Efficacy of a new nutraceutical formulation: L-tryptophan, probiotics, charcoal, chamomile, mint, and licorice (COLONIR®) in the improvement of gastrointestinal symptoms in subjects with irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders. IBS is characterized by recurrent chronic abdominal pain and altered bowel habits in the absence of organic damage. Although there are reviews and guidelines for treating IBS, the complexity and diversity of IBS presentation make treatment difficult. Treatment of IBS focuses on relieving symptoms as mild signs and symptoms can often be controlled by managing stress and by making changes in diet and lifestyle. The use of nutraceutical compounds has been advocated as a possible alternative treatment in patients with IBS. COLONIR® (Omega Pharma Srl, Milan, Italy) may be an alternative or adjuvant treatment in patients with gastrointestinal symptoms. This study aimed to evaluate the effect of this new nutraceutical formulation in inducing symptoms remission and improve gastrointestinal habits. METHODS: An initial cohort of 1004 consecutive patients referred to 25 different Units of Internal Medicine a/o Gastroenterology in Italy to perform colonoscopy for intestinal symptoms was asked to participate. Patients were treated for 2 months with two doses of nutraceuticals/day during meals namely COLONIR®. Patients were assessed at baseline and after 2 months to evaluate the frequency and severity of gastrointestinal symptoms in the past seven days with a questionnaire based on ROMA IV criteria. RESULTS: After 2 months, 899 patients completed the follow-up. COLONIR® achieved a statistically significant reduction of severity of symptoms in the study population without any documented side effects. CONCLUSIONS: These promising results, here reported, need to be confirmed, valuating the efficacy of COLONIR® in relieving gastrointestinal symptoms in IBS patients in further studies.

Rescue endoscopy to identify site of gastric dysplasia or carcinoma found at random biopsies.

BACKGROUND: Incidental findings of high-grade dysplasia or gastric cancer at random biopsies with endoscopic diagnosis of chronic gastritis constitute a serious problem to clinical management of patients and sometimes requires blind gastrectomy. AIM: To evaluate diagnostic value of second-look endoscopy, called "rescue endoscopy", in order to identify focal lesions containing neoplastic changes. METHODS: Over a three-year period, 20 patients underwent rescue endoscopy using advanced endoscopy and mapping technique. All mucosal irregularities were identified and the locations of these areas were mapped onto a schematic diagram of gastric anatomy. Each area was biopsied and samples included in individually marked specimen containers, to evaluate the correlation between macroscopic and microscopic diagnosis. RESULTS: Rescue endoscopy identified a total of 68 focal lesions, 18 of which were focal areas of high-grade dysplasia (13 patients) or gastric cancer (5 patients). Two patients had no dysplastic change identified by our targeted biopsies. A second pathologist's opinion confirmed absence of dysplasia on random and targeted biopsies. All patients underwent a median follow-up of 15.2 months (2.6-43.5), and no residual or metachronous lesions were identified. CONCLUSIONS: In our experience, rescue endoscopy is highly effective in localizing undetermined areas of high-grade dysplasia or carcinoma.