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https://www.readbyqxmd.com/read/29457869/assessment-of-the-spectrum-of-hepatic-encephalopathy-a-multi-center-study
#1
Bradley Reuter, Kara Walter, Julien Bissonnette, Michael D Leise, Jennifer Lai, Puneeta Tandon, Patrick S Kamath, Scott W Biggins, Christopher F Rose, James B Wade, Jasmohan S Bajaj
Hepatic encephalopathy (HE) is a major cause of morbidity in cirrhosis. However its severity assessment is often subjective, which needs to be studied systematically. AIM: To determine how accurately trainee and non-trainee practitioners grade and manage HE patients throughout its severity. METHODS: We performed a survey study using standardized simulated patient videos at 4 US and 3 Canadian centers. Participants were trainees (gastroenterology/hepatology fellows) and non-trainees (faculty, nurse practitioners, physician assistants)...
February 19, 2018: Liver Transplantation
https://www.readbyqxmd.com/read/29446765/gut-microbiota-based-therapies-for-irritable-bowel-syndrome
#2
Emily K Stern, Darren M Brenner
Irritable bowel syndrome (IBS) is a common, heterogeneous disorder characterized by abdominal pain associated with changes in bowel habits. The pathogenesis of IBS is multifactorial and may relate to alterations in the gut microbiota, changes in visceral sensation and motility, and genetic and environmental factors. Administration of systemic antibiotics may increase the risk of IBS by altering gastrointestinal homeostasis. Therapeutic interventions for IBS with diarrhea that are thought to target alterations in the gut microbiota include the nonsystemic antibiotic rifaximin, the medical food serum-derived bovine immunoglobulin, prebiotics, probiotics, and dietary modification...
February 15, 2018: Clinical and Translational Gastroenterology
https://www.readbyqxmd.com/read/29436337/rifaximin-reduces-markers-of-inflammation-and-bacterial-16s-rrna-in-zambian-adults-with-hepatosplenic-schistosomiasis-a-randomized-control-trial
#3
Edford Sinkala, Kanekwa Zyambo, Ellen Besa, Patrick Kaonga, Bright Nsokolo, Violet Kayamba, Michael Vinikoor, Rabison Zulu, Martin Bwalya, Graham R Foster, Paul Kelly
Cirrhosis is the dominant cause of portal hypertension globally but may be overshadowed by hepatosplenic schistosomiasis (HSS) in the tropics. In Zambia, schistosomiasis seroprevalence can reach 88% in endemic areas. Bacterial translocation (BT) drives portal hypertension in cirrhosis contributing to mortality but remains unexplored in HSS. Rifaximin, a non-absorbable antibiotic may reduce BT. We aimed to explore the influence of rifaximin on BT, inflammation, and fibrosis in HSS. In this phase II open-label trial (ISRCTN67590499), 186 patients with HSS in Zambia were evaluated and 85 were randomized to standard care with or without rifaximin for 42 days...
February 12, 2018: American Journal of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/29417604/effects-of-alcohol-on-the-brain-in-cirrhosis-beyond-hepatic-encephalopathy
#4
Brian C Davis, Jasmohan S Bajaj
Recent advances have led to a greater understanding of how alcohol alters the brain, both in acute stages (intoxication and alcohol withdrawal) and in chronic misuse. This review focuses on the current understanding of how alcohol affects the brain in cirrhosis patients with and without hepatic encephalopathy. Chronic alcohol use is associated with nutritional deficiencies, dementia, cirrhosis, and decompensating events such as hepatic encephalopathy. Direct toxicity on brain tissue, induction of neuro-inflammation, and alcohol's alterations of the gut microbiome are possible mechanisms for the clinical features of hepatic encephalopathy associated with alcohol use...
February 8, 2018: Alcoholism, Clinical and Experimental Research
https://www.readbyqxmd.com/read/29411990/diagnosis-and-management-of-hepatic-encephalopathy
#5
Debbie L Shawcross
Overt and covert hepatic encephalopathy (HE) are debilitating complications of cirrhosis. HE results in a poor quality of life for patients and their caregivers and, unless there is access to liver transplantation, the prognosis is poor. The development of overt HE is often unpredictable, and its management, particularly in the ward, remains challenging. There is an urgent need for novel approaches to treat HE. Until recently, therapies for this complication were disappointing, with frequently intolerable side effects such as diarrhoea and faecal incontinence...
