PubMed · 587248
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P Copper. 1977. Minor digestive disturbances.. https://pubmed.ncbi.nlm.nih.gov/587248/
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Ghrelin was first discovered as a peptide involved in growth hormone release, but has now emerged as a new player in the regulation of gastrointestinal function. Ghrelin is structurally and functionally related to motilin. Like motilin, it induces a specific motor pattern in the fasted state and acts postprandially to accelerate gastric emptying. There is no apparent cross-reactivity with motilin at the receptor level. Ghrelin agonists have the same potential as motilin agonists, and applications in post-operative ileus and gastroparesis have already been explored. Although promising, there is still the need to avoid side effects and the problems encountered with motilides. This will require drugs with an appropriate pharmacokinetic profile. In addition, the dosage regimen and target population should be carefully taken into consideration when planning clinical trials.
The short bowel is defined by the extended resection of the small intestine, leaving a maximum of 100 cm of healthy organ beyond the ligament of Treitz, with or without preservation of the colon. Nutritional management must be quick in order to optimize adaptation of the remaining intestine, therefore avoiding intestinal insufficiency. Consequent nutrition support such as long term enteral or parental nutrition is some times indispensable. Home enteral nutrition is relatively comfortable. Home parental nutrition somewhat complex, necessitates the creation of a strong home support group. This article addresses practitioners unfamiliar with clinical nutrition, directly faced with problems due to the short bowel in hospital (short and mean term phases) and in home settings (mean and long term phases).
Medical management of inflammatory bowel diseases (IBD) includes two treatment strategies: induction and maintenance of remission. 5-Aminosalicylates are mostly used for mild active IBD and for maintenance treatment in ulcerative colitis (UC). Glucocorticoids remain, despite their frequent (and occasionally severe) side effects, as the mainstay for induction of remission in moderate to severe active IBD, both UC and Crohn's disease (CD). Cyclosporine and infliximab have emerged as the main, rapid-acting, alternatives in steroid-refractory UC and CD, respectively. Thiopurines (azathioprine and 6-mercaptopurine) are the most efficient and used immunomodulators in IBD; steroid refractoriness, steroid dependency, and long-term maintenance of remission for both UC and CD are their main indications. Methotrexate and infliximab may be used in the same clinical settings as thiopurines in CD, but not in UC; however, these drugs are a second-line treatment because of safety profile and economic costs.