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1.
Article in English | WPRIM | ID: wpr-903898

ABSTRACT

Interstitial cells of Cajal (ICC) are known as the pacemaker cells of gastrointestinal tract, and it has been reported that acute gastroenteritis induces intestinal dysmotility through antibody to vinculin, a cytoskeletal protein in gut, resulting in small intestinal bacterial overgrowth, so that anti-vinculin antibody can be used as a biomarker for irritable bowel syndrome. This study aimed to determine correlation between serum anti-vinculin antibody and ICC density in human stomach. Gastric specimens from 45 patients with gastric cancer who received gastric surgery at Kangwon National University Hospital from 2013 to 2017 were used. ICC in inner circular muscle, and myenteric plexus were counted. Corresponding patient's blood samples were used to determine the amount of anti-vinculin antibody by enzyme-linked immunosorbent assay. Analysis was done to determine correlation between anti-vinculin antibody and ICC numbers. Patients with elevated anti-vinculin antibody titer (above median value) had significantly lower number of ICC in inner circular muscle (71.0 vs. 240.5, p = 0.047), and myenteric plexus (12.0 vs. 68.5, p < 0.01) compared to patients with lower anti-vinculin antibody titer. Level of serum anti-vinculin antibody correlated significantly with density of ICC in myenteric plexus (r = −0.379, p = 0.01; Spearman correlation). Increased level of circulating anti-vinculin antibody was significantly correlated with decreased density of ICC in myenteric plexus of human stomach.

2.
Article in English | WPRIM | ID: wpr-896194

ABSTRACT

Interstitial cells of Cajal (ICC) are known as the pacemaker cells of gastrointestinal tract, and it has been reported that acute gastroenteritis induces intestinal dysmotility through antibody to vinculin, a cytoskeletal protein in gut, resulting in small intestinal bacterial overgrowth, so that anti-vinculin antibody can be used as a biomarker for irritable bowel syndrome. This study aimed to determine correlation between serum anti-vinculin antibody and ICC density in human stomach. Gastric specimens from 45 patients with gastric cancer who received gastric surgery at Kangwon National University Hospital from 2013 to 2017 were used. ICC in inner circular muscle, and myenteric plexus were counted. Corresponding patient's blood samples were used to determine the amount of anti-vinculin antibody by enzyme-linked immunosorbent assay. Analysis was done to determine correlation between anti-vinculin antibody and ICC numbers. Patients with elevated anti-vinculin antibody titer (above median value) had significantly lower number of ICC in inner circular muscle (71.0 vs. 240.5, p = 0.047), and myenteric plexus (12.0 vs. 68.5, p < 0.01) compared to patients with lower anti-vinculin antibody titer. Level of serum anti-vinculin antibody correlated significantly with density of ICC in myenteric plexus (r = −0.379, p = 0.01; Spearman correlation). Increased level of circulating anti-vinculin antibody was significantly correlated with decreased density of ICC in myenteric plexus of human stomach.

3.
Article | WPRIM | ID: wpr-834116

ABSTRACT

Serrated polyposis syndrome (SPS) can transform to malignant lesions through the sessile serrated pathway and traditional serrated pathway. These pathways may cause rapid neoplastic progression compared to the adenoma-carcinoma sequence, which may cause interval colorectal cancer. The authors experienced a case of SPS with a synchronous colon adenocarcinoma that was treated with an endoscopic mucosal resection. In pathology reviews, other parts of the adenocarcinoma showed sessile serrated adenoma. Therefore, patients with SPS have a potential for malignant transformation, highlighting the need for strict colonoscopy surveillance starting at the time of SPS diagnosis.

