利福昔明-金双歧序贯治疗腹泻型肠易激综合征临床观察

目的 观察利福昔明-金双歧序贯疗法治疗腹泻型肠易激综合征疗效.方法 80例IBS-D病人按照随机原则分为A组（利福昔明-金双歧序贯组）、B组（益生菌组）、C组（对照组）治疗,疗程均4周,记录治疗前后患者胃肠道主要症状评分.统计分析采用SPSS17.0软件,P＜0.05为差异有统计学意义.结果 治疗4周后,A组患者较同组治疗前及C组同期腹痛、腹胀程度和频度、排便次数及大便性状和总评分均显著下降（P＜0.05）,具有统计学意义;A组较B组同期腹痛程度和频度、腹胀程度、排便次数及大便性状和总评分均显著下降（P＜0.05）,具有统计学意义.B组患者治疗后腹痛程度和频度、腹胀频度、大便性状及总评分显著下降（P＜0.05）,具有统计学意义.C组患者治疗后症状评分下降不明显（P＞0.05）.结论 利福昔明-金双歧序贯治疗腹泻型肠易激综合征有效,可有效改善临床症状,且作用优于单用益生菌治疗,值得临床推广应用.     

Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care

BACKGROUND Hepatic encephalopathy(HE) is a reversible neuropsychiatric complication of liver cirrhosis and occurs in up to 50% of cirrhotic patients. Studies examining the prognostic significance of HE are limited despite the high prevalence in cirrhosis.AIM To define the clinical outcomes of patients after an episode of HE treated with current standards-of-care.METHODS All patients hospitalised with HE requiring Rifaximin to 3 tertiary centres over46-mo(2012–2016) were identified via pharmacy dispensing records. Patients with hepatocellular carcinoma and those prescribed Rifaximin prior to admission were excluded. Medical records were reviewed to determine baseline characteristics and survival. The Kaplan-Meier method was used to calculate survival probability. Univariate survival analysis was performed with variables reaching statistical significance included in a multivariate analysis. The primary outcome was 12-mo mortality following commencement of Rifaximin.RESULTS188 patients were included. Median age was 57 years(IQR 50-65), 71% were male and median model for end stage liver disease and Child Pugh scores were 25(IQR 18-31) and 11(IQR 9-12) respectively. The most common causes of cirrhosis were alcohol(62%), hepatitis C(31%) and non-alcoholic fatty liver disease(20%).A precipitating cause for HE was found in 92% patients with infection(43%), GI bleeding(16%), medication non-compliance(15%) and electrolyte imbalance(14%) the most common. During a mean follow up period of 12 ± 13 mo 107(57%) patients died and 32(17%) received orthotopic liver transplantation. Themost common causes of death were decompensated chronic liver disease(57%)and sepsis(19%). The probability of survival was 44% and 35% at 12-and 24-mo respectively. At multivariate analysis a model for end stage liver disease 15 and international normalised ratio reached statistical significance in predicting mortality.CONCLUSION Despite advances made in the management of HE patients continue to have poor survival. Thus, in all patients presenting with HE the appropriateness of orthotopic liver transplantation should be considered.     

Evidence-based approach to management of hepatic encephalopathy in adults

Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function and represents one of the many complications of portal hypertension and decompensated liver disease. Although ammonia is clearly implicated in the pathogenesis of HE, the pathogenesis of HE is multifactorial with numerous mechanisms that results in functional impairment of neuronal cells. The initial management of HE focuses on supportive care and stabilization which includes providing appropriate nutritional support. Thereafter, focus should be on identifying and treating the precipitating factors. There are many therapeutic agents available for the management of HE, most of which are directed towards lowering the gut nitrogen load and thus the serum ammonia level. This review aims to provide an update on the conventional and emerging treatment options for HE.     

Efficacy of long-term rifaximin treatment for hepatic encephalopathy in the Japanese

