Ulcerations of the colon associated with naproxen and acetylsalicylic acid treatment (original) (raw)
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Pharmaceutical Research, 2009
Purpose. To characterize the contents of the ascending colon in healthy adults under fasting and fed state conditions, with a view to designing in vitro studies to explain/predict dosage form performance in the lower gut. Methods. Twelve healthy adults participated in a two-phase crossover study. In Phase A, subjects were fasted (water allowed) overnight plus 5 h in the morning prior to colonoscopy (fasted state). In Phase B, subjects were fasted overnight, consumed a standard breakfast (960 kcal) in the morning, and were offered a light lunch 4.5 h later. In this phase, colonoscopy was performed 1 h after lunch (fed state). Volume, pH, and buffer capacity of colonic contents were measured immediately upon collection. After ultracentrifugation, the supernatant was further characterized. Results. Free water content, pH, surface tension, and isobutyrate levels were lower in fed than in fasted subjects. On the other hand, buffer capacity, osmolality, acetate, butyrate, cholate, and chenodeoxycholate levels were higher in fed subjects. Carbohydrate content; protein content; and levels of long chain fatty acids, phosphatidylcholine, and cholesterol were not affected significantly by prandial state. Conclusion. Composition of fluids in the ascending colon is affected by feeding. This may affect the performance of products designed to deliver drug to the colon.
Cherry-tree colon: colonoscopic appearance suggesting drug-induced mucosal injury
Internal and Emergency Medicine, 2013
Drug-induced damage to the gastrointestinal mucosa has been mainly focused on damage in the upper tract. However, increasing evidence suggests that commonly used drugs may also affect the mucosa of the lower gut, and particularly in the colon. The aim of this study was to report that fairly homogeneous colonoscopic findings, correlate with histological evidence of drug-induced mucosal injury. Charts of patients with the ''cherry tree'' colonoscopic aspect were reviewed to correlate the endoscopic and histological findings for a possible association with the use of drugs. Data from 29 patients (5 men, 24 women, age range 16-76 years) with the ''cherry tree'' colonoscopic findings were analyzed. Histology revealed an increase in eosinophils in the left colon in 23 patients, pseudomelanosis coli in 3, and microscopic colitis in 3. The findings were associated with proton pump inhibitors in 19 (65.5 %), non-steroidal anti-inflammatory drugs or statins (3 cases each), and other drugs [4 cases, including estroprogestinics (1), antidepressants (2), and thyroxin (1)]. The ''cherry tree'' colonoscopic appearance suggests druginduced colonic damage. Awareness of this association may prevent unnecessary, expensive and time-consuming procedures.
Therapeutic advances in gastroenterology, 2017
Antispasmodic drugs are cheap, effective and generally safe. They may improve outcomes in colonoscopy, however their use has not been consistent or widespread. This manuscript reviews the three most commonly used antispasmodics in colonoscopy, namely, hyoscine butylbromide (and related ammonium compounds), glucagon and peppermint oil. The pharmacology, action and safety of the agents, as well as the evidence for them improving colonoscopic outcomes will be discussed. In addition to polyp detection, other colonoscopic outcome endpoints of interest include cecal and ileal intubation, and patient comfort. The drugs studied were all found to be effective gastrointestinal antispasmodics with good safety profiles. There is insufficient evidence to conclude whether antispasmodics improve cecal intubation rate, predominantly because the baseline rates are already high. Antispasmodics probably have efficacy in reducing cecal intubation time especially in those with marked colonic spasm. Anti...
Colonic and small intestinal response to intravenous prostaglandin F2 alpha and E2 in man
Gut, 1975
The effects of intravenous infusions of prostaglandins (PGs) F2 alpha(0-4 or 0-8 mug kg-1 min-1) or E2 (0-08 or 0-1 mug kg-1 min equals1) on net colonic movement of water and electrolytes and on ileal flow were measured in eight healthy males by simultaneous ileal and colonic perfusion. Ileal flow was increased by PGF2 alpha (six subjects) from a mean of 1-69 ml min-1 to 4-63 ml min-1 (P smaller than 0-01); it also increased in the two subjects given PGE2. Colonic absorptive function was not significantly diminished by either prostaglandin. These results suggest that diarrhoea due to prostaglandins originates in the small intestine.
Vitamine K Antagonist and Colonoscopy: Proposal to Get out of a Dilemma
International Journal of Anesthesia and Clinical Medicine
The management of anticoagulants in patients requiring digestive endoscopy, and particularly VKA, is not always easy. There is indeed often a discrepancy between the recommendations of leaned societies and practice in the conduct of VKA treatment before a screening colonoscopy. The recommendations take into account the haemorrhagic risk of the endoscopic procedure and the nature and importance of the thrombotic risk for which the patient is under treatment. A colonoscopy with or without a biopsy is considered a low bleeding risk procedure for which it is recommended not to stop VKA treatment. If the examination reveals a lesion, the resection gesture will be programmed in a second time after stopping the AVK which will possibly be substituted by a Low molecular weight heparin according to a very precise schedule. In practice, this recommendation is poorly followed, because the continuation of VKA does not allow to carry out simultaneously a diagnostic and therapeutic gesture and sometimes imposes an overload of work. Its systematic stopping is also not the right solution, because it often consists of unnecessary thromboembolic risk taking. To resolve this dilemma, we propose to decide whether to discontinue VKA treatment based on the level of risk of adenoma and colorectal cancer.