scholarly journals Efficacy of Hymecromone in Post-Cholecystectomy Patients

2021 ◽  
Vol 31 (4) ◽  
pp. 37-44
Author(s):  
A V. Okhlobystin ◽  
A. К. Ufimtseva ◽  
M. A. Tatarkina ◽  
O. Z. Okhlobystina ◽  
V. T. Ivashkin
Keyword(s):  
Abdominal Pain ◽  
Gallstone Disease ◽  
Sphincter Of Oddi ◽  
Sphincter Of Oddi Dysfunction ◽  
Biliary Pain ◽  
Full Dose ◽  
Half Dose ◽  
Group A ◽  
Group B ◽  
Symptomatic Gallstone Disease

Background. The cholecystectomy is the major cause of sphincter of Oddi dysfunction (SOD), that may be classified as post-cholecystectomy syndrome (PCES). Treatment of PCES requires in most of the cases application of selective antispasmodic drugs.Aim. To evaluate efficacy and safety of hymecromone in patients with post-cholecystectomy SOD, to compare standard and reduced doses of hymecromone.Methods. Overall, 26 patients were enrolled in non-interventional comparative study: 2 males, 24 females, aged from 25 to 74 years. All patients underwent cholecystectomy for symptomatic gallstone disease within 1 to 10 years prior to beginning of the study. All patients were diagnosed to have SOD according to Rome IV Diagnostic Criteria for functional biliary sphincter of Oddi disorder (E1b). All patients underwent hymecromone monotherapy for 3 weeks. Patients were randomized to group A and B to receive full-dose or half-dose of the drug respectively.Results. Abdominal pain completely subsided in 85 % of patients, significant improvement was found for bloating and diarrhea. Mild increase in fasting common bile duct (CBD) diameter after treatment (7.23 ± 0.99 vs 6.78 ± 1.01; p = 0.029) was attributed to choleretic action of hymecromone. Hymecromone resulted in significant improvement of CBD response to fatty meal stimulation (ΔCBD): –1.08 ± 0.46 mm vs –0.10 ± 0.33 mm pretreatment (p = 0.016). Degree of improvement was more pronounced in the group A (full-dose) as compared to group B (half-dose) for abdominal pain (Z = 2.74, p = 0.031), bloating (Z = 2.63, p = 0.035) and constipation (Z = 2.61, p = 0.038)Conclusion. Hymecromone demonstrated itself to be an effective and safe drug, that may be applied both in standard and half dose. However, the efficacy of full-dose is higher both for the treatment of biliary pain and dyspeptic symptoms. Transabdominal ultrasound may be applied as a reliable test for both prediction of treatment efficacy and to monitor patients state during treatment course.

scholarly journals LAPAROSCOPIC CHOLECYSTECTOMY IN CIRRHOTIC PATIENTS

2012 ◽  
Vol 19 (03) ◽  
pp. 364-368
Author(s):  
MUHAMMAD SAJID ◽  
Junaid MISBAH
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallstone Disease ◽  
Site Infection ◽  
Class A ◽  
Group A ◽  
Cirrhotic Patients ◽  
Group B ◽  
Symptomatic Gallstone Disease ◽  
Study Setting ◽  
Surgical Unit

Objective: It was conducted to evaluate laparoscopic cholecystectomy in cirrhotics in terms of procedural safety and betteroutcome with decreased morbidity. Study Design: A retrospective, multicenteric study. Setting: Surgical Unit-III and IV DHQ Faisalabad.Period: Jan 2000 to Dec 2009. Methods: 2610 patients undergoing laparoscopic cholecystectomy from January 2000 to December 2009 forcholecystitis and symptomatic gallstone disease. 61 of the patients being cirrhotics falling in child’s class A&B. Evaluation of results was done byanalyzining the data in SPSS V-17. Results: of the 2610 patients who underwent laparoscopic cholecystectomy, 61(2.3%) were cirrhotic. Ofthese 61, 47(77%) belonged to Childs group A and 14(23%) were group B. Hepatitis C was the major cause of cirrhosis (72%). Morbidity incirrhotics was 11.4% in the form of ascities leakage (57%) and port site infection (43%). Mean hospital stay was 2±1 days and the meanoperative time as 60±20 minutes in cirrhotics. Conclusions: Laparoscopic cholecystectomy offers a better post op recovery and decreasedmorbidity in Childs group A & B cirrhotics as it does in non cirrhotic patients.

scholarly journals Efficacy of trimebutine in the treatment of functional gastrointestinal disorders: an observational multicenter study

