Occurrence Of Gastrointestinal Side Effects Research Articles

Possibilities for reducing toxicity in colon cancer patients receiving adjuvant polychemotherapy

Introduction. According to the World Health Organization, colorectal cancer is the third most common type of cancer in the world. The surgical method of treatment is the main one in locally advanced stages; however, a large proportion of patients require complex treatment, including adjuvant chemotherapy. When conducting adjuvant chemotherapy, it is extremely important to maintain the rhythm of cycles and minimize adverse events that may lead to dose reduction. Prevention of dose-limiting toxicity allows us to achieve the following goals – improving the quality of life of the patient and adherence to treatment, as well as performing a full-fledged stage of the planned complex treatment.Aim. Evaluation of the effectiveness of Polisorb MP in the occurrence of gastrointestinal side effects of adjuvant polychemotherapy in patients with colorectal cancer.Materials and methods. The prospective study included 40 patients with a verified diagnosis of CCR, received treatment and observation at the St. Petersburg City Clinical Oncology Centre from April 2022 to October 2022. All patients received radical surgery and subsequent adjuvant chemotherapy in the XELOX regimen were divided into two groups. The first group of patients (n = 20) received only ACT, patients of group 2 from 16 to 20 days after the completion of each session of ACT received Polysorb MP. Both groups were comparable in terms of gender and age. In the studied cohort of patients there were 20 (50.0 %) men and 20 (50.0 %) women. The age of patients ranged from 31 to 75 years; the median age was 62 years [54.00–68.50]. The quality of life of patients receiving adjuvant polychemotherapy was assessed using the QLQ-C30 questionnaires with the QLQ-CR29, EQ-5D module.Results. The use of Polysorb MP made it possible to significantly reduce the level of creatinine in the blood of patients, which can increase after one cycle of ACT, especially with the use of platinum preparations. In addition, our results indicate that the use of Polysorb MP after ACT in patients with colorectal cancer can significantly improve the quality of life of patients, both by minimizing the symptoms associated with previous treatment and the adverse effects of the drug treatment itself, as well as by improving the general condition of the patient. In patients who received Polysorb MP as an accompanying therapy against the background of AHT, significant deterioration in general and functional health (according to the results of the analysis of the QLQ-C30 questionnaires), increased severity of disease symptoms and treatment complications (according to the results of the analysis of the QLQ-C29 and QLQ-C30 questionnaires), as well as a significant decrease in the general state of health according to the results of the analysis of the dynamics on the EQ-5D scale, was not detected.Conclusions. In patients receiving adjuvant polychemotherapy for locally advanced colon cancer, it can be concluded that it is advisable to use Polysorb MP in order to reduce the manifestation of gastrointestinal toxicity and improve the quality of life of patients, which, in turn, allows a full course of treatment, avoiding dose-limiting adverse events.

Probiotics can prevent drug-induced gastrointestinal symptoms

Probiotics such as Bacillus clausii reduce the occurrence of gastrointestinal side effects of commonly used medications such as antibiotics and proton pump inhibitors in placebo-controlled randomized trials. Their use can make Helicobacter pylori eradication schemes more tolerable.

Real-World Effectiveness Analysis of Switching From Liraglutide or Dulaglutide to Semaglutide in Patients With Type2 Diabetes Mellitus: The Retrospective REALISE-DM Study.

