remaining 2 L from 7:00 AM for morning colonoscopy or from 10:00 AM for afternoon colonoscopy. Colonoscopy was performed from 10:00 AM. MAIN OUTCOME MEASURES: The efficacy of bowel cleansing was evaluated using the Boston bowel preparation scale. The participants completed questionnaires asking about adverse events, bowel movement kinetics, and tolerability of the preparation before colonoscopy. RESULTS: A total of 339 subjects were included (same-day dose = 172; split dose = 167). One subject in each group did not undergo colonoscopy. The rate of successful cleansing did not differ between the groups (same-day dose = 98.8% vs split dose = 98.2%; p = 0.681). There were no instances of hemodynamic instability or aspiration in either group. Tolerability, including overall satisfaction and willingness to reuse, were comparable between the groups. LIMITATIONS: This was a single-center study. CONCLUSIONS: The bowel cleansing efficacy, safety profile, and tolerability of same-day dosing with polyethylene glycol were comparable with those of split dose. Therefore, same-day dosing with 4 L of polyethylene glycol is a feasible bowel preparation method. See Video Abstract at http://links.lww.com/DCR/B44. COMPARACIÓN DE LA EFICACIA DE LA LIMPIEZA INTESTINAL, LA SEGURIDAD, LA CINÉTICA DEL MOVIMIENTO INTESTINAL Y LA TOLERABILIDAD DEL PACIENTE DE LA PREPARACIÓN INTESTINAL EN EL MISMO DÍA Y EN DOSIS DIVIDIDAS UTILIZANDO 4 L DE POLIETILENGLICOL: UN ESTUDIO PROSPECTIVO ALEATORIZADO: Se recomienda la preparación del intestino en dosis divididas para la colonoscopia de la mañana, aunque un régimen de una sola dosis el mismo día es una alternativa para la colonoscopia en la tarde. La preparación de una sola dosis el mismo día para la colonoscopia matutina rara vez se ha evaluado.Comparamos la eficacia de la limpieza intestinal, la cinética del movimiento intestinal, el perfil de seguridad y la tolerabilidad del paciente de la dosis dividida y la preparación el mismo día utilizando 4 L de polietilenglicol.Este fue un estudio prospectivo, aleatorizado, cegado por el evaluador.Este estudio se realizó en un centro terciario en Corea.Los sujetos del estudio fueron asignados aleatoriamente a el grupo de una dosis en el mismo día o al grupo de dosis dividida. Para el grupo de dosis del mismo día, se ingirieron 4 L de polietilenglicol el día de la colonoscopia a partir de las 5 a.m. para la colonoscopia de la mañana o las 7 a.m. para la colonoscopia de la tarde. En el grupo de dosis dividida, se ingirieron 2 L de polietilenglicol a las 9 p.m. el día anterior a la colonoscopia, y los otros 2 L restantes a partir de las 7 a.m. para la colonoscopia de la mañana o desde las 10 a.m. para la colonoscopia de la tarde. La colonoscopia se realizó a partir de las 10 a.m.La eficacia de la limpieza intestinal se evaluó mediante la escala de preparación intestinal de Boston. Los participantes completaron cuestionarios preguntando sobre los eventos adversos, la cinética del movimiento intestinal y la tolerabilidad de la preparación antes de la colonoscopia.Se incluyeron un total de 339 sujetos (dosis el mismo día, 172; dosis dividida, 167). Un sujeto en cada grupo no se sometió a colonoscopia. La tasa de limpieza exitosa no difirió entre los grupos (dosis el mismo día, 98.8% versus dosis dividida, 98.2%; p = 0.681). No hubo casos de inestabilidad hemodinámica o aspiración en ninguno de los grupos. La tolerabilidad, incluida la satisfacción general y la voluntad de reutilización, fueron comparables entre los grupos.Este fue un estudio de centro único.La eficacia de la limpieza intestinal, el perfil de seguridad y la tolerabilidad de la dosificación en el mismo día con polietilenglicol fueron comparables con los de la dosis dividida. Por lo tanto, la dosificación en el mismo día con 4 L de polietilenglicol es un método factible de preparación intestinal. Vea el video del resumen en http://links.lww.com/DCR/B44.


