Review article: colon cleansing preparation for gastrointestinal procedures.
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Adequate cleansing is essential for reliable diagnostic and surgical colon procedures. Accuracy and safety depend on good preparation. Patient compliance is enhanced by simplicity and well-tolerated methods. Several methods are available. Diet and cathartic regimens utilize clear liquids or diets designed to leave a minimal colonic residue. Laxatives, cathartics and enemas are employed. Gut lavage solutions are osmotically balanced electrolyte lavage products. Oral sodium phosphate solutions and tablets are available and are attractive because of good efficacy with a small volume of administration. For colonoscopy and colon surgery preparation, these methods have been proven safe and effective. For barium enema X-ray, lavage requires an adjunctive agent such as bisacodyl to enhance barium coating. Overall, all regimens are well-tolerated. This review discusses the development and clinical experience with various colon cleansing regimens. (+info)
Effects of ispaghula husk and guar gum on postprandial glucose and insulin concentrations in healthy subjects.
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OBJECTIVE: The aim of this study was to evaluate, under the same experimental conditions and in the same subjects, the effects of ispaghula husk and guar gum on postprandial glucose and insulin concentrations in healthy female subjects. DESIGN: An oral glucose load with and without fiber was administered in the morning after an overnight fast. The study of the fiber effect was planned according to a randomized and cross-over design. SETTING: The study was performed at the Department of Pharmacology, Toxicology and Nursing at the University of Leon (Spain). SUBJECTS: Ten healthy female volunteers aged 30-48 y with normal body mass indices participated in this study. RESULTS: A significant decrease in mean serum insulin concentrations was observed from 30 to 90 min in the presence of both fibers. The area under the insulin curve was significantly reduced by 36.1% for ispaghula husk and 39.4% for guar gum. The area under the glucose curve was reduced by 11.1% (significant difference) for ispaghula husk and 2.6% for guar gum (no significant difference). CONCLUSIONS: According to the results obtained in this study, the administration of ispaghula husk may be beneficial due to its ability to reduce glucose postprandial concentration and especially insulin requirements. Individualization of the treatment would be advisable due to large individual variations observed in glycemic and insulinemic postprandial responses. (+info)
Review article: the therapy of constipation.
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Constipation is a common symptom that may be idiopathic or due to various identifiable disease processes. Laxatives are agents that add bulk to intestinal contents, that retain water within the bowel lumen by virtue of osmotic effects, or that stimulate intestinal secretion or motility, thereby increasing the frequency and ease of defecation. Drugs which improve constipation by stimulating gastrointestinal motility by direct actions on the enteric nervous system are under development. Other modalities used to treat constipation include biofeedback and surgery. Laxatives and lavage solutions are also used for colon preparation and evacuation of the bowels after toxic ingestions. (+info)
Effects of brewer's yeast cell wall on constipation and defecation in experimentally constipated rats.
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Brewer's yeast cell wall (BYC) was tested on constipated male Sprague-Dawley rats that had been induced by loperamide (2 mg/kg of body weight). The preventive effect of BYC on constipation was examined and compared with that of a non-fiber diet (NF) as the control. The dose-response of BYC and the effect on defecation by constipated experimental rats were also compared with the characteristics of cellulose diet (CE) group which served as a control. Defecation was observed to be greater by the rats fed with BYC than by those fed with NF or CE. The fecal water content and level of volatile fatty acids (VFA) in the cecal contents were likewise higher in the rats fed with BYC. These results indicate that the administration of BYC was effective for improving defecation and other parameters related to defecation. These favorable effects of BYC supplemented to the diet are attributed to the fermentation ability, water holding capacity and swelling force in the large intestine. (+info)
Differential measurement of small and large bowel transit times in constipation and diarrhoea: A new approach.
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Differential measurements of small and large bowel transit times were performed in 13 subjects iwth a radiotelemetering pressure-sensitive capsule incorporating less than 10mugCi of 51-Cr. Six patients had constipation. The other seven patients had diarrhoea due to the irritable bowel syndrome (3), following vagotomy and pyloroplasty (3), or due to laxative abuse (1). This new method enables the gastric, small intestinal, and colonic transit times to be measured differentially in the same subject. The capsule can be localized in the gut lumen by reference to the characteristic pressure pattern and in relation to bony landmarks by the radioactive marker as frequently as desired without recourse to radiographs. The results show that gastric emptying and small intestinal transit did not differ in constipation and diarrhoea. By contrast the mean colonic transit was significantly faster (P smaller than 0.01) in diarrhoea whatever the cause (17.5 plus or minus 4.1 hours) than in constipation (118 plus or minus 4.1 hours). (+info)
Review article: over-the-counter drugs and the gastrointestinal tract.
