Search

Antibiotics for presumed small intestinal bacterial overgrowth have been shown to improve irritable bowel syndrome symptoms in at least 40% of subjects. A lactulose breath test for small intestinal bacterial overgrowth has been used to select patients who will respond. However, its predictive value, using the classic definition of a positive lactulose breath test, has been disappointing.We conducted a retrospective evaluation to study characteristics of the lactulose breath test that may be predictive of a response to antibiotics in patients with the irritable bowel syndrome.A clinical practice database was interrogated for consecutive patients who had a lactulose breath test for irritable bowel syndrome symptoms and a subsequent antibiotic course. Hydrogen + methane levels with carbon dioxide correction were plotted against time. Various profiles of the breath test curves were catalogued and compared with respect to their predictive value for symptom response to antibiotics.Lactulose breath test graphs of 561 patients of all irritable bowel syndrome subtypes were grouped into categories based on their hydrogen + methane levels with respect to time. Of subjects whose hydrogen + methane rise was20 ppm throughout the test (group 1; N = 95), 94.7% improved after antibiotics (95% CI 90.1-99.3). Of those with a rise20 ppm within the first 90 min but a rise50 ppm thereafter (group 3; N = 53), 47.2% improved (95% CI 33.7-60.6). The difference between groups 1 and 3 was statistically significant P0.001.A lactulose breath test appears to be useful in predicting response to antibiotics in patients with the irritable bowel syndrome. A hydrogen + methane rise20 ppm throughout the duration of the test is most predictive. This observation contradicts the classic definition of a positive lactulose breath test.

Background Patients with ulcerative colitis (UC) who achieve remission with corticosteroids often relapse after tapering or discontinuation; alternative treatments limiting steroid exposure and UC relapse would be beneficial. It remains uncertain whether patients with corticosteroid-induced remission experience benefit with mesalamine granules (MG), a locally acting aminosalicylate extended-release capsule formulation for maintenance of UC remission in adults. Aims Efficacy and safety of MG 1.5 g once daily was evaluated in patients with UC in corticosteroid-induced remission. Methods Data from patients with previous corticosteroid use to achieve baseline UC remission were analyzed from two 6-month randomized, double-blind, placebo-controlled trials and a 24-month open-label extension (OLE). Six-month relapse-free rates were assessed using the revised Sutherland Disease Activity Index. UC-related adverse events (AEs) were recorded during the 30 months. Results Included were 158 steroid-treated patients in UC remission (MG, n = 105; placebo, n = 53) and 74/105 MG-treated patients who continued MG in the OLE. A significantly larger percentage of patients remained relapse-free at 6 months with MG (77.1 %) versus placebo (54.7 %; P = 0.006), with a 55 % reduction in relapse risk (hazard ratio [HR] 0.45; 95 % CI 0.25–0.79). There was a similar (49.2 %) reduction in risk of UC-related AEs at 6 months (HR 0.51; 95 % CI 0.31–0.84; P = 0.009) that was sustained during the OLE. Conclusions MG 1.5 g once daily administered for maintenance of corticosteroid-induced remission was associated with low risk of relapse and UC-related AEs. ClinicalTrials.gov NCT00744016, NCT00767728, and NCT00326209.

During topical dissolution of gallstones,solvent can escape to the duodenum causing toxic effectsthat have not yet been adequately quantified. Wecompared the local intestinal cytotoxic and systemichepatotoxic effects of two gallstone solvents, methyltert-butyl ether and ethyl propionate, on the rabbit'sduodenum. Methyl tert-butyl ether, ethyl propionate, orsaline (control) was infused intraduodenally for 3 hr in 32 male New Zealand rabbits. Thesolvents were infused either at a high infusion rate of8.5 μl/min or at a low rate of 4.0 μl/min. Bloodsamples were collected for biochemical analysis fromeach animal before and after the 3-hr infusionperiod. A standardized histologic scoring system wasused by a pathologist blinded to the treatments toquantify liver and intestinal tissue injury. None of the animals studied showed any significant changesin serum alkaline phosphatase, amylase, bilirubin, ortheir hepatic histology or histologic scoring formucosal necrosis and ulceration. At the higher dose, methyl tert-butyl ether produced significantlymore submucosal inflammation (P = 0.0017) and showed atrend of causing more submucosal edema than ethylpropionate, but ethyl propionate led to significantly higher elevations of aminotransferases thanmethyl tert-butyl ether as compared to saline. Therewere no detectable blood levels of methanol or ethanolin any of the animals studied. Ethyl propionate may be less damaging to the intestinal mucosa ofthe rabbit than methyl tert-butyl ether, but at thehigher dose (equivalent to 60 ml/3 hr in a 70-kg human)it appears to produce more biochemical liver injury when administered intraduodenally.