Assuntos
Catárticos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Idoso , Catárticos/efeitos adversos , Colonoscopia/estatística & dados numéricos , Defecação/efeitos dos fármacos , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Polietilenoglicóis/efeitos adversos , Estudos Prospectivos , Inquéritos e Questionários , Centros de Atenção Terciária , Resultado do Tratamento
5.
J Med Food ; 22(10): 1009-1021, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31536448

RESUMO

Constipation is a common gastrointestinal disorder characterized by changes in intestinal habits. Increasing evidence indicates that long-term use of irritant laxatives causes serious side effects. Meanwhile, more than 50% of patients are dissatisfied with sense of use of non-prescriptional laxatives. ß-glucans are natural polysaccharides widely found in yeast, fungus, and plants, which have been reported to exhibit various pharmacological effects. The aim of this study was to characterize the effect of ß-glucans extracted from the bread yeast cell wall on loperamide-induced constipation mice. Forty mice were fed with loperamide (10 mg/kg) to make the constipation model and a diet supplemented with 2.5, 5, and 10 mg/kg ß-glucan. We assessed the defecation frequency, intestinal transit function of mice, as well as used high-throughput sequencing to analyze the intestinal microbiota composition and functional biological profiles data. Meanwhile, we detected expression of neurotransmitters including acetylcholinesterase, substance P, and serotonin (5-HT) and expression of tight junction protein (TJP) including zonula occludens-1 and mucin-2 in distal colon to characterize the possible molecular mechanisms. ß-glucans significantly enhanced intestinal motility and provided a possibility to regulate the expression of neurotransmitters and TJP in mice. The intestinal microecological portion of the treatment group partially recovered and was closer to the normal group. This study showed that ß-glucans can influence the intestinal microbiota and restore microecological balance to regulate the express of neurotransmitters and TJP to recover intestinal epithelial mechanical barrier. We suggested that ß-glucans could be used as an active nutritional supplement to protect the damaged intestinal barrier and help patients who have constipation complications and dysbiosis.


Assuntos
Constipação Intestinal/tratamento farmacológico , Microbioma Gastrointestinal , Loperamida/efeitos adversos , Saccharomyces cerevisiae/química , beta-Glucanas/farmacologia , Acetilcolinesterase/metabolismo , Animais , Constipação Intestinal/induzido quimicamente , Defecação/efeitos dos fármacos , Trânsito Gastrointestinal/efeitos dos fármacos , Masculino , Metagenoma , Camundongos , Camundongos Endogâmicos BALB C , Mucina-2/metabolismo , Serotonina/metabolismo , Substância P/metabolismo , Proteína da Zônula de Oclusão-1/metabolismo
6.
Neuropeptides ; 77: 101956, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31324387

RESUMO

The effects of the neurokinin NK2 receptor agonist [Lys5,MeLeu9,Nle10]-NKA(4-10) (LMN-NKA) on bladder and colorectal function were examined in minipigs. In anesthetized animals, subcutaneous (SC) administration of 30-100 µg/kg increased peak bladder and colorectal pressures. Increases in bladder and colorectal pressure were inhibited by a 15 min pretreatment with the NK2 receptor antagonist GR 159897 (1 mg/kg intravenously (IV)). Bladder and colorectal pressures were also increased after IV (0.3 µg/kg), intranasal (IN; 100 µg/kg) and sublingual administration (SL; 5 mg/kg). There was a nonsignificant trend for hypotension (16 or 12% decrease in mean arterial pressure) after 100 µg/kg SC and 0.3 µg/kg IV, respectively, but not after 100 µg/kg IN or 5 mg/kg SL. In conscious minipigs, 30-300 µg/kg SC caused a dose-related increase in defecation that was accompanied by emesis in 38% of subjects receiving 300 µg/kg. Urination was increased after 100 µg/kg SC but not lower or higher doses. The peak plasma exposure (Cmax) after 100 µg/kg SC was 123 ng/mL, and area under the curve (AUC) was 1790 min * ng/mL. Defecation response rates (~82%) were maintained after SC administration of LMN-NKA (30 µg/kg) given 3 times daily over 5 consecutive days. Defecation rates were higher after a single dose of 100 µg/kg IN compared with vehicle, but this did not reach significance. After 7-10 mg/kg SL, 83% of animals urinated and defecated, and none had emesis. The data support the feasibility of developing a convenient and well-tolerated route of administration of LMN-NKA for human use. Minipigs may be a suitable species for toxicology studies with LMN-NKA due to the relatively low rate of emesis in this species.


