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ABSTRACT: Functional gut symptoms are induced by inclusion and reduced by dietary restriction of poorly absorbed short-chain carbohydrates (FODMAPs), but the mechanisms of action remain untested.
To determine the effect of dietary FODMAPs on the content of water and fermentable substrates of ileal effluent.
Twelve ileostomates without evidence of small intestinal disease undertook two 4-day dietary periods, comprising diets differing only in FODMAP content in a randomized, cross-over, single-blinded intervention study. Daytime (14 h) ileal effluent was collected on day four of each diet. Patients rated effluent volume and consistency on a 10-cm visual analogue scale. The FODMAP content of the diet and effluent was measured.
Ingested FODMAPs of 32% (range 6-73%) was recovered in the high FODMAP diet effluent. Effluent collection weight increased by a mean of 22% (95% CI, 5-39), water content by 20% (2-38%) and dry weight by 24% (4-43%) with the high compared to low FODMAP diet arm. Output increased by 95 (28-161) mL. Volunteers perceived effluent consistency was thicker (95% CI, 0.6-1.9) with the low FODMAP diet than with the high FODMAP diet (3.5-6.1; P = 0.006).
These data support the hypothetical mechanism; FODMAPs increase delivery of water and fermentable substrates to the proximal colon.
Alimentary Pharmacology & Therapeutics 04/2010; 31(8):874-82. · 3.77 Impact Factor
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ABSTRACT: The majority of patients with ulcerative colitis have disease involving only the distal colon. Although 5-aminosalicylic acid (5-ASA, mesalazine) and corticosteroids remain the important drugs used in the management of distal colitis and proctitis, recent expansion of delivery options of 5-ASA and high level evidence regarding efficacy have led to a shift in treatment strategies. The availability of 5-ASA in enema, foam and suppository formulations has enabled optimization of delivery of 5-ASA to the affected mucosa. Such therapy has superior efficacy and fewer adverse effects compared with those of topical corticosteroids. Furthermore, rectal delivery is effective in the maintenance of remission. Consequently, new guidelines for the management of distal colitis have focussed more on rectal delivery and on optimizing 5-ASA dosage than previously. However, corticosteroids remain an important remission-inducing agent, and immune-modulating drugs play a clear role in prevention of relapse and in managing chronically active disease. The changes in guidelines have raised several management questions, many of which are addressed in this review.
Internal Medicine Journal 03/2008; 38(2):114-9. · 1.54 Impact Factor
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ABSTRACT: Corticosteroids are a well-established treatment for active Crohn's disease and have been widely used for decades. It has become apparent, however, that a proportion of patients either fails to respond to corticosteroids or is unable to withdraw from them without relapsing. Furthermore, their use is associated with a range of side effects, such that long-term treatment carries unacceptable risk.
To review the evidence regarding the appropriate use of corticosteroids in Crohn's disease, along with their side effects, safety and alternatives.
To collect relevant articles, a PubMed search was performed from 1966 to November 2006 using the terms 'steroid', 'corticosteroid', 'glucocorticoid', 'prednisolone', 'prednisone', 'methylprednisolone', 'hydrocortisone', 'dexamethasone' and 'budesonide' in combination with 'Crohn(s) disease'. Relevant articles were reviewed, as were their reference lists to identify further articles.
When used correctly, corticosteroids are a highly effective, well tolerated, cheap and generally safe treatment for active Crohn' disease. Nevertheless, approximately 50% of recipients will either fail to respond (steroid-resistant) or will be steroid dependent at 1 year. Newer alternatives to corticosteroids are not, however, without risk themselves and, moreover, are not necessarily available universally.
Steroids are used widely to treat Crohn's disease, a situation that is unlikely to change in the near future. Accordingly, efforts should be made to ensure that they are used correctly and that their side effects are minimized. Reference is made to recently published guidelines and a simplified 'users guide' is presented.
Alimentary Pharmacology & Therapeutics 09/2007; 26(3):313-29. · 3.77 Impact Factor
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ABSTRACT: Background Corticosteroids are a well-established treatment for active Crohn’s disease and have been widely used for decades. It has become apparent, however, that a proportion of patients either fails to respond to corticosteroids or is unable to withdraw from them without relapsing. Furthermore, their use is associated with a range of side effects, such that long-term treatment carries unacceptable risk.Aim To review the evidence regarding the appropriate use of corticosteroids in Crohn’s disease, along with their side effects, safety and alternatives.Methods To collect relevant articles, a PubMed search was performed from 1966 to November 2006 using the terms ‘steroid’, ‘corticosteroid’, ‘glucocorticoid’, ‘prednisolone’, ‘prednisone’, ‘methylprednislone’, ‘hydrocortisone’, ‘dexamethasone’ and ‘budesonide’ in combination with ‘Crohn(s) disease’. Relevant articles were reviewed, as were their reference lists to identify further articles.Results When used correctly, corticosteroids are a highly effective, well tolerated, cheap and generally safe treatment for active Crohn’ disease. Nevertheless, approximately 50% of recipients will either fail to respond (steroid-resistant) or will be steroid dependent at 1 year. Newer alternatives to corticosteroids are not, however, without risk themselves and, moreover, are not necessarily available universally.Conclusions Steroids are used widely to treat Crohn’s disease, a situation that is unlikely to change in the near future. Accordingly, efforts should be made to ensure that they are used correctly and that their side effects are minimized. Reference is made to recently published guidelines and a simplified ‘users guide’ is presented.
Alimentary Pharmacology & Therapeutics 07/2007; 26(3):313 - 329. · 3.77 Impact Factor
