Journal of clinical gastroenterology
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Probiotics have been extensively studied over the past several years in the prevention and, to a larger extent, in the treatment of diarrheal diseases, especially in pediatric populations. Diarrhea is a symptom, and not a disease. This review will not address chronic disorders associated with diarrhea, or Clostridium difficile-induced diarrhea. ⋯ The vast majority of the published trials show a statistically significant benefit and moderate clinical benefit of a few, well-identified probiotic strains-mostly Lactobacillus GG and S. boulardii-in the treatment of acute watery diarrhea, and particularly those due to rotavirus. Such a beneficial effect results, on average, in a reduction of diarrhea duration of approximately 1 day. The effect is strain-dependent and dose-dependent.
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J. Clin. Gastroenterol. · Nov 2011
Case ReportsMethylnaltrexone for treatment of acute colonic pseudo-obstruction.
Acute colonic pseudo-obstruction (ACPO) or Ogilvie syndrome is an idiopathic syndrome of dilation of the colon without mechanical obstruction that develops in hospitalized patients usually in the setting of significant medical and surgical conditions. Standard care therapy includes colonoscopic decompression or neostigmine. The latter is not Food and Drug Administration-approved for this indication but has been the recent intervention of choice. ⋯ There was a brisk response to methylnaltrexone, a μ-opioid-receptor antagonist which does not cross the blood-brain barrier. This is the first case report in the literature and in the pharmaceutical company's data bank that illustrates a potential role for methylnaltrexone in ACPO. Prospective, larger studies to determine the role of methylnaltrexone in ACPO are warranted.
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The development of pulmonary arterial hypertension in the setting of portal hypertension is known as portopulmonary hypertension. Portal hypertension is thought to predispose patients to disturbances in the homeostatic regulation of numerous neurohumoral and vasoactive mediators that induce the development of pulmonary arterial hypertension. Portopulmonary hypertension is pathologically indistinguishable from idiopathic pulmonary arterial hypertension and is characterized by the development of vasoconstriction, vascular remodeling, and thrombosis within the pulmonary vasculature. ⋯ However, the diagnosis of portopulmonary hypertension is based on unique hemodynamic criteria as determined by right heart catheterization. Untreated portopulmonary hypertension portends a poor prognosis, and the efficacy of current treatment modalities is limited. At present, the primary goals of therapy are to provide symptomatic relief, prolong survival, and improve pulmonary hemodynamics to facilitate safe and successful liver transplantation.