Assuntos
Colo/efeitos dos fármacos , Defecação/efeitos dos fármacos , Receptores da Neurocinina-2/agonistas , Reto/efeitos dos fármacos , Bexiga Urinária/efeitos dos fármacos , Micção/efeitos dos fármacos , Animais , Indóis/farmacologia , Piperidinas/farmacologia , Pressão , Receptores da Neurocinina-2/antagonistas & inibidores , Suínos , Porco Miniatura
7.
Am J Gastroenterol ; 114(6): 954-963, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31058652

RESUMO

OBJECTIVES: To determine patient preference for treating opioid-induced constipation (OIC) using naloxegol or polyethylene glycol (PEG) 3350 in patients receiving opioids for noncancer pain. METHODS: This crossover study included two 2-week active treatment periods, each preceded by a 1-week washout period (NCT03060512). Individuals with baseline Bowel Function Index scores ≥30 were randomized to 1 of 2 treatment sequences (naloxegol/PEG 3350 or PEG 3350/naloxegol). Patient preference (primary end point) was measured at the end of the second treatment period. RESULTS: Of 276 patients randomized, 246 completed both treatment periods and reported preference (per protocol). Similar proportions of patients reported overall preference for naloxegol (50.4%) or PEG 3350 (48.0%; P = 0.92); 1.6% reported no preference. Medication characteristics influencing preference were similar for both treatments, except convenience and working quickly, which were strong influences of preference for higher proportions of patients preferring naloxegol (69.9% and 39.0%, respectively) vs those preferring PEG 3350 (29.9% and 27.4%, respectively). Patients aged <50 years or receiving laxatives within the previous 2 weeks generally preferred naloxegol. Changes from baseline in overall Bowel Function Index and Patient Global Impression of Change scores were similar between treatments, but analyses according to treatment preference revealed clinical improvement aligned with reported preference. Safety profiles were generally consistent with known medication profiles. CONCLUSIONS: Almost equal proportions of patients with OIC reported similar preference for daily naloxegol or PEG 3350 treatment, and their preference was generally supported by clinically relevant and measurable improvements in OIC symptoms.


Assuntos
Analgésicos Opioides/efeitos adversos , Constipação Intestinal/tratamento farmacológico , Defecação/fisiologia , Morfinanos/administração & dosagem , Preferência do Paciente , Polietilenoglicóis/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/induzido quimicamente , Estudos Cross-Over , Defecação/efeitos dos fármacos , Relação Dose-Resposta a Droga , Eletrólitos , Feminino , Seguimentos , Humanos , Laxantes/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
8.
Int J Biol Macromol ; 133: 1090-1101, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31054300

RESUMO

The aim of this study is to probe new functions of a polysaccharide from Spirulina platensis (PSP) on constipation and intestinal microbiota in mice. Diphenoxylate-induced constipation in mice was treated with different doses of PSP, followed by examining the defecation patterns, levels of acetyl cholinesterase (AchE), nitric oxide (NO), and tissue section histopathology. The composition of intestinal microbiota was determined by genome sequencing analysis of the 16S rDNA. This study found that the average molecular weight of PSP was 29, 600 Da, and mainly monosaccharides of PSP were rhamnose (24.7%), glucose (16.15%) and galactose (13.32%). The beneficial effects of PSP treatment include defecation improvement, increase of AchE activity, reduction of NO concentration, renovation of the damaged intestinal villus and affection on the expression of some related genes in the constipated mice. In addition, PSP had significant effects on the gut microbiota, showing the enhancement in abundance of beneficial bacteria including Akkermansia, Lactobacillus, Butyricimonas, Candidatus Arthromitus and Prevotella, and the reduction in abundance of harmful bacteria such as Clostridium and Dorea. The present s uncovered a new function of PSP, indicating that PSP could be used in constipation therapies.


