A candidate probiotic with unfavourable effects in subjects with irritable bowel syndrome: a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Some probiotics have shown efficacy for patients with irritable bowel syndrome (IBS). <it>Lactobacillus (L.) plantarum </it>MF1298 was found to have the best <it>in vitro </it>probiotic properties of 22 strains of lactobacilli. The aim of this study was to investigate the symptomatic effect of <it>L. plantarum </it>MF1298 in subjects with IBS. Primary outcome was treatment preference and secondary outcomes were number of weeks with satisfactory relief of symptoms and IBS sum score.</p> <p>Methods</p> <p>The design was a randomised double blind placebo-controlled crossover trial. 16 subjects with IBS underwent two three-week periods of daily intake of one capsule of 10¹⁰CFU <it>L. plantarum </it>MF 1298 or placebo separated by a four-week washout period.</p> <p>Results</p> <p>Thirteen participants (81%; 95% CI 57% to 93%; <it>P </it>= 0.012) preferred placebo to <it>L. plantarum </it>MF1298 treatment. The mean (SD) number of weeks with satisfactory relief of symptoms in the periods with <it>L. plantarum </it>MF1298 and placebo were 0.50 (0.89) and 1.44 (1.26), respectively (<it>P </it>= 0.006). IBS sum score was 6.44 (1.81) in the period with <it>L. plantarum </it>MF1298 treatment compared with 5.35 (1.77) in the period with placebo (<it>P </it>= 0.010). With a clinically significant difference in the IBS sum score of 2 in disfavour of active treatment, the number needed to harm was 3.7, 95% CI 2.3 to 10.9.</p> <p>Conclusions</p> <p>This trial shows for the first time an unfavourable effect on symptoms in subjects with IBS after intake of a potential probiotic.</p> <p>The trial registration number</p> <p>Clinical trials NCT00355810.</p

The role of open abdomen in non-trauma patient : WSES Consensus Paper

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.Peer reviewe

Illness perceptions mediate the relationship between bowel symptom severity and health-related quality of life in IBS patients

PURPOSE: Irritable bowel syndrome (IBS) is a functional bowel disorder with a large negative impact on HRQOL. The present study examines whether severity of bowel symptoms is directly related to HRQOL, and/or indirectly, mediated by the patients’ illness perceptions. METHODS: Patients were recruited from an IBS support group (N = 123), and data were collected online. HRQOL was measured with the Quality of Life Measure for Persons with IBS and illness perceptions with the brief Illness Perception Questionnaire. Mediation models were tested using the bootstrapping procedure developed by Hayes. RESULTS: Irritable bowel syndrome symptom severity is directly related to total HRQOL and its subscales; after entering the mediator variables (i.e. the patients’ illness perceptions) into the model, this direct association remained only significant for total HRQOL. The relationship between bowel symptom severity and total HRQOL was partially mediated by illness perceptions, and its relationship with each of the HRQOL subscales was fully mediated by the patients’ illness perceptions. Perceived consequences were a mediator of the relationship between bowel symptom severity, total HRQOL as well as its subscales, with the exception of Sexuality. CONCLUSIONS: Bowel symptom severity not only has a direct relationship with HRQOL, but also an indirect relationship via the patients’ cognitive and emotional representations of their illness. In order to better understand this relationship, future research should not only include illness perceptions but also assess cognitive and behavioural coping responses. Clinicians wanting to improve patients’ HRQOL should not only focus on the patients’ symptoms, but also on their illness beliefs and coping responses

Abdominal compartment syndrome and colonic ischaemia after abdominal aortic aneurysm repair in the endovascular era

Abdominal Compartment Syndrome (ACS) and colonic ischaemia (CI) are serious and potentially lethal complications after open (OSR) and endovascular repair (EVAR) of ruptured (rAAA) and intact (iAAA) abdominal aortic aneurysms. The aims of this thesis were to investigate the incidence, outcome, and risk factors associated with ACS (Papers I-III) and to evaluate extraluminal colonic tonometry for postoperative surveillance of colonic perfusion (Paper IV). Papers I-III combined data from the nationwide Swedish vascular registry (Swedvasc) (2008-2015) with case records and radiologic imaging. Paper I investigated incidence and outcome of ACS. The incidence was approximately 7% for both EVAR and OSR after rAAA and 1.6% after OSR and 0.5% after EVAR for iAAA. ACS was associated with a more than two-fold (59% vs 27%) 90-day mortality after rAAA and six-fold (19% vs 3%) after iAAA. Paper II investigated risk factors and outcome among subgroups. Risk of death could not be attributed to a specific main pathology of ACS: CI, postoperative bleeding and general oedema, nor to timing of decompressive laparotomy in relation to AAA surgery. However, the duration of intra-abdominal hypertension (IAH) predicted the need for renal replacement therapy. Paper III investigated risk factors after EVAR for rAAA. ACS was rare without pronounced pre- or intraoperative physiologic derangement associated with circulatory instability. Aortic morphology did not impact ACS development, nor did presence of a patent inferior mesenteric and lumbar arteries, known risk factors for type II endoleak. Paper IV studied patients operated on for iAAA/rAAA (n=27), and demonstrated extraluminal colonic tonometry safe, reliable and indicative of CI among all affected patients (n=4). In conclusion, ACS was common after rAAA repair, with poor outcome irrespective of AAA repair technique and indication for repair. Outcome did not differ depending on the main pathophysiological finding associated with ACS development, while a longer duration of IAH increased the risk of renal replacement therapy. ACS after EVAR for rAAA was largely associated with pre- and intraoperative physiologic factors. These findings highlight the importance of vigilant intra-abdominal pressure measurement after rAAA repair and in case of haemodynamic instability, as well as timely interventions to treat IAH. Extraluminal colonic tonometry appears promising for surveillance of postoperative colonic perfusion

