Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
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The pathogenesis and pathophysiology of irritable bowel syndrome is complex and still incompletely known. Potential pathogenetic factors include genes, infectious events, psychological symptoms and other loosely defined environmental factors. ⋯ Lines of evidence also suggest that inflammation within the gastrointestinal tract may be of great importance in at least subgroups of irritable bowel syndrome patients. To conclude, a complex picture of the pathogenesis and pathophysiology of irritable bowel syndrome is emerging, with interactions between several different alterations resulting in the divergent symptom pattern in these patients.
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Randomized Controlled Trial Comparative Study
Target-controlled infusion during monitored anesthesia care in patients undergoing EUS: propofol alone versus midazolam plus propofol. A prospective double-blind randomised controlled trial.
It has been speculated that midazolam may be effective in reducing the required dose of propofol during sedation. ⋯ Target-controlled propofol infusion provides safe and effective sedation; premedication with low dose of midazolam does not reduce the total amount of propofol administered. Further studies are needed to compare propofol alone with propofol co-administered with opioid.
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Randomized Controlled Trial
Colonisation of the gastrointestinal tract by probiotic L. rhamnosus strains in acute diarrhoea in children.
Lactobacillus rhamnosus (573L/1-3) strains are considered effective in the treatment of rotaviral diarrhoea in children. The colonisation of the gastrointestinal (G. I.) tract by the Lactobacillus rhamnosus strains and the determining factors are discussed reporting data of a prospective, double-blinded, placebo-controlled randomized study in children between the 2nd month and 6th year of life with acute diarrhoea lasting not longer than 5 days. ⋯ L. rhamnosus strains are effective in colonising the G. I. tract during acute diarrhoea. Persistence of colonisation is dependent on the properties of administered probiotic strains.
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Barrett's oesophagus embodies the risk of malignant transformation. High-grade intraepithelial neoplasia and early cancer in Barrett's oesophagus are often discrete or macroscopically occult lesions and show a patchy distribution and therefore, directed biopsies in combination with four-quadrant random biopsies are the gold standard for surveillance. ⋯ Chromoendoscopy with methylene blue diagnosed significantly more patients and lesions with intraepithelial neoplasia or early cancer in Barrett's oesophagus compared to random biopsies. In addition, significantly less biopsies were needed with methylene blue compared to random biopsies. The use of methylene blue-directed biopsies appears to improve the detection of intraepithelial neoplasia and early cancer in Barrett's oesophagus.
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We have shown that bran exacerbates irritable bowel syndrome symptoms in a large proportion of secondary-care patients. However, it is unknown if this also happens in primary-care or whether a better response to bran occurs, leading to bran failures being selected for referral to the specialist. ⋯ Although not especially effective in primary-care irritable bowel syndrome patients, bran does not cause so many problems and is more helpful than in secondary-care. The effects of soluble fibre are similar in both primary-care and secondary-care. This study highlights the problem of extrapolating the response to treatment in irritable bowel syndrome from different care settings.