Italian journal of gastroenterology and hepatology最新文献

Results from a controlled clinical trial indicate that low doses of polyethylene glycol solutions are more effective and have fewer side-effects than lactulose. Large doses of polyethylene glycol are effective in the treatment of faecal impaction. Resolution of faecal impaction was obtained in all patients, and in 25/30 patients with three administrations in a three-day period.

In patients with digestive complaints, endoscopy is the gold standard and is often the primary exploration. Positive findings in upper gastrointestinal endoscopy occur in 30 to 40% in relation to a benign or malignant structural disease. Negative findings occur therefore in 60 to 70% of cases: dyspepsia and/or reflux are functional diseases. Colonoscopy aims essentially at screening of colorectal cancer. Digestive cancer is very rare under 50 years, and most cases detected with symptoms are advanced; asymptomatic early and curable cancer is detected in screening. A negative finding at endoscopy is reliable in the hands of an experienced endoscopist controlling the risk of false negative and false positive findings. A reliable negative endoscopy is beneficial for the quality of life when it relieves anxiousness of the patient. It may be cost effective if drugs and consultations are decreased. Overuse of negative endoscopy is not so much through large indications, that in repetition of negative procedures. The relevance of negative endoscopy in screening for cancer in the upper and lower digestive tract, is whether is should be repeated. There is tendency to increased intervals in surveillance protocols. In the very near future the first role of endoscopy in the primary diagnosis could be challenged by concurrent techniques. Future progress is based upon a Quality Assurance program for quality, experience of the operator a control of the cost and a research programme on tolerance with a trend to reduced sedation.

There is increasing evidence that modifications in brain-gut communications are responsible for the occurrence of Functional Bowel Disorders. Based on various experimental models of modified gut sensitivity and the emergence of new pharmacological tools, it is now possible to identify new targets for the corrections of altered brain-gut communications and to improve our understanding of functional gastrointestinal disorders. Both local inflammatory related components and central nervous system acting factors are associated to trigger dysfunctioning and neuropeptides such as tachykinins, bradykinin and calcitonin gene-related peptide are involved in peripheral and spinal sensitization of afferent neurons. Serotonin released from entero chromaffin cells, mast cells, platelets or nerves also play a role, through different receptor subtypes, in initiating gut hypersensitivity. Brain modulation of impaired ascending messages also appears to be an important approach for the correction of symptoms related to gut hyper-responsiveness.

No definition of the term laxative is satisfactory since their mode of actions affects multiple mechanisms, absorption/secretion and motor activity. Laxatives are very heterogeneous chemically. They act by either holding water inside the bowel lumen (dietary fibre, osmotic laxatives), by inhibition of water absorption or stimulation of secretion (stimulant laxatives), or by stimulation of colonic motility (stimulant laxatives, 5HT4 agonists). Most laxatives have side-effects but these are usually mild.

Some objectives of the Rome International Congress of Gastroenterology and Digestive Endoscopy (1988) and their development during the past eleven years are described in the perspective of Roma99, the Seventh United European Gastroenterology Week.

Different doses of polyethylene glycol have different effects on intestinal function. In normal volunteers, low doses increase stool weight without modifying oro-anal transit time. In constipated patients, low doses decrease stool consistency, increase stool frequency, and facilitate stool evacuation without modifying stool weight and colonic transit time. Low doses of polyethylene glycol may be efficient in the treatment of functional constipation by effecting dilution water in the faeces and, thus, reducing stool consistency.

This brief review has explored the rationale for therapy of polyethylene glycol electrolyte solutions in subgroups of patients with chronic constipation. There appears to be a good rationale for their use in patients with colonic inertia or those with extrinsic denervation. However, first-line therapies such as dietary fibre and bulking agents should be tried initially prior to resorting to osmotic agents such as polyethylene glycol electrolyte solutions.

Gastrointestinal disease occurs in a high proportion of patients with primary immunodeficiency. While enteric infections are responsible for the gastrointestinal pathology in many individuals, it is now clear that infection alone is not sufficient to explain the gut pathology found in many immunodeficiencies. This article focuses on recent developments in this field and highlights the insights gained in understanding the complex relationship between immunodeficiency and the gut.