2021 ◽  
Vol 93 (8) ◽  
pp. 897-903
Author(s):  
Dmitry N. Andreev ◽  
Igor V. Maev
Keyword(s):  
Abdominal Pain ◽  
Rating Scale ◽  
Epigastric Pain ◽  
Functional Gastrointestinal Disorders ◽  
Sphincter Of Oddi ◽  
Gastrointestinal Disorders ◽  
Sphincter Of Oddi Dysfunction ◽  
Interventional Study ◽  
Biliary Pain ◽  
Postprandial Fullness

Aim. Evaluation of the practice of using trimebutine (tablets, 300 mg, extended release), for the treatment of patients with functional gastrointestinal disorders (FGID) in primary health care. Materials and methods. A prospective observational multicenter non-interventional study was carried out, which included patients of both sexes aged 18 to 60 years with a verified diagnosis of functional gastrointestinal disorders (functional dyspepsia, irritable bowel syndrome, biliary tract dysfunction, sphincter of Oddi dysfunction, postcholecystectomy syndrome). Trimebutine was prescribed in accordance with the instructions for medical use: orally, 300 mg twice per day for 28 days. The severity of simptoms was evaluated by five-point rating scale. Results. The study included 4433 patients, the per protocol sample consisted of 3831 people. The proportion of patients with a significant decrease in the severity of abdominal pain after treatment was 74.73% (95% confidence interval CI 73.3276.11). At the and of the study a statistically significant decrease in the severity of FGID` simptoms was observed: epigastric pain/burning (mean score at the 1st visit was 1.21 [95% CI 1.181.25], at the 2nd visit 0.22 [95% CI 0.20.23]; p0.001), abdominal pain (1st visit 2.01 [95% CI 1.982.04), 2nd visit 0.33 [95% CI 0.310.35]; p0.001), biliary pain (1st visit 1.22 [95% CI 1.181.26], 2nd visit 0.2 [95% CI 0.190.22]; p0.001), postprandial fullness and early satiation (1st visit 1.29 [95% CI 1.251.32], 2nd visit 0.21 [95% CI 0.190.22]; p0.001), severity of heartburn (1st visit 0.92 [95% CI 0.880.95], 2nd visit 0.18 [95% CI 0.170.20]; p0.001), belching (1st visit 1.13 [95% CI 1.091.16], 2nd visit 0.22 [95% CI 0.210.24]; p0.001), as well as abdominal distention (1st visit 1.99 (95% CI 1, 96, 2.03), 2nd visit 0.43 [95% CI 0.410.45]; p0.001). Conclusion. The present prospective observational multicenter non-interventional study has demonstrated that trimebutine is an effective approach to treating FGID.

scholarly journals Sphincter of Oddi Dysfunction: A Perplexing Presentation

2016 ◽  
Vol 10 (3) ◽  
pp. 714-719 ◽  
Author(s):  
Sana Ahmad Din ◽  
Iman Naimi ◽  
Mirza Beg
Keyword(s):  
Abdominal Pain ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Sphincter Of Oddi ◽  
Abdominal Ultrasound ◽  
Sphincter Of Oddi Dysfunction ◽  
Sphincter Pressure ◽  
Abdominal Symptoms ◽  
Biliary Sphincterotomy ◽  
Bile Drainage ◽  
Oddi Dysfunction

Sphincter of Oddi dysfunction is caused by stenosis or dyskinesia of the sphincter of Oddi, leading to blockage of bile drainage from the common bile duct. We present the case of a 16-year-old female with chronic abdominal pain who underwent laparoscopic cholecystectomy for cholelithiasis but continued to experience abdominal pain, nausea, and vomiting along with persistently elevated ALT and AST levels. Postoperative abdominal ultrasound was nondiagnostic. Esophagogastroduodenoscopy showed mild reflux esophagitis and mild chronic Helicobacter pylori-negative gastritis. Omeprazole was started, but it did not decrease the frequency and severity of the abdominal symptoms. Magnetic resonance cholangiopancreatography did not reveal any pathology. Endoscopic retrograde cholangiopancreatography with manometry confirmed an elevated biliary sphincter pressure. Biliary sphincterotomy was performed, and the symptoms improved.

scholarly journals Recombinant human granulocyte-macrophage colony-stimulating factor ameliorates zidovudine-induced neutropenia in patients with acquired immunodeficiency syndrome (AIDS)/AIDS-related complex