February 7, 2018: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/29410518/rifaximin-decreases-virulence-of-crohn-s-disease-associated-escherichia-coli-and-epithelial-inflammatory-responses
#6
Belgin Dogan, Jing Fu, Shiying Zhang, Ellen J Scherl, Kenneth W Simpson
Escherichia coli with an adherent and invasive pathotype (AIEC) is implicated in the pathogenesis of Crohn's disease (CD). Rifaximin improves symptoms in mild-to-moderate CD. It is unclear if this outcome is due to its effects on bacteria or intestinal epithelial inflammatory responses. We examined the effects of rifaximin on the growth and virulence of CD-associated E. coli and intestinal epithelial inflammatory responses. Seven well-characterized CD-associated E. coli strains (six AIEC, one non-AIEC; four rifaximin-resistant, three sensitive) were evaluated...
February 6, 2018: Journal of Antibiotics
https://www.readbyqxmd.com/read/29408226/prevalence-genetic-relatedness-and-antibiotic-resistance-of-hospital-acquired-clostridium-difficile-pcr-ribotype-018-strains
#7
Mi-Ran Seo, Jieun Kim, Yangsoon Lee, Dong-Gyun Lim, Hyunjoo Pai
Clostridium difficile infection (CDI) is a major healthcare-associated infection. Aim of this study was to investigate the genetic relatedness of the endemic C. difficile PCR ribotype 018 strains in an institution and changes to their characteristics during five-year period. A total of 207 isolates obtained from inpatients at Hanyang University Hospital from 2009 to 2013 were analyzed using multilocus variable-number tandem-repeat analysis (MLVA). Minimum inhibitory concentrations (MICs) of several antibiotics were determined...
February 2, 2018: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/29394969/is-lactulose-plus-rifaximin-better-than-lactulose-alone-in-the-management-of-hepatic-encephalopathy
#8
Nauman Ismat Butt, Usman Ismat Butt, Aniqa Anser Tufail Khan Kakar, Tashia Malik, Arif Mahmood Siddiqui
OBJECTIVE: To compare the efficacy of lactulose plus rifaximin with efficacy of lactulose alone in the treatment of hepatic encephalopathy. STUDY DESIGN: A randomized controlled trial. PLACE AND DURATION OF STUDY: Department of Medicine, Jinnah Hospital, Lahore, from December 2014 to June 2015. METHODOLOGY: All patients who presented with hepatic encephalopathy due to decompensated chronic liver disease were randomly divided into two groups of 65 patients each...
February 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/29372994/evidence-based-management-of-irritable-bowel-syndrome-with-diarrhea
#9
Mark Pimentel
Irritable bowel syndrome (IBS), a complex disorder of the gastrointestinal tract, is characterized by abdominal pain associated with defecation or changes in stool form or frequency. IBS is associated with substantial burden, including direct medical costs and indirect costs. Direct costs associated with IBS in the United States have been estimated to exceed $1 billion. However, indirect costs, such as negative effect on quality of life (QOL) and work productivity, are difficult to quantify. There are 3 main subtypes: IBS with prominent diarrhea (IBS-D), IBS with constipation, and IBS with mixed symptoms of both constipation and diarrhea...
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29372991/evidence-based-management-of-irritable-bowel-syndrome-with-diarrhea
#10
Mark Pimentel
Irritable bowel syndrome (IBS), a complex disorder of the gastrointestinal tract, is characterized by abdominal pain associated with defecation or changes in stool form or frequency. IBS is associated with substantial burden, including direct medical costs and indirect costs. Direct costs associated with IBS in the United States have been estimated to exceed $1 billion. However, indirect costs, such as negative effect on quality of life (QOL) and work productivity, are difficult to quantify. There are 3 main subtypes: IBS with prominent diarrhea (IBS-D), IBS with constipation, and IBS with mixed symptoms of both constipation and diarrhea...
