Bowel preparation is a core issue in colonoscopy,as it is closely related to the quality of the procedure.Patients often find that bowel preparation is the most unpleasant part of the examination.It is widely accepted...Bowel preparation is a core issue in colonoscopy,as it is closely related to the quality of the procedure.Patients often find that bowel preparation is the most unpleasant part of the examination.It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions.In spite of its importance and potential implications,until recently,bowel preparation has not been the subject of much study.The most commonly used agents are high-volume polyethylene glycol(PEG)electrolyte solution and sodium phosphate.There has been some confusion,even in published meta-analyses,regarding which of the two agents provides better cleansing.It is clear now that both PEG and sodium phosphate are effectivewhen administered with proper timing.Consequently,the timing of administration is recognized as one of the central factors to the quality of cleansing.The bowel preparation agent should be administered,at least in part,a few hours in advance of the colonoscopy.Several low volume agents are available,and either new or modified schedules with PEG that usually improve tolerance.Certain adjuvants can also be used to reduce the volume of PEG,or to improve the efficacy of other agents.Other factors apart from the choice of agent can improve the quality of bowel cleansing.For instance,the effect of diet before colonoscopy has not been completely clarified,but an exclusively liquid diet is probably not required,and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure.Some patients,such as diabetics and persons with heart or kidney disease,require modified procedures and certain precautions.Bowel preparation for pediatric patients is also reviewed here.In such cases,PEG remains the most commonly used agent.As detecting neoplasia is not the main objective with these patients,less intensive preparation may suffice.Special considerations must be made for patients with inflammatory bowel disease,including safety and diagnostic issues,so that the most adequate agent is chosen.Identifying neoplasia is one of the main objectives of colonoscopy with these patients,and the target lesions are often almost invisible with white light endoscopy.Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy.Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge,and the strategies available are also reviewed here.展开更多
AIM:To study the association between exposure toSalmonella enterica(SE)and Crohn’s disease(CD)and its clinical implications in Chilean patients.METHODS:Ninety-four unrelated Chilean CD patients from CAREI(Active Coho...AIM:To study the association between exposure toSalmonella enterica(SE)and Crohn’s disease(CD)and its clinical implications in Chilean patients.METHODS:Ninety-four unrelated Chilean CD patients from CAREI(Active Cohort Registry of Inflammatory Bowel Disease)presenting to a single inflammatory bowel disease(IBD)unit of a University Hospital were prospectively included in this study.A complete clinical evaluation,including smoking history,was performed at the initial visit,and all the important data of clinical evolution of CD were obtained.Blood samples from these CD patients and 88 healthy sex-and agematched control subjects were analyzed for exposure to SE and for their NOD2/CARD15 gene status using the presence of anti-Salmonella lipopolysaccharide antibodies[immunoglobulin-G type(IgG)]and polymerase chain reaction(PCR),respectively.We also evaluated exposure to SE in 90 sex-and age-matched patients without CD,but with known smoking status(30 smokers,30 non-smokers,and 30 former smokers).RESULTS:CD patients comprised 54 females and 40males,aged 35.5±15.2 years at diagnosis with a mean follow-up of 9.0±6.8 years.CD was inflammatory in 59 patients(62.7%),stricturing in 24(25.5%)and penetrating in 15(15.5%).Thirty cases(31.9%)had lesions in the ileum,29(30.8%)had ileocolonic lesions,32(34.0%)had colonic lesions and 23(24.4%)had perianal disease.Sixteen CD patients(17%)were exposed to SE compared to 15(17%)of 88 healthy control subjects(P=0.8).Thirty-one CD patients(32.9%)were smokers,and 7(7.4%)were former smokers at diagnosis.In the group exposed to SE,10 of 16 patients(62.5%)were active smokers compared to 21 of 78 patients(26.9%)in the unexposed group(P=0.01).On the other hand,10 of 31 smoking patients(32%)were exposed to SE compared to 5 of 56 nonsmoking patients(9%),and one of the seven former smokers(14%)(P=0.01).In the group of 90 patients without CD,but whose smoking status was known,there was no differ-ence in exposure to SE[3 of 30 smokers(10%),5 of30 non-smokers(16%),and 5 of 30 former smokers(16%);P=0.6].There were no differences in disease severity between CD patients with and those without anti-SE IgG antibodies,estimated as the appearance of stricturing[2(12.5%)vs 22(28.2%);P=0.2]or penetrating lesions[2(12.5%)vs 13(16.6%);P=1.0];or the need for immunosuppressants[11(68.7%)vs 55(70.5%);P=1.0],anti-tumor necrosis factor therapy[1(6.2%)vs 7(8.9%);P=1.0],hospitalization[13(81.2%)vs 58(74.3%);P=0.7],or surgery[3(18.7%)vs 12(15.3%);P=0.3),respectively].No other factors were associated with SE,including NOD2/CARD15 gene status.Seventeen CD patients(18%)had at least one mutation of the NOD2/CARD15 gene.CONCLUSION:Our study found no association between exposure to SE and CD.We observed a positive correlation between SE exposure and cigarette smoking in Chilean patients with CD,but not with disease severity.展开更多
