Oral Mannitol Research Articles

P200 Oral Mannitol for bowel preparation in IBD patients: a post-hoc analysis of a multicentre, controlled, randomized clinical trial

Abstract Background Bowel preparation is the most burdensome part of the whole colonoscopy procedure according to patients. A diagnosis of Inflammatory Bowel Disease (IBD) implies the need for lifelong repeated colonoscopies, therefore amplifying the problem. Bowel preparation with oral Mannitol, a sugar alcohol with a sweet taste, could significantly improve the patients’ tolerance as it has a quick onset, is single dose and has a low volume.1-3 Methods This is a post-hoc analysis of IBD patients included in the SATISFACTION study, a third phase multicentre, international, randomized, endoscopists-blinded controlled trial4. Patients were randomized (1:1) to 750mL of oral mannitol (OM, 100 g in 750 mL water) to be drunk in a single dose 4 hours before colonoscopy versus a standard split preparation with 2L PEG-ASC (PEG). An intention to treat analysis was performed on patients who underwent colonoscopy and who took bowel preparation even partially. Biological important parameters summarising the rate of bowel cleansing and patients’ satisfaction were collected. Results A total of 55 IBD patients (M = 24, P = 31, Crohn’s = 12, Ulcerative Colitis = 40, Microscopic colitis =3) from 7 centres were ruled in for this post-hoc analysis. The two population were comparable in terms of age and sex and diseases (Table 1). A statistically significant preference of OMl over PEG was found in terms of taste (numerical rating scale – NRS, p < 0.001), willingness to reuse the preparation (p = 0.03), and of time of first evacuation (M 56.6 minutes, P 90.7, p = 0.01). No differences were found in terms of adequate bowel cleansing as assessed by the Boston bowel preparation scale (96% OM, 97% PEG), adherence to bowel preparation (complete in 100% OM, 94% PEG) and easy of use (88% OM, 71% PEG). Minor and expected adverse events of special interest such as nausea and abdominal pain were comparable in the two courts (12% OM, 3% PEG). Conclusion Bowel preparation with a very low volume of oral mannitol in a single dose 4 h before colonoscopy provides better satisfaction among IBD patients and showed an excellent efficacy and safety profile as compared to the standard split preparation with 2L PEG-ASC. Same day bowel preparation with oral mannitol is a reliable option for colonoscopy in IBD and an effective strategy to improve the patients’ acceptance. Funding/Acknowledgment The Satisfaction study was funded by NTC, Milan, Italy.

Design of mobile and website health application devices for drug tolerability in hereditary fructose intolerance

BackgroundHereditary fructose intolerance (HFI) is a rare metabolic disease caused by aldolase B deficiency. The aim of our study was to analyse excipient tolerability in patients with HFI and other related diseases and to design mobile and website health applications to facilitate the search for drugs according to their tolerance.ResultsA total of 555 excipients listed in the Spanish Medicines Agency database (July 2023) were classified as suitable for HFI patients, suitable with considerations ((glucose and glucose syrup, intravenous sucrose, oral mannitol, polydextrose, gums and carrageenans, ethanol, sulfite caramel and vanilla), not recommended (intravenous mannitol) and contraindicated (fructose, oral sucrose, invert sugar, sorbitol, maltitol, lactitol, isomaltitol, fruit syrups, honey, sucrose esters and sorbitol esters). Glucose and glucose syrup were classified as suitable with considerations due to its possible fructose content and their potential endogenous fructose production. For other related intolerances, wheat starch was contraindicated and oatmeal was not recommended in celiac disease; oral lactose and lactose-based coprocessed excipient (Cellactose®) were not recommended in lactose intolerance; and glucose, invert sugar and oral sucrose were not recommended in diabetes mellitus. The applications were named IntoMed®. Results are listed in order of tolerability (suitable drugs appear first and contraindicated drugs at the end), and they are accompanied by a note detailing their classified excipients. If a drug contains excipients within different categories, the overall classification will be the most restrictive. The apps are also able to classify substances with the same criteria if they act as active ingredients. The tools exhibited good usability (82.07 ± 13.46 points on the System Usability Scale [range: 0-100]) on a sample of HFI patients, their families and health care professionals.ConclusionsIntoMed® is a tool for finding information about the tolerability of drugs according to excipients for patients with HFI and other related intolerances, with good usability. It is a fast and reliable system that covers the current excipient legislation and expands on it with other specific information: HFI patients should be alert for excipients such as mannitol (especially in intravenous drugs), fruit syrups, honey, sulfite caramel or vanilla. Glucose might contain or produce fructose, and special precaution is needed because of potential errors in their composition.

