BACKGROUND In the field of clinical intestinal preparation,compound polyethylene glycol electrolyte solution(SF-PEG)is a commonly used intestinal cleaner.However,practice has shown that using only a single polyethylen...BACKGROUND In the field of clinical intestinal preparation,compound polyethylene glycol electrolyte solution(SF-PEG)is a commonly used intestinal cleaner.However,practice has shown that using only a single polyethylene glycol formulation often fails to achieve the desired intestinal preparation effect.Linalotide has a unique mechanism of action,which can effectively enhance the secretion of small intestinal fluid and promote intestinal peristalsis.The combination of linaclotide and SF-PEG may provide a better solution for intestinal preparation and improve the quality of intestinal cleaning.Therefore,exploring the application value and clinical efficacy of linaclotide capsules combined with SF-PEG in intestinal preparation is of great clinical significance.AIM To explore the effects of the combination of linaclotide capsules and SF-PEG,including its efficacy in intestinal preparation and patient tolerance.METHODS To investigate the differences in the effectiveness of different bowel preparation plans in colonoscopy,this article conducted a comprehensive and detailed retrospective analysis of the medical records of patients who underwent colonoscopy from January 2023 to December 2023.In this study,116 patients were accurately divided into three groups based on the different intestinal preparation drugs used before colonoscopy.Among them,group A consisted of 29 patients who underwent intestinal preparation using 3 liters of SF-PEG combined with linaclotide;group B consists of 50 patients who underwent intestinal preparation using 3 liters of SF-PEG;group C consisted of 37 patients who underwent intestinal preparation using a combination of 2-liter SF-PEC and linaclotide.Subsequently,this article evaluated the quality of intestinal preparation in these three groups of patients,using the Boston bowel preparation scale(BBPS)as a quantitative indicator,while comparing multiple indicators such as intestinal preparation completion rate and detection of positive lesions,providing a strong basis for optimizing clinical intestinal preparation plans.RESULTS No statistically significant differences were found in BBPS scores(7.75±1.23,7.69±1.14,and 7.66±1.31;P=0.240),bowel preparation completion rates(96.55%,90.00%,and 97.30%;P=0.293),adenoma detection rates(20.69%,38.00%,and 32.43%;P=0.281),polyp detection rates(34.48%,50.00%,37.84%;P=0.326),insertion time(6.03±4.34,6.12±3.60,and 5.33±2.42;P=0.584),and patient satisfaction rates(89.66%,84.00%,and 97.30%;P=0.398)among the three groups.However,statistically significant differences were observed in withdrawal time(7.45±2.91,9.02±3.54,and 6.86±2.66;P=0.027)and adverse reaction rates(6.90%,20.00%,and 2.70%;P=0.029)among the three groups.Multiple comparisons showed that group C had significantly lower withdrawal time and adverse reaction rates than group B(P=0.013,P=0.016).CONCLUSION Linaclotide capsules show a trend in improving bowel preparation quality and reducing the dosage of SF-PEG.展开更多
Guanylate cyclase C(GC-C) is an important receptor protein expressed by intestinal epithelial cells, and its dysregulation leads to severe intestinal diseases. Linaclotide is a 14-amino acid peptide approved by the FD...Guanylate cyclase C(GC-C) is an important receptor protein expressed by intestinal epithelial cells, and its dysregulation leads to severe intestinal diseases. Linaclotide is a 14-amino acid peptide approved by the FDA for the treatment of irritable bowel syndrome with constipation(IBS-C), which activates guanylate cyclase C to accelerate intestinal transit. Drug molecule design based on structural information plays a crucial role and the activity of linaclotide still need to improve, while the structure of linaclotide remains unknown. In this work, linaclotide and its D-enantiomer were obtained through Fmoc solid phase peptide synthesis method and co-crystalized through racemic crystallization. The crystal structure showed that linaclotide has a tight, three-beta turns structure immobilized by three pairs of disulfide bonds.展开更多
Objective To explore the efficacy of linaclotide combined with compound polyethylene glycol(PEG)on bowel preparation,and compare it with traditional PEG 3 L and oral sulfate solution(OSS)3 L methods.Methods Patients a...Objective To explore the efficacy of linaclotide combined with compound polyethylene glycol(PEG)on bowel preparation,and compare it with traditional PEG 3 L and oral sulfate solution(OSS)3 L methods.Methods Patients aged 18-70 years who underwent colonoscopy attheDigestiveDiseases Hospital,Heilongjiang Provincial Hospital from January to June 2023 were continuously enrolled in the randomized controlled trial and randomly divided into 3 groups using the random number table.Intestinal preparation was conducted according to the protocols of each group,Group A:3 L PEG;Group B:3 L OSS;Group C:290μg of linaclotide+2 L PEG.The effects of bowel preparation,adverse reactions,satisfaction,and willingnesssfor repeated bowel preparation were compared.Results A total of 360 patients were included in the analysis,with 120 patients in each group.There