BACKGROUND Hepatic encephalopathy(HE) is a complication of liver cirrhosis and can result in neuropsychological and neuromuscular dysfunctions in patients. Rifaximin, an antibiotic, has been reported to decrease the occurrence of overt HE and also improve cognitive function in studies from Europe and the United States of America. There is not enough evidence of the relationship between the long-term use of rifaximin and its clinical effects in the Japanese.AIM To determine the clinical effects of long-term rifaximin therapy in decompensated liver cirrhosis patients, with overt HE or hyperammonemia.METHODS In this single-center retrospective observational cohort study, we reviewed the data of 38 patients who had taken rifaximin at the dose of 1200 mg/d for more than 24 wk. The primary outcome measured was the efficacy of long-term rifaximin use, and secondary outcome measured was the safety of its long-term use as determined by its influence on portosystemic shunts as well as Escherichia coli-related infections. Moreover, we compared the prognosis between the rifaximin group and control cases, matched for hepatic elasticity assessed by magnetic resonance ela-stography, age, and Child-Pugh classification.RESULTS Of the 38 patients included in the study, 12(31.6%) had overt HE, 27(71.1%) had complications of esophageal varices, and 9(23.7%) had hepatocellular carcinoma(HCC). The control group was matched for age, Child-Pugh classification, liver stiffness, and presence of HCC. The median of serum ammonia level before treatment was 104 μg/dL(59-297), and 2 wk after treatment, it significantly decreased to 85 μg/dL(34-153)(P = 0.002). A significantly low value of 80.5μg/dL(44-150) was maintained 24 wk after treatment. The long-term use of rifaximin did not cause a decline in liver function. Diarrhea occurred in 2 patients, who improved with the administration of probiotics, and there were no cases of aborted rifaximin therapy owing to adverse events. In patients with Child C, the survival was short, but there was no significant difference compared with that of the control group.CONCLUSION Rifaximin therapy improves overt HE. The long-term use of rifaximin in the Japanese is effective and safe.     

RP-HPLC测定利福昔明的含量及有关物质

目的　建立测定利福昔明含量及有关物质的方法。方法　采用C18色谱柱 (5 μm ,15 0mm× 4.6mm) ,流动相为甲醇 -乙腈 - 0 .0 5mol·L-1磷酸二氢钾溶液 - 0 .5mol·L-1枸橼酸溶液 (5 0∶2 5∶2 0∶5 ) ,检测波长 2 5 4nm。结果　利福昔明在 5 0～ 2 0 0 μg·ml-1浓度范围内 ,峰面积与浓度呈良好的线性关系 (r=0 .9999) ,平均回收率为 99.9%。结论　所建方法简便 ,专属性及重复性好 ,可用于利福昔明的含量及有关物质的测定。     

HPLC法测定利福昔明的含量与有关物质

目的建立利福昔明含量和有关物质的HPLC测定法。方法使用Resolve C18柱（150mm×5.0mm，5μm）；柱温40℃流动相：甲醇：乙腈：0.05mol／L磷酸二氢钾溶液：0．5mol／L柠檬酸溶液（15：30：26：4）；流速1ml／min；检测波长254nm；进样量20μl。结果利福营明在浓度为0．2～0.05mg／ml范围内呈很好的线性关系,r=0.9999，重复性和日内精密度RSD分别为0．25％（n=5）和0．83％（n=6）．结论该方法简单、准确、专属性强，可用于利福昔明含量及有关物质的测定。     

利福昔明治疗急性细菌性肠道感染临床试验

目的:评价利福昔明治疗急性肠道细菌感染性痰病的疗效和安全性。方法:采用多中心随机双盲双模拟阳性药物平行对照试验。急性细菌性肠道感染患者237例,随机分为:①治疗组118例,给予利福昔明0.2g,po,q6h,同时给予盐酸环丙沙星模拟片1片,bid,疗程5d,②对照组119例,给予环丙沙星0.25g,po,bid,同时给予利福昔明模拟片2片,po,q6h,疗程5d。结果:治疗组肠道感染的治愈率和显效率分别是79.49%,17.09%,总有效率96.58%;对照组分别是79.49%,16.24%,总有效率95.73%,两组差异无统计学意义。利福昔明和环丙沙星的细菌清除率分别是96.55%,100%。经确认与药物有关的不良反应发生率为2.54%和3.36%。各项结果的差异无统计学意义(P>0.05)。结论:利福昔明治疗肠道感染具有较好的疗效,该药有疗效高、起效快、疗程短、不良反应发生率低等优点,是临床治疗急性肠道细茵感染的一种安全有效的抗菌药。     

利福昔明片治疗急性感染性腹泻的临床研究

目的评估利福昔明片治疗急性感染性腹泻的临床疗效及安全性。方法采用多中心、随机、双盲双模拟、阳性药物平行对照的方法,入选240例患者,试验组120例服用利福昔明片,第1天300 mg,3次/d;第2~5天400 mg,2次/d;对照组120例服用左氧氟沙星片,第1天100 mg,3次/d;第2~5天100 mg,2次/d,疗程为3~5 d。结果试验组治疗3~5 d后,腹痛腹泻及大便检查恢复正常或明显好转,痊愈率84.68%,显效率15.31%,总有效率为100.00%,细菌清除率为100.00%,与对照组比较P>0.05,两组均未见严重不良反应。结论利福昔明片是治疗急性感染性腹泻安全有效的药物。     

Síntomas intestinales en pacientes que reciben inhibidores de bomba de protones (IBP). Resultados de una encuesta multicéntrica en México

Introduction

Proton pump inhibitors (PPIs) have been associated with small intestinal bacterial overgrowth (SIBO), which increases with prolonged PPI use, and SIBO has been associated with irritable bowel syndrome (IBS).