Intestinal permeability in patients undergoing stem cell transplantation correlates with systemic acute phase responses and dysbiosis.

Intestinal permeability may correlate with adverse outcomes during hematopoietic stem cell transplantation (HSCT), but longitudinal quantification with traditional oral mannitol and lactulose is not feasible in HSCT recipients because of mucositis and diarrhea. A modified lactulose:rhamnose (LR) assay is validated in children with environmental enteritis. Our study objective was to quantify peri-HSCT intestinal permeability changes using the modified LR assay. The LR assay was administered before transplant, at day+7 and+30 to 80 pediatric and young adult patients who received allogeneic HSCT. Lactulose and rhamnose were detected using urine mass spectrometry and expressed as an L:R ratio. Metagenomic shotgun sequencing of stool for microbiome analyses and enzyme-linked immunosorbent assay analyses of plasma lipopolysaccharide binding protein (LBP), ST2, REG3α, claudin1, occludin, and intestinal alkaline phosphatase were performed at the same timepoints. L:R ratios were increased at day+7 but returned to baseline at day+30 in most patients (P= .014). Conditioning regimen intensity did not affect the trajectory of L:R (P= .39). Baseline L:R ratios did not vary with diagnosis. L:R correlated with LBP levels (r2= 0.208; P= .0014). High L:R ratios were associated with lower microbiome diversity (P= .035), loss of anaerobic organisms (P= .020), and higher plasma LBP (P= .0014). No adverse gastrointestinal effects occurred because of LR. Intestinal permeability as measured through L:R ratios after allogeneic HSCT correlates with intestinal dysbiosis and elevated plasma LBP. The LR assay is well-tolerated and may identify transplant recipients who are more likely to experience adverse outcomes.

Oral mannitol for bowel preparation: a dose-finding phase II study

BackgroundSuccessful bowel preparation (BP) for colonoscopy depends on the instructions, diet, the laxative product, and patient adherence, which all affect colonoscopy quality. Nevertheless, there are no laxatives which combine effectiveness, safety, easy self-administration, good patient acceptance, and low cost. However, mannitol, a sugar alcohol, could be an attractive candidate for use in clinical practice if it is shown to demonstrate adequate efficacy and safety.AimsThe present phase II dose-finding study compared three doses of mannitol (50, 100, and 150 g) to identify the best dose to be used in a subsequent phase III study.MethodsThe Boston Bowel Preparation Scale, caecal intubation rate, adherence, acceptability, and safety profile, including measurement of potentially dangerous colonic gas concentrations (CH4, H2, O2), were considered in all patients. A weighted algorithm was used to identify the best mannitol dose for use in the subsequent study.ResultsThe per-protocol population included 60 patients in the 50 g group, 54 in the 100 g group, and 49 in the 150 g group. The 100 g dose was the best as it afforded optimal colon cleansing efficacy (94.4% of patients had adequate BP), adherence, acceptability, and safety, including negligible gas concentrations.ConclusionsThe present study demonstrated that the colon cleansing efficacy and safety of mannitol were dose dependent. Conversely, gas concentrations were not dose dependent and negligible in all patients. Combined evaluation of efficacy, tolerability, and safety, using a weighted algorithm, determined that mannitol 100 g was the best dose for the phase III study.