文摘Bowel preparation is a core issue in colonoscopy,as it is closely related to the quality of the procedure.Patients often find that bowel preparation is the most unpleasant part of the examination.It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions.In spite of its importance and potential implications,until recently,bowel preparation has not been the subject of much study.The most commonly used agents are high-volume polyethylene glycol(PEG)electrolyte solution and sodium phosphate.There has been some confusion,even in published meta-analyses,regarding which of the two agents provides better cleansing.It is clear now that both PEG and sodium phosphate are effectivewhen administered with proper timing.Consequently,the timing of administration is recognized as one of the central factors to the quality of cleansing.The bowel preparation agent should be administered,at least in part,a few hours in advance of the colonoscopy.Several low volume agents are available,and either new or modified schedules with PEG that usually improve tolerance.Certain adjuvants can also be used to reduce the volume of PEG,or to improve the efficacy of other agents.Other factors apart from the choice of agent can improve the quality of bowel cleansing.For instance,the effect of diet before colonoscopy has not been completely clarified,but an exclusively liquid diet is probably not required,and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure.Some patients,such as diabetics and persons with heart or kidney disease,require modified procedures and certain precautions.Bowel preparation for pediatric patients is also reviewed here.In such cases,PEG remains the most commonly used agent.As detecting neoplasia is not the main objective with these patients,less intensive preparation may suffice.Special considerations must be made for patients with inflammatory bowel disease,including safety and diagnostic issues,so that the most adequate agent is chosen.Identifying neoplasia is one of the main objectives of colonoscopy with these patients,and the target lesions are often almost invisible with white light endoscopy.Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy.Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge,and the strategies available are also reviewed here.
基金Supported by The Fondo Nacional de Ciencia y Tecnología de ChileNo.1100971+1 种基金the Millennium Institute on Immunology and ImmunotherapyNo.P09/016F
文摘AIM:To study the association between exposure toSalmonella enterica(SE)and Crohn’s disease(CD)and its clinical implications in Chilean patients.METHODS:Ninety-four unrelated Chilean CD patients from CAREI(Active Cohort Registry of Inflammatory Bowel Disease)presenting to a single inflammatory bowel disease(IBD)unit of a University Hospital were prospectively included in this study.A complete clinical evaluation,including smoking history,was performed at the initial visit,and all the important data of clinical evolution of CD were obtained.Blood samples from these CD patients and 88 healthy sex-and agematched control subjects were analyzed for exposure to SE and for their NOD2/CARD15 gene status using the presence of anti-Salmonella lipopolysaccharide antibodies[immunoglobulin-G type(IgG)]and polymerase chain reaction(PCR),respectively.We also evaluated exposure to SE in 90 sex-and age-matched patients without CD,but with known smoking status(30 smokers,30 non-smokers,and 30 former smokers).RESULTS:CD patients comprised 54 females and 40males,aged 35.5±15.2 years at diagnosis with a mean follow-up of 9.0±6.8 years.CD was inflammatory in 59 patients(62.7%),stricturing in 24(25.5%)and penetrating in 15(15.5%).Thirty cases(31.9%)had lesions in the ileum,29(30.8%)had ileocolonic lesions,32(34.0%)had colonic lesions and 23(24.4%)had perianal disease.Sixteen CD patients(17%)were exposed to SE compared to 15(17%)of 88 healthy control subjects(P=0.8).Thirty-one CD patients(32.9%)were smokers,and 7(7.4%)were former smokers at diagnosis.In the group exposed to SE,10 of 16 patients(62.5%)were active smokers compared to 21 of 78 patients(26.9%)in the unexposed group(P=0.01).On the other hand,10 of 31 smoking patients(32%)were exposed to SE compared to 5 of 56 nonsmoking patients(9%),and one of the seven former smokers(14%)(P=0.01).In the group of 90 patients without CD,but whose smoking status was known,there was no differ-ence in exposure to SE[3 of 30 smokers(10%),5 of30 non-smokers(16%),and 5 of 30 former smokers(16%);P=0.6].There were no differences in disease severity between CD patients with and those without anti-SE IgG antibodies,estimated as the appearance of stricturing[2(12.5%)vs 22(28.2%);P=0.2]or penetrating lesions[2(12.5%)vs 13(16.6%);P=1.0];or the need for immunosuppressants[11(68.7%)vs 55(70.5%);P=1.0],anti-tumor necrosis factor therapy[1(6.2%)vs 7(8.9%);P=1.0],hospitalization[13(81.2%)vs 58(74.3%);P=0.7],or surgery[3(18.7%)vs 12(15.3%);P=0.3),respectively].No other factors were associated with SE,including NOD2/CARD15 gene status.Seventeen CD patients(18%)had at least one mutation of the NOD2/CARD15 gene.CONCLUSION:Our study found no association between exposure to SE and CD.We observed a positive correlation between SE exposure and cigarette smoking in Chilean patients with CD,but not with disease severity.