IntroductionInjectable semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) that was previously shown to be superior to liraglutide and dulaglutide in head-to-head comparisons in GLP-1 RA-naïve individuals. It is hypothesized that semaglutide will cause further reductions in glycated hemoglobin A1c (HbA1c) and weight in type 2 diabetes mellitus (T2DM) patients previously treated with liraglutide or dulaglutide. The REALISE-DM study provides the first real-world evidence of the effectiveness and tolerability of semaglutide in patients switching from another GLP-1 RA.MethodsThis retrospective real-world effectiveness analysis included T2DM adults who were on a stable dose of liraglutide or dulaglutide prior to switching to semaglutide. The primary outcome was change in HbA1c. Secondary outcomes were the changes in weight and body mass index (BMI), the occurrence of gastrointestinal side effects (GSEs), and discontinuations. Linear mixed models were used to estimate changes in HbA1c, weight, and BMI, and logistic regression was employed to analyze GSEs and discontinuations.ResultsSix months after the 164 patients in this study had switched to semaglutide, their mean HbA1c had decreased by 0.65% (7.1 mmol/mol) (95% prediction interval [PI]: 0.48, 0.81% [5.2, 8.9 mmol/mol]) from a baseline of 7.9% (interquartile range [IQR]: 7.3, 8.8) (62.8 mmol/mol [IQR: 56.3, 72.7]), while their weight and BMI had reduced by 1.69 kg (95% PI: 1.01, 2.37) and 0.59 kg/m2 (95% PI: 0.34, 0.84), respectively. Nineteen patients (11.6%) developed GSEs after switching.ConclusionsThis study supports switching T2DM patients on liraglutide or dulaglutide to injectable semaglutide to achieve further reductions in HbA1c and weight. Although a small number of GSEs occurred, semaglutide was well tolerated by the majority of the patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-020-00984-x.

Incretin-based therapies for patients with type 1 diabetes: a meta-analysis.

ObjectiveCombined treatment with an incretin-based drug, such as a glucagon-like peptide 1 receptor agonist (GLP-1 RA) or a dipeptidyl peptidase-4 (DPP-4) inhibitor, and basal insulin is a new strategy for improving glucose control in type 1 diabetes mellitus (T1DM). We performed a meta-analysis to assess the effect of this combined treatment on glycaemic control, insulin dose, severe hypoglycaemia, weight gain and gastrointestinal side effects in T1DM patients.MethodsWe searched PubMed, EMBASE and the Cochrane Library for relevant studies published before July 16, 2018. The primary outcome was glycosylated haemoglobin (HbA1c). Secondary outcomes included total daily insulin dose, body weight, severe hypoglycaemia and gastrointestinal side effects.ResultsNine randomized controlled trials (RCTs) involving 2389 patients were ultimately included in the meta-analysis. The pooled data suggested that incretin-based therapy was associated with a reduction in HbA1c levels (weighted mean difference (WMD) −0.17%, 95% confidence interval (CI) −0.24 to −0.11, P < 0.001), total daily insulin dose (WMD −5.53 IU/day, 95% CI −8.89 to −2.17, P = 0.001) and body weight (WMD −3.24 kg, 95% CI −4.43 to −2.04, P < 0.001). Incretins did not increase the risk of severe hypoglycaemia (odds ratio (OR) 0.83, 95% CI 0.60–1.16, P = 0.287) but increased the occurrence of gastrointestinal side effects (OR 3.46, 95% CI 2.20–5.45, P < 0.001).ConclusionsIn T1DM patients, GLP-1 RAs, but not DPP-4 inhibitors, combined with insulin appear to be an effective therapy but may increase the occurrence of gastrointestinal side effects.

Efficacy and safety of Huachansu combined with chemotherapy in advanced gastric cancer: A meta-analysis

BackgroundHuachansu, a Chinese medicine that comes from dried toad venom from the skin glands of Bufo bufo gargarizans Cantor or Bufo melanostictus Schneider, has been used in treatment of cancers. We conducted a meta-analysis to evaluate the efficacy and safety of Huachansu combined with chemotherapy for advanced gastric cancer. MethodsThe main efficacy measures were total response rates, quality of life and one-year survival rate. We also assessed the safety of treatments by evaluating the rate of occurrence of gastrointestinal side effects, leucocytopenia and neurotoxicity. The pooled relative ratio (RR) with 95% confidence interval (95% CI) was calculated to estimate the efficacy and safety of Huachansu combined with chemotherapy. ResultsFifteen randomized controlled trails were eligible. The result showed that Huachansu combined with chemotherapy was superior to simple chemotherapy treatment in increasing of total response rate [RR=1.28; 95% CI: (1.11, 1.18)] and Karnofsky score [RR=1.31; 95% CI: (1.18, 1.45)], and reducing gastrointestinal side effects [RR=0.71; 95% CI: (0.61, 0.82)], and leucocytopenia [RR=0.75; 95% CI: (0.64, 0.87)]; there was no significant difference on one-year survival rate (RR=1.25; 95% CI: 0.73, 2.14) between combination group and simple chemotherapy group. ConclusionCompared with chemotherapy control group, Huchansu combined with chemotherapy provide benefits for advanced gastric cancer on improving the response rate, increasing Karnofsky score, reducing leucocytopenia and major side effects such as gastrointestinal side effects caused by chemotherapy.