were no statistically significant differences in the median Boston bowel preparation score for each intestinal segment or the total score among the 3 groups(left colon:3 VS 2 VS 3,H=0.371,P=0.831;transverse colon:3 VS 3 VS 3,H=0.487,P=0.784;right colon:2VS 2VS 2,H=1.088,P=0.580;total score:8 VS 8 VS 8,H=0.017,P=0.991).Among the adverse reactions,the incidence of nausea and vomiting in Group B[3.33%(4/120)]was lower than that in Group A[12.50%(15/120),x^(2)=8.042,P=0.018],and there were no statistically significant differences in other adverse reactions among the 3 groups(P>0.05).There was no significant difference in the satisfaction level among the 3 groups(x^(2)=11.840,P=0.158).The willingness to undergo bowel preparation again in Group C[95.83%(115/120)]and Group B[96.67%(116/120)w]as higher than that in Group A[85.00%(102/120)](Group C VS Group A:x^(2)=8.127,P=0.004;Group B VS Group A:X=9.808,P=0.002),and there was no significant difference between Group C and B(x^(2)=0.000,P=1.000).Conclusion Linaclotide combined with 2 L PEG offers comparable bowel preparation efficacy and safety to 3 L PEG or 3 L OSS,with improved patient compliance due to reduced water intake,suggesting its potential as an enhanced bowel preparation regimen.展开更多
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders causing patients to seek medical treatment. It is relatively resource intensive and the source of significant morbidity. Recent insig...Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders causing patients to seek medical treatment. It is relatively resource intensive and the source of significant morbidity. Recent insights into the pathophysiology and treatment of IBS has given clinicians more options than ever to contend with this disorder. The purpose of our paper is to review older, “classic” treatments for IBS as well as newer agents and “alternative” therapies. We discuss the evidence base of these drugs and provide context to help develop appropriate treatment plans for IBS patients.展开更多
Constipation is a common medical problem and when standard laxatives fail it can be difficult to treat.Different aetiologies require tailored therapeutic approaches.Simple constipation may only require dietary manipul...Constipation is a common medical problem and when standard laxatives fail it can be difficult to treat.Different aetiologies require tailored therapeutic approaches.Simple constipation may only require dietary manipulation while severe neurological or slow transit constipation may need pharmacologic intervention.Recently new drug therapies have been introduced.PubMed and Ovid were searched for reviews,systematic reviews and meta-analysis published since 2003 using the terms:constipation,Prucalopride,Linaclotide and Lubiprostone.This review summarizes potential novel therapies identified as effective in the management of chronic constipation.Prucalopride is a selective 5-hydroxytryptamine receptor agonist.The prucalopride study was in patients,largely women with idiopathic constipation showed improved spontaneous complete bowel movement(SCBM)at a dose of 2 mg a day with few adverse events reported.Linaclotide is a 14-amino acid peptide guanylate cyclase-C agonist.The linaclotide study was carried out in patients with irritable bowel syndrome,constipation group(IBS-C).There was significant improvement of bowel evacuation and symptom resolution in patients on the active treatment arm.Lubiprostone activates type-2 chloride channels,increasing intestinal fluid secretion.In the trials of this drug,the lubiprostone arms had a greater mean number of SCBM.The novel therapies,prucalopride,lubiprostone,and linaclotide had very different modes of action yet,all three have been shown to be efficacious and safe in the treatment dose for constipation.展开更多
AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxative...AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxatives in elderly with constipation,which were conducted between January1990 and January 2013 using the specified keywords.Controlled studies that enrolled geriatric patients with a diagnosis of constipation and addressed the efficacy and/or the safety of pharmacological treatments were included.Studies were excluded from this review if they were non-controlled trials,case series,or case reports.RESULTS:Out of twenty three studies we initially retrieved in our search,only nine studies met the eligibility criteria of being controlled trials within geriatrics.The laxatives examined in the nine studies were senna,lactulose,sorbital,polyethylene glycol(PEG),lubiprostone,linaclotide,and prucalopride.In those studies,senna combinations had a higher efficacy than sorbitol or lactulose as well as,a very good adverse effect profile.PEG was also shown to be safe and effective in geriatric population.Furthermore,it has been shown that PEG is as safe in geriatrics as in general population.New agents like lubiprostone and prucalopride show promising results but the data about these agents in geriatrics are still limited which warrant further investigation.CONCLUSION:Senna combinations and PEG appear to have a more favorable profile over the other traditionally used laxatives in elderly patients with constipation.展开更多
基金Supported by the Science and Technology Program of Rui’an,No.MS2023030.