4.
Article in English | WPRIM | ID: wpr-765953

ABSTRACT

BACKGROUND/AIMS: Proton pump inhibitors (PPIs) are frequently used to treat non-erosive reflux disease (NERD), but their effect is limited. It is not known whether a potential alternative, AlbisD, containing ranitidine hydrochloride, sucralfate hydrate, and tripotassium dicitrato bismuthate, is effective and safe in treating NERD. The aim of the study is to evaluate the efficacy and safety of AlbisD compared with omperazole in patients with NERD. METHODS: This was a multicenter, randomized, open-label, parallel-group, non-inferiority comparative study. A total of 126 patients with NERD were randomly allocated to either AlbisD twice daily or omeprazole 20 mg once daily for 4 weeks from February 2016 to August 2016. The study patients had histories of heartburn or regurgitation of moderate severity (> score 2) and a frequency of at least 2 episodes per week, and had no mucosal breaks of the esophagus on endoscopy. The primary efficacy variable was complete cure of heartburn at week 4. Secondary efficacy variables evaluating symptoms of heartburn and acid reflux as well as safety profiles were compared in the 2 groups at week 2 and 4 after treatment. RESULTS: A total of 113 patients completed the study (57 and 56 in AlbisD and omeprazole groups, respectively). The proportion of patients with complete cure of heartburn at week 4 was not significantly different between the AlbisD and omeprazole groups (35.1% vs 32.1% respectively, P = 0.740). There were no significant differences between the 2 groups in the any secondary variables including proportions of days without heartburn or acid reflux over 4 weeks (including daytime and nighttime). Adverse events were similarly reported in the 2 groups (7 [12.3%] vs 6 [10.7%]), and there were no serious adverse events. CONCLUSIONS: The efficacy and safety of AlibsD in treating NERD patients are not inferior to those of omeprazole. Therefore, AlbisD can be an alternative to PPIs for NERD.


Subject(s)
Bismuth , Endoscopy , Esophagus , Gastroesophageal Reflux , Heartburn , Humans , Omeprazole , Pilot Projects , Proton Pump Inhibitors , Ranitidine , Sucralfate
5.
Article in Korean | WPRIM | ID: wpr-760173

ABSTRACT

Ceftriaxone is commonly used for the treatment of bacterial infection. But it may precipitate in bile causing biliary sludge, pseudolithiasis and gallstone especially in children. We report a case of ceftriaxone-induced acute pancreatitis in an old woman. An 83-year-old woman was admitted for treatment of renal stone. She had received intravenous ceftriaxone for 11 days. After percutaneous nephrolithotomy, she was discharged. After 12 days, she visited the emergency department due to epigastric pain. Laboratory finding was suggestive of gallstone pancreatitis and abdominal computed tomography revealed gallbladder stone, which was absent previously. After conservative care, she received cholecystectomy and discharged without sequelae.


Subject(s)
Adult , Aged, 80 and over , Bacterial Infections , Bile , Ceftriaxone , Child , Cholecystectomy , Emergency Service, Hospital , Female , Gallbladder , Gallstones , Humans , Nephrostomy, Percutaneous , Pancreatitis
6.
Article in English | WPRIM | ID: wpr-742144

ABSTRACT

Pancreatic metastasis from cervical cancer is extremely rare. We report a case of metastatic adenocarcinoma of the pancreas from uterine cervical cancer. A 70-year-old woman was referred because of a pancreatic mass detected by CT. She had been diagnosed with uterine cervical adenocarcinoma 20 months previously. After concurrent chemoradiotherapy, CT showed no evidence of the cervical mass, and follow-up showed no evidence of recurrence. Endoscopic ultrasound-guided fine needle aspiration biopsy of the pancreatic mass resulted in a diagnosis of metastatic adenocarcinoma from uterine cervix.


Subject(s)
Adenocarcinoma , Aged , Biopsy , Cervix Uteri , Chemoradiotherapy , Diagnosis , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Female , Follow-Up Studies , Humans , Neoplasm Metastasis , Pancreas , Recurrence , Uterine Cervical Neoplasms
7.
Article in Korean | WPRIM | ID: wpr-742133

ABSTRACT

After gastrojejunostomy, a small space can occur between the jejunum at the anastomosis site, the transverse mesocolon, and retroperitoneum, which may cause an intestinal hernia. This report presents a rare case of intestinal ischemic necrosis caused by retroanastomotic hernia after subtotal gastrectomy. A 56-year-old male was admitted to Kangwon National University Hospital with melena, abdominal pain, and nausea. His only relevant medical history was gastrectomy due to stomach cancer. Endoscopic findings revealed subtotal gastrectomy with Billroth-II reconstruction and a bluish edematous mucosal change with necrotic tissue in afferent and efferent loops including the anastomosis site. Abdominopelvic CT showed strangulation of proximal small bowel loops due to mesenteric torsion and thickening of the wall of the gastric remnant. Emergency laparotomy was performed. Surgical findings revealed the internal hernia through the defect behind the anastomosis site with strangulation of the jejunum between 20 cm below the Treitz ligament and the proximal ileum. Roux-en-Y anastomosis was performed, and he was discharged without complication. Retroanastomotic hernia, also called Petersen's space hernia, is a rare complication after gastric surgery, cannot be easily recognized, and leads to strangulation.