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An increasing number of drugs are becoming available over-the-counter, empowering patients to treat them- selves. Although drugs presently available over-the-counter are generally safe, there are issues of safety and possible delays in diagnosis of serious conditions. Therefore it is vital that patients are made aware of the indications and limitations of over-the-counter drugs through improved communication and education. Pharmacists and drug companies will have an increasingly important role in giving information and advice to patients. This review looks at the present and future of over-the-counter medication, highlighting the safety aspects. (+info)
Nepadutant pharmacokinetics and dose-effect relationships as tachykinin NK2 receptor antagonist are altered by intestinal inflammation in rodent models.
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Tachykinin NK2 receptor antagonists could reduce motility and symptoms during gastrointestinal diseases characterized by local inflammation such as diarrhea or colitis; however, how these conditions change pharmacodynamic and pharmacokinetic characteristics of NK2 receptor antagonists is unknown. We investigated the effect of the peptide NK2 receptor antagonist nepadutant on spontaneous intestinal motility or [betaAla8]NKA(4-10)-induced colonic and bladder contractions in rodent models of intestinal inflammation (enteritis induced by castor oil and rectocolitis induced by local instillation of acetic acid in rats, enteritis induced by bacterial toxins in mice). In the castor oil model, the oral/intraduodenal bioavailability of nepadutant was also determined. The intrarectal (i.r.) administration of nepadutant (100 nmol/kg) did not reduce [betaAla8]NKA(4-10) (10 nmol/kg i.v.)-induced colonic and bladder contractions in normal animals, but the same dose of nepadutant produced an inhibitory effect in the two organs following rectocolitis; in contrast, nepadutant is equieffective by the intravenous route in normal and colitic animals. In this model, nepadutant (100 nmol/kg i.r. or i.v.) decreased spontaneous colonic hypermotility, without affecting motility in controls. The intraduodenal administration of nepadutant (30 nmol/kg), which was ineffective on [betaAla8]NKA(4-10) (10 nmol/kg i.v.)-induced colonic and bladder contractions in control animals, abolished bladder contractions in castor oil-pretreated animals. In this latter group, the oral and intraduodenal bioavailability of nepadutant showed a 7- to 9-fold increase with respect to controls. Oral administration of nepadutant, in nanomolar or subnanomolar dosage, reduced diarrhea induced by bacterial toxins in mice. It is concluded that intestinal inflammation increases nepadutant absorption in the intestine, enhancing its activity. These results suggest that a drug with a limited oral bioavailability could be used for treating gastrointestinal diseases associated with a local inflammation. (+info)
Sex and hormonal status influence plasma lipid responses to psyllium.
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BACKGROUND: The primary mechanisms by which soluble fiber lowers plasma cholesterol are well known. However, specific effects of fiber on lipoprotein metabolism and how sex and hormonal status influence these effects are not well defined. OBJECTIVE: The effects of a psyllium supplement in men, premenopausal women, and postmenopausal women were examined to determine the mechanisms by which psyllium lowers plasma LDL-cholesterol concentrations and affects lipoprotein remodeling in the intravascular compartment. DESIGN: We designed a crossover trial in which 24 men, 23 premenopausal women, and 21 postmenopausal women were randomly assigned for 30 d to a fiber supplement (15 g psyllium/d) or a control. Plasma lipids and cholesteryl ester transfer protein and lecithin-cholesterol acyltransferase (phosphatidylcholine-sterol O-acyltransferase) activities were measured after each treatment. RESULTS: When compared with the control, psyllium intake lowered plasma LDL-cholesterol concentrations by 7-9% (P < 0.0001) without affecting plasma HDL-cholesterol concentrations. An interactive effect between fiber and sex and hormonal status was observed for plasma triacylglycerol. Psyllium supplementation significantly lowered plasma triacylglycerol concentrations in men by 17% and raised triacylglycerol concentrations in postmenopausal women by 16% (P < 0.01). The dietary treatment did not significantly affect plasma triacylglycerol in premenopausal women. Lecithin-cholesterol acyltransferase was unaffected by psyllium intake whereas cholesteryl ester transfer protein activity was 18% lower after psyllium supplementation than after the control treatment (P < 0.0001). CONCLUSIONS: This trial showed that the psyllium-induced responses to plasma lipids were associated with sex and hormonal status and that psyllium, through its action in the intestinal lumen, indirectly affected the intravascular processing of lipoproteins. (+info)