No description available.

Purpose: Administration of a mechanical bowel preparation (MBP) has long been standard before colorectal surgery with the aim of preventing complications such as surgical site infection (SSI). Newer evidence suggests that MBP does not reduce the risk of infection and that oral antibiotic (OA) use may be important in reducing post-operative infectious complications, however, there is little evidence comparing MBP, OA, and combination preparations. Our goal was to determine the relationship between type of bowel preparation and SSI in patients undergoing elective colorectal resections Methods: All patients within the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database undergoing elective colorectal resections from 2012 to 2013 were identified. The primary outcomes of interest were: any post-operative SSI, wound SSI, and organ/space SSI. Secondary outcomes were anastomotic leak, post-operative ileus, cardiac complications, renal complications, death, unplanned readmission, and length of stay (LOS). Univariate models were used to compare frequencies of patient and surgical characteristics across types of bowel preparation, and propensity adjustment was used to study the relationship between type of bowel preparation and all outcomes of interest. Results: Among the study sample, 25.5% received no bowel preparation, 40.8% received MBP, 3.3% received OA, and 30.4% received OA+MBP. A total of 1,844 patients (9.5%) developed any type of post-operative SSI. 1,231 (6.4%) developed a wound SSI and 672 (3.5%) developed an organ/space SSI. MBP was not associated with a reduced risk of any type of SSI compared to no bowel preparation. Both OA and OA+MBP were significantly associated with a decreased risk of any SSI and wound SSI compared to both no preparation and compared to MBP. No differences were observed for any SSI or wound SSI between OA and OA+MBP. Compared to no preparation, OA+MBP was associated with a decreased risk of anastomotic leak and post-operative ileus. No differences were observed between MBP and OA, or between these preparation methods and no preparation, for these secondary outcomes. There were no significant associations between type of bowel preparation and cardiac or renal complications, mortality, or readmissions. Both OA and OA+MBP were associated with a reduction in LOS. Conclusion: These results suggest that a combination oral and mechanical bowel preparation may be most effective at preventing SSI after elective colorectal resection and that OA alone may also be effective. Future prospective studies comparing combination and OA preparations may be warranted to explore this relationship further. / Clinical Research and Translational Medicine

No description available.

Bakgrund: IBS (Irritabel Bowel Syndrome) är en funktionell mag-tarmsjukdom, med en oklar patofysiologi och etiologi. IBS är en vanlig åkomma hos den västerländska befolkningen och karakteriseras av återkommande buksmärta/obehag, uppblåsthet, diarré och/eller förstoppning samt ökad gasbildning. Det finns idag inget botemedel för IBS, men intresset för probiotika som behandling vid IBS har på senare tid ökat. Probiotika, vilket definieras som levande mikroorganismer, som när de intas i adekvata mängder ger en hälsovinst hos värden tros ha en symptomatisk effekt vid IBS, och har därmed varit av intresse för behandling av IBS. Syfte: Syftet med denna litteraturstudie är att undersöka om probiotika har någon terapeutisk effekt och kan användas som behandling vid IBS. Metod: Fem randomiserade, dubbelblindade, placebo-kontrollerade studier granskades. De undersökte den terapeutiska effekten av varierande probiotika på IBS-patienter. Artiklarna erhölls genom sökningar i den medicinska databasen PubMed, under februari månad 2016. Resultat: Av dessa fem studier visade fyra på en signifikant symptomförbättring av framförallt buksmärta/obehag. Bäst resultat sågs i en studie som undersökte probiotikan Lactobacillus plantarum 299v. Tre av fem studier visade på en signifikant förbättring av testpersonernas livskvalité. I endast en av studierna, som undersökte effekten av Escherichia coli Nissle 1917, påvisades ingen signifikant skillnad mellan E.coli (probiotika) och placebo. Slutsats: Baserat på de fem studierna föreligger det i nuläget skäliga bevis för att en behandling med specifika probiotika kan ge symtomförbättring av buksmärta/obehag hos IBS-patienter, och förbättrar patienternas livskvalité. Vidare studier krävs för att fastställa den mest effektiva probiotikan, dosen och behandlingslängden. / Background: IBS (Irritable Bowel Syndrome) is a functional gastrointestinal disorder, with an unclear etiology and pathophysiology. IBS is a common disorder in the Western population and is characterized by recurrent abdominal pain/ discomfort, bloating, flatulence, diarrhea and/ or constipation. There is currently no cure for IBS, but the interest in probiotics as an option of treatment has recently increased. Probiotics have been defined as live microorganisms that, when administered in adequate amounts, provide a health benefit on the host, and are believed to have a symptomatic effect in IBS. Probiotics have therefore been of interest for the treatment in IBS. Purpose: The purpose of this study is to examine whether probiotics have a therapeutic effect and if it could be used as a treatment for IBS. Method: Five randomized, double-blind, placebo-controlled studies were reviewed that examined the therapeutic effect of different probiotics in the IBS-patients. Articles were obtained through searches in the medical database PubMed, during the month of February 2016. Results: Four of the five studies showed a significant improvement of symptoms especially in abdominal pain/ discomfort. The best results were seen in a study that investigated the probiotic Lactobacillus plantarum 299v. Three of the five studies showed a significant improvement in quality of life (QOL) of the subjects in the study. One of the five studies which examined the effect of Escherichia coli Nissle 1917, there was no significant difference between E.coli (probiotics) and placebo. Conclusion: There is reasonable evidence that treatment with certain probiotics might provide improvement in symptoms of abdominal pain/ discomfort, and increase patients quality of life based on the five studies. Further studies are required to determine the most effective probiotic, dose and duration of IBS-treatment.

