[Causal association between isotretinoin and inflammatory bowel disease: a case report]

Roaccutane[R] [isotretinoin] is used for the treatment of severe forms of acne resistant to adequate standard therapy. Inflammatory bowel disease [IBD] is described as a possible adverse drug reaction in the product information of isotretinoin. In a case study, we report the case of a 30 year old woman with a history of bloody diarrhea, abdominal pain and severe folliculitis/acne which had been treated with isotretinoin. Her clinical features worsened whilst on isotretinoin. Colonoscopy demonstrated diffuse ulcerative pancolitis. Isotretinoin treatment was discontinued and the patient was prescribed 5-aminosalicylic acid and corticosteroids. After a few months, steroids were discontinued and the patient went into clinical and laboratory remission. Evaluation of the possible causal association between isotretinoin treatment and IBD suggested a probable relationship, which should lead to considerable caution while prescribing this drug

Insulin resistance and related factors in non-alcoholic fatty liver disease [NAFLD]: an analytic cross-sectional study

Non-alcoholic fatty liver disease [NAFLD] is characterized by fatty change of liver without inflammation. The aim of this study was to evaluate presence of clinical and metabolic components in non-diabetic patients with NAFLD and to assess the relationship between insulin resistance and these factors. In this study, a group of 50 sonographically confirmed patients with NAFLD was studied. Following an overnight fasting, blood samples were obtained to measure serum levels of Triglyceride, Cholesterol, Low Density Lipoprotein [LDL-C], High Density Lipoprotein [HDL-C], SGOT and SGPT, haemoglobin A1C, Fasting Blood Sugar [FBS] and peripheral blood insulin level. Based on homeostatic model assessment [HOMA] score, patients were divided into four quartiles. Other variables including BMI, waist and hip circumference were also measured. The mean age was 42 +/- 10.3 years [range, 22-65], 33 cases [66%] were men, and 17 cases [34%] were women. Mean insulin level was higher in females [female=15.3 +/- 6.7, males=12.9 +/- 5.7]. Variables including waist [P=0.38] and LDL-C [P =0.49] were significantly different among defined study groups. The higher the HOMA index, the lower the HDL-C level [P <0.05]. Patients with insulin resistance showed significant higher values of LDL and Waist circumference. Values of HDL were significantly lower in these patients. Body mass index, Weight, Triglyceride, Cholesterol, AST and ALT values showed no relation with insulin resistance

Mast cell stabilizers as a potential treatment for Irritable bowel syndrome: a randomized placebo-controlled clinical trial

Mast cells are believed to play a role in irritable bowel syndrome pathogenesis and symptom genesis due to their close neighborhood to gastrointestinal innervations. This study was designed to evaluate the efficacy of orally administered cromolyn for reduction of symptoms in patients with irritable bowel syndrome [IBS]. A randomized placebo-controlled double-blinded 6x6 weeks cross-over study was performed in a private gastrointestinal clinic. 10 patients were allocated to group A and 6 patients to group B. Patients in group A received 150 mg cromolyn divided in three equal doses for the first 6 weeks and placebo for the next 6 weeks but patients in group B received placebo for the first 6 weeks and cromolyn in the next 6 weeks. Weekly evaluation was performed and visual analogue scale was used to determine severity of symptoms. Sixteen patients completed the study. Mean age of the patients was 40.3 +/- 10.9 years old [range: 24-57]. Eight patients had D-IBS [Diarrhea dominant] and other 8 had CIBS [Constipation dominant]. Both cromolyn sodium and the placebo decreased the severity of bloating [Freidman test, p 0.001 and 0.006 respectively]. The severity of the main symptom [diarrhea or constipation] did not decrease in patients of group A and B who were treated with different sequences of the drug or placebo. The severity of pain decreased drastically after 6th week of treatment with cromolyn. Freidman test showed a significant difference between the pain levels of the former defined treatment spots [p 0.01, and 0.02 for patients in group A and B, respectively]. No adverse drug reactions were observed during the study. In conclusion, long term administration of cromolyn seems to be partially effective for treatment of abdominal pain in patients with IBS while main symptoms [diarrhea or constipation] might not decrease during this treatment

Diagnosis and treatment of constipation: a review

Constipation is a common medical problem that imposes multiple clinical referrals in addition to familial and social impacts. The condition is functional in most cases, despite the presence of several etiologies, especially in severe cases and patients unresponsiveness to treatment. Assessment of secondary causes are important. A comprehensive and economic diagnostic and treatment approach for the large number of cases suffering from this medical problem is essential. In medical history and physical examination, the patient's aim regarding the word "constipation" should be considered, and symptoms and signs of secondary causes [such as weight loss, gastrointestinal bleeding, anemia, and ...] should be evaluated. In cases without these alarming clues, treatment with fibers, diet, liquids, physical activity and discontinuation of medications resulting in constipation can be recommended. Re-evaluation of patients in order to find out other defecation problems, slow transit of colon, and secondary causes like malignant or metabolic etiologies should be considered. Defecation problems resisting medical treatment, are always responding to biofeedback treatment. Psychological support and consultation are also helpful in treatment. Long term consumption of medications affecting constipation should be considered with due regard to their side effects. Surgical operations might be performed in unresponsive patients. It should be mentioned that success of surgical methods are greatly dependent on concise selection of patients; lowest success are detected in cases with background psychological problems. Researches on new treatment options for constipation are continually conducted