Blood ◽  
1991 ◽  
Vol 78 (12) ◽  
pp. 3148-3154 ◽  
Author(s):  
JD Levine ◽  
JD Allan ◽  
JH Tessitore ◽  
N Falcone ◽  
F Galasso ◽  
...  
Keyword(s):  
Full Dose ◽  
Gm Csf ◽  
Aids Related Complex ◽  
Group A ◽  
Acquired Immunodeficiency ◽  
Macrophage Colony Stimulating Factor ◽  
Macrophage Colony ◽  
Group B ◽  
Immunodeficiency Syndrome ◽  
Stimulating Factor

Abstract To evaluate the effect of recombinant granulocyte-macrophage colony- stimulating factor (GM-CSF) on patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) who were intolerant to zidovudine because of neutropenia, we performed a randomized, open- label study in which patients were assigned to one of two groups. Zidovudine was discontinued in group A patients before instituting GM- CSF treatment and was restarted in a graduated fashion over 4 weeks. Group B patients continued on full-dose (1,200 mg/d) zidovudine therapy while beginning GM-CSF therapy. A total of 17 patients were entered, eight in group A and nine in group B. Five of eight patients in group A and seven of nine in group B had a history of Pneumocystis carinii pneumonia (PCP). All were homosexual males, except one female in group A who was the sex partner of a bisexual male with AIDS. All patients had neutropenia (absolute neutrophil count [ANC] less than 1,000/microL) while taking full-dose zidovudine. The mean CD4 (+/- SD) lymphocyte level was 37 (+/- 29)/microL and 39 (+/- 44)/microL in groups A and B, respectively. After randomization, patients were begun on subcutaneous GM-CSF at a dose of 1.0 microgram/kg/d. Patients in group A received 2 weeks of daily GM-CSF, at which time zidovudine was restarted if the ANC was greater than 1,000/microL; if the ANC was less than 1,000/microL, the dose of GM-CSF was increased to 3.0 micrograms/kg, and at 2-week intervals either zidovudine was restarted or the dose of GM-CSF was increased to 5 micrograms/kg and then 10 micrograms/kg, to maintain the ANC greater than 1,000/microL. Group B patients received full-dose zidovudine concurrently with GM-CSF administration. The dose of GM-CSF was increased every 2 weeks if necessary to keep the ANC greater than 1,000/microL while maintaining full-dose zidovudine therapy. Patients in each group showed an increase in total white blood cell (WBC) count. Neutrophils and eosinophils were responsible for the majority of this increase. Patients in group A had a more rapid increase in WBC than those in group B; however, by week 8, the WBC in each group was essentially equal. Viral replication as measured by human immunodeficiency virus (HIV) p24 antigen (Ag) was decreased in four patients in each group, increased in one patient in each group, and remained unchanged in the remainder. The ability to culture virus from peripheral blood mononuclear cells was not changed by the regimen. The major toxicities of the regimen were fever and malaise.(ABSTRACT TRUNCATED AT 400 WORDS)

scholarly journals Clinical features and management of painless biliary type sphincter of Oddi dysfunction

2019 ◽  
Vol 47 (7) ◽  
pp. 2940-2950
Author(s):  
Hiroyuki Miyatani ◽  
Hirosato Mashima ◽  
Masanari Sekine ◽  
Satohiro Matsumoto
Keyword(s):  
Bile Duct ◽  
Liver Dysfunction ◽  
Endoscopic Sphincterotomy ◽  
Sphincter Of Oddi ◽  
Sphincter Of Oddi Dysfunction ◽  
Short Term ◽  
Biliary Pain ◽  
Oddi Dysfunction ◽  
Acute Cholestasis ◽  
Symptom Recurrence

Objective The objective of this study was to clarify the characteristics and management of painless biliary type sphincter of Oddi dysfunction (SOD). Methods From June 2002 to July 2018, 12 patients who had recurrent liver dysfunction with a dilated bile duct or acute cholestasis of unknown cause without biliary pain (painless SOD) were included in this study. These patients’ characteristics were compared with those of 36 patients with biliary type SOD based on the conventional definition (criteria-based SOD). Results Patients with painless SOD had significantly more prominent bile duct dilation than patients with criteria-based SOD (13.9 vs. 12.2 mm, respectively). Prophylactic biliary drainage was performed significantly more often in patients with painless SOD than criteria-based SOD (67% vs. 11%, respectively). The short-term effectiveness rate of endoscopic sphincterotomy, the symptom recurrence rate, and the incidence of adverse events were not significantly different between the two groups. Conclusions Painless SOD is a specific subtype of biliary SOD that causes recurring liver dysfunction or acute cholestasis without biliary pain. Endoscopic sphincterotomy was effective in the present study, but the relapse rate was as high as that in typical SOD.