Subject(s)
Abdominal Pain , Anastomosis, Roux-en-Y , Emergencies , Gastrectomy , Gastric Bypass , Gastric Stump , Hernia , Humans , Ileum , Ischemia , Jejunum , Laparotomy , Ligaments , Male , Melena , Mesocolon , Middle Aged , Nausea , Necrosis , Stomach Neoplasms
8.
Article in English | WPRIM | ID: wpr-787172

ABSTRACT

Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.


Subject(s)
Actinomycosis , Aged , B-Lymphocytes , Biopsy , Colon , Colon, Ascending , Colonic Neoplasms , Colonoscopy , Diagnosis , Drug Therapy , Female , Flank Pain , Follow-Up Studies , Humans , Lymphoma , Lymphoma, B-Cell , Lymphoma, Large B-Cell, Diffuse , Masks , Penicillin G , Sulfur , Tomography, X-Ray Computed , Weight Loss
10.
Article in English | WPRIM | ID: wpr-761524

ABSTRACT

Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.


Subject(s)
Actinomycosis , Aged , B-Lymphocytes , Biopsy , Colon , Colon, Ascending , Colonic Neoplasms , Colonoscopy , Diagnosis , Drug Therapy , Female , Flank Pain , Follow-Up Studies , Humans , Lymphoma , Lymphoma, B-Cell , Lymphoma, Large B-Cell, Diffuse , Masks , Penicillin G , Sulfur , Tomography, X-Ray Computed , Weight Loss
12.
Korean Journal of Medicine ; : 473-476, 2018.
Article in Korean | WPRIM | ID: wpr-717448

ABSTRACT

Eosinophilic gastritis is characterized by eosinophilic infiltration of the gastrointestinal tract, which is associated with abdominal pain, diarrhea, nausea, and vomiting. The possible etiologies of secondary eosinophilic gastritis, including drug reactions, parasitic infestation, and malignancy, must be evaluated. Herein we report the case of a 65-year-old North Korean defector who presented with nausea and vomiting for 1 year. Secondary (reactive) eosinophilic gastritis caused by cerebral sparganosis was suspected after a workup that included brain magnetic resonance imaging, cerebrospinal fluid tapping, and gastric mucosal biopsy. The patient showed dramatic clinical improvement with high-dose praziquantel treatment. Even though secondary (reactive) eosinophilic gastritis caused by parasites is very rare, this case shows the importance of considering parasitic infection in eosinophilic gastritis.


Subject(s)
Abdominal Pain , Aged , Biopsy , Brain , Cerebrospinal Fluid , Diarrhea , Eosinophils , Gastritis , Gastrointestinal Tract , Humans , Magnetic Resonance Imaging , Nausea , Parasites , Praziquantel , Sparganosis , Vomiting
13.
Article in Korean | WPRIM | ID: wpr-742124

ABSTRACT

We report a case of acute pancreatitis secondary to pancreatic neuroendocrine tumor. A 46-year old man presented with upper abdominal pain. The serum amylase and lipase were elevated. Abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a 1.7 cm sized mass at the pancreas body with a dilatation of the upstream pancreatic duct and mild infiltrations of peripancreatic fat. An endoscopic ultrasound-guided fine needle biopsy was performed for the pancreatic mass, but only necrotic tissue was observed on the pathologic examination. A chest and neck CT scan revealed anterior mediastinal, paratracheal, and cervical lymph node enlargement, which were indicative of metastasis. An ultrasound-guided core needle biopsy was performed for the enlarged neck lymph node, and pathologic examination revealed a metastatic poorly differentiated carcinoma. Immunohistochemical analysis showed positive staining for synaptophysin, chromogranin A, and CD 56, indicative of a neuroendocrine carcinoma.