文摘BACKGROUND In the field of clinical intestinal preparation,compound polyethylene glycol electrolyte solution(SF-PEG)is a commonly used intestinal cleaner.However,practice has shown that using only a single polyethylene glycol formulation often fails to achieve the desired intestinal preparation effect.Linalotide has a unique mechanism of action,which can effectively enhance the secretion of small intestinal fluid and promote intestinal peristalsis.The combination of linaclotide and SF-PEG may provide a better solution for intestinal preparation and improve the quality of intestinal cleaning.Therefore,exploring the application value and clinical efficacy of linaclotide capsules combined with SF-PEG in intestinal preparation is of great clinical significance.AIM To explore the effects of the combination of linaclotide capsules and SF-PEG,including its efficacy in intestinal preparation and patient tolerance.METHODS To investigate the differences in the effectiveness of different bowel preparation plans in colonoscopy,this article conducted a comprehensive and detailed retrospective analysis of the medical records of patients who underwent colonoscopy from January 2023 to December 2023.In this study,116 patients were accurately divided into three groups based on the different intestinal preparation drugs used before colonoscopy.Among them,group A consisted of 29 patients who underwent intestinal preparation using 3 liters of SF-PEG combined with linaclotide;group B consists of 50 patients who underwent intestinal preparation using 3 liters of SF-PEG;group C consisted of 37 patients who underwent intestinal preparation using a combination of 2-liter SF-PEC and linaclotide.Subsequently,this article evaluated the quality of intestinal preparation in these three groups of patients,using the Boston bowel preparation scale(BBPS)as a quantitative indicator,while comparing multiple indicators such as intestinal preparation completion rate and detection of positive lesions,providing a strong basis for optimizing clinical intestinal preparation plans.RESULTS No statistically significant differences were found in BBPS scores(7.75±1.23,7.69±1.14,and 7.66±1.31;P=0.240),bowel preparation completion rates(96.55%,90.00%,and 97.30%;P=0.293),adenoma detection rates(20.69%,38.00%,and 32.43%;P=0.281),polyp detection rates(34.48%,50.00%,37.84%;P=0.326),insertion time(6.03±4.34,6.12±3.60,and 5.33±2.42;P=0.584),and patient satisfaction rates(89.66%,84.00%,and 97.30%;P=0.398)among the three groups.However,statistically significant differences were observed in withdrawal time(7.45±2.91,9.02±3.54,and 6.86±2.66;P=0.027)and adverse reaction rates(6.90%,20.00%,and 2.70%;P=0.029)among the three groups.Multiple comparisons showed that group C had significantly lower withdrawal time and adverse reaction rates than group B(P=0.013,P=0.016).CONCLUSION Linaclotide capsules show a trend in improving bowel preparation quality and reducing the dosage of SF-PEG.
基金supported by the National Natural Science Foundation of China (NSFC No. 21572043)the Fundamental Research Funds for the Central Universities (No. PA2017GDQT0021)
文摘Guanylate cyclase C(GC-C) is an important receptor protein expressed by intestinal epithelial cells, and its dysregulation leads to severe intestinal diseases. Linaclotide is a 14-amino acid peptide approved by the FDA for the treatment of irritable bowel syndrome with constipation(IBS-C), which activates guanylate cyclase C to accelerate intestinal transit. Drug molecule design based on structural information plays a crucial role and the activity of linaclotide still need to improve, while the structure of linaclotide remains unknown. In this work, linaclotide and its D-enantiomer were obtained through Fmoc solid phase peptide synthesis method and co-crystalized through racemic crystallization. The crystal structure showed that linaclotide has a tight, three-beta turns structure immobilized by three pairs of disulfide bonds.
