Soluble or insoluble fibre in irritable bowel syndrome in primary care?

Serat larut atau tak larut untuk pasien dengan irritable bowel syndrome Penelitian ini membuktikan serat larut (psilium) lebih baik bagi pasien irritable bowel syndrome   Published 27 August 2009, doi:10.1136/bmj.b3154 Cite this as: BMJ 2009;339:b3154 Research Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial C J Bijkerk, general practitioner1, N J de Wit, associate professor of general practice1, J W M Muris, associate professor of general practice2, P J Whorwell, professor of medicine and gastroenterology3, J A Knottnerus, professor of general practice2, A W Hoes, professor of clinical epidemiology and general practice1 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands, 2 Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, Netherlands, 3 Department of Medicine and Gastroenterology, University of Manchester, Manchester, M23 9LT Objective To determine the effectiveness of increasing the dietary content of soluble fibre (psyllium) or insoluble fibre (bran) in patients with irritable bowel syndrome. Design Randomised controlled trial. Setting General practice. Participants 275 patients aged 18-65 years with irritable bowel syndrome. Interventions 12 weeks of treatment with 10 g psyllium (n=85), 10 g bran (n=97), or 10 g placebo (rice flour) (n=93). Main outcome measures The primary end point was adequate symptom relief during at least two weeks in the previous month, analysed after one, two, and three months of treatment to assess both short term and sustained effectiveness. Secondary end points included irritable bowel syndrome symptom severity score, severity of abdominal pain, and irritable bowel syndrome quality of life scale. Results The proportion of responders was significantly greater in the psyllium group than in the placebo group during the first month (57% v 35%; relative risk 1.60, 95% confidence interval 1.13 to 2.26) and the second month of treatment (59% v 41%; 1.44, 1.02 to 2.06). Bran was more effective than placebo during the third month of treatment only (57% v 32%; 1.70, 1.12 to 2.57), but this was not statistically significant in the worst case analysis (1.45, 0.97 to 2.16). After three months of treatment, symptom severity in the psyllium group was reduced by 90 points, compared with 49 points in the placebo group (P=0.03) and 58 points in the bran group (P=0.61 versus placebo). No differences were found with respect to quality of life. Fifty four (64%) of the patients allocated to psyllium, 54 (56%) in the bran group, and 56 (60%) in the placebo group completed the three month treatment period. Early dropout was most common in the bran group; the main reason was that the symptoms of irritable bowel syndrome worsened. Conclusions Psyllium offers benefits in patients with irritable bowel syndrome in primary care. Trial registration Clinical trials NCT00189033

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Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery

N Engl J Med 361(5):445-454, 30 July 2009 © 2009 to the Massachusetts Medical Society
Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery. The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium.

 

ABSTRACT

Background To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization.

Methods We performed a prospective, multicenter, observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007. A composite end point of 30-day major adverse outcomes (including death; venous thromboembolism; percutaneous, endoscopic, or operative reintervention; and failure to be discharged from the hospital) was evaluated among patients undergoing first-time bariatric surgery.

Results There were 4776 patients who had a first-time bariatric procedure (mean age, 44.5 years; 21.1% men; 10.9% nonwhite; median body-mass index [the weight in kilograms divided by the square of the height in meters], 46.5). More than half had at least two coexisting conditions. A Roux-en-Y gastric bypass was performed in 3412 patients (with 87.2% of the procedures performed laparoscopically), and laparoscopic adjustable gastric banding was performed in 1198 patients; 166 patients underwent other procedures and were not included in the analysis. The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding was 0.3%; a total of 4.3% of patients had at least one major adverse outcome. A history of deep-vein thrombosis or pulmonary embolus, a diagnosis of obstructive sleep apnea, and impaired functional status were each independently associated with an increased risk of the composite end point. Extreme values of body-mass index were significantly associated with an increased risk of the composite end point, whereas age, sex, race, ethnic group, and other coexisting conditions were not.