Subject(s)
Abdominal Pain , Amylases , Biopsy, Fine-Needle , Biopsy, Large-Core Needle , Carcinoma, Neuroendocrine , Cholangiopancreatography, Magnetic Resonance , Chromogranin A , Dilatation , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Lipase , Lymph Nodes , Neck , Neoplasm Metastasis , Neuroendocrine Tumors , Pancreas , Pancreatic Ducts , Pancreatitis , Synaptophysin , Thorax , Tomography, X-Ray Computed
14.
Article in English | WPRIM | ID: wpr-715280

ABSTRACT

OBJECTIVE: In our series, endovascular coiling with Target® Nano™ coils (Stryker Neurovascular, Fremont, CA, USA) with diameters of 1 or 1.5 mm exhibited favorable technical feasibility in the treatment of small cerebral aneurysms (< 4 mm). However, little is known about the recurrence of small cerebral aneurysms treated using Target® Nano™ coils. We investigated recurrence following the treatment of small cerebral aneurysms using Target® Nano™ coils. MATERIALS AND METHODS: Between January 2012 and November 2013, 143 patients with 148 small cerebral aneurysms (< 4 mm) were included our study. A total of 135 cerebral aneurysms (91.2%) were unruptured; 45 cerebral aneurysms (30.4%) were treated by endovascular coiling using Target® Nano™ coils. Follow-up radiological images were obtained for 132 cerebral aneurysms (89.2%) over a range of 3 to 58 months (mean, 34.3 months; standard deviation, 14.2). RESULTS: In the group treated with Target® Nano™ coils, radiological outcomes revealed complete occlusion in 33 (73.3%), residual necks in eight (17.8%), and residual sacs in four (8.9%) cases. Follow-up radiological outcomes revealed complete occlusion in 35 (77.8%) and residual necks in four (8.9%) cases that exhibited stable coil masses. In the group that was not treated with Target® Nano™ coils, radiological outcomes revealed complete occlusion in 69 (67%), residual necks in 18 (17.5%), and residual sacs in 16 (15.5%) cases. Follow-up radiological outcomes revealed complete occlusion in 87 (84.5%) and residual necks (5.8%) in six cases that exhibited stable coil masses. No significant differences were observed in the radiological outcomes or follow-up radiological outcomes between the two groups. No recurrences or retreatments occurred in our series. CONCLUSION: Endovascular treatment using Target® Nano™ coils may be a robust treatment option for small cerebral aneurysms (< 4 mm).


Subject(s)
Follow-Up Studies , Humans , Intracranial Aneurysm , Neck , Recurrence , Retreatment
15.
Article in English | WPRIM | ID: wpr-225692

ABSTRACT

This study compared the efficacy of DA-9601 (Dong-A ST Co., Seoul, Korea) and its new formulation, DA-5204 (Dong-A ST Co.), for treating erosive gastritis. This phase III, randomized, multicenter, double-blind, non-inferiority trial randomly assigned 434 patients with endoscopically proven gastric mucosal erosions into two groups: DA-9601 3 times daily or DA-5,204 twice daily for 2 weeks. The final analysis included 421 patients (DA-5204, 209; DA-9601, 212). The primary endpoint (rate of effective gastric erosion healing) and secondary endpoints (cure rate of endoscopic erosion and gastrointestinal [GI] symptom relief) were assessed using endoscopy after the treatment. Drug-related adverse events (AEs), including GI symptoms, were also compared. At week 2, gastric healing rates with DA-5204 and DA-9601 were 42.1% (88/209) and 42.5% (90/212), respectively. The difference between the groups was −0.4% (95% confidence interval, −9.8% to 9.1%), which was above the non-inferiority margin of −14%. The cure rate of gastric erosion in both groups was 37.3%. The improvement rates of GI symptoms with DA-5204 and DA-9601 were 40.4% and 40.8%, respectively. There were no statistically significant differences between the two groups in both secondary endpoints. AEs were reported in 18 (8.4%) patients in the DA-5204 group and 19 (8.8%) in the DA-9601 group. Rates of AE were not different between the two groups. No serious AE or adverse drug reaction (ADR) occurred. These results demonstrate the non-inferiority of DA-5204 compared to DA-9601. DA-5204 is as effective as DA-9601 in the treatment of erosive gastritis. Registered randomized clinical trial at ClinicalTrials.gov (NCT02282670)