Feasibility of Simple Oral Preparation Contrast-Enhanced CT Colonography (SOP-CE-CTC) Using Mannitol as a Neutral Oral Contrast Agent

Abstract Purpose This article prospectively assesses the feasibility of simple oral preparation contrast-enhanced computed tomography colonography (SOP-CE-CTC) using a large volume of oral 3% mannitol for good colonic distension along with mural and mucosal fold visualization. Methods A total of 100 patients in whom contrast CT abdomen was requested, recruited as per selection criteria, were advised to take mild oral bowel preparation for two nights, prior to the investigation. Then, after fasting overnight, they were asked to consume 1,500 to 2,000 mL of 3% mannitol solution in about an hour. Thirty minutes after completing the ingestion of oral mannitol, intravenous contrast was injected and SOP-CE-CTC was acquired at 55 seconds. Distension of six segments of the colon was evaluated by assigning scores 1 to 4 for qualitative assessment; and measuring the maximum luminal diameter of the colon, for quantitative assessment. Colonic mucosal and mural visualization were evaluated subjectively. All observations were recorded by two reviewers (with varying levels of experience) independently. Results On qualitative analysis, the colon showed optimal distension (score 4) in 58 to 89% cases on SOP-CE-CTC. There was agreement between both the reviewers in 89 to 99% cases (weighted kappa 0.820–0.979; p < 0.001). On quantitative analysis, the mean of the maximum colonic diameter ranged between 3.4 and 5.2 cm; and both the reviewers agreed in 89 to 97% cases (weighted kappa 0.777–0.967; p < 0.001). Mural and mucosal fold visualization in the proximal four segments of the colon was excellent (in 90–98%) but in the rectum and sigmoid it was 45 and 66%, respectively; both the reviewers agreed in 100% cases (weighted kappa 1.0 and p < 0.001). Conclusion Good colonic distension, mural, and mucosal fold visualization can be achieved on SOP-CE-CTC using 1,500 to 2,000 mL of 3% oral mannitol and mild oral bowel preparation agents.

Image optimization of abdominal and pelvic multislice computed tomography with oral mannitol contrast

Image optimization of abdominal and pelvic multislice computed tomography with oral mannitol contrast

Anaphylactic reaction to mannitol as excipient

Introduction ( contexte de la recherche ) Perioperative anaphylaxis requires thorough explorations. When no active substance is detected as responsible for the anaphylaxis, investigations of potential responsible excipients should be performed. We describe the case of a patient who experienced a perioperative anaphylactic reaction attributed to mannitol. 0. A 15 year-old teenager was admitted to a tertiary care hospital for extraction of her wisdom teeth under general anaesthesia (GA). At the end of the surgery, she suffered from tachycardia, hypotension, bronchospasm and urticaria. She was immediately treated with epinephrine and transferred to the intensive care unit (ICU). One hour after the reaction, her tryptase level was 15.5 μg/L, and it was 14 μg/L two hours after. Her basal level of tryptase was 3.6 μg/L. The patient was discharged from the ICU 24 h later (total recovery) and was further referred to the allergy team for investigations. Drugs used during the GA were Rocuronium, Sufentanyl, Remifentanyl, Dexamethasone, Ketoprofen and Paracetamol. Skin pricks tests (SPT) and intradermal testing (IDT) at the recommended concentrations were performed for all drugs except for paracetamol (given orally in the ICU and well tolerated after the reaction). Skin testing was negative for all drugs, as were oral challenges (OC) for dexamethasone and ketoprofen. Serum specific IgE dosages for quaternary ammonium, latex, chlorhexidine were also negative. In absence of an obvious culprit, SPT and IDT for the intravenous form of paracetamol (containing mannitol) were performed. The SPT exhibited negative result, but the IDT of the pure dilution 10 mg/ml and the 1/10 (1 mg/ml) dilution were positive. It was then decided to perform SPT and IDT for mannitol 10% and 20%, at 1/100 and 1/10 dilutions, which turned out positive (but negative on 2 controls). An OC with an effervescent tablet of paracetamol (2000 mg) containing mannitol was realised and was negative. Oral mannitol was well tolerated. Our clinical case raises awareness about the possible allergy to mannitol when administered through the intravenous route even though the oral route is well tolerated.