Introduction et objectifs: Les préparations coliques sont utilisées pour nettoyer le côlon avant de subir une coloscopie. Il existe plusieurs types de préparations coliques; celles-ci contiennent du polyéthylène glycol (PEG), du phosphate de sodium (NaP), du picosulfate (PICOS) ou une solution orale contenant du sulfate (OSS). L'administration en doses fractionnées est recommandées par plusieurs études randomisées mais une étude approfondie de la littérature n'a pas encore été effectuée. Notre objectifs est de déterminer l’efficacité des doses fractionnées comparativement à d’autres régimes posologiques, ainsi que le produit optimal et le volume le plus efficace. Méthode: Nous avons procédé à une recension systématique de la littérature publiée entre janvier 1980 et mars 2014, à partir des bases de données MEDLINE, Embase, Scopus, CENTRAL et ISI Web of Knowledge. Une méta-analyse a été effectuée en incluant les études randomisées qui comparent des doses fractionnées à des doses administrées uniquement la veille de l’examen (non fractionnées). Ont été exclues les études portant sur une population pédiatrique ainsi que celles portant sur des patients hospitalisés ou atteints d’une affection intestinale inflammatoire. L’issue primaire consistait à déterminer la propreté du côlon. Les issues secondaires sont les effets indésirables,les issues procédurales, la volonté des patients à répéter la préparation colique et le temps requis pour reprendre leurs activités normales. Résultats: Quarante-sept études randomisées répondant aux critères d’inclusion ont été répertoriées (n = 13 487 patients). La propreté du côlon était signficativement supérieure avec les doses fractionnées [rapport de cotes (RC) = 2,51; intervalle de confiance à 95 % (IC) = (1,86-3,39)]. Le côlon était significativement plus propre avec les doses fractionnées de PEG [RC=2,60 (1,46-4,63)] de même qu’avec le NaP [RC=9,34 (2,12-41,11)] et le PICOS [RC=3,54 (1,95-6,45)] comparativement aux doses non fractionnées du même produit. La solution de 3 L ou plus de PEG en doses fractionnées a démontré une propreté supérieure à celle du PEG en doses fractionnées de faible volume [RC=1,89 (1,01-3,46)], mais seulement dans les analyses par intention de traitement. La volonté de répéter la préparation colique était supérieur chez les patients ayant reçu des doses fractionnées comparé aux doses non fractionnées [RC=1,90 (1,05-3,46)]; de même, que ceux ayant reçu <3 L de PEG en doses fractionnées comparativement à ceux qui ont PEG ≥ 3L en doses fractionnées [RC=4,95 (2,21-11,10)]. Les différences n’étaient pas significatives pour les autres issues. Conclusion: Les doses fractionnées augmentent le degré de propreté du côlon, en plus d’être le mode d’administration que les patients préfèrent, comparativement aux doses non fractionnées. D’autres études sont nécessaires afin d’évaluer L'OSS et les volumes réduits de PEG. / Abstract : Background & Aims Bowel preparations are used before a colonoscopy to clean the bowel. There are different regimens of preparing the colon for colonoscopy, including polyethylene glycol (PEG), sodium phosphate (NaP), picosulfate (PICO), or oral sulfate solutions (OSS). Split-dose are recommended in several randomized trials but a thorough literature review has not yet been performed. Our aim was to determine the efficacy of split-dose vs other colon preparation regimens, the optimal products for use, and the most effective preparation volumes. Methods We performed systematic searches of MEDLINE, EMBASE, Scopus, CENTRAL, and ISI Web of Knowledge databases, from January 1980 to March 2014. A meta-analysis was done by including all randomized trials that assessed split-dose regimens vs day before colonoscopy preparation. We excluded studies that included pediatric or hospitalized patients, or patients with inflammatory bowel disease. The primary outcome was efficacy of bowel cleansing. Secondary outcomes included side effects, outcomes of procedures, patients’ willingness to repeat the procedure, and the amount of time required for patients to resume daily activities. Results We identified 47 trials that fulfilled our inclusion criteria (n=13,487 patients). Split-dose preparations provided significantly better colon cleansing than all day-before preparations (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.86–3.39), as well as day-before preparations with PEG (OR, 2.60; 95% CI, 1.46–4.63), sodium phosphate (OR, 9.34; 95% CI, 2.12–41.11), or picosulfate (OR, 3.54; 95% CI, 1.95–6.45). PEG split-dose preparations of 3L or more yielded greater bowel cleanliness than lower-volume split-dose regimens (OR, 1.89; 95% CI, 1.01–3.46), but only in intention-to-treat analysis. A higher proportion of patients were willing to repeat split-dose vs day-prior cleansing (OR, 1.90; 95% CI, 1.05–3.46) and low-volume split-dose preparations vs high-volume split-dose preparation (OR, 4.95; 95% CI, 2.21–11.10). There were no differences between preparations in other secondary outcome measures. Conclusion Based on meta-analysis, split-dose regimens increase quality of colon cleansing and are preferred by patients, compared with day-before preparations. Additional research is required to further evaluate oral sulfate solution-based and PEG low-volume regimens.

Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that result in considerable morbidity and impaired quality of life. Although IBD is ubiquitous, heterogeneity in incidence is noted geographically and among different ethnicities, presumably due to genetic and environmental factors. The incidence and prevalence of IBD has plateaued in many Western countries but are increasing in developing nations. There is a lack of data on IBD pertaining to the Chinese population. / Studies were conducted to determine the characteristics of IBD in the Chinese population. The incidence of IBD in the Chinese population is a fifth to a tenth of Western societies but has risen sharply over the past decade. Several distinct demographic and phenotypic features were noted in the Chinese IBD population. Genetically, Chinese CD patients do not harbour the NOD2/CARD15 polymorphisms unlike Caucasian CD subjects. ANCA and ASCA are serologic markers that are highly specific for UC and CD respectively in the Chinese but ANCA sensitivity in Chinese UC is significantly lower than in Caucasian UC, while quantitative IgG ASCA (and not IgA) is a moderately sensitive test for CD. These markers are useful in differentiating UC from CD. A Chinese translation of the Inflammatory Bowel Disease Questionnaire (IBDQ) was developed and validated to be reliable, sensitive to change and reproducible. A prospective cross-sectional survey of the disease-related knowledge of Chinese and Australian IBD patients identified a low level of IBD-knowledge but with a similar quality of life as Caucasians with IBD. There was a similar but high rate of use of complementary alternative medicines in both populations. / These studies were instrumental in: describing IBD in the Chinese population; developing a Chinese IBD database; acquiring techniques of investigating genetic polymorphisms and ASCA serology; devising the Chinese IBDQ to open up IBD trials to Hong Kong; and identifying knowledge deficiencies to help plan a targeted education programme. / Leong Rupert Wing-Loong. / Adviser: Joseph J.Y. Sung. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

<p>One hundred haemorrhoid patients were compared with 300 matched control persons. Haemorrhoid symptoms and bowel symptoms were studied. Most common symptom of the patients was bleeding (44%), followed by prolapse (24%), hygiene problem (14%), pain (12%) and itching (5%). Bowel symptoms, as bloating and evacuation difficulties, possibly related to IBS, were frequent among the patients.</p><p>556 patients were operated upon with Milligan-Morgan haemorrhoidectomy. 418 (81%) answered a questionnaire on results, and on disturbances in anal continence. Totally140 (33%) reported recurrence, and 139 (33%) patients reported anal incontinence. Forty of the 139 patients associated this to the surgical procedure. Female gender was associated to increased risk of incontinence.</p><p>The 40 patients who reported incontinence, were invited to undergo ano-rectal manometry, saline infusion test, endo-anal ultrasound, proctoscopy and clinical examination. Altogether 19 patients approved to participate. Matched control subjects and 15 persons previously operated for haemorrhoids, but without symptoms of incontinence, served as two reference groups. Incontinence score and saline infusion test showed significantly poorer continence in the patient group. Endo-anal ultrasound showed injury to the external sphincter in 20% of the patients. Anal pressure was slightly lower in the patient group, but the difference was not significant. </p><p>Totally 225 patients were randomised to Milligan-Morgan or Ferguson haemorrhoidectomy. Primary aim was to study changes in anal continence. Other aims were to study postoperative pain, wound healing, complications, patient satisfaction and recurrence and changes in bowel function. Patients in the Ferguson group reported, slightly quicker wound healing (P=0.06). Postoperative pain was equal, as was rate of complications. After one year the Ferguson group reported lower incontinence score, and more satisfied patients. Recurrence rate was equal, 15-17%. Most bowel symptoms were reduced one year after surgery.</p><p>In conclusion, functional bowel symptoms are common in haemorrhoid patients. Haemorrhoidectomy is associated with risk for incontinence in 5-10% of patients and females are at greater risk. A proportion of the patients who claim postoperative incontinence have physiological signs of sphincter incompetence, and external sphincter injuries are observed in those patients. Ferguson haemorrhoidectomy results in better anal continence and more satisfied patients. </p>

Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 160-170).

One hundred haemorrhoid patients were compared with 300 matched control persons. Haemorrhoid symptoms and bowel symptoms were studied. Most common symptom of the patients was bleeding (44%), followed by prolapse (24%), hygiene problem (14%), pain (12%) and itching (5%). Bowel symptoms, as bloating and evacuation difficulties, possibly related to IBS, were frequent among the patients. 556 patients were operated upon with Milligan-Morgan haemorrhoidectomy. 418 (81%) answered a questionnaire on results, and on disturbances in anal continence. Totally140 (33%) reported recurrence, and 139 (33%) patients reported anal incontinence. Forty of the 139 patients associated this to the surgical procedure. Female gender was associated to increased risk of incontinence. The 40 patients who reported incontinence, were invited to undergo ano-rectal manometry, saline infusion test, endo-anal ultrasound, proctoscopy and clinical examination. Altogether 19 patients approved to participate. Matched control subjects and 15 persons previously operated for haemorrhoids, but without symptoms of incontinence, served as two reference groups. Incontinence score and saline infusion test showed significantly poorer continence in the patient group. Endo-anal ultrasound showed injury to the external sphincter in 20% of the patients. Anal pressure was slightly lower in the patient group, but the difference was not significant. Totally 225 patients were randomised to Milligan-Morgan or Ferguson haemorrhoidectomy. Primary aim was to study changes in anal continence. Other aims were to study postoperative pain, wound healing, complications, patient satisfaction and recurrence and changes in bowel function. Patients in the Ferguson group reported, slightly quicker wound healing (P=0.06). Postoperative pain was equal, as was rate of complications. After one year the Ferguson group reported lower incontinence score, and more satisfied patients. Recurrence rate was equal, 15-17%. Most bowel symptoms were reduced one year after surgery. In conclusion, functional bowel symptoms are common in haemorrhoid patients. Haemorrhoidectomy is associated with risk for incontinence in 5-10% of patients and females are at greater risk. A proportion of the patients who claim postoperative incontinence have physiological signs of sphincter incompetence, and external sphincter injuries are observed in those patients. Ferguson haemorrhoidectomy results in better anal continence and more satisfied patients.

Syftet med denna systematiska litteraturstudie var att belysa hur sjuksköterskans omvårdnad kan stödja egenvårdsförmågan hos patienter med IBS. Den viktigaste omvårdnadsåtgärden var att tidigt i samband med diagnostiseringen av IBS, ge information och kunskap om sjukdomen, dess prognos samt behandling, vilket visades förbättra upplevd livskvalitet samt ge symtom-lindring. IBS skolor startade av sjuksköterskor förbättrade patienternas hälsobeteende samt minskade symtomen. Genom introduktion av guidebok innehållande råd om kost, motion, stresshantering samt symtomkontroll upplevde patienterna en minskning av symtom, vilket även ledde till en minskning av antalet besök inom sjukvården. När sjuksköterskan använde olika frågeformulär i kontakten med patienter med IBS kunde patienternas problem identifieras och strategier för egenvården planeras samt individuella handlingsplaner skapas. Sjuksköterskans kunskap och förståelse om patientens egen sjukdomsupplevelse samt copingstrategi ledde till att patienten tog en mer aktiv roll i sjukdomshantering. Patienters behandling borde inriktas på livsstilsförändringar, som till exempel psykosocial arbetsmiljö, kost, fysisk aktivitet, samt stresshantering. Genom att patienten förde dagbok över kostintag och sedan gjorde jämförelser med ökade eller minskade symtom kunde faktorer identifieras i matvanor samt kostintag som inverkade på symtomen. Dorotea Orems omvårdnadsmodell har legat till grund för denna studie där tron på människans egna resurser framhålls.