Review : Bile Acid Diarrhea: Prevalence, Pathogenesis, and Therapy

( Michael Camilleri ) The Editorial Office of Gut and Liver 2015 Gut and Liver Vol.9 No.3

Bile acid diarrhea (BAD) is usually seen in patients with ileal Crohn’s disease or ileal resection. However, 25% to 50% of patients with functional diarrhea or diarrhea-predominant irritable bowel syndrome (IBS-D) also have evidence of BAD. It is estimated that 1% of the population may have BAD. The causes of BAD include a deficiency in fibroblast growth factor 19 (FGF-19), a hormone produced in enterocytes that regulates hepatic bile acid (BA) synthesis. Other potential causes include genetic variations that affect the proteins involved in BA enterohepatic circulation and synthesis or in the TGR5 receptor that mediates the actions of BA in colonic secretion and motility. BAs enhance mucosal permeability, induce water and electrolyte secretion, and accelerate colonic transit partly by stimulating propulsive high-amplitude colonic contractions. There is an increased proportion of primary BAs in the stool of patients with IBS-D, and some changes in the fecal microbiome have been described. There are several methods of diagnosing BAD, such as 75selenium homotaurocholic acid test retention, serum C4, FGF-19, and fecal BA measurement; presently, therapeutic trials with BA sequestrants are most commonly used for diagnosis. Management involves the use of BA sequestrants including cholestyramine, colestipol, and colesevelam. FXR agonists such as obeticholic acid constitute a promising new approach to treating BAD. (Gut Liver 2015;9:332-339)

간호학 탐구의 방향

Kim, Mi Ja,Camilleri, Drothy 연세대학교 간호정책연구소 1992 간호학탐구 Vol.1 No.1

Review : Noninvasive Measurement of Gastric Accommodation by SPECT

Doe Young Kim,Michael Camilleri 대한내과학회 2002 The Korean Journal of Internal Medicine Vol.17 No.1

A Pilot Study of the Effect of Daikenchuto on Rectal Sensation in Patients with Irritable Bowel Syndrome

( Andres Acosta ),( Michael Camilleri ),( Sara Linker Nord ),( Irene Busciglio ),( Johanna Iturrino ),( Lawrence A Szarka ),( Alan R Zinsmeister ) 대한소화기기능성질환·운동학회 2016 Journal of Neurogastroenterology and Motility (JNM Vol.22 No.1

Background/Aims Daikenchuto (TU 100), a botanical agent that modulates gastrointestinal nerves, is used in the treatment of motility and functional disorders. Our aim was to study the effects of TU-100 on rectal compliance and sensation in patients with irritable bowel syndrome (IBS). Methods In 20 patients per treatment arm, we conducted a single-center, randomized, parallel-group, double-blind, placebo-controlled, singledose pharmacodynamics study evaluating the effects of TU-100, 15 g (5 g t.i.d. [means 3 times a day]), for 14-16 consecutive days on rectal compliance and rectal sensation (thresholds and sensation ratings), all measured at baseline and on the last day of medication treatment. The primary endpoint was rectal sensation thresholds and sensation ratings in response to balloon distension at 32 mmHg. Secondary endpoints were rectal compliance, sensation thresholds, ratings and tone (fasting and postprandial), bowel pattern, abdominal pain (average and worst severity) and bloating scores, IBS quality of life and safety profile. Results Rectal sensation ratings post-treatment were significantly associated with baseline (pre-treatment) ratings and with level of anxiety or stress recorded at the time of the sensation testing. There were no effects of TU-100 treatment on rectal sensation ratings, sensation thresholds, rectal fasting or postprandial tone, rectal compliance, bowel function, abdominal pain or bloating scores, or IBS quality of life. Conclusions TU-100 did not significantly affect rectal compliance and sensation in patients with IBS in this study. (J Neurogastroenterol Motil 2016;22:69-77)

Nicotine dependence and the International Association for the Study of Pain neuropathic pain grade in patients with chronic low back pain and radicular pain: is there an association?

