Herbal medicines for the treatment of functional and inflammatory bowel disorders

In many parts of the world, there continues to be a long-standing tradition of prescribing herbal products for a range of gastrointestinal conditions. Scientific evidence supporting the use of all herbal preparations is imperfect, however, and available studies are plagued by methodological limitations. For functional gastrointestinal disorders, there is limited evidence supporting the use of some well-characterized preparations. A number of herbals have immunomodulatory activity, and in inflammatory bowel disease there are limited positive placebo-controlled trials; other studies used active controls with suboptimal doses of the comparators. Like all drugs, herbals can lead to serious adverse events (eg, hepatic failure). Quality control is a serious issue to consider when prescribing herbal medicines. Many herbal preparations are marketed without evidence for stringent adherence to good manufacturing practice guidelines. Unpredictable environmental conditions may affect the composition and the concentration of the active ingredients of plant extracts. Further, commercial herbal products usually combine a variable plethora of chemical families with possible medicinal utility. While some of these ingredients might be of benefit, the concentration and dose of these constituents needs to be closely monitored. Physicians and regulators need to remain very cautious about the use of herbal remedies. Appropriate scientific evidence for the claimed clinical benefits should become mandatory worldwide, and the standards for production and safety monitoring should comply with established standards for chemically defined products. If these principles were adopted, the full value of herbal remedies may come to light, particularly as the individually bioactive compounds present in these preparations become recognized

Measuring Successful Treatment of Irritable Bowel Syndrome: Is “Satisfactory Relief ” Enough?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75081/1/j.1572-0241.2006.00519.x.pd

Prevalence and Risk Factors of Gastrointestinal Disorders in Patients with Rheumatoid Arthritis: Results from a Population-Based Survey in Olmsted County, Minnesota

Objectives. To compare the prevalence of gastrointestinal (GI) disorders in rheumatoid arthritis (RA) versus non-RA subjects and to describe determinants of GI disorders in RA. Methods. The bowel disease questionnaire was completed by RA and non-RA subjects. RA patients also completed the health assessment questionnaire (HAQ). Results. The study responders included 284 RA and 233 non-RA subjects. Abdominal pain/discomfort, postprandial fullness, nausea, and stool leakage were significantly more common in RA versus non-RA (odds ratios [OR] = 1.8; 1.9; 4.0; 8.2, resp.). The use of laxatives, proton pump inhibitors, NSAIDs, acetaminophen, and narcotics was more commonly reported in RA versus non-RA (OR = 2.0; 1.7; 3.0; 2.0; 1.9, resp.). Age < 60 and HAQ ≥ 1 were associated with dyspepsia, irritable bowel syndrome, gastroesophageal reflux disease, and GI symptom complex overlap in RA. Conclusion. Several upper and lower GI disorders were significantly more prevalent in RA versus non-RA subjects. Age <60 and physical function impairment (HAQ ≥ 1) were associated with GI disorders in RA

Self-reported effectiveness and physician consultation rate in users of over-the-counter histamine-2 receptor antagonists

Decreased physician visits for dyspepsia were predicted with the histamine-2 receptor antagonists (H2RA) release to over-the-counter (OTC) status. The aim of this study was to examine the presentation frequency for dyspeptic complaints before and after the OTC release of the H2RA and the self-reported effectiveness of OTC H2RA. METHODS : Two cross-sectional surveys were used in a community sample. The patients comprised a random age- and sex-stratified sample of 1600 ambulatory adults in 1993 and 1800 in 1997. Self-report, valid mail surveys gathered information on healthcare seeking and gastrointestinal symptoms in 1993 and 1997 and antisecretory use in 1997. RESULTS : Presentation frequency for dyspepsia was 22% in 1993 versus 23.5% in 1997. Only 16% of chronic users of the OTC H2RA obtained complete relief of symptomatic episodes. Use of an OTC H2RA was highly associated with presentation to a physician in the past year. CONCLUSIONS : OTC H2RA infrequently provided the complete relief desired by patients. Presentation frequency to physicians for dyspeptic complaints did not change with availability of H2RA OTC.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72813/1/j.1572-0241.2001.03602.x.pd