Abdominal compartment syndrome and colonic ischaemia after abdominal aortic aneurysm repair in the endovascular era

Abdominal Compartment Syndrome (ACS) and colonic ischaemia (CI) are serious and potentially lethal complications after open (OSR) and endovascular repair (EVAR) of ruptured (rAAA) and intact (iAAA) abdominal aortic aneurysms. The aims of this thesis were to investigate the incidence, outcome, and risk factors associated with ACS (Papers I-III) and to evaluate extraluminal colonic tonometry for postoperative surveillance of colonic perfusion (Paper IV). Papers I-III combined data from the nationwide Swedish vascular registry (Swedvasc) (2008-2015) with case records and radiologic imaging. Paper I investigated incidence and outcome of ACS. The incidence was approximately 7% for both EVAR and OSR after rAAA and 1.6% after OSR and 0.5% after EVAR for iAAA. ACS was associated with a more than two-fold (59% vs 27%) 90-day mortality after rAAA and six-fold (19% vs 3%) after iAAA. Paper II investigated risk factors and outcome among subgroups. Risk of death could not be attributed to a specific main pathology of ACS: CI, postoperative bleeding and general oedema, nor to timing of decompressive laparotomy in relation to AAA surgery. However, the duration of intra-abdominal hypertension (IAH) predicted the need for renal replacement therapy. Paper III investigated risk factors after EVAR for rAAA. ACS was rare without pronounced pre- or intraoperative physiologic derangement associated with circulatory instability. Aortic morphology did not impact ACS development, nor did presence of a patent inferior mesenteric and lumbar arteries, known risk factors for type II endoleak. Paper IV studied patients operated on for iAAA/rAAA (n=27), and demonstrated extraluminal colonic tonometry safe, reliable and indicative of CI among all affected patients (n=4). In conclusion, ACS was common after rAAA repair, with poor outcome irrespective of AAA repair technique and indication for repair. Outcome did not differ depending on the main pathophysiological finding associated with ACS development, while a longer duration of IAH increased the risk of renal replacement therapy. ACS after EVAR for rAAA was largely associated with pre- and intraoperative physiologic factors. These findings highlight the importance of vigilant intra-abdominal pressure measurement after rAAA repair and in case of haemodynamic instability, as well as timely interventions to treat IAH. Extraluminal colonic tonometry appears promising for surveillance of postoperative colonic perfusion

Surveillance to detect colonic ischemia with extraluminal pH measurement after open surgery for abdominal aortic aneurysm

Objective: Colonic ischemia (CI) is a life-threatening complication after aortic surgery. Postoperative surveillance of colonic perfusion may be warranted. The aim was to evaluate the safety and feasibility of postoperative extraluminal pH measurement (pHe) using colonic tonometry after open abdominal aortic aneurysm (AAA) repair. Methods: Before closing the abdomen after open AAA repair, a tonometric catheter was placed transabdominally in contact with the sigmoid colon serosa, similar to a drainage catheter. Extraluminal partial pressure of carbon dioxide was measured postoperatively and combined with arterial blood gas analysis, the pHe was calculated. The measurements were repeated every four hours alongside simultaneous intra-abdominal pressure measurements. The threshold for colonic malperfusion was set at pHe&lt;7.2. Results: Twenty-seven patients were monitored, twelve operated on for ruptured AAA and fifteen for intact AAA. Four patients developed clinically significant CI requiring surgical treatment, all of which were preceded by prolonged (&gt;5h) pHe&lt;7.2 indicating malperfusion. A fifth patient, who during monitoring had a lowest pHe of 7.21, developed mild colonic ischemia with onset after completion of monitoring, which was successfully managed conservatively. Seven patients who had brief durations (&lt;5h) of pHe&lt;7.2 did not develop clinical signs of CI or any related adverse events. Conclusions: Measurements of pHe using colonic tonometry indicated malperfusion in all patients who developed clinically significant CI. Shorter duration of low pHe was well tolerated without any signs of CI. Measurement of pHe was safe and reliable for surveillance of colonic perfusion after open aortic surgery, indicating a promising technique, but larger studies are needed