文摘Objective To explore the efficacy of linaclotide combined with compound polyethylene glycol(PEG)on bowel preparation,and compare it with traditional PEG 3 L and oral sulfate solution(OSS)3 L methods.Methods Patients aged 18-70 years who underwent colonoscopy attheDigestiveDiseases Hospital,Heilongjiang Provincial Hospital from January to June 2023 were continuously enrolled in the randomized controlled trial and randomly divided into 3 groups using the random number table.Intestinal preparation was conducted according to the protocols of each group,Group A:3 L PEG;Group B:3 L OSS;Group C:290μg of linaclotide+2 L PEG.The effects of bowel preparation,adverse reactions,satisfaction,and willingnesssfor repeated bowel preparation were compared.Results A total of 360 patients were included in the analysis,with 120 patients in each group.There were no statistically significant differences in the median Boston bowel preparation score for each intestinal segment or the total score among the 3 groups(left colon:3 VS 2 VS 3,H=0.371,P=0.831;transverse colon:3 VS 3 VS 3,H=0.487,P=0.784;right colon:2VS 2VS 2,H=1.088,P=0.580;total score:8 VS 8 VS 8,H=0.017,P=0.991).Among the adverse reactions,the incidence of nausea and vomiting in Group B[3.33%(4/120)]was lower than that in Group A[12.50%(15/120),x^(2)=8.042,P=0.018],and there were no statistically significant differences in other adverse reactions among the 3 groups(P>0.05).There was no significant difference in the satisfaction level among the 3 groups(x^(2)=11.840,P=0.158).The willingness to undergo bowel preparation again in Group C[95.83%(115/120)]and Group B[96.67%(116/120)w]as higher than that in Group A[85.00%(102/120)](Group C VS Group A:x^(2)=8.127,P=0.004;Group B VS Group A:X=9.808,P=0.002),and there was no significant difference between Group C and B(x^(2)=0.000,P=1.000).Conclusion Linaclotide combined with 2 L PEG offers comparable bowel preparation efficacy and safety to 3 L PEG or 3 L OSS,with improved patient compliance due to reduced water intake,suggesting its potential as an enhanced bowel preparation regimen.
文摘Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders causing patients to seek medical treatment. It is relatively resource intensive and the source of significant morbidity. Recent insights into the pathophysiology and treatment of IBS has given clinicians more options than ever to contend with this disorder. The purpose of our paper is to review older, “classic” treatments for IBS as well as newer agents and “alternative” therapies. We discuss the evidence base of these drugs and provide context to help develop appropriate treatment plans for IBS patients.
文摘Constipation is a common medical problem and when standard laxatives fail it can be difficult to treat.Different aetiologies require tailored therapeutic approaches.Simple constipation may only require dietary manipulation while severe neurological or slow transit constipation may need pharmacologic intervention.Recently new drug therapies have been introduced.PubMed and Ovid were searched for reviews,systematic reviews and meta-analysis published since 2003 using the terms:constipation,Prucalopride,Linaclotide and Lubiprostone.This review summarizes potential novel therapies identified as effective in the management of chronic constipation.Prucalopride is a selective 5-hydroxytryptamine receptor agonist.The prucalopride study was in patients,largely women with idiopathic constipation showed improved spontaneous complete bowel movement(SCBM)at a dose of 2 mg a day with few adverse events reported.Linaclotide is a 14-amino acid peptide guanylate cyclase-C agonist.The linaclotide study was carried out in patients with irritable bowel syndrome,constipation group(IBS-C).There was significant improvement of bowel evacuation and symptom resolution in patients on the active treatment arm.Lubiprostone activates type-2 chloride channels,increasing intestinal fluid secretion.In the trials of this drug,the lubiprostone arms had a greater mean number of SCBM.The novel therapies,prucalopride,lubiprostone,and linaclotide had very different modes of action yet,all three have been shown to be efficacious and safe in the treatment dose for constipation.
文摘AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxatives in elderly with constipation,which were conducted between January1990 and January 2013 using the specified keywords.Controlled studies that enrolled geriatric patients with a diagnosis of constipation and addressed the efficacy and/or the safety of pharmacological treatments were included.Studies were excluded from this review if they were non-controlled trials,case series,or case reports.RESULTS:Out of twenty three studies we initially retrieved in our search,only nine studies met the eligibility criteria of being controlled trials within geriatrics.The laxatives examined in the nine studies were senna,lactulose,sorbital,polyethylene glycol(PEG),lubiprostone,linaclotide,and prucalopride.In those studies,senna combinations had a higher efficacy than sorbitol or lactulose as well as,a very good adverse effect profile.PEG was also shown to be safe and effective in geriatric population.Furthermore,it has been shown that PEG is as safe in geriatrics as in general population.New agents like lubiprostone and prucalopride show promising results but the data about these agents in geriatrics are still limited which warrant further investigation.CONCLUSION:Senna combinations and PEG appear to have a more favorable profile over the other traditionally used laxatives in elderly patients with constipation.
