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Discussion Starter · #1 ·
FYI:II. Alosetron Background. Alosetron is a 5-HT3 (serotonin) receptor antagonist. 5-HT3 receptors are widely present on enteric neurons, where they mediate increased visceral sensitivity, increased colonic transit, and increased gastrointestinal secretion. Alosetron has been previously demonstrated to reduce pain and slow transit. Study. Six hundred and twenty-one nonconstipated, female patients with irritable bowel syndrome (IBS) were randomized to treatment with either alosetron 1 mg po bid or placebo for 12 weeks.[5] By 4 weeks, alosetron improved pain and discomfort, and by 1 week decreased urgency and stool frequency and led to firmer stools. These effects rapidly dissipated after discontinuation of the drug. Constipation occurred in 26% of those receiving alosetron but only in 7% of those on placebo. Summary: implications for clinical practice. Alosetron is likely to become available for use in clinical practice within the next year. Why the drug is effective only in female patients remains uncertain. However, demonstration of superiority on placebo is uncommon in IBS trials and alosetron is likely to become an important treatment for IBS patients with diarrhea or alternating diarrhea and constipation. III. Prucalopride Background. Prucalopride is a selective 5-HT4 (serotonin) agonist with prokinetic properties. Study. Two randomized trials[6] were reported in constipated patients given prucalopride. Results showed that 1 mg, 2 mg, and 4 mg daily were all superior to placebo in improving colonic transit. Summary: implications for clinical practice. Currently available prokinetics such as metoclopramide and cisapride have little effect on colonic function and are associated with significant toxicity. Prucalopride appears to have true prokinetic effects and at this stage, no significant toxicity has been detected. Whether the drug will provide advantages over currently available laxatives is uncertain, but it is likely to receive considerable use, particularly in laxative-refractory patients. Tegaserod is another selective 5-HT4 receptor agonist with prokinetic activity that is also effective and likely to appear in clinical practice in the near future. This agent will be useful in the management of constipation-predominant IBS.FYI on new: Sedation for Colonoscopy Background. Sedation is an attractive aspect of colonoscopy, because it tends to result in high patient satisfaction levels. The use of colonoscopy in the United States has expanded rapidly and this may be a function of widespread use of sedation. In some countries, sedation is used very infrequently for colonoscopy, and this may have a negative impact on the use of this procedure, a possibility that requires further exploration. In the US, several studies have suggested that a minority of patients, particularly men without abdominal pain, are able to tolerate colonoscopy with high satisfaction levels and no sedation. However, most US colonoscopists use sedation on a routine basis, and the most commonly used regimen is a combination of meperidine and midazolam. This combination is safe in clinical use but has the disadvantage of requiring 45 to 60 minutes of postprocedure recovery time, and with higher doses, significant sedative effects may persist for hours. This element can produce a significant bottleneck in endoscopy suite recovery space. As the demand for colonoscopy increases, sedatives with shorter recovery times are becoming more attractive. Propofol is a short-acting, hypnotic that generally requires administration by anesthesiologists because of its association with the production of sudden apnea and hypotension. Two papers were presented at this year's ACG meeting[7,8] on the use of bolus propofol administered by gastroenterologists or nurses with excellent safety and patient satisfaction levels. In one study, bolus propofol was given in combination with fentanyl for injection, followed by prn boluses of propofol. Patients given standard medication with meperidine and midazolam were twice as likely to complain of pain, and those given propofol were 1.8 times more likely to develop deep sedation. However, none developed prolonged hypoxemia or required intubation. In the second study, nearly 1300 patients underwent upper endoscopy or colonoscopy using nurse-administered intermittent propofol bolus injection. Satisfaction levels were very high, although no controls were studied, and there were no adverse events reported. Summary: implications for clinical practice. As the demand for colonoscopy increases, propofol administration by gastroenterologists or by nurses may offer a way to substantially reduce recovery room times and thus reduce the cost of colonoscopy. Furthermore, if the drug is associated with increased patient satisfaction and rapid recovery of psychomotor function, it would help to improve the "attractiveness" of colonoscopy. Additional questions about the level of monitoring required for safe administration by nurses or gastroenterologists remain.------------------ http://webpotential.com/ericibs/index.htm
 

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Discussion Starter · #2 ·
Bump, I hope people took notice to the new colonoscopy drug as well as the article on Alestron.
 

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Eric:Thanks for the info. Jean
------------------"Never let the fear of striking out get in your way." Babe Ruth. And I'm also Praying with Bettie for a cure for this NASTY IBS! Jean
 
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Good, accurate info from Eric. Thanks. Also, because the number of men in the initial study was small, plans are underway to repeat the study using just men. The drug is probably on a "fast track" for FDA approval, but the indications will be for IBS-D in women only. I'll bet a lot of men will try it anyway!
 
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