Alimentary pharmacology & therapeutics
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Aliment. Pharmacol. Ther. · Jun 2013
ReviewSystematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy.
Radiotherapy-induced damage to noncancerous gastrointestinal mucosa has effects on secretory and absorptive functions and can interfere with normal gastrointestinal physiology. Nutrient absorption and digestion may be compromised. Dietary manipulation is an attractive option for the prevention and management of symptoms. ⋯ There is insufficient high-grade evidence to recommend nutritional intervention during pelvic radiotherapy. Total replacement of diet with elemental formula may be appropriate in severe toxicity. Probiotics offer promise, but cannot be introduced into clinical practice without rigorous safety analysis, not least in immunocompromised patients. The methodological quality of nutritional intervention studies needs to be improved.
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Aliment. Pharmacol. Ther. · May 2013
ReviewSystematic review: pentoxifylline for the treatment of severe alcoholic hepatitis.
Acute alcoholic hepatitis (AH) is a severe manifestation of alcoholic liver disease with a grave prognosis. Pentoxifylline, an oral antitumour necrosis factor agent, has been reported to reduce mortality and incidence of hepatorenal syndrome (HRS) in severe alcoholic hepatitis (SAH). ⋯ Pentoxifylline appears superior to placebo in prevention of fatal HRS and thus may be effective treatment of SAH when corticosteroids are contraindicated. However, multiple trials have failed to show conclusive superiority of either pentoxifylline or corticosteroids.
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Aliment. Pharmacol. Ther. · May 2013
ReviewSystematic review: the quality of the scientific evidence and conflicts of interest in international inflammatory bowel disease practice guidelines.
Guidelines published by the international gastroenterology societies establish standards of care and seek to improve patient outcomes. ⋯ Nearly half the IBD guideline recommendations are based on expert opinion or no evidence. Majority of the guidelines fail to disclose any COI, and when commenting, all have numerous COI. Furthermore, the guidelines are not updated frequently and there is a lack of consensus between societal guidelines. This study highlights the critical need to centralize and redesign the guidelines development process.
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Aliment. Pharmacol. Ther. · Mar 2013
ReviewReview article: the management of long-term parenteral nutrition.
Home parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure. ⋯ Home parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter-related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.
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Aliment. Pharmacol. Ther. · Jan 2013
ReviewReview article: towards a considered and ethical approach to organ support in critically-ill patients with cirrhosis.
Increasing numbers of patients are being admitted to hospital with decompensated chronic liver disease in the UK. A significant proportion will develop complicating extra-hepatic organ dysfunction, but the selection of those who should be admitted to intensive care is complex and challenging. Alcohol-related liver disease also presents complex ethical dilemmas. ⋯ An early, aggressive approach to organ support is justified. Further discussions between hepatologists and critical care physicians are required to determine acceptable burden-to-benefit ratios for prolonged intensive care support in young alcoholic patients.