Influence of oral contrast type and volume on patient experience and quality of luminal distension at MR Enterography in Crohn’s disease: an observational study of patients recruited to the METRIC trial

ObjectivesTo compare the distention quality and patient experience of oral mannitol and polyethylene glycol (PEG) for MRE.MethodsThis study is a retrospective, observational study of a subset of patients enrolled in a multicentre, prospective trial evaluating the diagnostic accuracy of MRE for small bowel Crohn’s. Overall and segmental MRE small bowel distention, from 105 patients (64 F, mean age 37) was scored from 0 = poor to 4 = excellent by two experienced observers (68 [65%] mannitol and 37 [35%] PEG). Additionally, 130 patients (77 F, mean age 34) completed a questionnaire rating tolerability of various symptoms immediately and 2 days after MRE (85 [65%] receiving mannitol 45 [35%] receiving PEG). Distension was compared between agents and between those ingesting ≤ 1 L or > 1 L of mannitol using the test of proportions. Tolerability grades were collapsed into “very tolerable,” “moderately tolerable,” and “not tolerable.”ResultsPer patient distension quality was similar between agents (“excellent” or “good” in 54% [37/68] versus 46% [17/37]) with mannitol and PEG respectively. Jejunal distension was significantly better with mannitol compared to PEG (40% [27/68] versus 14% [5/37] rated as excellent or good respectively). There was no significant difference according to the volume of mannitol ingested. Symptom tolerability was comparable between agents, although fullness following MRE was graded as “very tolerable” in 27% (12/45) of patients ingesting PEG, verses 44% (37/84) ingesting mannitol, difference 17% (95% CI 0.6 to 34%).ConclusionMannitol-based solutions and PEG generally achieve comparable distension quality and side effect profiles, although jejunal distension is better quality with mannitol. Neither distension quality nor side-effect profile is altered by ingestion of more than 1 L of mannitol.Key Points• Mannitol-based and PEG-based oral preparation agents generally achieve comparable distension quality for MRE with the exception of the jejunum which is better distended with mannitol.• Mannitol-based and PEG-based oral preparation agents used for MRE have similar side effect profiles.• Neither distension quality nor side-effect profile is altered by ingestion of more than 1 L of mannitol.

Safety and Tolerability, Dose-Escalating, Double-Blind Trial of Oral Mannitol in Parkinson's Disease.

Mannitol, a natural alcoholic-sugar, was recently suggested as a potential disease-modifying agent in Parkinson's disease. In animal models of the disease, mannitol interferes with the formation of α-synuclein fibrils, inhibits the formation of α-synuclein oligomers and leads to phenotypic recovery of impaired motor functions. Parkinson's patients who consume mannitol report improvements of both motor and non-motor symptoms. Safety of long-term use of oral mannitol, tolerable dose and possible benefit, however, were never clinically studied. We studied the safety of oral mannitol in Parkinson's disease and assessed the maximal tolerable oral dose by conducting a phase IIa, randomized, double-blind, placebo-controlled, single-center, dose-escalating study (ClinicalTrials.gov Identifier: NCT03823638). The study lasted 36 weeks and included four dose escalations of oral mannitol or dextrose to a maximal dose of 18 g per day. The primary outcome was the safety of oral mannitol, as assessed by the number of adverse events and abnormal laboratory results. Clinical and biochemical efficacy measures were collected but were not statistically-powered. Fourteen patients receiving mannitol completed the trial (in addition to eight patients on placebo). Mannitol-related severe adverse events were not observed. Gastrointestinal symptoms limited dose escalation in 6/14 participants on mannitol. None of the clinical or biochemical efficacy secondary outcome measures significantly differed between groups. We concluded that long-term use of 18 g per day of oral mannitol is safe in Parkinson's disease patients but only two third of patients tolerate this maximal dose. These findings should be considered in the design of future efficacy trials.