Assuntos
Constipação Intestinal/induzido quimicamente , Constipação Intestinal/tratamento farmacológico , Difenoxilato/efeitos adversos , Polissacarídeos Bacterianos/farmacologia , Spirulina/química , Animais , Vilosidades Coriônicas/efeitos dos fármacos , Vilosidades Coriônicas/metabolismo , Constipação Intestinal/metabolismo , Constipação Intestinal/fisiopatologia , Defecação/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Intestinos/efeitos dos fármacos , Masculino , Camundongos , Camundongos Endogâmicos ICR , Neurotransmissores/metabolismo , Polissacarídeos Bacterianos/uso terapêutico , Água/metabolismo
9.
J Gastrointestin Liver Dis ; 28(1): 41-46, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30851171

RESUMO

BACKGROUND AND AIM: Opioid induced constipation (OIC) is the most common side effect of opioid therapy. It can lead to a decreased quality of life. Naldemedine is a peripherally acting µ-opioid receptor antagonist that has been recently studied in randomized controlled trials (RCTs) for the management of OIC. The aim of this study is to perform a meta-analysis of existing clinical trials to estimate the efficacy and safety of naldemedine in opioid-induced constipation. METHODS: A systematic search of PubMed, CINAHL, Scopus, Cochrane database of systematic reviews, and ClinicalTrials.gov registry was performed in March 2018. Two independent reviewers systematically identified prospective RCTs published in the English language that compared the effect of oral naldemedine versus placebo in adults with OIC. Meta-analysis was performed using a random effects model to assess the primary outcome: spontaneous bowel movement (SBM) responder rates. Assessed secondary outcomes were: a change in SBM frequency per week from baseline during the treatment period, change from baseline in the frequency of complete SBM and incidence of treatment-emergent adverse events. Review Manager 5.3 software program was utilized for statistical analysis. RESULTS: Six RCTs met the inclusion criteria. A total of 2,762 patients were included in the meta-analysis. The proportion of SBM responders was significantly higher in the naldemedine group compared to the placebo group (56.4%, vs. 34.7%, p<0.00001). There was no statistically significant difference in treatment-emergent adverse events between naldemedine group and placebo group (mean odds ratio=1.18, p = 0.25, 95% CI: 0.89-1.55). Change in SBM frequency was higher in the naldemedine group versus placebo group (p<0.00001), as well as the change in complete SBM frequency. CONCLUSIONS: Naldemedine 0.2 mg daily significantly improved symptoms in patients with opioid-induced constipation and was generally well tolerated. These results support the use of naldemedine for the treatment of opioid-induced constipation.


Assuntos
Analgésicos Opioides/efeitos adversos , Constipação Intestinal/tratamento farmacológico , Defecação/efeitos dos fármacos , Motilidade Gastrointestinal/efeitos dos fármacos , Naltrexona/análogos & derivados , Antagonistas de Entorpecentes/uso terapêutico , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/diagnóstico , Constipação Intestinal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Naltrexona/efeitos adversos , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/efeitos adversos , Recuperação de Função Fisiológica , Resultado do Tratamento
10.
Equine Vet J ; 51(5): 653-657, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30835841