MO696INCREMENTAL PERITONEAL DIALYSIS: BENEFICIAL EFFECTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Adriana Fernandes ◽  
João Carvão ◽  
Rita Veríssimo ◽  
Patrícia Branco ◽  
Patricia Matias ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Hospital Admissions ◽  
Angiotensin Receptor Blockers ◽  
Cardiac Insufficiency ◽  
Full Dose ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background and Aims Incremental peritoneal dialysis (Incr_Dial) is a renal replacement therapy strategy based on lower dose prescription rather than the standard “full dose” (Full_Dial). Individualized clearance goals were achieved combining residual renal function (RRF) and peritoneal clearance. Maintaining RRF is a crucial issue to peritoneal dialysis (PD) patients and the best PD strategy to preserve it is subject to debate. The aim of this study is to compare Incr_Dial and Full_Dial in terms of RRF preservation and other clinical outcomes. Method This was a single-center, retrospective descriptive study. We included a cohort of incident and prevalent adult PD patients in the PD Unit between January – December of 2020. Patients without a follow-up < six months and who started PD at another center were excluded. Patients were assigned according to their first PD protocol in two groups – Group A: Incr_Dial protocol (continuous ambulatory PD: less than four dwells daily, less than 2 L dwell volumes, less than seven days a week treatment, or some combination of these; automated PD: without a long dwell, less than 10 L daily delivered by cycler and day dwells, treatment for less than 7 days a week or some combination of these); Group B: Full_Dial protocol. Statistical analysis was performed using SPSS 20.0. Statistical significance level p <0.05. Results Among 84 PD patients, 68% underwent incremental PD (Group A) and 31% underwent conventional full-dose PD (Group B). The mean age was 55.9±15.4 years, 60.7% were male and 32.5% diabetic. There were no statistically significant differences between the two groups regarding: demographic characteristics, comorbidities (diabetes, hypertension, cardiac insufficiency or ischemic heart disease) and drugs (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and/or loop diuretics). The median Incr_Dial duration to achieve PD full dose was 10.2 months (IQ 5.1-17). At the beginning of PD, there was no statistically significant difference in diuresis between both groups (A: 1.79L vs B: 1.2L, p=0.07), however after 6 months of PD there was a superior urinary output in Group A (A: 1.67L vs B: 1.1L, p=0.037). Group A (Incr_Dial) was also associated with a superior renal clearance of creatinine at the beginning (A: 81 L/sem/1.73m2 vs B: 56.8L/sem/1.73m2, p=0.021) and after 12 months (A: 70.7L/sem/1.73m2 vs B: 26.3 L/sem/1.73m2, p<0.01); and superior Kt/V renal/week at the beginning (A: 1.48 vs B: 1.02, p=0.02) and after 12 months (A: 1.28 vs B: 0.49, p<0.001). There are no differences between mortality (A: 1.9% vs B: 12%, p=0.094), peritonitis-free time (A: 158 days vs B: 236 days, p=0.133) and the numbers of peritonitis per year (A: 0.32 vs B: 0.5, p=0.940). However, the rate of hospital admissions per year was lower in Group A (A: 0.22 vs B: 0.70, p=0.001). Conclusion Incremental PD is a safe strategy of renal replacement therapy to start PD. In our PD population, it showed similar patient survival rates and a significantly less hospital admissions. Incremental PD was also beneficial for preserving RRF when compared to full-dose PD.

The effect of endoscopic sphincterotomy on the motility of the gallbladder and sphincter of Oddi in patients with acalculous biliary pain syndrome

2013 ◽  
Vol 154 (8) ◽  
pp. 306-313 ◽  
Author(s):  
Attila Szepes ◽  
Zsolt Dubravcsik ◽  
László Madácsy
Keyword(s):  
Ejection Fraction ◽  
Endoscopic Sphincterotomy ◽  
Pain Syndrome ◽  
Sphincter Of Oddi ◽  
Gallbladder Motility ◽  
Sphincter Of Oddi Dysfunction ◽  
Biliary Pain ◽  
Gallbladder Ejection Fraction ◽  
Oddi Dysfunction ◽  
Acalculous Biliary Pain