Magnetic resonance enterography with oral mannitol solution: Diagnostic efficacy and image quality in Crohn disease.

The aim of this study was to investigate the diagnostic efficacy and image quality of magnetic resonance enterography (MRE) using oral mannitol solution for the evaluation Crohn disease (CD). We retrospectively evaluated MRE examinations of 153 patients with an assumed or definitive diagnosis of CD. There were 65 men and 88 women, with a mean age of 35.7 years (range: 6-73years). MRE findings of the patients were compared to histopathologic results obtained by surgery-fiberoptic endoscopy. The sensitivity, specificity and diagnostic efficacy rate were calculated. Additionally, image quality of MRE was evaluated using a four-point scale (1=excellent, 4=poor/non-diagnostic). Sensitivity, specificity and diagnostic efficacy were 92.5%, 93% and 92.8%, respectively. Six patients had false-positive and five patients had false-negative findings. Three falsely positive patients had ulcerative colitis and three had non-specific terminal ileitis. A total of 765 small bowel segments were analyzed; 475 (62%) had an image quality score of 1 and 15 (2%), an image quality score of 4. MRE using oral mannitol solution provides excellent image quality for MRE and has high degrees of diagnostic efficacy in CD patients.

Acute Effects of a Glucagon-Like Peptide 2 Analogue, Teduglutide, on Gastrointestinal Motor Function and Permeability in Adult Patients With Short Bowel Syndrome on Home Parenteral Nutrition.

Glucagon-like peptide 2 (GLP-2) agonists decrease the need for parenteral nutrition (PN) in short bowel syndrome (SBS); mechanisms evaluated to date have focused on the intestinotrophic effect of GLP-2 agonists such as increased absorptive capacity of the remnant intestine and increased citrulline levels. Other mechanisms may also play a role in effects of GLP-2 agonists. To measure effects of a GLP-2 agonist, teduglutide (TED), compared with placebo (PLA) on gastric emptying (GE), overall gut transit, fluid balance, intestinal monosaccharide absorption, and permeability in patients with SBS on home PN (HPN). In 8 adults with SBS on HPN, we compared daily subcutaneous TED (0.05 mg/kg) and PLA (crossover design, each treatment 7 days with a 14-day washout) on gut transit, intestinal absorption, and permeability after oral mannitol (200 mg) and lactulose (1 g), as well as stool weight and urine volume over 8 hours. Analysis used the paired t test. Of 8 patients, 4 were men, with a mean ± SD age of 54 ± 1 years, body mass index of 25 ± 4 kg/m2, residual small intestine of 63 ± 12 cm, and 25% ± 15% of residual colon. The overall gut transit (% emptied at 6 hours) was 53.4% ± 15% for TED vs 62.4% ± 15.2% for PLA (P = .075), with no effect on GE (P = .74). TED increased urine mannitol excretion at 0-2 hours (16.2 ± 3.6 mg TED vs 11.3 ± 2.2 mg PLA, P = .20) and 0-8 hours (32.7 ± 5.9 mg PLA vs 48.8 ± 8.9 mg TED, P = .17). There were no differences in urine lactulose excretion or lactulose/mannitol ratio (0.024 ± 0.005 TED vs 0.021 ± 0.005 PLA). Over 8 hours, TED (vs PLA) numerically reduced stool weight (mean ± SEM, 77 ± 18 g TED vs 106 ± 43 g PLA, P = .42) and increased urine volume (408.9 ± 52.2 mL TED vs 365.7 ± 57.3 mL PLA, P = .34). Seven-day TED treatment in 8 participants suggests beneficial effects on fluid balance and monosaccharide absorption, and it retarded overall gut transit with no effects on GE or mucosal permeability. Larger, longer, mechanistic studies of TED in SBS are warranted. This trial was registered at clinicaltrials.gov as NCT02099084.