RESUMO

BACKGROUND: There are no data investigating the effect of systemic morphine on the size of the stomach or the food consumption in horses. OBJECTIVES: To evaluate gastrointestinal side effects of morphine administered systemically in healthy horses by the means of clinical and ultrasonographic evaluations. STUDY DESIGN: In vivo experiment. METHODS: On day 1 of the experiment, six healthy French Trotter mares were evaluated clinically and an abdominal ultrasonography was performed three times 4 h apart to record the size of the stomach, the number of contractions per minute of the duodenum, jejunum, caecum, left and right ventral colons. On Day 2, morphine was administered three times 4 h apart at the dose of 0.1 mg/kg i.v. and the same ultrasonographic examinations performed. On Day 3, only clinical and ultrasonographic examinations were performed as on Day 1. Amounts of hay and water ingested, frequency and weight of faeces were recorded throughout the study. RESULTS: Number of contractions of the duodenum, caecum, left and right ventral colons were significantly decreased after morphine administration. Size of the stomach was increased significantly with a cumulative effect of repeated doses of morphine. Hay (+0.4 kg/h, P<0.001) and water (+1.1 L/h, P<0.001) consumption were significantly increased. MAIN LIMITATIONS: The study was performed in healthy horses. CONCLUSIONS: Systemic morphine administration causes gastrointestinal depression, gastric distention and hyperphagia in horses. Clinical and ultrasonographical examinations are valuable tools to identify side effects of morphine administration in horses. Further studies are needed to assess side effects and monitoring in clinically painful cases. Horses receiving systemic morphine administration should be closely monitored for signs of gastric distention and, specifically, the amount of food given while receiving treatment should be controlled to avoid complications.


Assuntos
Cavalos , Hiperfagia/induzido quimicamente , Morfina/farmacologia , Estômago/efeitos dos fármacos , Animais , Defecação/efeitos dos fármacos , Feminino , Motilidade Gastrointestinal/efeitos dos fármacos , Injeções Intravenosas , Morfina/administração & dosagem
11.
Tech Coloproctol ; 23(1): 15-24, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30721376

RESUMO

BACKGROUND: Return of normal gastrointestinal (GI) function is a critical determinant of recovery after colorectal surgery. The aim of this meta-analysis was to evaluate whether perioperative intravenous (IV) lidocaine benefits return of gastrointestinal function after colorectal resection. METHODS: A comprehensive search of Ovid Medline, PubMed, Embase, Cochrane library, and clinicaltrials.org was performed on 1st July 2018. A manual search of reference lists was also performed. Inclusion criteria were as follows: randomized controlled trials (RCTs) of intravenous (IV) lidocaine administered perioperatively compared to placebo (0.9% saline infusion) as part of a multimodal perioperative analgesic regimen, human adults (> 16 years), and open or laparoscopic colorectal resectional surgery. EXCLUSION CRITERIA: non-colorectal surgery, non-placebo comparator, children, non-general anaesthetic, and pharmacokinetic studies. The primary endpoint was time to first bowel movement. Secondary endpoints were time to first passage of flatus, time to toleration of diet, nausea and vomiting, ileus, pain scores, opioid analgesia consumption, and length of stay. RESULTS: One hundred and ninety one studies were screened, with 9 RCTs meeting inclusion criteria (405 patients, four laparoscopic and five open surgery studies). IV lidocaine reduced time to first bowel movement compared to placebo [seven studies, 325 patients, mean weighted difference - 9.54 h, 95% CI 18.72-0.36, p = 0.04]. Ileus, pain scores, and length of stay were reduced with IV lidocaine compared with placebo. CONCLUSIONS: Perioperative IV lidocaine may improve recovery of gastrointestinal function after colorectal surgery. Large-scale effectiveness studies to measure effect size and evaluate optimum dose/duration are warranted.


Assuntos
Anestésicos Locais/efeitos adversos , Doenças do Colo/fisiopatologia , Colonoscopia/efeitos adversos , Laparoscopia/efeitos adversos , Lidocaína/efeitos adversos , Dor Pós-Operatória/fisiopatologia , Administração Intravenosa , Adolescente , Adulto , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/administração & dosagem , Doenças do Colo/cirurgia , Colonoscopia/métodos , Defecação/efeitos dos fármacos , Feminino , Humanos , Laparoscopia/métodos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica/efeitos dos fármacos , Adulto Jovem
12.
Expert Rev Gastroenterol Hepatol ; 13(3): 257-262, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30791758