Conclusions The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics. In helping patients make appropriate choices, short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese.

Efek probiotik pada anak

 

Penelitian menilai pengaruh pemberian probiotik pada anak terhadap gejala 'masuk angin' (cold) dan 'influenza-like' selama musim dingin.

Desain penelitian double-blind, placebo-controlled dengan subyek 326 anak berusia 3-5 tahun. Subyek dibagi 3 kelompok, plasebo (N=104), Lactobacillus acidophilus NCFM (N = 110), atau kombinasi L acidophilus NCFM dan Bifidobacterium animalis subsp lactis Bi-07 (N = 112). Diberikan probiotik dua kali sehari selama 6 bulan.

1. Hasilnya penelitian menunjukkan  pemberian probiotik tunggal dan kombinasi mengurangi insidan demam sebesar 53.0% (P = .0085) dan 72.7% (P = .0009).

2. Mengurangi insidan batuk sebesar 41.4% (P = .027) and 62.1% (P = .005).

3. Mengurangi insiden pilek (rhinorrhea) sebesar 28.2% (P = .68) and 58.8% (P = .03).

4. Durasi demam, batuk dan pilek juga berkurang signifikan dibanding plasebo sebesar 32% (single strain; P = .0023) dan 48% (strain combination; P < .001).

5. Sehingga penggunaan antibiotika dapat diturunkan signifikan sebesar 68.4% (single strain; P = .0002) dan 84.2% (strain combination; P < .0001) dibanding plasebo.

6. Jumlah hari absen pada kelompok yang mendapat probiotik juga berkurang signifikan sebesar 31.8% (single strain; P = .002) dan 27.7% (strain combination; P < .001) dibanding plasebo.

Kesimpulan pemberian probiotik setiap hari selama 6 bulan merupakan cara yang aman dan efektif untuk mengurangi insiden demam, batuk dan pilek, sehingga mengurangi pemberian antibiotika dan sekaligus mengurangi jumlah hari absen pada anak prasekolah usia 3-5 tahun. 

Pediatrics Vol. 124 No. 2 August 2009, pp. e172-e179 © American Academy of Pediatrics.
Probiotic Effects on Cold and Influenza-Like Symptom Incidence and Duration in Children. Gregory J. Leyer, PhD, Shuguang Li, MS, Mohamed E. Mubasher, PhDc Cheryl Reifer, PhD and Arthur C. Ouwehand, PhD.
Probiotic Effects on Cold and Influenza-Like Symptom Incidence and Duration in Children

OBJECTIVE: Probiotic consumption effects on cold and influenza-like symptom incidence and duration were evaluated in healthy children during the winter season.

METHODS: In this double-blind, placebo-controlled study, 326 eligible children (3–5 years of age) were assigned randomly to receive placebo (N = 104), Lactobacillus acidophilus NCFM (N = 110), or L acidophilus NCFM in combination with Bifidobacterium animalis subsp lactis Bi-07 (N = 112). Children were treated twice daily for 6 months.

RESULTS: Relative to the placebo group, single and combination probiotics reduced fever incidence by 53.0% (P = .0085) and 72.7% (P = .0009), coughing incidence by 41.4% (P = .027) and 62.1% (P = .005), and rhinorrhea incidence by 28.2% (P = .68) and 58.8% (P = .03), respectively. Fever, coughing, and rhinorrhea duration was decreased significantly, relative to placebo, by 32% (single strain; P = .0023) and 48% (strain combination; P < .001). Antibiotic use incidence was reduced, relative to placebo, by 68.4% (single strain; P = .0002) and 84.2% (strain combination; P < .0001). Subjects receiving probiotic products had significant reductions in days absent from group child care, by 31.8% (single strain; P = .002) and 27.7% (strain combination; P < .001), compared with subjects receiving placebo treatment.

CONCLUSION: Daily dietary probiotic supplementation for 6 months was a safe effective way to reduce fever, rhinorrhea, and cough incidence and duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children 3 to 5 years of age.