The effects of hypotonic and isotonic negative contrast agent on gastrointestinal distention and physiological intake of 18F-FDG.

The objective of this study was to explore the effects of hypotonic and isotonic oral mannitol on intestinal distention and fluorine-18 fluorodeoxyglucose ((18)F-FDG) intake in PET/computed tomography (CT) imaging. A total of 124 patients without gastrointestinal disease were evaluated with PET/CT imaging and divided into four groups using a random number table. Group 1 drank plain water, group 2 drank 2.5% mannitol, group 3 drank 2.5% mannitol and also received 10 mg of scopolamine butylbromide, and group 4 drank 2.5% mannitol and also received 20 mg of scopolamine butylbromide. The patients in each group underwent PET/CT imaging 50 min after (18)F-FDG injection. In these groups, differences such as age, sex, disease distribution, oral liquid amount, and adverse reactions were compared. Gastrointestinal distention and F-FDG intake were analyzed by two experts in nuclear medicine by visual observation. Data were statistically analyzed using a rank-sum test, R×C contingency table, one-way analysis of variance, and a paired t-test. There were no significant differences in blood glucose levels after oral administration of 2.5% mannitol (t=0.62, P>0.05). Gastrointestinal distention of patients in groups 2, 3, and 4 was superior to that of patients in group 1 (P<0.05/6). In addition to the sigmoid colon and rectum, (18)F-FDG intake in each part of the gastrointestinal tract in groups 2, 3, and 4 was less than that in group 1 (P<0.05/6). Patients in group 4 experienced significantly more adverse reactions compared with patients in the other groups (P<0.05). Oral negative contrast agent and hypotonic bowel preparation decreased the physiological intake of (18)F-FDG, increased the distention of the gastrointestinal tract, and thus improved the image quality.

Three kinds of laxatives in the comparative study of the effect of bowel preparation

Objective The new method of re-evaluation of drugs in bowel preparation , to explore an effective bowel preparation medication and measures to improve the success rate of colonoscopy and treatment . Methods Between January 2011 and December 2012 , 85 simple colon polyps patients were recruited . According to the principles of self-control design , cases were received 3 times of colonoscopy , and they were divided into 3 groups according to the bowel preparation medication： group A （ 20% Oral Mannitol group ） , group B （ oral 50%magnesium sulfate group ） , group C （ orally taken Senna group ） .3 groups of patients after intestinal cleanliness were investigated with Boston bowel preparation scale .Results PPBS scores after left colon, transverse colon, right colonand the entire colon intestinal cleansing effects of the three groups , while the differences were no statistically different （ H =1.103, 1.377, 0.179, 0.160, respectively;P ＆gt;0.05 ）. Conclusions Oral administration of 20%mannitol,50%magnesium sulfate, and senna bowel cleansing has no significantly difference in bowel cleansing . Care and health education are important factors for intestinal cleansing of bowel preparation . Key words: Colonoscopy bowel preparation; Mannitol; Magnesium sulphate; Senna