RESUMO

INTRODUCTION: Prucalopride is a prokinetic drug, that has been commercially available in recent years for the treatment of chronically constipated patients. In this update of a previous 2016 article, we reviewed the more recent data supporting its role in the treatment of constipation and constipation-associated conditions. Areas covered: We carried out an extensive literature review on the effects of prucalopride for the years 2012-2018 by means of scientific databases and manual research. More evidence was found on its possible therapeutic role in conditions in which constipation plays a role as an associated symptom, such as opioid-induced constipation, constipation-predominant irritable bowel syndrome, post-operative ileus, colonic diverticular disease, drug-related constipation, and chronic intestinal pseudo-obstruction. Expert opinion: Based on the added literature evidence, we feel that prucalopride is an effective, although expensive, drug for the treatment of primary and secondary forms of constipation, and of other clinical conditions associated with constipation.


Assuntos
Benzofuranos/uso terapêutico , Constipação Intestinal/tratamento farmacológico , Defecação/efeitos dos fármacos , Motilidade Gastrointestinal/efeitos dos fármacos , Intestinos/efeitos dos fármacos , Laxantes/uso terapêutico , Agonistas do Receptor 5-HT4 de Serotonina/uso terapêutico , Benzofuranos/efeitos adversos , Benzofuranos/economia , Constipação Intestinal/diagnóstico , Constipação Intestinal/economia , Constipação Intestinal/fisiopatologia , Análise Custo-Benefício , Custos de Medicamentos , Humanos , Intestinos/fisiopatologia , Laxantes/efeitos adversos , Laxantes/economia , Recuperação de Função Fisiológica , Agonistas do Receptor 5-HT4 de Serotonina/efeitos adversos , Agonistas do Receptor 5-HT4 de Serotonina/economia , Resultado do Tratamento
13.
Expert Rev Gastroenterol Hepatol ; 13(4): 397-406, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30791771

RESUMO

BACKGROUND: Linaclotide is approved for treating irritable bowel syndrome with constipation (IBS-C; 290 µg QD) and chronic idiopathic constipation (CIC; 145 µg or 72 µg QD). These analyses aimed to assess linaclotide safety in a large, pooled Phase 3 population. METHODS: In six randomized controlled trials (RCTs), patients received linaclotide (72 µg, 145 µg, 290 µg) or placebo daily for 12-26 weeks; in two long-term safety (LTS) studies, patients received open-label linaclotide for ≤78 additional weeks. Laboratory values, vital signs, and treatment-emergent adverse events (TEAEs) were assessed. RESULTS: Overall, 3853 patients received ≥1 dose of linaclotide. The most common TEAE was diarrhea (majority [90.5% in RCTs] mild/moderate). Linaclotide patients experienced 1.1 diarrhea TEAE per patient-year in the RCTs (0.2 in placebo), and 0.3 in the LTS studies. In RCTs, 6.9% linaclotide and 3.0% placebo patients discontinued due to any adverse event (AE); 4.0% linaclotide and 0.3% placebo patients discontinued due to diarrhea. In LTS studies, 9.4% patients discontinued due to any AE, and 3.8% due to diarrhea. Serious AEs (SAEs) were rare and similar across treatment groups; there were no SAEs of diarrhea. CONCLUSION: These pooled analyses of patients treated for ≤104 weeks confirm linaclotide's overall safety.


Assuntos
Constipação Intestinal/tratamento farmacológico , Defecação/efeitos dos fármacos , Agonistas da Guanilil Ciclase C/uso terapêutico , Síndrome do Intestino Irritável/tratamento farmacológico , Peptídeos/uso terapêutico , Doença Crônica , Ensaios Clínicos Fase III como Assunto , Constipação Intestinal/diagnóstico , Constipação Intestinal/fisiopatologia , Diarreia/induzido quimicamente , Diarreia/fisiopatologia , Agonistas da Guanilil Ciclase C/efeitos adversos , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/fisiopatologia , Peptídeos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento
14.
Nutrients ; 11(1)2019 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-30621208

