28 research outputs found
Functional gastrointestinal disorders in inflammatory bowel disease: Time for a paradigm shift?
Recent advances in biological therapies have revolutionalised and redefined treatment targets in inflammatory bowel disease (IBD). There is now a stronger emphasis on achieving the more stringent therapeutic goals of mucosal and histological healing, rather than clinical remission alone. Consequently, the treatment of refractory âfunctionalâ gastrointestinal symptoms, often attributed as the aftermath of previous inflammation, has recently become more prominent in quiescent disease. With further expected advances in anti-inflammatory treatments on the horizon, the burden of such symptoms in quiescent disease, which have been relatively neglected, is set to become an even bigger problem. In this article, we highlight the current state of research and understanding in this field, including recent developments and clinical practice guidelines on the diagnosis and management of functional gastrointestinal symptoms, such as irritable bowel syndrome and functional anorectal and pelvic floor disorders, in patients with quiescent IBD. These disorders are not only highly prevalent in these patients, they are often misdiagnosed, and are difficult to treat, with very few evidence-based therapies. Moreover, they are associated with substantial impairment in quality-of-life, considerable morbidity, and psychological distress. There is therefore an urgent need for a change in emphasis towards earlier recognition, positive diagnosis, and targeted treatment for patients with ongoing functional gastrointestinal symptoms in the absence of active IBD. This article also highlights the need for further research to develop much needed evidence-based therapies
Zinc and silica are active components to efficiently treat in vitro simulated eroded dentin.
Objectives: Biomaterials for treating dentin hypersensitivity and dentin wear were
evaluated, to efficiently occlude the dentinal tubules and to increase dentin resistance to
abrasion. Materials and Methods: 24 dentin surfaces were treated with EDTA to expose
dentinal tubules, and were: 1) non-brushed, 2) brushed with distilled water, or with pastes
containing 3) Monetite, 4) Brushite, 5) Zn-Monetite, 6) Zn-Brushite, 7) Silica-Brushite
and 8) NovaMinÂź. Topography, nanomechanical and chemical analysis were assessed on
dentin surfaces (n=3) after artificial saliva immersion for 24 h, and after citric acid
challenge. 21 further dentin specimens were created to evaluate dentin permeability after
brushing, saliva storage and acid application (n=3). ANOVA, Student-Newman-Keuls
(p<0.05) and Student t-test (p<0.001) were used. Results: Particles containing major
proportion of silica attained intratubular occlusion by carbonate crystals (Raman
carbonate peak heights: 15.17 and 19.24 au; complex modulus: 110 and 140 GPa, at
intratubular dentin). When brushing with pastes containing higher proportion of silica or
zinc, phosphate calcium compounds were encountered into tubules and over dentin
surfaces (Raman intratubular phosphate peak heights: 49 to 70 au, and at the intertubular
dentin: 78 to 92). The formed carbonated apatite and calcium phosphate layer were
resistant to citric acid application. Zinc compounds drastically increased tubule occlusion,
decreased dentin permeability (up to 30%) and augmented mechanical properties at the
intertubular dentin (90-130 GPa), it was maintained after acid challenging. Conclusions:
Zinc-containing pastes occluded dentinal tubules and improved dentin mechanical
properties. Clinical Relevance: Using zinc as an active component to treat eroded dentin
is encouraged.Projects RTC-2014-1731-1 and MAT2014-52036-P
supported by the Ministry of Economy and Competitiveness and European Regional
Development Fund