Introduction: Sphincter of Oddi dysfunction usually occurs after cholecystectomy, but it can sometimes be detected in patients with intact gallbladder too. The diagnostic value of the non-invasive functional tests is not established in this group of patients and the effects of sphincterotomy on transpapillary bile outflow and gallbladder motility are unknown. Aims: The aim of this study was to determine the effect of endoscopic sphincterotomy on the gallbladder ejection fraction, transpapillary bile outflow and the clinical symptoms of patients with acalculous biliary pain syndrome. Patients and methods: 36 patients with acalculous biliary pain syndrome underwent quantitative hepatobiliary scintigraphy, and all of them had decreased cholecytokinin-induced gallbladder ejection fraction. The endoscopic manometry of the sphincter of Oddi showed abnormal sphincter function in 26 patients who were enrolled the study. Before and after endoscopic sphincterotomy all patients had ultrasonographic measurement of cholecystokinin-induced gallbladder ejection fraction with and without nitroglycerin pretreatment and scintigraphy was repeated as well. The effects of sphincterotomy on gallbladder ejection fraction and transpapillary biliary outflow were evaluated. In addition, changes in biliary pain score with a previously validated questionnaire were also determined. Results: All 26 patients had decreased gallbladder ejection fraction before sphincterotomy measured with scintigraphy (19+18%) and ultrasound (16+9.7%), which was improved after nitroglycerin pretreatment (48.2+17%; p<0.005). Detected with both methods, the ejection fraction was in the normal range after sphincterotomy (52+37% and 40.8+16.5%), but nitroglycerin pretreatment failed to produce further improvement (48.67+22.2%, NS). Based on scintigraphic examination sphincterotomy significantly improved transpapillary biliary outflow (common bile duct half time 63±33 min vs. 37±17 min; p<0.05). According to results obtained from questionneries, 22 of the 26 patients gave an account of significant symptom improvement after sphincterotomy. Conclusions: Endoscopic sphincterotomy improves cholecystokinin-induced gallbladder ejection fraction, transpapillary biliary outflow as well as biliary symptoms in patients with acalculous biliary pain syndrome and sphincter of Oddi dysfunction. Cholecystokinin-induced gallbladder ejection fraction with nitroglycerin pretreatment, measured with ultrasonography can be useful to select a subgroup of patients who can benefit from sphincterotomy. Orv. Hetil., 2013, 154, 306–313.

scholarly journals Effect of polydextrose-containing beverage on bowel habits and gastrointestinal symptoms of constipated subjects: a pilot study

2020 ◽  
Vol 26 (3) ◽  
pp. 353-367
Author(s):  
Mohamad Yulianto Kurniawan ◽  
◽  
Nourmatania Istiftiani ◽  
Lilis Heryati ◽  
Christian Reinaldo ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Intervention Group ◽  
Gastrointestinal Symptoms ◽  
Stool Frequency ◽  
Stool Consistency ◽  
Control Group ◽  
Bowel Habits ◽  
Group A ◽  
Group B ◽  
Gut Microbiota Composition

Introduction: Indonesians have a low intake of dietary fibre, a key component for an increased incidence in constipation. Available data have documented the benefits of polydextrose (PDX) in healthy subjects. However, data on constipated subjects are lacking. This study aimed to investigate the effect of consuming a PDX (prebiotic) beverage on bowel habits and gastrointestinal symptoms of constipated subjects over seven days. Methods: This was a randomised, non-blinded, nonplacebo-controlled parallel design study involving 24 subjects, divided equally into two groups. Group A (active control group) consisted of 12 subjects, consuming one serving size of 6g PDX beverage. While Group B (intervention group) consisted of 12 subjects, consuming two servings of the same product, containing 12g PDX beverage. Changes in bowel habits (constipation score, stool frequency and stool consistency) and gastrointestinal symptoms (abdominal pain, bloating and flatulence) were monitored. Results: Within seven days, Group B showed 4.9% more reduction in overall constipation mean score than that of Group A. Positive improvement in gastrointestinal symptoms were reported: i.e. abdominal pain (∆M = -0.08±0.43), bloating (∆M = -0.29±0.37) and flatulence (∆M = -0.17±0.47). Majority of subjects had desirable stool frequency (87.5%, >3 defecations/week) and stool consistency (58.3%, type 4). These improvements were due to the fact that PDX provides physiological effects consistent with prebiotic fibre, which alters the gut microbiota composition during the fermentation cycle in the large intestine. Conclusion: Findings of this study suggested that daily PDX beverage consumption effectively improved bowel habits, with fewer constipated subjects reporting of gastrointestinal symptoms.

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