Subject(s)
Artemisia , Double-Blind Method , Drug-Related Side Effects and Adverse Reactions , Endoscopy , Gastritis , Humans , Seoul
16.
Korean Journal of Medicine ; : 257-263, 2016.
Article in Korean | WPRIM | ID: wpr-20337

ABSTRACT

Gastroesophageal reflux disease (GERD) is prevalent in Korea. Clinical manifestations include typical symptoms which are heartburn and regurgitation and atypical symptoms that can be esophageal or extraesophageal. Various extraesophageal manifestations are associated with GERD, and the most significant of these are chronic cough, laryngitis, and asthma. The diagnosis of extraesophageal syndrome is often difficult due to the poor sensitivity and specificity of available diagnostic modalities, including endoscopy, pH monitoring, and laryngoscopy. Consequently, empirical treatment with a proton pump inhibitor (PPI) is considered to be the most cost-effective tool for the diagnosis and management of patients suspected of having extraesophageal syndrome without alarm features. Those who do not respond to PPI therapy should undergo an additional work-up that includes monitoring esophageal pH or impedance, and motility tests to evaluate the relationship between reflux and symptoms. Surgical management should cautiously be considered for very carefully selected patients.


Subject(s)
Asthma , Cough , Diagnosis , Electric Impedance , Endoscopy , Gastroesophageal Reflux , Heartburn , Humans , Hydrogen-Ion Concentration , Korea , Laryngitis , Laryngoscopy , Proton Pumps , Sensitivity and Specificity
17.
Article in English | WPRIM | ID: wpr-104383

ABSTRACT

Although coffee is known to have antioxidant, anti-inflammatory, and antitumor properties, there have been few reports about the effect and mechanism of coffee compounds in colorectal cancer. Heat shock proteins (HSPs) are molecular chaperones that prevent cell death. Their expression is significantly elevated in many tumors and is accompanied by increased cell proliferation, metastasis and poor response to chemotherapy. In this study, we investigated the cytotoxicity of four bioactive compounds in coffee, namely, caffeine, caffeic acid, chlorogenic acid, and kahweol, in HT-29 human colon adenocarcinoma cells. Only kahweol showed significant cytotoxicity. Specifically, kahweol increased the expression of caspase-3, a pro-apoptotic factor, and decreased the expression of anti-apoptotic factors, such as Bcl-2 and phosphorylated Akt. In addition, kahweol significantly attenuated the expression of HSP70. Inhibition of HSP70 activity with triptolide increased kahweol-induced cytotoxicity. In contrast, overexpression of HSP70 significantly reduced kahweol-induced cell death. Taken together, these results demonstrate that kahweol inhibits colorectal tumor cell growth by promoting apoptosis and suppressing HSP70 expression.


Subject(s)
Adenocarcinoma , Apoptosis , Caffeine , Caspase 3 , Cell Death , Cell Proliferation , Chlorogenic Acid , Coffee , Colon , Colorectal Neoplasms , Drug Therapy , Heat-Shock Proteins , HSP70 Heat-Shock Proteins , Humans , Molecular Chaperones , Neoplasm Metastasis
18.
Article in Korean | WPRIM | ID: wpr-49747

ABSTRACT

Nonerosive reflux disease (NERD) is a distinct presentation of gastroesophageal reflux disease (GERD). NERD is commonly defined as the presence of classical GERD symptoms in the absence of esophageal mucosal erosions/breaks on upper endoscopy. Within the spectrum of GERD, the pathophysiological and clinical characteristics distinguishing NERD and erosive esophagitis remain a matter for debate. Recent research on NERD has focused on understanding the pathophysiology and natural history. Given the increased incidence of NERD in Korea, we reviewed the concept of NERD and its relationship to GERD and functional gastrointestinal disorders.


