Alimentary pharmacology & therapeutics
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Aliment. Pharmacol. Ther. · Jun 2013
Review Meta AnalysisMeta-analysis: peri-operative anti-TNFα treatment and post-operative complications in patients with inflammatory bowel disease.
The impact of peri-operative use of TNFα antagonists on post-operative complications such as infection and wound healing is controversial. ⋯ Anti-TNFα therapies appear to increase the risk of post-operative complications. The increase in risk is small, and may well reflect residual confounding rather than a true biological effect. Nevertheless, physicians should exercise caution when continuing biological therapies during the peri-operative period.
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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
The characterisation and risk factors of ischaemic heart disease in patients with coeliac disease.
Studies have shown an increased risk of ischaemic heart disease (IHD) in patients with coeliac disease (CD), despite the patients' lack of traditional IHD risk factors. ⋯ Despite evidence of an increased risk of IHD and higher cardiovascular mortality, patients with coeliac disease with IHD have a more favourable cardiac risk profile compared with IHD in reference individuals.
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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.