Schembri, Emanuel,Massalha, Victoria,Spiteri, Karl,Camilleri, Liberato,Lungaro-Mifsud, Stephen The Korean Pain Society 2020 The Korean Journal of Pain Vol.33 No.4

Background: This study investigated whether current smoking and a higher nicotine dependency were associated with chronic low back pain (LBP), lumbar related leg pain (sciatica) and/or radicular neuropathic pain. Methods: A cross-sectional study was conducted on 150 patients (mean age, 60.1 ± 13.1 yr). Demographic data, the International Association for the Study of Pain (IASP) neuropathic pain grade, STarT Back tool, and the Fagerström test were completed. A control group (n = 50) was recruited. Results: There was a significant difference between current smokers and nonsmokers in the chronic LBP group in the mean pain score (P = 0.025), total STarT Back score (P = 0.015), worst pain location (P = 0.020), most distal pain radiation (P = 0.042), and in the IASP neuropathic pain grade (P = 0.026). There was a significant difference in the mean Fagerström score between the four IASP neuropathic pain grades (P = 0.005). Current smoking yielded an odds ratio (OR) of 3.071 (P = 0.011) for developing chronic LBP and sciatica, and an OR of 4.028 (P = 0.002) for obtaining an IASP "definite/probable" neuropathic pain grade, for both cohorts. The likelihood for chronic LBP and sciatica increased by 40.9% (P = 0.007), while the likelihood for an IASP neuropathic grade of "definite/probable" increased by 50.8% (P = 0.002), for both cohorts, for every one unit increase in the Fagerström score. Conclusions: A current smoking status and higher nicotine dependence increase the odds for chronic LBP, sciatica and radicular neuropathic pain.

Constipation in Patients With Chronic Kidney Disease

Ra Ri Cha,Seon-Young Park,Michael Camilleri 대한소화기 기능성질환∙운동학회 2023 Journal of Neurogastroenterology and Motility (JNM Vol.29 No.4

Constipation is a frequent symptom in patients with chronic kidney disease (CKD). This review outlines the mechanisms and management of constipation in patients with CKD from a physician’s perspective. Common causes of constipation in patients with CKD include concomitant medications, low dietary fiber intake, water-restricted diet, lack of physical activity, altered gut microbiota, and reduced gastrointestinal motility. Constipation has a negative impact on overall health, and, in particular, the presence of constipation has been associated with worsening kidney function and increased risk of developing advanced stages of CKD. Although lifestyle and dietary modifications may not always be practical for patients with CKD, they are recommended because they are beneficial as they lower mortality in patients with CKD. The use of laxatives containing magnesium salts, bulking agents, and osmotic laxatives may have insufficient efficacy and may be associated with adverse effects. In contrast, lactulose and lubiprostone have been shown to exhibit reno-protective effects. Linaclotide and plecanatide have very limited systemic absorption and appear safe in patients with CKD. Tenapanor reduces paracellular intestinal phosphate absorption in addition to blocking sodium uptake by enterocytes, and provides additional benefit in patients patients with CKD who have hyperphosphatemia and constipation. Prucalopride leads to improvements in bowel function and constipation-related symptoms in cases in which response to conventional laxatives are inadequate. However, the dose of prucalopride should be reduced to 1 mg once daily for patients with CKD. In conclusion, there are important advances on the impact and treatment of constipation in patients with CKD.

Regional Colonic Transit Pattern Does Not Conclusively Identify Evacuation Disorders in Constipated Patients with Delayed Colonic Transit

( Seon-young Park ),( Duane Burton ),( Irene Busciglio ),( Deborah Eckert ),( Michael Camilleri ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2017 Journal of Neurogastroenterology and Motility (JNM Vol.23 No.1

Background/Aims After exclusion of structural diseases, chronic constipation may be associated with normal or slow transit or rectal evacuation disorders. We evaluated: (1) clinical features and anorectal function, (2) difference of regional colonic transit according to the presence or absence of evacuation disorders, and (3) association of colonic transit with gender in patients with objectively slow colonic transit. Methods We reviewed electronic medical records of 1553 patients with constipation seen by one gastroenterologist from 1994-2015 at a tertiary medical center. We identified patients with slow colonic transit using scintigraphy. Evacuation disorders were identified on clinical examination or anorectal manometry. Colonic compliance and tone were measured in 29 patients. Statistical analysis was by the Mann-Whitney rank sum test. Results Of the 207 patients (155 females, mean age 41.3 ± 15.3 [SD] years), 113 had evacuation disorders (ED+ve) and 94 did not (ED-ve). There were no significant differences in colonic transit or gastric emptying between ED+ve or ED-ve; similarly, colonic compliance, tone and responses to neostigmine were not different in ED+ve and ED-ve. Conversely, there were significant differences by gender in patients with slow colonic transit: colonic transit, small bowel transit, and gastric emptying (all P < 0.005). Conclusions Delayed colonic transit does not exclude evacuation disorders in chronic constipation. In chronic constipation and objectively slow colonic transit, females had slower gastric, small bowel, and colonic transit than males. (J Neurogastroenterol Motil 2017;23:92-100)

