Effect of Probiotic Lactobacillus (Lacidofil® Cap) for the Prevention of Antibiotic-associated Diarrhea: A Prospective, Randomized, Double-blind, Multicenter Study

Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic use. There is growing interest in probiotics for the treatment of AAD and Clostridium difficile infection because of the wide availability of probiotics. The aim of this multicenter, randomized, placebo-controlled, double-blind trial was to assess the efficacy of probiotic Lactobacillus (Lacidofil® cap) for the prevention of AAD in adults. From September 2008 to November 2009, a total of 214 patients with respiratory tract infection who had begun receiving antibiotics were randomized to receive Lactobacillus (Lacidofil® cap) or placebo for 14 days. Patients recorded bowel frequency and stool consistency daily for 14 days. The primary outcome was the proportion of patients who developed AAD within 14 days of enrollment. AAD developed in 4 (3.9%) of 103 patients in the Lactobacillus group and in 8 (7.2%) of 111 patients in the placebo group (P=0.44). However, the Lactobacillus group showed lower change in bowel frequency and consistency (50/103, 48.5%) than the placebo group (35/111, 31.5%) (P=0.01). Although the Lacidofil® cap does not reduce the rate of occurrence of AAD in adult patients with respiratory tract infection who have taken antibiotics, the Lactobacillus group maintains their bowel habits to a greater extent than the placebo group

Comparison of Concomitant Mesalamine and Immunomodulator Therapy and Immunomodulator Monotherapy for Crohn’s Disease

Background. Although immunomodulators are increasingly used in Crohn’s disease (CD), a significant number of gastroenterologists still use 5-aminosalicylate (5-ASA) in combination with azathioprine (AZA) or 6-mercaptopurine (6-MP); there is limited evidence regarding the benefit of concomitant 5-ASA with AZA/6-MP compared with AZA/6-MP monotherapy for the treatment of CD. Study Design. A total of 106 patients who received AZA/6-MP for more than 3 months between January 1991 and May 2014 were identified retrospectively. Each patient was matched with 3 randomly selected controls who were treated with concomitant therapy during the same period. Results. The cumulative probabilities of steroid use at 5 and 10 years were 24.9% and 75.8% in the 5-ASA + AZA/6-MP group and 31.2% and 87.8% in the AZA/6-MP group, respectively (P=0.187). The cumulative probabilities of anti-TNF use, resectional surgery, and disease-related hospitalization were comparable between the groups. The younger age and the use of lower doses of immunomodulators were associated with higher requirement of rescue therapy. Conclusions. This study did not demonstrate that the concomitant use of 5-ASA with AZA/6-MP showed the proof or effect in terms of steroid requirements, anti-TNF use, resectional surgery, or disease-related hospitalization compared with that of AZA/6-MP alone

Development and Validation of Novel Diagnostic Criteria for Intestinal Behet`s Disease in Korean Patients With Ileocolonic Ulcers

OBJECTIVES: It is difficult to diagnose intestinal Behcet`s disease (BD) due to various extraintestinal manifestations emerging at different time points in the disease course and a lack of reliable diagnostic criteria. We conducted this study to develop and validate novel diagnostic criteria for intestinal BD. METHODS: Experts from three universities generated the preliminary diagnostic criteria for intestinal BD, and a consensus was reached using a modified Delphi method with 13 gastroenterologists participating. To validate the criteria, we recruited 12,850 consecutive patients who underwent colonoscopic examinations between January 2000 and December 2006 at Severance Hospital, Yonsei University, Seoul, Korea. RESULTS: The novel diagnostic criteria were developed on the basis of two aspects: colonoscopic findings and extraintestinal manifestations. Of the 12,850 patients, 280 with ileocolonic ulcers were enrolled for validation. At the time of initial colonoscopic examinations, patients were categorized for BD status into 4 groups: definite (84 patients), probable (67), suspected (15), and nondiagnostic (114). At the end of the follow-up period (mean, 50.9 +/- 25.7 months), intestinal BD was confirmed in 145 patients (51.8%)-84 (100%) from the definite group, 49 (73.1%) from the probable group, 10 (66.7%) from the suspected group, and 2 (1.8%) from the nondiagnostic group. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the diagnosis probability of these criteria were 98.6, 83.0, 86.1, 98.2, and 91.1%, respectively. CONCLUSIONS: These newly proposed, simple criteria might be useful in diagnosing intestinal BD, especially in patients with ileocolonic ulcers who do not fully satisfy the diagnostic criteria of systemic BD.Lee SK, 2009, ENDOSCOPY, V41, P9, DOI 10.1055/s-0028-1103481Kobayashi K, 2007, J GASTROENTEROL, V42, P737, DOI 10.1007/s00535-007-2090-4Choi CH, 2006, DIS COLON RECTUM, V49, P1849, DOI 10.1007/s10350-006-0706-zCampbell SM, 2002, QUAL SAF HEALTH CARE, V11, P358Chang HK, 2002, J KOREAN MED SCI, V17, P371Lee CR, 2001, INFLAMM BOWEL DIS, V7, P243Chung SY, 2001, RADIOGRAPHICS, V21, P911Campbell SM, 2001, J CLIN PHARM THER, V26, P5CHUNG SY, 2001, RADIOGRAPHICS, V21, P924Mignogna MD, 2000, J RHEUMATOL, V27, P2725Choi IJ, 2000, DIS COLON RECTUM, V43, P692Sakane T, 1999, NEW ENGL J MED, V341, P1284Shimizu S, 1998, BRIT J DERMATOL, V139, P160Kaklamani VG, 1998, SEMIN ARTHRITIS RHEU, V27, P197Takada Y, 1997, J GASTROENTEROL, V32, P598GURLER A, 1997, YONSEI MED J, V38, P423Dilsen N, 1996, REV RHUM, V63, P512BANG D, 1995, J DERMATOL, V22, P926JUNG HC, 1991, J KOREAN MED SCI, V6, P313ODUFFY JD, 1990, RHEUM DIS CLIN N AM, V16, P4231990, LANCET, V335, P1078MIZUSHIMA Y, 1988, INT J TISSUE REACT, V10, P59LEE RG, 1986, AM J SURG PATHOL, V10, P888BROOK RH, 1986, INT J TECHNOL ASSESS, V2, P53LAKHANPAL S, 1985, HUM PATHOL, V16, P790KASAHARA Y, 1981, DIS COLON RECTUM, V24, P103JAMES DG, 1979, NEW ENGL J MED, V301, P431BABA S, 1976, DIS COLON RECTUM, V19, P428PRICE AB, 1975, HUM PATHOL, V6, P7SMITH GE, 1973, AM J DIG DIS, V18, P987KIM BK, ENDOSCOPY, V41, P91