RESUMO

The aim of this systematic review and meta-analysis was to assess the effects of ß-fructan supplementation on bowel function in healthy volunteers and patients. The search process was based on the selection of publications listed in the Pubmed and EUPMC database until December 2017, plus two unpublished studies, to identify studies evaluating the impact of ß-fructans on bowel movement and stool parameters. Forty-seven publications were selected for inclusion. Primary parameter was frequency of bowel movements, evaluated by the number of defecations per day during the study period. Secondary outcomes were stool consistency, stool dry and wet weights, and transit time. Short-chain (DP < 10) ß-fructans contributed to increased stool frequency (0.36 defecation +/- 0.06 per day; p < 0.001), while no significant effect was reported with long-chain (DP ≥ 10) ß-fructans (-0.03 +/- 0.11, p = 0.82). A minimal increase in stool wet weight was also statistically demonstrated with short-chain ß-fructans. Moreover, the meta-analysis highlighted significant differences in stool consistency in contrast to fecal dry weight after ß-fructan supplementation. This systematic review and meta-analysis indicates that short-chain ß-fructan supplementation has a positive effect on bowel function by significantly increasing the frequency of bowel movements.


Assuntos
Fibras na Dieta/administração & dosagem , Frutanos/administração & dosagem , Intestinos/efeitos dos fármacos , Intestinos/fisiologia , Constipação Intestinal/dietoterapia , Constipação Intestinal/prevenção & controle , Defecação/efeitos dos fármacos , Suplementos Nutricionais , Fezes , Trânsito Gastrointestinal , Humanos , Prebióticos/administração & dosagem
15.
Food Funct ; 10(2): 646-651, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30652171

RESUMO

The beneficial effect of wheat fibres on faecal bulk and stool pattern has mainly been observed with intact wheat fibres. This study investigates the effect of extrinsic wheat fibre (VITACEL® wheat fibre), which can be easily incorporated in many food products, on faecal bulk, stool pattern, gastrointestinal complaints, satiety and food liking. In a double-blind randomized crossover trial, healthy male volunteers received meal boxes for 10 days, containing various food products enriched with extrinsic wheat fibre (∼20 grams of additional fibre per day) or control food products containing conventional levels of fibre with similar taste, appearance and caloric values. Meal boxes were integrated in the normal dietary pattern. Stool frequency, stool consistency, gastrointestinal complaints, satiety and product liking were assessed daily, and the last 5 days of each intervention, participants collected all their faeces to analyse faecal bulk. We found that consumption of extrinsic wheat fibre-enriched products significantly enhanced faecal bulk; faecal wet and dry weight showed a 1.41 ± 0.1 and 1.55 ± 0.1 times increase compared to control, respectively (p < 0.01). Extrinsic wheat fibre intervention furthermore increased stool frequency (1.3 ± 0.1 defecations per day compared to 1.1 ± 0.1 defecations per day during control diet, p < 0.05), but did not affect stool consistency, satiety, gastrointestinal complaints or product liking. So, increased consumption of extrinsic wheat fibre enhances faecal bulk and stool frequency. As this extrinsic wheat fibre can be easily incorporated in many food products without affecting appearance or taste, it might facilitate the increase of overall fibre intake and subsequently improve (intestinal) health.


Assuntos
Defecação/efeitos dos fármacos , Fibras na Dieta/administração & dosagem , Fibras na Dieta/farmacologia , Fezes/química , Triticum/química , Adulto , Estudos Cross-Over , Fibras na Dieta/análise , Método Duplo-Cego , Análise de Alimentos , Humanos , Masculino , Resposta de Saciedade
16.
J Sci Food Agric ; 99(6): 3045-3056, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30488458

RESUMO

BACKGROUND: This study investigated the in vivo prophylactic effect of probiotic chocolate on constipation. Rats were administered chocolate containing 2.5 × 1010 CFU g-1 of probiotics daily for 4 weeks and treated with loperamide (5 mg kg-1 ) daily at the fourth week of treatment. RESULTS: Probiotic chocolate treatment significantly (P < 0.05) increased the intestinal motility, colon length, fecal moisture content and number of excreted fecal pellets in constipated rats. Moreover, quantitative real-time polymerase chain reaction data and histological images also revealed that both probiotic chocolate LYC and BB12 treatments were capable of upregulating the mRNA expression levels of colonic ZO-1, occludin and AQP8, leading to the maintenance of the defensive barrier function in the constipated rats compared with the negative controls. Interestingly, these treatments also modulated gut bacterial populations by increasing the abundance levels of Lactobacillus and Bifidobacterium, as well as reducing the abundance level of Enterobacteriaceae. CONCLUSION: The present study demonstrated that probiotic chocolate LYC and BB12 could potentially be used as alternative agents for prophylactic constipation. © 2018 Society of Chemical Industry.