Coronal tooth discoloration induced by regenerative endodontic treatment using different scaffolds and intracanal coronal barriers: a 6-month ex vivo study

Shokouhinejad, Noushin,Razmi, Hassan,Farbod, Maryam,Alikhasi, Marzieh,Camilleri, Josette The Korean Academy of Conservative Dentistry 2019 Restorative Dentistry & Endodontics Vol.44 No.3

Objective: The aim of this study was to evaluate discoloration of teeth undergoing regenerative endodontic procedures (REPs) using blood clot or platelet-rich fibrin (PRF) as the scaffolds and different calcium silicate-based materials as the intracanal coronal barriers in an ex vivo model. Materials and Methods: Forty-eight bovine incisors were prepared and disinfected using 1 mg/mL double antibiotic paste (DAP). The specimens were then randomly divided into 2 groups (n = 24) according to the scaffolds (blood or PRF). After placement of scaffolds each group was divided into 2 subgroups (n = 12) according to the intracanal coronal barriers (ProRoot MTA or Biodentine). The pulp chamber walls were sealed with dentin bonding agent before placement of DAP and before placement of scaffolds. The color changes (${\Delta}E$) were measured at different steps. The data were analyzed using 2-way analysis of variance. Results: Coronal discoloration induced by DAP was not clinically perceptible (${\Delta}E{\leq}3.3$). Regarding the type of the scaffold, coronal discoloration was significantly higher in blood groups compared with PRF groups at the end of REP and after 1 month (p < 0.05). However, no significant difference was found between PRF and blood clot after 6 months (p > 0.05). Considering the type of intracanal coronal barrier, no significant difference existed between ProRoot MTA and Biodentine (p > 0.05). Conclusions: With sealing the dentinal tubules of pulp chamber with a dentin bonding agent and application of DAP as an intracanal medicament, coronal color change of the teeth following the use of PRF and blood sealed with either ProRoot MTA or Biodentine was not different at 6-month follow-up.

Coronal tooth discoloration induced by regenerative endodontic treatment using different scaffolds and intracanal coronal barriers: a 6-month ex vivo study

Noushin Shokouhinejad,Hassan Razmi,Marzieh Alikhasi,Marzieh Alikhasi,Josette Camilleri 대한치과보존학회 2019 Restorative Dentistry & Endodontics Vol.44 No.3

Objective: The aim of this study was to evaluate discoloration of teeth undergoing regenerative endodontic procedures (REPs) using blood clot or platelet-rich fibrin (PRF) as the scaffolds and different calcium silicate-based materials as the intracanal coronal barriers in an ex vivo model. Materials and Methods: Forty-eight bovine incisors were prepared and disinfected using 1 mg/mL double antibiotic paste (DAP). The specimens were then randomly divided into 2 groups (n = 24) according to the scaffolds (blood or PRF). After placement of scaffolds each group was divided into 2 subgroups (n = 12) according to the intracanal coronal barriers (ProRoot MTA or Biodentine). The pulp chamber walls were sealed with dentin bonding agent before placement of DAP and before placement of scaffolds. The color changes (∆E) were measured at different steps. The data were analyzed using 2-way analysis of variance. Results: Coronal discoloration induced by DAP was not clinically perceptible (ΔE ≤ 3.3). Regarding the type of the scaffold, coronal discoloration was significantly higher in blood groups compared with PRF groups at the end of REP and after 1 month (p < 0.05). However, no significant difference was found between PRF and blood clot after 6 months (p > 0.05). Considering the type of intracanal coronal barrier, no significant difference existed between ProRoot MTA and Biodentine (p > 0.05). Conclusions: With sealing the dentinal tubules of pulp chamber with a dentin bonding agent and application of DAP as an intracanal medicament, coronal color change of the teeth following the use of PRF and blood sealed with either ProRoot MTA or Biodentine was not different at 6-month follow-up.