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29353143/contractile-effect-of-rifaximin-on-bovine-uterus-in-the-presence-of-steroid-hormone-antagonists
#11
R L Sciorsci, M Piccinno, A Rizzo
This in vitro study investigated the modulatory effect of rifaximin on bovine uterus contractility, in both phases of the oestrous cycle, with and without the steroid hormones that are predominant in the respective phases: oestrogen in the follicular phase and progesterone in the luteal phase. The procedures were conducted in an isolated organ bath by using rifaximin alone (10-4 M) and in association with the steroid hormone antagonists (10-5 M) tamoxifen (oestrogen antagonist) in the follicular phase and mifepristone (progesterone antagonist) in the luteal phase...
January 10, 2018: Theriogenology
https://www.readbyqxmd.com/read/29350768/diet-affects-gut-microbiota-and-modulates-hospitalization-risk-differentially-in-an-international-cirrhosis-cohort
#12
Jasmohan S Bajaj, Ramazan Idilman, Leila Mabudian, Matthew Hood, Andrew Fagan, Dilara Turan, Melanie B White, Fatih Karakaya, Jessica Wang, Rengül Atalay, Phillip B Hylemon, Edith A Gavis, Robert Brown, Leroy R Thacker, Chathur Acharya, Douglas M Heuman, Masoumeh Sikaroodi, Patrick M Gillevet
The relative ranking of cirrhosis-related deaths differs between high/middle-income countries. Gut microbiome is affected in cirrhosis and related to diet. Our aim was to determine the effect of differing dietary habits on gut microbiota and clinical outcomes. METHODS: Outpatient compensated/decompensated cirrhotics and controls from Turkey and USA underwent dietary and stool microbiota analysis. Cirrhotics were followed till 90-day hospitalizations. Shannon diversity and multi-variable determinants (Cox and binary logistic) of microbial diversity and hospitalizations were studied within/between groups...
January 19, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29342270/whole-genome-analysis-reveals-the-evolution-and-transmission-of-an-mdr-dh-nap11-106-clostridium-difficile-clone-in-a-paediatric-hospital
#13
Larry K Kociolek, Egon A Ozer, Dale N Gerding, David W Hecht, Sameer J Patel, Alan R Hauser
Background: Clostridium difficile strain DH/NAP11/106, a relatively antibiotic-susceptible strain, is now the most common cause of C. difficile infection (CDI) among adults in the USA. Objectives: To identify mechanisms underlying the evolution and transmission of an MDR DH/NAP11/106 clone. Methods: WGS (Illumina MiSeq), restriction endonuclease analysis (REA) and antibiotic susceptibility testing were performed on 134 C. difficile isolates collected from paediatric patients with CDI over a 2 year period...
January 12, 2018: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29336930/exploring-ways-to-improve-cdi-outcomes
#14
REVIEW
T Galpérine, B Guery
Clostridium difficile is an anaerobic spore-forming Gram-positive bacillus recognized as an evolving international health problem. Metronidazole and vancomycin were - until recently - the only drugs available to treat C. difficile infection (CDI). Better knowledge of the pathophysiology and the development of new drugs completely modified the management of initial episodes and recurrences of CDI. Fidaxomicin significantly reduced recurrences compared with vancomycin. New drugs are also currently evaluated (cadazolid, surotomycin, ridinilazole, rifaximin)...
January 11, 2018: Médecine et Maladies Infectieuses
https://www.readbyqxmd.com/read/29309934/update-of-treatment-algorithms-for-clostridium-difficile-infection
#15
REVIEW
R E Ooijevaar, Y H van Beurden, E M Terveer, A Goorhuis, M P Bauer, J J Keller, C J J Mulder, E J Kuijper
BACKGROUND: Clostridium difficile is the leading cause of antibiotic-associated diarrhea, both in healthcare facilities and the community. The recurrence rate of C. difficile infection (CDI) remains high, up to 20%. Since the publication of the ESCMID guidance document on CDI treatment in 2014, new therapeutic approaches have been developed and tested to achieve higher sustained clinical cure in CDI. AIM: To review novel treatments and approaches for CDI, except probiotics and vaccines...
