Efficacy of Polyethylene Glycol Electrolyte Powder Combined with Linaclotide for Colon Cleansing in Patients with Chronic Constipation undergoing colonoscopy: a Multi-centre, single-blinded, Randomized-Controlled Trial.

BACKGROUND AND AIMS: Constipation is an independent risk factor for poor bowel preparation. This study aimed to evaluate the bowel-cleansing efficacy and safety of polyethylene glycol (PEG) combined with linaclotide (lin) for colonoscopy in patients with chronic constipation. METHODS: This single-blinded, randomized, controlled and multicenter study was conducted from July 2021 to December 2022 at seven hospitals. Patients with chronic constipation who underwent colonoscopies were enrolled and randomly assigned to 4 groups with split -PEG regimens: 4L-PEG group, 4L-PEG+1d-Lin group, 3L-PEG+1d-Lin group, and 3L-PEG+3d-Lin group. The primary outcome was rates of adequate bowel preparation, defined as a total BBPS score ≥6 and a score ≥2 for each segment. Secondary outcomes were adverse effects, sleep quality, willingness to repeat the colonoscopy, adenoma detection rate, and polyp detection rate. RESULTS: 502 patients were enrolled. The rates of adequate bowel preparation (80.0% vs. 60.3%, P<0.001; 84.4% vs. 60.3%, P<0.001) and the total BBPS scores (6.90±1.28 vs. 6.00±1.61, P<0.001; 7.03±1.24 vs. 6.00±1.61, P<0.01) in 4L-PEG+1d-Lin group and 3L-PEG+3d-Lin group were superior to that in 4L-PEG group. Compared with 4L-PEG group, 4L-PEG+1d-Lin group (66.7% vs. 81.7%, P=0.008) and 3L-PEG+3d-Lin group (75.0% vs. 81.7%, P=0.224) had a lower percentage of mild adverse events. No statistically significant difference in willingness to repeat the colonoscopy, sleep quality, polyp detection rate, or adenoma detection rate was observed among groups. CONCLUSIONS: PEG combined with linaclotide might be an effective method for bowel preparation before colonoscopy in patients with chronic constipation.

Losartan attenuates acetic acid enema-induced visceral hypersensitivity by inhibiting the ACE1/Ang II/AT1 receptor axis in enteric glial cells.

Enteric glial cells (EGCs) play an important role in visceral hypersensitivity associated with irritable bowel syndrome (IBS). Losartan (Los) is known to reduce pain; however, its function in IBS is unclear. The present study aimed to investigate Los's therapeutic effect on visceral hypersensitivity in IBS rats. Thirty rats were randomly divided into control, acetic acid enema (AA), AA + Los low, medium and high dose groups in vivo. EGCs were treated with lipopolysaccharide (LPS) and Los in vitro. The molecular mechanisms were explored by assessing the expression of EGC activation markers, pain mediators, inflammatory factors and angiotensin-converting enzyme 1(ACE1)/angiotensin II (Ang II)/Ang II type 1 (AT1) receptor axis molecules in colon tissue and EGCs. The results showed that the rats in the AA group showed significantly higher visceral hypersensitivity than the control rats, which was alleviated by different doses of Los. The expression of GFAP, S100ß, substance P (SP), calcitonin gene-related peptide (CGRP), transient receptor potential vanilloid 1 (TRPV1), tumor necrosis factor (TNF), interleukin-1ß (IL-1ß) and interleukin-6 (IL-6) was considerably increased in colonic tissues of AA group rats and LPS-treated EGCs compared with control rats and EGCs, and reduced by Los. In addition, Los reversed ACE1/Ang II/AT1 receptor axis upregulation in AA colon tissues and LPS-treated EGCs. These results show that Los inhibits ACE1/Ang II/AT1 receptor axis upregulation by suppressing EGC activation, resulting in reduced expression of pain mediators and inflammatory factors, thereby alleviating visceral hypersensitivity.

Effect of group cognitive-behavioral therapy on the quality of life and social functioning of patients with mild depression.

BACKGROUND: Several studies of moderate-to-severe depression have shown that combined treatment with individual cognitive behavioral therapy (CBT) and antidepressant medication is better than either CBT or antidepressants alone. Less research has focused on the outcomes of group-CBT and antidepressants in persons with mild depression. AIM: Evaluate the effects of group-CBT in combination with antidepressants on the quality of life and social functioning of outpatients with mild depression. METHODS: We randomized 62 outpatients with mild depression into a control group (n=30) that received antidepressant medication for 12 weeks and an intervention group (n=32) that received antidepressants and group-CBT for 12 weeks; both groups were then continued on antidepressants alone for one year. Blinded evaluators used Chinese versions of the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Social Disability Screening Schedule, Life Satisfaction Rating, Multidimensional Scale of Perceived Social Support, and Short Form Health Survey to assess participants after 12 weeks of treatment and at the end of one year of follow-up. RESULTS: Repeated measures analysis of variance showed that the depressive and anxiety symptoms of both groups improved significantly during treatment and that the improvement was greater in the CBT+antidepressant experimental group. Almost all of the social functioning, social support, and quality of life measures also showed significantly greater improvement in the CBT+antidepressant group than in the antidepressant-only group. Moreover, even after adjusting for differences in baseline demographic and clinical characteristics and for changes in the severity of depression and anxiety over time using an analysis of covariance, the greater improvement in the CBT+antidepressant group remained statistically significant both after the 12 weeks of group-CBT treatment and one year after the group CBT had ended. CONCLUSION: Antidepressants alone or combined treatment with antidepressants and group-CBT can effectively improve the social function, quality of life, and healthy functioning of individuals with mild depression. However, combined treatment with both antidepressants and group CBT is better than treatment with antidepressants alone, and these benefits persist for up to one year after the CBT sessions have ended.