Subject(s)
Endoscopy , Esophagitis , Gastroesophageal Reflux , Gastrointestinal Diseases , Heartburn , Incidence , Korea , Natural History
19.
Intestinal Research ; : 205-213, 2014.
Article in English | WPRIM | ID: wpr-123038

ABSTRACT

BACKGROUND/AIMS: Ethanol administration causes intestinal epithelial cell damage by increasing intestinal permeability and the translocation of endotoxins from intestinal bacterial flora. Heat shock proteins (HSPs) are associated with recovery and protection from cell damage. The aim of the current study was to investigate differences in the expression of HSPs in the small intestine and the biochemical changes attributable to ethanol-induced intestinal damage. METHODS: Ethanol (20%) was injected intraperitoneally (2.75 g/kg, 5.5 g/kg, 8.25 g/kg) in ICR mice and the same volume of saline was administered to controls. After 1 hour, the proximal, middle, and distal segments were taken from the small intestine and the degree of damage was analyzed. In each segment, the expression of HSPs was analyzed by western blotting. The expression of inflammatory mediators including interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), cyclooxygenase-2 (COX-2), and antioxidant enzyme such as glutathione-S-transferase were compared using real-time polymerase chain reaction assays. RESULTS: In the control group, HSP70 increased in all segments of small intestine. Additionally, increases in the expression of HSP40 and HSP90 in the distal regions and an increase in HSP32 in the middle regions were observed. After ethanol treatment, greater histological damage was observed in the distal small intestine and significant decreases in HSPs were observed generally. Increased expression of IL-1beta, TNF-alpha, and COX-2 was observed in small intestinal tissues exposed to ethanol-induced damage. However, there was no significant difference in the expression of an antioxidant enzyme. CONCLUSIONS: Significant differences in the expression of HSPs in different intestinal regions were observed. These differences may have been attributable to the distribution of intestinal bacteria.


Subject(s)
Animals , Bacteria , Blotting, Western , Cyclooxygenase 2 , Cytokines , Endotoxins , Epithelial Cells , Ethanol , Heat-Shock Proteins , Interleukin-1beta , Intestine, Small , Mice , Mice, Inbred ICR , Permeability , Real-Time Polymerase Chain Reaction , Tumor Necrosis Factor-alpha
20.
Article in Korean | WPRIM | ID: wpr-171345

ABSTRACT

BACKGROUND/AIMS: Antispasmodic agents have been used in the management of irritable bowel syndrome. However, systematic reviews have come to different conclusions about the efficacy in irritable bowel syndrome. Fenoverine acts as a synchronizer of smooth muscle in modulating the intracellular influx of calcium. We compared fenoverine with trimebutine for the treatment of patients with IBS. METHODS: A multicenter, randomized, double-blind, non-inferiority clinical study was conducted to compared fenoverine with trimebutine. Subjects were randomized to receive either fenoverine (100 mg three times a day) or trimebutine (150 mg three times a day) for 8 weeks. A total of 197 patients were analyzed by the intention-to-treat approach. The primary endpoint was the proportion of patients who had 30% reduction in abdominal pain or discomfort measured by bowel symptom scale (BSS) score at week 8 compared to the baseline. The secondary endpoints were changes of abdominal bloating, diarrhea, constipation, overall and total scores of BSS, and overall satisfaction. RESULTS: At week 8, fenoverine was shown to be non-inferior to trimebutine (treatment difference, 1.76%; 90% CI, -10.30-13.82; p=0.81); 69.23% (54 of 78 patients) of patients taking fenoverine and 67.47% (56 of 83 patients) of patients taking trimebutine showed 30% reduction in abdominal pain or discomfort compared to the baseline. There results of the secondary endpoints were also comparable between the fenoverine group and the trimebutine group. CONCLUSIONS: Fenoverine is non-inferior to trimebutine for treating IBS in terms of both efficacy and tolerability.


Subject(s)
Abdominal Pain/etiology , Adult , Constipation/etiology , Diarrhea/etiology , Double-Blind Method , Drug Administration Schedule , Female , Humans , Irritable Bowel Syndrome/complications , Male , Middle Aged , Parasympatholytics/therapeutic use , Phenothiazines/therapeutic use , Severity of Illness Index , Treatment Outcome , Trimebutine/therapeutic use
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