Small Bowel Preparations for Capsule Endoscopy With Mannitol and Simethicone

There is no consensus concerning small bowel preparation before capsule endoscopy (CE). This study evaluated the effects of 4 regimens on small bowel cleansing and diagnostic yield. Patients were randomly divided into 4 groups. Group A consumed a clear liquid diet after lunch on the day before CE, followed by overnight fasting. Group B took 250 mL 20% mannitol and 1 L 0.9% saline orally at 05:00 hours on the day of the procedure. In group C, the same regimen was taken at 20:00 hours on the day before and at 05:00 hours on the day of CE. In group D, in addition to the group C regimen, 20 mL oral simethicone was taken 30 minutes before CE. Two hundred patients were prospectively enrolled, and 7 were excluded from the final analysis because of incomplete small bowel transit. No significant difference was noted among the 4 groups for small bowel transit time. Bowel preparation in group D was significantly better than for the other regimens for overall cleansing of the proximal small bowel, and showed improved overall cleansing of the distal small bowel when compared with 10-hours overnight fasting. Pathological lesions of the proximal and distal small bowel were, respectively, achieved in 82 and 74 patients, mostly distributed in group D. Small bowel preparation that involves split-dose oral mannitol plus single-dose simethicone for CE can improve mucosal visualization and subsequent diagnostic yield when compared with 10-hours overnight fasting.

Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure

Recent studies have shown that local anesthesia for loop colostomy closure is as safe as spinal anesthesia for this procedure. Randomized clinical trial to compare the results from these two techniques. Fifty patients were randomized for loop colostomy closure using spinal anesthesia (n = 25) and using local anesthesia (n = 25). Preoperatively, the bowel was evaluated by means of colonoscopy, and bowel preparation was performed with 10% oral mannitol solution and physiological saline solution for lavage through the distal colostomy orifice. All patients were given prophylactic antibiotics (cefoxitin). Pain, analgesia, reestablishment of peristaltism or peristalsis, diet reintroduction, length of hospitalization and rehospitalization were analyzed postoperatively. Surgery duration and local complications were greater in the spinal anesthesia group. Conversion to general anesthesia occurred only with spinal anesthesia. There was no difference in intraoperative pain between the groups, but postoperative pain, reestablishment of peristaltism or peristalsis, diet reintroduction and length of hospitalization were lower with local anesthesia. Local anesthesia plus sedation offers a safer and more effective method than spinal anesthesia for loop colostomy closure.

Nursing experience of 560 cases undergoing intravenous pyelography with computed radiography

Objective To summarize the nursing experience of intravenous pyelography with computed radiography (IVP - CR) . Methods Clinical and imaging data of 560 cases undergoing IVP - CR were collected. The effect of bowel preparation with oral mannitol on the digital photos and incidence of side effects of iopromide were observed. Results Adverse effects occurred in 27 patients (4. 8% ) ;of them, 6 cases had to give up IVP - CR. Although there existed a lot of intestinal gas and contents in 98 cases ( 17. 7% ), their imaging findings of urinary system diseases were satisfactory. Conclusion Bowel preparation by oral mannitol is enough for IVP CR. The achievement ratio of IVP - CR can be improved by reasonable nursing intervention. Key words: Intravenous pyelography; Computed radiography; Allergic reaction; Nursing

Bowel magnetic resonance imaging of pediatric patients with oral mannitol

The purpose of this study was to assess the sensitivity, specificity, and diagnostic accuracy of magnetic resonance imaging (MRI) in pediatric patients with clinical suspicion of inflammatory bowel disease (IBD) by comparing MRI and ultrasound (US) to endoscopy, the gold standard. A median volume of 300 ml of mannitol in a 4.5% watery solution were ingested by 43 children prior to examination. The 53 MRI examinations were compared with 20 endoscopies and 41 US of the terminal ileum. The outcomes were MRI quality; pathologic findings; level of adverse events; and concordance between endoscopy, MRI, and US estimated by kappa statistics. The ileum and terminal ileum were very good or excellently imaged in approximately 80% of cases. Wall thickening and enhancement were most frequent in the terminal ileum. MRI compared with endoscopy had a sensitivity of 81.8% [95% confidence interval (CI)], specificity of 100%, diagnostic accuracy of 90%, and kappa value of 0.80 (95% CI), indicating a good degree of concordance. A similar degree of concordance was achieved between US and endoscopy. In spite of the frequent adverse reactions, such as diarrhea and nausea, half of the patients were prepared to repeat the examination. The results of MRI are concordant with endoscopy and US of the terminal ileum.