Assuntos
Chocolate/microbiologia , Constipação Intestinal/prevenção & controle , Intestinos/fisiopatologia , Probióticos/administração & dosagem , Animais , Bifidobacterium animalis/química , Bifidobacterium animalis/metabolismo , Chocolate/análise , Constipação Intestinal/fisiopatologia , Defecação/efeitos dos fármacos , Fezes/microbiologia , Feminino , Humanos , Lactobacillus plantarum/química , Lactobacillus plantarum/fisiologia , Probióticos/química , Ratos , Ratos Sprague-Dawley , Streptococcus thermophilus/química , Streptococcus thermophilus/fisiologia
19.
Dig Dis Sci ; 64(3): 838-845, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30370492

RESUMO

BACKGROUND: Irritable bowel syndrome (IBS) occurs in up to 33% of Gulf War (GW) Veterans. Alterations in gut microflora including small intestinal bacterial overgrowth (SIBO) during deployment may play a role in development of IBS. Rifaximin is a minimally absorbed antibiotic speculated to improve IBS symptoms, in part, by restoring normal gut microflora. The aim of this study was to compare rifaximin to placebo on IBS symptoms and quality of life (QOL) in GW Veterans with IBS without constipation. METHODS: A double-blind, placebo-controlled study was performed. One hundred and twenty-two GW Veterans with IBS (Rome III) from our database and referral to gastroenterology and internal medicine clinics were screened. After a 2-week run-in period, 50 patients were randomized (1:1) to receive either rifaximin 550 gm or placebo twice daily for 2 weeks in a double-blind study. Patients were advised not to change their diet or medications during the study. The symptoms assessed were: (1) stool frequency, (2) stool consistency (Bristol stool scale, 1-7, very hard to watery), (3) urgency (1 = yes/0 = no daily for 7 days), (4) severity of abdominal pain (0-4, none to severe), (5) severity of bloating (1-4, none to severe), and (6) global improvement scale (1-7, substantially worse to substantially improved). These were recorded for 7 consecutive days and then averaged across the 7 days, to generate a continuous variable. The symptom data were compared after 2 weeks of treatment. QOL was assessed using IBS-QOL. The lactulose hydrogen breath test (LHBT) was performed at baseline and after 2 weeks of treatment. RESULTS: Fifty Veterans were randomized to receive treatment; 3 withdrew and 3 were lost to follow-up. Data were analyzed from 44 patients (38 men, 6 women, median age 52, range 33-77 years). Rifaximin was not associated with significant improvement in global symptoms, abdominal pain, bloating, stool urgency, frequency, or consistency (all P ≥ 0.25) or QOL (all P ≥ 0.26). Normalization of SIBO by LHBT was not different between rifaximin- and placebo-treated Veterans (7 vs. 22%, P = 0. 54). CONCLUSION: Rifaximin was not effective in improving IBS symptoms and QOL in GW Veterans with non-constipated IBS.


Assuntos
Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Testes Respiratórios/métodos , Microbioma Gastrointestinal/efeitos dos fármacos , Guerra do Golfo , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/tratamento farmacológico , Lactulose/administração & dosagem , Rifaximina/uso terapêutico , Veteranos , Adulto , Idoso , Antibacterianos/efeitos adversos , Bactérias/crescimento & desenvolvimento , Bactérias/metabolismo , Defecação/efeitos dos fármacos , Método Duplo-Cego , Feminino , Humanos , Síndrome do Intestino Irritável/microbiologia , Síndrome do Intestino Irritável/fisiopatologia , Lactulose/metabolismo , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Qualidade de Vida , Rifaximina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
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