January 5, 2018: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/29308002/disabling-portosystemic-encephalopathy-in-a-non-cirrhotic-patient-successful-endovascular-treatment-of-a-giant-inferior-mesenteric-caval-shunt-via-the-left-internal-iliac-vein
#16
Luca de Martinis, Gloria Groppelli, Riccardo Corti, Lorenzo Paolo Moramarco, Pietro Quaretti, Pasquale De Cata, Mario Rotondi, Luca Chiovato
Hepatic encephalopathy is suspected in non-cirrhotic cases of encephalopathy because the symptoms are accompanied by hyperammonaemia. Some cases have been misdiagnosed as psychiatric diseases and consequently patients hospitalized in psychiatric institutions or geriatric facilities. Therefore, the importance of accurate diagnosis of this disease should be strongly emphasized. A 68-year-old female patient presented to the Emergency Room with confusion, lethargy, nausea and vomiting. Examination disclosed normal vital signs...
December 21, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/29307995/rifaximin-ameliorates-hepatic-encephalopathy-and-endotoxemia-without-affecting-the-gut-microbiome-diversity
#17
Kosuke Kaji, Hiroaki Takaya, Soichiro Saikawa, Masanori Furukawa, Shinya Sato, Hideto Kawaratani, Mitsuteru Kitade, Kei Moriya, Tadashi Namisaki, Takemi Akahane, Akira Mitoro, Hitoshi Yoshiji
AIM: To determine the efficacy of rifaximin for hepatic encephalopathy (HE) with the linkage of gut microbiome in decompensated cirrhotic patients. METHODS: Twenty patients (12 men and 8 women; median age, 66.8 years; range, 46-81 years) with decompensated cirrhosis (Child-pugh score > 7) underwent cognitive neuropsychological testing, endotoxin analysis, and fecal microbiome assessment at baseline and after 4 wk of treatment with rifaximin 400 mg thrice a day...
December 21, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/29235218/efficacy-and-safety-of-rifaximin-in-japanese-patients-with-hepatic-encephalopathy-a-phase-2-3-multicenter-randomized-evaluator-blinded-active-controlled-trial-and-a-phase-3-multicenter-open-trial
#18
Kazuyuki Suzuki, Ryujin Endo, Yasuhiro Takikawa, Fuminori Moriyasu, Yutaka Aoyagi, Hisataka Moriwaki, Shuji Terai, Isao Sakaida, Yoshiyuki Sakai, Shuhei Nishiguchi, Toru Ishikawa, Hitoshi Takagi, Atsushi Naganuma, Takuya Genda, Takafumi Ichida, Koichi Takaguchi, Katsuhiko Miyazawa, Kiwamu Okita
AIM: The efficacy and safety of rifaximin in the treatment of hepatic encephalopathy (HE) are widely known, but they have not been confirmed in Japanese patients with HE. Thus, two prospective, randomized studies (phase 2/3 study and phase 3 study) were conducted. METHODS: Subjects with grade I or II HE and hyperammonemia were enrolled. The phase 2/3 study, which was a randomized, evaluator-blinded, active-comparator, parallel-group study, was conducted at 37 institutions in Japan...
December 13, 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/29204952/-therapeutic-modulation-of-intestinal-microbiota-in-irritable-bowel-syndrome-from-probiotics-to-fecal-microbiota-therapy
#19
P C Konturek, Yurdagül Zopf
BACKGROUND: An abnormal intestinal microbiota (dysbiosis) plays a central role in the pathogenesis of the irritable bowel syndrome. METHOD: An overview of four current options for the treatment of irritable bowel syndrome, which are characterized by modulation of intestinal microbiota, is given. RESULTS AND CONCLUSIONS: Probiotics have very different effects on the individual symptoms of the irritable bowel. The choice of the appropriate preparation should therefore be based on the clinical symptomatology...
December 2017: MMW Fortschritte der Medizin
https://www.readbyqxmd.com/read/29201772/managing-encephalopathy-in-the-outpatient-setting
#20
REVIEW
Tarana Gupta, Sahaj Rathi, Radha K Dhiman
In cirrhosis of liver, hepatic encephalopathy (HE) has an important impact on health-related quality of life. It is important to define whether HE is episodic, recurrent, or persistent; types A, B, or C; overt HE or covert HE; and spontaneous or precipitated. The overt HE is clinically evident and needs hospitalization. Nonabsorbable disaccharides, rifaximin, and probiotics are proven to be useful in the treatment of overt HE. Covert HE includes both minimal HE and grade I HE. It is not apparent on routine clinical examination...
January 2017: Euroasian journal of hepato-gastroenterology
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