A randomised double blind trial comparing misoprostol or placebo in the management of early miscarriage

To study if misoprostol 400 microg, administered vaginally, increased the successful resolution of early miscarriage compared with placebo. Randomised, double blind placebo controlled study. Sahlgrenska University Hospital, Göteborg, Sweden. One hundred and twenty-six women seeking medical attention for early miscarriage. Women with a non-viable, first trimester miscarriage were randomised to vaginal administration of misoprostol 400 microg or placebo. Main outcome measure was the proportion of successful complete resolution of miscarriage. Secondary outcomes were incidence of infection, bleeding, gastrointestinal side effects, pain, use of analgesics and length of sick leave between groups. Sixty-four patients were randomised to misoprostol and 62 to placebo. Eighty-one percent in the misoprostol and 52% in the placebo group had a complete miscarriage within one week of the primary visit (RR 1.57; 95% CI 1.20-2.06). Patients in the misoprostol group reported more pain as assessed on a visual analogue scale (60.4 [31.0] vs 43.8 [37.1] mm; P < 0.007) and required analgesics more often (83%vs 61%, RR 1.35; 95% CI 1.08-1.70). There were no significant differences in the occurrence of gastrointestinal side effects, infection, reduction in haemoglobin or sick leave between the groups. Treatment with 400 mug misoprostol administered vaginally increased the success rate of resolvement of uncomplicated early miscarriages compared with placebo. However, women who received misoprostol experienced more pain and required more analgesics than those who did not.

Effect of Lactobacillus GG Supplementation on Antibiotic-Associated Gastrointestinal Side Effects during Helicobacter pylori Eradication Therapy: A Pilot Study

Background: One-week triple therapy is currently regarded as the reference of anti-Helicobacter pylori treatment. However, antibiotic-associated gastrointestinal side effects are among the major pitfalls of such regimens. Probiotic supplementation may be regarded as a therapeutic tool to prevent or reduce these troublesome drug-related manifestations. Aim: To determine whether the addition of the probiotic Lactobacillus GG to an anti-H. pylori standard triple therapy could help to prevent or minimize the occurrence of gastrointestinal side effects. Methods: One hundred and twenty healthy asymptomatic subjects screened positive for H. pylori infection and deciding to receive eradication therapy were randomized either to 1-week pantoprazole (40 mg b.i.d.), clarithromycin (500 mg b.i.d.), tinidazole (500 mg b.i.d.) or to the same regimen supplemented with Lactobacillus GG for 14 days. Patients filled in validated questionnaires during follow-up to determine the type and severity of side effects and to judge overall tolerability. Results: Bloating, diarrhea and taste disturbances were the most frequent side effects during the eradication week and were significantly reduced in the Lactobacillus GG-supplemented group (RR = 0.4, CI 0.2–0.8; RR = 0.3, CI 0.1–0.8; RR = 0.3, CI 0.1–0.7, respectively). The same pattern was observed throughout the follow-up period. Overall assessment of treatment tolerability showed a significant trend in favor of the Lactobacillus GG-supplemented group (p = 0.03). Conclusions:Lactobacillus GG supplementation beneficially affects H. pylori therapy-related side effects and overall treatment tolerance.

First clinical studies with orlistat: a short review.

Lipase inhibition, leading to decreased intestinal fat adsorption can be used in the treatment of obesity. Orlistat, a lipase inhibitor, in a dose of 50 mg three times a day leads to a significant increase in weight loss compared to placebo in moderately obese people. These results are confirmed in a multiple-dose study using 10 mg, 60 mg and 120 mg Orlistat three times a day vs. placebo. The use of lipase inhibition has no significant influence on fasting levels of several hormonal systems, including thyroid hormones, catecholamines and IGF-I. The same is true for the responses of several gastrointestinal and pancreatic hormones after a liquid high-fat mixed meal. In general, Orlistat is tolerated very well, although a higher occurrence of gastrointestinal side effects is seen.