Report from the multinational irritable bowel syndrome initiative 2012

Q1Q1In 2012, a group of 29 internationally recognized experts in the pathophysiology, diagnosis, and treatment of irritable bowel syndrome (IBS) convened to audit the current state of IBS research. The meeting was preceded by a comprehensive online survey that focused on research needs for IBS diagnosis (particularly the strengths and shortcomings of current criteria), definitions used in clinical trials for IBS patients and “healthy controls,” potential biomarkers for IBS, and outcome measures in drug trials. While the purpose of the meeting was not to make binding recommendations, participants developed a framework for future questions and research needs in IBS. First, participants indicated the need for revised criteria for the diagnosis of IBS; in particular, inclusion of bloating and de-emphasis of pain as criteria were considered critical needs. Second, participants noted that definitions of normal, healthy controls varied widely among clinical trials; these definitions need to be standardized not only to improve the reliability of results, but also to better facilitate inter-trial comparisons and data synthesis. Third, participants highlighted the need for accurate biomarkers of disease. Fourth and finally, participants noted that further defining outcome measures, so that they are functionally relevant and reflect normalization of bowel function, is a critical need. Together, the discussions held at this workshop form a framework to address future research in IBS.https://orcid.org/0000-0002-9219-4548Revista Internacional - Indexad

Systematic Review on the Management of Chronic Constipation in North America

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72642/1/j.1572-0241.2005.50613_2.x.pd

RECOMED: A Comprehensive Pharmaceutical Recommendation System

A comprehensive pharmaceutical recommendation system was designed based on the patients and drugs features extracted from Drugs.com and Druglib.com. First, data from these databases were combined, and a dataset of patients and drug information was built. Secondly, the patients and drugs were clustered, and then the recommendation was performed using different ratings provided by patients, and importantly by the knowledge obtained from patients and drug specifications, and considering drug interactions. To the best of our knowledge, we are the first group to consider patients conditions and history in the proposed approach for selecting a specific medicine appropriate for that particular user. Our approach applies artificial intelligence (AI) models for the implementation. Sentiment analysis using natural language processing approaches is employed in pre-processing along with neural network-based methods and recommender system algorithms for modeling the system. In our work, patients conditions and drugs features are used for making two models based on matrix factorization. Then we used drug interaction to filter drugs with severe or mild interactions with other drugs. We developed a deep learning model for recommending drugs by using data from 2304 patients as a training set, and then we used data from 660 patients as our validation set. After that, we used knowledge from critical information about drugs and combined the outcome of the model into a knowledge-based system with the rules obtained from constraints on taking medicine.Comment: 39 pages, 14 figures, 13 table

Functional Dyspepsia

Dyspepsia is a constellation of symptoms referable to the gastroduodenal region of the upper gastrointestinal tract. Functional dyspepsia, a relapsing and remitting disorder, is the most common cause of these symptoms. The current standard for the diagnosis of functional dyspepsia is the Rome III criteria, developed by the Rome III Committees, a multinational group of experts in the field, first convened in 1990, that meets regularly to review and revise the diagnostic criteria for all functional gastrointestinal disorders. In most patients with functional dyspepsia, the natural history is chronic and fluctuating, with periods of time when the patient is asymptomatic followed by episodes of symptom relapse. Data from population-based studies suggest that, during extended follow-up, approximately 15 to 20% of people with functional dyspepsia have persistent symptoms and 50% have resolution of symptoms; in the remaining 30 to 35% of patients symptoms will fluctuate and meet the criteria for another functional gastrointestinal disorder.81 Despite the chronic nature of functional dyspepsia, there is no evidence to suggest that it is associated with decreased survival