Influence of oral mannitol bowel preparation on colonic microflora and the risk of explosion during endoscopic diathermy.

Oral mannitol has been widely accepted as the bowel preparation of choice for colonoscopy and elective colorectal operation because it is well tolerated by patients. Recent concern has been expressed regarding the risk of explosion and sepsis using oral mannitol because it may provide a nutrient for certain gas-producing bacteria in the colon. Samples of colonic contents aspirated at operation were compared in patients prepared by oral mannitol, by whole bowel irrigation, mannitol preceded by 48 h of oral antibiotics (neomycin with metronidazole) and in patients who did not undergo any preparation. Significantly higher counts of gas-producing Escherichia coli were recovered from patients prepared with mannitol alone compared with whole bowel irrigation or mannitol preceded by oral antimicrobials. These data are consistent with the hypothesis that fermentation of mannitol by Escherichia coli is responsible for the production of potentially explosive gas mixtures after oral mannitol preparation and may also explain the increased incidence of sepsis when oral mannitol is used for bowel preparation.

Bowel magnetic resonance imaging of pediatric patients with oral mannitol

The purpose of this study was to assess the sensitivity, specificity, and diagnostic accuracy of magnetic resonance imaging (MRI) in pediatric patients with clinical suspicion of inflammatory bowel disease (IBD) by comparing MRI and ultrasound (US) to endoscopy, the gold standard. A median volume of 300 ml of mannitol in a 15% [corrected] watery solution were ingested by 43 children prior to examination. The 53 MRI examinations were compared with 20 endoscopies and 41 US of the terminal ileum. The outcomes were MRI quality; pathologic findings; level of adverse events; and concordance between endoscopy, MRI, and US estimated by kappa statistics. The ileum and terminal ileum were very good or excellently imaged in approximately 80% of cases. Wall thickening and enhancement were most frequent in the terminal ileum. MRI compared with endoscopy had a sensitivity of 81.8% [95% confidence interval (CI)], specificity of 100%, diagnostic accuracy of 90%, and kappa value of 0.80 (95% CI), indicating a good degree of concordance. A similar degree of concordance was achieved between US and endoscopy. In spite of the frequent adverse reactions, such as diarrhea and nausea, half of the patients were prepared to repeat the examination. The results of MRI are concordant with endoscopy and US of the terminal ileum.

Efficacy of contrast chromoendoscopy of the colon after oral administration of indigo carmine dye

Indigo carmine dye is usually spread directly over the colon in many chromoscopic techniques aiming better visualization of a lesion already detected by conventional colonoscopy. Examination of the colon already stained by oral administration of indigo carmine dye may increase detection of small lesions resulting in higher sensibility of the colonoscopy in diagnosing diminutive lesions. Analyze the results regarding the quality of chromoscopic technique and the indigo carmine dye distribution over the colon after oral administration. Fifty patients undergoing colonoscopy were evaluated. A capsule containing 100 mg of indigo carmine dye was offered to these patients 30 min before oral mannitol prep routinely used. The indigo carmine dye contrast effect was graded as bad, regular or good according to preestablished criteria in three segments of the colon: right and left colon and the rectum. In the right colon, good indigo carmine dye contrast effect was observed in only 9 (18.8%) patients, while it was considered regular and bad in 32 (66.6%) and in 7 (14.6%) patients, respectively. A good indigo carmine dye contrast effect was never observed in this series for the left colon or in the rectum. As a matter of fact, no indigo carmine dye was observed in the left colon in 80.9% and in the rectum in 92% of patients in this series. Although it may be simple and desirable, oral administration of indigo carmine dye seems ineffective for enhancing detection of diminutive lesions by chromoscopy as result of poor colonic distribution of indigo carmine dye mainly at distal colonic sites.